Behavioral/Developmental Peds Flashcards
Development generals
Motor, language, problem solving, psychosocial
Head to toe, prox to distal, gross before fine
Intrinsic and extrinsic factors, dont skip oe skill, go in order, delays in one domain may affect another, or compromise assessment in another
Many of the tests lack sensitivity so listen to the parents!!
DQ = dev. age/chrono age (DQ >85 = normal, <70 = abnormal, followup in between)
General milestone info
Primitive reflexes like Moro present at birth, desappear at 3-6 mos, need sensory stim to generate steerotypical motor response, cns injuries = stronger/more sustained.
Postural rxns = parachute rxn, acquired, faciliated orientation of body in space, adjust things. CNS damage = delayed development of postural rxns
Fine motor skills - during first year of life, hands can do more, conrol of distal muscles improves
Gross Motor Milestones
Birth- turns head side to side,
2 months- lifts head when lying prone, head lag when pulled from supine,
4 mo- rolls over, no head lag when pulled from supine, pushes chest up w/ arms,
6 mo- sits alone, leads with head when pulled from supine
9 mo- pulls to stand, cruises
12 mo- walk
Moro
Symmetric abduction/extension of arms w/ trunk extension, followed by adduction of upper extremeties, from birth- 4 mos
Hand grasp
Grab anything, birth to 1-3 months
Atonic neck reflex
IF head to one side, arms/legs extend on same side and flex on opposite. Fencer position
2-4 weeks to 6 months
Rooting reflex
Turning of head to same side as stimulus when corner of mouth stimulated, birth to 6 months
Head righting
keep head vertical despite body being tilted, 4-6 months and persists
Parachute
Outstretched arms/legs when body is abruptly moved head first in downward direction, starts at 8-9 months
Fine Motor Milestones
Birth- keep hands tightly fisted
3-4 months- bring hands together to midline and then to mouth
4-5 mo- reaches for objects
6-7- rakes objects/transfers from hand to hand
9- immature pincer, hold small obj between thumb/index
12- mature pincer (just tip of index)
Fine motor skills
By second year of life, use objects as tools.
Red flags- persistent fisting beyond 3 mos = earliest sign of neuromotor issues
Early roll over/pulling to stand/toe walking = spasticity
Spont postures like scissoring in spazzy kid or frog-leg in hypotnoic
Early hand dominance pre 18 mo may = weakness in other side
Ddx of motor delay
CNS injury, spinal cord dysfn, periph nerve path, motor endplate dysfn, musc disorder, met disorder, neurodegen conditions
Language skills!
Language = most common delay domain, receptive always mroe advanced than expressive (understand 10x more than speak)
Window of opp for optimal acquisition in first two years
Lang isnt speech?
Lang = ability to comm w/ symbols (signs, writing, body) Speech = vocal only.
Language Milestones
Birth = attunes to human voice, diff recog of parent’s voices, 2-3 mo = cooing, musical, 6 mo = babble, 9-12 = jargon (babble + consonants)
12 mo- 1-3 words mama/dada, 18 mo- 20-50 words, 2 word phrases, 2 years = telegraphic 2 word sentences, 25-50% intelligible, 3 years = 3 word sentences 3/4 understandable
Periods of speech development
Prespeech = 0-10 cooing, babbling (w/ consonants), naming = 10-18, ya get that things have names/labels, word combo period- 18-24 mo, telegraphic,
DDx speech/language delay
Global delay, hearing impariment, environ deprivation, pervasive developmental disorders (autism specturm)
Cog development
Intellectual development dep on attention, info processing, memory. Infant intel look at prob solve/language.
Lang = BEST indicator of intellectual potential (more than gross motor)
big diff between verbal vs. nonverbal = maybe learning disabled
Stages in cog development
Sensorimotor birth to 2 years, from learning to manipulate to manipulating to learn
Functional play at 1yo, imaginative play at 24-30 mo, concrete thinking in late preschool/early elem, abstract in adolescent
Cognitive concepts over time
1) Objective permanence- things exist when ya can’t see em, separation anxiety develops (9 mts, 6-18 mos)
2_ Cause and effect- 9-15 months
3) Magical thinking- normal state of mind, objects are alive/have feelings
Red flags in cog development
Sig delay in language + prob solving = MR
Only language? maybe hearing issue, or commu disorder
Only problem solving? Visual/fine motor problems, cant do manipulation
Diff in language vs. problem solving? Learning disabilities
Social skill milestones
Attachment- bonding w/ primary caregiver, empaty developing in first 3 years
Sense of self/indep - process of separation/individuation at 15 months
Social play- parallel play during first 2 years, play together and share at 3 years
Cerebral Palsy
Static encephalopathies where motor function affected, intelligence may be normal, but CP brain inuries => seizures, cog deficits, MR, learning disab, sensory loss, aud deficits
Timing prenatal or perinatal, .2-.5% incidence, dx from repeated neuro exams w/ spasticit, hypotonia, assym reflexes, weird reflex disappearance
CP Risk factors
Maternal = multiple gest, ptl Prenatal = IUGR< congen malform, TORCH Perinatal = prolonged/precip/trauma delivery, apgar <3 at 15 min, preemie/postdates Postnala = HIE, IVH, trauma, kernicterus (bili in brain)
