Abnormal development Flashcards
Major milestones to remember
4-6wk - smiles socially, fixes face with eye
6m - sits unsupported
9m - Gets into sitting position
10m - Pincer grasp, waves bye bye
12m - walks unsupported, 2or 3words with meaning
12-18m - speaks 2-3 words
18m - Tower of 3-4 cubes, fees self wth spoon, points to things, Throws a ball without falling
24 m 2-3 words sentences, running, kicks a ball.
Developmental features with a child with ASD
12m child does not babble, point to objects or use gestures
18m no meaningful words
24m does not use 2 word phrases spontaneously
Loss of language or social skills at any age.
Red flags at any age for development abnormality
Not achieving indicated developmental milestones
Strong parent concerns
Signigicant loss of skills
Lack of response to sound or visual stimuli
Poor interaction with adult or other children
Difference between right and left sides of body in strength, movement or tone.
Loose and floppy movement (low tone) or stiff and tense (high tone)
Red flags of milestones in a 6 month old
S and E - Does not smile or squeal in response to people
C - Not starting to babble eg Adam, oogoo
FM and C - not reaching for and holding (grasping) toys
GM - Not rolling, not holding head and shoulders up when on tummy
Persistent primitive reflexes
Persistent squint
Hand preferences
Red flags of milestones of a 9 month old
S and E - not sharing enjoyment with other using eye contact or facial expression
C - no gestures eg pointing, showing, waving. Not using 2 part babble eg gaga,
FM and C - Unable to hold and/or release toys. Cannot move toy from one hand to another.
GM - Not sitting without support, not moving eg creeping or crawling motion, Does not take weight well on legs when held by an adult.
Red flags of milestones in a 12 month old
S and E - does not notice someone new, does not play early turn taking games eg peekaboo, rolling a ball.
C - No babbled phrases that sound like talking
FM and C - Majority of nutrition still liquid/purée, cannot chew solid food, unable to pick up small items using pincher grin.
GM - Not crawling or bottom shuffling, not pulling to stand, Not standing holding on to furniture.
Red flags of milestones in a 18 months
S and E - lacks interest in playing and interacting with others
C - No clear words, cannot understand short request eg where is the ball.
FM and C - Not holding or scribbling with a crayon, Does not attempt to tower blocks
GM - Not attempting to walk without support, not standing alone.
Persistent mouthing or drooling.
Red flags of milestones at age 2 yrs
S and E - when playing with toys tends to bang, drop, or throw them rather than use them for their purpose eg cuddle doll, build blocks.
C - does not have at least 50 words, not putting words together eg push car, Most of what is said is not easily understood.
FM and C - No interest in self care skills eg feeding dressing
Red flags of milestones 3yr old
S and E - no interest in pretend play or other children,Difficulities in noticing and understanding feelings in themselves and other eg happy, sad.
C - Speech difficult to understand, not using simple sentences eg big car go
FM and C - Difficulty helping with self care eg feeding dressing, Difficulty manipulating small objects eg threading beads.
GM - Not running well, Cannot walk up and down stairs, cannot kick or throw a ball, cannot jump with 2 feet together
Red flags of milestones at 4 yrs
S and E - Unwilling/unable to play cooperatively
C - speech difficult to understand, unable to follow directions with 2 steps
FM and C - Not toilet trained by day, unable to draw lines and circles
GM - Cannot pedal a tricycle, cannot catch throw or kick a ball, cannot balance well standing on one leg.
Red flags of milestones in a 5 yr old
S and E - Play is different than their friends
C - Difficulty telling a parent what is wrong, cannot answer questions in a simple conversation
FM and C - Concerns from teacher about school readiness, not independent with eating and dressing, Cannot draw wimple pictures eg stick person.
GM - Awkward when walking, running, climbing and using stairs, Ball skills are very different to their peers, unable to hop 5 times on each foot.
Red flag milestones at any age
Lack of or limited eye contact.
Causes of developmental delay
Idiopathic - autism, Various Dysmorphic syndromes
Chromosomal abnormalities - Down’s syndrome, Fragile X
Perinatal injury - Asphyxia, birth trauma
Prenatal injury - feral alcohol syndrome, intrauterine infection (TORCH)
Endocrine and metabolic defects - Congenital Hypothroidism, Phenylketonuria
Neurodegenerative disorders - Leucomalacia
Neurocutaneous syndrome - Sturge-Weber, neurofibromatosis, tuberous sclerosis
Post natal injury - Meningitis, non-accidentally injury, Neglect
Central nervous system malformation - Neural tube defects, hydrocephalus
Hx Q for development delay
Milestones
Loss of skills suggests a neurodegenerative condition
Check if concerns about vision and hearing
PmHx - Alcohol consumption. Medica problems and medication during preg. Enquire about prematurity and neonatal complications
FmHx - learning difficulties and consanguinity
Global development delay
Delay in all milestones
Generally indicated significant learning disability
Need to refer to a development assessment team.
Examination of a child with developmental delay
Developmental skills all four areas of development as well as vision and hearing. Also alertness, responsiveness, interest in surroundings, determination and concentration; these all have positive influences on a child’s attainment.
GI - Dysmorphic features, microcephaly (Fetal alcohol syndrome or intrauterine infections). Poor growth is common but may be due to Hypothroidism or non-organic failure to thrive - look for signs of neglect
Look for cafe au lait spots, Depigmentation patches and port wine stains which are indicative of neurocutaneous syndromes.
Hepatosplenomegaly suggests metabolic disorder
Neuro examination - abnormal tone, strength and coordination, deep tendon reflexes, clonus, cranial nerves and primitive reflexes and ocular abnormalities.
