Paediatrics Development Flashcards

Question

What are the initial investigations for faltering growth?

Answer 1

Urine dip for UTI Coeliac screen (**anti-TTG or anti-EMA**) Further investigations where additional signs/symptoms suggest diagnosis e.g. CF or pyloric stenosis

Answer 2

**Multidisciplinary team** with regular reviews **Breast feeding problems** = help from midwives, health visitors, peer groups and "lactation consultants) **Supplement with formula milk** to improve growth (often results with breastfeeding stopping)

Answer 3

- Encourage **regular structured mealtimes and snacks** - **Reduce milk consumption** to improve appetite for other foods - Review by **dietician** - Additional **energy dense foods** to boost calories - **Nutritional supplement drinks** - Consider **enteral tube feeding:** has to have defined end point

Answer 4

**Boys** = (M+D + 14)/2 **Girls** = (M+D-14cm)/2

Answer 5

**Familial short stature** **Constitutional delay in growth and development** **Malnutrition** **Chronic diseases** e.g. coeliac disease, IBD or congenital heart disease **Endocrine disorders** e.g. hypothyroidism **Genetic conditions** e.g. Down syndrome **Skeletal dysplasia****s** e.g. achondroplasia

Answer 6

Variation on normal development - causes **short stature in childhood** when compared to peers but **normal height in adulthood** Puberty is delayed and growth spurt is then longer

Answer 7

**Delayed bones age** - age of child estimated with x-ray images of wrist and hand ans assessing the size and shapre of bones and **growth plates** - these children have a delayed bones age

Answer 8

Suggestive **history** and **examination** **X-ray of hand and wrist** to assess bone age

Answer 9

**Exclude other causes** **Reassure parents** **Monitor growth over time**

Answer 10

**Gross** motor **Fine** motor **Language** **Personal** and **social**

Answer 11

**Head downwards**: **4 months**: Support their head and keep it **in line with the body** **6 months:** Maintain sitting position by 6 months, however they often don’t have the balance to sit **9 months**: They should **sit unsupported by 9 months.** They can start **crawling** at this stage. Maintain a **standing position** **12 months:** **They should stand and begin cruising** (walking whilst holding onto furniture). **15 months:** **Walk unaided.** **18 months:** **Squat and pick things up from the floor**. **2 years**: **Run. Kick a ball.** **3 years**: **Climb stairs one foot at a time**. **Stand** on **one leg** for a few seconds. **Ride a tricycle.** **4 years:** **Hop. Climb and descend stairs** like an adult.

Answer 12

**8 weeks**: **Fix their eyes** on an **object 30 centimetres in front of them** **attempt to follow it**. **Preference for a face** rather than an inanimate object. **6 months**: **Palmar grasp of objects** (wraps thumb and fingers around the object). **9 months: Scissor grasp** of objects (squashes it between thumb and forefinger). **12 months**: **Pincer grasp** (with the **tip of the thumb and forefinger**). 14-18 months: They can clumsily use a spoon to bring food from a bowl to their mouth.

Answer 13

**12 months:** Holds crayon and **scribbles randomly** **2 years:** Copies **vertical line** **2.5 years**: Copies **horizontal line** **3 years:** Copies **circle** **4 years**: Copies **cross and square** **5 years**: Copies **triangle**

Answer 14

**14 months:** Tower of **2 bricks** **18 months:** Tower of **4 bricks** **2 years:** Tower of **8 bricks** **2.5 years:** Tower of **12 bricks** **3 years:** Can build a **3 block bridge or train** **4 years:** Can **build steps**

Answer 15

**Under 2 years:** Palmar supinate grasp (**fist grip)** **2-3 years:** Digital pronate grasp **3-4 years**: Quadrupod grasp or static tripod grasp **5 years:** Mature tripod grasp

Answer 16

**3 years** - thread large beads onto string **4 years** - cut paper in half

Answer 17

**3 months:** Cooing noises **6 months:** Makes noises with consonants (starting with g, b and p) **9 months**: Babbles, sounding more like talking but not saying any recognisable words **12 months:** Says single words in context, e.g. “Dad-da” or “Hi” **18 months:** Has around 5 – 10 words **2 years:** Combines 2 words. Around 50+ words total. **2.5 years:** Combines 3 – 4 words **3 years:** Using basic sentences **4 years:** Tells stories

Answer 18

**3 months: Recognises parents** and **familiar voices** **6 months:** Responds to **tone of voice** **9 months:** **Listens** to speech **12 months:** Follows **very simple instructions** **18 months:** Understands **nouns**, for example “**show me the spoon”** **2 years:** Understands **verbs,** for example “show me what **you eat with**” **2.5 years**: Understands **plan of action**, for example **“put the spoon on / under the step”** **3 years:** Understands **adjectives**, for example “show me the **red brick**” and “which one of these is bigger?” **4 years:** Follows **complex instructions**, for example “pick the spoon up, put it under the carpet and go to mummy”

Answer 19

**6 weeks:** Smiles **3 months**: Communicates pleasure **6 months:** Curious and engaged with people **9 months**: They become c**autious and apprehensive with strangers** **12 months:** Engages with others by pointing and handing objects. Waves bye bye. Claps hands. **18 months**: Imitates activities such as **using a phone** **2 years:** Extends interest to others beyond parents, such as waving to strangers. Plays next to but not necessarily with other children (parallel play). Usually dry by day. **3 years:** They will seek out other children and plays with them. Bowel control. **4 years:** Has best friend. Dry by night. Dresses self. Imaginative play.

Answer 20

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**

Answer 21

Use their **name** **Use parents** to encourage Visually **estimate how old** **Test milestones** and work up **Say things to let examiner know**"really good pincer grip" "you build a tower of 6 bricks" "thats really good walking"

Answer 22

**Dyslexia** - difficulty in reading, writing and spelling **Dysgraphia** - difficulty in writing **Dyspraxia** (aka developmental co-ordination disorder) - specific type of difficulty in physical co-ordination - delayed gross and fine motor skills **Auditory processing disorderb -** difficulty processing auditory information **Non-verbal learning disability** - difficulty in processing non-verbal information e.g. body language and facial expressions **Profound and multiple learning disability** - difficulties across multiple areas - often requiring help with all aspects of daily life

Answer 23

55-70 = **mild** 40-55 = **moderate** 25-40 = **severe** Under 25 = **profound**

Answer 24

Often **no clear cause** **FH** increases risk **Environmental factors** e.g. abuse, neglect, phychological trauma and toxins all increase risk

Answer 25

**Down's syndrome** **Antenatal problems** e.g. Fetal alcohol syndrome and maternal chickenpox **Problems at birth** e.g. prematurity and **hypoxic ischaemic encephalopathy** **Meningitis** **Autism** **Epilepsy**

Answer 26

**Health visitors** **Social** workers **Schools** Educational **psychologists** **Paediatricians**, **GPs and nurses** **Occupational therapists** **Speech and language** therapists

Answer 27

**Decision specific** - may take several attempts on different days to make a decision

Answer 28

**Understand decision** to be made **Retain** information long enough to make decision **Weight up** options **Communicate** decision

Answer 29

Girls = 8-14 Boys = 9-15 Taking **4 years from start to finish**

Answer 30

**Breast buds** **Pubic hair** **Menstrual periods** about 2 years from start of puberty

Answer 31

Enlargement of **testicles** Enlargement of **penis** Darkening of **scrotum** Development of **pubic hair** **Deeping of voice**

Answer 32

**Tanner scale**

Answer 33

Lack of the **sex hormones**, oestrogen and testosterone which normally rise prior to and during puberty

Answer 34

**Hypogonadotrophic hypogonadism**: deficiency of LH and FSH **Hypergonadotrophic hypogonadism**: lack of response to LH and FSH by the gonads (testes and ovaries)

Answer 35

Abnormal functioning of the **hypothalamus** or **pituitary gland** * Previous damage to the **hypothalamus** or **pituitary** e.g. by radiotherapy or surgery for previouc cancer * **Growth hormone deficiency** * **Hypothyroidism** * **Hyperprolactinaemia** (high prolactin) * **Serious chronic conditions** e.g. CF or IBD * **Excessive exercise or dieting** can delay onset of **menstuation** * Constituational delay in growth or development - temp delay in grwoth and puberty without underlying physical pathology * **Kallman syndrome**

Answer 36

Abnormal functioning of the gonads, due to: **Previous damage to gonads** (e.g. testicular torsion, cancer, infections e.g. mumps **Congenital absence** of testes **Kleinfelter's syndrome** (XXY) **Turner's syndrome** (XO)

Answer 37

Genetic condition causing **hypogonadotrophic hypogonadism** resulting in **failure to start puberty** associated with **anosmia**

Answer 38

No evidence of pubertal changes in **girl aged 13 or a boy aged 14**

Answer 39

Take **detailed history** of general health, development, FH, diet and lifestyle **Examination** to assess height, weight, stage of pubertal development and features of underlying conditions

Answer 40

**FBC** and **ferritin** for anaemia **U&Es** for chronic kidney disease **Anti-TTG** or **anti-EMA** antibodies for coeliac disease

Answer 41

**Early morning** serum **FSH** and **LH** **TFTs** **Growth hormone testing** (insulin-like growth factor I is used as a screening test for GH deficiency) **Serum prolactin**

Answer 42

**Genetic testing** with a **microassay** - **Kleinfelter's syndrome** (XXY) - **Turner's syndrome** (XO)

Answer 43

**X-ray of the wrist** for bone age and to inform a diagnosis of **constitutional delay** **Pelvic ultrasound in girls** to assess ovaries and other pelvic organs **MRI** of the brain to look for **pituitary pathology** and **assess the olfactory bulbs** in possible **Kallman syndrome**

Answer 44

Treat **underlying condition** Constitutional delay = reassurance and observation **Oestrogen in girls and testosterone in boys** (replacement sex hormones) can be used to induce puberty under expert guidance

Answer 45

**Safeguarding** = all aspects of ensuring welfare of child **Child protection =** process of protecting a child that is at risk of / suffering harm

Answer 46

**Children Act 1989**

Answer 47

**Physical** **Emotional** **Sexual** **Neglect** **Financial** **Identity**

Answer 48

**Domestic violence** **Previously abused parents** **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 with services**

Answer 49

**Safeguarding team** - person who identifies concern should escalate it to someone who can action it

Answer 50

**Children's services** (social services)

Answer 51

**Yes** but only if they are

Answer 52

Over 13 years old

Answer 53

- Number of children who **die** is **small** - Many of the conditions are **rare** and **diverse** / **genetic** - Needed for **few days**, **weeks** or **months**

Answer 54

**Autonomy** - right to self-determination **Non-maleficence** - need to avoid harm **Beneficence** - ability to do good **Justice**