3. Paeds [Development]

Question 1

What are the 4 domains of child development?

Answer 1

Gross motor

Vision and fine motor

Social, emotional and behavioural

Hearing, speech and language

Question 2

What is the red flag age for first steps unsupported?

Answer 2

18 months

Bottom shuffle rather than crawlers develop later; most by 27 months.

Question 3

What is the median age for first steps unsupported?

Answer 3

12 months

Question 4

What should be excluded if a child is a late-walker?

Answer 4

Hypotonia of cerebral palsy
Global developmental delay
Primary muscle disorder
DDH

Question 5

Describe how to adjust for prematurity when calculating developmental age.

Answer 5

Calculate developmental age from the expected delivery date, not the early delivery date.

Correction not required after 2 years when the proportion becomes insignificant.

Question 6

List the 6 primitive reflexes that are evident at birth and gradually disappear:

Answer 6

Placing reflex

Palmar grasp

Rooting reflex

Sucking reflex

Asymmetric tonic neck reflex (ATNR)

Moro reflex

Question 7

List 4 postural reflexes that appear at 4-12 months.

Answer 7

Labyrinthine righting

Postural support

Lateral propping

Parachute

Question 8

Risk factors for hearing loss in babies (6):

Answer 8

FHx of hereditary hearing loss

Congenital infections e.g. CMV and rubella

Craniofacial anomalies of the ear, inc cleft lip and palate

Bacterial meningitis

> 48hrs in the NICU

Genetic syndromes with hearing loss e.g. Down syndrome

Question 9

Describe when and which type of vision screening is performed in the newborn.

Answer 9

Birth - structure of the eye and red reflex (cataracts)

6-8 wks - red reflex for cataracts again. + Fixing and following.

Preschool vision screening - visual acuity and eye alignment

Question 10

Cerebral palsy describes a group of permanent disorders of movement and posture resulting from non-progressive structural abnormalities in the developing brain. Outline the causes of it and % prevalence.

Answer 10

Prenatal = 80%

Perinatal / intrapartum = 10%

Postnatal = 10%

Question 11

Discuss the prenatal causes of cerebral palsy.

Answer 11

Cerebral malformation

Congenital infection e.g. rubella, toxoplasmosis, CMV

Question 12

Discuss the postnatal causes of cerebral palsy.

Answer 12

Meningitis, encephalitis, encephalopathy

Head trauma from accidental or NAI

Symptomatic hypoglycaemia

Hydrocephalus

Hyperbilirubinaemia

Question 13

Discuss the perinatal causes of cerebral palsy.

Answer 13

Birth asphyxia / trauma

Question 14

Possible manifestations of cerebral palsy / symptoms:

Answer 14

Abnormal tone in early infancy
Delayed motor milestones
Abnormal gait
Feeding difficulties

Question 15

Children with cerebral palsy often have associated non-motor problems. List 4.

Answer 15

Learning difficulties (60%)

Epilepsy (30%)

Squint (30%)

Hearing problems (20%)

Question 16

What are the 4 types of cerebral palsy?

Answer 16

Spastic - hemiplegia / diplegia or quadriplegia. Increased tone due to UMN damage.

Dyskinetic - caused by damage to basal ganglia and substantia nigra. Causes athetoid movements and oromotor problems.

Ataxic - caused by damage to the cerebellum with typical cerebellar signs

Mixed

Question 17

Discuss management of cerebral palsy.

Answer 17

MDT approach, child will have multiple and complex needs.

Spasticity treatment inc oral diazepam, oral baclofen, botulinum toxin 2, orthopaedic surgery and selective dorsal rhizotomy.

Anticonvulsants / analgesia as required.

https://www.orthobullets.com/pediatrics/4084/cerebral-palsy–general