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Year 2 BRS added > Postnatal and Child Development > Flashcards

Postnatal and Child Development Flashcards

1
Q

Genetics effect on prenatal?

A

Minor effect overall
Maternal size important in determining birth size
Paternal genetic factors have little effect on birth
Maternal factors tend to override fetal genetic factors in determining prenatal growth

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2
Q

Genetics effect on postnatal?

A

Largely determines final adult height
Sex chromosomes have an effect:
XY boys are taller than XX girls

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3
Q

Endocrine effect on prenatal? What are the major prenatal hormones influencing growth?

A

Insulin and insulin-like growth factors (IGFs) are major prenatal hormones influencing growth:
IGF-2 most important for embryonic growth
IGF-1 most important for later fetal and infant growth

(Growth hormone has no effect on early growth)

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4
Q

Endocrine effect on postnatal?

A

Human growth hormone (hGH) is the major hormone controlling growth after birth

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5
Q

Nutrition effect on prenatal?

A

Placenta provides all nutrients to growing fetus, therefore essential for growth
Placental insufficiency most common cause of intrauterine growth restriction
Placenta also controls hormones necessary for fetal growth
Maternal diet influences nutritional availability

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6
Q

Nutrition effect on postnatal?

A

Adequate nutrition is essential for growth
Starvation due to lack of substrate availability can limit growth potential
Obesity occurs mostly as a result of excessive intake of food
Poor nutrition may delay the onset of puberty
Malabsorption of nutrients may cause reduced growth

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7
Q

Environment effect on prenatal?

A

Uterine capacity and placental sufficiency important in providing optimal environment for fetus
Placental function is more influential in fetal growth than uterine capacity

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8
Q

Environment effect on postnatal?

A

The following factors are known to influence growth:
Socioeconomic status
Chronic disease
Emotional status
Altitude (mediated by lower oxygen saturation levels)

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9
Q

When do cranial sutures close?

A

Open at birth
Close by 18 months

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10
Q

4 phases of growth?

A

Fetal
Infantile
Childhood
Pubertal

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11
Q

Fetal phase?

A

Accounts for 30% of eventual height
Repeatedly doubles in size over gestation
Driven by HYPERPLASIA
42 cycles of cell division before birth, only further five cycles of cell division occur from birth to adulthood

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12
Q

Infantile phase?

A

0-18 months after birth, 15% of eventual height.
Rapid, but decelerating growth (vs fetal phase)

Length increases by 50%, head circumference by 30% and weight triples vs birth
nutrition dependent

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13
Q

Childhood phase?

A

18 months to 12 years of age, 40% of eventual height.
Steady, slow prolongued growth

5-6 cm annual increase in height, and 3-3.5kg annual increase in weight

Good nutrition and health important, but endocrine growth regulation increasing

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14
Q

Pubertal phase?

A

“Pubertal growth spurt”, 15% of eventual height.
Rising levels of sex hormones boost hGH production

~25cm (XY boys) ~20cm (XX girls) increase in height over 3-4 years

Temporary growth spurt as sex hormones also cause fusion of growth plates

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15
Q

What is the mini-puberty?

A

HPG axis is transiently activated after birth (mini-puberty), after release from restraint by placental hormones
Continues for around 6 months after birth before declining

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16
Q

Mini-puberty reason in males?

A

Elevated sex steroids in males during mini-puberty seems to be important for normal gonadal development (testicular tissue and penile development)

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17
Q

Mini puberty reasons in female?

A

Role of minipuberty less clear in female infants:
Estradiol levels fluctuate through first few months after birth
Follicular development occurs in the ovary
Important for patterning and development of mammary tissue?

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18
Q

Mini-puberty effect on programming of body composition and linear growth?

A

Elevated sex steroids in minipuberty may also influence programming of body composition and linear growth.
High testosterone levels in boys during minipuberty, may partly explain the higher growth velocity observed in boys compared to girls.

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19
Q

Puberty trigger?

A

Release of neurokinin KNDy neurons may regulate release of Kisspeptin peptides, which act on GnRH neurons to promote pulsatile GnRH release

Mutations in KISS1R affect puberty timing, implicating Kisspeptin-KISS1R signalling in regulation of this process.

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20
Q

Consonance meaning?

A

Complying with predictable pattern of developmental events of puberty

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21
Q

IGF 2 vs IGF 1?

A

IGF-2 most important for embryonic growth
IGF-1 most important for later fetal and infant growth

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22
Q

Most common cause of intrauterine growth restriction

A

Placental insufficiency

23
Q

Gonadotrophin secretions during pregnancy?

A

Commences towards the end of the first trimester, peaks mid-pregnancy, then declines

24
Q

Mutations in KISS1R?

A

Affect puberty timing, implicating Kisspeptin-KISS1R signalling in regulation of this process.

25
NHS healthy child programme aims?
To prevent disease and promote good health: - universal - reduced health inequalities
26
NHS healthy child programme includes?
Health promotion Supporting care giving and care givers Screening Immunisation Identification of high-risk families Signposting - accident prevention and dental hygiene
27
Fundamentals of a good screening test? Disease factors and test factors
Disease screening for: -should be able to identified early/before critical point -treatable -prevent/reduce morbidity/mortality -acceptable/easy to administer -cost effective -reproducible and accurate results
28
Examples of important early childhood screening?
-newborn check -newborn hearing screen -blood spot check
29
Newborn physical exam? When and what.
Within 72 hours Weight, eyes, heart, hips, testes
30
Blood spot test? When and what.
Within 7 days, ideally 5 CF, sickle cell, congenital hypothyroidism, inherited metabolic diseased (PKU)
31
Newborn hearing test? When and what.
3-5 weeks Sometimes done in hospital before discharge, can be done up to 3 months
32
Infant physical exam? When and what.
6-8 weeks With GP, as newborn physical, with length and head circumference - opportunity to discuss vaccinations
33
Sure start?
Optimises early life outcomes High level of investment in children’s community centres, aims to help support families with under 5 year old children in low income households Parent and child education Health promotion
34
Global developmental delay?
Significant delay in reaching two or more developmental milestones
35
Specific developmental disorder?
Refers to delays in developmental domains in absense of sensory deficits, subnormal intelligence or poor educational conditions - learning disorders - motor skill disorders - communication disorders
36
Causes of global developmental delay?
Chromosomal abnormalities Metabolic Antenatal and perinatal factors Environmental-social issues Chronic illness
37
Causes of motor skill developmental delay?
(Aspects of global developmental delay) Cerebral palsy Congenital dislocation of the hip Muscular dystrophies Neural tube defects Social deprivation
38
Causes of language skill developmental delay?
Hearing loss Autism spectrum disorders Lack of stimulation Impaired comprehension of language (developmental dysphasia) Impaired speech production (stammer, dysarthria)
39
Schedule of growing skills?
0-5y standardised test examining 8 criteria (Locomotor, manipulative, self-care, social skills, hearing and language, speech and language, visuals and cognitive)
40
Griffiths developmental scale?
0-6y measures trends indicative of functional mental growth and the domains listed above through play activities.
41
Bayley Scales of Infant Development?
1-42m assesses cognitive, motor and language skills
42
Denver developmental screening tests?
0-6y assesses ability in domains relative to %age blocks of children from a population who could achieve a skill by a particular age.
43
Developmental domains?
Gross motor skills Fine motor skills Speech, language and hearing skills Social behaviour and play skills
44
Newborn developmental milestones?
Flexed posture Fixes and follows face Stills to voice, startles to loud noise Smiles - by 6 weeks
45
7 months developmental milestones?
Sits without support Transfers objects from hand to hand Turns to voice, polysyllabic babble Finger feeds, fears strangers
46
1 year developmental milestones?
Stands independently Pincer grip (10 months), points 1-2 words, understands name Drinks from cup, waves
47
15-18 months developments milestones?
Walks independently Immature grip of pencil, random scribble 6-10 words, points to four body parts Feeds self with spoon, beginning to help with dressing
48
2.5 years developmental milestones
Runs and jumps Draws 3-4 word sentences, understands two joined commands Parallel play, clean and dry
49
Gross motor skills from birth to 15m?
6-8 weeks - raises head to 45degrees in prone 6-8 months - sits with round back at 6 months, with straight back at 8 months 8-9 months - crawling 10 months - cruises around furniture 12 months - walks unsteadily, broad gait, hands apart 15 months - walks steadily
50
Fine motor skills from birth?
6 weeks - follows moving object or face 4 months - reaches out for toys 4-6 months - palmar grasp 7 months - transfers toys between hands 10 months - mature pincher grip 16-18 months - makes marks with crayon
51
Language skills from birth?
Newborn - startles to loud noise 3-4m - vocalises alone or when spoken to, coos and laughs 7m - turns to sounds out of sight 7-10m - 7m sounds used, 10m sounds used discriminately to parents 12m - 2-3 words other than dada or mama 18m - 6-10 words 20-24m - simple phrases of 2 or more words 2.5-3y - talks in 3-4 word sentences
52
Social/behavioural skills from birth?
6 weeks - smiles 6-8m - puts food in mouth 10-12m - waves bye 12m - drinks from a cup with 2 hands 18m - holds spoon and gets food safely to mouth 18-24m - symbolic play 2y - dry by day, pulls off some clothing 2.5-3y - parallel play, interactive play, takes turns
53

Year 2 BRS added (13 decks)

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