Postnatal and Child Development Flashcards
How do genetics impact prenatal development?
- minor overall effect
- mainly determined by maternal genetic factors and maternal size
How do genetics impact postnatal growth?
- largely determines final adult height
- XY results in taller height than XX
Which hormones are most important in prenatal growth?
- insulin and IGFs
- IGF-2 for embryonic growth
- IGF-1 for late fetal and infant growth
What is the most important hormone in post-natal growth?
Human Growth Hormone
How is nutrition provided to the fetus?
Placenta provides all nutrients
How can fetal nutrition impact prenatal growth?
- placental insufficiency is most common cause of IUGR
- placenta controls hormones necessary for fetal growth
- placental nutrition is influenced by maternal diet
How does nutrition impact postnatal growth?
Poor nutrition can limit growth potential and delay puberty onset
How does the uterine environment influence prenatal development?
- uterine capacity and placental sufficiency needed for optimal environment
- placenta function more important than uterine capacity
Which environmental factors can influence postnatal development?
- socioeconomic status
- chronic disease
- emotional status
- altitude (low O2 sats)
What are the four phases of growth?
- fetal
- infantile
- childhood
- pubertal
What happens during the fetal growth phase?
- fastest period of growth
- accounts for 30% of final height
- growth mainly driven by fetal hyperplasia
How many cycles of cell division are ther before birth and after birth?
- 42 pre birth
- 5 after birth
What is the infantile growth phase?
- first 18 months after birth
- 15% of final height
- slower than fetal phase
- largely dependent on nutrition
- increase in length, head circumference and weight
What is the childhood growth phase?
- 18months to 12 years
- 40% of eventual height
- steady, slow growth
- increases 5-6cm and 3-3.5kg annually
- determined by nutrition, good health and endocrine growth regulation
What is the pubertal growth phase?
- pubertal growth spurt
- 15% of final height
- rising sex hormones and hGH
- XY grow more than XX
- sex hormones cause fusion of growth plates
What are the determinants of fetal growth?
Uterine environment
What are the determinants of infantile growth?
- nutrition
- good health and happiness
- thyroid hormones
What are the determinants of childhood growth?
- growth hormone
- thyroid hormone
- genes
- good health and happiness
What are the determinants of pubertal growth?
- testosterone and oestrogen
- growth hormone
What is the development of the HPG axis?
- fetal development of GnRH network and sexual organs
- neonatal priming of HPG axis (mini-puberty)
- childhood linear growth and developmental milestones with no HPG axis activity
- adolescent sexual maturation (puberty)
- reproductive capacity plateaus in adulthood
What is mini puberty?
- gonadotrophin secretion begins at the end of the first trimester
- peaks mid-pregnancy and then declines
- HPG axis is activated again after birth after release from placental hormones
- continues for 6 months after birth
What is the purpose of mini-puberty?
- contributes to normal gonadal development in males
- may be important in development of mammary tissue in females
- may influence body composition and linear growth in males
What triggers puberty?
- influenced by metabolic status
- neurokinin KNDy neurons may regulate kisspeptin which stimulates GnRH release
A mutation in which gene can cause pubertal delays?
KISS1R
What is consonance?
Compliance with the typical sequence of pubertal milestones
How has the onset of menarche changed over since the 19th century?
Decreased by 4+ years
What are the four developmental domains?
- gross motor skills
- fine motor skills
- speach, language and hearing skills
- social behaviour and play skills
Which developmental skill should be present in newborns?
- flexed posture
- fixes on and follows faces
- stills to voice and startles to loud noises
- smiles responsively
Which developmental skills are present at 7 months?
- sitting without support
- transferring objects from hand to hand
- polysyllabic babble and turning to voice
- finger feeding and fearing strangers
Which developmental skills should be present by 12 months?
- standing independently
- pincer grip
- knowing a few words and understanding name
- drinking from a cup and waving
Which developmental skills should be present at 15-18months?
- walking independently
- immature grip of pencils/crayons
- knowing 6-10 words and being able to point to four body parts
- feeding self with spoon and starting to dress self
Which developmental skills should be present at 2.5 years?
- running and jumping
- drawing
- short sentences and understanding joint commands
- playing with others
How many children are born with a genetic disorder?
1 in 25
How many children are born with congenital defects?
1 in 45
How many children experience some sort of developmental delay during childhood?
1 in 10
What is the NHS Healthy Child Programme?
- prevent diseases and promotes good health
- universal
- reduces health inequalities
What does the NHS Healthy Child Programme provide?
- health promotion
- obesity prevention
- supporting care giving and care givers
- screening
- immunisation
- identifying individuals who need additional support
- signposting for accident prevention and dental hygiene§
What are some important early childhood screening programs?
- newborn check
- new born hearing check
- blood spot check
What are the fundementals of a good screening program?
- able to identify disease before critical point
- disease is treatable
- prevents morbidity and mortality
- easy to administer
- cost effective
- reproducible and accurate results
What does the newborn physical exam measure?
- weight
- eyes
- heart
- hips
- testes
What does the blood spot test test for?
- cystic fibrosis
- sickle cell
- congenital hypothyroidism
- inherited metabolic disorders
What is a newborn hearing test?
Hearing test done in hospital before discharge, can be up to 3 months
What is an infant physical exam?
- done at 6-8 weeks by GP
- measures length and head circumference
- oppurtunity to discuss vaccinations
What is the Sure Start program?
- helps support low-income families with children under 5 years old
- provides parent and child education
- health promotion
What are the two different types of developmental delays?
- global development delays
- specific developmental disorder
What is a global developmental delay?
Significant delay in reaching two or more developmental milestones
What is a specific developmental disorder?
Delays in specific developmental domains in absence of sensory deficits, subnormal intelligence or poor education conditions
What are the causes of global developmental delays?
- chromosomal abnormalities
- metabolic e.g hypothyroidism
- antenatal and perinatal factors
- environmental-social issues
- chronic illness
What are some antenatal and perinatal factors which can cause global developmental delays?
- infections
- drugs
- toxins
- anoxia
- trauma
- folate deficiency
What are some screenings which asses language skill development?
- schedule of growing skills
- Griffith’s developmental scale
- Bayley Scales of Infant Development
What are some causes of motor skill developmental delays?
- cerbral palsy
- congenital hip dislocation
- muscular dystrophy
- neural tube defects
- social deprivation
What are some causes of language skill developmental delays?
- hearing loss
- autism spectrum disorders
- lack of stimulation
- imparied language comprehension
- impaired speech production e.g. stammer, dysarthia
