Physical milestones and failure to thrive Flashcards
Development =
Increase in the complexity of the organisms due to maturation of the nervous system
Types of development:
Physical Emotional Functional Psychological Social
4 areas of development:
- gross motor
- fine motor and vision
- hearing, speech and language
- social skills and behaviour
Ex of gross motor skills =
Walking, running, climbing, jumping
Why should you always assess all areas of development?
Not every issue is a global issue
Red flags =
Points at which you should refer
Gross motor is a what progression?
Cephalo-caudal progression
3 months GM =
Hold head up 45 degrees prone
6 months Gm =
Sit up without support
Red flag for sit up =
9 months
9 months GM =
Crawling
12 months GM =
Walking
Running and jumping by
2.5 years
Red flag for walking =
18 months
Why is the red flag for walking when it is?
2 SD from mean
Most children with a walking delay will be
Normal late walkers, smaller risk of neurological/muscular disease
Neurological disease which can cause walking delay
Cerebral palsy
Muscular disease which can cause walking delay
Duchenne muscular dystrophy
Ex of fine motor skills =
Grabbing Transferring from hands Building blocks Radial/palmar grasp Mature pincer grip
Scribbling:
Line - 2 yrs
Circle - 3 yrs
Square - 4 yrs
Triangle - 5 yrs
6 months FM =
Palmar grasp
10 months FM =
Mature pincer grip
Red flag for mature pincer grip =
12 months
Tower of 3 =
18 months
Tower of 6 =
2 years
Tower of 8 =
2.5 years
Speech vs language =
Speech - sounds
Language - content and organisation
Types of hearing loss:
Conductive
Sensorineural
Mixed
What can cause problems with speech and language?
Hearing loss Forming words (muscles, palate) Wernickes, Broca's area from hypoxia/ischemia global develoment problem Environmental deprivation Autism spectrum disorder
Ex of social and behavioural behaviour =
Waving Smiling Peek-a-boo Stranger danger Pointing Imaginative play Toilet training
Smiling =
6 weeks
Smiling red flag =
8 weeks
Stranger danger =
8-10 months
Speech 3 months =
1 syllable
Speech at 10 months =
2 syllables
Speech at 12 months =
2-3 words
What do children need in psychological needs?
Security Role models Opportunity to learn Independence Self respect Personal identity Attention Play
Who checks on development?
Patents/grandparents GP Health visitor Nursery Pediatrician Speech and language therapists Play therapists
Times when development can be surveyed:
- Newborn exam
- 6-8 week check at GP
- 1 year health visitor
- 2-2.5 health visitor
Regression =
Having a skill and losing it
Ex of red flag with hand preference =
Early hand preference (before 18 months). Before this could be a sign of something wrong with the hand they’re not using
Persistent toe walking is a sign of =
Increased tone
Isolated delay =
1 domain
Delay in 4 domains =
Global delay
Problems with weight:
Obesity
Failure to thrive
4 phases of growth =
- Fetal
- Infancy
- Childhood
- Puberty
Fastest growth is at what age?
in first 2 years
In week 1, how much weight can a baby lose?
10% of birth weight
Should regain birth weight at
2 weeks
Weight by 5 months =
doubles
Weight by 12 months -
trebled
What influenced growth?
Genetic potential Intra-uterine conditions Post-natal nutrition Diet Hormonal status Health Nurturing social environment
Why can poor health slow growth?
Some conditions have high nutritional/metabolic demands
In FTT, patient should fall =
2 centiles
Traditionally, FTT can be spilt into:
Organic
Non-organic
Organic FTT makes up what %?
<10%
4 broad causes of FTT =
Inadequate intake Inadequate retention Malabsorption Failure to utilise Increased requirements
Ex of inadequate intake =
Poor technique
Wrong milk
Social
Palate
Ex of inadequate retention =
Vomiting
GORD
Ex of malabsorption =
Cows milk protein intolerance
Cystic fibrosis
Short gut
Ex of failure to utilise:
Renal, liver disease
Ex of increased requirements:
Thyrotoxiosis Cystic fibrosis Chronic infections Malignancy Heart disease
How to assess FTT:
- Hx and FHx
- Accurate social history
- Observe parent-child interaction
- Nutritional assessment: weights, height, dietary diary, FBC, albumin, vitamins, minerals
Things to remember with Marfans’s =
Heart (aortic dilation), eyes (lens displacement)
Signs of DMD =
Waddling gait
Slow to walk
Calf pseudohypertrophy
Gower’s sign
DMD can lead to =
Respiratory failure
Dialted cardiomyopathy
DMD is a mutation in =
Dystrophin gene - dystrophin stabalises sarcolemma