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Paediatrics > Children with Special Needs > Flashcards

Children with Special Needs Flashcards

1
Q

What is child development?

A

The process by which each child evolves from infancy to adulthood

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2
Q

What are features of normal development?

A
  • A constant pattern
  • Sequential acquisition of skills
  • Median age vs limit age
    • limit age, skill should have been acquired and is 2 SD from the mean
  • Genetic factors
  • Environmental influences
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3
Q

What are some normal developmental milestones?

A
  • Gross motor skills
  • Fine motor skills
  • Speech and Language
  • Social, Personal, Activities of Daily living
  • Performance and Cognition
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4
Q

What is developmental delay?

A

Is present when functional aspects of the child’s development in one or more domains (motor, language, cognitive, social, emotional) are significantly delayed compared to the expected level for age.

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5
Q

What is criteria for developmental delay?

A
  • ‘Global developmental delay’ (GDD)
  • Performance below 2SD below mean of age-appropriate, norm-referenced testing
  • GDD vs Learning disability
    • A learning disability is a significant impairment in intellectual functioning and affects the person’s ability to learn and problem-solve in their daily life.It has nearly always been present since childhood.
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6
Q

What is the epidemiology of GDD?

A
  • GDD: 1-3% of children (? Upto 16%…)
  • 1% have an autistic spectrum disorder
  • Only 1/3 identified before school entrance
  • Careful evaluation and investigation can reveal a cause in 50-70% of cases.
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7
Q

How do we detect these children?

A
  • Routine health surveillance
  • Children with identified risk factors
  • Parental concern
  • Professional contact: nursery/ daycare
  • Opportunistic health contact
  • The UK Healthy Child programme (HCP)
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8
Q

How can we assess development?

A
  • History and examination
  • Prenatal, perinatal, postnatal events
  • Developmental milestones
  • The ‘Red Book’
  • Environmental, social and family history
  • Video recordings of child
  • Observation in clinic / other settings
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9
Q

What are some of our primary care assessment tools for assessing 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)a
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10
Q

What is SOGS?

A

Schedule of growing skills

  • Information of child’s development across a range of areas
  • 0-5 years
  • 9 key areas
  • Separate cognitive score can be derived
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11
Q

What are some secondary care assessment tools?

A
  • Griffiths mental development scales
  • Bayley scales of infant development
  • Wechsler preschool and primary scales of intelligence
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12
Q

What do we need to include in the history?

A
  • Comprehensive
  • FH
  • H/O misscarriage
  • Prenatal, perinatal, neonatal course
  • Drugs/bevvies during pregnancy
  • Developmental, behavioural, social and educational history
  • Record of medications
  • Results of previous thyroid testing
  • Neuroimaging
  • Lead/iron screening
  • Growth records
  • Vision/hearing surveillance
  • High index suspicion for abuse/neglect
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13
Q

What is included in examination?

A
  • Head circumference
  • Dysmorphic features
  • Skin abnormalities
  • Movement quality
  • Ability to sit and stand from supine
  • Eye movements and eye examination
  • General examination: CVS, Respiratory
  • Abdominal examination
  • Observation of behaviour
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14
Q

What are common syndromes?

A
  • Down syndrome
  • Fragile X syndrome
  • William’s syndrome
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15
Q

What sensory screening do we use?

A
  • Vision disorders: 13-50%
  • Hearing impairment: 18%
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16
Q

What positive red flag signs do we use?

A
  • Loss of developmental skills
  • Concerns re vision
  • Concerns re hearing
  • Floppiness
  • No speech by 18-24 months
  • Asymmetry of movement
  • Persistent toe walking
  • Head circumference >99.6th C or < 0.4th C
17
Q

What negative red flags do we use?

A
  • Sit unsupported by 12 months
  • Walk by 18months (boys) or 2 years (girls): Check creatinine inase
  • Walk other than on tiptoes
  • Run by 2.5 years
  • Hold objects in hand by 5 months
  • Reach for objects by 6 months
  • Points to objects to share interest by 2 years
18
Q

Ix for developmental probs?

A
  • Based on clinical abnormalities
  • Diagnostic yield of specific tests
  • Timing
  • Genetic testing: chromosomal analysis, Fragile X, FISH, array CGH
  • Creatine kinase
  • Thyroid screening
  • Metabolic testing: amino and organic acids,NH4,Lactate.
  • Ophthalmological examination
  • Audiology assessment
  • Consider congenital infection
  • Neuroimaging
19
Q

Common motor problems?

A
  • Delayed maturation
  • Cerebral palsy
  • Developmental coordination disorder
20
Q

Common sensory problems?

A
  • Deafness
  • Visual impairment
  • Multisensory impairment
21
Q

Common language problems?

A
  • Specific Language Impairment
  • Learning Disabilitya
22
Q

Common social/communication problems?

A
  • Autism
  • Asperger syndrome
  • Elective mutism
23
Q

How do we break the bad news?

A

Tact, Timing, Tenderness

Bad news broken well minimises the tragedy (Tact), badly broken compounds it.

Timing: both parents together ASAP ( as soon as diagnosis probable, not wait till confirmatory test).

We have a duty to do no harm, misplaced worry can do harm.

Tenderness: the way you tell parents. Show you care and empathise but be careful not to go overboard.

24
Q

How do we evaluate developmental problems?

A
  • Is there a problem?
  • Global or single field?
  • Delay, Disorder or Regression
  • Aetiology
  • Co-ordination of care and support
  • Problem based approach
25
Q

What services can we use?

A
  • Community paediatric clinics
  • Child development teams
  • Multidisciplinary assessment
  • Therapy services
26
Q

What additional support may a child need ?

A
  • Difficulties with mainstream approaches to learning
  • Disability or health needs, such as motor or sensory impairment, learning difficulties or autistic spectrum disorder.
  • Family circumstances e.g. young people who are carers or parents.
27
Q

What is PLP?

A
  • Personal learning planning(PLP) is a way of thinking about, talking about and planning what and how a child learns. It’s also a way of assessing their progress and acting on the results of that assessment.
28
Q

What is IEP?

A
  • lEP is a detailed plan for a child’s learning. It contains some specific, short-term learning targets for the child and will set out how those targets will be reached. Targets are:
29
Q

What is CSP?

A

Coordinated support plan

  • Detailed plan of how child’s support will be provided. It is a legal document and aims to ensure all the professionals who are helping the child, work together. It also helps ensure that everyone, including parents and the child, is fully involved in that support
30
Q

What is GIRFEC?

A
  • ‘Getting it right for every child’ (GIRFEC) approach, many children will now have a Child’s Plan. This is part of the Children and Young People Act that applies from Autumn 2016. Child’s Plans are created if a child or young person needs some extra support to meet their wellbeing

Paediatrics (32 decks)

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