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Child Health > Normal Growth and Development > Flashcards

Normal Growth and Development Flashcards

1
Q

What factors influence normal development

A

Genetic - major player
Nutrition - includes mother’s nutrition in pregnancy and after birth
Environmental - determine to what extent your genetic potential is realised

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2
Q

What can malnutrition in infancy cause

A

Permanent damage to the developing brain (under 6 months)

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3
Q

What is a developmental milestone

A

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

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4
Q

What is the median age for a developmental milestone

A

Age when 50% population achieve a skill

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5
Q

What is the limit age for a developmental milestone

A

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

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6
Q

Describe the difference between developmental age and chronological age

A

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

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7
Q

List the principles of normal development

A

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

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8
Q

What are the 4 main areas of development

A

Gross motor
Fine motor and vision
Speech, language and hearing
Social behaviour and play

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9
Q

Give examples of gross motor skills

A 
Head control - 3 months
Sitting unaided - 6m
Crawling - 9m
Standing - 12m
Walking
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10
Q

What are the primitive motor skills

A

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

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11
Q

Give examples of fine motor and vision milestones

A

hand regard in midline
Grasp toy
Build tower
Draw simple shape

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12
Q

What is the main risk of baby developing a fine grip

A

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

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13
Q

List some hearing and language milestones

A 
Vocalises 
Imitates sound 
Knows name 
Develops words 
Follows simple instructions
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14
Q

List some social behaviour and play milestones

A 
Social smile 
Plays with feet 
Peek-a-boo 
Stranger awareness 
Drinks 
Feeds 
Symbolic play 
Interactive play 
Toilet training
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15
Q

What are the nutritional requirements of young children

A

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

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16
Q

Describe the 3 phases of child growth

A

Infant - rapid growth led by nutrients
Child - slower phase led by growth hormones
Pubertal - another fast period led by sex/steroid hormones

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17
Q

What external factors can influence growth

A

Disease
Feeding patterns
Socioeconomic status

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18
Q

Describe protein intake in kids

A

Increases with age

Usually higher intake than recommended

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19
Q

Where do you get vitamin A from

A

cheese
eggs
yoghurt

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20
Q

Describe the trends in vitamin A intake

A

Usually higher than recommended level

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21
Q

Where do you get Vitamin C from

A

Oranges
Blackcurrants
Potatoes

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22
Q

Describe the trends in vitamin C intake

A

Above national guidelines in all age groups

Lower in Scotland but still above guidelines

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23
Q

Where do we get vitamin D from

A

Sunlight - main source

Oily fish and eggs

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24
Q

Describe the trends in vitamin D intake

A

Below recommended level for all groups

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25
Q

Who is recommended to take supplements

A

All babies from 6 months who take less the 500ml of formula

Pregnant women and breastfeeding mothers

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26
Q

Describe the trends in sodium intake

A

Higher than recommended

Higher in Scotland than in rest of UK

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27
Q

Describe the recommendations for milk feeding

A

Exclusive breastfeeding is recommended for the first 6 months
Good for immune system, growth, overall health and future

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28
Q

Describe weaning

A

Its the process of introducing a variety of new foods

Starts at about 6 months as breastmilk no longer sufficient for nutrition

29
Q

Why should nuts and seeds be avoided in young children

A

Choking risk

30
Q

How should you introduce foods that commonly cause allergy

A

One at a time

31
Q

What are the key nutritional vulnerabilities of school age children

A

Chronic disease
Disrodered eating pattern
Supply/demand imbalance - obesity

32
Q

What are the key nutritional vulnerabilities of adolescents

A

Eating disorders
Obesity
Early pregnancy - change in needs that needs managed

33
Q

List factors that decrease risk of dental caries

A

Fluoride exposure
Hard cheese
Sugar-free chewing gum

34
Q

What factors are associated with early introduction of solids

A

Living in deprived area
Opinions of grandparents
Disagreeing with advice
Lack of encouragement from peers to wait

35
Q

Describe a normal distribution curve

A

Middle line - mean or median

Standard deviation measures the variability

36
Q

What is the Z score

A

The number of standard deviations from the mean

37
Q

Which weight group makes it more likely to go into early puberty

A

Overweight children

38
Q

What suggests that a child is showing normal growth

A

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

39
Q

Describe the trends in normal growth charts over the last 30 years

A

Increase in severe obesity has shifted curve to the right

Upward trend in height

40
Q

What procedures must be followed when weighing a child

A

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

41
Q

What procedures must be followed when measuring head circumference

A

Use narrow plastic or disposable tape

Take measurement where head is widest

42
Q

How do you measure a child’s height

A

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

43
Q

What are the average ages for kids to enter puberty

A

Girls - 11

Boys - 11y 6m

44
Q

How do you stage puberty

A

Tanner scale

Stage 1 is pre-pubertal and stage 5 is adult

45
Q

What are the stages of puberty in girls

A

Thelarche - breast budding
Adrenarche - body hair
Menarche - periods start

46
Q

What measurement suggests boys have started puberty

A

Testicular volume over 4ml

47
Q

What is the definition of precocious puberty

A

Normal pubertal development occurring abnormally early
before age 8 in girls and before age 9 in boys
More common in girls

48
Q

What is the definition of pubertal delay

A

Absence of secondary sexual development in a girl aged 13 or a boy aged 14 years
More common in boys

49
Q

What do you need to cover in the history for suspected growth problem

A

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

50
Q

What investigations would you do if a growth problem was suspected

A 
Bloods - gonadotrophins, growth factors, thyroid etc 
Bone age 
Dynamic function tests 
MRI to check pituitary 
USS uterus
51
Q

How do you test bone age

A

X ray of wrist in the non dominant hand

Very subjective so only concerned by big differences from chronological age

52
Q

What is the WHO definition of adolescence

A

10-19 years

53
Q

What is the WHO definition of youth

A

15-24 years

54
Q

What is the WHO definition of young people

A

Those aged 10-24 years

55
Q

How do you stage puberty

A

Tanner staging
Looks at testicular volume and pubic hair in men
Breast development, pubic hair and periods in women

56
Q

What are the main biological changes that occur in adolescence

A

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

57
Q

What are the main psychological changes that occur in adolescence

A

Development of abstract thinking, identity and mortality

58
Q

What are the main social changes that occur in adolescence

A

Developing autonomy

Changing relationships - with family and peers

59
Q

What is the STEP assessment of developmental stage

A

S - sexual maturation and growth
T - thinking
E - education and employment
P - peers and parents

60
Q

What is the definition of competence

A

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

61
Q

At what age is competence assumed in the UK

A

16

some exceptions e.g. learning difficulty

62
Q

Can an under 16 provide competent consent to a medical procedure

A

Yes

If the medical professionals deem them competent

63
Q

Can you ever override a young persons decision to refuse treatment

A

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

64
Q

What topics may you need to cover in an adolescent history (HEEADSSS)

A 
Home 
Education/employment 
Eating 
Activities - peers, sport 
Drugs 
Sex 
Suicide 
Safety
65
Q

Describe the trends in sugar intake in children

A

Average intake is more than double the recommended

Around 1/3 comes from fruit juice

66
Q

Which biological factors can influence a childs development

A

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

67
Q

Which environmental factors can influence a childs development

A

Opportunities - parenting and education
Threats - economic and social deprivation
Experience and encouragement

68
Q

What are primitive reflexes

A

Reflexes that are generally present from birth

Usually ‘lost’ (i.e. suppressed by brain) by 12 months)

69
Q

List some of the primitive reflexes

A

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

Child Health (14 decks)

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