Normal Growth and Development Flashcards
What factors influence normal development
Genetic - major player
Nutrition - includes mother’s nutrition in pregnancy and after birth
Environmental - determine to what extent your genetic potential is realised
What can malnutrition in infancy cause
Permanent damage to the developing brain (under 6 months)
What is a developmental milestone
A key stage where a new life skill is developed
Have rough guides to what age this should be reached by but varies between kids
What is the median age for a developmental milestone
Age when 50% population achieve a skill
What is the limit age for a developmental milestone
Age when skill should have been acquired by 97.5% of children
More useful for determining if something is abnormal - e.g. if not reached
Describe the difference between developmental age and chronological age
Usually refers to a premature baby
As they were born early they will reach milestones later than expected for their chronological age but this will not be abnormal
Add the number of weeks to their developmental milestones to get adjusted age
List the principles of normal development
Continuous process
Maturation of nervous system
Sequence same but rate varies
Cephalocaudal direction - movement develops from head down
Generalised mass activity changing to more specific controlled movements
What are the 4 main areas of development
Gross motor
Fine motor and vision
Speech, language and hearing
Social behaviour and play
Give examples of gross motor skills
Head control - 3 months Sitting unaided - 6m Crawling - 9m Standing - 12m Walking
What are the primitive motor skills
Reflexes that kids are born with - thought to be evolutionary
Sucking and rooting - find nipple and suck
Palmar/plantar grasp - very strong grip
ATNR - put hand out to side to prevent rolling
Give examples of fine motor and vision milestones
hand regard in midline
Grasp toy
Build tower
Draw simple shape
What is the main risk of baby developing a fine grip
More likely to be able to lift something and put it in their mouth - ingestion accidents and choking
At this stage also becoming mobile which increases risk
List some hearing and language milestones
Vocalises Imitates sound Knows name Develops words Follows simple instructions
List some social behaviour and play milestones
Social smile Plays with feet Peek-a-boo Stranger awareness Drinks Feeds Symbolic play Interactive play Toilet training
What are the nutritional requirements of young children
Need essential nutrients to replace losses and grow new tissues
Energy to permit metabolic function
Need it for maintenance growth and development
Develop their immunity
Describe the 3 phases of child growth
Infant - rapid growth led by nutrients
Child - slower phase led by growth hormones
Pubertal - another fast period led by sex/steroid hormones
What external factors can influence growth
Disease
Feeding patterns
Socioeconomic status
Describe protein intake in kids
Increases with age
Usually higher intake than recommended
Where do you get vitamin A from
cheese
eggs
yoghurt
Describe the trends in vitamin A intake
Usually higher than recommended level
Where do you get Vitamin C from
Oranges
Blackcurrants
Potatoes
Describe the trends in vitamin C intake
Above national guidelines in all age groups
Lower in Scotland but still above guidelines
Where do we get vitamin D from
Sunlight - main source
Oily fish and eggs
Describe the trends in vitamin D intake
Below recommended level for all groups
Who is recommended to take supplements
All babies from 6 months who take less the 500ml of formula
Pregnant women and breastfeeding mothers
Describe the trends in sodium intake
Higher than recommended
Higher in Scotland than in rest of UK
Describe the recommendations for milk feeding
Exclusive breastfeeding is recommended for the first 6 months
Good for immune system, growth, overall health and future
Describe weaning
Its the process of introducing a variety of new foods
Starts at about 6 months as breastmilk no longer sufficient for nutrition
Why should nuts and seeds be avoided in young children
Choking risk
How should you introduce foods that commonly cause allergy
One at a time
What are the key nutritional vulnerabilities of school age children
Chronic disease
Disrodered eating pattern
Supply/demand imbalance - obesity
What are the key nutritional vulnerabilities of adolescents
Eating disorders
Obesity
Early pregnancy - change in needs that needs managed
List factors that decrease risk of dental caries
Fluoride exposure
Hard cheese
Sugar-free chewing gum
What factors are associated with early introduction of solids
Living in deprived area
Opinions of grandparents
Disagreeing with advice
Lack of encouragement from peers to wait
Describe a normal distribution curve
Middle line - mean or median
Standard deviation measures the variability
What is the Z score
The number of standard deviations from the mean
Which weight group makes it more likely to go into early puberty
Overweight children
What suggests that a child is showing normal growth
Their measurements are within the normal range compared with children of their age
Their rate of growth is within the normal range compared with children of their age
Describe the trends in normal growth charts over the last 30 years
Increase in severe obesity has shifted curve to the right
Upward trend in height
What procedures must be followed when weighing a child
Babies need to be weighed without clothes or nappy
Children >2 can be weighed in underwear but no shoes or teddies
Only clinical electronic scales in metric setting should be used
What procedures must be followed when measuring head circumference
Use narrow plastic or disposable tape
Take measurement where head is widest
How do you measure a child’s height
Can do length before age 2 but unreliable
Measure with a rigid rule/T piece etc
Ensure eyes at 90’ and heels are touching the wall
Take shoes off
What are the average ages for kids to enter puberty
Girls - 11
Boys - 11y 6m
How do you stage puberty
Tanner scale
Stage 1 is pre-pubertal and stage 5 is adult
What are the stages of puberty in girls
Thelarche - breast budding
Adrenarche - body hair
Menarche - periods start
What measurement suggests boys have started puberty
Testicular volume over 4ml
What is the definition of precocious puberty
Normal pubertal development occurring abnormally early
before age 8 in girls and before age 9 in boys
More common in girls
What is the definition of pubertal delay
Absence of secondary sexual development in a girl aged 13 or a boy aged 14 years
More common in boys
What do you need to cover in the history for suspected growth problem
ICE - does their height actually bother them
Birth - low birth weight often means they’ll be small for a few years then catch up
PMH
Parental growth and puberty - can influence kid
What investigations would you do if a growth problem was suspected
Bloods - gonadotrophins, growth factors, thyroid etc Bone age Dynamic function tests MRI to check pituitary USS uterus
How do you test bone age
X ray of wrist in the non dominant hand
Very subjective so only concerned by big differences from chronological age
What is the WHO definition of adolescence
10-19 years
What is the WHO definition of youth
15-24 years
What is the WHO definition of young people
Those aged 10-24 years
How do you stage puberty
Tanner staging
Looks at testicular volume and pubic hair in men
Breast development, pubic hair and periods in women
What are the main biological changes that occur in adolescence
Puberty
Growth - often a ‘spurt’
CNS development - Increase in grey matter and the number of synaptic connections - impacts on behaviour, rational thinking and decision making
What are the main psychological changes that occur in adolescence
Development of abstract thinking, identity and mortality
What are the main social changes that occur in adolescence
Developing autonomy
Changing relationships - with family and peers
What is the STEP assessment of developmental stage
S - sexual maturation and growth
T - thinking
E - education and employment
P - peers and parents
What is the definition of competence
Understand simple terms and the nature, purpose and necessity for proposed treatment
Understand the benefits, risks and effects of, as well as the alternatives to, non-treatment
Understand that the information applies to them
Retain the information long enough to make a choice
Make a choice free from pressure
At what age is competence assumed in the UK
16
some exceptions e.g. learning difficulty
Can an under 16 provide competent consent to a medical procedure
Yes
If the medical professionals deem them competent
Can you ever override a young persons decision to refuse treatment
Parents are NOT allowed to overrule
If treatment is really in their best intertest - e.g. refusing treatment for eating disorder - there may be some cases
What topics may you need to cover in an adolescent history (HEEADSSS)
Home Education/employment Eating Activities - peers, sport Drugs Sex Suicide Safety
Describe the trends in sugar intake in children
Average intake is more than double the recommended
Around 1/3 comes from fruit juice
Which biological factors can influence a childs development
Inherited characteristics – cognitive potential and temperament
Ante- and perinatal history - e.g. maternal drugs/alcohol or prematurity
General health - chronic or recurrent illness
Vision and hearing difficulties - can impact on other domains
Which environmental factors can influence a childs development
Opportunities - parenting and education
Threats - economic and social deprivation
Experience and encouragement
What are primitive reflexes
Reflexes that are generally present from birth
Usually ‘lost’ (i.e. suppressed by brain) by 12 months)
List some of the primitive reflexes
Rooting and sucking = turn to food source and suck
Moro - arms thrown up and out
Stepping
Asymmetrical tonic neck reflex (ATNR) - fencing stance
Symmetrical tonic neck reflex (STNR)
Tonic labyrinthine reflex - legs stiffen and hands fist when baby is tilted back
Palmar and plantar grasp reflexes
