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Normal Growth and Development Flashcards

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1
Q

What factors influence normal development

A

Genetic - major player
Nutrition - includes mother’s nutrition in pregnancy and after birth
Environmental - determine to what extent your genetic potential is realised

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2
Q

What can malnutrition in infancy cause

A

Permanent damage to the developing brain (under 6 months)

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3
Q

What is a developmental milestone

A

A key stage where a new life skill is developed

Have rough guides to what age this should be reached by but varies between kids

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4
Q

What is the median age for a developmental milestone

A

Age when 50% population achieve a skill

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5
Q

What is the limit age for a developmental milestone

A

Age when skill should have been acquired by 97.5% of children
More useful for determining if something is abnormal - e.g. if not reached

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6
Q

Describe the difference between developmental age and chronological age

A

Usually refers to a premature baby
As they were born early they will reach milestones later than expected for their chronological age but this will not be abnormal
Add the number of weeks to their developmental milestones to get adjusted age

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7
Q

List the principles of normal development

A

Continuous process
Maturation of nervous system
Sequence same but rate varies
Cephalocaudal direction - movement develops from head down
Generalised mass activity changing to more specific controlled movements

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8
Q

What are the 4 main areas of development

A

Gross motor
Fine motor and vision
Speech, language and hearing
Social behaviour and play

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9
Q

Give examples of gross motor skills

A 
Head control - 3 months
Sitting unaided - 6m
Crawling - 9m
Standing - 12m
Walking
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10
Q

What are the primitive motor skills

A

Reflexes that kids are born with - thought to be evolutionary
Sucking and rooting - find nipple and suck
Palmar/plantar grasp - very strong grip
ATNR - put hand out to side to prevent rolling

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11
Q

Give examples of fine motor and vision milestones

A

hand regard in midline
Grasp toy
Build tower
Draw simple shape

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12
Q

What is the main risk of baby developing a fine grip

A

More likely to be able to lift something and put it in their mouth - ingestion accidents and choking
At this stage also becoming mobile which increases risk

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13
Q

List some hearing and language milestones

A 
Vocalises 
Imitates sound 
Knows name 
Develops words 
Follows simple instructions
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14
Q

List some social behaviour and play milestones

A 
Social smile 
Plays with feet 
Peek-a-boo 
Stranger awareness 
Drinks 
Feeds 
Symbolic play 
Interactive play 
Toilet training
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15
Q

What are the nutritional requirements of young children

A

Need essential nutrients to replace losses and grow new tissues
Energy to permit metabolic function
Need it for maintenance growth and development
Develop their immunity

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16
Q

Describe the 3 phases of child growth

A

Infant - rapid growth led by nutrients
Child - slower phase led by growth hormones
Pubertal - another fast period led by sex/steroid hormones

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17
Q

What external factors can influence growth

A

Disease
Feeding patterns
Socioeconomic status

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18
Q

Describe protein intake in kids

A

Increases with age

Usually higher intake than recommended

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19
Q

Where do you get vitamin A from

A

cheese
eggs
yoghurt

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20
Q

Describe the trends in vitamin A intake

A

Usually higher than recommended level

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21
Q

Where do you get Vitamin C from

A

Oranges
Blackcurrants
Potatoes

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22
Q

Describe the trends in vitamin C intake

A

Above national guidelines in all age groups

Lower in Scotland but still above guidelines

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23
Q

Where do we get vitamin D from

A

Sunlight - main source

Oily fish and eggs

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24
Q

Describe the trends in vitamin D intake

A

Below recommended level for all groups

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25
Who is recommended to take supplements
All babies from 6 months who take less the 500ml of formula | Pregnant women and breastfeeding mothers
26
Describe the trends in sodium intake
Higher than recommended | Higher in Scotland than in rest of UK
27
Describe the recommendations for milk feeding
Exclusive breastfeeding is recommended for the first 6 months Good for immune system, growth, overall health and future
28
Describe weaning
Its the process of introducing a variety of new foods | Starts at about 6 months as breastmilk no longer sufficient for nutrition
29
Why should nuts and seeds be avoided in young children
Choking risk
30
How should you introduce foods that commonly cause allergy
One at a time
31
What are the key nutritional vulnerabilities of school age children
Chronic disease Disrodered eating pattern Supply/demand imbalance - obesity
32
What are the key nutritional vulnerabilities of adolescents
Eating disorders Obesity Early pregnancy - change in needs that needs managed
33
List factors that decrease risk of dental caries
Fluoride exposure Hard cheese Sugar-free chewing gum
34
What factors are associated with early introduction of solids
Living in deprived area Opinions of grandparents Disagreeing with advice Lack of encouragement from peers to wait
35
Describe a normal distribution curve
Middle line - mean or median | Standard deviation measures the variability
36
What is the Z score
The number of standard deviations from the mean
37
Which weight group makes it more likely to go into early puberty
Overweight children
38
What suggests that a child is showing normal growth
Their measurements are within the normal range compared with children of their age Their rate of growth is within the normal range compared with children of their age
39
Describe the trends in normal growth charts over the last 30 years
Increase in severe obesity has shifted curve to the right | Upward trend in height
40
What procedures must be followed when weighing a child
Babies need to be weighed without clothes or nappy Children >2 can be weighed in underwear but no shoes or teddies Only clinical electronic scales in metric setting should be used
41
What procedures must be followed when measuring head circumference
Use narrow plastic or disposable tape | Take measurement where head is widest
42
How do you measure a child's height
Can do length before age 2 but unreliable Measure with a rigid rule/T piece etc Ensure eyes at 90' and heels are touching the wall Take shoes off
43
What are the average ages for kids to enter puberty
Girls - 11 | Boys - 11y 6m
44
How do you stage puberty
Tanner scale | Stage 1 is pre-pubertal and stage 5 is adult
45
What are the stages of puberty in girls
Thelarche - breast budding Adrenarche - body hair Menarche - periods start
46
What measurement suggests boys have started puberty
Testicular volume over 4ml
47
What is the definition of precocious puberty
Normal pubertal development occurring abnormally early before age 8 in girls and before age 9 in boys More common in girls
48
What is the definition of pubertal delay
Absence of secondary sexual development in a girl aged 13 or a boy aged 14 years More common in boys
49
What do you need to cover in the history for suspected growth problem
ICE - does their height actually bother them Birth - low birth weight often means they'll be small for a few years then catch up PMH Parental growth and puberty - can influence kid
50
What investigations would you do if a growth problem was suspected
``` Bloods - gonadotrophins, growth factors, thyroid etc Bone age Dynamic function tests MRI to check pituitary USS uterus ```
51
How do you test bone age
X ray of wrist in the non dominant hand | Very subjective so only concerned by big differences from chronological age
52
What is the WHO definition of adolescence
10-19 years
53
What is the WHO definition of youth
15-24 years
54
What is the WHO definition of young people
Those aged 10-24 years
55
How do you stage puberty
Tanner staging Looks at testicular volume and pubic hair in men Breast development, pubic hair and periods in women
56
What are the main biological changes that occur in adolescence
Puberty Growth - often a 'spurt' CNS development - Increase in grey matter and the number of synaptic connections - impacts on behaviour, rational thinking and decision making
57
What are the main psychological changes that occur in adolescence
Development of abstract thinking, identity and mortality
58
What are the main social changes that occur in adolescence
Developing autonomy | Changing relationships - with family and peers
59
What is the STEP assessment of developmental stage
S - sexual maturation and growth T - thinking E - education and employment P - peers and parents
60
What is the definition of competence
Understand simple terms and the nature, purpose and necessity for proposed treatment Understand the benefits, risks and effects of, as well as the alternatives to, non-treatment Understand that the information applies to them Retain the information long enough to make a choice Make a choice free from pressure
61
At what age is competence assumed in the UK
16 | some exceptions e.g. learning difficulty
62
Can an under 16 provide competent consent to a medical procedure
Yes | If the medical professionals deem them competent
63
Can you ever override a young persons decision to refuse treatment
Parents are NOT allowed to overrule | If treatment is really in their best intertest - e.g. refusing treatment for eating disorder - there may be some cases
64
What topics may you need to cover in an adolescent history (HEEADSSS)
``` Home Education/employment Eating Activities - peers, sport Drugs Sex Suicide Safety ```
65
Describe the trends in sugar intake in children
Average intake is more than double the recommended | Around 1/3 comes from fruit juice
66
Which biological factors can influence a childs development
Inherited characteristics – cognitive potential and temperament Ante- and perinatal history - e.g. maternal drugs/alcohol or prematurity General health - chronic or recurrent illness Vision and hearing difficulties - can impact on other domains
67
Which environmental factors can influence a childs development
Opportunities - parenting and education Threats - economic and social deprivation Experience and encouragement
68
What are primitive reflexes
Reflexes that are generally present from birth | Usually ‘lost’ (i.e. suppressed by brain) by 12 months)
69
List some of the primitive reflexes
Rooting and sucking = turn to food source and suck Moro - arms thrown up and out Stepping Asymmetrical tonic neck reflex (ATNR) - fencing stance Symmetrical tonic neck reflex (STNR) Tonic labyrinthine reflex - legs stiffen and hands fist when baby is tilted back Palmar and plantar grasp reflexes

Child Health (14 decks)

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