Postnatal and Child Development Flashcards
Genetics effect on prenatal?
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
Genetics effect on postnatal?
Largely determines final adult height
Sex chromosomes have an effect:
XY boys are taller than XX girls
Endocrine effect on prenatal? What are the major prenatal hormones influencing growth?
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)
Endocrine effect on postnatal?
Human growth hormone (hGH) is the major hormone controlling growth after birth
Nutrition effect on prenatal?
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
Nutrition effect on postnatal?
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
Environment effect on prenatal?
Uterine capacity and placental sufficiency important in providing optimal environment for fetus
Placental function is more influential in fetal growth than uterine capacity
Environment effect on postnatal?
The following factors are known to influence growth:
Socioeconomic status
Chronic disease
Emotional status
Altitude (mediated by lower oxygen saturation levels)
When do cranial sutures close?
Open at birth
Close by 18 months
4 phases of growth?
Fetal
Infantile
Childhood
Pubertal
Fetal phase?
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
Infantile phase?
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
Childhood phase?
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
Pubertal phase?
“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
What is the mini-puberty?
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
Mini-puberty reason in males?
Elevated sex steroids in males during mini-puberty seems to be important for normal gonadal development (testicular tissue and penile development)
Mini puberty reasons in female?
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?
Mini-puberty effect on programming of body composition and linear growth?
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.
Puberty trigger?
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.
Consonance meaning?
Complying with predictable pattern of developmental events of puberty
IGF 2 vs IGF 1?
IGF-2 most important for embryonic growth
IGF-1 most important for later fetal and infant growth
Most common cause of intrauterine growth restriction
Placental insufficiency
Gonadotrophin secretions during pregnancy?
Commences towards the end of the first trimester, peaks mid-pregnancy, then declines
Mutations in KISS1R?
Affect puberty timing, implicating Kisspeptin-KISS1R signalling in regulation of this process.
NHS healthy child programme aims?
To prevent disease and promote good health:
- universal
- reduced health inequalities
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
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
Examples of important early childhood screening?
-newborn check
-newborn hearing screen
-blood spot check
Newborn physical exam? When and what.
Within 72 hours
Weight, eyes, heart, hips, testes
Blood spot test? When and what.
Within 7 days, ideally 5
CF, sickle cell, congenital hypothyroidism, inherited metabolic diseased (PKU)
Newborn hearing test? When and what.
3-5 weeks
Sometimes done in hospital before discharge, can be done up to 3 months
Infant physical exam? When and what.
6-8 weeks
With GP, as newborn physical, with length and head circumference - opportunity to discuss vaccinations
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
Global developmental delay?
Significant delay in reaching two or more developmental milestones
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
Causes of global developmental delay?
Chromosomal abnormalities
Metabolic
Antenatal and perinatal factors
Environmental-social issues
Chronic illness
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
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)
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)
Griffiths developmental scale?
0-6y
measures trends indicative of functional mental growth and the domains listed above through play activities.
Bayley Scales of Infant Development?
1-42m
assesses cognitive, motor and language skills
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.
Developmental domains?
Gross motor skills
Fine motor skills
Speech, language and hearing skills
Social behaviour and play skills
Newborn developmental milestones?
Flexed posture
Fixes and follows face
Stills to voice, startles to loud noise
Smiles - by 6 weeks
7 months developmental milestones?
Sits without support
Transfers objects from hand to hand
Turns to voice, polysyllabic babble
Finger feeds, fears strangers
1 year developmental milestones?
Stands independently
Pincer grip (10 months), points
1-2 words, understands name
Drinks from cup, waves
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
2.5 years developmental milestones
Runs and jumps
Draws
3-4 word sentences, understands two joined commands
Parallel play, clean and dry
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
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
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
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
