Normal Development Flashcards
What is play preparation?
Way of giving the child information on procedures etc which may be stressful for the at first but then allowed them to act out and work through it
What is play therapy?
Play which encourages children to play out their frustrations and tensions, going through previous stressful events and displacing negative feelings
What is the ICP model and what leads each phase?
Model explaining the phases of child growth: infant (nutrient led), child (growth hormone led) and pubertal (sex steroid led)
What are Diet Reference Values, and the 3 main types?
Nutrient recommendations, 3 main types: RNI - Reference Nutrient Intake, EAR - Estimated Average Requirement (of energy), LRNI - Lower Recommended Nutritional Intake
True or False: - Recommended that from 6 months, all children consuming <500mls/d of infant formula should take vitamin A, C & D supplements
True
What is the UK DoH physical activity guidelines for under 5s in infants not yet walking?
• Encourage from birth • Floor based & water-based activities in safe environments • Minimise time spent sedentary for extended periods (except sleeping)
What is the UK DoH physical activity guidelines for under 5s in children capable of walking?
• 180 minutes throughout the day • Minimise time spent sedentary for extended periods (except sleeping?
What is the UK DoH physical activity guidelines for over 5s?
- ≥ 60 minutes/day of moderate to vigorous intensity physical activity - 3 days/week - vigorous intensity activities - Minimal time being sedentary (sitting)
How much of an infants life is exclusive breastfeeding recommended?
First 6 months
At what age does weaning begin and why?
Around 6 months, because breast milk no longer enough to meet nutritional needs
True or False: First foods should be gluten free if <6months e.g. baby rice, cooked & mashed fruits & vegetables
True
True or False: Childhood obesity is associated with late weaning
False, it is associated with early weaning
‘The obesogenic environment’
the modern environment that encourages both foods high in energy density but low in nutrients and decreased physical activity levels
What are the centile categories of obesity on the BMI gentile chart?
• ≥ 91st c - overweight • ≥ 98th c - obese • ≥ 99.6th Severely obese • +3.33 SD Morbidly obese
At what age does obesity support/treatment primarily aim at the child and not the parents?
Age 8
When are anti-obesity drugs and surgery recommended?
Anti-obesity drugs (orlistat) should only be prescribed for severely obese adolescents (BMI >99.6th percentile) with comorbidities attending a specialist clinic, and bariatric surgery can be considered for post-pubertal adolescents with very severe to extreme obesity (BMI >3.5 SD above mean) and severe co-morbidities
What are the lifestyle recommendations for managing childhood obesity? (123)
- 1 Hour Physical Activity per day - 2 Hours (maximum) screen time - 3 Balanced meals
What 3 facts influence normal development?
Genetics, nutrition and environment
In what direction does development occur?
Cephalocaudal
What is infant formula?
Modified cows milk with whey/casein
What is preferred, infant formula or follow-on formula?
Infant formula, which follow-on formula has no advantage over
When can unmodified cow’s milk be introduced?
Full fat (as a drink) from 12 months, semi-skimmed shouldn’t be given before 2 years, and skimmed shouldn’t be given before 5 years
What milestones should be achieved by 6 weeks?
- Gross motor*: Head control in vertical
- Fine motor + vision:* follows torch with eyes
- Language + hearing*: Stills to voice
- Social + Play*: social smile
What Milestones should be achieved by 3 months?
- Gross moto*r: Head control (No head lag on pulling to sit)
- Fine motor + vision:* regards hands held in midline
- Language + hearing:* vocalises with familiar person, laughs and coos
- Social + play:* reacts to familiar situations
What gross motor skills should be achieved by 6 months?
Sitting balance -
- Pushes up on arms in prone
- Can roll from stomach to back
- Weight bears on legs
What gross motor skills should be achieved by 9 months?
Crawling -
- Sits well and leans forward to reach toys
- Stands holding on to furniture
- May crawl
What gross motor skills should be achieved by 12 months?
Standing -
- ‘Cruises’ around furniture
- May take first step
What gross motor skills should be achieved by 18 months?
Runs
- Climbs onto adult chair
What gross motor skills should be achieved by 2 years?
Stairs - 2 feet/tread:
- Ascends and descends stairs 2 feet per tread
- Can throw ball overhand
What gross motor skills should be achieved by 3 years?
Stairs - alternate feet:
- Up stairs with alternating feet
- Stands on one foot momentarily
- Pedals trike
What gross motor skills should be achieved by 4 years?
Hops -
- Runs up + down stairs
- Can kick, throw + catch ball
- Hops on preferred foot
What fine motor + vision milestones should be achieved by 6 months?
Grasps toy palmar-
- Transfers objects hand to hand
- Palmar grasp
- Mouths objects
What fine motor + vision milestones should be achieved by 9 months?
Scissor grasp-
- Using index finger to point
- Picks up tiny objects between thumb and hand
What fine motor + vision milestones should be achieved by 12 months?
Pincer grasp -
- Neat fine pincer grip
- Bangs toys together
- Casting toys
What fine motor + vision milestones should be achieved by 18 months?
Builds tower of 3-4 bricks
- Hand preference
- Enjoys picture books
What fine motor + vision milestones should be achieved by 2 years?
Builds tower of 6-7 bricks -
- Circular scribble
What fine motor + vision milestones should be achieved by 3 years?
Builds tower of 9-10 bricks
- Copies circle
- Cuts with scissors
What fine motor + vision milestones should be achieved by 4 years?
Draws simple man -
- Threads beads
- Copies cross
- Draws a man with head, legs and trunk
What language + hearing milestones should be achieved by 6 months?
Babbles -
- Babbles tunefully (mamama)
- Screams when annoyed
What language + hearing milestones should be achieved by 9 months?
Imitates sounds -
- Localises sound consistently
- Polysyllabic babble (ahgah ahgah)
- Imitates sounds
What language + hearing milestones should be achieved by 12 months?
Knows name -
- Knows and responds to name
- Jargons vowels + consonants
What language + hearing milestones should be achieved by 18 months?
- 5-20 words
- Points to 2 body parts
What language + hearing milestones should be achieved by 2 years?
50+ words and simple instructions -
- Joins 2 words
- Talks to self
- Understands simple instructions
What language + hearing milestones should be achieved by 3 years?
Complex instructions/asks questions -
- Knows own name + gender
- Asks lots of questions
- Carries on simple conversation
- Understands prepositions
What language + hearing milestones should be achieved by 4 years?
Can tell stories -
- Recounts stories of recent experiences
- Sentences of 5+ words
- Counts to 20
Which social + play milestones should be achieved by 6 months?
- Still friendly with strangers
- Plays with feet
Which social + play milestones should be achieved by 9 months?
Peek-a-boo and stranger awareness -
- Anxious around strangers
- Plays peek-a-boo
- Object permanence
Which social + play milestones should be achieved by 12 months?
- Drinks from cup
- Waves bye-bye
Which social + play milestones should be achieved by 18 months?
Feeds with spoon
- Imitates adult activities eg sweeping
Which social + play milestones should be achieved by 2 years?
Symbolic play and puts on some clothes -
- Puts on hat + shoes
- Developing symbolic play eg feeding teddy
Which social + play milestones should be achieved by 3 years?
- Pretend interactive play
- Toilet trained
Which social + play milestones should be achieved by 4 years?
- Dresses fully
- Understands concept of turn taking
When should you be concerned by a lack of social mile development?
8 weeks - may indicate underlying development problem
What are the main primitive reflexes that much be lost in order to learn new motor developments?
- Sucking and rooting (Automatically turn the face towards stimulus and make suckling motions with the mouth when the cheek or lip are touched)
- Palmar and plantar grasp
- Asymmetric tonic neck reflex
- Moro (Response to a sudden loss of support)
- Stepping and placing
What are important points for measuring height?
- Height should be measured from ages 2 years (length measured before this) using a rigid rule with T piece, or stadiometer
- Ensure heels, bottom, back and head are touching the apparatus with eyes and ears at 90 degrees
- Measure on expiration
- Always measure with shoes removed
When should weeks be used to describe age until?
Described in weeks for first 6-12months, then calandar months thereafter
How should growth charts be plotted for premature children?
Up until 2years, take the amount of time they were premature by (length of time from 40 weeks) off of the chronological age. Prematurity = any baby born before 37weeks. So if you see them at 12 months, but they were born at 36 weeks, then mark them as 11 months.
What is the average age girls and boys enter puberty? When is precocious and delayed puberty?
- Girls
- on average start puberty at 11.
- Precocious: If puberty begins <8 years
- Delayed: if no signs of puberty at 13
- Boys
- On average start puberty at 11 years 6 months.
- Precocious: If puberty begins <9 years
- Delayed: No signs sof puberty by 14
What causes puberty to begin?
Puberty occurs when the secretion of gonadotrophin releasing hormone (GnRH) by the hypothalamus, which is largely but not entirely suppressed during childhood, increases so that pulsatile secretion of luteinizing hormone (LH) increases, resulting in sufficient sex steroid production to result in the secondary sexual development.
What effect does the gonadotrophins have in boys at the start of puberty?
- LH stimulates the leydig cells to produce testosterone, which promotes formation of secondary sexual characteristics
- FSH stimulates sertoli cells to enhance spermatogenesis
What effect does the gonadotrophins have in girls at the start of puberty?
- LH stimulates proliferation of follicular and thecal cells, and during the follicular phase of the menstrual cycle induces androgen secretion by theca cells.
- FSH induces proliferation of granulosa cells; increases expression of LH receptors on granulosa cells; enhances oestradiol (E2) production; and increases progesterone production.
What system is used to stage puberty?
Tanner staging system (1= pre-pubertal and 5 = fully developed)
What testicular volume indicated pre-pubety and beginning of puberty?
<4ml = pre-pubertal and >4ml = puberty began (goes up to 12ml)
In terms of girls puberty, what does Thelarche, Adrenarche and Menarche mean?
“-arche” = beginning, so:
- Thelarche = breast budding
- Adrenarche = body hair and odour
- Menarche = start of periods
Why are men taller than women?
- Boys have delayed peak height velocity (PHV) - period where max height growth occurs
- Boys PHV > girls (Driven by androgens in boys)
- Boys taller in pre-puberty
