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Y2 RDA > Child development > Flashcards

Child development Flashcards

1
Q

What is development?

A
  • The global impression of a child which encompasses growth, increases in understanding, acquisition of new skills and more sophisticated responses and behaviour
  • A dynamic process of growth, transformation, learning and acquisition of abilities to respond to and adapt to the environment in a planned, organised and independent manner
  • A process by which each child evolves into an independent adult
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2
Q

Antenatal causes of damage to brain development

A

Infectious agents
Hormones
Drugs

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3
Q

What infectious agents can cause antenatal damage?

A

TORCH:

  • Toxicoplasmosis
  • Other (syphilis/HIV/HepC)
  • Rubella -> cataracts, glaucoma, heart defects, hearing loss, tooth abnormalities
  • Cytomegalovirus
  • Herpes
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4
Q

What hormones can cause antenatal damage?

A
  • Androgenic agents
  • DES
  • Maternal diabetes -> various: heart and neural tube defects most common
  • Maternal obesity
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5
Q

What drugs can cause antenatal damage?

A
  • Phenytoin
  • Valproic acid -> neural tube defects, heart, craniofacial and limb anomalies
  • Trimethadione
  • Lithium
  • SSRIs
  • Amphetamines
  • Warfarin
  • ACE inhibitors
  • Alcohol -> foetal alcohol syndrome, short palpebral fissures, maxillary hypoplasia, heart defects, intellectual disability
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6
Q

Postnatal causes of damage to development

A

Infections, metabolic disorders, toxins, trauma, domestic violence (maltreatment), malnutrition, maternal mental health disorders

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7
Q

Complications of spina bifida cystica

A
  • Neurogenic bowel and bladder incontinence
  • Lower limb paralysis
  • Fractures and joint contractures
  • Developmental deformities and learning disabilities
  • Hydrocephalus and meningitis
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8
Q

What are the developmental domains?

A
  • Gross motor performance
  • Vision and fine motor
  • Hearing, speech and language
  • Social, emotional and behavioural
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9
Q

What is a milestone?

A

Acquisition of a key performance skill

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10
Q

Define the median age for development

A

Age when half of standard population of children achieved that level

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11
Q

Define the limit age for development

A

Age by which children should have achieved that level

= 2.5 SD from mean age

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12
Q

What gross motor performance milestone should be seen in a newborn?

A

Limbs flexed on symmetrical position, head lag on pulling up

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13
Q

What gross motor performance milestone should be seen at 6-8 weeks?

A

Raises head to 45 degrees in prone

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14
Q

What gross motor performance milestone should be seen at 6-8 months?

A

Sits without support

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15
Q

What gross motor performance milestone should be seen at 8-9 months?

A

Crawling

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16
Q

What gross motor performance milestone should be seen at 10 months?

A

Cruising around furniture

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17
Q

What gross motor performance milestone should be seen at 12 months?

A

Walks unsteadily

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18
Q

What gross motor performance milestone should be seen at 15 months?

A

Walks steadily

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19
Q

Why do we have primitive reflexes?

A

Protective and serve to promote support, balance and orientation

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20
Q

What are the primitive reflexes?

A
  • Stepping
  • Moro (startled, falling reflex - arms outstretched, ‘startled’ expression)
  • Grasp
  • Asymmetric tonic reflex (arm outstretches towards where head is turned)
  • Rooting (suckling)
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21
Q

When should the primitive reflexes disappear?

A

4-6 months

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22
Q

What are protective reflexes?

A

Develop from 4 to 5 months onwards and can be absent or abnormal in motor disorders

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23
Q

What is the downward parachute reflex?

A

Develops at 5 months

When held and rapidly lowered infant extends and abducts both legs; feet are plantigrade

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24
Q

What is the sideward protective reflex?

A

Develops at 6 months

Infant puts arms out to save if tilted off balance

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25
Q

What is the forward protective reflex?

A

Develops at 7 months

Arms and hands extend on forward descent to ground

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26
Q

What is the backward protective reflex?

A

Develops at 9 months

Backward protective extension of both arms when pushed backwards in sitting position

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27
Q

When is object permanence obtained?

A

9 months

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28
Q

What fine motor and vision milestone should be seen at 6 weeks?

A

Turning head to follow object

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29
Q

What fine motor and vision milestone should be seen at 4 months?

A

Reaching out to toys

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30
Q

What fine motor and vision milestone should be seen at 4-6 months?

A

Palmar grasp

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31
Q

What fine motor and vision milestone should be seen at 7 months?

A

Can transfer toys between hands

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32
Q

What fine motor and vision milestone should be seen at 10 months?

A

Mature pincer grip

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33
Q

What fine motor and vision milestone should be seen at 16-18 months?

A

Making marks with crayon

34
Q

What fine motor and vision milestone should be seen at 14 months - 4 years?

A

Building towers out of blocks

35
Q

What fine motor and vision milestone should be seen at 2-5 years?

A

Ability to draw basic shape without seeing it

Copying shape can be done 6 months earlier

36
Q

What language and hearing milestone should be seen in a newborn?

A

Startles to loud noises

37
Q

What language and hearing milestone should be seen at 3-4 months?

A

Vocalises alone or when spoken to

38
Q

What language and hearing milestone should be seen at 7 months?

A

Turns to soft sounds out of sight

39
Q

What language and hearing milestone should be seen at 7-10 months?

A

Uses sound indiscriminately or discriminately

40
Q

What language and hearing milestone should be seen at 12 months?

A

Two to three words other than dada or mama

41
Q

What language and hearing milestone should be seen at 18 months?

A

Six to ten words

42
Q

What language and hearing milestone should be seen at 20-24 months?

A

Makes simple phrases

43
Q

What language and hearing milestone should be seen at 1.5-3 years?

A

Talk constantly in 3-4 word sentences

44
Q

What social and behavioural milestone should be seen at 6 weeks?

A

Smile responsively

45
Q

What social and behavioural milestone should be seen at 6-8 months?

A

Puts food in mouth

46
Q

What social and behavioural milestone should be seen at 10-12 months?

A

Wave bye, play peek-a-boo

47
Q

What social and behavioural milestone should be seen at 12 months?

A

Drink from cup with two hands

48
Q

What social and behavioural milestone should be seen at 18 months?

A

Can eat by themselves

49
Q

What social and behavioural milestone should be seen at 18-24 months?

A

Symbolic play

50
Q

What social and behavioural milestone should be seen at 2 years?

A

Potty trained

51
Q

What social and behavioural milestone should be seen at 2.5-3 years?

A

Parallel play

52
Q

What are the limit age examples at:

  • 18 months
  • 3 months
  • 2 years
  • 2-2.5 years
A

18 months: walking independently
3 months: fixes and follows visually
2 years: joins words
2-2.5 years: symbolic play

53
Q

What is consonant delay?

A

All developmental domains affected equally

54
Q

What is dissonant delay?

A

All developmental domains affected differently

55
Q

What is the difference between delay and disorder?

A 
Delay = slow acquisition of skills
Disorder = maldevelopment of a skill
56
Q

What are some causes of abnmormal development?

A
  • Abuse, trauma, drugs, infection
  • Autism, deficits in development
  • Malnutrition, cerebral palsy etc
57
Q

How/when does delay present?

A
  • Routine surveillance
  • Identified risk factors
  • Parents/HCPs worried
  • Opportunistic worries raised
58
Q

What factors are important in a history of abnormal development?

A
  • Antenatal
  • Birth
  • Postnatal
  • Consanguinity - increased chance of chromosomal/autosomal conditions
  • Developmental milestones from parents
59
Q

What factors are important in the examination for abnormal development?

A
  • Growth parameters (height, weight, head circumference)
  • Dysmorphic features
  • Neurological exam & skin exam
  • Systems exam
  • Standardises developmental assessments (SOGSII, Griffiths, Denver)
60
Q

What factors are important in the management of abnormal development?

A
  • Investigations - cytogenic studies, metabolic screens, blood ammonia and lactate, urine and blood amino acids, creatine kinase, imaging and nerve/muscle biopsies
  • Referral to MDT
61
Q

What is cerebral palsy?

A

Disorder of movement and posture due to non-progressive lesion of motor pathways

62
Q

Cerebral palsy features

A

Manifestations emerge over time
Most common cause of motor impairment in children
Prevalence 2.5-2.7 per 1000 children

63
Q

What is the most common cause of cerebral palsy?

A

Antenatal cause (80%) - genetic syndromes and congenital infection

64
Q

Cerebral palsy presentation

A
  • Abnormal limb tone and delayed milestones
  • Feeding difficulties
  • Abnormal gait once walking achieved
  • Asymmetric hand function before 12 months
  • Primitive reflexes persist
65
Q

Types of cerebral palsy

A

Spastic (70%)

Ataxic hypotonic, dyskinetic, mixed pattern (each 10%)

66
Q

Associated problems with cerebral palsy

A

Learning difficulty, epilepsy, visual impairment, hearing loss, feeding difficulty, poor growth, respiratory problems

67
Q

Management of cerebral palsy

A

Minimise spasticity and manage associated symptoms

68
Q

What is autism?

A

Neurobiological disorder characterised by:

  • impairments of social interactions and communication
  • restricted, repetitive and/or stereotyped patterns of behaviour, interests and activities
69
Q

What is the prevalence of autism?

A

3-6 per 1000 live births
M > F
Presents at 2-4 years

70
Q

Comorbidities with autism

A

Learning difficulties, attention difficulties and epilepsy

71
Q

Management of autism

A

Intensive support for child and family

72
Q

What are the criteria for diagnosis with attention deficit hyperactivity disorder?

A
  • Inattention
  • Hyperactivity
  • Impulsivity
  • Lasting >6 months
  • Commencing <12 years and inconsistent with child’s developmental level
  • Criteria should be present in more than one setting and cause significant interference at school/socially
73
Q

How is ADHD diagnosed?

A
  • Questionnaires (SDQ - strengths and difficulties questionnaire)
  • Exclude medial causes such as hyperthyroidism
  • Hearing deficits
  • Identify risk factors and comorbidities
74
Q

What other disorders have increased risk with ADHD?

A

Conduct disorder, anxiety disorder and aggression

75
Q

What are risk factors for ADHD?

A

M > F, learning difficulties and developmental delay, neurological disorders, first-degree relatives , relatives with depression/ learning disabilities/ antisocial behaviour/ substance abuse

76
Q

Management of ADHD

A

Psychotherapy - behaviour therapy
Family therapy, drugs - if psychotherapy alone insufficient
Diet - exclusion of some foods

77
Q

How are learning disabilities classified?

A

Mild, moderate, severe and profound

78
Q

What is the prevalence of mild learning disabilities?

A

30 per 1000 children

79
Q

What is the prevalence of severe learning disabilities?

A

4 per 1000 children

80
Q

Common causes of learning disabilities

A 
25% have no identifiable cause
30% chromosome disorder
20% other syndromes
20% postnatal cerebral insults
1% metabolic or degenerative disease
81
Q

Common presentations of learning disabilities

A

Reduced intellectual functioning
Early delay in milestones
Dysmorphic features and associated problems e.g. ADHD, epilepsy, sensory impairment

82
Q

Management of learning disabilities

A

MDT for long term and follow up
School recognition of learning disability
SEND (special education needs and disability)

Y2 RDA (3 decks)

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