Flashcards in Clinical Deck (114):
How far apart are centile lines on a growth chart?
2/3 of a standard deviation
A child shows normal growth if what two conditions are met?
Measurements are in normal range for their age
Growth rate is in normal range
What has happened to growth charts over the last 30 years?
Increase in severe obesity
Similar trend with height
How should babies be weighed?
Without clothes or nappy
How should children older than 2 be weighed?
In vest and pants
How and where do you measure head circumference?
With a narrow plastic/disposable paper tape
Measure at widest point
When would you measure a babies length before the age of 2?
If you were concerned
How do you measure a babies length before they are 2?
Requires two measurements
What can affect the babies length?
Style of measurer
How do you measure a child older than 2?
Rigid rule with T-piece
Ensure heels, bottom, back and head touch apparatus
Eyes and ears at 90 degrees
Measure on expiration
Where must a recording be on a growth chart for the child to be considered on the centile line?
Either on the line of within 1/4 of a space of it
What is a centile space?
Distance between two centile lines
What is the average age of puberty in girls and boys?
Girls - 11 years
Boys - 11.5 years
When does puberty start?
When GnRH is secreted by hypothalamus
What cells does LH binds to in boys and what does this cause?
Leydig cells -> Testosterone
What cells does FSH bind to in boys and what does this cause?
Sertoli cells -> Spermatogenesis
What is also produced by Sertoli cells and what does it do?
Inhibin B -> Reduces FSH secretion
What does LH do in girls?
Stimulates proliferation of follicular and theca cells
Triggers androgen release from theca cells
What does FSH do in girls?
Increases granulosa cell proliferation
Enhances aromatase activity:
- Prodcuing oestradiol
Increases progesterone production
What cells produce Inhibin B in girls?
What cells produce Inhibin A in girls?
Large antral follicles in corpus luteum
What do increased levels of sex steroids and insulin cause in both sexes?
GH and IGF-1 are enhanced
How is puberty staged and how many stages are there? Is this diagnostic of the patient's actual age?
- 5 stages
What is thelarche?
What is adrenarche?
Body hair and odour
What is menarche?
When does menarche tend to occur?
2 years post-thelarche
What age defines precocious puberty in girls and boys?
What is pubertal delay and at what ages are boys and girls considered to have delayed puberty?
Absence of secondary sexual characteristis
Girls - 13 years
Boys - 14 years
What gender is precocious puberty more common in?
What gender is delayed puberty more common in?
When are the peak height velocities in each gender?
Girls at B2-3 ie ~12 years
Boys at G4-5 ie ~14 years
What is the average height difference between girls and boys?
What causes the height difference between girls and boys?
Delayed PHV in boys
Boys PHV > Girls
Boys taller pre-puberty
What family history is important to know when determining if there is a growth problem?
What blood investigations are indicated in determining if there is a growth problem?
What other investigations might be carried out when investigating a growth problem?
Dynamic function tests
What type of short stature are the following seen in:
- Healthy, well child
- Short parents
- No endocrine problem; normal bone age
Genetic short stature
What type of short stature do the following indicate:
- Late maturation
- Often presents around puberty with delayed onset
- Delayed maturation and bone age
Constitutional growth delay
What are other causes of short stature?
What contributes to the obesogenic environment?
High energy-dense foods
Decreased physical activity:
What percentile is overweight classed as?
What percentile is obese classed as?
What are some inheritable disorders than can result in obesity?
With what kids is the lifestyle advice mainly aimed at the parents?
Kids younger than 8 years
Kids with special needs
When is lifestyle advice predominantly aimed at the kids with only minor parent interaction?
When should orlistat be prescribed?
BMI >99.6th percentile
Patient is visiting a specialist
When is bariatric surgery considered?
BMI >3.5 standard deviations above mean
What is development?
Maturation of the nervous system
True or false; development has the same sequence at the same rate in all individuals?
- Same sequence
- Variable rate
What direction does development occur in?
What are the four main areas of development?
Fine motor and vision
Language and hearing
Social behaviour and play
At what age should a child be able to do the following (gross motor skills):
- Head control
- Sitting balance
- Stairs (2 feet/step)
- Stairs (1 foot/step)
Head control -> 3 months
Sitting balance -> 6 months
Crawling -> 9 months
Standing -> 12 months
Running -> 18 months
Stairs (2 feet/step) -> 24 months
Stairs (1 foot/step) -> 36 months
Hops -> 48 months
What are the primitive reflexes?
Sucking and rooting
Palmar and plantar grasp
Asymmetric tonic neck reflex
Stepping and placing
At what age should a child do the following (fine motor and vision skills):
- Hand regard in midline
- Palmar grasp
- Scissor grasp
- Pincer grasp
- Tower of 3-4 bricks
- Tower of 6-7 blocks/Scribbles
- Tower of 9 blocks/Copies circle
- Draws simple man
Hand regard in midline -> 3 months
Palmar grasp -> 6 months
Scissor grasp -> 9 months
Pincer grasp -> 12 months
Tower of 3-4 bricks -> 18 months
Tower of 6-7 blocks/Scribbles -> 24 months
Tower of 9 blocks/Copies circle -> 36 months
Draws simple man -> 48 months
At what age should a child do the following (hearing and language skills):
- Imitates sounds
- Knows name
- 2 body parts/15-20 words
- Simple instructions/50+ words
- Complex instructions/Ask questions
- Can tell stories
Vocalise -> 3 months
Babble -> 6 months
Imitates sounds -> 9 months
Knows name -> 12 months
2 body parts/15-20 words -> 18 months
Simple instructions/50+ words -> 24 months
Complex instructions/Ask questions -> 36 months
Can tell stories -> 48 months
At what age should a child do the following (social and play skills):
- Social smile
- Pleasure on friendly handling
- Play with feet/Friendly with strangers
- Play peek-a-boo/Stranger awareness
- Drink from cup/Wave bye-bye
- Feed with spoon
- Symbolic play/Put on some clothes
- Pretend play/Toilet-trained
- Understands turn-taking/Dress fully
Social smile -> 6 weeks
Pleasure on friendly handling -> 3 months
Play with feet/Friendly with strangers -> 6 months
Play peek-a-boo/Stranger awareness -> 9 months
Drink from cup/Wave bye-bye -> 12 months
Feed with spoon -> 18 months
Symbolic play/Put on some clothes -> 24 months
Pretend play/Toilet-trained -> 36 months
Understands turn-taking/Dress fully -> 48 months
What is developmental delay?
Failure to attain normal milestones for the child's corrected chronological age
What patterns of developmental delay are there?
Regression (Rett's syndrome)
Which of the following isn't a red flag for developmental delay:
- Asymmetrey of movement
- Not reaching objects by 6 months
- Unable to sit unsupported by 12 months
- Unable to walk by 24 months
- No speech at 18 months
- Concerns re. vision or hearing
- Loss of skills
Unable to walk by 24 months:
- It should be 18 months
What is global developmental delay?
Significant delay in 2+ of:
- Gross/Fine motor and Speech/Language
- Cognitions, Social/Personal and ADL
What percentage of kids with global developmental delay are due to a genetic cause?
What screening is imperative in Down's Syndrome?
What are the IQ ranges for the following classes of learning disability
Mild -> 50-70
Severe -> 20-50
Profound -> Less than 20
What conditions cause motor delay only?
What conditions cause language delays only?
Specific language impairment
What conditions cause sensory deficits and an associated delay?
What type of specific developmental delay is Autism-Spectrum Disorder (ASD)?
What type of cerebral palsy is characterised by:
- Arm and leg on one side affected
- Arm is bent -> Spastic/Floppy/Of no use
- Walks on tiptoe/outside of foot
How does paraplegic CP present?
Both legs affectd
Upper body normal or having very minor signs
Ankle and feet contractures
If there is slight impairment anywhere else in paraplegic CP, what is it called?
What is the third kind of CP?
True or false; CP is associated with epilepsy?
What percentage of visual impairment is cerebral?
Kids with what sort of disabilities tend to have visual impairment?
Those with more complex disabilities
What is cerebral visual impairment associated with?
What tracts are often both affected in cerebral visual impairment?
What is the autistic triad?
Flexibility of thought and imagination
What is receptive language?
The ability to understand language you hear or read
What is expressive language?
Putting thoughts into sentences that are grammatically correct
How is receptive language altered in a child with ASD?
Abstract language difficult
Visually more able
How is expressive language altered in a child with ASD?
Child echoes others
Chunks of video speak:
- Repeating phrases of others
What other language difficulties to children with ASD possess?
Initiating and sustaining a conversation
Lack of awareness of reciprocal nature of a conversation
Are children with ASD motivated by social approval?
Do kids with ASD have difficulty sharing pleasure?
What sensory issues are often seen in children with ASD?
Like certain textures of cothing
What assessment tools exist and what ages are they suitable for?
Griffiths (0-8 years)
Bayleys (0-3 years)
Schedule of Growing Skills (0-5 years)
At the 6-8 weeks screening of a newborn, what parental concerns might a parent have?
What physical examinations are carried out at 6-8 weeks?
Testes and genitalia
How do the head and occiput differ in children>
Head is relatively larger
Occiput is more prominent
How does a child's larnyx and epiglottis differ?
High anterior larynx
What is the blood volume of a child?
What type of Hb does a baby have at birth?
How long does the birth Hb persist for?
What is the most common acute presentation of a child?
How is bronchiolitis treated?
It is viral:
- Supportive measures
How is croup treated?
It is viral:
What investigations can be done in a child with a CNS infection?
What can cause fits and fainting in children?
Reflex anoxic seizures
Breath holding attacks
What can commonly cause GI obstruction in children?
Congenital pyloric stenosis
How can systolic BP be roughly worked out for a child?
Systolic BP = 85 + (Age in years x 2)
How do we manage the circulating volume in a child?
20ml/kg of 0.9% saline
What do we do if a patient requires more than 20ml/kg of fluid?
May need more fluid
When should we contact the PICU?
When 60ml/kg or more is needed
At what stage of dehydration do the fontanelle become sunken?
At what stage of dehydration is shock apparent?
What types of posture in a child are important in assessing their conscious level?
- Abnormal flexion
- Arms adducted
- Forearms and wrists flexed -> Like Cs
- Extension posture
- Arms adducted
- Foraerms pronated and extended
- Wrists flexed
What is the commonest cause of UTIs in kids?
What complications can childhood UTIs cause?
Renal tract abnormalities
How do we treat constipation in kids?
Attention to food and drink
What causes of abdominal pain in a child shouldn't be missed?
In terms of headache, which of the following is not a symptom or sign of concern:
- Headache on waking
- Worse with coughing/bending
- More than 5 a week
- Visual problems
- Gait problems
- CN palsy
More than 5 per week
What is the median time between symptoms onset and diagnosis of a child brain tumour?