Postnatal and child development

Question 1

Genetic impact on prenatal growth

Answer 1

Minor overall effect
Maternal factors are the main determinants, with maternal size affecting birth size

Question 2

Genetic impact on postnatal growth

Answer 2

Largely determines final height
sex chromosomes influence it

Question 3

Endocrine impact on prenatal growth

Answer 3

Insulin/IGF prenatal hormones affecting growth
IGF-1, later fetal and infant growth
IGF-2, embryonic growth

Question 4

4 phases of growth

Answer 4

Fetal
Infantile
Childhood
Pubertal

Question 4

Nutrition impact on prenatal growth

Answer 4

Placenta provides nutrients and hormones
Placental insufficiency commonest cause of FGR
Maternal diet influences nutrient availability

Question 4

Endocrine impact on postnatal growth

Answer 4

human growth hormone (hGH) major hormone controlling growth

Question 4

Nutrition impact on postnatal growth

Answer 4

Adequate nutrition rq for growth
poor nutrition may delay puberty onset
malabsorption of nutrients -> red. growth

Question 5

Environmental impact on prenatal growth

Answer 5

Uterine capacity/ Placental sufficiency provide optimal environment for fetal growth

Question 5

Environmental impact on postnatal growth

Answer 5

factors influencing growth:
socioeconomic status
chronic status
emotional status e.g. stress
altitude

Question 6

When do cranial sutures close

Answer 6

18mths

Question 7

Describe the fetal growth phase

Answer 7

Fastest period of growth
fetus doubles in size over gestation
growth driven by hyperplasia (cells increase in number)

Question 8

Describe the infantile growth phase

Answer 8

0-18mths
rapid but decelerating growth
nutrition dependent growth
increase in length, head circumference, weight

Question 9

Describe the childhood growth phase

Answer 9

18mths - 12yrs
steady, slow growth
Increased endocrine growth regulation

Question 10

Describe the pubertal growth phase

Answer 10

Rising levels of sex hormones boost hGH
Temporary growth spurt as hGH causes fusion of growth plates
driven predominantly by hormones

Question 11

What is a mini-puberty

Answer 11

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

Question 12

Role of mini puberty in males

Answer 12

Normal gonadal development
- testicular tissue and penile development

Question 13

Role of mini puberty in females

Answer 13

largely unclear
follicular development
patterning and development of mammary tissue

Question 14

Role of mini puberty in body composition and growth

Answer 14

May affect growth velocity as testosterone is greater in boys than girls

Question 15

What is puberty onset driven by

Answer 15

Transition to pulsatile GnRH release
Regulated by KNDy neuronal control of kisspeptin

Question 16

Consonant puberty

Answer 16

Follows the typical sequence of development for their gender

Question 17

What are the 4 developmental domains

Answer 17

Gross motor skills - crawling, walking
Fine motor skills - handling small objects
Speech, language, hearing skills
Social behaviour and play skills

Question 18

Median age for development of gross motor skills

Answer 18

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

Question 19

Median age for development of fine motor skills

Answer 19

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

Question 20

Median age for development of language skills

Answer 20

Newborn - startles at loud noises
3-4mths - vocalises, laughs
7mths - responding to sounds
12mths - few words
18mths - recognise body parts
2yrs - simple phrases

Question 21

Median age for development of social/behavioural skills

Answer 21

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

Question 22

What is an example of a planned programme of reviews for child development?

Answer 22

NHS Healthy Child Programme

Question 23

What are the four elements to the healthy child programme?

Answer 23

Screening, Immunisation, Child Health Reviews, Health Promotion

Question 24

Aims of the NHS Healthy Child Programme

Answer 24

Prevent disease and promote good health by reducing health inequalities

Question 25

Fundamentals of a Good Screening Test

Answer 25

Acceptable/easy to administer Cost effective Reproducible and accurate results Early identification of a treatable disease

Question 26

Important Early Childhood Screening types

Answer 26

Newborn Check Newborn Hearing Screen Blood spot check

Question 27

What does the Newborn physical test check for

Answer 27

done w/in 72hrs weight, eyes, heart, hips and testes

Question 28

What does the Blood spot test check for

Answer 28

done w/in 7d CF, Sickle Cell, congenital hypothyroidism, inherited metabolic diseases (eg PKU)

Question 29

Newborn hearing test

Answer 29

done @ 3-5wks sometimes done in hospital before discharge, can be done up to 3 months

Question 30

What is the Infant physical exam

Answer 30

done @ 6-8 wks with GP, measures length + head circumference – opportunity to discuss vaccinations.

Question 31

What is Global developmental delay

Answer 31

significant delay in reaching two or more developmental milestones

Question 32

What is Specific developmental disorder

Answer 32

delays in developmental domains in the absence of sensory deficits, subnormal intelligence or poor educational conditions

Question 33

What are the two types of developmental delay

Answer 33

Global and Specific

Question 34

Types of specific developmental disorder

Answer 34

- learning disorders - motor skill disorders - communication disorders

Question 35

Causes of Global developmental delay

Answer 35

Chromosomal abnormalities e.g. Downs Metabolic issues e.g.hypothyroidism Antenatal/perinatal factors e.g. infection, drugs Environmental-social issues Chronic illness

Question 36

Causes of motor skill developmental delay

Answer 36

Cerebral palsy Congenital dislocation of the hip Muscular dystrophies Neural tube defects Social deprivation

Question 37

Causes of language skill developmental delay

Answer 37

Hearing loss Autism spectrum disorders Lack of stimulation Impaired comprehension of language – e.g. developmental dysphasia Impaired speech production – e.g. stammer, dysarthria

Question 38

What are some examples of prenatal causes of impairment?

Answer 38

Maternal nutrition (iron, folate)

Question 39

What are some examples of perinatal causes of impairment?

Answer 39

Delivery problems - trauma, low oxygen, drugs in ICU

Question 40

What are some examples of postnatal causes of impairment?

Answer 40

Trauma, Meningitis

Question 41

What are some commonly used assessment tools for development?

Answer 41

Standardised Tests (such as Denver developmental screening tests)