Child Development Flashcards
what are the 3 definitions of development?
o The global impression of a child which encompasses growth, increases in understanding, acquisition of new skills and more sophisticated responses and behaviour.
o 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.
o A process by which each child evolves into an independent adult.
what are the antenatal factors that affect development?
- infections maternally e.g. herpes, rubella
- toxins
- drugs e.g. valproic acid, alcohol
- hormones e.g. androgenic agents, maternal diabetes and obesity
what are the postnatal factors that affect development?
- infections
- metabolic disorders
- toxins
- trauma
- domestic violence (maltreatment)
- malnutrition
- maternal mental health disorders.
what are the complications of spina bifida?
o Neurogenic bowel and bladder incontinence.
o Lower limb paralysis.
o Fractures and joint contractures.
o Developmental deformities and learning disabilities.
o Hydrocephalus and meningitis.
IMPORTANT
what are the 4 Development Domains?
1) Gross motor performance and posture
2) Vision and fine motor.
3) Hearing, speech and language.
4) Social, emotional and behavioural.
how does acquisition of skills occur during development?q
key performance skills are attained at milestones. There is a constant pattern but a variable rate of attainment.
what is median age in context of development?
age when half of the standard population of children achieve that level of development
what is limit age in context of development?
age by which they should have achieved the level and is equal to 2 S. Ds from the mean age.
the measures are corrected for prematurity (<2)
what are the developmental milestones in gross motor performance?
o New-born – limbs flexed in symmetrical posture, head lag on pulling up. o 6-8 weeks – raises head to 45degrees in prone. o 6-8 months – sits without support. o 8-9 months – crawling. o 10 months – cruising around furniture. o 12 months – walks unsteadily. o 15 months – walks steadily.
what primitive reflex is present till about 3-6 months?
Moro reflex: response to a sudden loss of support and involves three distinct components: spreading out the arms (abduction) pulling the arms in (adduction) crying (usually)
what is the purpose of the Moro reflex?
protective and serve to promote support, balance and orientation
when do primitive reflexes disappear? examples of primitive reflexes?
3-6 months Stepping. Moro. Grasp. Asymmetric tonic reflex – which way babies head is turned, arm outstretches. Rooting
when do protective reflexes develop? examples of protective reflexes
from 5 months
- downward parachute reflex
- sideward protective reflex
- forward and backward protective reflex
when is object permanence attained?
at 9 months of age – the idea that when out if sight, not out of mind.
what are the milestones in fine motor and vision?
o 6 weeks – turns head to follow object. o 4 months – reaches out to toys. o 4-6 months – palmar grasp. o 7 months – transfers between hands. o 10 months – mature pincer grip. o 16-18 months – marks with crayons. o 14 months-4 years – towering. o 2-5 years – ability to draw without seeing how it’s done (after seeing it can be done 6m earlier).
what are the milestones in language and hearing?
o New born – startles. o 3-4 months – vocalises alone or when spoken to. o 7 months – turns to soft sounds out of sight. o 7-10 months – uses sound indiscriminately or discriminately. o 12 months – two to three words other than dada or mama. o 18 months – six to ten words. o 20-24 months – makes simple phrases. o 1.5-3 years – talk constantly in 3-4 word sentences.
what are the developmental milestones in social, behaviour and play?
o 6 weeks – smile responsively. o 6-8 months – puts food in mouth. o 10-12 months – wave bye, play peek-a-boo. o 12 months – drink from cut with two hands. o 18 months – can eat by themselves. o 18-24 months – symbolic play. o 2 years – potty trained. o 2.5-3 years – parallel play.
give examples of limit ages
o Walking independently - 18 months. o Fixes and follows visually - 3 months. o Joins words - 2 years. o Symbolic play - 2-2.5 years.
what is does delay in development mean?
slow acquisition of skills
this can occur in one or more domains
- global delay= >1 domain
- specific delay = 1 domain
what are the types of delay regarding number of domains affected?
- global delay= >1 domain
- specific delay = 1 domain
what are the types of delay regarding how the domains are affected?
in global:
- consonant delay=
All domains affected equally - dissonant delay=
All domains affected differently
what does disorder in development mean?
mal-development of a skill
what kind of delay patterns are there (not in the normal range) ?
- slow but steady
- plateaued
- regressive
overtime the gap between the normal and delayed pattern becomes wider so the deficits become more apparent
what are the causes of abnormal development?
o Abuse, trauma, drugs, infection.
o Autism, deficits in development.
o Malnutrition, cerebral palsy, etc.
when does delayed development become obvious?
o Routine surveillance.
o Identified risk factors.
o Parents/HCPs worried.
o Opportunistic worries raised.
what are some signs of development problems?
- delayed walker
- clumsy
- delayed speech and language
- odd social interactions (ASD, Aspergers)
- hyperactivity
what must be part of there history taken to assess abnormal development?
o Antenatal
– illnesses/infections, medications, drugs and environmental exposures.
o Birth
– premature, prolonged/complicated labour.
o Post-natal
– illness/infections, trauma.
o Consanguinity
– increased chance of chromosomal/autosomal conditions.
o Developmental milestones from parents.
what must be examined in the assessment of development?
o Growth parameters
– height, weight, head circumference.
o Dysmorphic features.
o Neurological examination and skin examination
o Systems examination
– identify syndromes and associations.
o Standardised developmental assessments
– SOGSII, Griffiths, Denver, Specialised assessments
what screening investigations can be done?
- cytogenic studies
- metabolic screens (function tests and blood profiles)
blood ammonia and lactate - urine and blood amino-acids, creatine kinase
- imaging and nerve/muscle biopsies.
management by MDT
what is cerebral palsy?
disorder of movement and posture due to a non-progressive lesion of motor pathways.
what are the features of cerebral palsy?
o Manifestations emerge over time – reflects balance between normal/abnormal cerebral maturation.
o Most common cause of motor impairment in children
what is the most common cause of cerebral palsy? what is the other cause
- antenatal causes: genetic syndromes and congenital infection
- hypoxic ischaemia injury at birth
- postnatal origin: infection, trauma
how does cerebral palsy present?
o Abnormal limb tone and delayed milestones.
o Feeding difficulties.
o Abnormal gait once walking achieved.
o Asymmetric hand function before 12 months.
o Primitive reflexes persist.
what are the types of cerebral palsy?
- spastic (70%)
- ataxic hypotonic (10%)
- dyskinetic (10%)
- mixed pattern (10%)
what are the associated problems in cerebral palsy?
learning difficulty epilepsy visual impairment hearing loss feeding difficulty poor growth respiratory problems.
how is cerebral palsy managed?
minimise spasticity and manage associated symptoms.
what is autism?
neurobiological disorder characterised by – impairments of social interactions and communication and restricted, repetitive, and/or stereotyped patterns of behaviour, interests and activities.
what are the associated problems with autism?
learning difficulties
attention difficulties
epilepsy.
managed by intensive support for the child and family
what is the criteria for the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD)?
o Inattention.
o Hyperactivity.
o Impulsivity.
o Lasting >6 months.
o Commencing <12 years and inconsistent with child’s developmental level.
o Criteria should be present in more than one setting and cause significant interference at school/social.
how can ADHD be diagnosed?
o Questionnaires
– SDQ (Strengths and Difficulties Questionnaire), Connors.
o Exclude medical causes such as hyperthyroidism.
o Hearing deficits.
o Identify risk factors and co-morbidities.
what do people with ADHD have the increased risk of?
conduct disorder
anxiety disorder
aggression.
risk factors greater in males
what are the risk factors for ADHD?
learning difficulties developmental delay, neurological disorders
first-degree relatives, relatives with depression/learning disabilities/antisocial behaviour/substance abuse.
how is ADHD managed?
o Psychotherapy – behaviour therapy. o Family therapy, Drugs – if psychotherapy alone insufficient. o Diet – exclusion of some foods.
what are the causes of learning disabilities?
o Chromosome disorder. o Other syndromes. o Post-natal cerebral insults. o Metabolic or degenerative disease. o unidentifiable cause
how does learning disability present?
o Reduced intellectual functioning.
o Delay in milestones early.
o Dysmorphic features and associated problems – e.g. ADHD, epilepsy, sensory impairment.
how is learning disability managed?
MDT for long-term follow up and school recognition via the education acts and SEND
SEND- Special Education Needs and Disability
what are centile charts?
- age against height
- 100 centiles
- cumulative height
how is height velocity calculated?
change in height (cm)/ number of years over which this change occurs
what are some genetic syndromes causing abnormal growth?
- Turner’s (females 45 XO)
- Down’s
- Skeletal dysplasia
- IUGR
- endocrine disorders
- psychosocial deprivation
what are causes of IUGR?
- Advanced diabetes.
- High blood pressure or heart disease.
- Infections such as rubella, cytomegalovirus, toxoplasmosis, and syphilis.
- Kidney disease or lung disease.
- Malnutrition or anemia.
- Sickle cell anemia.
- Smoking, drinking alcohol, or abusing drugs.
what are the causes of short stature?
- genetic: Down’s, Turner’s, Prader Willi
- emotional deprivation
- systemic disease: cystic fibrosis, rheumatoid arthritis
- malnutrition
- malabsorption: coeliac disease
- endocrine disorders: Cushing’s syndrome, hypothyroidism, GH deficiency, poorly controlled T1DM
- skeletal dysplasia: achondroplasia, osteogenesis imperfecta
what are the endocrine causes of short stature?
- GH deficiency
- Hypothyroidism
- Cushing’s syndrome
- poorly controlled T1DM
what skeletal dysplasias lead to short stature?
- achondroplasia
- osteogenesis imperfecta
what are the stimulatory and inhibitory hormones that affect GH release?
GHRH (+)
somatostatin (-)
what does the target organ of GH produce?
IGF-1 in the liver
(insulin-like growth factor 1)
leads to protein synthesis and cell division
what are the BMI parameters for overweight and obese?
overweight= >25kg/m2
obese= >30kg/m2
mismatch between energy intake and energy expenditure
what hormone can a single mutation affect leading to an excessive appetite and leads to severe obesity?
leptin
name a gene that can affect eating behaviour and appetite?
FTO
what social/emotional/behavioural does a 12 month child show?
- imitates activity
- object permanence established
- stranger anxiety
- pointing to indicate wants
how does a child build a tower aged:
- 18 months
- 2 years
- 3 years
- builds tower with 2-4 cubes; hand preference emerges
- builds tower with 6-7 cubes; circular scribbles
- builds tower of 9 cubes; copies a circle
what is abnormal development?
slow acquisition of skills:
- slow but steady
- plateau after such good progression
- or regression (loss of skills aquired)
what are some reasons for global developmental delay?
- Down’s syndrome
- Foetal alcohol syndrome
- Meningitis
- Trauma
what are some reasons for delay in talking?
- stammering
- hearing deficit
- maturational delay
- environmental factor
what are some reasons for delay in walking?
- maturational delay
- severe learning disabilities
- cerebral palsy
who would be involved in the clinical approach for developmental delay?
- paediatrician
- specialist health visitors
- speech and language therapists
- occupational therapists
- physiotherapists
- psychologists
who does autism affect most?
boys>girls
2-4 years
co-morbidities: learning and attention difficulties and epilepsy
what are the features of autism?
- impaired social interaction
- speech and language disorder
- imposition of routines with ritualistic and repetitive behaviour
what are the diagnostic features of ADHD?
1- inattention
2- hyperactivity
3- impulsivity
- this all lasts for more. than 6 months
- commences at an age less then 7
- inconsistent with the child’ developmental level
who does ADHD affect most?
boys> girls
what are the risk factors for ADHD?
epilepsy cerebral palsy first-degree relative with ADHD family member with depression learning disability antisocial personality substance abuse
what is cerebral palsy?
- disorder of movement and posture
- arises from non-progressive lesion of the brain
- < 2 years
what are the features of cerebral palsy?
Learning difficulties
epilepsy
visual/ hearing impairment, poor growth
respiratory problem
what are some causes of learning disability?
- chromosomal abnormalities
- syndromes
- postnatal cerebral insults
- metabolic or degenerative disease
what are features of learning disability?
reduced intellectual functioning
delay in early milestones, dysmorphic features
± associated problems (epilepsy, sensory impairment, ADHD)
