Behavior and Development Flashcards
development quotient
dev age/chronologic age *100. 70-85- close f/u. 85= normal
primitive reflex
present at birth. gone in 3-6mo. if have CNS injury, become stronger and more sustained.
Moro: birth-4mo
hand grasp- birth-1 to 3mo
rooting: turn head to same side of stimulus when corner of mouth stimulated: birth-6mo
atonic neck reflex- head to one side, arm and leg extend on same side and flex on pop: 2-4wk to 6mo
postural reflex
not present at birth= acquired. facilitate oritentation of body. CNS damage cause delay dev
head rigging: keep head vertical despite tilted body.
parachute: outstretch arm and legs when body moved head first in downward direction
gross motor milestone
birth- head side to side
2mo- lift head when prone. lag when lift from supine position
4mo: roless over, no head lag from supine, rushes chest up with arms
6mo: sits alone, lead with head when pull from supine
9mo: pulls to stand, cruises
12mo- walk
fine motor milestone
birth: fisted hands
3-4mo: hands to midline together then to mouth
4-5mo: reach for obj
6-7mo: rakes. transfer obj from hand to hand
9mo: use immature pincer
12mo: mature pincer (tip of index finger
motor dev red flags
- persistent fisting after 3mo- earliest sign of NM prob
- early rolling over, pulling to stand instead of sitting, persistent toe walking- spasticity
3) spontaneous postures ~ scissoring in spastic kid, frog leg position with hypotonic infant
4) : early hand dominance (bf 18mo) - hemiparesis
language milestone
Prespeech: : 0-10mo
1) brith- attune to human voice, dd parents
2) 2-3: coo (voos), musical sounds
3) 6mo: blabbing (mix vowel + consonants
naming period: 10-18mo
1) 9-12: jargon- parsody
2) 12mo: 1-3 words
3) 18: 20-50 words
word combination period 18-24mo- telegraphic
2y: 25-50% speech intelligible
3y: 3 word sentence. 75% speech intelligible
DD speech or language delay
1) global dev delay or MR
2) hearing impairment
3) enviro deprivation
4) pervasive dev D, like autism
intellectual dev
dep on attention, information processing, memory. language in infants is best indicator of intellectual potential. motor correlates poorly
stages in cog dev
1) sensorimotor: birth -2yo: explore through physical manipulation of obj
2) functional play: >1yo: rec obj and their function
3) imaginative play: 24-30mo: use symbols- blocks to build forts
4) concrete thinking: preschool- elementary- interpret literally
5) abstract thinking: adolescent
obj permanence
9m = why separation anxiety start 6-18mo
cause and effect
9-15mo
magical thinking
noral in preschool toddler years. inanimate obj are alive and have feelings
red flags in cog dev
language estimate verbal IQ, problem solving measure nonverbal so delay in both = think MR
if only language delay ck hearing prob or communication D
only problem solving delay then visual or fine motor prob
discrepancy btw language and problem solve - learning disability
social skills
self and indeed at 15mo. parallel play at 2y. together play at 3
motor deficits
cerebral palsy, metabolic abn, chromosomal abn, MN disease, degen diseasl, SC injury, myopathies, CNS strucural defects
cerebral palsy define and RF
static encephalopathies caused by injury to developing brain in which motor func is primary affected. IQ could be normal.
P: neuro damage- motor prob, seizure, cog defict, MR, learning disability, sensory loss visual and auditory deficits
RF: mom (multiple gestation, premie), prenatal (IUGR, congeital, TORCH), perinatal (traumatic delivery, low apgar, premature or postdate), postnatal hypoxic encephalopathy, intraventricular hemorrhage, trauam, kernicterus)
cerebral palsy epi, dx, classification
epi- .2-.5%
dx- repeated neurodev examinations with incr tone, opacity, hypotonia, asylum reflexes, mV D, abn pattern in disappearance of primitive reflexes.
classification: spastic cerebral palsy- incr tone, scisorring = sign of spasticity, early hand pref, seizure, scoliosis; extrapyramidal cerebral palsy= athetoid CP, writhing, oral motor mvt= prob speech/drooling, hypotonia of neck and trunk limiting exploration
pervasive dev disorder (PDD)
affect multiple dev areas, especially behavior and learning
autism
ADHD
30-50% have 1st degree relative with it
dop and NE prob
dx bf 7
comorbidity: anxiety, conduct D, ODD, OCD
hearing impairment- etio, prognosis
screen bc outcome better if intervene bc 6mo- less delayed speech and language defect, behavioral prob
80% auto recessive. 20% pre/peri/postnatal factors( congenital infection, prematurity, bacterial meningitis, middle ear anomalies)
prog: degree of loss, etiology( inherited is better. acquired associated with more other neural def), family support, after age two>bf, timing of amplification- early=better, cochlear implants- improve hearing
hearing medical eval
genetic eval. Cr lvl bc kidney disease + hearing = aport, viral serologies, CT head
blindness
leading cause: trachoma infection. especially developing countries
retinopathy of prematurity
congenital cataracts
haptic perfection- tactile sensation to dev mental image
colic: define, sig, epi,
crying>3hr
sig: disrupt attachment, cause family stress.
10% newborn- healthy, well fed. being 2-4wk and end 3-4mo
periods of irrtability
enuresis
etio- genetics - chromsome 13; infection, DM, child abuse; constipation is comorbid
sleep
0-4wks: day light reversal.
>4wks: start clustering sleep time
3mo: 50% sleep through the night= 5hr after 12am for 4 wks
abn- trained night waking and feeding= parent need to stop intervening when baby fusses. 4-8mo
nightmare
> 3yo. but can start at 6mo. REM
night terror
common 3-5yo. non REM stage 4 sleep. autonomic arousal
feeding
appetite decr after 1yo. autonomy more important so avoid power struggles
breath -hold spells
5%. start btw 6-18mo. disappear by 5yo
involuntary and harmless
cyanotic speels- most common- frustration/anger - cries- becomes cyanotic- apnea and loc or seizure
pallid spells: unexpected event- fright- hypervasogvagl repsonse- become pale and limp
if induced by excitement or excursus need to ECG to r/o dysrrhythmia
bowel control
avg 29mo. range 16-48mo
bladder control
32 mo. range 16-60
discipline
pubertal growth spurt
50% of wt and 25% ht. happens 18-24hr earlier in female than males
male puberty
6-12mo after female
1) testical enlargement 11-12
2) facial and axillary hair- 2y after pubic hair
female puberty
1) breast buds - thelarche at 9.5yo
2) public hair
3) menarch avg 12.5
tanner male
1: preadolescent. no PH, prepubertal testes
2: testes larger, PH
3: tests larger, penis length incr, darker coarse, curlier hair
4L darkening of scrotal skin, penis length/width incr, PH extending over symphysis pubis
5: adult size genitals, adult PH spread to medial surface of thighs
tanner female
1: pre adolescent breast, no PH
2. elevation of breast and nipple, space downy hair
3: enlargement of breast do sep of areola and breast. darker coarser curlier hair
4: areola and nipple project to form secondary mound. adult type hair cover symphysis pubis
5: nipple project, areola recede. adult PH spread to medial surface of thigh.
sexually active female screen for
culture of gonorrheaew. immunofluorescent ab for chlamydia. syphilis serologic test, POP for HPV, wet mount of trichinous vaginalis
sexually active male screen for
annual syphilis, urinalysis of pyruria, urine ligase for chlamydia
problem drinking
intoxicated 6+ in 1y or having problems in areas attributable to drinking
binge drinking
5+ consecutive drinks at one sitting.
smoking complications
CAD. peptic ulcer disease, preg complications- stillbirth, low birth wt,
obesity
wt >20% ideal body wt= >95% for age and sex.
obesity heath effects
earlier pubertal dev, HTN and CVD, hyperchol, elevated triglycerides, DM2, gallbladder disease, orthopedic prob, poor body image - depression
OCP distadvantages
CI: breast or endometrial ca, stroke, CAD, liver disease
relative CI: HTN, migrane HA, dibetes, sicke cell anemia, elevated lipids, smoking
most common std
herpes simplex, HPV, C trachomatis
T vaginalis
yellow green discharge. strawberry cervix. pH>4.5. tx- oral metronidazole (if alc= antabuse) tx partner. protozoa
bacteria vaginosis
decr in lactobacilli cause inr in gardenella vaginalsi, mycoplasma hominis, gram neg
gray white vaginal disrachge. fishy, little info
pos whiff test. - enhance on KOH. clue cells
pH>4.5.
tx- oral metronidazole or topical clindamycin. partners don’t need tx
candidal vulvovaginitis
candida albicans. ithcing, white curdle dc. inflm. fungal hyphae on wet mount. oral fluconazole. partners don’t need tx
cervicitis
inflm of mucous men of endocerviz. chlamydia or gonorrhea.
purulent endocervical dx, fribale edematous erythmaouts, dyruria, urinary freq, most asx
culture endocervix is gold standard.
tx: clamydia- doxy, erythromycine or azithromycine
gonorrhea- I’m ceftriazone or oral ciprofloacin.
tx partner
PID
lower abd tenderness, cervical motion tenderness, uni/bl adnexal tenderness. and 1 of: fever, wbc>10.5K, infm pelvic mass, incr ERS or CRP, lab evidence of gonorrhea or clamydia
inpt tx- iv cefoxitin + oral doxy or IV clindamycine + gentamicin
urethritis
M>F. info of urethra. but if in F, ck for cervicitis.
most common is gonorrhea or chlamydia.
clinical: dysuria, inc urinary freq, mucopurulent dx, asx infection
dx: pos leukocyte esterase on first void urine specimen, greater than 10bc on gram stain. definitive dx- culture
newborn growth
1-2mo old term: 100cal/kg/d= 20-30g wt gain preterm- 115-130kcal VLBW: 150kcal double wt by 5mo triple by 12
sleep through the night
by age 4-6mo
car seat
under 13yo = back seat. until 2yo, face rear
acetaminophen v vaccine
may lower ab response for some immunizations
RUQ mass + pallor on 9mo old DD
hepatic neoplasm, hydronephrosis, neuroblastoma, teratoma, wilm’s tumor
hepatic neoplasm
can cause asx abd tumor. may have jaundice
hydronephrosis
multicystic kidney could cause this. ck for UTI
neuroblastoma
most common neoplasm in infants. 50% present
wilm’s
likely in 9mo with asx RUQ mass and no jaundice, lymphadenopathy, norm dev. smooth mass and rarely cross midline. 50% have ab pain, V, HTN
mean age of dx-3yo
