Normal Development, Growth, Milestones, Piaget, Health surveillance Flashcards
3 types of growth and the corresponding ages
Infancy - birth to 2
Childhood - 3 to 11
Puberty - 12 to 18
What affects fetal growth
MOST IMPORTANT
Environmental
-maternal nutrition
-uterine capacity
Placental
Hormonal
Genetic (mainly maternal)
Main drivers of
-infant growth
-childhood growth
-pubertal growth
Infant - NUTRITION and INSULIN
Childhood - GH and THYROXINE
Pubertal - GH and SEX STEROIDS
-GH important in growth spurts
Describe the timeline for growth monitoring
-0-1
-1-2
-2+
-when and who to refer to
0-1 - min5 recordings of weight
1-2 - min3 recordings of weight
2+ - annual recording of weight
U2nd centile => GP review
U0.4th centile => paediatrician review
What is developmental delay
Significant lag in physical, cognitive, behavioural, emotional, social development relative to established growth milestones
Common causes for developmental delay
ASD - impairment in social interaction and communication, restricted interests and repetitive behaviours
Cerebral palsy - permanent movement disorders due to abnormal brain development/damage
Fragile X syndrome - intellectual disability, behavioural challenges, physical characteristics
Down’s syndrome - global developmental delay, characteristic facial features
Fetal Alcohol Spectrum Disorders
Initial management of suspected developmental delay
Clinical examination - physical, neurological to assess developmental milestones
Investigations
-genetic testing
-metabolic screening
-neuroimaging (MRI, CT)
-hearing/vision assessments
Specialist assessment for specific cause
-paediatric neurologist
-geneticist
-developmental paediatrician
Early intervention services - can include
-OT
-SALT
-physio
-educational support
5 main primitive reflexes
-when are they lost
-why is this important
Stepping - 2 months
Moro (startle), rooting - 3-4 months
Suck and swallow - 4 months
Palmar grasp - 4-5 months
Present from birth
Shows CNS development
6wk developmental milestones
-gross
-fine
-language
-social
45 head prone
Stable head when sitting
Tracks objects
Startle
Social smile
6 month developmental milestones
-gross
-fine
-language
-social
Pulls to sit => without support at 7-8months
-REFER AT 12 MONTHS
Rolls front => back
Palmar, hand to hand
Monosyllabic babble
Understands bye bye, no
Turns head to loud sounds
Reaches out
Objects in mouth
9 month developmental milestones
-gross
-fine
-language
-social
Pulls to stand
Sits, no help with straight back
Crawl
Inf pincer
Object permanence
Name response
Stranger fear
Holds, bites
1 year developmental milestones
-gross
-fine
-language
-social
Walks, 1 hand support => unsupported at 13-15months
-REFER AT 18 MONTHS
Cruises
Developed pincer
2 block tower
Casting
Nouns, 3words
Point to own body parts
Drink from lidded cup
Plays alone with carer nearby
Bye bye, claps
1 1/2 year developmental milestones
-gross
-fine
-language
-social
Run (16m) => jump (18m)
Squat to pick up toy
Zig zag, 4 block tower
Nouns, 1-6 words => if not refer
Imitation
2 year developmental milestones
-gross
-fine
-language
-social
Run tip toes
Throw
2 feet, 1 step
Vertical, 8 block tower
Many pages turned, shape matching
Verbs, 50+ words
Combines 2 words
Spoon
2 1/2 year developmental milestones
-gross
-fine
-language
Kick
Horizontal
Prepositions
3-4 word sentences
3 year developmental milestones
-gross
-fine
-language
-social
Hop for 3 steps on 1 foot
1 foot, 1 step upwards
2 feet, 1 step downwards
Circle, bridge blocks
Cuts
-ves
Adjectives
3-5 word sentences
Sharing, plays alone without parent
Fork, spoon
Bowel control
3 1/2 year developmental milestones
-fine
-language
Cuts
Comparatives
4 year developmental milestones
-gross
-fine
-language
-social
1 foot, 1 step
Cross, square, triangle, person
Step blocks
Complex instructions - multiple steps
Sympathy
BFF
Role play
Knife, fork, spoon
Dressing
Bladder control
Signs of neonatal hearing problems
No startle response
No turning head to sounds
Hard to locate sounds, parent’s voice
Speech delay, can’t understand simple commands
Key hearing tests done in children
Newborn (Newborn Hearing Screening Programme) - otoacoustic emission test
-tests cochlear function
If otoacoustic emission test abnormal => auditory brainstem response test
On school entry - pure tone audiometry
-find the quietest sound you can hear at different frequencies
Name Piaget’s 4 milestones
-ages associated with each one
Sensorimotor - U2
Preoperational - 2-7
Concrete - 7-11
Formal operational - 11+
What are the main characteristics of the sensorimotor stage
Learning through the senses
Object permanence - understanding that objects still exist even when they aren’t visible
Stranger anxiety
What are the main characteristics of the preoperational stage
Egocentric thinking - thinking is centred on the child’s own view of the world
Reasoning dominated by perception
Use of language to represent objects
Role play, imagination
What are the main characteristics of the concrete stage
Logical thinking only applies to concrete events and objects - analogies needed for explanations (cutting cake for fractions)
Reasoning involves more than 1 salient feature
Law of conservation - objects may change I appearance but certain properties will stay the same
Thinking is less egocentric, able to consider how others may think and feel
What are the main characteristics of the formal operations stage
Logical thinking can now apply to ideas - can follow to form of an argument without specific examples
Ability to deal with hypothetical problems with many solutions
Ability to think systematically and reason
Antenatal health surveillance
Growth
Maternal infections
US for fetal abnormalities
Bloods for NTD
Newborn health surveillance
AGPAR
NIPE - U72hrs and 6wks
Newborn hearing screening programme
1st month health surveillance
Heel prick D5-9
-hypothyroidism
-PKU
-metabolic diseases
-cystic fibrosis
-medium chain acyl CoA dehydrogenase deficiency (MCADD)
Midwife visit in 4wks
Following months health surveillance
Health visitor input
GP NIPE at 6wks
Routine immunisations
Preschool health surveillance
Pre-school vision screening
Risk factors for developmental dealy
-neuro
-infection
-neuromuscular
-endocrine
-genetic
-congenital
-metabolic
-idiopathic
Neuro
Congenital
-antenatal vascular event
-spina bifida
Acquired
-stroke
-epilepsy
Birth-related
-HIE
-intraventricular hemorrhage
-prolonged hypoglycemia
Infection
-TORCHZ
-meningitis
-encephalitis
Neuromuscular
-DMD
Endocrine
-hypothyroidism
Genetic
-Downs
Congenital
-ASD
Metabolic
-PKU
Prematurity
Idiopathic
Red flags in developmental domains
MAKE SURE TO CORRECT FOR PREMATURITY + weeks before 40
Social - no smile by 10wks
Gross motor
-not sitting unsupported by 12 months
-not walking by 18 months
Fine motor
-hand preference before 12 months
Speech and language
-not knowing 2-6 words by 18 months
Regression of any skills
Investigations for developmental delay
FBC - Fe, folate, B12 deficiency
U&E - renal failure, low Na
CK - DMD
TFT - congenital hypothyroidism
LFT - metabolic disorders
Vit D - can cause motor delay
Karyotyping, detailed metabolic screens, MRI, EEG may be useful
Hearing test - isolated SALT delay commonly due to hearing impairment
-newborn otoacoustic emission test => brainstem testing
Management of potential developmental delay
Refer to community paeds for detailed developmental assessment
MDT management
Address any reversible causes
