Child Development Flashcards

Question

What do the WHO recommend in regards to breast feeding?

Answer 1

Exclusive breast feeding for first 6 months of life

Answer 2

Bottle fed babies *\*NOTE: children & adolescents that were breastfed tend to have less obesity*

Answer 3

For the baby: * Contains antibodies to fight infection * Better cognitive developoment * Reduced risk sudden infant death syndrome * Reduced risk of obesity * Reduced risk of cardiovascular disease in adulthood For the mother: * Decreased risk of breast cancer * Decreased risk of ovarian cancer * Decreased risk of osteoporosis * Decreased risk of obesity * Decreased risk of cardiovascular disease *\*NOTE: it is not clear how far these benefits can be attributed to differences in socioeconomic factors that influence a mother's decision to breastfeed; may in fact be due to confounding.*

Answer 4

* Day 1: 60ml/kg/day * Day 2: 90ml/kg/day * Day 3: 120ml/kg/day * Day 4 and onwards: 150ml/kg/day

Answer 5

* Initially every 2-3hrs * Then every 4hrs * Gradually increase time between feeds * Eventually they feed on demand (when hungry)

Answer 6

* Breast fed can lose up to 10% * Formula fed can lose up to 5% But should be back at birth weight by day 10.

Answer 7

* Lose more than the allowed amount (10% in breastfed or 5% in formula fed by day 5) * Do not regain their birth weigh by 14 days of age

Answer 8

Weight loss!

Answer 9

**Dehydration due to under feeding** (even when they don't aappear clinically dehydrated; weight loss is most reliable sign in babies)

Answer 10

* Gradual transition from milk to normal food * Starts around 6 months * Start with pureed food that easy to palate, swallow & digest. Over 6 months this will progress to healthy diet similar to an older childs; supplement wil milk and snakcs to 1 year of age.

Answer 11

* Used to monitor growth by plotting a child's **weight, length/height& head circumference** against the **normal distribution** for their **age and gender** * Growth charts have curves that indicate the **normal distribution of growth over time**. The **centiles** indicate how a **child's growth compares to the normal distribution for their age and sex** * X axis= age * Y axis= weight, height & head circumference * Main concern is whether the child is **maintaing their centile** *\*NOTE: length is used up to 2hrs, then height is used*

Answer 12

* NICM (neonatal & infant close monitoring) * 0-4yrs *(this includes a pre-term section, 0-1yrs and 1-4yrs chart)* * 2-18yrs For each there is a separate chart for boys and girls as growth is different in each sex.

Answer 13

Describe the number of children, in %, expected to be below that line (e.g. 91st centile: 91% of children expected to be below that) * \*50% of children lie between 25th & 75th centile lines* * \*99% children lie between 0.4th and 99.6th centile lines*

Answer 14

9 centile lines (0.4th, 2nd, 9th, 25th, 50th, 75th, 91st, 99.6th)

Answer 15

Centile space can be either: * Distance between two centile lines on a growth chart * Equivalent distance if midway between two centiles (i.e if midway between 25th & 9th centile but 3 months later they wer midway between 9th and 2nd centile they would have dropped one centile space) *\*centile spacesw are 2/3 of standard deviation*

Answer 16

* \<32 weeks: NICM chart * \>32 weeks but \<37: plot all measurements on preterm section until 42 weeks gestation then plot on the 0-1yr chart using gestation correction * 37 weeks or more: plot on 0-1yr chart

Answer 17

* Mark a **dot** where the vertical line through the child's age and the horizontal line through the child's height/weight/head circumference intersect * If the point is **within 1/4** of centile space of the line they are **on the centile** * If they are **not (^)** they should be described as **being between the two centiles** * If infant is pre-term, **plot all measurements in preterm section until 42 weeks gestation** then plot on the 0-1 year chart using **gestational correction** (draw a dashed line back to the number of weeks preterm and mark with an arrow so that the dot is their actual age and the arrow is their gestationally age giving their gestationally corrected centile. Gestational correction should continue until at least 1 year of age)

Answer 18

* 1st centile: shorter than 99% of children their age & gender * 50th centile: exactly average height for their age & gender * 91st centile: taller than 91% of children their age & gender

Answer 19

* Average adult height centile to be expected for all children of these particular parents * Measure both parents heights (or use reported heights if not available). Mark their heights on relevant mother & father scales. Join the two points with a line. The mid parental centile is where this line crosses the centile line in the middle. * You can compare the mid-parental centile line to the child's current height centile to assess whether child is growing as expected; if large discrepancy between mid-parental centile and child's current height centile increased likelihood of growth disorder in child. * +/- 2 centile spaces of mid parental centile

Answer 20

* Predict a child's adult height based on their current height (it is adjusted to allow for very tall and short children to be less extreme as adults) * Plot most recent height centile on the centre line and read off the predicted adult height for this centile *\*80% of children will be within +/- 6cm of this value as adults*

Answer 21

* After 6 weeks of age head circumference below the 2nd centile * Head circumference above 99.6th centile that continues to rise after 6 months or has associated signs and symptoms (e.g. irritability, vomitting, bulging fontanelles, persistent downward gaze) * Head circumference crossing upwards through 2 centile spaces that continues to rise after 6 months or has associated signs and symptoms (e.g. irritability, vomitting, bulging fontanelles, persistent downward gaze)

Answer 22

Poor physical growth & development in a child NICE "**a lower weight, or rate of weight gain, than expected for age and sex in childhood.**" *\*also referred to as faltering growth or under-nutrition*

Answer 23

* **Indadequete nutritional intake** * ****Maternal malabsorption if breastfeeding * Poor availability of food (e.g. poverty) * Neglect * Lack of knowledge of age appropriate healthy food, feeding skills and interactions * **Difficulty feeding*****(could think of as subcategory of inadequete intake)*** * Poor suck e.g due to cerebral palsy * Cleft lip or palate * Pyloric stenosis * Genetic conditions wiht abnormal facial structure * **Malabsorption** * ****Cystic fibrosis * Coeliac disease * Cows milk intolerance * Chronic diarrhoea * IBD * **Increased energy requirements** * Hyperthyroidism * Chronic diseases e.g. cystic fibrosis, congenital heart disease * Malignancy * Chronic infections e.g. HIV, immunodeficiency * **Inability to process nutrients properly** * ****Inborn errors of metabolism (e.g. phenylketonuria, homocysteineuria, galactosaemia) * T1DM

Answer 24

* **Feeding or eating history** * *Feeding: breast or bottle, volume, frequency, feeding times & any difficulties* * *Eating: food choices, food aversion, appetite, meal time routines (may ask to keep a food diary)* * **Associated symptoms***(e.g. coughing, SOB fever, vomiting, dysphagia, diarrhoea)* * **Pregnancy & birth history** * **PMH including:** * Congenital abnormalities * Developmental delay * Any other known conditions * Allergies & food intolerances * **Psychosocial history, including**: * Social circumstances e.g. who at home, access to food. * Family stress e.g. divorce, housing, financial problems. * Substance and domestic abuse. * Health beliefs that may result in restricted diet (e.g. vegan) * Maternal depression and anxiety. * **Family history including:** * Familial disorders such as coeliac disease, inflammatory bowel disease, and endocrine disorders. * Parental mental health. * Constitutional growth delay in parents. * **Height, weight & BMI (if older than 2yrs)** to plot on growth chart * **Biological parent's heigh to calculate mid-parental height centile**

Answer 25

* **Vital signs** (HR, BP, CRT, RR, Sats, temp) * **General inspection** looking for signs of dehydration, dysmorphic features, anaemia, jaundice, skin or mucosal changes, wasting, lack of energy, or oedema * **Signs of maltreatment** e.g. poor hygience, unexplained bruising * **Carry out a full systems review/examine all systems** looking for signs of cardiac, respiratory, gastrointestinal, neurological, endocrine or other chronic disorders or developmental delay.

Answer 26

* Urine dipstick (for UTI) * Coeliac screen (anti-TTG or anti-EMA antibodies) Dependent on cause may consider/refer for other investigations e.g. for cystic fibrosis, pyloric stenosis, IBD etc..

Answer 27

_Weight_ * Weight falls across 1 or more weight centile spaces if birthweight was below the 9th centile * Weight falls across 2 or more weight centile spaces if birthweight was between the 9th and 91st centiles * Weight falls across 3 or more weight centile spaces if birthweight was above the 91st centile * Current weight is below the 2nd centile for age, regardless of birthweight _BMI_ * BMI below 2nd centile (could be small build or undernutrition) * BMI below 0.4th centile (probable undernutrition) _Length/height_ * Length/height centile is more than 2 centile spaces below mid-parental height centile

Answer 28

**True** *In children over the age of 2 years a body mass index (BMI):* * *Below the 2nd centile may indicate either undernutrition or a small build.* * *Below the 0.4th centile indicates probable undernutrition.*

Answer 29

* 2yrs & under remove all clothes and nappy * Children older than 2 years should wear minimal clothing only. Always remove shoes.

Answer 30

* Should all be weighed in first week and again around 2/3 weeks to check regained birth weight * Once feeding established, weight around **8,12 and 16 weeks and then at 1yr (coincides with when have routine immunisations)** * Aged 1-2yrs have at least 3 recordings of weight * Older than 2yrs have annual recording * Weighing too often can be misleading

Answer 31

Management depends on cause (may have input from MDT) * **Regular reviews** to monitor weight (but not to frequent!) * **Manage/treat underlying cause** e.g. IBD, cystic fibrosis * If there is **difficulty breastfeeding offer support** (involve midwife/health visitor/lactation consultatnt, peer groups) and **advise that can supplement with formula milk** but they should be encouraged to feed with breastmilk prior to top up feeds and express when not breastfeeding to encourage supply * **Signpost to appropriate information & give advice regarding nutrition** such as: * Feed nutrient rich healthy food appropriate to childs age * Encouraging regular structured meal times & snacks * Eat as a family/with other children * Encourage children to feed themselves & allow young children to be messy * Set boundaries for meal times but avoid punishing behaviour or coercive feeding * Avoid too many energy dense drinks e.g. milk as these decrease appetite * **Review/referral to dietician who may:** * Give nutritional supplements * Consider enteral feeding (alongside input from other MDT members)

Answer 32

* Boys: (mother height + father height +14)/2 * Girls: (mother height + father height -14)/2 All in **cm**

Answer 33

* Infancy (birth to 2yrs): rapid growth driven by nutritional factors * Childhood (2yrs to puberty- about aged 11/12): steady slow growth driven by growth hormone & thyroxine * During puberty: rapid growth spurt driven by growth hormone & sex hormones

Answer 34

* **Overweight:** BMI above the **85th** percentile * **Obese:** BMI above **95th** percentile *\*Have growth charts for BMI*

Answer 35

FALSE; obese children are often tall for their age and come from overweight families *\*\*\*If children are short & obese consider endocrine investigations for underlying cause e.g. hypothyroidism (but pathological cause is rare)*

Answer 36

* **Bullying** * Impaired glucose tolerance * T2DM * Cardiovascular disease * Arthritis * Certain cancers e.g. colorectal, gallbladder, pancreatic *\*Unless family addresses issue then it is likely to continue into adulthood and have all negative health implications of adulthood obesity*

Answer 37

**Height more than 2 standard deviations below the average for their age & sex/ height below the 2nd centile for their age & sex** *(this is the same as being below the 2nd centile. Remember centile space is 2/3 of standard deviation so 3 centile spaces is 2 standard deviations. Centiles are 0.4th, 2nd, 9th, 25th, 50th, 75th, 91st and 99.6th. Average heigh tis the 50th centile so 2 standard deviations below is 3 centiles below the 50th centile which is the 2nd centile)*

Answer 38

* Boys starts aged 9-15yrs * Girls starts aged 8-14yrs Puberty usually takes about 4yrs from start to finish

Answer 39

* Familial short stature * Constituional delay in growth & development * Malnutrition * Chronic diseases e.g. coeliac disease, IBD, congential heart disease * Endocrine disorders e.g. hypothryoidims * Genetic conditions e.g. down syndrome * Skeleteal dysplasias e.g. achondroplasia

Answer 40

* CDGP is a **variation of normal development**; **puberty is delayed hence the pubertal growth spurt is delayed and lasts longer.** It is the delay in puberty that causes the delay in the growth spurt. Final height & sexual development are reached at a later age. * Presents with short stature in childhood but child evnetually reaches a normal height in adulthood * Key feature= delayed bone age * Diagnosis is by history, examination & x-ray of hand & wrist to assess bone age * Managment= exclusion of other causes (it is a diagnosis of exlcusion), reassuring parents and child, monitoring overtime

Answer 41

Lack of sex hormones, oestrogen & testosterone/decreased functional activity of gonads

Answer 42

1. Enlargement of testes 2. Gradual darkening of scrotum 3. Development of pubic hair, lengthening of penis and deepening of voice 4. Growth spurt (including development of more muscular physique) 5. Genitals conitnue to enlarge 6. Adult pubic hair, growth of faical hair

Answer 43

1. Thelarche (development of breast buds) 2. Pubic hair growth 3. Growth spurt 4. Menarche *(about 2yrs from start of puberty)* 5. Pubic hair adult 6. Breast adult

Answer 44

* Ages & Stages questionnaire * Denver developmental assessment and schedule of growing skills * Bayley and Griffiths

Answer 45

* Hypogonadotrophic (secondary) hypogonadism: *deficiency of LH & FSH* * Hypergonadotrophic (primary) hypogonadism: *lakc of response to LH & FSH by the gonads (ovaries & testes)*

Answer 46

Tanner scale (based pm examination findings of sexual characteristics)

Answer 47

For girls, look at **both breast development & pubic hair**. Stage 1-5: _Breast Development_ 1: No glandular breast tissue 2: Breeast bud 3: Breast tissue palpable outside areola 4: Areolar elevated forming 'double scoop' appearance 5: Areolar mound recedes back with areolar hyperpigmentation, papillae development & nipple protrusion _Pubic Hair_ 1: No hair 2: Initial growth of long, straight and lightly coloured hairs 3: Pubic hair is s becomes darker, coarser, curlier and spread scarcely over mons pubis 4: Abundant adult type pubic hair (terminal hair) over mons 5: Adult pubic hair distribution- classic traingle. Some may have hair that extends beyond inguinal crease onto medial thigh

Answer 48

For boys, look at both male external genitalia and pubic hair. Stages 1-5: _Male external genitalia_ 1: Testicular volume \<4ml or long axis \<2.5cm 2: Enlargement of scrotum & testes so that testicular volume is \>/= 4ml. Penis may have grown a little in length. 3: Testes continue to enlarge, penis grown in length 4: Testes continue to enlarge, penis grown in both length & width. Head of penis become larger. 5. Adult sized & shaped penis & testes _Pubic hair_ 1: No hair 2: Initial growth of long, straight and lightly coloured hairs at root of penis 3: Pubic hair is s becomes darker, coarser- mostly at the root of penis 4: Abundant adult type pubic hair (terminal hair) which reaches thights 5: Adult pubic hair distribution with hair extending up towards umbilicus & may spread to medial thighs

Answer 49

GnRH (gonadotrophin releasing hormone) is release by hypothalamus and stimulates the anterior pituitary to release LSH and FSH. LH and FSH are gonadotrophins which stimulate the gonads to produce sex hormones. Deficiency of either GnRH or LH and FSH can lead to decreased sex hormones. Occurs due to either abnormal functioning of the hypothalamus or the pituitary: * Damage to hypothalamus or pituitary (e.g. radiotherapy for cancer, injury,. tumour) * Growth hormone deficiency * Hypothyroidism * Hyperprolactinaemia * Congenital e.g. Kallman syndrome * Chronic disease e.g. cystic fibrosis, IBD * Functional e.g. inadequate nutrition/rapid weight loss/eating disorders

Answer 50

GnRH, LH and FSH are released as they should be but the gonads show a lack of response to the gonadotrophins LH & FSH. There is no negative feedback from the sex hormones hence anterior pituitary produces increasing amounts of LH & FSH in attempt to stimulte the gonads hence you get high levels of gonadotrophins (hypergonadotrophic). Occurs due to abnormally functioning gonads: * Damage to gonads (e.g. testicular torsion, cancer, infections such as mumps) * Congenital absence of testes or ovaries * Kleinfelters syndrome (XXY) * Turner's syndrome (XO)

Answer 51

Genetic syndrome causing hypogonadotrophic hypogonadism and an impaired (reduced or absent) sense of smell

Answer 52

Female only genetic disorder in which child only has 1 X chromosome (as opposed to 2); hence karyotype is XO. Ovaries do not complete normal development and hence there is a lack of oestrogen resulting in hypergonadotropic hypogonadism. Treat with HRT. See image for characteristics.

Answer 53

Boys are born with extra X chromosome so have karotype XXY. Symptoms & signs: * History of delayed early development * Delayed puberty * Tiredness * Reduced muscle tone * Gynaecomastia * Taller than expected with long arms & legs * Broad hips * Reduced facial & body hair * Small penis & testicles * Subfertility

Answer 54

* Girls: 13yrs * Boys: 14yrs

Answer 55

_Blood Tests_ * FBC & ferritin: *assess for anaemia (severe chronic anaemia can lead to delayed growth)* * U&E: *asses for CKD (can delay and blunt affects of puberty)* * Anti TTG or anti EMA: *assess for coeliac disease as can delay puberty* * Early morning FSH & LH:*asses if hypergonadotropic or hypogonadotropic* * TFTs: *hypothyroidism can delay puberty* * Prolactin: *prolactin inhibits GnRH release so can cause hypogonadotropic hypogonadism* * Insulin-like growth factor: *assess for GH deficiency as can delay puberty* _Imaging_ * X-ray of wrist: *asses bone age to make diagnosis of CDGD* * Pelvic ultrasound: *asses ovaries in females* * MRI brain: *asses for pituitary pathology & olfactory bulbs (in possible Kallman syndrome)* _Genetic testing_ * E.g. for Turner's syndrome (XO), Kleinfelter's syndrome (XXY)

Answer 56

Depends on cause but may include: * Treat the underlying condition (if present) * If CDGP, reassure and monitor * Replacement sex hormones under expert guidance * Growth hormone supplementation in some conditions such as Turner's syndrome

Answer 57

Healthy child programme The Healthy Child Programme is designed to **offer every family support in making healthy choices**. It includes **immunisations**, **health information**, **developmental reviews**, and access to a range of **community services and resources.**

Child Development Flashcards

(85 cards)