abnormal development Flashcards
what can cause a developmental delay
underlying pathology
reflection of their environement (neglect, parent mental health)
RF for developmental delay
prem
dysmorphism
visual/hearing impairments
autistic behaviour
what can cause delayed speech/language
hearing impairment cognitive diability constitutional language delay cleft palate ASH psychosocial
what hx is important for delayed speech/language
regression RF for hearing loss - familial, ++ AOM obs hx - maternal infections, drugs other aspects of development ?GDD ?ASD sx
what can cause delayed walking
CP
DMD
what is CP
a group of disorders
persistent but changing disorder of movement and posture due to a defect/lesion of the developing brain
criteria for dx of CP
- <5yrs
- permanent motor impairment
- non progressive neurological insult
how does CP present
neuro-behavioural - ++ irritability or docility - poor feeding - poor visual attention motor - hypotonia then spacticity - poor head control - delayed motor milestones - asymmetric movements - strong early hand preference persistent primative reflexes
what are the 5 types of CP
hemiplegia
- one side
- arms >legs
- delayed walking
- tip toe gait, arm in dystonic position
diplegia
- legs +/- arms
- legs >arms
- ++ hip adduction, scissoring legs
- equinovarus feet, tip toe gait
total body impairment
- most severe
- all limbs involved
- associated with severe learning disability, seizures, swalloing difficulty, GOR
- flexion contractures of knees, elbows by late childhood
athetoid - basal ganglia damage - writhing movements - normal intelligence \++ physical imapirment
ataxic CP
- cerebral damage
- ataxic gait, poor coordination
associated problems with CP
- visual impairment
- squint
- hearing imapirment
- swallowing impairment - dysphagia, drooling
- speech/language impairment
- epilepsy
- chest infections
- GIT - gord, constipation
- dentition - due to CORD
- cognitive impairment
- malnutrition
what are the different levels of CP in terms of gross motor assessment
- normal, can walk, jump
- can walk in most stituations expcept for long, incline. cannot jump
- can walk with hand held aid
- wheel chair bound mostly, can occasioanlly walk
- completely wheelchair bound
what services are involved in CP management
- PT - movement, contractures, splints, aids
- OT - improve functionality in the home
- ST - swallow and language problems
- paediatrician - cooridinate, medical management
- ortho - contractures, skeletal deformitites
- dietician - malnourished
how can CP commonly present to ED
- chest infections
- seizures
- increased pain and irritability
what is ASD
a spectrum of conditions characterised by
- impaired social interaction and communication
- repetitive and restricted behaviour, interests, activities
DSM V for ASD
- Deficits in social communication and interaction in 1+ setting (3/3)
- social emotional reciprocity
- NVC
- devloping, maintaining understanding relationships - restricted, repetitive behaviour/interests/activities >2
- repetitive motor movements/speech
- insistence on sameness, inflexible
- restricted, fixed interests
- increased/decreased response to sensory input or unusual interest in sensory aspects - impairs 2+ facets of life
- sx early in development period
- sx not explained by II or GDD
what conditions are associated with ASD
II
language impairment
ADHD
catatonia
red flags for ASD
- little smiling
- rarely tries to imitate others
- delayed babbling
- no response to name
- no gesture by 10mo
- poor eye contact
- does not seek attention
- abnormal movments
- motor delay
mx of ASD
refer early to paediatrician and child development services
support groups
funding schemes
allied health
how common is ADHD
3-5:100
males more common
DSM V for ADHD
A. 1+/-2
1. 6+ sx of inattention
2. 6+ sx of hyperactivity/impulsiveness
B. sx present for >6mo
C. 2+ settings
D. interferes with social, academic, occupational
E. not better explained by another mental health condition
what is the diagnostic process for ADHD
- initial consult
- detailed hx
- detailed examination
- school report from teacher
- explain what ADHD is to parents and child
- handouts
- discuss medication
diagnostic process
- parents and school vanderbilt assessment
- school report
diagnostic appt
- more explanation of ADHD
- explain rresults of vanderbilt
- examine child
- consider fidget toys and medication
- focus on home and school strategies
- letter to school about dx, strategies +/- medication
long term care
- focus on posititves
- funding for school help
- school feedback
- monitor meds
management options for ADHD
behavioural strategies - structure, smaller tasks posititve parenting medication - methylphenidate SE: HTN, wt loss, stunts linear growth, appetite suppressant
