growth, development and health

Question 1

what are the recognised phases of childhood?

Answer 1

neonate (<4w)
infant (<12m/1y)
toddler (~1-2y)
pre-school (~2-5y)
school age
teenager/ adolescent

Question 2

what are the main objectives of childhood?

Answer 2

• grow
• develop and achieve their potential
• attain optimal health
• develop independence
• be safe
• be cared for
• be involved

Question 3

what are the 5 key developmental fields?

Answer 3

• gross motor
• fine motor
• speech and language
• social and self help
• hearing and vision

Question 4

what are the 4 key milestones?

Answer 4

• social smile
• sitting
• walking
• first words

Question 5

when should children be referred for not meeting milestones?

Answer 5

if not achieved by limit age (2 SDs from mean)

Question 6

what must you correct for with milestones?

Answer 6

correct for prematurity until 2 years old

Question 7

what is the usual development of walking?

Answer 7

• 9/10 months: start
• 12 months: 50% have started walking (median age)
• 18 months: refer
• beware of bottom shufflers and commando crawlers

Question 8

why is development important?

Answer 8

allow our brain’s genetic potential to be fully realised

equip us with tools needed to function as older children and adults

Question 9

what factors influence development?

Answer 9

genetics: family, race, gender
environment
childhood: positive experience
insults: developing brain (including antenatal, post natal and abuse and neglect)

Question 10

what antenatal factors can influence development?

Answer 10

• infections (toxoplasmosis, rubella CMV, herpes simplex)

- toxins (Alcohol, Smoking, Anti-epileptics)

Question 11

What post-natal factors can influence development?

Answer 11

• infection (meningitis, encephalitis)
• toxins (solvents mercury, lead)
• trauma (Head injuries)
• malnutrition (iron, folate, vit D)
• metabolic (hypoglycaemia, hyper + hyponatraemia)
• maltreatment/ under stimulation/ domestic violence
• maternal mental health issues

Question 12

why do we assess development?

Answer 12

• reassurance and showing progress
• early diagnosis and intervention
• discuss positive stimulation/parenting strategies
• provision of information
• improving outcomes (pre-school years critical)
• genetic counselling
• coexistent health issues

Question 13

who assesses child development

Answer 13

• parents and wider family
• health visitors, nursery, teachers
• GPs, A+E, FYs, STs, students
• paediatricians and community paediatricians

Question 14

What is involved in assessing development?

Answer 14

• Healthy Child Programme (HCP) UK
• screening (may not always be sensitive/ specific)
• parental concerns/ videos on phone
• observation of play and activity
• medical history and examination
• review the red book

Question 15

give examples of normal variation

Answer 15

• early developers
• late normal
• bottom shufflers - walking delay
• bilingual families- apparent language delay (total words may be normal)
• familial traits

Question 16

What are the red flags when assessing development?

Answer 16

• loss of developmental skills
• muscle tone: low (floppiness), high
• no speech, hearing, walking
• occipital frontal circumference (OFC) disproportion

Question 17

where is a child’s progress recorded?

Answer 17

the RED book

Question 18

what are the different components of the child health programme?

Answer 18

• new-born exam and blood spot screening
• hearing screening (by day 28)
• health visitor first visit
• 6-8w review (Max 12w)
• 27-30 month review (Max 32m)
• orthoptist vision screening (4-5y)

Question 19

give examples of conditions that are screened for using blood spotting

Answer 19

• PKU (phenylketonuria)
• congenital hypothyroidism
• CF
• medium chain acyl-CoA dehydrogenase deficiency
• sickle cell disorder

Question 20

what does the 6-8 week review consist of?

Answer 20

• identification data (name, address, GP)
• feeding (breast/ bottle/ both)
• parental concerns (appearance, hearing; eyes, sleeping, movement, illness, crying, weight)
• development (gross motor, hearing + communication, vision + social awareness)
• measurements (weight, OFC, Length)
• examination (heart, hips, testes, genitalia, femoral pulses and eyes (red reflex))
• sleeping position (supine, prone, side)

Question 21

what does the 27-30 month review consist of?

Answer 21

• identification data (name, address, GP)

development

• social, behavioural, attention and emotional
• communication, speech and language
• gross and fine motor
• vision, hearing
• physical measurements (height and weight)
• diagnoses / other issues

Question 22

What are the components of the Healthy Child Programme?

Answer 22

• antenatal
• birth 1w (feeding, hearing, examination, Vit K immunisations, blood spot
• 2w (feeding, mat mental health, jaundice, SIDS)
• 6-8w (exam, imms, measure, mat mental health)
• 1y (growth, health promotion, questions)
• 2-2.5y (development, concerns, language)
• 5y (Imms, dental, support, hearing, vision, dev)

Question 23

What health promotion is given to parents?

Answer 23

• Smoking
• Alcohol/ Drugs
• Nutrition
• Hazards and safety
• Dental Health
• Support services

Question 24

why are children vaccinated?

Answer 24

highly effective public health measure to reduce and eradicate diseases

Question 25

who receives vaccinations?

Answer 25

all children (additional if “at risk”)

Question 26

When should children not receive vaccines?

Answer 26

no live vaccines if child is immunocompromised

postpone if child is unwell

Question 27

What are the 3 key physical measurements?

Answer 27

• Weight (grams and Kgs)
• Length (cm) or height (if >2y)
• Head circumference (OFC) (cm)

Question 28

what are the useful reference values to remember for weight, length and head circumference

Answer 28

Question 29

what is a centile?

Answer 29

% division of population sampled

Question 30

what is failure to thrive?

Answer 30

child growing too slowly in form and function at the expected rate for his age

demand for energy and nutrients> supply

Question 31

what can cause failure to thrive?

Answer 31

maternal: poor lactation, incorrectly prepared feeds, inadequate care
infant: prematurity, small for dates, oro palatal abnormalities, neuromuscular disease, genetic disorders

Question 32

what increased metabolic demands can cause FTT?

Answer 32

• congenital lung disease
• ♡ disease
• liver disease
• renal disease
• infection
• anaemia
• inborn errors of metabolism
• cystic fibrosis
• thyroid disease-
• crohn’s/ IBD
• malignancy

Question 33

what excessive nutrient loss causes of FTT are there?

Answer 33

• gastro oesophageal reflux
• pyloric stenosis
• gastroenteritis (post-infectious phase)
• malabsorption (food allergy, diarrhoea, coeliac disease, pancreatic insuffiency, short bowel syndrome)

Question 34

what non-organic causes of FTT are there?

Answer 34

• poverty/ socio-economic status
• family: lack of parental support (eg, no friends, no extended family or preparation for parenting
• neglect: emotional deprivation syndrome
• feeding: poor, disorders (eg, anorexia, bulimia- later years)