The Growing Child

Question 1

1. define global developmental delay
2. define isolated developmental delay
3. define developmental disorder
4. define developmental regression

Answer 1

1. developmental delay in at least 2 areas
2. developmental delay in one area
3. a group of psychiatric conditions originating in childhood, that involve serious impairment in different areas; comprised of language disorders, learning disorders, motor disorders and ASD
4. loss of ability to perform previously achieved milestones

Question 2

1. In what “direction” does gross motor development occur
2. describe gross motor development at:
   a) 3 months
   b) 6 months
   c) 9 months
   d) 12 months
3. What is the red flag for walking

Answer 2

1. cephalo-caudal progression - from head to toe
   2a) head control
   2b) sitting
   2c) crawling
   2d) walking
2. 18 months

Question 3

by what age can a child:

1. reach out and grab
2. transfer objects hand to hand
3. build blocks
4. palmar grasp
5. pincer grasp
6. draw a triangle

Answer 3

1. 3-5 months
2. 6 months
3. 15-18 months
4. 6-9 months
5. 12 months
6. 3 years

Question 4

Name 5 causes of speech delay

Answer 4

1. hearing loss
2. mechanical issues
3. part of global developmental problem
4. environmental deprivation
5. ASD

Question 5

When does a child meet the following speech and language milestones:

1. starts making noises
2. responds to own name
3. puts at least two words together
4. talks well in sentences

Answer 5

1. 4-6 months
2. 12 months
3. 18 -24 months
4. 24-36 months

Question 6

When does a child usually:

1. smile
2. parallel play
3. taking own clothes off
4. dressing independently
5. toilet training

Answer 6

1. 5-8 weeks
2. 18-24 months
3. 15 months
4. 4 years
5. 2-4 years

Question 7

1. why is early hand preference a red flag?
2. What are the following red flags for:
   a) smiling
   b) holding objects
   c) sitting

Answer 7

1. can indicate problem with non-preferred hand
   2a) 8 weeks
   b) 5 months
   c) 12 months

Question 8

1. What is the normal weight gain for children at two years?
2. when is birth weight regained?
3. When is birth weight doubled
4. when is birth weight tripled?

Answer 8

1. 2 kg/year
2. 2 weeks
3. 5 months
4. 12 months

Question 9

1. What is failure to thrive?
2. Below what centile do most children with FTT fall below?
3. Is FTT mainly organic or inorganic?
4. What weight milk does a baby usually require?

Answer 9

1. suboptimal weight gain in infants and toddlers
2. second centile
3. inorganic
4. 150ml/kg body weight

Question 10

Name 5 organic causes of failure to thrive

Answer 10

1. inadequate intake - poor technique, social issues
2. inadequate retention - vomiting, GORD
3. malabsorption - cow’s milk insuficiency
4. failure to utilise nutrients - renal/liver disease, metabolic errors
5. increased requirements - malignancy, thyrooxicosis

Question 11

State the four basic issues in child development

Answer 11

1. is child development continuous or discontinuous
2. does child development follow one universal course or many?
3. is development due to nature or nurture
4. is the course of child development stable or subject to change?

Question 12

DEVELOPMENTAL RISK FACTORS

1. describe adverse prenatal experiences
2. descrive adverse postnatal experiences

Answer 12

1. maternal depression during pregnancy, HIV, drug use

2. global deprivation, postnatal depression, quality of infant child care

Question 13

1. What is a microsystem?

2. what is a macrosystem?

Answer 13

1. relationship between person and their immediate environment
2. institutional patterns of culture: SES, poverty, ethnicity

Question 14

How is socio-emotional functioning in middle childhood seen through? (4)

Answer 14

1. understanding and regulating emotions
2. relationships between parents and children
3. relationships with siblings
4. relationships with peers

Question 15

How is socio-emotional functioning in adolescence seen through? (4)

Answer 15

1. social cognition
2. increased understanding of morality and social conventions, and the functions they serve
3. identity crisis
4. peer acceptance, popularity, rejection

Question 16

Describe the psychosocial stages at the folliwing ages:

1. 0-1 years
2. 1-3 years
3. 3-6 years
4. 6-11 years
5. adolescence

Answer 16

1. basic trust v mistrust
2. autonomy v shame
3. initiative v guilt
4. industry v inferiority
5. identity v confusion

Question 17

Define the following:

1. schemes
2. adaptation
3. assimilation
4. accomodation

Answer 17

1. basic unit of cognition or understanding about an aspect of the world
2. mechanism through which schemes result as a result of adjusting to changes
3. the way in which we take information and perceptions so that they fit with our current understanding of the world
4. process whereby a person changes and alters cognitive structures to incorporate new information

Question 18

What is the difference between “age” and “stage”

Answer 18

age - chronological age

stage - where the child is at in developmental terms

Question 19

Name 6 factors that can affect communication with a child

Answer 19

1. hearing impairment
2. speech development
3. language comprehension
4. visual impairment
5. major life events
6. if feeling unwell, might not feel like talking

Question 20

1. which type of questions are best to use with children?

2. why should you avoid why questions?

Answer 20

1. open questions

2. tend to be threatening and generate responses that are external to the child

Question 21

How may a child express their feelings about the illness of of significant others (5)

Answer 21

1. loss of appetite
2. sleeping difficulties
3. underachievement at school
4. spending more time away from home
5. stop asking friends home

Question 22

What drives growth during the following periods:

1. infancy
2. early childhood
3. pubertal growth spurt

Answer 22

1. nutritional factors
2. growth hormone
3. growth hormone and sex hormones

Question 23

1. Where is growth hormone produced?
2. How is growth hormone secreted?
3. Describe the negative feedback loop of GH secretion

Answer 23

1. anterior pituitary somatotrophs
2. highly episodic pulses - prominent bursts of secretion during slow wave sleep
3. GH directly inhibits the anterior pituitary, and suppresses hypothalamic GHRH release

Question 24

1. Describe 3 acute effects of growth hormone

2. Describe 3 long term effects of growth hormone

Answer 24

1. stimulation of lipolysis
   inhibition of glucose uptake by muscle
   stimulation of gluconeogenesis
2. stimulates the production of insulin like growth factors
   increased protein synthesis
   cell growth/proliferation

Question 25

1. Where are insulin like growth factors produced? 2. Describe the structure of the insulin like growth factor receptor 3. Which IGF is the most influential on growth? 4. Which IGF is largely independent of GH 5. Describe the two instances in life where growth does not parallel [IGF-1] and GH

Answer 25

1. various tissues, including kidney, muscle, cartilage, and bone, but predominantly the liver 2. heterotetramer; RTK 3. IGF-1 4. IGF-2 5. adulthood - longitudinal growth ceases but secretion of GH and IGF-1 continues (thought to be important regulators of body composition and promote anabolic reactions in muscle) early life - rapid growth but low levels of IGF-1

Question 26

Name 3 ways in which the thyroid hormones are important for normal growth

Answer 26

1. essential for protein synthesis in the brain of foetus and infants 2. essential for normal differentiation and maturation of skeleton and nervous tissue 3. promotes linear growth of bone until puberty, ossification of bones and maturation of growth plates

Question 27

1. What condition can inadequate levels of thyroid hormones during late foetal and early prenatal periods cause? 2. describe 5 characteristics of this condition

Answer 27

1. cretinism 2. decreased size and number of cortical neurons reduction of branching in dendrites poor myelination reduced cerebral blood supply dwarfism

Question 28

1. How do the sex hormones promote growth? 2. Which sex hormones are important in: a) boys b) girls 3. Why do people who go through puberty later tend to be taller?

Answer 28

1. promotes secretion of GH 2a. testosterone 2b. oestradiol-17 beta 3. sex hormones accelerate the rate at which the skeleton matures and thus shortens time available for growth before epiphyseal closure occurs

Question 29

When are the following hormones important for growth? 1. thyroid hormones 2. growth hormones 3. oestrogens and androgens

Answer 29

1. up to ~ age 4 2. throughout development 3. puberty

Question 30

When is the normal age of puberty in 1. males 2. females 3. what is the onset of puberty associated with? (hormone) 4. When is a diagnosis of delayed puberty given a) boys b) girls

Answer 30

1. 9-14 (av age 12) 2. 9-14 (av age 11) 3. GnRH pulsing - causes rise in LH and FSH 4a) no testicular development by 14 4b) no breast development by 13 or no periods 3 years after breast development

Question 31

1. What is the inheritance pattern of Duchenne Muscular Dystrophy 2. what gene is mutated in DMD? 3. What is the normal function of this protein? 4. How does a loss of function of this protein lead to pathology?

Answer 31

1. X linked 2. dystrophin - usually large insertions/deletions that result in frameshift mutations 3. connects the actin cytoskeleton of skeletal muscle fibres to the surroindiing EXM, as part of the costamere complex 4. destablises the costamere complex, leading to fibre damage and membrane leakage of intracellular proteins

Question 32

1. What sign is positive in DMD | 2. name symptoms of DMD

Answer 32

1. Gower's sign 2. muscle weakness, typically of hips, pelvic area, thighs, calves first awkward manner of walking lumbar hyperlordosis frequent falls contractures of achilles and hamstrings progressive difficulty walking difficulty getting up from standing