7 - Child Development Flashcards
What overall factors can affect child development?
Antenatal – illnesses/infections; medications; drugs; environmental exposures
Birth –Prematurity, Prolonged/complicated labour
Postnatal – illnesses/infections; Trauma
Consanguinity – increases chances of chromosomal or autosomal recessive conditions
Developmental milestones from parent
What examinations are used to monitor child development?
Growth parameters – height, weight and head circumference
Dysmorphic features
Neurological examination and skin
Systems examination to identify associations, syndromes
Standardised developmental assessment – SOGSII, Griffiths
What management is used when child development is not progressing as expected?
(Investigations – depends on suspected cause but may include cytogenetic studies; metabolic screen (thyroid, renal, liver and bone profiles); blood ammonia and lactate; urine and blood organic and amino acids; creatine kinase; imaging – CT, MRI; EEG; nerve and muscle biopsy.
Other professionals – referral to members of the multidisciplinary team (MDT) would help identify problems and target input.
The multidisciplinary team – the many professionals who may be involved in the care of children with developmental problems.
What is cerebral palsy?
CEREBRAL PALSY
A disorder of movement and posture arising from a non-progressive lesion of the brain acquired before the age of 2 years.
Incidence 1-2 per 1000 live births
Most causes (~80%) are antenatal
Presentation may evolve and vary with age
Associated problems exist – learning difficulties, epilepsy, visual impairment, hearing loss, feeding difficulties, poor growth, and respiratory problems.
Outline the management of cerebral palsy
Aim is to minimise spasticity and manage associated problems
Summarise some common developmental problems
What is autism spectrum disorder and how is it managed?
AUTISM SPECTRUM DISORDER
Prevalence is 3-6 per 1000 live births
Boys>girls
Usually presents between 2 – 4 years of age
Features include (1) impaired social interaction; (2) speech and language disorder; and (3) imposition of routines with ritualistic and repetitive behaviour.
Comorbidities include learning and attention difficulties, and epilepsy
Management:
Intensive support for child and family
What is Attention Deficit Hyperactivity Disorder (ADHD) and how is it managed?
ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
Diagnostic criteria – (1 )Inattention; (2) Hyperactivity; (3) Impulsivity; (4) Lasting > 6 months; (5) commencing < 7 years and inconsistent with the child’s developmental level
These features should be present in more than one setting, and cause significant social or school impairment.
These children also have an increased risk of: conduct disorder, anxiety disorder & aggression
Risk factors – Boys > girls, ratio 4:1; Learning difficulties and developmental delay
Neurological disorder, e.g. epilepsy, cerebral palsy; first-degree relative with ADHD; family member with depression, learning disability, antisocial personality or substance abuse
A significant proportion of children with ADHD will become adults with antisocial personality and there is an increased incidence of criminal behaviour and substance abuse.
MANAGEMENT:
Psychotherapy – Behavioural therapies
Family therapy
Drugs – If behavioural therapy alone insufficient; stimulants, e.g. methylphenidate (Ritalin), amphetamines (dexamphetamine)
Diet – Some children benefit noticeably from exclusion of certain foods from their diet, e.g. red food colouring
What are learning disabilities and how are they managed?
Prevalence of moderate learning difficulty is 30 per 1000 children
Prevalence of severe learning difficulty is 4 per 1000 children
25% of children with severe learning disability have no identifiable cause
Causes include – (i) chromosome disorders (30%); (ii) other identifiable syndromes (20%); (iii) postnatal cerebral insults (20%); (iv) metabolic or degenerative diseases (1%)
Classified as mild, moderate, severe or profound
May present with reduced intellectual functioning, delay in early milestones, dysmorphic features, ± associated problems (epilepsy, sensory impairment, ADHD)
MANAGEMENT:
Involves establishing a diagnosis and input from the multidisciplinary team with long term follow up.
What is development?
Development is the global impression of a child which encompasses growth, increase in understanding, acquisition of new skills and more sophisticated responses and behaviour.
It serves to endow the child with increasingly complex skills in order to function in society.
What are the four domains/fields of development?
(1) gross motor and posture
(2) fine motor and vision
(3) language and hearing
(4) social, emotional and behaviour.
What does development progress depend on?
Developmental progress depends on the interplay between biological and environmental influences. It follows a constant pattern, although at variable rates, among children.
What are limit ages?
Limit ages are the age by which certain milestones should have been achieved = 2 standard deviations from the mean.
They indicate cause of major concern.
How can developmental progress be monitored or identified?
Developmental progress can be monitored or identified either through developmental screening or by the use of standardised developmental tools.
What is abnormal development?
Refers to the slow acquisition of skills and follows three main patterns:
(1) slow but steady
(2) plateau
(3) regression.
Delay may occur in one or more domain
Summarise the stages of child development
