Postnatal and child development Flashcards
Genetic impact on prenatal growth
Minor overall effect
Maternal factors are the main determinants, with maternal size affecting birth size
Genetic impact on postnatal growth
Largely determines final height
sex chromosomes influence it
Endocrine impact on prenatal growth
Insulin/IGF prenatal hormones affecting growth
IGF-1, later fetal and infant growth
IGF-2, embryonic growth
4 phases of growth
Fetal
Infantile
Childhood
Pubertal
Nutrition impact on prenatal growth
Placenta provides nutrients and hormones
Placental insufficiency commonest cause of FGR
Maternal diet influences nutrient availability
Endocrine impact on postnatal growth
human growth hormone (hGH) major hormone controlling growth
Nutrition impact on postnatal growth
Adequate nutrition rq for growth
poor nutrition may delay puberty onset
malabsorption of nutrients -> red. growth
Environmental impact on prenatal growth
Uterine capacity/ Placental sufficiency provide optimal environment for fetal growth
Environmental impact on postnatal growth
factors influencing growth:
socioeconomic status
chronic status
emotional status e.g. stress
altitude
When do cranial sutures close
18mths
Describe the fetal growth phase
Fastest period of growth
fetus doubles in size over gestation
growth driven by hyperplasia (cells increase in number)
Describe the infantile growth phase
0-18mths
rapid but decelerating growth
nutrition dependent growth
increase in length, head circumference, weight
Describe the childhood growth phase
18mths - 12yrs
steady, slow growth
Increased endocrine growth regulation
Describe the pubertal growth phase
Rising levels of sex hormones boost hGH
Temporary growth spurt as hGH causes fusion of growth plates
driven predominantly by hormones
What is a mini-puberty
Gonadotrophin secretion begins at the end of the first trimester and declines to zero at birth.
HPG axis transiently activated post birth ≈6mths
due to lack of inhibition by placental hormones
Role of mini puberty in males
Normal gonadal development
- testicular tissue and penile development
Role of mini puberty in females
largely unclear
follicular development
patterning and development of mammary tissue
Role of mini puberty in body composition and growth
May affect growth velocity as testosterone is greater in boys than girls
What is puberty onset driven by
Transition to pulsatile GnRH release
Regulated by KNDy neuronal control of kisspeptin
Consonant puberty
Follows the typical sequence of development for their gender
What are the 4 developmental domains
Gross motor skills - crawling, walking
Fine motor skills - handling small objects
Speech, language, hearing skills
Social behaviour and play skills
Median age for development of gross motor skills
Newborn - raises head whilst on stomach
7mths - sit w/o support
8-9mths - crawling
1yr - stand independently
15-18mths - walks independently
2.5yrs - runs and jumps
Median age for development of fine motor skills
Newborn - turns head to follow object
4-6mths - palmar grasp
7mths- transfer objects btw hands
10-12mths - pincer grip/pts
15-18mths - marks with crayon
2-5yrs - draws shapes
Median age for development of language skills
Newborn - startles at loud noises
3-4mths - vocalises, laughs
7mths - responding to sounds
12mths - few words
18mths - recognise body parts
2yrs - simple phrases
Median age for development of social/behavioural skills
6wks- smiles responsively
6-8mths - finger feeds
1 year - play games e.g. peekaboo
- drink from cup
18mths - hold spoon and feed
2 years - symbolic play e.g. feeding teddy
- potty trained
What is an example of a planned programme of reviews for child development?
NHS Healthy Child Programme
What are the four elements to the healthy child programme?
Screening,
Immunisation,
Child Health Reviews,
Health Promotion
Aims of the NHS Healthy Child Programme
Prevent disease and promote good health
by reducing health inequalities
Fundamentals of a Good Screening Test
Acceptable/easy to administer
Cost effective
Reproducible and accurate results
Early identification of a treatable disease
Important Early Childhood Screening types
Newborn Check
Newborn Hearing Screen
Blood spot check
What does the Newborn physical test check for
done w/in 72hrs
weight, eyes, heart, hips and testes
What does the Blood spot test check for
done w/in 7d
CF, Sickle Cell, congenital hypothyroidism, inherited metabolic diseases (eg PKU)
Newborn hearing test
done @ 3-5wks
sometimes done in hospital before discharge, can be done up to 3 months
What is the Infant physical exam
done @ 6-8 wks
with GP, measures length + head circumference – opportunity to discuss vaccinations.
What is Global developmental delay
significant delay in reaching two or more developmental milestones
What is Specific developmental disorder
delays in developmental domains in the absence of sensory deficits, subnormal intelligence or poor educational conditions
What are the two types of developmental delay
Global and Specific
Types of specific developmental disorder
- learning disorders
- motor skill disorders
- communication disorders
Causes of Global developmental delay
Chromosomal abnormalities e.g. Downs
Metabolic issues e.g.hypothyroidism
Antenatal/perinatal factors e.g. infection, drugs
Environmental-social issues
Chronic illness
Causes of motor skill developmental delay
Cerebral palsy
Congenital dislocation of the hip
Muscular dystrophies
Neural tube defects
Social deprivation
Causes of language skill developmental delay
Hearing loss
Autism spectrum disorders
Lack of stimulation
Impaired comprehension of language – e.g. developmental dysphasia
Impaired speech production – e.g. stammer, dysarthria
What are some examples of prenatal causes of impairment?
Maternal nutrition (iron, folate)
What are some examples of perinatal causes of impairment?
Delivery problems - trauma, low oxygen, drugs in ICU
What are some examples of postnatal causes of impairment?
Trauma, Meningitis
What are some commonly used assessment tools for development?
Standardised Tests (such as Denver developmental screening tests)
