children and complex needs Flashcards
what is difference between mild LD and severe LD?
LD: general umbrella for range of conditions that affect from mild to severe
- Mild: child may need extra time and help with learning new skills
- Severe: significant intellectual impairment and they may need help with ADLs
what is dyslexia?
Dyslexia: specific difficulty in reading, writing and spelling
what is dysgraphia?
Dysgraphia: specific difficulty in writing
what is dyspraxia?
Dyspraxia: developmental co-ordinator disorder
- Specific type in physical co-ordination
- Presents with delayed gross and fine motor skills and child that appears clumsy
who is dyspraxia more common in?
boys
what is auditory processing disorder?
Auditory processing disorder: specific disability in processing auditory info
what is non-verbal LD?
Non-verbal learning disability: difficulty in processing non-verbal information such as body language and facial expression
how is LD classified?
based on IQ
what are the classifications of LD based on IQ?
- Mild: 55-70
- Moderate: 40-55
- Severe: 25-40
- Profound: <25
which is the most common IQ bracket for children with LD to be within?
mild - 55 to 70
children may be borderline
what can cause LDs?
- May have underlying family Hx
- Environmental factors:
genetics
antenatal probelms
labour problems
problems in early childhood
autism
epilepsy
what environmental factors can cause LD?
- Environmental factors: abuse, neglect, psychological trauma and toxins (alcohol in-utero) can increase risk
what antenatal problems may cause LD?
fetal alcohol, maternal chickenpos
name some labour problems that may cause LDs?
preemie, hypoxic ischaemia encephalopathy
what childhood conditions can cause LD?
meningitis
who is in MDT to manage childhood LDs?
MDT approach to support parents/ child
- Paediatrician
- Social workers
- Health visitors – all under 5 have one
- Schools
- Educational psychologists
- GPs/ nurses
- Ots
- SALT
what is developmental delay?
There is flexibility within milestones children that are slow to achieve all milestone sor lags behind in certain areas pathological
what is global developmental delay?
Global developmental delay: child is displacing slow development in all developmental domains
what conditions can cause global developmental delay?
- Down’s syndrome
- Fragile X syndrome
- Fetal alcohol
- Rett syndrome
- Metabolic disorders
what conditions can cause gross motor delay?
Cerebral palsy
Ataxia
Myopathy
Spina bifida
Visual impairments
what can cause fine motor delay?
Dyspraxia
Cerebral palsy
Muscular dystrophy
Visual impairment
Congenital ataxia (rare)
what can cause language delay?
specific social - many siblings or multiple languages
Hearing impairment
LD
Neglect
Autism
Cerebral palsy
who should you refer to with language delay?
Need referral to SALT, audiology, health visitor and safeguarding?
what can cause personal and social delay?
Emotional and social neglect
Parenting issues
Autism
what is HIE?
Hypoxic ischaemic encephalopathy:
HIE: occurs in neonates as a result of hypoxia during birth
what is the pathophys of HIE?
- Lack of oxygen causing restriction of blood flow to brain causing encephalopathy (malfunctioning of the brain)
what can HIE lead to?
cerebral palsy
what events can cause hypoxia in neonates?
- Acidosis on umbilical artery blood gas
- Poor apgar
- Features of mild/ moderate, severe HIE
- Multi organ failure
what is asphyxia?
anything leading to asphyxia (deprivation of oxygen) to brian can cause HIE
what can cause asphyxia which can lead to HIE?
- Maternal shock
- Intrapartum haemorrhage
- Prolapsed cord
- nuchal cord
what is prolapsed cord?
compression of cord during birth
what is nuchal cord?
cord wrapped around neck of baby
what grading system is used for HIE?
Sarnat staging
what are the three stages within HIE staging
Sarnat
mild
moderate
severe
how would mild HIE present?
Poor feeding, general irritability and hyper-alert
Resolves within 24hrs
Normal prognosis
how would moderate HIE present?
Poor feeding, lethargic,, hypotonic, seizures
Can take weeks to resolve
Up to 40% go on to develop cerebral palsy
how would severe HIE present?
Reduced consciousness, apneoas, flaccid, reduced/ absent reflexes
50% mortality
90% develop cerebral palsy
how do you manage HIE?
need specialist in neonatology
- Supportive care:
therapeutic hypothermia
MDT throughout childhood
what is supportive care within HIE?
neonatal resus, ongoing optimal ventilation, circulatory support, nutrition, acid-base balance, manage seizures
what is therapeutic hypothermia within HIE and why?
- Need therapeutic hypothermia cooling baby core to 33-34 in NICU for 72hrs and then gradually increased temp back up, can help reduce inflammation, neurone loss, reduced risk of cerebral palsy, developmental delay, blindness and death
what is ASD?
Autism spectrum disorder: ASD
ASD: refers to full range of people affect by deficit in social interaction, communication and flexible behaviour
- Groups autistic disorder and Aspergers
what components make up ASD?
social interaction
communication
behaviour
what features within social interaction would indicate ASD?
Social interaction: lack of eye contact, delay in smiling, avoids physical contact, unabale to read on non-verbal cues, difficulty in establishing cues, difficulty in establishing friendships, not wanting to share attention (no playing with others)
what communications skills would indicate ASD?
Comms: delay/ regression in language development
- Lack of appropriate non-verbal comms eg smiling, eye contact, responding to others with shared interest
- Difficulty with imaginative/ imitative behaviour
- Repetitive use of words
what behavioural attributes would indicate ASD?
Behaviour: greater interest in objects, numbers, patterns than people
- Stereotypical behaviour eg self stimulating to comfrot themselves egg hand-flapping/ rocking
- Intensive and deep interests that are persistent and rigid
- Repetitive behaviours + fixed routine
- Anxiety and distress with outside of routine
- Extremely restricted food preferences
who can diagnose autism?
: made by specialist paeds psych or peads specialist with interest in developmental and behaviour
does an autism diagnosis have to be at school age?
no can be before 3yrs
who is within MDT of autism management?
Management: MDT to provide best environment and support for child and parent
- CAMHS
- SALT
- Dietician
- DR
- Social worker
- Specially trained educators and special school environments
- Charities such as national autistic society
what is ADHD?
There is a normal spectrum among children and adults in their level of activity throughout day and night and ability to concentrate on a single task for an extended period
ADHD: is extreme end of hyperactivity + inability to concentrate
how should ADHA affect child in order for diagnoses?
- Affecting person’s ability to carry out everyday tasks, develop normal skills and perform well in school
- Should be consistent across various setting eg only doing this at school but well and behaved at home: environmental problem
what are features of ADHD?
ADHD is pat of normal spectrum when it adversely affecting child
- Very short attention span
- Quickly moving from one activity to another
- Quickly losing interest and not being able to persist with challenging tasks
- Constantly moving/ fidgeting
- Impulsive behaviour
- Disruptive / rule breaking
how do you manage ADHD?
coordination from specialist
- Parental strategies to manage behaviour
- Establishing healthy food and exercise can have significant improvement in symptoms
- Keeping a food diary alongside behaviour eg food colourings
Medications: specialist only
what is the moa of ADHD meds?
- Central nervous system stimulants
name some examples of medications used in ADHD management?
- Methylphenidate (Ritalin)
- Dexamphetamine
- Atomoxetine
