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Year 2 BRS added > Postnatal and Child Development > Flashcards

Postnatal and Child Development Flashcards

1
Q

Genetics effect on prenatal?

A

Minor effect overall
Maternal size important in determining birth size
Paternal genetic factors have little effect on birth
Maternal factors tend to override fetal genetic factors in determining prenatal growth

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2
Q

Genetics effect on postnatal?

A

Largely determines final adult height
Sex chromosomes have an effect:
XY boys are taller than XX girls

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3
Q

Endocrine effect on prenatal? What are the major prenatal hormones influencing growth?

A

Insulin and insulin-like growth factors (IGFs) are major prenatal hormones influencing growth:
IGF-2 most important for embryonic growth
IGF-1 most important for later fetal and infant growth

(Growth hormone has no effect on early growth)

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4
Q

Endocrine effect on postnatal?

A

Human growth hormone (hGH) is the major hormone controlling growth after birth

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5
Q

Nutrition effect on prenatal?

A

Placenta provides all nutrients to growing fetus, therefore essential for growth
Placental insufficiency most common cause of intrauterine growth restriction
Placenta also controls hormones necessary for fetal growth
Maternal diet influences nutritional availability

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6
Q

Nutrition effect on postnatal?

A

Adequate nutrition is essential for growth
Starvation due to lack of substrate availability can limit growth potential
Obesity occurs mostly as a result of excessive intake of food
Poor nutrition may delay the onset of puberty
Malabsorption of nutrients may cause reduced growth

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7
Q

Environment effect on prenatal?

A

Uterine capacity and placental sufficiency important in providing optimal environment for fetus
Placental function is more influential in fetal growth than uterine capacity

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8
Q

Environment effect on postnatal?

A

The following factors are known to influence growth:
Socioeconomic status
Chronic disease
Emotional status
Altitude (mediated by lower oxygen saturation levels)

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9
Q

When do cranial sutures close?

A

Open at birth
Close by 18 months

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10
Q

4 phases of growth?

A

Fetal
Infantile
Childhood
Pubertal

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11
Q

Fetal phase?

A

Accounts for 30% of eventual height
Repeatedly doubles in size over gestation
Driven by HYPERPLASIA
42 cycles of cell division before birth, only further five cycles of cell division occur from birth to adulthood

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12
Q

Infantile phase?

A

0-18 months after birth, 15% of eventual height.
Rapid, but decelerating growth (vs fetal phase)

Length increases by 50%, head circumference by 30% and weight triples vs birth
nutrition dependent

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13
Q

Childhood phase?

A

18 months to 12 years of age, 40% of eventual height.
Steady, slow prolongued growth

5-6 cm annual increase in height, and 3-3.5kg annual increase in weight

Good nutrition and health important, but endocrine growth regulation increasing

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14
Q

Pubertal phase?

A

“Pubertal growth spurt”, 15% of eventual height.
Rising levels of sex hormones boost hGH production

~25cm (XY boys) ~20cm (XX girls) increase in height over 3-4 years

Temporary growth spurt as sex hormones also cause fusion of growth plates

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15
Q

What is the mini-puberty?

A

HPG axis is transiently activated after birth (mini-puberty), after release from restraint by placental hormones
Continues for around 6 months after birth before declining

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16
Q

Mini-puberty reason in males?

A

Elevated sex steroids in males during mini-puberty seems to be important for normal gonadal development (testicular tissue and penile development)

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17
Q

Mini puberty reasons in female?

A

Role of minipuberty less clear in female infants:
Estradiol levels fluctuate through first few months after birth
Follicular development occurs in the ovary
Important for patterning and development of mammary tissue?

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18
Q

Mini-puberty effect on programming of body composition and linear growth?

A

Elevated sex steroids in minipuberty may also influence programming of body composition and linear growth.
High testosterone levels in boys during minipuberty, may partly explain the higher growth velocity observed in boys compared to girls.

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19
Q

Puberty trigger?

A

Release of neurokinin KNDy neurons may regulate release of Kisspeptin peptides, which act on GnRH neurons to promote pulsatile GnRH release

Mutations in KISS1R affect puberty timing, implicating Kisspeptin-KISS1R signalling in regulation of this process.

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20
Q

Consonance meaning?

A

Complying with predictable pattern of developmental events of puberty

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21
Q

IGF 2 vs IGF 1?

A

IGF-2 most important for embryonic growth
IGF-1 most important for later fetal and infant growth

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22
Q

Most common cause of intrauterine growth restriction

A

Placental insufficiency

23
Q

Gonadotrophin secretions during pregnancy?

A

Commences towards the end of the first trimester, peaks mid-pregnancy, then declines

24
Q

Mutations in KISS1R?

A

Affect puberty timing, implicating Kisspeptin-KISS1R signalling in regulation of this process.

25
Q

NHS healthy child programme aims?

A

To prevent disease and promote good health:
- universal
- reduced health inequalities

26
Q

NHS healthy child programme includes?

A

Health promotion
Supporting care giving and care givers
Screening
Immunisation
Identification of high-risk families
Signposting - accident prevention and dental hygiene

27
Q

Fundamentals of a good screening test? Disease factors and test factors

A

Disease screening for:
-should be able to identified early/before critical point
-treatable
-prevent/reduce morbidity/mortality

-acceptable/easy to administer
-cost effective
-reproducible and accurate results

28
Q

Examples of important early childhood screening?

A

-newborn check
-newborn hearing screen
-blood spot check

29
Q

Newborn physical exam? When and what.

A

Within 72 hours
Weight, eyes, heart, hips, testes

30
Q

Blood spot test? When and what.

A

Within 7 days, ideally 5
CF, sickle cell, congenital hypothyroidism, inherited metabolic diseased (PKU)

31
Q

Newborn hearing test? When and what.

A

3-5 weeks
Sometimes done in hospital before discharge, can be done up to 3 months

32
Q

Infant physical exam? When and what.

A

6-8 weeks
With GP, as newborn physical, with length and head circumference - opportunity to discuss vaccinations

33
Q

Sure start?

A

Optimises early life outcomes
High level of investment in children’s community centres, aims to help support families with under 5 year old children in low income households
Parent and child education
Health promotion

34
Q

Global developmental delay?

A

Significant delay in reaching two or more developmental milestones

35
Q

Specific developmental disorder?

A

Refers to delays in developmental domains in absense of sensory deficits, subnormal intelligence or poor educational conditions
- learning disorders
- motor skill disorders
- communication disorders

36
Q

Causes of global developmental delay?

A

Chromosomal abnormalities
Metabolic
Antenatal and perinatal factors
Environmental-social issues
Chronic illness

37
Q

Causes of motor skill developmental delay?

A

(Aspects of global developmental delay)
Cerebral palsy
Congenital dislocation of the hip
Muscular dystrophies
Neural tube defects
Social deprivation

38
Q

Causes of language skill developmental delay?

A

Hearing loss
Autism spectrum disorders
Lack of stimulation
Impaired comprehension of language (developmental dysphasia)
Impaired speech production (stammer, dysarthria)

39
Q

Schedule of growing skills?

A

0-5y
standardised test examining 8 criteria (Locomotor, manipulative, self-care, social skills, hearing and language, speech and language, visuals and cognitive)

40
Q

Griffiths developmental scale?

A

0-6y
measures trends indicative of functional mental growth and the domains listed above through play activities.

41
Q

Bayley Scales of Infant Development?

A

1-42m
assesses cognitive, motor and language skills

42
Q

Denver developmental screening tests?

A

0-6y
assesses ability in domains relative to %age blocks of children from a population who could achieve a skill by a particular age.

43
Q

Developmental domains?

A

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

44
Q

Newborn developmental milestones?

A

Flexed posture
Fixes and follows face
Stills to voice, startles to loud noise
Smiles - by 6 weeks

45
Q

7 months developmental milestones?

A

Sits without support
Transfers objects from hand to hand
Turns to voice, polysyllabic babble
Finger feeds, fears strangers

46
Q

1 year developmental milestones?

A

Stands independently
Pincer grip (10 months), points
1-2 words, understands name
Drinks from cup, waves

47
Q

15-18 months developments milestones?

A

Walks independently
Immature grip of pencil, random scribble
6-10 words, points to four body parts
Feeds self with spoon, beginning to help with dressing

48
Q

2.5 years developmental milestones

A

Runs and jumps
Draws
3-4 word sentences, understands two joined commands
Parallel play, clean and dry

49
Q

Gross motor skills from birth to 15m?

A

6-8 weeks - raises head to 45degrees in prone
6-8 months - sits with round back at 6 months, with straight back at 8 months
8-9 months - crawling
10 months - cruises around furniture
12 months - walks unsteadily, broad gait, hands apart
15 months - walks steadily

50
Q

Fine motor skills from birth?

A

6 weeks - follows moving object or face
4 months - reaches out for toys
4-6 months - palmar grasp
7 months - transfers toys between hands
10 months - mature pincher grip
16-18 months - makes marks with crayon

51
Q

Language skills from birth?

A

Newborn - startles to loud noise
3-4m - vocalises alone or when spoken to, coos and laughs
7m - turns to sounds out of sight
7-10m - 7m sounds used, 10m sounds used discriminately to parents
12m - 2-3 words other than dada or mama
18m - 6-10 words
20-24m - simple phrases of 2 or more words
2.5-3y - talks in 3-4 word sentences

52
Q

Social/behavioural skills from birth?

A

6 weeks - smiles
6-8m - puts food in mouth
10-12m - waves bye
12m - drinks from a cup with 2 hands
18m - holds spoon and gets food safely to mouth
18-24m - symbolic play
2y - dry by day, pulls off some clothing
2.5-3y - parallel play, interactive play, takes turns

53
Q
A

Year 2 BRS added (13 decks)

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