Child Development Flashcards

Question 1

Q

What is meant by child development?

Answer

A

Child development is the process by which the dependent infant matures into the independent adult.

Question 2

Q

Children should be progressing in all areas/domains of development at roughly the same rate; true or false?

Question 3

Q

Child development can be separted into 4 major domains; state and briefly describe each

*NOTE: different sources group differently; use grouping which makes most sense to you

Answer

A

Gross motor: large movements e.g. sitting, standing, walking, posture etc…
Fine motor & vision: precise & skilled movements, hand-eye coordination, vision
Hearing, speech & language: using speech & language to communicate, hearing
Social, emotional & behavioural: interaction, playing, builiding relationships

Question 4

Q

Gross motor development occurs from the ________?

*HINT: which part of body develops gross motor function first

Answer

A

Head downwards

Question 5

Q

Discuss the major gross motor developmental milestones, consider ages:

3-4 months
6 months
9 months
10 months
12 months
15 months
18 months
2 years
3 years
4 years

Answer

A

3-4 months: able to suppport head & keep it in line with body
6 months: sit supported with back straight (often don’t have balance to do this on unsupported at this stage), roll over
9 months: sit unsupported, start crawling, stand holding on to furniture, bounce on legs when supported
10 months: stand unsupported, begin cruising
12 months: walks unaided unsteadily
15 months: walk unaided steadily
18 months: squat & pick things up from the floor
2 years: run, kick a ball, walk up & downstairs holding a rail one foot at at time
3 years: climb stairs one foot at a time without holding a rail, stand on one leg for a few seconds, ride a tricycle, catch a large ball
4 years: hop, walk up & down stairs like an adult

Question 6

Q

At what age would you refer a child who is:

Not sitting unsupported
Not walking

Answer

A

Not sitting unsupported: 12 months
Not walking unsupported: 18 months

Question 7

Q

When assessing fine motor development, what areas can we look at to help us assess this? (4)

Answer

A

Vision
Grasp/grip (including how hold a pencil)
Drawing skills
Tower of brick skills

Question 8

Q

When assessing fine motor development we can look at vision, grasp/grip, drawing skills and tower of bricks skills

Dicsuss the major fine motor & vision developmental milestones, consider ages:

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

Answer

A

1 month: grasp finger when placed in palm
6 weeks: watches objects and attempts to follow them (preferring animate objects e.g. faces. their hands)
3 months: moves head to look around, reaches for toys, holds a toy briefly
6 months: palmer grasp, puts objects in mouth, pass from one hand to another
9 months: early pincer grip/scissor grasp (squahes it between thumb & forefinger), points with finger
12 months: fine pincer grip
15 months: hold crayon using palmar supinate grasp & scribble, build a tower of 2 bricks, look at book & pat page, clumsily use a spoon
18 months: tower of 3 blocks, turn pages several at a time
2 years: tower of 6 blocks, copy a vertical/horizontal line, turn page one at a time, digital pronate grasp pencil
3 years: can build a bridge from blocks, copy a circle, put beads on string, cut side of paper with scissors, qaudrupod grasp or static tripod grasp
4 years: build steps using blocks, copy a square & cross, cut paper in half
5 years: copies a triangle, copies alphabet letters, mature dynamic tripod grasp

Question 9

Q

There are lots of ways of assessing fine motor skills; to help keep it clear in your mind, summarise the drawing skills milestones

Answer

A

15 months: scribble
2 years: copy vertical line
2.5yrs: copy horizontal line
3yrs: copya circle
4yrs: copy a cross & square
5 yrs: copy a triangle

Question 10

Q

There are lots of ways of assessing fine motor skills; to help keep it clear in your mind, summarise the tower of bricks skills milestones

Answer

A

15 months: tower of 2 bricks
18 months: tower of 3 bricks
2 yrs: tower of 6 blocks
3yrs: make a bridge using blocks
4yrs: build steps using blocks

Question 11

Q

There are lots of ways of assessing fine motor skills; to help keep it clear in your mind, summarise the grasp/grip developmental milestones

Answer

A

1 month: graps finger in palm
6 months: palmar graps
9 months: early pincer grip/scissor grip (squash things between thumb & forefinger)
12 months: fine pincer grip
15 months: hold pencil using palmar supinate grasp and scribble
2yrs: copy vertical/horizontal line and start to use digital pronate grasp
3yrs: copy a circle and start to use quadrupod grasp or static tripod grasp, make cuts in side of paper using scissors, put beads on a string
4yrs: copy a cross & square, cut paper in half using scissors
5yrs: copy a triangle and develop mature tripod grasp

Question 12

Q

To help you remember the order of drawing developmental milestones think of drawing a person

Question 13

Q

Hand preference before ___ months is abnormal

Answer

A

12 months (and may indicate cerebral palsy)

Question 14

Q

Hearing, speech & language can be separated into two components: expressive & receptive.

Discuss the major expressive hearing, speech and langauge developmental milestones, consider ages:

6-8 weeks
3 months
6 months
9 months
12 months
15 months
18 months
2yrs
3yrs
4yrs

Answer

A

6-8 weeks: cooing noises
3 months: laughs & vocalises
6 months: makes noises (often starting with g,b,p) first monosyllables then double syllables
9 months: babbling continues may say mama, dada
12 months: knows & responds to own name
15 months: knows 2-6 words
18 months: able to point to body parts
2yrs: combines 2 words, knows ~200 words by 2.5yrs
3yrs: talks in short sentences, asks “who and what” questions, name 2/3 colours, count to 10
4yrs: ask “why, when, how” questions, talks fluently & can tell stories

Question 15

Q

Hearing, speech & language can be separated into two components: expressive & receptive.

Discuss the major receptive hearing, speech and langauge developmental milestones, consider ages:

Answer

A

3 months: turns towards sound
6 months: responds to tone of voice
9 months: understands no
12 months: knows & responds to own name, follows simple instructions
18 months: can point to pats of body
2yrs: understands verbs e.g. show me what you eat with
2.5yrs: understands propositions e.g. put spoon under the step
3yrs: understands adjectives e.g show me red brick, which is bigger
4yrs: follows complext instructions e.g. pick up spoon, put it under the pillow and go to mummy

Question 16

Q

Social, emotional & behavioural development can be assesed in terms of play, feeding, continence and dressing. Discuss major social, emotional & behavioural developmental milestones, consider ages:

6 weeks
3 months
6 months
9 months
12 months
18 months
2yrs
3yrs
4yrs
5yrs

Answer

A

6 weeks: smiles
3 months: laughs
6 months: curious & engaged with people, smile at strangers
9 months: become shy/show stranger fear, puts everything to their mouth, plays peek-a-boo
12 months: wave bye, start to drink from cup & use spoon, helps getting dressed/undressed
18 months: imitates activities (e.g. using phone), take shoes off but can’t put back on
2yrs: parallel play (next to but not withe other children), dry in day time, competent with spoon & cup
3yrs: play with other children, bowel control
4yrs: have friends, imaginative play, dry by night, dress & undress independently except laces & buttons
5yrs: use knife & fork

Question 17

Q

Developmental milestones must be considered in regards to their ‘median age of acquisition’ (when half of a standard population of children achieve that level) and the ‘limit age’ by which they should have been achieved. Limit ages are generally considered to be two standard deviations from the mean age of acquisition. If the skill is not achieved by this age, more detailed assessment, investigation or intervention may be required. State the limit ages for:

Smiling
Sitting unsupported
Walking unaided
*

Answer

A

Not smiling by 10 weeks (refer at 10 weeks if not smiled)
Not sitting unsupported by 12 months (refer at 12 months)
Not walking unaided by 18 months (refer at 18 months)

Question 18

Q

Dicuss some tips for performing a developmental assessment

Answer

A

Build rapport with child: make it fun, give plenty of praise, use their name
First test milestones that they should be able to achieve based on their age and then work your way up until unable to complete a task
If child doesn’t want to engage with you, ask parent to try or ask about milestones

*In an exam, encourage child in a way that lets examiner know you noticed certain things like’ you built a tower of 6 bricks great’, ‘that’s a great pincer grip’

Question 19

Q

State some common causes of gross motor developmental delay

Answer

A

Variant of normal
Neuromuscular disorders e.g. Duchenne muscular distrophy
Cerebral palsy
Spina bifida

Question 20

Q

What is meant by global developmental delay?

Answer

A

Delayed development in ALL developmental domains

Question 21

Q

State some common causes of global developmental delay

Answer

A

Down’s syndrome
Fetal alcohol syndrome
Rett syndrome
Fragile X syndrome
Metabolic disorders

Question 22

Q

State some common causes of fine motor delay

Answer

A

Cerebral palsy
Muscular dystrophy
Dyspraxia
Visual impairment
Congenital ataxia (rare)

Question 23

Q

State some common causes of hearing, speech & language delay

Answer

A

Hearing impairment
Autism
Learning disability
Neglect
Specific social circumstances (e.g. multiple languages spoken in home)
Cerebral palsy

Question 24

Q

State some common causes of personal & social delay

Answer

A

Autism
Emotional & social neglect
Parenting issues

Question 25

Q

What do the WHO recommend in regards to breast feeding?

Answer

A

Exclusive breast feeding for first 6 months of life

Question 26

Q

Both breast & bottle feeding can lead to overfeeding; however it is more common in….?

Answer

A

Bottle fed babies

*NOTE: children & adolescents that were breastfed tend to have less obesity

Question 27

Q

State some benefits of breast milk for the baby

State some benefits of breastfeeding for the mother

Answer

A

For the baby:

Contains antibodies to fight infection
Better cognitive developoment
Reduced risk sudden infant death syndrome
Reduced risk of obesity
Reduced risk of cardiovascular disease in adulthood

For the mother:

Decreased risk of breast cancer
Decreased risk of ovarian cancer
Decreased risk of osteoporosis
Decreased risk of obesity
Decreased risk of cardiovascular disease

*NOTE: it is not clear how far these benefits can be attributed to differences in socioeconomic factors that influence a mother’s decision to breastfeed; may in fact be due to confounding.

Question 28

Q

How much milk should formula fed babies receive per kg of body weight per day on:

Day 1
Day 2
Day 3
Day 4 and onwards

*Obviously cannot monitor in breastfed babies

Answer

A

Day 1: 60ml/kg/day
Day 2: 90ml/kg/day
Day 3: 120ml/kg/day
Day 4 and onwards: 150ml/kg/day

Question 29

Q

Preterm & underweight babies may require larger volumes of milk; true or false?

Question 30

Q

Discuss how often you should feed a newborn baby and how this changes over time

Answer

A

Initially every 2-3hrs
Then every 4hrs
Gradually increase time between feeds
Eventually they feed on demand (when hungry)

Question 31

Q

It is acceptable for babies to lose some weight by day 5 of life but should be back at their birth weight by day 10. How much weight, in %, can:

Breast fed
Formula fed

… babies lose by day 5?

Answer

A

Breast fed can lose up to 10%
Formula fed can lose up to 5%

But should be back at birth weight by day 10.

Question 32

Q

When would you need to admit a baby (14 days old or less) to hospital for assessment due to their weight?

Answer

A

Lose more than the allowed amount (10% in breastfed or 5% in formula fed by day 5)
Do not regain their birth weigh by 14 days of age

Question 33

Q

What is the most reliable sign of dehydration in babies?

Answer

A

Weight loss!

Question 34

Q

What is the most common cause of excessive weight loss or not regaining birth weight in babies that are a few weeks old or less?

Answer

A

Dehydration due to under feeding (even when they don’t aappear clinically dehydrated; weight loss is most reliable sign in babies)

Question 35

Q

What is weaning?

When does weaning usually start?

How does the process of weaning progress?

Answer

A

Gradual transition from milk to normal food
Starts around 6 months
Start with pureed food that easy to palate, swallow & digest. Over 6 months this will progress to healthy diet similar to an older childs; supplement wil milk and snakcs to 1 year of age.

Question 36

Q

For growth charts, discuss:

Why are growth charts used
What the centiles represent
What is plotted on the axis
What is plotted on the y axis
What is the main thing you are concerned with when looking at growth charts

Answer

A

Used to monitor growth by plotting a child’s weight, length/height& head circumference against the normal distribution for their age and gender
Growth charts have curves that indicate the normal distribution of growth over time. The centiles indicate how a child’s growth compares to the normal distribution for their age and sex
X axis= age
Y axis= weight, height & head circumference
Main concern is whether the child is maintaing their centile

*NOTE: length is used up to 2hrs, then height is used

Question 37

Q

What growth charts are avialable?

Answer

A

NICM (neonatal & infant close monitoring)
0-4yrs (this includes a pre-term section, 0-1yrs and 1-4yrs chart)
2-18yrs

For each there is a separate chart for boys and girls as growth is different in each sex.

Question 38

Q

What do centile lines show?

Answer

A

Describe the number of children, in %, expected to be below that line (e.g. 91st centile: 91% of children expected to be below that)

*50% of children lie between 25th & 75th centile lines*
*99% children lie between 0.4th and 99.6th centile lines*

Question 39

Q

What centiles are included on modern british growth charts?

Answer

A

9 centile lines (0.4th, 2nd, 9th, 25th, 50th, 75th, 91st, 99.6th)

Question 40

Q

What are centile spaces?

Answer

A

Centile space can be either:

Distance between two centile lines on a growth chart
Equivalent distance if midway between two centiles (i.e if midway between 25th & 9th centile but 3 months later they wer midway between 9th and 2nd centile they would have dropped one centile space)

*centile spacesw are 2/3 of standard deviation

Question 41

Q

Which chart should you use for:

Babies <32 weeks gestation
Babies >32 weeks gestation but <37 weeks gestation
Babies 37 weeks gestation or more

Answer

A

<32 weeks: NICM chart
>32 weeks but <37: plot all measurements on preterm section until 42 weeks gestation then plot on the 0-1yr chart using gestation correction
37 weeks or more: plot on 0-1yr chart

Question 42

Q

Describe how you would plot a child’s measurements on a growth chart

What do you have to do if the child is pre-term?

Answer

A

Mark a dot where the vertical line through the child’s age and the horizontal line through the child’s height/weight/head circumference intersect
If the point is within 1/4 of centile space of the line they are on the centile
If they are not (^) they should be described as being between the two centiles
If infant is pre-term, plot all measurements in preterm section until 42 weeks gestation then plot on the 0-1 year chart using gestational correction (draw a dashed line back to the number of weeks preterm and mark with an arrow so that the dot is their actual age and the arrow is their gestationally age giving their gestationally corrected centile. Gestational correction should continue until at least 1 year of age)

Question 43

Q

*Use height as an example for the following

If a child is in the 1st centile what does this mean?

If a child is in the 50th centile what does this mean?

If a child is in the 91st centile what does this mean?

Answer

A

1st centile: shorter than 99% of children their age & gender
50th centile: exactly average height for their age & gender
91st centile: taller than 91% of children their age & gender

Question 44

Q

What is the mid-parental centile?

How do you calcualte the mid-parental centile?

Dicuss how the mid-parental centile can be used to assess for growth disorders

90% of childrens height centiles are within how many centile spaces of the mid-parental centile?

Answer

A

Average adult height centile to be expected for all children of these particular parents
Measure both parents heights (or use reported heights if not available). Mark their heights on relevant mother & father scales. Join the two points with a line. The mid parental centile is where this line crosses the centile line in the middle.
You can compare the mid-parental centile line to the child’s current height centile to assess whether child is growing as expected; if large discrepancy between mid-parental centile and child’s current height centile increased likelihood of growth disorder in child.
+/- 2 centile spaces of mid parental centile

Question 45

Q

What can the adult height predictor chart be used to do?

How do you use the adult height predictor chart?

Answer

A

Predict a child’s adult height based on their current height (it is adjusted to allow for very tall and short children to be less extreme as adults)
Plot most recent height centile on the centre line and read off the predicted adult height for this centile

*80% of children will be within +/- 6cm of this value as adults

Question 46

Q

State 3 situations in which head circumferance centiles should cause concern and be investigated

Answer

A

After 6 weeks of age head circumference below the 2nd centile
Head circumference above 99.6th centile that continues to rise after 6 months or has associated signs and symptoms (e.g. irritability, vomitting, bulging fontanelles, persistent downward gaze)
Head circumference crossing upwards through 2 centile spaces that continues to rise after 6 months or has associated signs and symptoms (e.g. irritability, vomitting, bulging fontanelles, persistent downward gaze)

Question 47

Q

What do we mean by failure to thrive?

Answer

A

Poor physical growth & development in a child

NICE “a lower weight, or rate of weight gain, than expected for age and sex in childhood.”

*also referred to as faltering growth or under-nutrition

Question 48

Q

State some potential causes of failure to thrive

*Hint: think of 5 overarching reasons then give examples of specific conditions within each

Answer

A

Indadequete nutritional intake
- Maternal malabsorption if breastfeeding
- Poor availability of food (e.g. poverty)
- Neglect
- Lack of knowledge of age appropriate healthy food, feeding skills and interactions
Difficulty feeding(could think of as subcategory of inadequete intake)
- Poor suck e.g due to cerebral palsy
- Cleft lip or palate
- Pyloric stenosis
- Genetic conditions wiht abnormal facial structure
Malabsorption
- Cystic fibrosis
- Coeliac disease
- Cows milk intolerance
- Chronic diarrhoea
- IBD
Increased energy requirements
- Hyperthyroidism
- Chronic diseases e.g. cystic fibrosis, congenital heart disease
- Malignancy
- Chronic infections e.g. HIV, immunodeficiency
Inability to process nutrients properly
- Inborn errors of metabolism (e.g. phenylketonuria, homocysteineuria, galactosaemia)
- T1DM

Question 49

Q

Assessing a child with failure to thrive involves taking a full history, examining the child and performing any relevant investigations; state some key aspects of the assessment (not asking about examinations or investigations)

Answer

A

Feeding or eating history
- Feeding: breast or bottle, volume, frequency, feeding times & any difficulties
- Eating: food choices, food aversion, appetite, meal time routines (may ask to keep a food diary)
Associated symptoms(e.g. coughing, SOB fever, vomiting, dysphagia, diarrhoea)
Pregnancy & birth history
PMH including:
- Congenital abnormalities
- Developmental delay
- Any other known conditions
- Allergies & food intolerances
Psychosocial history, including:
- Social circumstances e.g. who at home, access to food.
- Family stress e.g. divorce, housing, financial problems.
- Substance and domestic abuse.
- Health beliefs that may result in restricted diet (e.g. vegan)
- Maternal depression and anxiety.
Family history including:
- Familial disorders such as coeliac disease, inflammatory bowel disease, and endocrine disorders.
- Parental mental health.
- Constitutional growth delay in parents.
Height, weight & BMI (if older than 2yrs) to plot on growth chart
Biological parent’s heigh to calculate mid-parental height centile

Question 50

Q

When examining a child with faltered growth what should this involve?

Answer

A

Vital signs (HR, BP, CRT, RR, Sats, temp)
General inspection looking for signs of dehydration, dysmorphic features, anaemia, jaundice, skin or mucosal changes, wasting, lack of energy, or oedema
Signs of maltreatment e.g. poor hygience, unexplained bruising
Carry out a full systems review/examine all systems looking for signs of cardiac, respiratory, gastrointestinal, neurological, endocrine or other chronic disorders or developmental delay.

Question 51

Q

State some investigations you may consider in child with faltering growth in primary care (it will depend on results of assessment)

Answer

A

Urine dipstick (for UTI)
Coeliac screen (anti-TTG or anti-EMA antibodies)

Dependent on cause may consider/refer for other investigations e.g. for cystic fibrosis, pyloric stenosis, IBD etc..

Question 52

Q

Faltered growth can be assessed by looking at either weight, BMI (in children over 2yrs) or length/height. When, according to NICE guidance, should you consider faltered growth in a child?

Split answer into weight, BMI and length/height circumstances

Answer

A

Weight

Weight falls across 1 or more weight centile spaces if birthweight was below the 9th centile
Weight falls across 2 or more weight centile spaces if birthweight was between the 9th and 91st centiles
Weight falls across 3 or more weight centile spaces if birthweight was above the 91st centile
Current weight is below the 2nd centile for age, regardless of birthweight

BMI

BMI below 2nd centile (could be small build or undernutrition)
BMI below 0.4th centile (probable undernutrition)

Length/height

Length/height centile is more than 2 centile spaces below mid-parental height centile

Question 53

Q

In a child over 2 years of age, the BMI centile is a better indicator of overweight or underweight than the weight centile; true or false?

Answer

A

True

In children over the age of 2 years a body mass index (BMI):

Below the 2nd centile may indicate either undernutrition or a small build.
Below the 0.4th centile indicates probable undernutrition.

Question 54

Q

What must you remove, in terms of clothing, when weighing children:

2yrs and under
Over 2yrs

Answer

A

2yrs & under remove all clothes and nappy
Children older than 2 years should wear minimal clothing only. Always remove shoes.

Question 55

Q

Discuss how often should babies be weighed

Answer

A

Should all be weighed in first week and again around 2/3 weeks to check regained birth weight
Once feeding established, weight around 8,12 and 16 weeks and then at 1yr (coincides with when have routine immunisations)
Aged 1-2yrs have at least 3 recordings of weight
Older than 2yrs have annual recording
Weighing too often can be misleading

Question 56

Q

Discuss the general management of faltered growth in children

(specific management will depend on condition so just asking for general mangement/general principles)

Answer

A

Management depends on cause (may have input from MDT)

Regular reviews to monitor weight (but not to frequent!)
Manage/treat underlying cause e.g. IBD, cystic fibrosis
If there is difficulty breastfeeding offer support (involve midwife/health visitor/lactation consultatnt, peer groups) and advise that can supplement with formula milk but they should be encouraged to feed with breastmilk prior to top up feeds and express when not breastfeeding to encourage supply
Signpost to appropriate information & give advice regarding nutrition such as:
- Feed nutrient rich healthy food appropriate to childs age
- Encouraging regular structured meal times & snacks
- Eat as a family/with other children
- Encourage children to feed themselves & allow young children to be messy
- Set boundaries for meal times but avoid punishing behaviour or coercive feeding
- Avoid too many energy dense drinks e.g. milk as these decrease appetite
Review/referral to dietician who may:
- Give nutritional supplements
- Consider enteral feeding (alongside input from other MDT members)

Question 57

Q

State the formula a child’s predicted final/adult height for:

Boys
Girls

Answer

A

Boys: (mother height + father height +14)/2
Girls: (mother height + father height -14)/2

All in cm

Question 58

Q

What are the 3 phases of growth children go through?

Answer

A

Infancy (birth to 2yrs): rapid growth driven by nutritional factors
Childhood (2yrs to puberty- about aged 11/12): steady slow growth driven by growth hormone & thyroxine
During puberty: rapid growth spurt driven by growth hormone & sex hormones

Question 59

Q

How do we define being overweight in children (what BMI)?

How do we define being obese in children (what BMI)?

Answer

A

Overweight: BMI above the 85th percentile
Obese: BMI above 95th percentile

*Have growth charts for BMI

Question 60

Q

Obese children are often short for their age and come from overweight families; true or false?

Answer

A

FALSE; obese children are often tall for their age and come from overweight families

***If children are short & obese consider endocrine investigations for underlying cause e.g. hypothyroidism (but pathological cause is rare)

Question 61

Q

State some negative effects/potential complications of obesity in children- highlighting the main one

Answer

A

Bullying
Impaired glucose tolerance
T2DM
Cardiovascular disease
Arthritis
Certain cancers e.g. colorectal, gallbladder, pancreatic

*Unless family addresses issue then it is likely to continue into adulthood and have all negative health implications of adulthood obesity

Question 62

Q

Define short stature

Answer

A

Height more than 2 standard deviations below the average for their age & sex/ height below the 2nd centile for their age & sex

(this is the same as being below the 2nd centile. Remember centile space is 2/3 of standard deviation so 3 centile spaces is 2 standard deviations. Centiles are 0.4th, 2nd, 9th, 25th, 50th, 75th, 91st and 99.6th. Average heigh tis the 50th centile so 2 standard deviations below is 3 centiles below the 50th centile which is the 2nd centile)

Question 63

Q

When does puberty start in:

Boys
Girls

How long does it take to finish?

Answer

A

Boys starts aged 9-15yrs
Girls starts aged 8-14yrs

Puberty usually takes about 4yrs from start to finish

Question 64

Q

State some potential causes for short stature

Answer

A

Familial short stature
Constituional delay in growth & development
Malnutrition
Chronic diseases e.g. coeliac disease, IBD, congential heart disease
Endocrine disorders e.g. hypothryoidims
Genetic conditions e.g. down syndrome
Skeleteal dysplasias e.g. achondroplasia

Answer 62

A

CDGP is a variation of normal development; puberty is delayed hence the pubertal growth spurt is delayed and lasts longer. It is the delay in puberty that causes the delay in the growth spurt. Final height & sexual development are reached at a later age.
Presents with short stature in childhood but child evnetually reaches a normal height in adulthood
Key feature= delayed bone age
Diagnosis is by history, examination & x-ray of hand & wrist to assess bone age
Managment= exclusion of other causes (it is a diagnosis of exlcusion), reassuring parents and child, monitoring overtime

Answer 63

A

Lack of sex hormones, oestrogen & testosterone/decreased functional activity of gonads

Answer 64

A

Enlargement of testes
Gradual darkening of scrotum
Development of pubic hair, lengthening of penis and deepening of voice
Growth spurt (including development of more muscular physique)
Genitals conitnue to enlarge
Adult pubic hair, growth of faical hair

Answer 65

A

Thelarche (development of breast buds)
Pubic hair growth
Growth spurt
Menarche (about 2yrs from start of puberty)
Pubic hair adult
Breast adult

Answer 66

A

Ages & Stages questionnaire
Denver developmental assessment and schedule of growing skills
Bayley and Griffiths

Answer 67

A

Hypogonadotrophic (secondary) hypogonadism: deficiency of LH & FSH
Hypergonadotrophic (primary) hypogonadism: lakc of response to LH & FSH by the gonads (ovaries & testes)

Answer 68

A

Tanner scale (based pm examination findings of sexual characteristics)

Answer 69

A

For girls, look at both breast development & pubic hair. Stage 1-5:

Breast Development

1: No glandular breast tissue
2: Breeast bud
3: Breast tissue palpable outside areola
4: Areolar elevated forming ‘double scoop’ appearance
5: Areolar mound recedes back with areolar hyperpigmentation, papillae development & nipple protrusion

Pubic Hair

1: No hair
2: Initial growth of long, straight and lightly coloured hairs
3: Pubic hair is s becomes darker, coarser, curlier and spread scarcely over mons pubis
4: Abundant adult type pubic hair (terminal hair) over mons
5: Adult pubic hair distribution- classic traingle. Some may have hair that extends beyond inguinal crease onto medial thigh

Answer 70

A

For boys, look at both male external genitalia and pubic hair. Stages 1-5:

Male external genitalia

1: Testicular volume <4ml or long axis <2.5cm
2: Enlargement of scrotum & testes so that testicular volume is >/= 4ml. Penis may have grown a little in length.
3: Testes continue to enlarge, penis grown in length
4: Testes continue to enlarge, penis grown in both length & width. Head of penis become larger.
5. Adult sized & shaped penis & testes

Pubic hair

1: No hair
2: Initial growth of long, straight and lightly coloured hairs at root of penis
3: Pubic hair is s becomes darker, coarser- mostly at the root of penis
4: Abundant adult type pubic hair (terminal hair) which reaches thights
5: Adult pubic hair distribution with hair extending up towards umbilicus & may spread to medial thighs

Answer 71

A

GnRH (gonadotrophin releasing hormone) is release by hypothalamus and stimulates the anterior pituitary to release LSH and FSH. LH and FSH are gonadotrophins which stimulate the gonads to produce sex hormones. Deficiency of either GnRH or LH and FSH can lead to decreased sex hormones.

Occurs due to either abnormal functioning of the hypothalamus or the pituitary:

Damage to hypothalamus or pituitary (e.g. radiotherapy for cancer, injury,. tumour)
Growth hormone deficiency
Hypothyroidism
Hyperprolactinaemia
Congenital e.g. Kallman syndrome
Chronic disease e.g. cystic fibrosis, IBD
Functional e.g. inadequate nutrition/rapid weight loss/eating disorders

Answer 72

A

GnRH, LH and FSH are released as they should be but the gonads show a lack of response to the gonadotrophins LH & FSH. There is no negative feedback from the sex hormones hence anterior pituitary produces increasing amounts of LH & FSH in attempt to stimulte the gonads hence you get high levels of gonadotrophins (hypergonadotrophic).

Occurs due to abnormally functioning gonads:

Damage to gonads (e.g. testicular torsion, cancer, infections such as mumps)
Congenital absence of testes or ovaries
Kleinfelters syndrome (XXY)
Turner’s syndrome (XO)

Answer 73

A

Genetic syndrome causing hypogonadotrophic hypogonadism and an impaired (reduced or absent) sense of smell

Answer 74

A

Female only genetic disorder in which child only has 1 X chromosome (as opposed to 2); hence karyotype is XO. Ovaries do not complete normal development and hence there is a lack of oestrogen resulting in hypergonadotropic hypogonadism. Treat with HRT. See image for characteristics.

Answer 75

A

Boys are born with extra X chromosome so have karotype XXY. Symptoms & signs:

History of delayed early development
Delayed puberty
Tiredness
Reduced muscle tone
Gynaecomastia
Taller than expected with long arms & legs
Broad hips
Reduced facial & body hair
Small penis & testicles
Subfertility

Answer 76

A

Girls: 13yrs
Boys: 14yrs

Answer 77

A

Blood Tests

FBC & ferritin: assess for anaemia (severe chronic anaemia can lead to delayed growth)
U&E: asses for CKD (can delay and blunt affects of puberty)
Anti TTG or anti EMA: assess for coeliac disease as can delay puberty
Early morning FSH & LH:asses if hypergonadotropic or hypogonadotropic
TFTs: hypothyroidism can delay puberty
Prolactin: prolactin inhibits GnRH release so can cause hypogonadotropic hypogonadism
Insulin-like growth factor: assess for GH deficiency as can delay puberty

Imaging

X-ray of wrist: asses bone age to make diagnosis of CDGD
Pelvic ultrasound: asses ovaries in females
MRI brain: asses for pituitary pathology & olfactory bulbs (in possible Kallman syndrome)

Genetic testing

E.g. for Turner’s syndrome (XO), Kleinfelter’s syndrome (XXY)

Answer 78

A

Depends on cause but may include:

Treat the underlying condition (if present)
If CDGP, reassure and monitor
Replacement sex hormones under expert guidance
Growth hormone supplementation in some conditions such as Turner’s syndrome

Answer 79

A

Healthy child programme The Healthy Child Programme is designed to offer every family support in making healthy choices. It includes immunisations, health information, developmental reviews, and access to a range of community services and resources.

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