Week 6: Paediatric 2 (developmental milestone, safeguarding and newborn check)

Question 1

developmental milestones

Answer 1

• Children acquire functional skills throughout their childhood and we use the term ‘development’ to describe those skills acquired between birth and approximately 5 years of age

Question 2

Children’s growth and development is monitored by

Answer 2

their health visitor. If the health visitor has any concerns, they will highlight these to the GP for further assessment. Some children will need additional monitoring (e.g. if they were pre-term and/or have known medical problems).

Question 3

Children will normally be seen by their GP/midwife as a newborn and by their health visitor at

Answer 3

6 – 8 weeks,

9 – 12 months

2 – 2.5 years

Question 4

Developmental milestones are often divided into 4 categories

Answer 4

• Gross motor
• Vision and fine motor
• Hearing, speech and language
• Social, emotional and behavioural

Question 5

developmental milestrones are considered in regards to their

Answer 5

Considered in regards to their ‘median age of acquisition’ and ‘limit age’ by which they should have been achieved. If the skill is not attained by this age then more detailed assessment, investigation or intervention may be required.

Question 6

Developmental milestones are acquired in a

Answer 6

serial manner- one after the other- and their achievement follows similar pattern between children

Question 7

red book

Answer 7

personal child health record

• Shortly before or after your baby is born, you’ll be given a personal child health record (PCHR). This usually has a red cover and is known as the “red book”.
• It’s a good idea to take your baby’s red book with you every time you visit the baby clinic or GP.
• They will use it to record
  
  • Child details e.g. NHS number and DoB
  • Birth history
  • Screening results
  • Growth charts: child weight and height
  • Vaccinations
  • Illness
  • Accidents
  • Medication

You’ll find it helpful to keep the developmental milestones section of the red book up to date too.

Question 8

gross motor development

Answer 8

Question 9

visiona nd fine motor development

Answer 9

Question 10

Hearing, speech and language development

Answer 10

Question 11

Social, emotional and behavioural development

Answer 11

Question 12

Red flags for detection of developmental delay

Answer 12

Question 13

What is the cut-off for an acceptable weight loss in the first 7 days of life?

Answer 13

10%

Question 14

At what age should a child be referred to a paediatrician if they have not begun to walk?

Answer 14

• 18 months
• An infant usually begins to cruise furniture around 10-12 months and can walk alone by 15 months. If walking has not occurred by 18 months the toddler should see a paediatrician

Question 15

How is the seasonal flu vaccination usually administered in children aged 2 and 3?

Answer 15

Nasally

Question 16

At what age should a child develop a mature pincer grip?

Answer 16

9-12 months

Question 17

Which of the following is an example of “Double-syllable babble” displayed by an infant around 9-12 months?

Answer 17

Ba-ba (usually involves repetition of same syllable)

Question 18

Which of the following should be avoided when weaning a child of 7 months?

Answer 18

Honey – risk of infant botulism before 12 months

Question 19

Around what age should a child be able to build a tower of three building blocks?

*

Answer 19

The average age for building a 3 block tower is 18 months. This increases to around 6 cubes by 2 years, and 9 cubes by 3 years.

Question 20

In normal fine motor development, which of the following should occur first?

ADrawing a square

BCopying a circle

CTripod pencil grip

DCopying a cross

ECopying a triangle

Answer 20

Copying a circle

Children tend to be able to copy a shape 6 months before they can draw it. The usual developmental order of drawing shapes is line, circle, cross, square, triangle. Tripod pencil grip is a more mature grip, occurring between 4 and 6 years of age.

Question 21

A resurgence of which hormone precipitates puberty?

Answer 21

GnRH

Question 22

key points regarding child safeguarding

Answer 22

• Safeguarding is everyone’s business
• Put child first and at the centre of all decision
• Communicatee, particularly if concerned
• Cooperate- work together with other professionals and support safeguarding investigations
• Think family
• Recognise the importance of language, faith and culture
• Remember that children can be in need of services as well as needing protecting

Question 23

Immediate referral into social care

Answer 23

• Children at immediate risk of signif harm, including physical, sexual, emotional harm and neglect
  
  • Children with unexplained injuries, suspicious injuries where there is an inconsistent explanation of the injury
  • Children under 2 having unexplained bruising
  • Child victims of trafficking
  • Children where there is evidence of repeated domestic violence witnessed or experienced by a child; adult mental health issues and substance use
    
    • Triad of vulnerability
  • Children who are experiencing, or at risk of, sexual abuse or exploitation
  • Concerns regarding risk of signif harm to unborn baby
  • Children who live or have contact with adults who are known to pose a risk to children
  • Children left home alone
  • Children who allege abuse, inc sexual abuse and grooming
  • Primary age children reporting self harming

Question 24

What is abuse and neglect?

Answer 24

Forms of maltreatment of a child. Somebody may abuse or neglect a child by inflicting harm, or by failing to act to prevent harm. Children may be abused in a family or in an institutional or community setting; by those known to them or more rarely, by others ( e.g. via the internet). They may be abused by an adult or adults or another child or children.

Question 25

categories of abuse

Answer 25

physical, sexual, emotional, neglect

Question 26

**Physical abuse**

Answer 26

May be caused when a parent or carer fabricates symptoms or deliberately induces illness in a child (fabricated or induced illness- Munchausen’s) * Hitting * Shaking * Throwing * Poisoning * Burning * Scalding * Drowning * Suffocating * Physical harm to a child

Question 27

**Sexual abuse**

Answer 27

Involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. * Activities may involve * Physical contact including assault by penetration or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing * Non contact activity such as involving children in looking at, or in the production of sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, grooming a child into preparation for abuse (inc via internet) * Not solely perpetrated by adult males, women can also commit acts of sexual abuse as can other children

Question 28

child sexual exploitation

Answer 28

Question 29

**Emotional Abuse**

Answer 29

* Is the persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development. * It may involve conveying to children that they are worthless or unloved, inadequate, or valued only in so far as they meet the needs of another person. * It may include not giving the child opportunities to express their views, deliberately silencing them or ‘making fun’ of what they say or how they communicate. * It may feature age or developmentally inappropriate expectations being imposed on children. These may include interactions that are beyond the child’s developmental capability, as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction. * It may involve seeing or hearing the ill-treatment of another. Some level of emotional abuse is involved in all types of * maltreatment of a child, though it may occur alone. * Adverse Childhood Experiences

Question 30

**Neglect**

Answer 30

* Is the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. * Neglect may occur during pregnancy as a result of maternal substance abuse. **Once a child is born, neglect may involve a parent or carer failing to:** * Provide adequate food, clothing, shelter (including exclusion from home or abandonment) * Protect a child from physical and emotional harm or danger * Ensure adequate supervision (including the use of inadequate care-givers) * Ensure access to appropriate medical care or treatment. * It may also include neglect of, or unresponsiveness to, a child or young person’s basic emotional needs.

Question 31

**Medical neglect** *

Answer 31

This involves carers minimising or ignoring children’s illness or health (including oral health) needs, and failing to seek medical attention or administrating medication and treatments. This is equally relevant to expectant mothers who fail to prepare appropriately for the child’s birth, fail to seek ante-natal care, and/or engage in behaviours that place the baby at risk through, for example, substance misuse

Question 32

**Handling a disclosure**

Answer 32

* Listen rather than ask questions * Do not stop a young person who is freely recalling signif events * Remain calm, do not give the young person the impression that what they have said is shocking or upsetting * Document everything * Don’t promise not to tell anyone else or that everything will be okay * Report as soon as possible * Record timing, setting, people present, content, quotes * Record all subsequent events up to the time of the decision as to whether to start a formal child protection investigation * Reassure the child and tell them it was the right thing to do in telling

Question 33

**The wider context of safeguarding**

Answer 33

* Domestic and sexual violence * Trafficking * Radicalisation * Modern slavery * Female genital mutilation/cutting * Forced marriage * Honour based violence * Discriminatory abuse

Question 34

**Signs of child abuse**

Answer 34

* Bruising in under 2 * Numerous bruises * Self harm * Withdrawn behaviour * They tell you * Poor dental hygiene * Anxiety * Lack of cleanliness * Unexplained injury’s * Running away * Choosing clothes to cover body

Question 35

**Risk factors for abuse**

Answer 35

* Drug abuse * Mental health * Low socio-economic background

Question 36

signs indicating abuse or neglect

Answer 36

Question 37

indicators of physical abuse

Answer 37

Question 38

indicators of emotional abuse

Answer 38

Question 39

indicators of sexual abuse

Answer 39

Question 40

indicators of sexual exploitation

Answer 40

Question 41

indicators of neglect

Answer 41

Question 42

**Neonatal screening involves**

Answer 42

* Newborn blood spot test * Newborn hearing screening test * Newborn physical examination

Question 43

**Newborn hearing screening**

Answer 43

* The newborn hearing test is done soon after your baby is born. * If you give birth in hospital, you may be offered the test before you and your baby are discharged. * Otherwise, it will be done by your health visitor or another healthcare professional within the first few weeks.

Question 44

which health conditions does the newborn blood spot (heel prick) test screen for

Answer 44

* The new-born blood spot test involves taking a small sample of your baby's blood to check it for **9** rare but serious health conditions. * Sickle cell disease * Cystic fibrosis * Congenital hypothyroidism * Inherited metabolic disease e.g. * Phenylketonuria * Homocystinuria * Severe combined immunodeficiency (SCID)

Question 45

when is the heel prick test done

Answer 45

about day 5 * results take around 6 weeks to be read and results should be recorded in red book

Question 46

**Newborn physical examination (neonate developmental checks)**

Answer 46

* Every baby is offered a thorough physical examination soon after birth to check their eyes, heart, hips and, in boys, testicles. * This is to identify babies who may have conditions that need further testing or treatment. * The examination is carried out within 24 hours of birth and then again at 6 to 8 weeks of age, as some conditions can take a while to develop. * screening tool

Question 47

why do neonatal developmental checks

Answer 47

1. Identify abnormalities (screening tool) 2. Parental reassurance and health education

Question 48

**Neonatal developmental checks: before you begin**

Answer 48

* Establish if baby has name * Carefully inspect both maternal and baby notes * Baby birth weight * Any issues at birth/ pregnancy * APGARs score * Go through history with parents * History’s’ * Maternal history * Antenatal history * Social history * Ask parents * Formula fed or breast fed and how much are they eating * Ask about meconium (tarring stool- first poo) and urine in first 24 hours

Question 49

neonatal developmental checks: (1) prepare and inspect

Answer 49

* Wash hands, intro and consent * Ensure child is settled, stripped and have assistance ready * Top to toe approach * Inspect * General state * Posture * Movements * Colours, skin marks * Dysmorphic features * Length and weight  plot on growth chart

Question 50

neonatal developmental checks: head

Answer 50

* Measure and plot occipito-frontal circumference (biggest of 3 readings) * Palpate suture lines and fontanelles * **Eyes**  red reflex with ophthalmoscope (congenital cataracts and retinoblastoma) * **Nose and mouth** * Cleft-lip * Palate * Suck reflex asking parents if it is okay by placing a gloved finger inside the babies mouth * **Ears** * Mobile pinna * Patent external auditory canal

Question 51

neonatal developmental checks: (3) chest

Answer 51

* Palpate clavicles to ensure no fracture during delivery * Chest * Shape * Movement during resp * Auscultates * HS * Chest bilateral air entry * Heart rate and resp rate * Peripheral saturations using sats probe on babies foot

Question 52

neonatal developmental checks: (4) abdomen

Answer 52

* Inspect: shape (distension), umbilicus, movement with resp’n * Palpate: masses (inguinal, umbilical hernias) * Groin: hernias, femoral pulses (coarctation of the aorta possible if not felt) * External genitalia (+testes in male x2), perineum, anus (position and patency)

Question 53

neonatal developmental checks: (5) Hips, limbs and back

Answer 53

* Movements on limbs equal? * Hands: digits, arm position (brachial plexus) and presence of single palmar crease * Grasp reflex → put finger in hand * Hips – dysplasia- Barlow (do first) and Ortolani tests * Legs : posture, movement and digits * Spine : palpate spinal processes, closely focus on sacrum (spina bifida)

Question 54

neonatal developmental checks: (6) reflexes (brief neurological assessment)

Answer 54

* Tone * Moro’s reflex (Warn parents) * Others e.g. stepping