Physical milestones and failure to thrive Flashcards

1
Q

What is development?

A

Increase in complexity of an organism due to maturation of the nervous system. It includes physical, functional, emotional, psychological and social development.

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2
Q

How does development occur?

A

Pattern of development constant and sequential, based on already acquired skills. Genetics and environment play a role

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3
Q

What are the areas of development?

A

Gross motor skills eg walking, sitting up and crawling
Fine motor skills and vision eg picking up objects
Hearing, speech and language
Social skills and behaviour

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4
Q

How is development assessed?

A

History from caregiver
Observing child for ability and quality of performance as well as considering ALL other areas of development.

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5
Q

How are the gross motor skills developed?

A

Cephalo-caudal progression where control of the body begins with keeping the head up and control of the upper limbs prior to the lower body
1) Hold head up
2) Sit up
3) Stand up
4) Walking

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6
Q

What are the milestones for gross motor skills?

A

6 weeks old they can hold their head up, at 6 months they will sit up.
50% of children walk by 1 years old with 90% walking by 14-15 months. 18 months and over is a cause of concern.
At 18m->2years old, running begins and tiptoeing. At 3 years old, they can walk like an adult.

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7
Q

What age is a concern for gross motor skills?

A

Threshold for concern is no walking by 18 months old, which is 2 standard deviations from the average. This may indicate neurological/muscular issue such as Duchenne’s, cerebral palsy or hip dislocation.

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8
Q

What is Cerebral Palsy?

A

Impairment of the brain’s motor function due to brain damage in pregnancy or infancy, leading to issues with posture and movement. It is the most common childhood physical disability.

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9
Q

How are fine motor skills developed?

A

Grabbing objects
Transferring between hands
Radial-palmer grasp (between thumb and all fingers) -> mature pincer grasp (between thumb and forefinger finger)
Scribbling from lines to distinguishable circles

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10
Q

What are the milestones for fine motor skills?

A

At 6 weeks tracking objects visually
6 months there is a palmar grasp with transfer between hands
9 months, there is object permanence

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11
Q

What are the hearing, speech and language skills?

A

Speech is producing sounds; language is the content of organisation of speech.
This requires Receiving input via the auditory cortex to make sense of the input in Wernicke’s area in the superior temporal gyrus of the brain.
Producing language uses Broca’s area in the frontal lobe using tongue muscles and palate to form words and

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12
Q

Which areas of the brain are involved in speech and language?

A

Wernicke’s area in the superior temporal lobe receives input from the auditory cortex to interpret speech into sensical words.
Broca’s area in the frontal lobe for producing speech via the motor cortex.

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13
Q

What are the milestones for hearing, speech and language skills?

A

6 wks: react to loud noise
6 ms: Babble and turn head to loud noises
By 1 years old, they should have an understanding of nouns

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14
Q

Why do speech delays occur?

A

Hearing loss
Mechanical issue with the palate or the muscles
Autism Spectral disorder
Environmental deprivation due to neglect/abuse and no talking interaction with the baby

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15
Q

What are the social and behavioural development?

A

Smiling at 6 weeks and waving, playing peek-a-boo, imaginative play and being able to independently dress

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16
Q

What are the psychological needs of a child?

A

Role models, opportunity to learn from experience, personal identity, independence

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17
Q

Who monitors child development?

A

Caregivers, Teachers, GPs, HEALTH VISITORS Physiotherapists, Speech and Language therapist

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18
Q

When does developmental surveillance occur?

A

4 appointments to identify developmental challenges:
Neonatal examination
6-8 week check by GP
1 year old check by health visitor
2-2.5 year old check by health visitor

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19
Q

What is the protocol for suspected developmental delay?

A

Full medical history for pregnancy/birth/neonatal period
Family history and current social environment
Assess other areas of development
Check hearing and vision and try to find a medical cause

20
Q

What are the general developmental red flags at all ages?

A

Regression, not responding to sounds, early hand preference, persistent toe walking
Not Fixing and following: tracking movement with the eyes alone
Change in muscle tone
No smile at 8 weeks

21
Q

What is the most variable domain for milestones?

A

Speech and language

22
Q

What is the most significant red flags for domain milestones?

A

Delay in more than one domain, such as fine motor skills and vision

23
Q

What are the developmental red flags at 12 months?

A

After 8 weeks old, there is no smile.
After 5 months old, not holding objects.
At 12 months, Not sitting and no babbling.

24
Q

What are the developmental red flags at 18 months?

A

Not walking by 18 months
Inability to understand simple commands and no speech

25
Q

What are the developmental red flags at 2 years old?

A

Not pointing at objects

26
Q

What are the patterns in developmental delay?

A

Regression
Isolated delay in one domain or Global domain in all domains
Developmental disorders: neurologically based condition

27
Q

What causes developmental problems?

A

Congeintial infection
Antenatal insult
Perinatal hypoxia/hypoglycaemia
Post natal meningitis, metabolic insult or infection
Deprivation or abuse

28
Q

What does antenatal mean?

A

During pregnancy

29
Q

What does perinatal mean?

A

During pregnancy and 12 months after birth

30
Q

What is assessed in growth?

A

Weight, height and head circumference which should all be used together and compared with accepted range

31
Q

What are the growth issues?

A
32
Q

What are the key periods for growth?

A

Foetal period
Growth in infancy
Pre-pubertal stage
Pubertal stage
-> Children from 2 years old will gain 2kg in growth per year.

33
Q

Period of time with fastest growth rate?

A

First 2 years of life

34
Q

Period of time with slowest growth rate?

A

Pre-pubertal stage

35
Q

What are important considerations in growth?

A

Newborns lose 10% of birthweight due to fluid loss
Regain birth weight after 2 weeks
Double in weight during week 5-12
Triple in weight by week 12

36
Q

What influences height in children?

A

Genetics, nutrition, emotional deprivation, chronic illness or constitutionally may be slow grower or developer.

37
Q

What are possible causes for short stature in children?

A

Deficiency in growth hormone, hypothyroidism, chromosomal disorder, excess steroid hormone or hypopituitarism.

38
Q

What influences growth?

A

Genetic potential, intrauterine conditions such as IUGR, post-natal nutrition, diet, health status and nurturing environment.

39
Q

What is failure to thrive?

A

Suboptimal weight gain in infant or toddler, and height and head circumference which falls below growth expectations across charts below 2 centiles

40
Q

What is organic FTT?

A

Due to medical condition such as:
Inadequate intake of food because of technique of breastfeeding

Inadequate retention because of vomiting or reflux

Malabsorption eg Cystic fibrosis, cow’s milk intolerance

Failure to utilise nutrients eg renal/liver disease

Increased caloric demand eg malignancy, thyrotoxicosis, chronic infection

41
Q

What is non-organic FTT?

A

Linked to environmental deprivation and psychosocial such as child neglect

42
Q

What is an important consideration in FTT?

A

Toddlers and children have high energy demand which vary individualistically. Mostly caused by inadequate intake.

43
Q

How is a nutritional assessment carried out?

A

Dietary diary, weight and heght, mid upper arm circumference and skinfold thickness

44
Q

Indication for short and overweight child?

A

May be genetic or endocrine issue.

45
Q

Indication for tall and overweight child?

A

Likely to be behavioural.

46
Q

How is obesity determined in adults?

A

Calculating BMI using height/weight (m)

47
Q

How is obesity determined in children?

A

Normal BMI varies in children so RCPCH growth charts are used