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Endocrinology, O&G, Paediatric Core Conditions > Normal Development, Growth, Milestones, Piaget, Health surveillance > Flashcards

Normal Development, Growth, Milestones, Piaget, Health surveillance Flashcards

1
Q

3 types of growth and the corresponding ages

A

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

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2
Q

What affects fetal growth

A

MOST IMPORTANT
Environmental
-maternal nutrition
-uterine capacity

Placental

Hormonal

Genetic (mainly maternal)

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3
Q

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

A

Infant - NUTRITION and INSULIN

Childhood - GH and THYROXINE

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

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4
Q

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

A

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

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5
Q

What is developmental delay

A

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

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6
Q

Common causes for developmental delay

A

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

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7
Q

Initial management of suspected developmental delay

A

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

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8
Q

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

A

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

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9
Q

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

A

45 head prone
Stable head when sitting

Tracks objects

Startle

Social smile

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9
Q

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

A

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

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10
Q

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

A

Pulls to stand
Sits, no help with straight back
Crawl

Inf pincer
Object permanence

Name response

Stranger fear
Holds, bites

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11
Q

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

A

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

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12
Q

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

A

Run (16m) => jump (18m)
Squat to pick up toy

Zig zag, 4 block tower

Nouns, 1-6 words => if not refer

Imitation

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13
Q

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

A

Run tip toes
Throw

2 feet, 1 step
Vertical, 8 block tower
Many pages turned, shape matching

Verbs, 50+ words
Combines 2 words

Spoon

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14
Q

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

A

Kick

Horizontal

Prepositions
3-4 word sentences

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15
Q

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

A

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

16
Q

3 1/2 year developmental milestones
-fine
-language

A

Cuts

Comparatives

17
Q

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

A

1 foot, 1 step

Cross, square, triangle, person
Step blocks

Complex instructions - multiple steps

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

18
Q

Signs of neonatal hearing problems

A

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

19
Q

Key hearing tests done in children

A

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

20
Q

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

A

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

21
Q

What are the main characteristics of the sensorimotor stage

A

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

22
Q

What are the main characteristics of the preoperational stage

A

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

23
Q

What are the main characteristics of the concrete stage

A

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

24
Q

What are the main characteristics of the formal operations stage

A

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

25
Q

Antenatal health surveillance

A

Growth
Maternal infections
US for fetal abnormalities
Bloods for NTD

26
Q

Newborn health surveillance

A

AGPAR
NIPE - U72hrs and 6wks
Newborn hearing screening programme

27
Q

1st month health surveillance

A

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

Midwife visit in 4wks

28
Q

Following months health surveillance

A

Health visitor input
GP NIPE at 6wks
Routine immunisations

29
Q

Preschool health surveillance

A

Pre-school vision screening

30
Q

Risk factors for developmental dealy
-neuro
-infection
-neuromuscular
-endocrine
-genetic
-congenital
-metabolic
-idiopathic

A

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

31
Q

Red flags in developmental domains

A

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

32
Q

Investigations for developmental delay

A

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

33
Q

Management of potential developmental delay

A

Refer to community paeds for detailed developmental assessment
MDT management

Address any reversible causes

Endocrinology, O&G, Paediatric Core Conditions (65 decks)

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