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Paeds > A childs journey > Flashcards

A childs journey Flashcards

1
Q

How old are neonates?

A

< 4 weeks

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2
Q

How old are infants?

A

< 12 months

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3
Q

How old are toddlers?

A

1 - 2 years

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4
Q

How old are pre school aged children?

A

2 - 5 years

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5
Q

Main childhood objectives

A 
To grow
To develop and achieve their potential 
To attain optimal health 
To be safe
To develop independence 
To be cared for
To be involved
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6
Q

What is development?

A

Gaining functional skills throughout childhood

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7
Q

When does development occur?

A

Typically birth to 5 y/o (but brains develop in utero)

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8
Q

Physiology of development

A

Cell growth, migration, connection, pruning and myelination (use it or lose it)

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9
Q

What age is the brain the most connective as it will ever be?

A

2 y/o

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10
Q

In development, if what you see in motor wise is normal, what are the chances?

A

Chances are what follows will be normal

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11
Q

In development, if what you see in motor wise is abnormal, what are the chances?

A

What came before and what comes after may well be abnormal

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12
Q

What development occurs during school age?

A

Cognitive and thought development (early skills become more refined)

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13
Q

Key developmental fields

A 
Gross motor skills
Fine motor skills
Speech and Language 
Social and self help 
Hearing and vision
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14
Q

What is involved in gross motor skills?

A 
Sitting
standing 
holding neck 
walking
stairs etc
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15
Q

What is involved in fine motor skills?

A

Hands - e.g. grabbing things - begin to be more precise

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16
Q

What is involved in social and self help?

A 
Toilet
Feeding yourself
Imaginary play 
Copying others
Reciprocate emotion
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17
Q

What are milestones?

A

Achievement of key developmental skills

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18
Q

Examples of milestones

A

Social smiling
Sitting
First words
First steps

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19
Q

What is done in prematurity and milestones?

A

Prematurity is counted for until 2 y/o

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20
Q

What is the association between bottom shufflers and crawling?

A

Bottom shufflers crawl later

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21
Q

When are children referred for milestones?

A

If not reached by age limit

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22
Q

Why is development important?

A

Learning functional skills for later in life
Hone skills in a safe environment
Allow our brains genetic potential to be fully realised
equip us with tools needed to function as older children and adults

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23
Q

Influencing factors of development

A

Genetics (family, race, gender)
Environment
Positive early childhood experience
Developing brain vulnerable to insults

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24
Q

What does environment influence in development?

A

language

Skills developed

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25
Q

Examples of insults that the developing brain is vulnerable to

A 
Antenatal 
- infections (CMV, rubella)
- toxins (alcohol, smoking)
Post natal 
- infections (meningitis) 
- toxins (lead, mercury)
- trauma (head injuries)
- malnutrition (iron, vit D)
- metabolic (hypoglycaemia)
- maltreatment 
- under stimulation
- domestic violence 
- maternal mental health issues 
- abuse and neglect
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26
Q

What screening is done for childs development?

A

Healthy child programme (HCP) UK

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27
Q

Examples of ways to check development skills

A

Bricks (motor skills / fine motor skills)
Crayons
Balls (movement / motor skills)
Books (recognition of colours / numbers / language)

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28
Q

Link to development and bilingual families

A

Apparent language delay (total words may be normal)

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29
Q

Normal variation

A 
early developers
late normal 
bottom shufflers - walking delay 
bilingual families - apparent language delay 
familial traits
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30
Q

Red flags for development

A

Loss of developmental skills
Parental / professional concern r.e. vision
Hearing loss
Persistent loss muscle tone / floppiness
No speech by 18 months esp if no other communication
Asymmetry of movements / increased muscle tone
Not walking by 18 months
Persistent toe walking
OFC > 99.6th / <0.4th / crossed two centiles / disproportionate to parental OFC
Clinician uncertain / thinks that development may be distorted

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31
Q

What age should children be able to sit comfortably?

A

6 months

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32
Q

What age should children be able to pull to stand?

A

10 months

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33
Q

What age should children be walking / running?

A

1 - 2 years

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34
Q

Main components of child health screening

A

Health promotion
Developmental screening (including hearing)
Immunisation

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35
Q

What programmes are used in child health screening?

A

Child Health programme

UK - healthy child programe

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36
Q

What is used if concerned / to refer?

A

Red book

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37
Q

What does the child health programme involve?

A 
New born exam and blood spot screening 
New born hearing screening (by day 28) 
Health visitor first visit 
6-8 week review (max 12w)
27-30 months review (max 32 months) 
Orthoptist vision screening (4-5 years)
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38
Q

What is looked at in the 6 - 8 week review by the GP / HV?

A 
Feeding (breast / bottle / both)
Parental concerns 
Development 
Measurements (weight, OFC, length) 
Examination (heart, hips, testes, genitalia, femoral pulses and eyes (red reflex) 
Sleeping position (supine, prone, side)
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39
Q

What is looked at in the 27-30 month review by the HV?

A

Development
Physical measurements (height and weight)
Diagnoses / other issues

40
Q

What is looked at in the Healthy child programme?

A

Antenatal
Birth - 1 week (feeding, hearing, exam, vit K immunisations, blood spot)
2 weeks (exam, maternal mental health, jaundice, SIDS)
6 - 8 weeks (exam, imm, measure, maternal mental health)
1 yr (growth, health promotion, questions)
2 - 2.5 y (development, concerns, language)
5 y (imms, dental, support, hearing, vision, dev)
Health promotion
- smoking
- alcohol /drugs
- nutrition
- hazards and safety
- dental health
- support services

41
Q

Why do we immunise?

A

A public health measure for the reduction and eradication of diseases

42
Q

Who gets immunised?

A

All children and additional people if at risk

43
Q

Do you correct immunisations for pre term babies?

A

NO - immunisations are done in chronological age

44
Q

When can a child not get a live vaccine?

A

If the child is immunocompromised (except HIV)

45
Q

Why do childhood immunisations get postponed?

A

If unwell

  • fever
  • systemic symptoms
46
Q

S / Es of immunisations

A

Mild temperature
Discomfort
Swelling
Anaphylaxis - RARE

47
Q

What are the 3 key parameters used in growth monitoring?

A

Weight (g and kg)
Length (cm) or height (if > 2 y)
Head circumference (OFC) (cm)

48
Q

When is a child measured in height instead of length?

A

> 2 y/o

49
Q

What OFC should a baby have at Birth?

A

35cm

50
Q

What OFC should a child have at 12 months old?

A

45cm

51
Q

What weight should a baby be at birth?

A

3.3kg

52
Q

What weight should a baby be at 4 months?

A

6.6kg

53
Q

What weight should a baby be at 12 months?

A

10 kg

54
Q

What weight should a baby be at 3 years?

A

15 kg

55
Q

What length should a baby be at birth?

A

50cm

56
Q

What length should a baby be at 4 months?

A

60 cm

57
Q

What length should a baby be at 12 months?

A

75 cm

58
Q

What length should a baby be at 3 years?

A

95cm

59
Q

Who has their head circumference size doubled?

A

Prem babies

60
Q

What is a centile?

A

% of population sampled

61
Q

What does failure to thrive (FTT) mean?

A

Child growing too slowly in form and usually in function at the expected rate for his / her age

62
Q

Pathology of FTT

A

Supply of energy and / or nutrients < demand for energy and / or nutrients

63
Q

Causes of FTT

A 
Deficient intake
- poor lactation 
- incorrectly prepared feeds
- unusual milk or other feeds
- inadequate care 
- prematurity 
- small for dates
- oro palatal abnormalities e.g. cleft palate
- Neuromuscular disease e.g. CP
- genetic disorders
Increased metabolic demands
- Congenital lung disease 
- Heart / lung / liver / renal disease 
- infection 
- anaemia 
- inborn errors of metabolism 
- cystic fibrosis 
- thyroid disease
- crohn's / IBD
- malignancy 
Excessive nutrient loss
- Gastro oesophageal reflux 
- pyloric stenosis 
- gastroenteritis (post infectious phase)
- malabsorption (food allergy, persistent diarrhoea, coeliac, pancreatic insuffiency, short bowel syndrome) 
Dysfunctional family interactions 
Poverty / socio economic status 
Neglect 
Poor feeding or feeding skills disorder
64
Q

At what age should a child acquire good pincer grip?

A

12 months

65
Q

What age should a child wave bye bye?

A

12 months

66
Q

What age should a child know and respond to their own name?

A

12 months

67
Q

What age should a child be able to tower 3 blocks?

A

18 months

68
Q

What age should a child be able to point with a finger?

A

9 months

69
Q

What age should a child crawl?

A

9 months

70
Q

What age should a child say mama and dada?

A

9 months

71
Q

What age should a child turn towards sound?

A

3 months

72
Q

What vaccination is given at birth if at risk?

A

BCG

73
Q

What vaccination is given at 2 months?

A

6 in 1 vaccine
Oral rotavirus vaccine
Men B

74
Q

What is in the 6 in 1 vaccine?

A 
Diptheria
Tetanus
Whooping cough 
Polio 
Hib 
Hepatitis B
75
Q

What vaccinations are given at 3 months?

A

6 in 1 vaccine
Oral rotavirus vaccine
PCV

76
Q

What vaccinations are given at 4 months?

A

6 in 1 vaccine

Men B

77
Q

What vaccinations are given 12 - 13 months?

A

Hib/Men C
MMR
PCV
Men B

78
Q

What vaccinations are given at 2-8 years annually?

A

Flu

79
Q

What vaccinations are given at 3 - 4 years?

A

4 in 1 pre school booster

MMR

80
Q

What is in the 4 in 1 pre school booster?

A

Diptheria
Tetanus
Whooping cough
Polio

81
Q

What vaccination is given at 12 - 13 y/o?

A

HPV

82
Q

What vaccination is given at 13 - 18 y/o?

A

3 in 1 teenage booster

Men ACWY

83
Q

What is in the 3 in 1 teenage booster?

A

Tetanus
Diptheria
Polio

84
Q

What is Men ACWY?

A

Meningococcal vaccine covering A, C, W and Y stereotypes

85
Q

What age do the majority of children achieve nighttime and day time urinary continence?

A

3 - 4 y/o

86
Q

What type of vaccine is the rotavirus vaccine?

A

Oral, live attenuated vaccine

87
Q

What age would the average child play alongside with, but not interacting with, other children?

A

2 years

88
Q

Describe the moro reflex

A

Head extension causes abduction followed by adduction of the arms

89
Q

When is the moro reflex present?

A

Birth - 3/4 months of age

90
Q

What is the grasp reflex?

A

Flexion of fingers when an object is placed in the palm

91
Q

When is the grasp reflex present?

A

Birth to around 4 - 5 months of age

92
Q

Describe the rooting reflex

A

Assists in breastfeeding

93
Q

When is the rooting reflex present?

A

Birth to approx. 4 months

94
Q

What is the stepping reflex also known as?

A

Walking reflex

95
Q

When is the stepping reflex present?

A

Birth to 2 months of age

96
Q

How do you account for prematurity when assessing milestones?

A

Age of baby - number of weeks born early from 40 weeks

97
Q

The corrected age of prematurity and milestones is used until what age?

A

2 y/o

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