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Paeds: development Flashcards

1
Q

Short Stature

definition

A

height > 2 standard deviations below the average for their age and sex

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2
Q

Short Stature

equation to predict height for boys

A

(mother height + fathers height + 14cm) / 2

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3
Q

Short Stature

equation to predict height for girls

A

Girls: (mothers height + father height – 14cm) / 2

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4
Q

Short Stature

causes

A
  • familial short stature
  • constitutional delay
  • malnutrition
  • chronic disease: coeliac, IBD, CHD
  • edocrine: hypothyroidism
  • genetic: Down’s
  • skeletal dysplasias: achondoplasia
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5
Q

Short Stature

what is Constitutional Delay In growth and puberty

A

variation on normal development.

short stature in childhood. normal height in adulthood

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6
Q

Short Stature

key feature of Constitutional Delay In Growth and Puberty

A

delayed bone age

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7
Q

Short Stature

Constitutional Delay In Growth and Puberty dx

A

history + exam

supported by xray of the hand and wrist to assess bone age.

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8
Q

Short Stature

mnx of Constitutional Delay In Growth and Puberty

A

excluding other causes of a short stature and delayed puberty

reassuring parents and the child

monitoring growth over time.

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9
Q

Delayed Puberty

in girls, puberty starts with what

A

development of breast buds,

then pubic hair

and finally starting menstrual periods about 2 years from the start of puberty.

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10
Q

Delayed Puberty

in boys, puberty starts with what

A

enlargement of the testicles,

then of the penis,

gradual darkening of the scrotum,

development of pubic hair and deepening of the voice.

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11
Q

Delayed Puberty

what can be used to determine the pubertal stage based on examination finding of sex characteristics

A

tanner staging

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12
Q

Delayed Puberty

what is hypogonadism

A

lack of the sex hormones, oestrogen and testosterone, that normally rise prior to and during puberty

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13
Q

Delayed Puberty

what is a lack of sex hormones due to

A
  • Hypogonadotrophic hypogonadism

- Hypergonadotrophic hypogonadism

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14
Q

Delayed Puberty

what is Hypogonadotropic Hypogonadism

A

deficiency of LH and FSH,

leading to a deficiency of the sex hormones testosterone and oestrogen

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15
Q

Delayed Puberty

causes of hypogonadotropic hypogonadism

A
  • damage to hypothalamus or pituitary e.g. radiotherapy or surgery for previous cancer
  • GH deficiency
  • hypothyroidism
  • hyperprolactinaemia
  • serious chronic conditions: CF, IBD
  • excessive exercise or dieting
  • constitutional delay in growth and development
  • Kallman syndrome
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16
Q

Delayed Puberty

what is Hypergonadotropic Hypogonadism

A

gonads fail to respond to stimulation from the gonadotrophins (LH and FSH).

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17
Q

Delayed Puberty

causes of hypergonadotrophic hypogonadism

A
  • Previous damage to the gonads (e.g. testicular torsion, cancers, mumps)
  • Congenital absence of the testes or ovaries
  • Kleinfelter’s Syndrome (XXY)
  • Turner’s Syndrome (XO)
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18
Q

Delayed Puberty

what is Kallman Syndrome

A

a genetic condition causing hypogonadotrophic hypogonadism, resulting in failure to start puberty

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19
Q

Delayed Puberty

what is Kallman Syndrome associated with

A

a reduced or absent sense of smell (anosmia)

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20
Q

Delayed Puberty

what is the threshold for initiating investigations

A

no evidence of pubertal changes in a girl aged 13 or a boy aged 14

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21
Q

Delayed Puberty

what initial investigations to do

A

look for underlying medical conditions

  • FBC + ferritin
  • U&E for CKD
  • Anti-TTG or anti-EMA antibodies
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22
Q

Delayed Puberty

results of early morning LH and FSH in hypogonadotrophic hypogonadism

A

low

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23
Q

Delayed Puberty

results of early morning LH and FSH in hypergonadotrophic hypogonadism

A

high

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24
Q

Delayed Puberty

what is the screening test for GH deficiency

A

Insulin-like growth factor I

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25
Q

Developmental Delay

what is global development delay

A

a child displaying slow development in all developmental domains.

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26
Q

Developmental Delay

which diagnoses could global developmental delay indicate

A
  • Down’s syndrome
  • Fragile X syndrome
  • Fetal alcohol syndrome
  • Rett syndrome
  • Metabolic disorders
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27
Q

Developmental Delay

what are the developmental domains

A
  • gross motor
  • fine motor
  • language
  • Personal and Social
28
Q

Developmental Delay

what may a delay that is specific to the gross motor domain indicate

A
  • Cerebral palsy
  • Ataxia
  • Myopathy
  • Spina bifida
  • Visual impairment
29
Q

Developmental Delay

what may a delay that is specific to the fine motor domain indicate

A
  • Dyspraxia
  • Cerebral palsy
  • Muscular dystrophy
  • Visual impairment
  • Congenital ataxia (rare)
30
Q

Developmental Delay

what may a delay that is specific to the speech and language domain indicate

A
  • Specific social circumstances e.g. multiple languages or siblings that do all the talking
  • Hearing impairment
  • Learning disability
  • Neglect
  • Autism
  • Cerebral palsy
31
Q

Developmental Delay

mnx of speech and language delay

A
  • referral to speech and language, audiology and the health visitor.
  • Referral to safeguarding is required if neglect is a concern.
32
Q

Developmental Delay

what may a delay that is specific to the personal and social domain indicate

A
  • Emotional and social neglect
  • Parenting issues
  • Autism
33
Q

Developmental Milestones

what does gross motor refer to

A

the child’s development of large movements, such as sitting, standing, walking and posture

34
Q

Developmental Milestones

gross motor: 4 months

A
  • can support head

- and keep it in line with the body

35
Q

Developmental Milestones

gross motor: 6 months

A
  • can maintain a sitting position

- but don’t have balance to sit unsupported

36
Q

Developmental Milestones

gross motor: 9 months

A
  • can sit unsupported
  • start crawling
  • maintain standing position and bounce on legs when supported
37
Q

Developmental Milestones

gross motor: 12 months

A
  • can stand

- begins cruising (walking whilst holding furniture

38
Q

Developmental Milestones

gross motor: 15 months

A

can walk unaided

39
Q

Developmental Milestones

gross motor: 18 months

A

can squat and pick things up from floor

40
Q

Developmental Milestones

gross motor: 2 years

A
  • run

- kick a ball

41
Q

Developmental Milestones

gross motor: 3 years

A
  • climb stairs 1 foot at a time
  • stand on 1 leg for a few secs
  • ride a tricycle
42
Q

Developmental Milestones

gross motor: 4 years

A
  • hop
  • climb
  • descend stairs like an adult
43
Q

Developmental Milestones

what does fine motor encompass

A

the child’s development of precise and skilled movements

and their their visual development and hand-eye coordination.

44
Q

Developmental Milestones

fine motor (early milestones): 8w

A
  • fixes eyes on object 30cm away and makes attempt to follow it
  • they show a preference for a face rather than an inanimate object
45
Q

Developmental Milestones

Red flags: Not able to hold an object at __

46
Q

Developmental Milestones

Red flags: Not sitting unsupported at __

47
Q

Developmental Milestones

Red flags: Not standing independently __

48
Q

Developmental Milestones

Red flags: Not walking independently at __

49
Q

Developmental Milestones

Red flags: Not running at __

50
Q

Developmental Milestones

Red flags: No words at __

51
Q

Developmental Milestones

Red flags: No interest in others at __

52
Q

Learning Disability

what is it

A

a general umbrella term encompassing a range of different conditions that affect the ability of the child to develop new skills

53
Q

Learning Disability

Types: what is dyslexia

A

a specific difficulty in reading, writing and spelling.

54
Q

Learning Disability

Types: what is Dysgraphia

A

a specific difficulty in writing.

55
Q

Learning Disability

Types: what is Dyspraxia

A

aka developmental co-ordination disorder

difficulty in physical co-ordination

more common in boys

delayed gross and fine motor skills and a child that appears clumsy.

56
Q

Learning Disability

Types: what is Auditory processing disorder

A

specific difficulty in processing auditory information.

57
Q

Learning Disability

Types: what is Non-verbal learning disability

A

difficulty in processing non-verbal information, such as body language and facial expressions.

58
Q

Learning Disability

Types: what is Profound and multiple learning disability

A

severe difficulties across multiple areas, often requiring help with all aspects of daily life.

59
Q

Learning Disability

what is the severity of the learning disability based on

A

IQ (intelligence quotient):

60
Q

Learning Disability

what IQ suggests a mild learning disability

61
Q

Learning Disability

what IQ suggests a moderate learning disability

62
Q

Learning Disability

what IQ suggests a severe learning disability

63
Q

Learning Disability

what IQ suggests a profound learning disability

64
Q

Learning Disability

what conditions are strongly associated with learning disability

A
  • genetics: Down’s
  • antenatal: fetal alcohol syndrome + maternal chickenpox
  • birth: prematurity, hypoxic ischaemic encephalopathy
  • early childhood: meningitis
  • autism
  • epilepsy
65
Q

Learning Disability

who will be involved in mnx

A
  • Health visitors
  • Social workers
  • Schools
  • Educational psychologists
  • Paediatricians, GPs and nurses
  • Occupational therapists
  • Speech and language therapists

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