Physical Milestones And Failure To Thrive Flashcards
Development is complex and multi-factorial. It can be
Physical
Functional
Emotional
Psychological
Social
Later goals depend on ____________ in the same domain of development
Achieving earlier goals
What plays a role in development
Genetics
Environment
What are the 4 areas of development
1) gross motor
2) fine motor and vision
3) hearing, speech and language
4) social skills and behaviour
What is used as the standard reference point for assessing development in each area
Child development charts
What is cephalo-caudal progression
In domain 1 of gross motor: babies will develop their gross motor skills from the head down to the toes
So hold their head up first
Learnt to sit
Learn to stand
Learn to walk
What % of children will be able to walk by their 1st birthday
50%
Examples of actions that involve fine motor and vision
Reaching for objects
Transfer object from hand to hand
Building blocks
Radical palmer grab
Mature pincer grab
Scribbling (lines to circles, squares and triangles)
For assessing the hearing, speech and language of a child what do we consider
Hearing input - conductive or sensorineural loss
Forming words - muscles and palate
Content of speech = speech areas in the brain and connections
Causes of impaired language and speech and hearing
Hearing loss
Mechanical issues
Global development problem (delayed milestones)
Environmental deprivation
Autism spectrum disorder
Examples of things children should be able to from domain 4 (social and behavioural)
Smile = 6 week stage
Waving
Peek-a boo
Stranger danger
Pointing
Getting dressed
Toilet training
Psychological needs
Security
Role models
Attention
Play
Opportunity to learn from experience
Self respect
Independence
Personal identity
Developmental surveillance occurs at 4 key appointments….
1) neonatal examination
2) 6-8 week check by GP
3) 1 year old check by healthcare visitor
4) 2-2.5 year old check by healthcare visitor
What protocol should be followed for children with suspected developmental delay
Full history including pregnancy, birth and neonatal period
Family, medical history
Assess all development
Assess social situation
Check hearing and vision
Look for medical cause if applicable
Ask for MDT assessment
Continue to observe
What are some developmental red flags
Regression (acting in a younger and needier way)
Not fixing or following
Not reacting to noise
Abnormal tone
Early hand preference
No smile at 8 weeks
Not holding objects at 5 months
Not sitting at 12 months
Not walking at 18 months
Not pointing at objects at 2 years
No smile at _______ weeks is a red flag
8
Not holding objects at ________ weeks is a red flag
5
Not sitting at _________ months is a red flag
12
Not walking at _______ months is a red flag
18
Not pointing at objects at ________ years is a red flag
2
What are some of the causes of developmental problems
Genetic syndromes such as trisomy 21
Cerebral malformations, hydrocephalus
Congenital infections
Antenatal insults
Perinatal hypoxia, hypoglycaemia
Postnatal meningitis/trauma and metabolic insults
Deprivation or abuse
For growth we assess for serial increases in
Weight
Height
Head circumference
Growth issues:
Weight
Short stature
Tall stature
Microcephaly
Macrocephaly
What are the 4 key phases of growth
1 foetal growth
2 growth in infancy
3 pre-pubertal growth
4 growth at puberty
There is fast growth in the first _____ years then a decline in the rate is observed
2
At 2 years child will gain 2kg per annum thereafter
Height change is slowest in ___________ stage and accelerates at _________
Pre-pubescent
Puberty
In week 1 what happens to the weight of the baby
Loses 10% of birth weight
In week 2 what happens to weight of baby
Baby will regain birth weight
What happens to baby’s weight in 5-12 weeks
Weight doubles
What happens to baby’s weight in week 12
Baby’s weight would have tripled
What factors influence growth
Genetic potential
Optimal intra-uterine conditions
Optimal post-natal nutrition
Normal hormonal status
Good health
Good diet
What is failure to thrive
Not a diagnosis but instead describes suboptimal weight gain in infants and toddlers
First sign is failing to meet growth expectations on charts
Most will lie below the 2nd centile
Organic causes (10%) of FTT:
Inadequate intake
Inadequate retention (vomiting, GORD
Malabsorption (CMPI cows milk protein intolerance, CF, short gut)
Failure to utilise nutrients - renal/liver disease,
Increased requirements - thyrotoxicosis, CF, chronic conditions and malignancy
Non organic causes of FTT
Maybe are being abused
Non organic causes are a broad spectrum of psychosocial, environmental, SES deprivation issues
What is final common pathway for FTT progression
under nutrition
Infants and toddlers have high energy requirements but each child is different with different energy needs
If child is short and overweight think….
Genetic or endocrine
If child is tall and overweight think cause is….
Behavioural
As BMI can’t be used for children what is used instead
RCPCH growth charts
Height velocity (cm gained per year) is influenced by
Genetics
Constitution slow growers and developers
Nutrition
Chronic illness
Emotional deprivation
Endocrine - various but rare cause in children
Short stature may be caused by which medical conditions
Growth hormone deficiency
Panhypopituitarism
Hypothyroidism
Steroid excess
Skeletal dysplasias (abnormal development of baby’s bones, joints and cartilage)
Chromosomal disorders
Achondroplasia ( ossification of long bones can’t occur) so short limbs
Mostly genetic though
Most common cause of short stature
Constitutional growth delay
