- familial short stature - constitutional delay - malnutrition - chronic disease: coeliac, IBD, CHD - edocrine: hypothyroidism - genetic: Down's - skeletal dysplasias: achondoplasia

Paeds: development Flashcards by Katherine Neo

Short Stature

definition

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

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Short Stature

equation to predict height for boys

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

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Short Stature

equation to predict height for girls

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

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Short Stature

causes

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

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Short Stature

what is Constitutional Delay In growth and puberty

variation on normal development.

short stature in childhood. normal height in adulthood

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Short Stature

key feature of Constitutional Delay In Growth and Puberty

delayed bone age

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Short Stature

Constitutional Delay In Growth and Puberty dx

history + exam

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

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Short Stature

mnx of Constitutional Delay In Growth and Puberty

excluding other causes of a short stature and delayed puberty

reassuring parents and the child

monitoring growth over time.

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Delayed Puberty

in girls, puberty starts with what

development of breast buds,

then pubic hair

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

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Delayed Puberty

in boys, puberty starts with what

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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Delayed Puberty

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

tanner staging

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Delayed Puberty

what is hypogonadism

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

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Delayed Puberty

what is a lack of sex hormones due to

Hypogonadotrophic hypogonadism

- Hypergonadotrophic hypogonadism

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Delayed Puberty

what is Hypogonadotropic Hypogonadism

deficiency of LH and FSH,

leading to a deficiency of the sex hormones testosterone and oestrogen

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Delayed Puberty

causes of hypogonadotropic hypogonadism

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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Delayed Puberty

what is Hypergonadotropic Hypogonadism

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

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Delayed Puberty

causes of hypergonadotrophic hypogonadism

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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Delayed Puberty

what is Kallman Syndrome

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

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Delayed Puberty

what is Kallman Syndrome associated with

a reduced or absent sense of smell (anosmia)

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Delayed Puberty

what is the threshold for initiating investigations

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

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Delayed Puberty

what initial investigations to do

look for underlying medical conditions

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

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Delayed Puberty

results of early morning LH and FSH in hypogonadotrophic hypogonadism

low

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Delayed Puberty

results of early morning LH and FSH in hypergonadotrophic hypogonadism

high

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Delayed Puberty

what is the screening test for GH deficiency

Insulin-like growth factor I

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Developmental Delay what is global development delay

a child displaying slow development in all developmental domains.

Developmental Delay which diagnoses could global developmental delay indicate

- Down’s syndrome - Fragile X syndrome - Fetal alcohol syndrome - Rett syndrome - Metabolic disorders

Developmental Delay what are the developmental domains

- gross motor - fine motor - language - Personal and Social

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

- Cerebral palsy - Ataxia - Myopathy - Spina bifida - Visual impairment

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

- Dyspraxia - Cerebral palsy - Muscular dystrophy - Visual impairment - Congenital ataxia (rare)

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

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

Developmental Delay mnx of speech and language delay

- referral to speech and language, audiology and the health visitor. - Referral to safeguarding is required if neglect is a concern.

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

- Emotional and social neglect - Parenting issues - Autism

Developmental Milestones what does gross motor refer to

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

Developmental Milestones gross motor: 4 months

- can support head | - and keep it in line with the body

Developmental Milestones gross motor: 6 months

- can maintain a sitting position | - but don't have balance to sit unsupported

Developmental Milestones gross motor: 9 months

- can sit unsupported - start crawling - maintain standing position and bounce on legs when supported

Developmental Milestones gross motor: 12 months

- can stand | - begins cruising (walking whilst holding furniture

Developmental Milestones gross motor: 15 months

can walk unaided

Developmental Milestones gross motor: 18 months

can squat and pick things up from floor

Developmental Milestones gross motor: 2 years

- run | - kick a ball

Developmental Milestones gross motor: 3 years

- climb stairs 1 foot at a time - stand on 1 leg for a few secs - ride a tricycle

Developmental Milestones gross motor: 4 years

- hop - climb - descend stairs like an adult

Developmental Milestones what does fine motor encompass

the child’s development of precise and skilled movements and their their visual development and hand-eye coordination.

Developmental Milestones fine motor (early milestones): 8w

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

Developmental Milestones Red flags: Not able to hold an object at __

5 months

Developmental Milestones Red flags: Not sitting unsupported at __

12 months

Developmental Milestones Red flags: Not standing independently __

18 months

Developmental Milestones Red flags: Not walking independently at __

2 years

Developmental Milestones Red flags: Not running at __

2.5 years

Developmental Milestones Red flags: No words at __

18 months

Developmental Milestones Red flags: No interest in others at __

18 months

Learning Disability what is it

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

Learning Disability Types: what is dyslexia

a specific difficulty in reading, writing and spelling.

Learning Disability Types: what is Dysgraphia

a specific difficulty in writing.

Learning Disability Types: what is Dyspraxia

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.

Learning Disability Types: what is Auditory processing disorder

specific difficulty in processing auditory information.

Learning Disability Types: what is Non-verbal learning disability

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

Learning Disability Types: what is Profound and multiple learning disability

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

Learning Disability what is the severity of the learning disability based on

IQ (intelligence quotient):

Learning Disability what IQ suggests a mild learning disability

55 – 70

Learning Disability what IQ suggests a moderate learning disability

40 – 55

Learning Disability what IQ suggests a severe learning disability

25 – 40

Learning Disability what IQ suggests a profound learning disability

<25

Learning Disability what conditions are strongly associated with learning disability

- genetics: Down's - antenatal: fetal alcohol syndrome + maternal chickenpox - birth: prematurity, hypoxic ischaemic encephalopathy - early childhood: meningitis - autism - epilepsy

Learning Disability who will be involved in mnx

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