CHILD DEVELOPMENT

Question 1

What does the developing brain look like after week 4?

Answer 1

Future forebrain, midbrain, hindbrain and spinal cord present

Cephalic flexure, pontine flexure, cervical flexure present

Question 2

What does the developing brain look like after week 5?

Answer 2

Telencephalon, diencephalon, pons and medulla present

Question 3

What does the developing brain look like after week 8?

Answer 3

Developing cerebral hemispheres
Developing cerebellum
Ventricles/aqueduct present

Question 4

Name some primitive reflexes that can observed to assess gross motor development and explain them

Answer 4

Moro reflex - Head is held and is suddenly allowed to fall back. Arms extend and abduct

Standing reflex - Baby held so they are in standing position, extension of lower extremities, hips slightly flexed and behind shoulder with head free to turn.

Grasp reflex - Object placed in hand of newborn and fingers grasp tightly, stroking of lateral hand opens fingers up

Parachute reflex - Baby tilted forward, outstretched hands to protect themselves

Question 5

When do the each of the primitive reflexes develop/disappear?

Answer 5

Moro reflex develops 28-32 weeks gestation, disappears 3-6 months

Standing reflex present at 3 months

Grasp reflex replaced at 6-9 months with voluntary hand movement (fine motor development)

Parachute reflex develops 6-9 months

Question 6

What does persistence of primitive reflexes after a certain age suggest?

Answer 6

Impaired development

Question 7

What are the 4 domains of child development?

Answer 7

Speech and language skills
Social skills
Gross motor skills
Fine motor skills

Question 8

What are some signs of gross motor development?

Answer 8

Raise head to 45 degrees when in prone position (6-8 weeks)

A median age baby (3 months) should be able to lift head up as well when pulled up from laying. A newborn cannot due to immaturity of neck muscles

Roll by itself (3-5 months)

Sit without support
6 months - round back
8months - straight back

Crawling (8-9 months)

Cruises around furniture (10 months)

Walk unsteadily (12 months)
Walks steadily (15 months)

Question 9

What are all the variations of progression of an immobile infant to a walking toddler?

Answer 9

Commando crawl
Crawling on all fours
Bottom shuffling (usually takes them longer to walk)

Question 10

What are the signs of vision and fine motor development?

Answer 10

Follows moving object or face by turning the head (6 weeks)
Reaches out for toys (4 months)
Palmar grasp (4-6 months)
Transfers toys from one hand to another (7 months)
Mature pincer grip (10 months)
Makes marks with crayon (16-18 months)
Block towers (14+ months)
Draw without seeing how its done (2-5 years)

Question 11

What are the signs of hearing, speech and language development?

Answer 11

Startles to loud noises (newborn)
Vocalises alone/when spoken to (3-4 months)
Turns to sounds (7 months)
Indiscriminate sound (7 months)
Discriminate sound (10 months)
2/3 words other than dada/mama (12 months)
6-10 words and shows 2 parts of body (18 months)
Simple phrases (20-24 months)
Constant talking in 3-4 word sentences (2.5-3 years)

Question 12

What type of babble will a child with hearing impairment have?

Answer 12

Monotone

Question 13

What are the signs of social, emotional and behavioural development?

Answer 13

Smiles responsively (6 weeks)
Self feeding (6-8 months)
Waves bye bye, plays peek-a-boo (10-12 months)
Drinks from a cup with 2 hands (12 months)
Holds spoon and gets food safely to mouth (18 months)
Symbolic play (18-24 months)
Potty training (2 years)
Parallel play/playing together(2.5-3 years)

Question 14

What are the different patterns of development?

Answer 14

Slow but steady
Plateau
Regression

Question 15

What are limit ages?

Answer 15

Ages at which certain abilities should have developed

Question 16

What are the limit ages of gross motor control?

Answer 16

Head control - 4 months
Sitting independently - 9 months
Standing independently - 12 months
Walking independently - 18 months

Question 17

What suggests evolving cerebral palsy in a baby?

Answer 17

Unable to life head or push up on arms with stiff extended legs at limit age 2 months

Question 18

Why do stiff arms, extended legs or stiff, crossed legs occur in abnormal motor development?

Answer 18

Disinhibition of the lower motor neurones

Question 19

What is an excessive tiptoe gait caused by?

Answer 19

Excess motor activity which is uninhibited by corticospinal neurones

Question 20

What are the limit ages of vision and fine motor development?

Answer 20

Fixes and follows visually - 3 months
Reaches for objects - 6 months
Transfers - 9 months
Pincer grip - 12 months

Question 21

What are the limit ages of hearing speech and language development?

Answer 21

Polysyllabic babble - 7 months
Consonant babble - 10 months
6 words with meaning - 18 months
Joins words - 2 years
3 word sentences - 2.5 years

Question 22

What are the limit ages of social, emotional and behaviour development?

Answer 22

Smiles - 8 weeks
Fear of strangers - 10 months
Feeds self/spoon - 18 months
Symbolic play - 2/2.5 years
Interactive play - 3/3.5 years

Question 23

Who should be carrying out developmental assessing?

Answer 23

Parents
All doctors
Nursery nurses
Teachers

Question 24

When should developmental assessing be carried out?

Answer 24

Opportunistically

Planned as part of programme of reviews e.g. the healthy child programme

Question 25

What are the key components of the healthy child programme?

Answer 25

Screening
General examination and immunisation
Health education/promotion

Question 26

What are some prenatal factors which may affect the developing human?

Answer 26

Folate –> spinal cord development

Iron–> cofactor for brain development

Question 27

What are some perinatal factors which may affect the developing human?

Answer 27

Delivery (traumatic event)
Oxygen deprivation (brain development)
Drugs used in neonatal period

Question 28

What are some postnatal factors which may affect the developing human?

Answer 28

Trauma, meningitis

Question 29

How should you evaluate a child with abnormal development?

Answer 29

History (parental concern, birth history, family history)
Past medical history (developmental history, current skills)
Examination (developmental assessment, general and neurological examination, investigations)

Question 30

What should be assessed in development assessment?

Answer 30

Milestones proceeding age (developmental history)
Expected milestones for age
Next important milestones (alerting patients to look out for them)

Question 31

What are the 4 factors causing developmental delay?

Answer 31

Lack of physical/psychological stimuli
Ill health
Sensory/motor impairment
Reduced inherent potential

Question 32

What are the types of developmental delay?

Answer 32

Specific - language, motor, sensory or cognitive

Global - in all 4 aspects

Question 33

What are some causes of global delay?

Answer 33

Chromosomal abnormalities e.g. Down's
Metabolic e.g. hypothyroidism
Antenatal/perinatal factors e.g. infections, drugs
Environmental-social issues
Chronic illness

Question 34

What are some causes of motor delay?

Answer 34

Cerebral palsy
Congenital dislocation of hip
Social deprivation
Muscular dystrophy - duchenne's
Neural tube defects
Hydrocephalus

Question 35

What are some causes of language delay?

Answer 35

Hearing loss
Learning disability
Autistic spectrum
Lack of stimulation
Impaired comprehension of language - developmental dysplasia
Impaired speech production - stammer, dysarthria

Question 36

What are some commonly used assessment tools for the development of a child?

Answer 36

Standardised tests:

• Schedule of growing skills
• Griffiths developmental scale
• Bailey developmental scale
• Denver developmental screening tests