Normal Development

Question 1

What are the four stages of normal growth?

Answer 1

Inter-uterine, infantile, childhood and pubertal

Question 2

What is hirschsprungs disease?

Answer 2

It is caused by an aganglionic segment of bowel due to a developmental failure of the parasympathetic Auerbach and Meissner plexuses.

Question 3

At what age would you refer a baby that wasn’t sitting up by itself?

Answer 3

12 months (should be sat upright at 7-8)

Question 4

What is the daily requirement of fluid in mls for a baby?

Answer 4

150mls/kg/day of fluid

Question 5

On days 1,2 & 3, how many mls of liquid does a child require?

Answer 5

60, 80 & 100 respectively and 150 every day after that

Question 6

How many calories per day does an infant need in its first year?

Answer 6

110 kcals per kg per day

Question 7

How many calories per day does an infant after 1 require?

Answer 7

1000 kcals

Question 8

How many calories are in 150mls of milk?

Answer 8

110kcals

Question 9

Why are so little calories needed in the first few days of life?

Answer 9

Term babies have glycogen reserves as well as excess fluid.

Question 10

Due to reserves, how much weight can a baby normally lose in the first few days?

Answer 10

5-7%

Question 11

When should a term baby’s birth weight be doubled by?

Answer 11

5 months

Question 12

When should a term baby’s birth weight be trebled by/.

Answer 12

1 year

Question 13

What conditions can breast feeding help protect against?

Answer 13

SIDS and NEC

Question 14

How long does it take a pre-term baby to double in weight? (28-40)

Answer 14

6 weeks

Question 15

How long does it take a pre-term baby to treble in weight?

Answer 15

12 weeks

Question 16

Why does a preterm baby have to have NG or OG feeding?

Answer 16

A preterm baby less that 35/36 weeks cannot suck or swallow

Question 17

What is breast milk jaundice?

Answer 17

A type of neonatal jaundice associated with breast feeding. It persists longer than neonatal jaundice and it has no pathological cause.

Question 18

What deficiency can happen in breast fed only babies?

Answer 18

Vitamin K deficiency, there is insufficient vitamin k in breast milk to prevent hemorrhagic disease of the newborn.

Question 19

What complications can GBS infection cause?

Answer 19

Meningitis, pneumonia and septicaemia.

Question 20

How many breast feeds should a baby be having each day by 1?

Answer 20

6 feeds per day with up to 4 hour gaps

Question 21

How many times a day should a baby be feeding at 6 months?

Answer 21

4 feeds per day

Question 22

How many mls in an ounce?

Answer 22

30 mls around

Question 23

Precocious puberty is defined as the development of secondary sexual characteristics before what age in females and males?

Answer 23

8 years of age in females and 9 years of age in males.

Question 24

What is rickets?

Answer 24

A failure in mineralisation of the growing bone or osteoid tissue
• Failure of mature bone to mineralise is called osteomalacia

Question 25

What are the causes of rickets?

Answer 25

o Dark-skinned o Decreased exposure to sunlight o Vit D deficiency o Low calcium diets o Strict vegan diets o Defective production of 25(OH)D3 – liver disease o Increased metabolism of 25(OH)D3 – enzyme induction by anticonvulsants

Question 26

What are the clinical features of rickets?

Answer 26

``` o Frontal bossing of skull o Craniotabes o Delayed closure of anterior fontanelle o Harrisons sulcus o Expansion of metaphyses especially in wrists o Bowing of weight-bearing bones o Seizures (late) ```

Question 27

How is rickets diagnosed and managed?

Answer 27

* Diagnosis made by dietary history of vitamin and calcium intake * Blood tests – low calcium, low phosphorous, increased ALP, low 25(OH)D * Wrist x-ray – cupping and fraying of metaphyses and widened epiphyseal plate * Managed by daily administration of cholecalciferol

Question 28

What is craniotabes?

Answer 28

Craniotabes is softening or thinning of the skull in infants and children, which may be normally present in newborns.

Question 29

Name the four stages of growth?

Answer 29

Foetal, infantile, childhood, pubertal

Question 30

Which period is the fastest?

Answer 30

Foetal- accounts for 30% of a persons eventual height

Question 31

What is the size at birth determined by?

Answer 31

The size of the mother and by placental nutrient supply.

Question 32

When is infantile growth and what is growth dependant on?

Answer 32

0-18 months and its largely dependant on nutrition and good health and happiness.

Question 33

When is the childhood phase and what is growth dependant on here?

Answer 33

18 months -12 years. Largely based on Growth hormone secretion acting to produce insulin-like growth factor 1 at the epiphyses ▪ thyroid hormone, vitamin D and steroids also effect cartilage cell division and bone formation Profound chronic unhappiness can decrease growth hormone secretion and accounts for psychosocial short stature

Question 34

When is the pubertal phase and what is growth dependant on here?

Answer 34

``` Sex hormones (mainly testosterone and oestradiol), causes the back to lengthen and boost GH secretion Same sex steroids cause fusion of the epiphyseal growth plates and a cessation of growth. ```

Question 35

When is the frankfurt plane used to measure kids?

Answer 35

Under 2, this is when the eye socket should be level with the ear hole, with possible upward pressure on the mastoid process.

Question 36

How do you work out the date of birth as a decimal?

Answer 36

Its taken away from todays year.todays decimal date - birthyear.thatdaysdecimal

Question 37

What is a short stature defined as?

Answer 37

Usually defined as a height below the second or 0.4th centile (-2.6 SD)

Question 38

What are foetal growth factors and how are they determined?

Answer 38

IGF-2, human placental lacotgen and insulin- they are determined by mothers size and sufficiency of the placenta. Therefore hyperinsulinaemina in mothers can result in macrocosmic babies as insulin is a GF here.

Question 39

What is the breakdown for height determined in each of the phases of growth?

Answer 39

Foetal- 30% of height determined here Infantile- 15% childhood- 40% Pubertal- 15%

Question 40

When does the childhood phase begin and end?

Answer 40

18 months-12 years

Question 41

What determines growth in the infantile phase?

Answer 41

Genetics, health, happiness, nutrition and thyroid function. 'failure to thrive'

Question 42

What determines growth in the childhood phase?

Answer 42

Pituitary GH and insulin-like GF 1 (IGF-1), good nutrition, vitamin D and steroids. Chronic profound unhappiness reduces secretion of GH and can cause short stature

Question 43

What determines growth in the pubertal phase?

Answer 43

Sex hormones (test and oest) boost GH secretion and cause fusion of the epiphyseal plates

Question 44

How do you calculate mean parental height?

Answer 44

mothers ht in cm + fathers height in cm/2 + 6.5 (for boys). and -6.5 for girls

Question 45

After which month should prematurity not impact on development?

Answer 45

24 months

Question 46

Growth charts must be corrected for gestation if the infant is born before....?

Answer 46

37 weeks

Question 47

What is the average weight at birth?

Answer 47

3.3kg

Question 48

How do you calculate expected weight ages 1-10?

Answer 48

2(age+4) kg

Question 49

What percentage is head circumference at birth to overall body?

Answer 49

19% SA (35cm on average) and by 15 it is 9%