5. Development Flashcards
What is normal development?
Development is a rapidly changing process with large variations in the population and for the same child.
This limits sensitivity and specificity of any examination method
Paediatricians rely on informal assessment
With are the components of the developmental screening process?
- Eliciting Concerns
(Referral letter, History) - Information on Social+Bio Risk Factors
(Discussion) - Structured Observations
(Spontaneous-Play + Illicated-Examination) - Interpreting Findings
(Knowledge of concerning behaviour phenotypes)
What are the 4 keys areas of developmental assessment?
- Gross Motor
- Fine Motor and vision
- Speech , Language and hearing
- Social, emotional and Behaviour
What are the gross motor milestones? (Median Ages)
8-9 months: Crawling
10 months: Walks around furniture
12 months: Walking unsteadily, broad gait, hands apart.
15 months: Walks Alone Steadily
What are the Fine Motor and Vision Milestones? (Median Ages)
Newborn: Follows faces in the midline.
6wks: Follows face by turning the head. (Fix+Follow)
4 Months: Reaching out for toy’s
6 Months: Transfers toy’s form one hand to another.
6 Months: Palmar Grasp
10-12 Months: Mature Pincer
14-18 Months: Scribbles
What clues can block building give to vision and fine motor development?
Towers
X3 = 18 months
X6 = 2 years
X8/train of 4 = 2.5 yeears
Bridge = 3 years
Steps = 4 years
What clues can drawn shapes give to vision and fine motor development?
Ability to draw without seeing how it’s done. (Can copy if drawn 6 months earlier)
Line = 2 years Circle = 3 years Cross = 4 years Square = 4.5 years Triangle <5 years.
What clues can pencil grip give to vision and fine motor development?
1-1.5 years = Cylindrical Grasp
2-3 years = Digital Grasp
- 5-4 years = Modified Tripod Grasp
- 5 – 7 years = Tripod Grasp
What are the hearing, speech and language? (Median Ages)
Newborn = Stills to Voice. Startles to loud noises
3-4 Months = Vocalises alone or when spoken to. (Cooing)
7 Months = Turns to soft sounds out of sight
7 Months = Turns voice to polysyllabic babble.
7 Months = Sounds used indiscriminately (babbling, dada, later mama)
10 Months = Sounds used discriminately to parents
1yr = 1-2 Words other than Mama, Dada. 1yr = Understands own name.
18 months = 6-10 words.
18 months = Points to 4 body parts
- 5 yrs = 3-4 word sentences
- 5 yrs = Understands 2 joined commands.
For how long should corrections for prematurity be applied?
Correction for prematurity should be made to 24 months.
How are the biological risk factors for poor developmental outcomes classified? Examples for each category?
Prenatal: drugs, alcohol, anticonvulsants, viral infections
Perinatal: Prematurity, Low birth weight, Obstetric factors
Neonatal: Neonatal encephalopathy, infections, severe hyperbilirubinaemia
Postnatal: injury/ NAI, meningitis, encephalitis, severe failure to thrive, severe epilepsy.
What are the Family and Social risk factors for poor development?
Poverty Child neglect or abuse Low maternal education Parental Psychopathology Inadequate parenting
Disadvantaged neighbourhood
Absence of a social network and community learning activities
How is development assessed?
Document current abilities
Detail presenting concerns
Review previous milestones and ask about REGRESSION
General health and Growth – centiles!
HISTORY
Previous medical history
Birth and pregnancy history
Family history- developmental delay?, childhood illnesses/ deaths
What physical indicators of development are there?
Centiles- Weight, height, head circumference
Examine the skin- neurocutaneous lesions
Dysmorphic Features
Signs of neglect
Observe
Limb posture, tone and movement.
What are Developmental Red Flags @ <18months.
- Not smiling at 10 weeks
- Early hand preference ( before 6 months) fisting /ATNR
- Not reaching for objects at 7 months
- Not sitting unsupported at 10 months
- No pincer grasp at 12 months /no pointing at 18m
- No single words with meaning at 18 months /comprehension
- Not walking at 18 months
- Developmental regressions at any age
What are Developmental Red Flags @ in the Preschool Child?
- Inability to perform self-care tasks, hand washing simple dressing, daytime toileting
- Lack of socialization
- Unable to play with other children
- Able to follow directions during exam
- Performance evaluation of pre-school teacher for primary school readiness
What is Autism?
A complex lifelong developmental disability that affects the way a person communicates and relates to people around them .
What are warning signs of autism in the <5 year olds?
Delay/absence of spoken language Regression Looks through people Not responsive to other people’s facial expressions Lack of pretend play Doesn’t show interest in peers Lack of turn taking
Unable to share pleasure Impaired non-verbal communication No pointing Lack of initiation of play Unusual repetitive hand mannerisms Unusual reaction/no reaction to sensory stimuli
What are the clinical signs of aurtism?
Triad of impairments:
Impairment of social interactions
Impairment of communication
Impairment of social imagination
What in the medical history may be suggestive of autism?
Epilepsy Visual impairments Hearing impairment Behaviour problems Mental ill health- anxiety, depression and ADHD Sleep problems Neuromotor problems-clumsiness and tics
What are neurodevelopmental disorders are Ddx’s in autism?
Specific language delay
Intellectual disability/global dev delay
Developmental co-ordination disorder
What conditions might cause regression?
Rett syndrome
Epileptic encephalopathy
What other conditions may impact on development?
Severe hearing impairment
Severe visual impairment
Maltreatment/neglect
Selective mutism
How can communication with children with autism be made easier?
Picture Exchange Communication System
What is the prognosis in autism?
Proportionally related to intelligence and development of speech by young age
Few long term good quality follow-up studies available
Few individuals live independently ~20% obtain formal academic qualifications 10-20% enter employment Often less than qualifications allow >66% have no friends
