4.4 - Pediatric Examination

Question 1

Describe each of the following motor development theories

Neuromaturation Theory
Cognitive Theory

Answer 1

Neuromaturation Theory
- Motor skills develop as the nervous system develops
- “Hierarchic” maturation of neural control
- Biases NATURE

Cognitive Theory
- Environment drives development
Biases NURTURE

Question 2

Describe the stages of motor learning

Answer 2

1) Cognitive - “understanding the goal”
2) Associative - “fine tuning”
3) Autonomic - “automatic”

Question 3

Describe each of the following developmental principles

Cephalocaudal
Proximodistal
Reflexive to voluntary
General to specific

Answer 3

Cephalocaudal - develop head & neck control > trunk control > extremities

Proximodistal - develop proximal control before distal control

Reflexive to voluntary - movements start initially as reflexes then progress to voluntary control

General to specific - just like it sounds lol

Question 4

Describe the developmental spiral / developmental regression

Answer 4

Children “spiral down” to a previous developmental position in order to perform a higher gross motor task

Ex: Child can obtain quadruped position, but must regress back to prone to reach for a toy (a progressive skill)

Question 5

Describe each of the following reflexes & when they should be integrated by

ATNR
STNR
Tonic Labyrinthine
Galant
Rooting
Step
Landau

Answer 5

ATNR - turn head to side, ipsilateral arm extends, contralateral arm bends (“fencing posture”); 6 mos

STNR - head extends –> arms extend & legs flex (quadruped position); head flexes –> UEs flex, LEs extend (downward dog); onset 4-6 mos, integration by 12 mos

Tonic Labyrinthine - prone –> flexor tone; supine –> extensor tone; birth to 6 mos

Galant - stroke on side of back –> ipsilateral sidebend; 9 mos

Rooting - 6 mos

Step - 4 mos

Landau - “superman pose”; occurs around 5 mos

Question 6

Describe the gross motor milestones through infancy

Answer 6

3 months: prone prop, hands to midline
4-6 months: rolling (often prone to supine first)
5 months: hands to feet
6 months: sit independently
8-9 mos: creeping
9-10 mos: pull to stand
10-11 mos: cruising
12-15 mos: independent standing & walking
18-24 mos: running & jumping
2-3 yo: start to stand on one foot, kick ball
4-5 yo: hopping on one foot, gallop
6 yo: skip

Question 7

Describe some common red flags in the pediatric population

Answer 7

Night pain
Pain after activity only
Limp
“can’t keep up with peers”
Gower’s sign
Nystagmus
Primitive reflexes after it should be integrated
Change in function

Question 8

What is a VP shunt?

Answer 8

A ventriculoperitoneal shunt

Drains excess CSF from the brain to treat hydrocephalus

Question 9

Describe s/sx of a VP shunt failure

What should be done if this is suspected?

Answer 9

SUNSETTING EYES

Change in function
Flu like symptoms
Swelling / redness along shunt tract

Medical emergency!

Question 10

What is a tethered spinal cord?

Describe the s/sx
What should be done if this is supsected?

Answer 10

Caudal end of spinal cord becomes stuck & begins to stretch out as the child grows

S/Sx:
- Common around puberty / growth spurt
- Rapid scoliosis
- Changes in urological function
- Back pain that worsens w/ activity

Medical emergency!

Question 11

What is Legg-Calve-Perthes?

Describe the typical presentation
What should be done if this is suspected?

Answer 11

AVN of the femoral head

Clinical Presentation:
- 4-8 yos - really YOUNG
- M > F
- Limp
- Pain w/ activity - groin, anterior / lateral hip, knee
- Painful / limited hip abd & IR

Radiograph of femoral head

Question 12

What is slipped capital femoral epiphysis (SCFE)?

Clinical Presentation
What should be done if this is supsected?

Answer 12

Superior slippage of the femur on the femoral epiphysis

Clinical Presentation:
- 9-16 yo (“SCFE = skipping = older children”)
- M > F
- Limp
- Limited hip flx, abd, IR
- Pain - groin, hip, knee, thigh
- Risk Factor: OBESITY

A/P and frog-leg radiograph

Question 13

What is hip dysplasia?

Clinical Presentation
What should be done if this is suspected?

Answer 13

Flattening of the femoral acetabulum

Clinical Presentation
- (+) Ortolani test
- (+) Barlow test

Ultrasound of hip (typically under 6 mos)
A/P hip radiograph (older children)

Question 14

Describe the Barlow & Ortolani tests

Answer 14

https://med.stanford.edu/newborns/clinical-rotations/residents/residents-newborn-exam/barlow-and-ortalani-manuevers.html

Question 15

Describe a spondylolisthesis

Clinical Presentation
What should be done if this is suspected?

Answer 15

BIL pars interarticularis fracture with anterior slippage of one vertebral body on another

Clinical Presentation:
- 10-15 yo
- Hypermobile females (gymnastics, cheerleaders)
- Step deformity
- Back pain w/ EXTENSION

Oblique radiograph (scotty dog sign)

Question 16

Describe Duchenne Muscular Dystrophy

Clinical Presentation
What to do if you are suspecting this?

Answer 16

A progressive neuromuscular degenerative disorder
- Only occurs in males (x-linked recessive trait)
- Mutation in the dystrophin gene –> lack of dystrophin protein –> allows for damage w/in the sarcolemma w/ contraction of the muscle
- Fat and connective tissue begin to replace the damaged muscle
- progresses rapidly w/ death typically occurring by the time they are a teenager

Clinical Presentation:
- Typically presents between 2-5 years of age
- GOWER’s SIGN
- “Can’t keep up with peers”
- Pseudohyertrophy of calves
- Lordosis
- Tight hip flexors & gastroc, weak hip extensors

Refer to pediatrician, neuro, and genetics

Question 17

Juvenile Arthritis

Clinical Presentation
What to do if suspecting this?

Answer 17

Clinical Presentation:
- Joint pain & swelling
- Morning stiffness
- Weakness
- Limp
- “Not able to keep up with peers”
- Delayed milestones

Refer to rheumatology

Question 18

What standardized assessment is typically used for children w/ CP?

Answer 18

Gross motor function measure (GMFM)
Gross motor functional classification system (GMFCS)

Evaluates changes in gross motor function in kids w/ CP (5 mos - 16 yrs)

Question 19

What does the Peabody assess? What age groups?

Answer 19

Total motor development (fine and gross)
0-5/6 yo

Question 20

What does the AIMS assess? What age groups?

Answer 20

Gross motor milestones
0-18 months