Paediatric development

Question 1

Development : Gross motor - 3 months

Answer 1

”High Leaping Rabbits Swiftly Climb White Walls, Squirrels Run Through Secret Holes”

1. High (0-3 months) - Head support, lifting and turning head
2. Leaping (4-6 months): Lifts legs when lying on back- Grasps at feet

• Rabbit : Rolls front to back

4. Swiftly (7-9 months): Sits without support, straight back and can pull to sitting
5. Climb (9 months): Crawling
6. White (12 months) - Walks with one hand held, cruises
7. Walls ( 13-15 months) - Walks unsupported
8. Squirrels (18 months) : Squats to pick up town
9. Run (2 years) : Runs + Rails used going up and down stars
10. Through secret (3 years) : Tricycle riden + Stairs without rails
11. Holes (4 years) : Hops on 1 leg

Question 2

Development : Feeding

Answer 2

”Hungry Chicks Savor Fresh Kiwis”
1. 6 months : Hand on bottle
2. 12 - 15 months : Cup to drink and uses spoon
3. 2 years : Spoon competent and doesn’t spill with cup
4. 3 years : Fork and Spoon used
5. 5 years : Knife and Fork used

Question 3

Development : Dressing

Answer 3

Helpful Unicorns Support Independent Buttoning
1. 12-15 months : Helps getting dressed/undressed
2. 18 months : Undresses shoes and hat but cannot replace
3. 2 years : Shoes and hat can be put back on
4. 4 years : Independent dressing/undressing except for buttons and laces

Question 4

Development : Play

Answer 4

Playful Bears Adore Naughty Fun
1. 9 months : ‘Peek-a-boo’
2. 12 months : ‘Bye-Bye’ wave
3. 18 months : Alone playing
4. 2 years : Near to other children playing
5. 4 years : Friends! Plays with other children

Question 5

Development : social

Answer 5

”Samantha Likes Engaging in Social Moments”
1. 6 weeks : Smiles
2. 3 months : Laughs
3. 6 months : Extroverted / Not shy
4. 9 months :
* Shy
* Takes everything into mouth

Question 6

Development : Language

Answer 6

”Quiet Toddlers Sound Serene; Do Sush! Moms, and Dads Know Names. 2 to 6, go to bed! Two words and points parts , Vocabulary Jumps. Tiny Explorers Ask: ‘Why, When, How?’

1. 3 months : Quietens to parents voice, Turns towards sound
2. 6 months : Double Syllable
3. 9 months : Says Mama and dada, understands ‘No’
4. 12 months : Knows and responds to name
5. 12-15 months : 2-6 words, understands simple commands
6. 2 years : Combine two words, Points to part of the body
7. 21/2 Years : Vocabulary of 200 words
8. 3 years : Short sentences, asks what and who
9. 4 years : asks why, when how

Question 7

Development : Objects

Answer 7

”Fixate, Palmar Grasp, Scissor Squash, Pincer Pinch, Spoon Scoop.

• • 8 weeks: Fixes their eyes on an object 30 centimetres in front of them and makes an attempt to follow it. They show a preference for a face rather than an inanimate object.
• 6 months: Palmar grasp of objects (wraps thumb and fingers around the object).
• 9 months: Scissor grasp of objects (squashes it between thumb and forefinger).
• 12 months: Pincer grasp (with the tip of the thumb and forefinger).
• 14-18 months: They can clumsily use a spoon to bring food from a bowl to their mouth.

Question 8

Development : Drawing

Answer 8

”Scribble vertically then horizontally create a cross, Try!”
* 12 months: Holds crayon and scribbles randomly
* 2 years: Copies vertical line
* 2.5 years: Copies horizontal line
* 3 years: Copies circle
* 4 years: Copies cross and square
* 5 years: Copies triangle

Question 9

Development : Bricks

Answer 9

**12 months plus two months tower of 2
Wait another 4 months for a tower of 4
Keep adding 4 every 6 months
3 years : 3 block train/bridge then step to 4

• 14 months: Tower of 2 bricks
• 18 month/s/: Tower of 4 bricks
• 2 years: Tower of 8 bricks
• 2.5 years: Tower of 12 bricks
• 3 years: Can build a 3 block bridge or train
• 4 years: Can build steps

Question 10

Red flag symptoms : Fine + Gross motor

Answer 10

Fine motor :
Unable to hold an object at 5 months
Hand preference before 12 months
Gross motor : Unable to sit unsupported by 12 months, Unable to stand by 18 months, unable to walk independently at 2 years

Question 11

Red flag symptoms : Language and social

Answer 11

Language : No words at 18 months
Social : No smiling at 10 weeks, No interest in others at 18 months

Question 12

Global development delay : Causes

Answer 12

Slow development in all developmental domains
1. Down’s syndrome
2. Fragile X syndrome

Question 13

Gross/Fine motor delay : Causes

Answer 13

1. Cerebral palsy
2. Visual impairment
3. Muscular dystrophy

Question 14

Language delay : Causes

Answer 14

Hearing impairment
Autism/Learning disability
Cerebral palsy

Question 15

Failure to thrive : Definition

Answer 15

Faltering growth in children as they fall in weight across centile spaces

Question 16

Failure to thrive : Causes

Answer 16

1 . **Inadequate nutritional intake **
* Maternal malabsorption

2 . Difficulty feeling
* Abnormal facial structure : Cerebral palsy, cleft lip
* Pyloric stenosis

3 . Malsorption
* Intolerence/Allergy : Coeliac’s disease, Cow’s milk intolerance
* GI disease : Cystic fibrosis, IBD
* T1DM

4 . Increased energy requirements
* Hyperthyroidism
* Chronic disease : Congential HF, Cystic fibrosis
* Infection

Question 17

Short stature : Definition

Answer 17

Short stature is defined as a height more than 2 standard deviations below the average for their age and sex. This is the same as being below the 2nd centile.

Question 18

Short stature : Causes

Answer 18

1. Familial short stature
2. Constitutional delay in growth and development : short stature in childhood but growth spurt during puberty lasts longer - reaching predicted adult height
3. Malnutrition
4. Chronic diseases, such as coeliac disease, inflammatory bowel disease or congenital heart disease
5. Endocrine disorders, such as hypothyroidism
6. Genetic conditions, such as Down syndrome
7. Skeletal dysplasias, such as achondroplasia

Question 19

Vaccination schedule - < 5 years old

Answer 19

‘Babies get protecting against many!
Babies : BCG if risk factors
Get (first jabs) :
1 . 2 months : 6-1 vaccine (1) + Rota virus + Men B(1)
2 . 3 months : 6-1 vaccine(2)+ Rota virus(2) + PVC(1)
Protecting (boosters)
3 . 4 months : 6-1 vaccine(3) + Men B(2)
Against many (lots of jabs)
4 . 1 year : HiB/MenC + MMR(1) + PCV (2) + MenB(3)

5 . 3-4 years : 4 in 1 pre-school booster + MMR

Question 20

Vaccination schedule - > 5 years old

Answer 20

1. 12-13 years : HPV vaccination
2. 13-18 years : 3 in 1 (think 13) teenage booster + Meningitis ACWY

Question 21

What are the component of the 6in1 vaccine vs 4in1

Answer 21

• ‘6-1 vaccine’ : diphtheria + tetanus + whooping cough + polio + Hib + hepatitis B
• ‘4-in-1 pre-school booster’ diphtheria + tetanus + whooping cough + polio

Question 22

Neonatal blood spot screening

Answer 22

Neonatal blood spot screening (previously called the Guthrie test or ‘heel-prick test’) is performed at 5-9 days of life

Conditions screened for;
* Congenital hypothyroidism
* Cystic fibrosis
* Sickle cell disease
* phenylketonuria
* medium chain acyl-CoA dehydrogenase deficiency (MCADD)
* maple syrup urine disease (MSUD)
* isovaleric acidaemia (IVA)
* glutaric aciduria type 1 (GA1)
* homocystinuria (pyridoxine unresponsive) (HCU)