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Child health > Approach to a child with developmental delays: > Flashcards

Approach to a child with developmental delays: Flashcards

1
Q

what is developmental delay?

A

i. Failure to attain appropriate developmental milestones for child’s corrected chronological age.
ii. Can correct up to 2 years for a child grown pre-mature

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2
Q

what are the patterns of abnormal development?

A

i. Delay (global – Down’s syndrome and specific – Duchenne’s muscular dystrophy)
ii. Deviation (autism spectrum disorder)
iii. Regression

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3
Q

at what age are deviant patterns of development looked at specifically?

A

27 months

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4
Q

what is delayed abnormal development?

A

achieves it but later on only

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5
Q

what is deviation?

A

not just a simple delay, they may just do things slightly differently

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6
Q

what is regression?

A

i. It is a loss of previously acquired skills
ii. Very worrying
iii. Looks like they are developing normally but if they get a disease and they get over it  might stop doing things the right way

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7
Q

what condition is an example of regression?

A

Retts syndrome - more predominant in girls, girls lose their ability to walk, in born biochemical problems

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8
Q

what percentage of UK children have autism spectrum disorder?

A

1%

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9
Q

what percentage of UK children have a mild learning disability?

A

1-2%

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10
Q

what percentage of UK children have severe learning disability?

A

0.3-0.5%

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11
Q

what percentage of UK children have a specific learning disability?

A

5-10%

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12
Q

what is the range for mild learning difficulty?

A

50-70 IQ

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13
Q

what is the range of IQ for moderate learning difficulty?

A

35-49 IQ

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14
Q

what are the red flags for development?

A 
asymmetry of movement
not reaching for objects by 6 months 
unable to sit unsupported by 12 months 
unable to walk by 18 months 
no speech by 18 months 
concerns regarding vision or hearing 
loss of skills
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15
Q

what is asymmetry of movement?

A
  • Usually we are right handed more than left handed, but in this case they are ignoring the use of one hand completely
  • Haven’t grown over the parachute reflex in one hand
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16
Q

not reaching for objects by 6 months?

A
  • Is there a problem with their vision?
  • Is there a problem with their motor skills?
  • Is there less interest in interaction?
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17
Q

unable to walk by 18 months?

A
  • CK  a small number of children may have a form of muscular dystrophy
  • Most will go on to walk but that is the time when we want to pick up diseases asap
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18
Q

what range of children are affected by global developmental delay?

A

significant under 5’s

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19
Q

how many skills should be affected in global developmental delay

A

Significant delay in 2+ of:

i. gross/ fine motor, speech/ language
ii. cognition. Social/personal, ADL

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20
Q

do children usually catch up with the delay in global developmental delay?

A

i. They say that children usually catch up, but it later on it increases the gap btw them and a child with a normal IQ
ii. 6 months delay/ 2 years  roughly 6 year level at 8 y/o, and 12 year level at 16 y/o
iii. The gap widens and many a times the kids won’t be able to live independently

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21
Q

what are the two types of delay?

A

global and specific

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22
Q

what is an example of global delay?

A

Down’s syndrome

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23
Q

what is an example of specific delay?

A

Duchenne’s muscular dystrophy

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24
Q

how common are genetic causes in global developmental delay?

A

common 5-25%

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25
Q

what are the 21 features of trisomy 21 (Down’s syndrome)

A

Mental impairment Abnormal teeth
Stunted growth
Slanted eyes

Umbilical hernia
Shortened hands
Increased skin on back of neck	
Short neck
Low muscle tone
Obstructive sleep apnea

Narrow roof of mouth
Bent fifth finger tip

Flat head
Brushfield spots in the iris

Flexible ligaments
Single transverse palmar crease

Proportionally large tongue
Protruding tongue
Abnormal outer ears
Congenital heart disease

Flattened nose Strabismus

Separation of first and second toes
Undescended testicles

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26
Q

what are the medical screenings that should be done for Down’s syndrome?

A

i. Cardiac
ii. Vision  hard to accommodate vision
iii. Hearing (Brachycephaly  increased middle ear effusions)
iv. Thyroid function  common under active thyroid
v. Sleep related breathing disorders  sleep apnoea
vi. Growth- charts  different growth patterns, height tends to be shorter and they tend to put on more weight
vii. Development

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27
Q

what is a motor delay in children?

A

Duchenne Muscular Dystrophy, Cerebral Palsy, Co-ordination disorders

28
Q

what is a language delay in children?

A

specific language impairment

29
Q

what is a sensory deficit and associated delay in children?

A

Oculocutaneous Albinism, Treacher-Collins

30
Q

what is a developmental deviation in children?

A

autism spectrum disorders

31
Q

what are the features of Duchenne muscular dystrophy?

A

i. X-linked disorder
ii. Mother is usually a carrier (50/50 chance of affecting the boy child)
iii. Carriers usually have a little bit delay in walking but nothing much
iv. Highly accentuated lordosis
v. Pseudohypertrophy of the calves (muscle replaced by fibrous tissue so they are still weak)
vi. Weakness of pelvic muscles **presents with Gower’s manoeuvre
vii. Speech and language delay
viii. Can develop associated respiratory and cardiac problems

32
Q

what maneuver do children with DMD present with?

A

Gower’s manoeuvre.

also present in any disease that causes pelvic weakness

33
Q

what are the conditions associated with cerebral palsy?

A 
diplegia
hemiplagia 
quadriplegia 
epilepsy 
visual/hearing impairment 
communication difficulties 
feeding difficulties 
sleep problems 
behavior problems 
hearing loss 
visual loss 
increased tightness of muscle groups
34
Q

what determines what conditions a child with cerebral palsy will have?

A

depends on which side of the brain are affected - children born pre-mature usually always have problems with visual tracts such a lower visual tract defects

35
Q

what is needed when there is increased tightness of muscle groups as those with CP grow older?

A

physiotherapy

36
Q

what may be different in delivering babies that are affected by CP?

A

may be difficult to deliver these babies (as there has been damage done antenatally and are born that way)

37
Q

diplegia

A

22-33 weeks of pregnancy, big placental abruption, interruption of blood shed to the water shed areas of the brain at crucial areas, walk on tiptoes so increased risk of falling

38
Q

between hemiplegia and quadriplegia which one is less common?

A

hemiplegia

quadriplegia - highest effect, worst prognosis

39
Q

CP

A

is not a progressive condition

40
Q

which type of cerebral palsy affects 22-33 weeks of pregnancy, big placental abruption, interruption of blood shed to the watershed areas of the brain at crucial areas?

A

diplegia

41
Q

what is spastic diplegia?

A

protected from learning problems

42
Q

what are sleep problems that people with CP have?

A
  • Normal circulating levels of melatonin not in the right amount in these children
  • Silent reflux  due to co-ordination difficulties
  • Bad dental decay
43
Q

what are behavior problems that people with CP have?

A

Abused

Poor communication skills

44
Q

what are hearing loss problems do people with CP get?

A

bilateral middle ear effusions, blocked, sticky ears, sounds like you are under water and miss out a lot of high frequency sounds

Sensory neuro

45
Q

what is affected in oculocutaneous albinism?

A

i. Blonde skin
ii. Blonde hair
iii. Can see right back to the retina (as the iris isn’t coloured)
iv. Involuntary to movement
v. Photophobia
vi. May have nystagmus
vii. Hearing ipairment

46
Q

what are the causes of hearing impairments in those with oculocutaneous albinism

A

i. bilateral middle ear effusions, blocked, sticky ears, sounds like you are under water and miss out a lot of high frequency sounds
ii. sensory neuro

47
Q

what is the autistic trio?

A

i. Communication
ii. Social interaction
iii. Flexibility of thought/ Imagination
iv. Restricted, repetitive behaviours
v. Sensory difficulties

48
Q

what are the differences in the language variations in ASD communication?

A

receptive language
expressive language
non-verbal language
use of language

49
Q

receptive language

A
  • Delayed
  • Expressive>Receptive
  • Abstract language difficult
  • Visually more able
50
Q

expressive language

A
  • Can appear Delayed
  • Echoes  repeating what they have just heard, or actually delayed  so it might look like they are coming up with something new but tbh they are just repeating it
  • Odd intonation/pitch  not spontaneous
  • Chunks of video speak
  • Non-verbal signs are affected
51
Q

non-verbal language

A
  • Facial expressions, gesture
  • Eye contact
  • Recognising intention of others
52
Q

use of language

A
  • Initiating and sustaining conversation
  • Restricted interests
  • Lack of awareness of reciprocal nature of conversation  they usually just keep going and don’t stop talking
  • They don’t know that they have to ask to get something
53
Q

difference in girls vs boys?

A

i. Girls  neurotypical, its something that their peers are talking about and they a lot about it but don’t know what else to talk about
ii. Boys  stuck with Thomas engine

54
Q

how does ASD affect social interaction?

A

i. Joint Attention and Referencing
• Trying to turn their attention to what you want
ii. Turn taking
• Very hard to get them to wait for others
• Keep control as much as they can
iii. Unable to share pleasure
iv. Not motivated by need for social approval
v. Social rules - don’t always follow it
vi. Empathy – can’t empathise with their own emotions, so extremely difficult to relate to others
vii. Relationships
viii. Others point of view/feelings

55
Q

what are the flexibility/thoughts/imagination in ASD?

A

i. Theory of mind – have a box with smarties cover in it but they only have pencil, and they think that everyone should know it
ii. Concrete and lateral – eg: told that they should cut out crisps from him diet but he thought they were literally going to cut him open
iii. Concept of time
iv. Routines
v. Changes in environment
• Some may notice very tiny changes in the environment
• Line up cars and objects according to size and shape and they want to put it back
vi. Ritualistic behaviour
• Carry around certain objects

56
Q

what are sensory issues associated with ASD?

A

i. Fussy eater/ medications
ii. Textures of clothes
iii. Sleep
iv. Toilet training – big issues
v. Hair washing / cutting – they will scream but will have a problem when they are not in control
vi. Nail cutting
vii. Noise
• May be over/ under sensitive – a big bag may calm them and stuffing themselves in small places

57
Q

what is the approach to developmental delay?

A

i. History
ii. Exam
iii. Investigations
iv. Assessments

58
Q

how to identify developmental delay in neonatal?

A

odd behavior, won’t eat, won’t respond to sound

59
Q

how to identify developmental delay in infants?

A

are they achieving their milestones, are they developing their language

60
Q

pregnancy and developmental delay

A

did mom smoke/alcohol infections?

61
Q

environmental and developmental delay

A

post natal depression/environmental problem, meningitis, post injury

62
Q

what are the investigations of developmental delay?

A

i. Chromosomes, FRAX (fragile x) & Oligoarray CGH
ii. Neonatal PKU, thyroid studies, CK
iii. If indicated:
- MRI brain 9only in indicated
- EEG (only is eizures)
- Metabolic studies (intervurrent illness)
- Genetic consultation (conasngruant parents)
- Others (hypertonic or not)

63
Q

what are the various developmental assessments done?

A

MDT
appropriate assessment tool
always start with immediate early intervention without waiting for the results to come back
other things to help make the environmental conditions better - realistic approach

64
Q

immediate early interventions:

A 
o	Therapy
o	Physio
o	SLT
o	OT
o	Family Support
o	Educational Placement
o	Referral to Other Agencies
65
Q 
appropriate assessment tools: for the ages:
0-3
0-5
0-8
ASD
A

Bayleys
schedule of growing skills
Griffiths
ADOS

Child health (10 decks)

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