Paediatric development Flashcards
(126 cards)
1
Q
Is over feeding more common in breast or bottle fed babies?
A
Bottle fed
2
Q
What is breastfeeding linked to?
A
reduced infections int he neonatal period, better cognitive development, lower risk of sudden infant death syndrome
3
Q
What can breastfeeding do for the mother?
A
Reduce breast cancer and ovarian cancer
4
Q
On formula, how much milk should babies get?
A
150 ml of milk per kg of body weight
5
Q
How is the feeding of bottle fed babies split?
A
2-3 hours initially then 4 hours
6
Q
How are volumes of milk increased in the first week of life?
A
60 mls/kg/day on day 1
90 mls/kg/day on day 2
120 mls/kg/day on day 3
150 mls/kg/day on day 4 and onwards
7
Q
What is the weight loss of babies like by day 5 of life?
A
10% loss in breast fed babies
5% loss in formula fed babies
8
Q
When should babies be back to their birth weight?
A
by day 10
9
Q
What is the most common cause of excessive weight loss in newborn babies?
A
Dehydration due to under feeding, weight loss in babies is the most reliable sign of dehydration
10
Q
When does weaning normally start in babies?
A
Around 6 months
11
Q
What is plotted on a growth chart?
A
weight, height and head circumference
12
Q
What are the phases of growth in children?
A
First 2 years: rapid growth driven by nutritional factors
From 2 years to puberty: steady slow growth
During puberty: rapid growth spurt driven by sex hormones
13
Q
What is overweight and obeses defined as?
A
BMI above 85th centile
BMI above 95th percentile
14
Q
What should you consider if children are short and obese?
A
Endocrine problems such as hypothyroidism
15
Q
What are obese children at a higher risk of later in life?
A
impaired glucose tolerance, type 2 diabetes, cardiovascular disease, arthritis and certain types of cancer
16
Q
How is faltering growth defined by NICE?
A
one or more centile spaces if their birthweight was below 9th centile
two or more centile spaces if their birthweight was between 9th and 91st centile
three or more centile spcaes if their birthweight was above the 91st centile
17
Q
What are the main causes of failure to thrive?
A
Inadequate nutritional intake
Difficulty feeding
Malabsorption
Increased energy requirements
Inability to process nutrition
18
Q
What are the casues of inadequate nutritional intake causng failure to thrive?
A
Maternal malabsorption if breasfeeding
Iron deficiency anaemia
Family or parental problems
Neglect
Availbaility of food
19
Q
What are the causes of difficult feeding causing failure to thrive?
A
Poor suck e.g. due to cerebral palsy
Cleft lip or palate
Genetic conditions with abnormal facial structure
Pyloric stenosis
20
Q
What are the causes of malabsorption causing failure to thrive?
A
Cystic fibrosis
Coeliac disease
Cows milk intolerance
Chronic diarrhoea
IBD
21
Q
What are the causes of increased energy requirements causing failure to thrive?
A
Hyperthyroidism
Chronic disease e.g. congenital heart disease and CF
Malignancy
Chronic infections e.g. HIV or immunodeficiency
22
Q
What causes inability to process nutrients properly in failure to thrive?
A
Inbron errors of metabolism
Type 1 diabetes
23
Q
How is BMI calculated?
A
weight (kg)/height (m)
24
Q
What outcomes of assessment suggests inadequate nutrition or growth in children?
A
height more than 2 centile spaces below the mid-parental height centile
BMI below the 2nd centile
25
What initial investigations are there for faltering growth?
Urine dipstick for UTI
Coeliac screen (anti-TTG or anti-EMA antibodies)
26
What is short stature defined as?
Height more than 2 standard deviations below the average for their age and sex (below the 2nd centile)
27
How is child's predicted height measured?
Boys (mother + fathers height + 14cm)/2
Girls (mothers + fathers height -14cm)/2
28
What are the causes of short stature?
Familial short stature
Constitutional delay in growth and development
Malnutrition
Chronic disease; e.g. coeliac disease, inflammatory bowel disease or congenital heart disease
Endocrine disorder e.g. hypothyroidism
Genetic conditions e.g. Down syndrome
Skeletal dysplasia e.g. achondroplasia
29
What is constitutional delay in growth and puberty?
CDGP us short stature in children but normal height in adults
30
What is a key feature in CDGP?
Delayed bone age
31
How is diagnosis of CDGP supported?
xray of hand and wrist
32
What are the 4 major domains of child development?
Gross motor
Fine motor
Language
Personal and social
33
In terms of gross motor development, what can children do at 4 months of age?
able to support their head and keep it in line with their body
34
In terms of gross motor development, what can children do at 6 months of age?
keep their trunk supported on their pelvis (e.g. sitting) however cant often balance to sit unsupported yet
35
In terms of gross motor development, what can children do at 9 months of age?
Should be able to sit unsupported, can start crawling, can maintain a standing position and bounce on their legs when supported
36
In terms of gross motor development, what can children do at 12 months of age?
stand and begin cruising
37
In terms of gross motor development, what can children do at 15 months of age?
walk unaided
38
In terms of gross motor development, what can children do at 18 months of age?
Squat and pick things up from the floor
39
In terms of gross motor development, what can children do at 2 years of age?
run, kick a ball
40
In terms of gross motor development, what can children do at 3 years of age?
climb stairs one foot at a time, stand on one leg for a few seconds
ride a tricycle
41
In terms of gross motor development, what can children do at 4 years of age?
hop and climb stairs like an adult
42
In terms of fine motor development, what can children do at 8 weeks of age?
fixes their eyes on an object 30 centimetres in front of them and attempt to follow it. They show a preference for a face rather than an inanimate object
43
In terms of fine motor development, what can children do at 6 months of age?
palmar grasp of object (wraps thumb and finger around the object)
44
In terms of fine motor development, what can children do at 9 months of age?
scissor grasp of object (squashes between thumb and forefinger)
45
In terms of fine motor development, what can children do at 12 months of age?
Pincer grasp (with the tip of the thumb and forefinger)
46
In terms of fine motor development, what can children do at 14-18 months of age?
Clumsily use a spoon to bring food from a bowl to their mouth
47
In terms of fine motor development drawing skills, what can children do at 12 months of age?
Holds crayon and scribbles randomly
48
In terms of fine motor development drawing skills, what can children do at 2 years of age?
copies vertical line
49
In terms of fine motor development drawing skills, what can children do at 1.5 years of age?
copies horizontal line
50
In terms of fine motor development drawing skills, what can children do at 3 years of age?
Copies circle
51
In terms of fine motor development drawing skills, what can children do at 4 years of age?
Copies cross and square
52
In terms of fine motor development drawing skills, what can children do at 5 years of age?
copies triangle
53
In terms of fine motor development tower of bricks, what can children do at14 months of age?
tower of 2 bricks
54
In terms of fine motor development tower of bricks, what can children do at 18 months of age?
tower of 4 bricks
55
In terms of fine motor development tower of bricks, what can children do at 2 years of age?
tower of 8 bricks
56
In terms of fine motor development tower of bricks, what can children do at 2.5 years of age?
tower of 12 bricks
57
In terms of fine motor development tower of bricks, what can children do at 3 years of age?
can build a 3 block bridge or train
58
In terms of fine motor development tower of bricks, what can children do at 4 years of age?
can build steps
59
In terms of fine motor development pencil grasp, what can children do at under 2 years of age?
palmar supinate grasp (fist grip)
60
In terms of fine motor development pencil grasp, what can children do at 2-3 years of age?
digital pronate grasp
61
In terms of fine motor development pencil grasp, what can children do at 3-4 years of age?
quadrupod grasp or static tripod grasp
62
In terms of fine motor development pencil grasp, what can children do at 5 years of age?
mature tripod grasp
63
When can children thread large beads onto a string and make cuts in the side of paper with scissors?
3 years
64
When can children cut paper in half using scissors?
4 years
65
What are the two types of language?
Expressive language
Receptive language
66
In terms of expressive language milestones, what can children do at 3 months of age?
cooing noises
67
In terms of expressive language milestones, what can children do at 6 months of age?
makes noises with consonants (starting with g,b and p)
68
In terms of expressive language milestones, what can children do at 9 months of age?
Babbles, sounding more like talking but not saying any recognisable words
69
In terms of expressive language milestones, what can children do at 12 months of age?
Says single words in context
70
In terms of expressive language milestones, what can children do at 18 months of age?
has around 5-10 words
71
In terms of expressive language milestones, what can children do at 2 years of age?
combines 2 words. Around 50 + words in total
72
In terms of expressive language milestones, what can children do at 2.5 years of age?
Combines 3-4 words
73
In terms of expressive language milestones, what can children do at 3 years of age?
Using basic sentences
74
In terms of expressive language milestones, what can children do at 4 years of age?
tells stories
75
In terms of receptive language milestones, what can children do at 3 months of age?
recognise parents and familiar voices and gets comfort from these
76
In terms of receptive language milestones, what can children do at 6 months of age?
responds to tone of voice
77
In terms of receptive language milestones, what can children do at 9 months of age?
listens to speech
78
In terms of receptive language milestones, what can children do at 12 months of age?
Follows very simple instructions
79
In terms of receptive language milestones, what can children do at 18 months of age?
Understands nouns, for example "show me the spoon"
80
In terms of receptive language milestones, what can children do at 2 years of age?
Understands verbs, for example "show me what you eat with"
81
In terms of receptive language milestones, what can children do at 2.5 years of age?
Understands the propositions, for example "put the spoon on/under the step"
82
In terms of receptive language milestones, what can children do at 3 years of age?
understands adjectives
83
In terms of receptive language milestones, what can children do at 4 years of age?
follows complex instructions
84
In terms of personal and social milestones, what can children do at 6 weeks of age?
Smile
85
In terms of personal and social milestones, what can children do at 3 months of age?
Communicates pleasure
86
In terms of personal and social milestones, what can children do at 6 months of age?
Curious and engaged with people
87
In terms of personal and social milestones, what can children do at 9 months of age?
They become cautious and apprehensive with strangers
88
In terms of personal and social milestones, what can children do at 12 months of age?
Engages with others by pointing and handing objetcs. Waves bye bye, claps hands
89
In terms of personal and social milestones, what can children do at 18 months of age?
Imitates activities such as using a phone
90
In terms of personal and social milestones, what can children do at 2 years of age?
Extends interest to others beyond parents such as waving to strangers. Plays but not necessarily with other children. Usually dry by day
91
In terms of personal and social milestones, what can children do at 3 years of age?
They will seek out other children and play with them. bowel control
92
In terms of personal and social milestones, what can children do at 4 years of age?
has best friend, dry by night, dresses self, imaginative play
93
What are the red flags for child development
lost development milestones
Not able to hold an object at 5 months
Not sitting unsupported at 12 months
Not standing independently at 18 months
Not walking independently at 2 years
Not running at 2.5 years
No words at 18 months
No interest in others at 18 months
94
What are the underlying diagnoses of global developmental delay?
Down's syndrome
Fragile X syndrome
Fetal alcohol syndrome
Rett syndrome
Metabolic disorders
95
What are the underlying diagnoses of gross motor delay?
Cerebral palsy
Ataxia
Myopathy
Spina bifida
Visual impairment
96
What are the underlying diagnoses of fine motor developmental delay?
Dyspraxia
Cerebral palsy
Muscular dystrophy
Visual impairment
Congenital ataxia (rare)
97
What are the underlying diagnoses of speech and language developmental delay?
Specific social circumstances- e.g. multiple languages or loud siblings
Hearing impairment
Learning disability
Neglect
Autism
Cerebral palsy
98
What are the underlying diagnoses of personal and social developmental delay?
Emotional and social neglect
Parenting issues
Autism
99
What are the types of learning disability?
Dyslexia
Dysgraphia
Dyspraxia
Auditory processing disorder
Non-verbal learning disability
Profound and multiple learning disability
100
What is dysgraphia?
Difficulty in writing
101
What is dyspraxia?
developmental co-ordination disorder, more common in boys, child appears clumsy
102
How are learning disabilities classified by IQ?
55-70 mild
40-55 moderate
25-40 severe
under 25 profound
103
What conditions are associated with learning disabilities?
Genetic disorder e.g. Down's
Antenatal problems e.g. fetal alcohol syndrome and maternal chickenpox
Problems at birth e.g. prematurity and hypoxic ischaemic encephalopathy
Problems in early childhood e.g. meningitis
Autism
Epilepsy
104
To have a capacity what must a patient be able to demonstrate?
Understand, Retain, Weigh up and communicate their decision
105
When does puberty start in girls and boys?
8-14 in girls and 9-15 in boys
106
How long does puberty usually take?
Around 4 years
107
What happens during puberty in girls?
Breast buds then pubic hair and menstruation about 2 years from the start of puberty
108
What happens during puberty in boys?
Enlargement of the testicles then the penis, gradual darkening of the scrotum and then development of pubic hair and deepening of the voice
109
What scale is used to determine the pubertal stage of a child?
Tanner scale
110
What is hypogonadism?
lack of the sex hormones oestrogen and testosterone
111
What is hypogonadism usually due to?
Hypogonadotrophic hypogonadism: a deficiency of LH and FSG or Hypergonadotrophic hypogonadism: a lack of response to LH and FSH by the gonads (testes and ovaries)
112
How does hypogonadotropic hypogonadism work?
Deficiency of LH and FSH (gonadotrophins) so the gonads do not get stimulated to produce testosterone and oestrogen
113
What could hypogonadotropic hypogonadism be due to?
Previous damage to the hypothalamus or pituitary
Growth hormone deficiency
Hypothyroidism
Hyperprolactinaemia
Serious chronic conditions
Excessive exercise or dieting can delay menstruation
Constitutional delay in growth and development
Kallman syndrome
114
How does hypergonadotrophic hypogonadism work?
Gondas fail to respond to LH and FSH therefore anterior pituitary produces increasing amounts of LH and FSH therefore high gonadotrophins and low sex hormones
115
What could hypergonadotrophic hypogonadism be due to?
Previous damage to the gonads
Congenital absence of the testes or ovaries
Kleinfelter's syndrome (XXY)
Turner's syndrome (XO)
116
What is kallman syndrome?
Genetic condition causing hypogonadotrophic hypogonadism resulting in failure to start puberty. Associated with a reduced or absent sense of smell (anosmia)
117
What is the threshold for initial investigations for pubertal problems?
No evidence of pubertal changes in a girl aged 13 or boy aged 14
118
What are the initial investigations for delayed puberty?
FBC and ferritin for anaemia
U and E for CKD
Anti-TTG or anti-EMA for coeliac disease
119
What hormonal blood tests can be used for delayed puberty?
Early morning FSH and LH (low in hypogonadotrophic hypogonadism and high in hypergonadotrophic hypogonadism)
Thyroid function tests
Growth hormone testing (Insulin-like growth factor I) is often used for GH deficiency
Serum prolactin
120
What genetic testing is there for delayed puberty/
Microarray looking for Kleinfelter or Turner's syndrome
121
What imaging can be useful for delayed puberty/
Xray of the wrist for constitutional delay
Pelvic ultrasound in girls to assess ovaries and pelvic organs
MRI of the brain for pituitary pathology and assess olfactory bulbs in possible kallman syndrome
122
What is the legal framework for child safeguarding?
Children Act 1989
123
What are the types of abuse?
Physical
Emotional
Sexual
Neglect
Financial
Identity
124
What are the risk factors for abuse?
Domestic violence
Previously abused parent
Mental health problems
Emotional volatility in the household
Social, psychological or economic stress
Disability in the child
Learning disability in the parents
Alcohol misuse
Substance misuse
Non-engagement in services
125
What are the Frazer guidelines?
1. they are mature and intelligent enough to understand the treatment
2. They can't be persuaded to discuss it with their parents or let the health professional discuss it
3. They are likely to have intercourse regardless of treatment
4. Their physcial or mental health is liekly to suffer without treatment
5. Treatment is in their best interest
126
What age can children not give consent for sexual activity?
13
