Development

Question 1

Define failure to thrive

Answer 1

Refers to poor physical growth and development in a child.
A fall in of one or more centile spaces below the 9th centila
Two or more centile spaces between the 9th and 91st centile
Three or more centile spaces above the 91st centile

Question 2

Caused of failure to thrive

Answer 2

Inadequate nutrition
Difficulty feeding
Malabsorption
Increased energy levels
Inability to process nutrition

Question 3

Causes of inadequate nutritional intake

Answer 3

Maternal malabsorption - breastfed
Iron deficiency anaemia
Family or parental problems
Neglect
Poor availability of food.

Question 4

Causes of difficulty feeding

Answer 4

Poor suck - cerebral palsy
Cleft lip or palate
Genetic conditions
Pyloric stenosis

Question 5

Causes of malabsorption

Answer 5

Cystic fibrosis
Coeliac disease
Cows milk intolerance
Chronic diarrhoea
Inflammatory bowel disease

Question 6

Causes of high energy requirement

Answer 6

Hyperthyroidism
Chronic disease - congenital heart, cystic fibrosis
Malignancy
Chronic infection - HIV, immunodeficient

Question 7

Inability to process nutrients

Answer 7

Inborn errors of metabolism
TIDM

Question 8

Assessment of failure to thrive

Answer 8

Full history examination and investigations
Pregnancy, birth, developmental and social history
Feeding or eating history
Observe feeding
Mums physical health
Parent-child interactions
Height weight and BMI - charts
Calculate mid-parental height

Question 9

Investigations in failure to thrive

Answer 9

Urine dip - UTI
Coeliac screen
Cystic fibrosis
Pyloric stenosis - US

Question 10

Management of failure to thrive

Answer 10

Manage cause
Encourage regular structured mealtimes and snacks
Reduce milk consumption - improve appetite for other snacks
Review by dietician
Additional energy dense food
Nutritional supplements
Enteral tube feeding

Question 11

Define short stature

Answer 11

Height more than 2 standard deviations below the average for their age and sex

Question 12

Causes of short stature

Answer 12

Familial short stature
Constitutional delay in growth and development
Malnutrition
Chronic disease - coeliac, IBD, congenital heart disease
Endocrine - hypothyroidism
Genetic - Down’s
Skeletal dysplasias - achondroplasia

Question 13

Define constitutional delay

Answer 13

Considered a variation on normal development
Leads to short stature in child hood but normal height in adulthood

Question 14

What is assessed in a developmental assessment

Answer 14

Gross motor
Fine motor
Language
Personal and social

Question 15

Milestones of gross motor development

Answer 15

4 months - support head
6 months - sitting supported
9 months - sitting unsupported
12 months - walking (cruising
15 months - walking unaided
18 months - squat and pick things up
2 years - Run, kick a ball
3 years - climb stairs one foot at a time
4 years - hop, climb and descend stairs like adult

Question 16

Milestones of fine motor development

Answer 16

8 weeks - fixes eyes on object
6 months - palmar grasp
9 months - scissor grasp
12 months - pincer grip
14-18 months - use spoon
Further - drawings, blocks in tower

Question 17

Milestones of language deelopment

Answer 17

3 months - cooing, recognises parents voices
6 months - consonants (g,b,p), responds to tone of voice
9 months - babbles, listens to speech
12 months - single words, simple instructions
18 months - 5-10 words, understands nouns
2 years - combine 2 words, understands verbs
3 years - using basic sentences, understands adjectives
4 years - tells stories, complex instruction

Question 18

Milestones of personal and social development

Answer 18

6 weeks- smiles
3 months - communicates pleasure
6 months - curious and engaged
9 months - cautious with stranegrs
12 months - engages with others by pointing, waves bye bye
18 months - imitates
2 years - waving to strangers, plays, dry by day
3 years - seek out other children to play, bowel control
4 years - best friend, dry by night, dresses self

Question 19

Red flags of development

Answer 19

Loss of developmental milestones
Not able to hold object by 5 months
Not sitting by 12 months
Not standing by 18 months ?walking
Not running by 2.5 years
No words at 18 months
No interest in others at 18 months

Question 20

Causes of global developmental delay

Answer 20

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

Question 21

Causese of gross motor delay

Answer 21

Cerebral palsy
Ataxia
Myopathy
Spina bifida
Visual impairment

Question 22

Causes of fine motor delay

Answer 22

Dyspraxia
Cerebral palsy
Muscular dystrophy
Visual impairment
Congenital ataxia

Question 23

Causes of language delay

Answer 23

Specific social circustances
Hearing impairment
Learning disability
Neglect
Autism
Cerebral palsy

Question 24

Causes of personal and social delay

Answer 24

Neglect
Parenting issues
Autism

Question 25

Define learning disablitiy

Answer 25

Umbrella term encompassing a range of different conditions that affect the ability of a child to develop new skills/

Question 26

Examples of learning disabiloty

Answer 26

Dyslexia Dysgraphia - writing specifically Dyspraxia - coordination Auditory processing disorder Non-verbal learning disability Profound and multiple learning disability

Question 27

Causes of learning disability

Answer 27

Genetics Antenatal - fetal alcohol, chickenpox Problems at birth - Prematurity, hypoxic ischaemic encephalopathy Problems in early childhood - meningitis Autism Epilepsy

Question 28

Define hypogonadism

Answer 28

Refers to lack of sex hormones, oestrogen and testosterone.

Question 29

Define hypogonadotropic hypogonadism

Answer 29

Deficiency of LH and FSH leading to dificiency in sex hormones.

Question 30

Causes of hypogonadotropic hypogonadism

Answer 30

Damage to hypothalamus or pituitary Growth hormone deficiency Hyperprolactinaemia Serious chronic conditions - cystic fibrosis, IBD Excessive exercise or dieting Constitutional delay Kallaman syndrome

Question 31

Define hypergonadotropic hypogonadism

Answer 31

Where the gonads fail to respond to gonadotropins - no negative feedback and large amounts of LH and FSH

Question 32

Causes of hypergonadotropic hypogonadism

Answer 32

Damage to gonads - torsion, cancer, mumps Congenital absence Kleinfelter's syndrome - XXY Turner's syndrome - XO

Question 33

Define Kallaman syndrome

Answer 33

Genetic condition causing hypogonadotropic hypogonadism resulting in faiolure to start puberty - associated with reduced smell, anosmia

Question 34

Investigations in delayed puberty

Answer 34

FBC UE antiTTG anti EMA FSH LH Thyroid function Growth hormone - insulin like growth factor Prolactin Genetic testing Xray 0 growth plates Pelvic US - ovaries MRI brain - pituitary

Question 35

Normal age of puberty

Answer 35

Female - 8-14 years Male - 9-15 years Investigate at 13 and 14 respectively

Question 36

Risk factors for abuse

Answer 36

Domestic violence Previously abused parent Mental health problems Emotional volatility in the household Social psychological or economic stress Disability in child Learning disability in parent Alcohol or substance misuse Non-engagement with services

Question 37

Possible signs of abuse

Answer 37

Change in behaviour or extreme emotional states Dissociative disorders Bullying, self harm or suicidal behaviours Unusually sexualised Unusual behaviours during examination Poor hygiene Poor physical or emotional development Missing appointments

Question 38

Frazer guidlines

Answer 38

1. Mature and intelligent enough to understand treatment 2. Can't be persuaded to discuss it with their parents 3. They are likely to have intercourse regardless 4. Physical or mental health is likely to suffer without treatment 5. Treatment is in their best interest