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Pediatrics BRS > Chapter 2 - Development and Behavior > Flashcards

Chapter 2 - Development and Behavior Flashcards

1
Q

Development of a child may be influenced by intrinsic or extrinsic factors. What are some extrinsic factors that may affect development?

A
  • personalities of family members
  • economic status
  • depression or mental illness in caregivers
  • availability of learning experiences
  • cultural setting into which the child is born
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2
Q

True or false? Attainment of a particular developmental milestone or skill depends on the achievement of earlier skills.

A

almost always true, rarely are skills skipped

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3
Q

Give two ways in which a delay or deficit in one developmental domain may affect another domain.

A
  • delay in one domain ay impair development in another

- a deficit in one developmental domain may compromise the assessment of skills in another domain

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4
Q

How might motor deficits affect a child’s cognitive development?

A

neuromuscular disorders affecting the child’s ability to explore the environment may compromise cognitive development

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5
Q

True or false? A normal developmental screening test should outweigh parental concern.

A

often false; because many developmental screening tests lack sensitivity, parental concern should not be disregarded

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6
Q

What is a developmental quotient and how is it calculated?

A

DQ = (developmental age/chronological age) x 100

  • it is used to determine whether a child’s development is delayed and to measure the extent of the delay
  • > 85 is considered normal, < 70 is considered abnormal, and between 70-85 requires close follow-up
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7
Q

Gross motor development evaluation includes assessment of what two sets of actions?

A
  • developmental milestones

- neuromaturational markers (i.e. primitive reflexes and postural reactions)

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8
Q

What are neuromaturational markers?

A

a term used to describe primitive reflexes and postural reactions

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9
Q

What is the difference between a primitive reflex and a postural reaction?

A
  • primitive reflexes are present at birth and then disappear (usually between 3-6 months); infants with CNS injuries show stronger and more-sustained primitive reflexes
  • postural reflexes are acquired and help facilitate the orientation of the body in space; CNS injuries delay development of postural reactions
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10
Q

How will CNS injury affect primitive reflexes and postural reactions?

A
  • primitive reflexes are likely to be stronger and more sustained
  • postural reactions are more likely to be delayed in developing
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11
Q

Describe the moro reflex, when it appears, and when it should disappear.

A
  • symmetric abduction and extension of the arms, followed by adduction of the upper extremities
  • present at birth
  • disappears by 4 months of age
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12
Q

Describe the hand grasp reflex, when it appears, and when it should disappear.

A
  • a reflexive grasp of any object placed in the palm
  • present at birth
  • disappears by 1 - 3 months of age
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13
Q

Describe the atonic neck reflex, when it appears, and when it should disappear.

A
  • if the head is turned to one side, the ipsilateral arms and legs extend while the contralateral side flexes
  • present around 2 - 4 weeks of age
  • disappears by 6 months of age
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14
Q

Describe the rooting reflex, when it appears, and when it should disappear.

A
  • stimulation of the corner of the infant’s mouth causes ipsilateral head turning
  • present at birth
  • disappears by 6 months
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15
Q

Describe the head righting postural reaction, when it appears, and when it should disappear.

A
  • it is the ability to keep the head vertical despite the body being tilted
  • first seen around 4 - 6 months of age
  • persists
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16
Q

Describe the parachute postural reaction, when it appears, and when it should disappear.

A
  • when the body is abruptly moved head first in a downward direction, the arms and legs outstretch
  • first seen around 8 - 9 months of age
  • persists
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17
Q

What general change occurs in the second year of life with regards to fine motor skills?

A

infants learn to use objects as tools

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18
Q

Give four red flags with regards to delayed motor development.

A
  • persistent fisting beyond 3 months of age (earliest sign)
  • early rolling over, early pulling to a stand instead of sitting, and persistent toe walking (may indicate spasticity)
  • spontaneous postures, such as scissoring
  • early hand dominance before 18 months of age may be a sign of weakness of the opposite upper extremity associated with hemiparesis
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19
Q

What is usually the earliest sign of neuromotor problems through the course of infant development?

A

persistent fisting beyond 3 months of age

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20
Q

Early rolling over, early pulling to a stand instead of sitting, and persistent toe walking could all be indicators of what?

A

spasticity

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21
Q

When should hand dominance first arise in children? What is early hand dominance often a sign of?

A
  • should be seen after 18 months of age

- early dominance may be a sign of weakness of the opposite upper extremity associated with hemiparesis

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22
Q

Delays in which developmental domain are most common?

A

delays in language

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23
Q

How does the development of receptive language compare to expressive language?

A

receptive language is always more advanced; children usually understand 10 times more words than they speak

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24
Q

What is the difference between speech and language?

A
  • language is the ability to communicate with symbols

- speech is the vocal expression of language

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25
Q

What is the optimal time period of life for language acquisition?

A

during the first two years of life

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26
Q

What and when are the three basic periods of speech development?

A
  • the prespeech period (0-10 months): expressive language consists of cooing and babbling while receptive language is characterized by an increasing ability to localize sounds
  • the naming period (10-18 months): is when infant’s understand that people have names and objects have labels
  • the word combination period (18-24 months): is when early word combinations are present but telegraphic
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27
Q

Children begin to combine words how long after saying their first word?

A

typically combine words 6 - 8 months after saying their first word

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28
Q

What are the four primary differential diagnoses for speech or language delay?

A
  • global developmental delay/mental retardation
  • hearing impairment
  • environmental deprivation
  • pervasive developmental disorders including autism
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29
Q

Intellectual development depends on what three other abilities?

A
  • attention
  • information processing
  • memory
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30
Q

What is the single best indicator of intellectual potential in an infant?

A

language; gross motor skills correlate very poorly with cognitive potential

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31
Q

On standardized intelligence tests, significant discrepancies between verbal and non-verbal (aka performance) abilities suggests what?

A

possible learning disabilities

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32
Q

Describe the stages of cognitive development.

A
  • sensorimotor period (birth to 2 years): infants explore their environment through physical manipulation of objects, first bringing objects to the mouth for oral exploration and then, as peripheral motor skills improve and precise manual-visual manipulation is possible, true inspection of objects; the infant goes from learning to manipulate to manipulating to learn
  • functional play (begins at 1 year): the child recognizes objects and associates them with their function
  • imaginative play (begins at 24-30 months) when the child is able to use symbols, for example using blocks to build a fort or using sticks as guns
  • concrete thinking (preschool and early elementary school years): interprets things literally
  • abstract thinking (develops adolescent years)
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33
Q

What is the sensorimotor period of cognitive development?

A
  • a period from birth to 2 years of age
  • begins by learning to manipulate objects and then manipulating objects to learn
  • they explore their environment through physical manipulation of objects, first bringing objects to their mouth for oral exploration
  • true, precise, manual-visual manipulation begins as the child’s peripheral motor skills improve
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34
Q

What is the functional play stage of cognitive development?

A
  • a period beginning at about 1 year of age

- the child recognizes objects and associates them with their function

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35
Q

When should imaginative play, concrete thinking, and abstract thinking develop?

A
  • imaginative play begins at 24-30 months of age
  • concrete thinking begins in preschool or early elementary school
  • abstract thinking develops during adolescence
36
Q

When does object permanence develop?

A

around 9 months of age

37
Q

When and why do babies develop separation anxiety?

A

it begins sometime between 6-18 months as the child develops an understanding of object permanence and can maintain an image of a person

38
Q

When do babies begin to explore and understand cause and effect?

A

around 9-15 months

39
Q

When is magical thinking normal?

A

during the preschool and toddler years it is normal for children to assume that inanimate objects are alive and have feelings

40
Q

How do we estimate verbal and non-verbal intelligence?

A

by assessing language development and problem solving skills, respectively

41
Q

What would be considered warning signs for poor cognitive development?

A
  • if skills are delayed in both language and problem solving domains, this suggests mental retardation
  • if only language skills are delayed, hearing impairment or communication disorder are possible
  • if only problem solving is delayed, visual or fine motor problems that interfere with manipulative tests may be present
  • if there is a significant discrepancy between language and problem solving skills, there is a high risk for learning disability
42
Q

When do babies develop a sense of self and independence?

A

individuation begins at about 15 months of age

43
Q

What kinds of social play do babies partake in and at what ages is this true?

A
  • parallel play occurs in the first two years of life

- they learn to play together and share at about three years

44
Q

Cerebral Palsy

A
  • a group of non-progressive (i.e. static) encephalopathies caused by injury to the developing brain, primarily affecting motor function but often leading to seizures, cognitive deficits, or visual and auditory deficits
  • risk factors include maternal (multiple gestation, preterm labor), prenatal (intrauterine growth retardation, congenital malformations or infections), perinatal (prolonged or traumatic delivery, apgar less than 3 at 15 minutes, premature or postdate birth), or postnatal factors (hypoxic-ischemic encephalopathy, intraventricular hemorrhage, trauma, or kernicterus)
  • the diagnosis is made based on repeated neurodevelopmental examinations showing increased tone or spasticity, hypotonia, asymmetric reflexes or movement disorder, or abnormal patterns of primitive reflexes or postural responses
  • can be classified as spastic cerebral palsy with increased tone and further divided into spastic diplegia, hemiplegia, or quadriplegia or as extrapyramidal cerebral palsy
45
Q

What are the risk factors for cerebral palsy?

A
  • maternal: multiple gestation or preterm labor
  • prenatal: intrauterine growth retardation, congenital malformations, or congenital infections
  • perinatal: prolonged or traumatic delivery, apgar score less than 3 at 15 minutes, premature or postdate birth
  • postnatal: hypoxic-ischemic encephalopathy, intraventricular hemorrhage, trauma, or kernicterus
46
Q

How is cerebral palsy classified?

A
  • spastic: affected patients have increased tone
    • spastic diplegia affecting lower more than upper limbs
    • hemiplegia: unilateral spastic motor weakness
    • quadriplegia: motor involvement of head, neck, all limbs
  • extrapyramidal: problems modulating the control of the face, trunk, and extremities
47
Q

Spastic Diplegia Cerebral Palsy

A
  • a static encephalopathy characterized by primarily spastic motor weakness in the lower extremities more than upper
  • other symptoms may include seizures, cognitive deficits, and auditory or visual defects
  • prematurity is the primary risk factor
  • clinical clues include a history of early rolling over, increased tone, and scissoring posture
48
Q

Spastic Hemiplegia Cerebral Palsy

A
  • a static encephalopathy characterized by primarily unilateral motor weakness
  • other symptoms may include seizures, cognitive deficits, and auditory or visual defects
  • perinatal vascular insult, postnatal trauma, and CNS malformations are the primary risk factors
  • clinical clues include early hand dominance, which may manifest as always attempting grasps with one hand and fisting or absent pincer on the affected side
49
Q

Spastic Quadriplegia Cerebral Palsy

A
  • a static encephalopathy characterized by primarily motor weakness affecting all four limbs, the head, and neck
  • other symptoms may include seizures, cognitive deficits, and auditory or visual defects
  • clinical clues are seizures, scoliosis, weakness of the face and pharyngeal muscles with dysphagia, gastroesophageal reflux or aspiration pneumonia, FTT, speech problems and sensory impairments
  • risk factors include hypoxic-ischemia encephalopathy, CNS infections, CNS trauma, or CNS malformations
50
Q

Extrapyramidal Cerebral Palsy

A
  • a static encephalopathy characterized primarily by involvement of extrapyramidal motor systems, resulting in athetoid movements
  • problems involve modulating control of the face, neck, trunk, and limbs with the arms more affected than the legs and prominent oral motor involvement
  • likely to present with marked hypotonia of the neck and trunk, intermittent posturing, and problems with feeding, speech, and drooling
  • risk factors are full-term infant with hypoxia-ischemia or kernicterus damaging the basal ganglia
51
Q

Mental Retardation

A
  • significantly subaverage general intellectual functioning which affects development of adaptive behavior
  • can be classified as mild (55
52
Q

What is the difference between mental retardation and learning disability?

A
  • mental retardation is a general intellectual functioning deficit which affects adaptive behavior and daily living
  • learning disabilities are defined by a significant difference between academic achievement and expectation based on age and intelligence
53
Q

Learning Disability

A
  • a significant discrepancy between a child’s academic achievement and the level expected based on age and intelligence
  • usually idiopathic but can be due to CNS insult, genetic disorder, or metabolic disorder
  • deficiencies may be in specific academic subjects or there may be defects in processing of information
  • managed with classroom accommodations, special education, and bypass strategies
54
Q

What are bypass strategies for those with learning disability?

A

methods for bypassing their information processing deficiency such that an individual with auditory processing disorder gets information only by visual aid

55
Q

What are pervasive developmental disorders?

A
  • a spectrum of developmental disabilities affecting multiple developmental areas, especially behavior and learning, with a wide range of severity
  • Autism is the prototype
56
Q

Autism

A
  • the prototype pervasive developmental disorder (one affecting multiple areas of development, especially behavior and learning)
  • onset prior to age 3 and more common in males
  • presents with difficulty using language to communicate with speech sometimes absent or having atypical features; unusual ways of relating; unusual or restrictive ranges of interests; unusual perseveration behavior or stereotypic movement rituals; and self-injurious behavior
57
Q

How does Asperger syndrome differ from Autism?

A

Asperger syndrome has both qualitative impairment in peer relationships and social interactions as well as repetitive, restricted, and stereotyped behaviors but has no clinically significant language delay

58
Q

ADHD

A
  • defined by symptoms before age 7; symptoms in more than one environment; impaired functioning; and symptoms of inattention, hyperactivity, or impulsivity
  • dopamine and NE are typically low and medications focus on raising levels
  • often assessed with parent and teacher questionnaires but direct and specific observations are most useful
  • managed with demystification (explaining ADHD), classroom modifications, educational assistance, counseling, and stimulants (methylphenidate aka Ritalin and amphetamines aka Adderall)
  • TCAs and adrenergic like clonidine are second line
59
Q

What are the common side effects of the stimulants used to manage ADHD?

A
  • anorexia, nausea, and abdominal pain
  • palpitations and hypertension
  • insomnia
  • headache
  • irritability, particularly as it wears off
60
Q

What is the cause of most cases of pediatric hearing loss?

A

autosomal recessive genetic conditions

61
Q

Hearing Loss

A
  • 80% of cases are genetic and 80% of these are autosomal recessive conditions
  • likely to affect speech development and language skills, limit academic achievement, and lead to behavioral problems
  • prognostic factors include degree of impairment; etiology with those who inherited deafness usually faring better and those who acquired deafness at greater risk for other neuro impairments; family willingness and ability to use ASL; age at onset with those who become deaf after two years of age and after incorporating some language structure doing better; early identification and intervention
  • evaluation includes a history of perinatal infections and antibiotic exposures, a creatine level to check for any associated kidney defect, and viral serologies
62
Q

Visual Impairment

A
  • classification of blindness depends on measures of corrected acuity in the better eye
  • trachoma infection is the leading cause worldwide; retinopathy of prematurity and congenital cataracts are also common causes
  • this impairment may delay locomotion, decrease fine motor skills, and cause difficulties with attachment
  • however, patients may compensate with auditory perception skills or haptic perception
63
Q

Colic

A
  • crying that lasts more than 3 hours per day and occurs more than 3 days per weeks
  • it begins in healthy, well-fed infants at 2-4 weeks of age, resolves by 3-4 months of age, and most often begins in the late afternoon or early evening
  • problematic because it may disrupt attachment and cause family stress
  • reassure parents and recommend comfort measures like decreased or increased sensory stimulation and positioning
64
Q

What is the difference between colic and normal crying?

A
  • normal crying usually lasts up to two hours per day at 2 weeks of age and increases to 3 hours a day at three months
  • colic is crying that lasts more than three hours per day and occurs more than three days per week beginning at 2-4 weeks of age
65
Q

Enuresis

A
  • defined as urinary incontinence beyond the age when the child is developmentally capable of continence
  • can be nocturnal or diurnal and primary (never been continent) or secondary (at least 6 prior months of consecutive dryness)
  • bed-wetting is seen in 30% of 4-year-olds
  • there can be many contributing factors including a gene on chromosome 13, psychosocial factors (especially secondary enuresis), chaotic home situations, impaired sleep arousal mechanisms, urine volume, bladder capacity, child abuse, and constipation, UTI, or diabetes mellitus
  • manage with education and removal of blame from child, use of conditioning alarms (trial requires minimum of 3-5 months), behavioral modification, and medications
  • medications include desmopressin acetate and TCAs but when used alone, relapses are extremely common
66
Q

What is the incidence of bed-wetting by age?

A
  • 30% of 4 year olds
  • 15-20% of 5 year olds
  • 10% of 6 year olds
  • 3% of 12 year olds
67
Q

Why is desmopressin acetate an effective medication for nocturnal enuresis? What is the primary limitation?

A
  • decreases urine volume, and may be especially helpful in children with no normal circadian rhythm for release of arginine vasopressin
  • if used alone, relapse is likely once medication is withdrawn
68
Q

What are day-night reversals and when are they considered normal?

A

common in the first weeks of life, it is a normal pattern of random sleep for four weeks, after which clustering of sleep time occurs

69
Q

How do we define sleeping through the night and when does it typically occur in an infants life?

A
  • it is defined as sleeping more than 5 hours after midnight for a 4-week period
  • fifty percent of infants sleep through the night by 3 months of age
70
Q

What is trained night waking?

A
  • an abnormal sleep pattern that typically occurs between 4 and 8 months of age during which the infant will not resettle without parental intervention during normal night stirrings and awakenings
  • best managed by establishing routines and placing the infant in bed while drowsy but awake
71
Q

What is trained night feeding?

A
  • an abnormal sleep pattern in which the infant continues to wake to eat because the parents keep responding with a feeding
  • management involves lengthening intervals of daytime feeding and teaching parents not to respond with a feed
72
Q

When in a child’s life do nightmares typically begin? How should they be managed?

A
  • common after 3 years of age
  • managed with reassurance by the parents and comforting measures; promote regular sleep patterns and good sleep habits; remove any inciting causes like scary movies
73
Q

When are night terrors common? How should they be managed?

A
  • they are common between 3 and 5 years of age

- reassure parents that they usually terminate spontaneously

74
Q

How does toddler feeding compare to that during infancy?

A

appetite normally decreases after 1 year of age

75
Q

What is the root cause of most toddler feeding problems? How should this be managed?

A
  • control is the major issue as autonomy is more important than hunger to the child at this stage
  • management involves avoidance of power struggles
76
Q

School Phobia

A
  • the child is usually fearful of leaving home and the caregiver and misses school due to vague physical complaints
  • complaints typically occur in the morning, worsen on departure for school, and disappear on weekends
  • ensure the child is healthy and return them to school while encouraging peer relationships
77
Q

Temper Tantrums

A
  • expressions of emotions, usually anger, which are beyond the child’s ability to control and are not necessarily manipulative or willful
  • commonly seen in those 1 to 3 years old
  • more common in those with poor fine motor skills or expressive language delays, which increase frustration
  • frequency decreases as the ability to verbalize feelings emerges (learned by 3 years of age)
  • tantrums that demand something should be ignored
78
Q

Breath-Holding Spells

A
  • involuntary, benign episodes that are harmless and always stop by themselves
  • most often occurring between 6 to 18 months of age and disappearing by age 5
  • cyanotic spells are most common, are precipitated by frustration or anger, and involve crying, becoming cyanotic, and occasionally apnea and unconscious
  • pallid spells are provoked by an unexpected event that elicits fear and results in a hypervasovagal response during which the child becomes pale and limp
  • reassure parents and counsel them not to undertake resuscitation efforts which may be harmful; if the spells are precipitated by exercise or excitement, an ECG may be indicated
79
Q

Sibling Rivalry

A
  • includes bids for attention, regressive symptoms, and aggression toward a new sibling
  • the arrival of a newborn is especially stressful for those less than 3 years old
  • prevent by talking about the new arrival, praise the child for being mature, avoid demanding mastery of new skills like toilet training at this time
  • older children should be encouraged to settle their own arguments without violence; parents should try to stay out of these, teach children to listen to one another, protect each child’s personal possessions, and praise good behavior
80
Q

When do bowel and bladder control typically develop?

A
  • bowel control is achieved by 29 months on average
  • bladder control is achieved by 32 months on average
  • both have wide ranges
81
Q

What are the prerequisites for toilet training?

A
  • understanding the meaning of words such as wet and dry
  • prefer being dry
  • recognize the sensation of bladder fullness
  • ability to hold urine and stool
  • ability to tell the caregiver about this need
82
Q

How should toilet training be taught?

A
  • stress encouragement, praise, and patience
  • allow multiple practice tries with praise for cooperation; social reinforcement is better than treats of some kind
  • avoid pressure as this can lead to a power struggle
83
Q

When should children begin developing self-control?

A

between 3 and 4 years of age

84
Q

How should discipline change with a child’s age?

A
  • before 6 months, no discipline is indicated
  • distraction and redirection can be used to ensure the child’s safety as the infant develops more mobility
  • from 18 to 36 months, ignoring, time-out, and disapproval may be effective
  • preschool children should have logical consequences
  • negotiation and restriction of privileges can be used after five years of age
85
Q

What are the typical guidelines for using punishment to control discipline issues?

A
  • rules must be clear, concrete, and consistent
  • consequences should be brief and immediate, followed by love and trust; direct the punishment towards the behavior, not the person
  • time-out should be 1 minute per year of age with a maximum of five minutes

Pediatrics BRS (20 decks)

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