Child Development 02.03.2020 Flashcards
Barker hypothesis
adverse nutrition in early life, including prenatally as measured by birth weight, increased susceptibility to the metabolic syndrome
- risk of deaths higher both when obese and underweight as a child.
What are the 4 domains of child development?
- gross motor skills and posture
- fine motor skills and vision
- language and speech skills (incl. hearing)
- social skills, emotional and behaviour
History taking re child development problems
- Antenatal – illnesses/infections; medications; drugs; environmental exposures
- Birth –Prematurity, Prolonged/complicated labour
- Postnatal – illnesses/infections; Trauma
- Consanguinity – increases chances of chromosomal or autosomal recessive conditions
- Developmental milestones from parent
Examinations re child development problems
- Growth parameters – height, weight and head circumference
- Dysmorphic features
- Neurological examination and skin
- Systems examination to identify associations, syndromes
- Standardised developmental assessment – SOGSII, Griffiths
management of child development issues
(Investigations – depends on suspected cause but may include cytogenetic studies; metabolic screen (thyroid, renal, liver and bone profiles); blood ammonia and lactate; urine and blood organic and amino acids; creatine kinase; imaging – CT, MRI; EEG; nerve and muscle biopsy.
Other professionals – referral to members of the multidisciplinary team (MDT) would help identify problems and target input.
The multidisciplinary team – the many professionals who may be involved in the care of children with developmental problems.
What are some common/typical developmental problems?
- Cerebral palsy
- autism spectrum disorder (ASD)
- attention deficit hyperactivity disorder (ADHD)
- learning disability
Cerebral palsy
- A disorder of movement and posture arising from a non-progressive lesion of the brain acquired before the age of 2 years.
- Incidence 1-2 per 1000 live births
- Most causes (~80%) are antenatal
- Presentation may evolve and vary with age
- Associated problems exist – learning difficulties, epilepsy, visual impairment, hearing loss, feeding difficulties, poor growth, and respiratory problems.
Management
- Aim is to minimise spasticity and manage associated problems
ASD
- Autism spectrum disorder
- Prevalence is 3-6 per 1000 live births
- Boys>girls
- Usually presents between 2 – 4 years of age
- Features include
(1) impaired social interaction;
(2) speech and language disorder; and
(3) imposition of routines with ritualistic and repetitive behaviour. - Comorbidities include learning and attention difficulties, and epilepsy
Management: Intensive support for child and family
ADHD diagnostic criteria
(1 )Inattention;
(2) Hyperactivity;
(3) Impulsivity;
(4) Lasting > 6 months;
(5) commencing < 7 years and inconsistent with the child’s developmental level
These features should be present in more than one setting, and cause significant social or school impairment.
ADHD
= attention deficit hyperactivity disorder
- These children also have an increased risk of: conduct disorder, anxiety disorder & aggression
- Risk factors – Boys > girls, ratio 4:1; Learning difficulties and developmental delay
- Neurological disorder, e.g. epilepsy, cerebral palsy; first-degree relative with ADHD; family member with depression, learning disability, antisocial personality or substance abuse
- A significant proportion of children with ADHD will become adults with antisocial personality and there is an increased incidence of criminal behaviour and substance abuse.
Management of ADHD
- Psychotherapy – Behavioural therapies
- Family therapy
- Drugs – If behavioural therapy alone insufficient; stimulants, e.g. methylphenidate (Ritalin), amphetamines (dexamphetamine)
- Diet – Some children benefit noticeably from exclusion of certain foods from their diet, e.g. red food colouring
Learning disability
- Prevalence of moderate learning difficulty is 30 per 1000 children
- Prevalence of severe learning difficulty is 4 per 1000 children
- 25% of children with severe learning disability have no identifiable cause
- Causes include – (i) chromosome disorders (30%); (ii) other identifiable syndromes (20%); (iii) postnatal cerebral insults (20%); (iv) metabolic or degenerative diseases (1%)
- Classified as mild, moderate, severe or profound
- May present with reduced intellectual functioning, delay in early milestones, dysmorphic features, ± associated problems (epilepsy, sensory impairment, ADHD)
- Management : Involves establishing a diagnosis and input from the multidisciplinary team with long term follow up.
What does developmental progress depend on?
depends on the interplay between biological and environmental influences. It follows a constant pattern, although at variable rates, among children.
Normal child development
- Development is the global impression of a child which encompasses growth, increase in understanding, acquisition of new skills and more sophisticated responses and behaviour. It serves to endow the child with increasingly complex skills in order to function in society.
- Limit ages are the age by which they should have been achieved = 2 standard deviations from the mean. They indicate cause of major concern.
- Developmental progress can be monitored or identified either through developmental screening or by the use of standardised developmental tools.
What are the three main patterns of abnormal development?
Refers to the slow acquisition of skills and follows three main patterns:
(1) slow but steady;
(2) plateau; and
(3) regression.
Abnormal development
- refers to the slow acquisition of skills
- delay may occur in one or more domains
- Biological factors may impact on development – e.g. folate deficiency increases the risk of neural tube defects which, in its most severe form, can result in limb paralysis, neurogenic bladder and bowel; and intellectual impairment.
When is a child able to sit?
around 6 months
When does a child acquire finer motor skills?
around 8 months
measurement results in achondroplasia
Achondroplasia has normal sitting height but short legs.
Skeletal dysplasia, something gone wrong with the genes that determine bone growth etc.
How may children present with developmental concerns
Children may present with developmental concerns either through
(i) identification of antenatal or postnatal risk factors;
(ii) developmental screening; or
(iii) concerns raised by parents or other healthcare professionals.
- > Thus, these children may present at any age.
When does the cerebellum develop?
- in utero but also:
- cerebellum grows 4x its size in the 1st year of life’
=> humans are born highly underdeveloped.
Which part of the spinal cord do spinal cord injuries then to affect?
- sacral and lumbar regions
- these are more lateral segments on the spinal cord and therefore more likely to be damaged
- makes sense in a protective way: you need thoracic and cervical for functions like breathing
What are some common problems in child development?
Delayed walker
Clumsy child
Delayed speech and language
Odd social interaction- ASD/Aspergers
Hyperactivity
Common behaviours – sleep onset/freq night - waking - eating - Toileting
Possible timings of factors that affect child development
Prenatal
Perinatal
Postnatal
Name some factors influencing developmental delay
- ill health
- lack of physical/psychological stimulation
- reduced inherent potentiaal
- sensory/motor impairment
What are the types of developmental delay?
- global
- specific (language, sensory, motor, cognitive)
What are some causes of global developmental delay?
- Chromosomal abnormalities
e. g. Down’s syndrome, Fragile X - Metabolic
e. g. hypothyroidism, inborn errors of metabolism - Antenatal and perinatal factors
Infections, drugs, toxins, anoxia, trauma, folate def - Environmental-social issues
- Chronic illness
Causes of motor delay
- Cerebral palsy
- Global delay eg Down’s syndrome
- Congenital dislocation hip
- Social deprivation
- Muscular dystrophy-Duchenne’s
- Neural tube defects: spina bifida
- Hydrocephalus
Causes of language delay
- Hearing loss
- Learning disability
- Autistic spectrum disorder
- Lack of stimulation
- Impaired comprehension of language
- Developmental dysphasia
- Impaired speech production
- stammer, dysarthria
What is important to consider when assessing a child?
PARENTS KNOW SOMETHING IS WRONG BEFORE PROFESSIONALS DO
Approach to developmental assessment
ask -> observe -> task
Need to assess
- Milestones preceding age
- Expected milestones for age
Evaluating the child with abnormal development
History
- Parental anxiety
- Birth history
- FHx
PMHX
- Developmental history
- Current skills
Examination
- Developmental assessment, + general and neurological examination
Investigations – as appropriate
Commonly used assessment tools
Standardised tests
Schedule of Growing Skills (II)
Griffiths developmental scale
Bailey developmental scale
Denver developmental screening tests
OFFER THE RIGHT TOOLS, OBSERVE, LISTEN
Focussed Physical examination
Look of child Growth OFC Hearing and vision Skin Genitalia
Blood and imaging examination in developmental problems
FBC and ferritin TSH Chromosomes Lead US CT/MRI
Hormonal problems in growth
- lack of GH
- lack of thyroid hormones
What are the objectives of management in developmental problems?
- Maximise mobility
- Minimise discomfort
- Promote speech and language
- Promote social and emotional health
What is the role of the MDT in child development?
Assessment
Diagnosis and disclosure
Management programme
Social support
Who is in the MDT in child development?
- paediatrician
- OT
- GP
- PT
- SALT
- social services
- school nurse
- Ed psychologist
- SENCo
- support groups
- specialists (neuro, oto, cardio, genetics, psych, opthalmo, surgeons)
What fraction of IUGR/SGA babies catch up?
85%
examples of causes for monogenic obesity
- MCR4R def
- leptin def (easy to treat)
- leptinR def
- …….
What is poor growth associated with?
increased morbidity and mortality.
Moro reflex
- infantile reflex that develops between 28-32w of gestation
- disappears between 3-6 months of age
- It is a response to a sudden loss of support (e.g. letting heard drop) and involves three distinct components: spreading out the arms (abduction) pulling the arms in (adduction) crying (usually)
regression in terms of development
- loss of skills that were previously acquired and present
- this is worrying
