Child development Flashcards
What are the 4 parts of the embryo in the dorsal view at 4 weeks
Future forebrain (prosencephalon)
Future midbrain (mesencephalon)
Future hindbrain (rhombencephalon)
Future spinal cord
Using the side view at 4 weeks of life, what are the 3 flexures
Cephalic
Pontine
Cervical
At 5 weeks, what can be seen
Fore - telencephalon and diencephalon
Mid
Hind - pons and medulla
What can you see at 8 weeks
Hemispheres and ventricles 3 and 4 developing
Cerebellum developing
Aqueduct developing
What do you see at term
Fully developed:
Cortex
Ventricular system
Aqueduct
Cerebellum
Pons
Medulla
What is the grey matter in the anterior section of the cord responsible for
Motor neurones
Where do the nerves in the pyramidal tract supply
They supply the sacral, lumbar, thoracic and cervical nerves in the lateral corticospinal tract
What are the extrapyramidal tracts responsible for
Co-ordination of lumens
Regulation of posture and balance
Components of the reflex arc
Starts with a sensory receptor responding to a stimulus by producing a generator or receptor potential
Moves across dorsal part of spine through the sensory neurones (axon conducts impulses from receptor to integrating centre)
Connects to interneuron and integrating centre (one or more regions within the CNS that relay impulses from sensory to motor neurones)
Then through motor neurones (axon that conducts impulses from integrating centre to effector)
Effector (muscle or gland that responds to motor nerve impulses)
Primitive reflex - moro reflex?
Extension, abduction and adduction
28-32 weeks gestation
Should disappear between 3-6 months or could be a sign of impaired development if it doesn’t
Standing primitive reflex?
Present at 3 months
Extension of lower extremities
Hip[s are slightly flexed and somewhat behind shoulder
Head free to turn
Grasp primitive reflex?
When object placed in palm of new-born hand, fingers grasp very tightly
Stroke on the lateral side of the fingers will open them again
Reflexes are replaced between 6-9months with voluntary movement of hand as part of fine motor development
Protective reflexes / parachute reflexes
Developed between 6-9 months
When baby placed in forward tilting position, protects themselves with stretched arms
Also occurs when baby is placed on side ; sideway parachute reflex
What is development
Global impression of a child encompassing: growth, increase in understanding, acquisition of new skills and more sophisticated responses and behavior
Endows child with increasingly complex skills in order to function in society
What are the 4 domains of developmental assessment
Gross motor skills - position, head lag, sitting, walking and running
Fine motor skills - use of hands, grasp and fine pincer, bricks, crayon and puzzles
Speech and language skills - vocalization, words, understanding and imaginative play
Social skills - social interaction, stranger reaction, eating skills and dressing
What should the posture of a new born be like
Limited flexed, symmetrical posture lying down
Marked head lag on pulling up due immaturity of neck muscles
How does a baby sit between 6 -8 weeks
Sits without support:
6: Round back
8: Straight back
How does vision and fine motor change from 6 weeks to 4 months
Follows moving object or face by turning head
Reaches out for toys
How does a baby’s grip change form 6 months to 8 months
Palmar grasp , inferior grasp - using whole hand
Transfers toys from one hand to another
How does a babys grip change from 10months to 17 months
Mature pincer grip
Makes mark with crayon
How does a newborns hearing compare to a 3-4month year old
Startles to loud noises
Vocalises alone or when spoken to, coos and laughs
Normal motor development:
Pushes up on arms
Holds head up
Unable to lift head or push up on arms
Stiff extended legs
Pushing back with head
Constantly fisted hand and stiff leg on one side
Difficulty moving out of this position
Sits with support
Holds head up
Rounded back
Unable to lift head
Floppy trunk
Stiff arms, extended legs
Arms flexed and held back
Stiff, crossed legs
Sits without support
Arms free to reach and grasp
Rounded back
Por use of arms for play
Stiff legs, pointed toes
Poor head control
Difficulty getting arms forward
Arches back – stiff legs
Poor ability to lift head and back
Will not take weight on legs
Pulls to stand
Not interested in weight bearing
Difficulty in pulling to stand
Stiff legs, pointed toes
Cannot crawl on hands and knees
May use only one side of body to move
Independent standing or walking
Holds arm or both arms stiffly and bent
Excessive tiptoe gait
Sits with weight to one side
Uses predominantly one hand for play
One leg may be stiff
What is the healthy child programme
Screening,
General examination and immunisation,
Health education /promotion
Screening?
Hbopathy, rhesus, infection
US scan dating and nuchal (down syndrome)
US scan detailed
New-born bloodspot, hearing and physical
Physical examination
Vision
Child health reviews
Birth visit
10-14 day visit
6-8 week review
first year review
two year review
How to evaluate a child for abnormal development
History
Parental concern
Birth history
Family history
PMHX
Developmental history
Current skills
Examination
Developmental assessment, + general and neurological examinationa
Investigations – as appropriate
How to approach a developmental assessment
Ask, observe and task
Need to assess
Milestones proceeding age
Expected milestones for age
Next important milestones
What factors can influence developmental dealy
Ill health
Lack of physical / or psychological stimuli
Sensory / motor impairment
Reduced inherent potential
What are the types of developomental delay
Global (all 4 domains)
Specific - language / motor / sensory / cognitive
What are causes of global 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
What are 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
What are 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 are commonly used assessment tools
Standardised tests
Schedule of Growing Skills (II)
Griffiths developmental scale
Bailey developmental scale
Denver developmental screening tests
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