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3b. CHILD HEALTH > Child Development > Flashcards

Child Development Flashcards

1
Q

Describe/define:

  • developmental milestone
  • median age
  • limit age
A
  • range of ages when children learn new skills
  • age at which 50% have achieved the skill
  • age at which 97.5% have learned the skill e.g. 2 standard deviations
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2
Q

What are the four regions of developmental milestones?

A

Gross motor, fine motor (/vision), language/speaking, social and play

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3
Q

Health visitors have a key role in child health. Name 3 of the most important dates and what is assessed.

A

6-8wks: gross motor movement, social smile
14 months: walking, fine pincer grip, single words
27 months: speech, language, social behaviour

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4
Q

What are the three types of abnormal development in children?

A
  • delay (can be global or specific)
  • deviation (e.g., ASD)
  • regression (had the skill but lost it (e.g. Rett syndrome)
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5
Q

Name the red flags of development.

A
  • asymmetry of movement, or marked change in tone
  • not reaching for objects by 6 months
  • unable to sit unsupported by 12 months
  • unable to walk by 18 months
  • no speech by 18m
  • concerns via hearing or sight at any age
  • regression of skills at any age
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6
Q

In what direction (of the body) does development generally happen?

A

Craniocaudal (e.g. top to toe)

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7
Q

Describe how developmental delay would be predicted to affect a child in later life.

A

better compared as percentages.
e.g. 6 month delay at 2 years is 25%
so at 16 years would be expected to have a 4 year delay (25%)

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8
Q

Name and describe the four main causes of global developmental delay.

A 
Down's syndrome (trisomy 21; screen yearly for cardiac, visual, hearing, hyperthyroid, OSA, growth milestones)
Duchenne's (progressive lordosis, calf pseudohypertrophy, Gower manoeuvre)
Cerebral palsy (most often spastic, overlap)
Oculocutaneous albinism (nystagmus, reduced vision, photophobia)
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9
Q

Name and describe the autistic triad.

A

communication, social interaction, and flexibility of thought/imagination

  • receptive/expressive language, nonverbal, conversations and interests
  • joint attention, taking turns, unable to share pleasure, not motivated by social rules
  • theory of mind, concept of time, routines, transitions, ritualistic
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10
Q

What are the three peaks of growth in childhood, and what are they mediated by?

A
  • baby (nutrition, 14-23cm/year)
  • middle (growth hormones)
  • puberty (androgens)
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11
Q

What is the onset of puberty?

A

Stage II Tanner Development

  • boys: 4ml testicular volume
  • girls: thelarche (breast bud development)
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12
Q

Define precocious and delayed puberty.

A 
Precocious (early)
- male <9 year
- female <8 year
Delayed (late)
- male >14 year
- female >13 year
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13
Q

What is the average height difference between males and females, and why does this occur?

A

12.5 - 14cm

Delayed male peak height velocity

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14
Q

What are the six main categories of growth deficiency?

A
  • genetic
  • constitutional
  • dysmorphic (Down’s, Turner syndrome)
  • endocrine
  • chronic disease
  • psychosocial deprivation
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15
Q

What/when are the three main brain development stages?

A

Embryonic (conception to 9 weeks)
Foetal (week 9 to term, wks 40-42)
Postnatal (after birth)

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16
Q

Describe the first structure developed in the embryonic stage of brain/CNS development.

A

The neural tube.
Lined by neural progenitor cells in the ventricular zone (day 20-27).
Anterior/rostral tube becomes the brain
Basal/caudal end becomes the spinal cord

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17
Q

Which conditions arise if the neural tube doesn’t close properly?

A

anterior closure - anencephaly (incompatible with life)

posterior closure - spina bifida

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18
Q

The neural tube develops into three primary vesicles; name these and describe what these develop into, and what they ultimately become.

A

prosencephalon (forebrain) -> telencephalon (cerebrum), diencephalon (hypo-, epi-, thalamus, eye cup)
mesencephalon -> midbrain
rhombencephalon (hindbrain) -> metencephalon (pons, cerebellum), myelencephalon (medulla oblongata)

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19
Q

Describe the role of signalling molecules in development of the brain.

A

Emx2 and Pax6

  • anterior brain has more Pax6, becomes motor neurones
  • posterior has more Emx2, becomes visual cortical neurones
20
Q

Initially in the foetal period, the brain is smooth - what is the descriptive term for this?

A

Lissencephalic

21
Q

Describe the formation and migration of neurons in the foetal period of brain development.

A

Neural progenitor cells have two methods of division:
- symmetric (two identical progenitors)
- asymmetric (one progenitor, one neuron)
Progenitor cells remain in the ventricles and neurons migrate outward to the neocortex by 3 methods:
- somal translocation
- radial glial guides
- tangential migration

22
Q

Which structures develop in the postnatal period of CNS development?

A

olfactory bulb, dentate gyrus of hippocampus, and glial progenitors, which form:

  • astrocytes
  • oligodendrocytes
  • (myelin sheaths)
23
Q

Name the rare genetic disease that arises from dysfunction of myelin sheaths, and the gene it affects.

A
  • pelizaeus-merzbacher disease
  • PLP1 gene
  • (nystagmus, hypotonia, cognitive impairment)
24
Q

Describe the need for visual stimulation for both eyes to work correctly.

A
  • when both eyes are stimulated together, ocular dominance columns both develop equally
  • monocular deprivation substantially alters patterns of organisation in the primary visual cortex
25
Q

What are the most important factors for prenatal and postnatal CNS development?

A

Pre-: term development (sets up core CNS)

Post-: diverse inputs and stimulation

26
Q

Name the 4 chronological stages of attachment, describe them and when they occur.

A
  1. asocial 0-6wks (smiles, cries, not directed at specific people, although preference for humans)
  2. indiscriminate (-7m) attention sought from different people, can tell people apart, no fear of strangers)
  3. specific (-11m): strong attachment to one individual, stranger and separation anxiety develop
  4. multiple attachments develop
27
Q

Name and briefly describe the four types of attachment personality, in relation to the strange situation.

A

A (insecure avoidant) - no distress when mother leaves, OK with stranger, little interest in mother return, both comfort equally
B (secure) - distress when mother leaves, friendly to stranger when mother present, happy when mother returns
C (insecure ambivalent) - some distress when mother leaves, fear of stranger, approaches mother but resists contact, cries more and explores less
D (disorganized) - mixed response

28
Q

Define the terms ‘secure base’ and ‘safe haven’.

A
  • secure base: attachment provides base from which infant can explore from
  • safe haven: attachment figure provides space to retreat to when danger/anxiety arises
29
Q

Name and describe the four types of temperament.

A

Easy (40%): easily adapts, reacts mildly, regular patterns
Hard (10%): slow to adapt, intense reactions, irregular routines
Slow to warm up (5-15%): slow to adapt, low levels of activity, ‘shy’
Don’t fit a category (40%)

30
Q

Describe the risks and types of reactive attachment disorder (RAD).

A

grossly pathological care
- persistent disregard for emotional needs (comfort, stimulation)
- persistent disregard for physical needs
- repeated change of caregivers
Types of RAD:
- inhibited (continuous failure to interact in social situations in an appropriate way)
- disinhibited (inability to display appropriate selective attachments; excessive friendliness to strangers)

31
Q

Name the co-morbidities associated with RAD.

A
  • emotional disorders
  • ADHD
  • behavioural disorders
  • all of the above
32
Q

Describe the assessment of RAD.

A

Based on age (years);

  • 1-2: strange situation
  • 2-4: modified strange situation
  • 1-4: attachment Q sort
  • 4-7: story stem attachment profile
  • 7-15: child attachment interview
  • 15+: adult attachment interview
33
Q

Describe the treatment of RAD.

A

Based on age:

  • preschool: video feedback to parents
  • school: parental therapy, group play sessions, group-based education, CBT for trauma
34
Q

Define conduct disorder (CD).

A

Repetitive, persistent pattern of behaviour in which basic rights of others are ignored, or major age-based norms are ignored

35
Q

Give the classification of CD.

A
  • mild-moderate; limited to family
  • unsocialised; violent behaviour, more likely to be associated with justice system
  • socialised; more covert or better ability to evade justice
36
Q

Give the risks for developing CD.

A
  • genetic
  • brain injury
  • antisocial behaviour (lack of house rules, lack of clarity how to behave, inconsistent behaviour, inconsistent responses to bad behaviour
37
Q

Give the options for treatment of CD.

A

Based on age
- <11: parent/foster training
- 9-14: child-focussed programme (social/cognitive)
- 11-17: multimodal multisystemic therapy with child and family
Medication not 1st line, but can help with aggressive behaviour.
- risperidone
- ADHD medication
- SSRIs

38
Q

Give the HEEADSSS framework of discussion points with adolescents.

A
  • home
  • education/employment
  • eating (weight/body image)
  • activity (with peers, physical)
  • drugs
  • sex (orientation, STIs)
  • suicidality
  • safety (risk taking, criminality)
39
Q

Regarding the bell curve and nutrition, name the terms used for 0, -2, and +2 standard deviations. Which nutrient guidelines are used for each?

A

-2: lower reference nutrition intake (LRNI)
0: estimated average requirement (EAR); energy
+2: reference nutrition intake (RNI); vitamins, protein

40
Q

What are the three types of undernutrition?

A
  • wasting (low weight for height)
  • stunting (low height for age)
  • underweight (low weight for age)
41
Q

When should complementary feeding be introduced?

A

Around about 6 months

42
Q

What are the population and clinical centile thresholds for overweight and obesity in children 2-18?

A

Population (>85, risk of overweight; >95, risk of obese)

Clinical (>91, overweight; >98 obese)

43
Q

Which two genetic syndromes, associated with hyperphagia, may cause overweight/obesity in children?

A
  • prader-willi syndrome

- bardet-biedl syndrome

44
Q

What are the 5 key considerations for weight management in children with overweight/obesity?

A
  • healthy eating/diet
  • physical activity
  • screentime
  • sleep
  • behaviour
45
Q

When should a child with overweight/obesity be referred for paediatric review?

A
  • serious morbidity that requires weight loss (benign intracranial HTN, OSA, orthopaedic problem)
  • suspected medical cause (e.g. endocrine)
  • child <24 months that is severely obese (>99.6th centile)

3b. CHILD HEALTH (3 decks)

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