Normal Development, Growth, Milestones, Piaget, Health surveillance

Question 1

3 types of growth and the corresponding ages

Answer 1

Infancy - birth to 2
Childhood - 3 to 11
Puberty - 12 to 18

Question 2

What affects fetal growth

Answer 2

MOST IMPORTANT
Environmental
-maternal nutrition
-uterine capacity

Placental

Hormonal

Genetic (mainly maternal)

Question 3

Main drivers of
-infant growth
-childhood growth
-pubertal growth

Answer 3

Infant - NUTRITION and INSULIN

Childhood - GH and THYROXINE

Pubertal - GH and SEX STEROIDS
-GH important in growth spurts

Question 4

Describe the timeline for growth monitoring
-0-1
-1-2
-2+
-when and who to refer to

Answer 4

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

Question 5

What is developmental delay

Answer 5

Significant lag in physical, cognitive, behavioural, emotional, social development relative to established growth milestones

Question 6

Common causes for developmental delay

Answer 6

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

Question 7

Initial management of suspected developmental delay

Answer 7

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

Question 8

5 main primitive reflexes
-when are they lost
-why is this important

Answer 8

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

Question 9

6wk developmental milestones
-gross
-fine
-language
-social

Answer 9

45 head prone
Stable head when sitting

Tracks objects

Startle

Social smile

Question 9

6 month developmental milestones
-gross
-fine
-language
-social

Answer 9

Sits, no support
Rolls

Palmar, hand to hand

Monosyllabic babble
Understands bye bye, no

Reaches out, holds

Question 10

9 month developmental milestones
-gross
-fine
-language
-social

Answer 10

Stands with help
Sits, no help

Inf pincer
Object permanence

Name response

Stranger fear
Holds, bites

Question 11

1 year developmental milestones
-gross
-fine
-language
-social

Answer 11

Walks, no help

Developed pincer
2 block tower
Casting

Nouns, 3words
Bye bye, claps

Drink from lidded cup
Plays alone with carer nearby

Question 12

1 1/2 year developmental milestones
-gross
-fine
-language
-social

Answer 12

Run => jump

Zig zag, 4 block tower

Nouns, 1-6 words

Imitation

Question 13

2 year developmental milestones
-gross
-fine
-language
-social

Answer 13

Throw, tip toe

2 feet, 1 step
Vertical, 8 block tower
Page turn, shape matching

Verbs, 50+ words

Spoon

Question 14

2 1/2 year developmental milestones
-gross
-fine
-language

Answer 14

Kick

Horizontal

Prepositions
3-4 word sentences

Question 15

3 year developmental milestones
-gross
-fine
-language
-social

Answer 15

Hop

1 foot, 1 step upwards
2 feet, 1 step downwards
Circle, bridge blocks
Cuts

-ve adjectives

Sharing, plays alone
Fork, spoon
Bowel control

Question 16

3 1/2 year developmental milestones
-fine
-language

Answer 16

Cuts

Comparatives

Question 17

4 year developmental milestones
-gross
-fine
-language
-social

Answer 17

1 foot, 1 step

Cross, square, triangle, person
Step blocks

Complex instructions

Sympathy
BFF
Role play
Knife, fork, spoon
Dressing
Bladder control

Question 18

Signs of neonatal hearing problems

Answer 18

No startle response
No turning head to sounds
Hard to locate sounds, parent’s voice
Speech delay, can’t understand simple commands

Question 19

Key hearing tests done in children

Answer 19

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

Question 20

Name Piaget’s 4 milestones
-ages associated with each one

Answer 20

Sensorimotor - U2
Preoperational - 2-7
Concrete - 7-11
Formal operational - 11+

Question 21

What are the main characteristics of the sensorimotor stage

Answer 21

Learning through the senses
Object permanence - understanding that objects still exist even when they aren’t visible
Stranger anxiety

Question 22

What are the main characteristics of the preoperational stage

Answer 22

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

Question 23

What are the main characteristics of the concrete stage

Answer 23

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

Question 24

What are the main characteristics of the formal operations stage

Answer 24

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

Question 25

Antenatal health surveillance

Answer 25

Growth
Maternal infections
US for fetal abnormalities
Bloods for NTD

Question 26

Newborn health surveillance

Answer 26

AGPAR
NIPE - U72hrs and 6wks
Newborn hearing screening programme

Question 27

1st month health surveillance

Answer 27

Heel prick D5-9
-hypothyroidism
-PKU
-metabolic diseases
-cystic fibrosis
-medium chain acyl CoA dehydrogenase deficiency (MCADD)

Midwife visit in 4wks

Question 28

Following months health surveillance

Answer 28

Health visitor input
GP NIPE at 6wks
Routine immunisations

Question 29

Preschool health surveillance

Answer 29

Pre-school vision screening