Physical Milestones And Failure To Thrive

Question 1

Development is complex and multi-factorial. It can be

Answer 1

Physical
Functional
Emotional
Psychological
Social

Question 2

Later goals depend on ____________ in the same domain of development

Answer 2

Achieving earlier goals

Question 3

What plays a role in development

Answer 3

Genetics
Environment

Question 4

What are the 4 areas of development

Answer 4

1) gross motor

2) fine motor and vision

3) hearing, speech and language

4) social skills and behaviour

Question 5

What is used as the standard reference point for assessing development in each area

Answer 5

Child development charts

Question 6

What is cephalo-caudal progression

Answer 6

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

Question 7

What % of children will be able to walk by their 1st birthday

Answer 7

50%

Question 8

Examples of actions that involve fine motor and vision

Answer 8

Reaching for objects
Transfer object from hand to hand
Building blocks
Radical palmer grab
Mature pincer grab
Scribbling (lines to circles, squares and triangles)

Question 9

For assessing the hearing, speech and language of a child what do we consider

Answer 9

Hearing input - conductive or sensorineural loss

Forming words - muscles and palate

Content of speech = speech areas in the brain and connections

Question 10

Causes of impaired language and speech and hearing

Answer 10

Hearing loss
Mechanical issues
Global development problem (delayed milestones)
Environmental deprivation
Autism spectrum disorder

Question 11

Examples of things children should be able to from domain 4 (social and behavioural)

Answer 11

Smile = 6 week stage
Waving
Peek-a boo
Stranger danger
Pointing
Getting dressed
Toilet training

Question 12

Psychological needs

Answer 12

Security
Role models
Attention
Play
Opportunity to learn from experience
Self respect
Independence
Personal identity

Question 13

Developmental surveillance occurs at 4 key appointments….

Answer 13

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

Question 14

What protocol should be followed for children with suspected developmental delay

Answer 14

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

Question 15

What are some developmental red flags

Answer 15

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

Question 16

No smile at _______ weeks is a red flag

Answer 16

8

Question 17

Not holding objects at ________ weeks is a red flag

Answer 17

5

Question 18

Not sitting at _________ months is a red flag

Answer 18

12

Question 19

Not walking at _______ months is a red flag

Answer 19

18

Question 20

Not pointing at objects at ________ years is a red flag

Answer 20

2

Question 21

What are some of the causes of developmental problems

Answer 21

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

Question 22

For growth we assess for serial increases in

Answer 22

Weight
Height
Head circumference

Question 23

Growth issues:

Answer 23

Weight
Short stature
Tall stature
Microcephaly
Macrocephaly

Question 24

What are the 4 key phases of growth

Answer 24

1 foetal growth
2 growth in infancy
3 pre-pubertal growth
4 growth at puberty

Question 25

There is fast growth in the first _____ years then a decline in the rate is observed

Answer 25

2 At 2 years child will gain 2kg per annum thereafter

Question 26

Height change is slowest in ___________ stage and accelerates at _________

Answer 26

Pre-pubescent Puberty

Question 27

In week 1 what happens to the weight of the baby

Answer 27

Loses 10% of birth weight

Question 28

In week 2 what happens to weight of baby

Answer 28

Baby will regain birth weight

Question 29

What happens to baby’s weight in 5-12 weeks

Answer 29

Weight doubles

Question 30

What happens to baby’s weight in week 12

Answer 30

Baby’s weight would have tripled

Question 31

What factors influence growth

Answer 31

Genetic potential Optimal intra-uterine conditions Optimal post-natal nutrition Normal hormonal status Good health Good diet

Question 32

What is failure to thrive

Answer 32

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

Question 33

Organic causes (10%) of FTT:

Answer 33

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

Question 34

Non organic causes of FTT

Answer 34

Maybe are being abused Non organic causes are a broad spectrum of psychosocial, environmental, SES deprivation issues

Question 35

What is final common pathway for FTT progression

Answer 35

under nutrition Infants and toddlers have high energy requirements but each child is different with different energy needs

Question 36

If child is short and overweight think….

Answer 36

Genetic or endocrine

Question 37

If child is tall and overweight think cause is….

Answer 37

Behavioural

Question 38

As BMI can’t be used for children what is used instead

Answer 38

RCPCH growth charts

Question 39

Height velocity (cm gained per year) is influenced by

Answer 39

Genetics Constitution slow growers and developers Nutrition Chronic illness Emotional deprivation Endocrine - various but rare cause in children

Question 40

Short stature may be caused by which medical conditions

Answer 40

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

Question 41

Most common cause of short stature

Answer 41

Constitutional growth delay