child developmenty Flashcards
what is the role of the frontal lobe
concentrating
executive function
what is the role of the temporal lobe
speech and language development
what is mediated through the reticulospinal tract
coordination - the cerebellum
importance of the vestibulospinal tract *
balance
importance of educational needs *
20% children have special educational needs
2% have severe disability
what are the developmental domains *
speech and language skills - vocalisation, words, understanding, imaginitive play
gross motor skills - position, head lag, sitting, walking, running
fine motor skills - use of hands, grasp and fine pincer, bricks, crayon, puzzles
social skills - social interaction, eating, stranger reaction, dressing
developmental domains at 2 and a half months *
uncoordinated and crude movements - gross motor only
developmental domains at 8 months *
gross motor - Hold self up – sitting and in prone position, Limbs more coordinated
fine motor - hold bricks, fine motor grasp
social - check for affirmation from mum, awareness of strangers
developmental domains at 2yrs *
gross - can stand
fine - do puzzles
language - 50words, pointing to things, wanting to show what is happening in their life, listen carefully and respond
social - follow instructions, eating skills
developmental domain at 4.5 yrs *
gross - catch and through
fine - hold pen, copy shapes
social - know colours
describe the mororeflex *
when you extend babies head quickly they extend their arms and then grasp
this is primitive and a protectve reflex
should disappear at 3-4months
what are the patterns of abnormal development *
there is a large normal range
abnormal if
- slow but steady
- plateu
- regression (lose skills)
what are common developmental problems *
delayed walking
clumsy
delayed speech and language
odd social interaction - ASD/Aspergers
hyperactivity
problems with sleep onset/frequent night waking
problems eating
problems toilet training
specific learning difficulties eg dyscalculia (cant use numbers well), dyslexia
area of the brain involved in speech and language *
wernick’s - collect information
broca’s - language
motor componenets
area of the brain involved in hyperactivity *
frontal lobe ie the prefrontal cortex
dopamine is low = ill attention, hyperactivity and impulsivity
describe autism *
distinguished by a pattern of symptoms rather than a single problem
effect boys more than girls
impairments in social interaction, communication, restricted interests and repetitive behaviour
solitary play - impaired social interaction
avoid gaze
preoccupation
self stimulating
line toys up in unusual way
speech and language disorder
routines and repetitive behaviour
learning and attention difficulties
epilepsy
describe cerebral palsy *
damage to the corticospinal pathway
have motor deficit/posture problem
it is a persistant disorder
from non-progressive lesion acquired before 2yrs, most acses antenatal
range in severity
brain abnormal development because of genetics, or an effect of infection/trauma
people walk on tip toes because of increased flexor contraction relative to extensor contraction - there is increased tone - the inhibitory pathways are effected
presentation may evolve and vary with age
epilepsy
hearing loss
feeding difficulties
poor growth
resp problems
what are the causes opf developmental impairments *
prenatal
perinatal
postnatal
eg folic acid deficiency, teratogens (eg alcohol)
what are the factors that influence developmental delay *
laco of physical/psychological stimuli
sensory/motor impairment
reduced inherent potential
ill health
what are the types of developmental delay *
global - ie in all domains
specific - language/motor/sensory/cognitive
what are the causes of global delay *
chromosomal abnormalities - Down’s/fragile X
metabolic - hypothyroidism, inborn errors of metabolism
antenatal and perinatal factors - Infections, drugs, toxins, anoxia, trauma, folate def
environmental/social issues
chronic illness
causes of motor delay *
- Cerebral palsy
- Global delay eg Down’s syndrome
- Congenital dislocation hip
- Social deprivation
- Muscular dystrophy-Duchenne’s
- Neural tube defects: spina bifida
- Hydrocephalus
causes of language delay *
- Hearing loss
- Learning disability
- Autistic spectrum disorder
- Lack of stimulation
- Impaired comprehension of language -Developmental dysphasia
- Impaired speech production -stammer, dysarthria
how do you assess child development *
parents know something is wrong before professionals do
therefore ask first, then observe and set tasks
need to assess the milestones preceding their age adn the expected milestones for age
take history - prenatal, birth and FH
PMH - developmental history and current skills
examination - developmental assessment and general and neuro examination
investigations as appropriate
what are the tools that can be used to assess developpment I
standardised tests
schedule of growing skills
griffiths developmental scale
bailey developmental scale
denver developmental screening tests
things involved in the physical examination of development *
look of child - can pick up syndromes
growth
OFC - occipitofrontal circumference - give idea of brain development
skin
genitalia
neurological examination
systems examination to identify associations or syndromes
growth parameters
dysmorphic features
blood and imaging used to assess development *
FBC and ferritin
TSH
Chromosomes, cytogenic studies
Lead
US
CT/MRI, EEG
blood ammonia/lactate
nerve/muscle biopsy
bone profile
urine and blood organic or amino acid
what are the objectives of managing development *
maximise mobility
minimise discomfort
promote speech and language
promote social and emotional health
who is involved in MDTs for development *
specialist health visitor
paediatrician
OT
psychologist
physio
social worder and social services
dietician
speech and language therapist
role of MDT *
assessment
diagnosis and disclosure
management program
social support
role of specialist health visitor *
helps coordinate multidisiplinary and multiagency care
advice on development of play or local authority schemes
role of psychologist *
cognitive testing
behavioural management
educational advice
role of social worker/services *
- Advice on benefits: disability, mobility, housing, respite care, voluntary support agencies
- Day nursery placements
- Advocate for child and family
- Register of children with special needs
role of dietician *
advice on feeding and nutrition
role of SALT *
- Feeding
- Language development
- Speech development
- AAC (augmentative and alternative communication aids) e.g. Makaton sign language, Bliss symbol boards, voice synthesisers
role of physio *
- Balance and mobility
- Postural maintenance
- Prevention of joint contractures, spinal deformity
Mobility aids, orthoses
role of OT *
- Eye-hand coordination
- ADL (activities of daily living) – feeding, washing, toileting, dressing, writing
- Seating
House adaptations
role of paediatrician *
- Assessment, investigation and diagnosis
- Continuing medical management
- Coordination of input from therapists and other agencies – health, social services, education
things included in a history *
Antenatal – illnesses/infections; medications; drugs; environmental exposures
Birth –Prematurity, Prolonged/complicated labour
Postnatal – illnesses/infections; Trauma
Consanguinity – increases chances of chromosomal or autosomal recessive conditions
Developmental milestones from parent
management of cerebral palsy
minimise spasticity and associated problems
management for autism *
intensive support for child and family
describe attention defiit hyperactivity disorder *
diagnostic criteria - inattention, hyperactivity, impulsivity, lasting >6months, commencing <7yrs and inconsistent with the child’s developmental level
features should present in >1 setting and cause significant school/social impairment
increased risk of CD, anxiety disorder, ad aggression
risk factors: boys, learning difficulties, developmental delay
Neurological disorder, e.g. epilepsy, cerebral palsy; first-degree relative with ADHD; family member with depression, learning disability, antisocial personality or substance abuse
large proportion become adults with antisocial personality, increased incidence of criminal behaviour and substance misuse
management of ADHD *
psychotherapy - behavioural therapies
family therapy
drugs - if behavioural therapy alone is insufficient give stimulants - methylphenidate (Ritalin), amphetamines (dexamphetamine)
diet - some benefit from exclusion of certain foods eg red food colouring
describe learning disability
1/4 people with severe learning disability have no identifyable cause
causes can be - chromosome disorders, syndromes, post-natal cerebral insults, metabolic or degenerative disease
lassified as mild, moderate, severe, profound
may present with reduced interlectual functioning, delay in early milestones, dysmorphic features and associated problmes (epilepsy, sensory impairment, ADHD)
management of learning difficulties
establishing a diagnosis and input from the multidisciplinary team with long term follow up.
define child development *
the global impression of a child which encompasses growth, increase in understanding, acquisition of new skills and more sophisticated responses and behaviour.
It serves to endow the child with increasingly complex skills in order to function in society.
what are limit ages *
the ages by which things should be achieved
if more than 2 SD from mean - could be major concern
effect of folate deficiency *
neural tube defects
limb paralysis
neurogenic bladder and bowel
intellectual impairment
identify child milestones *
