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Y3 paediatrics > child development and special needs > Flashcards

child development and special needs Flashcards

1
Q

what is developmental delay

A

present when functional aspects of the child’s development in one or more domains are significantly delayed compared to the expected level for age

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2
Q

what is global developmental delay

A

performance below 2SD below mean of age appropriate, norm referenced testing

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3
Q

what is a learning disability

A

significant impairment in intellectual functioning and affects the person’s ability to learn and problem solve in their daily life

has nearly always been present since childhood

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4
Q

how common is GDD

A

1-3% of children
? potentially up to 16%

1% have an autism spectrum disorder

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5
Q

when is GDD identified

A

only 1/3 identified before school entrance

careful evaluation and investigation can reveal a cause in 50-70% of cases

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6
Q

presentation of GDD - when is it picked up

A

routine health surveillance

children w/ identified risk factors

parental concern

professional contact - nursery/daycare

opportunistic health contact

UK healthy child programme

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7
Q

assessment of development in children

A
  • hx and examination
    • prenatal, perinatal and postnatal events
    • developmental milestones
    • red book
    • environmental, SHx, FHx
  • video recordings of child
  • observation
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8
Q

1y care assessment tools for development

A

ASQ - ages and stages questionnaire

PEDS - parents evaluation of developmental status

M-CHAT - checklist for autism in toddlers

SOGS-2 - schedule of growing skills

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9
Q

quantification of developmental abilities

A

areas of development are age appropriate?

  • delay: global (2 or more domains) vs isolated
  • disorder: abnormal progression and presentation e.g. autism
  • regression: loss of milestones
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10
Q

schedule of growing skills

A

information of child’s development across a range of areas

0-5yrs

9 key areas

separate cognitive score can be derived

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11
Q

2y care assessment tools

A

Griffiths mental development scales

Bayley scales of infant development

Wechsler preschool and 1y scale of intelligence

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12
Q

things to remeber to include in hx

A

comprehensive

  • FHx neurodevelopmental/genetic disorder
  • hx miscarriages
  • prenatal, perinatal, neonatal
  • drug and alcohol use in pregnancy
  • developmental, behavioural, social, educational hx
  • medications
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13
Q

hx - further investigatinos

A
  • results of prev metabolic/thyroid testing
  • neuroimaging
  • lead and iron screening
  • growth records
  • vision and hearing surveillance
  • high index of suspicion for abuse and neglect
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14
Q

examination - what do we include

A

head circumference

dysmorphic features

skin abnormalities - neuro-cutaneous markers

movement quality

ability to sit and stand from supine

eye movements and eye examination

general examination: CVS, resp, abdo

observation of behaviour

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15
Q

sensory screening - how common are disorders

A

vision - 13-50%

hearing impairment - 18%

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16
Q

red flag signs - positive

A

loss of developmental skills

concerns re vision/hearing

floppiness

no speech by 18-24mths

asymmetry of movement

persistent toe walking

head circumference >99.6th C or <0.4th C

17
Q

red flag signs - negative

A

sit unsupported by 12mths

walk by 18mths (M) or 24mths (F) - check CK

walk other than on tiptoes

run by 2.5yrs

hold objects in hand by 5mths

reach for objects by 6mths

points to objects to share interest by 2yrs

18
Q

investigations - 3 important things to remember

A

based on clinical abnormalities

diagnostic yield of specific tests

timing

19
Q

types of investigations

A
  • genetic testing - chromosomal analysis, fragile X, FISH, array CGH
  • CK
  • thyroid screening
  • metabolic testing: aa and organic acids, ammonia, lactate
  • ophthalmological examination
  • audiology assessment
  • consider congenital infection e.g. toxoplasmosis, CMV
  • neuroimaging
20
Q

1st line investigations for GDD

A

following thorough hx and exam:

  • chromosomes
  • fragile X
  • U+E
  • CK
  • lead
  • TFT
  • urate
  • FBC
  • ferritin
  • biotinidase
21
Q

2nd line investigations for GDD and when are they considered

A

metabolic: bloods (lactate, aa, ammonia, VLCFA, carnitine, homocysteine, disialotransferrin)

  • FHx
  • consanguinity
  • regression
  • organomegaly
  • coarse features

neuroimaging: MRI, CT (bones, calcification)

  • abnormal head size
  • seizures
  • focal neurology

EEG:

  • speech regression, seizures, neurodegenerative disorder

genetics:

  • dysmorphism
  • abnormal growth
  • sensory impairment
  • odd behaviour
  • FHx
22
Q

common motor problems

A

delayed maturation

cerebral palsy

developmental coordination disorder

23
Q

common sensory problems

A

deafness

visual impairment

multisensory impairment

24
Q

common language/cognitive disorders

A

specific language impairment

learning disability

25
Q

common social/communication problems

A

autism

asperger syndrome

elective mutism

26
Q

why is it important to investigate

A
  • family understanding of condition and prognosis
  • lessens parental blame and address concerns re causes
  • prevents co-morbidity by identify preventable factors
  • genetic counselling
  • support
  • potential treatment
27
Q

MDT approach

A

developmental paediatrician

SLT

OT/PT

psychologist

social worker

geneticist

28
Q

what are additional support needs

A

when a child needs additional support with their education

can mean any kind of educational provision that is more than/very different from the education that is normally provided in mainstream schools

29
Q

why might a child required additional support

A

may be multiple different reasons:

  • difficulties w/ mainstream approaches to learning
  • disabiility/health needs e.g. motor/sensory impairment, learning difficulties, ASD
  • family circumstances e.g. young people who are parents/carers
30
Q

what is personal learning planning

A

a way of thinking about, talking about and planning what and how a child learns

also a way of assessing their progress and acting on the results of that assessment

31
Q

what is an individualised educational plan (IEP)

A
  • detailed plan for the child’s learning
  • specific, short-term learning targets for the child and will set out how the targets will be reached
  • targets are: specific, measurable, achievable, relevant, timed
  • aka additional support plans, individual support plans
  • not a legal document
32
Q

what is a co-ordinated support plan (CSP)

A
  • detailed plan of how child’s support will be provided
  • legal document - aims to ensure all professionals helping the child work together
  • helps ensure everyone (incl parents and child) if fully involved in the support
33
Q

when is a CSP put in place

A
  • for children in local authority school education and needing significant additional support
  • complex/multiple needs, needs likely to continue >1yr
  • support required by >1 agency
34
Q

what is GIRFEC

A

getting it right for every child

  • many children will now have a child’s plan
35
Q

when is a child’s plan created

A

if a child/young person needs some extra support to meet their wellbeing needs

e.g. access to mental health services, respite care, help from a range of different agencies

36
Q

what does the child’s plan contain information about

A
  • why a child/young person needs support
  • the type of support they will need
  • how long they will need support and who should provide it
  • all professionals working with the child would use the plan, which may include an IEP or CSP
37
Q

what does the long term outlook of a developmental condition depend on

A

nature of the problem

acquisition of skills

social and emotional needs

personal attributes, family, social surroundings and level of care recieved

Y3 paediatrics (45 decks)

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