Child Development (incomplete)

Question 1

What are the primitive reflexes?

Answer 1

Asymmetric tonic neck reflex
Babinski (extensor plantar) reflex
Galant reflex
Grasp reflex
Moro reflex
Sucking (rooting) reflex
Walking (stepping) reflex

Question 2

What is the walking/stepping reflex?

Answer 2

Supporting infant upright with soles touching surface causes each foot in turn to lift as if walking

Disappears at 2 months

Question 3

What is the sucking/rooting reflex?

Answer 3

Coordinated suck and swallow and turning towards the breast. Rooting - stimulation of corner of mouth/cheek prompts baby to turn towards the source and open mouth

May not develop until 32-36 weeks gestation

Disappears at 4 months

Question 4

What is the galant reflex?

Answer 4

Stroking to the side of the spine causes body to curve towards the stimulus (lateral curvature of spine)

Disappears at 4-6 months

Question 5

What is the grasp reflex?

Answer 5

Fist clenches when palm stimulated

Disappears at 5-6 months

Question 6

What is the moro reflex?

Answer 6

Throws head back
Extends then contracts limbs and clenches fists

Disappears at 5-6 months

Question 7

What is the Asymmetric tonic neck reflex?

Answer 7

Extension of ipsilateral arm and contraction of contralateral elbow upon head turning (fencer’s posture)

Disappears at 6-7 months

Question 8

What is the Babinski reflex?

Answer 8

Extension of toes upon stroking lateral surface of foot

Disappears at 2 years

Question 9

What is congenital anosmia?

Answer 9

About 1% of total cases of anosmia

Most common cause is Kallman syndrome (associated with absent or incomplete puberty)

Question 10

What is visual acuity?

Answer 10

Minimal distance that 2 targets need to be separated in order to be seen as distinct

An individual with ‘perfect’ vision can resolve 2 targets serparated by one minute of an arc (1/60th of a degree) i.e. 6/6 Snellen (or 20/20 by US measures)

Question 11

How are the numbers on Snellen chart calculated?

Answer 11

Numerator - distance from chart, usually 6 meters (20 yards).

Denominator - number beneath smallest line patient can read

A child with 6/36 vision is reading print at 6 meters that an individual with ‘normal’ vision would be able to read at 36 meters

Question 12

What is expected mean visual acuity for a newborn?

Visual acuity test for a newborn?

Visual field test for a newborn?

Answer 12

<6/60

Acuity test = fixation to lights

Field tests are not possible

Question 13

What is expected mean visual acuity at 0-3 months?

Visual acuity test for 0-3 months?

Visual field test for 0-3 months?

Answer 13

6/60 - 6/38

Acuity: fixation to faces/large toys

Fields: visually elicited eye movements

Question 14

What is expected mean visual acuity at 3-24 months?

Visual acuity test for 3-24 months?

Visual field test for 3-24 months?

Answer 14

6/38 improving to 6/12

Acuity: preferential looking cards (Teller/Cardiff) - preference to look towards more interesting stimulus

Fields: confrontation techniques

Question 15

What is expected mean visual acuity at 2-4 years?

Visual acuity test for 2-4 years?

Visual field test for 2-4 years?

Answer 15

6/12 - 6/9

Acuity: picture optotype charts

Fields: ?confrontation techniques

Question 16

What is expected mean visual acuity at 5+ years?

Visual acuity test for 5+ years?

Visual field test for 5+ years?

Answer 16

6/9 - 6/6

Acuity: letter optotype charts

Fields: Goldmann perimetry / automated perimetry
(Humphrey/Octopus sometimes possible)

Fields are notoriously difficult to test in children but by 5 years expected 150 degrees horizontal and 130 degrees vertical

Question 17

What is logMAR?

Answer 17

Logarithmic minimal angle of resolution

Replacing Snellen charts in eye departments

Uniform 5 letters per line
Score 0.00 equivalent to 6/6, higher number = worse acuity

Question 18

What is VEP?

Answer 18

Visual evoked potentials

VEP pattern reversal test
= way of objectively assesing acuity, skin electrodes measure cortical activity stimulated from reversing white/black chequerboard pattern

Acuity is quantified by the smallest check size to elicit a cortical reaction

Can be esp. useful in non-organic visual loss

Question 19

What is variable angle squint?

Answer 19

Ocular misalignment

Common in neonates, reflects poor visual acuity at that stage of development. By 3 months, visual acuity should be sufficient to stimulate ocular alignment.

Squint after 3 months suggests vision is poor or squint is pathological

Question 20

Ocular and cortical immaturity causes pursuit and saccadic eye movements to be jerky and inaccurate until what age?

Answer 20

3-4 months

Question 21

When is vision routinely assessed in children?

Answer 21

Red reflex at birth

Orthoptist led service 4-5 years