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
