Common paeds hsitory - developmental delay Flashcards
If a child was presenting with developmental delay, what would you want to establish first?
- Red book - check this
- Which domain the delay is in
What key milestones would you want to ask about when asking about developmental delay?
- Smiling 6 weeks
- Turns to sounds - 6 months
- Sitting by 9 months
- First words - 18 months
- Walking - 18 months
- Short sentences - 3 years
What would you ask about the motor domain in a dvelopmental assessment?
- How mobile
- Hand dominance
- Balance problems
- Behavioural problems
What would you want to ask about language/social problems in a developmental delay history?
- Senses - hearing/vision
- Vocalisation/articulation
- Comprehension - follows commands, responds to voice
- Non-verbal - pointing, gestures, facies
- Social responsiveness - reactions, tantrums, playing, gestures
What domains would you want to cover in developmental history?
- Gross motor
- Fine motor/vision
- Hearing and language
- Social
What would you want to make sure to ask about in addition to developmental domains in a developmental history?
- Prenatal problems
- Perinatal problems
- Postnatal problems
- General symptoms
- Neuro symptoms
What would you want to ask about prenatal problems in a developmental history?
- Alcohol/drugs in pregnancy
- Maternal infection
What would you want to ask about perinatal problems in a developmental history?
Prolonged/difficult labour/difficulties
What would you want to ask about postnatal problems in a child with developmental delay?
- Meningitis
- Encephalitis
What general symptoms would you want to ask about in a developmental history?
- Fever
- Behaviour
- Activity/apathy/alertness
What neurological features would you want to ask about in a developmental delay history?
- Fits/LOC
- Headache
- Dizziness
- Vision/hearing loss
- Weakness
- Wasting
What features associated with generalised developmental delay would suggest chromosomal/genetic abnormalities as a cause?
Dysmoprhic features
What features associated with generalised developmental delay would suggest alcohol/drugs in pregnancy as a cause?
History of maternal drug/alcohol use
What features associated with generalised developmental delay would suggest TORCH infection as a cause?
History of toxo/rubella/CMV/herpes
What features associated with generalised developmental delay would suggest extreme prematurity as a cause?
Born < 28 weeks
What features associated with generalised developmental delay would suggest hypoxic brain injury?
Perinatal hypoxic insult
What features associated with generalised developmental delay would suggest hypoglycaemia as a cause?
Period of neonatal hypoglycaemia
What features associated with generalised developmental delay would suggest Intracerebral haemorrhage as a cause?
- Risk factors - difficult labour, prematurity
- Usually diangosed within first few days
What features associated with generalised deelopmental delay would suggest meningitis/encephalitis as a cause?
Onset after episode of meningitis/encephalitis
What are prenatal causes of Generalised developmental delay?
- Chromosomal/genetic problems
- TORCH infection
- Maternal Alcohol/drug use
What are perinatal causes of generalised developmental delay?
- Extreme prematurity
- Hypoxic brain injury
- Hypoglycaemia
- Intracerebral haemorrhage
What are post-natal causes of generalised developmental delay?
- Meningitis/encephalitis
- Head injury
- Hypoxic episode
- Hypoglycaemic episode
What are causes of motor delay?
- Cerebral palsy
- DMD or other dystrophies
- Hip dysplasia
What features associated with motor delay would suggest CP as a cause?
- Muscle stiffness/weakness/floppiness
- Spasm/dyskinesia/ataxia
- Caused by pre/peri/postnatal insult
What features associated with motor delay would suggest DMD?
- Progressive muscle weakness - beinning proximally
- Onset 2-3 years
What features associated with motor delay would suggest hip dysplasia?
Usuaully identified at brith but may present later with a limp
What are causes of social/language delay?
- Deafness
- Articulation problems
- Familial delay
- Lack of stimulus
- Autism
- ADHD
What features associated with social/language delay would suggest Deafness as a cause?
Cause of deafness - e.g. chronic otitis media
What features associated with social/language delay would suggest articulation problems as a cause?
Birth defects - e.g. cleft palate
What features associated with social/language delay would suggest a familial cause?
Similar history in family
What features associated with social/language delay would suggest lack of stimulus as a cause?
- Poor interaction with parents
- May show signs of neglect
What features associated with language/social delay would suggest autism as a cause?
- Imposition of routines
- Doesn’t seek friendships, prefers own company
- Limited gestures and expressions
What features associated with social/developmental delay suggest ADHD as a cause?
- Hyperarousal/Hyperactivity
- Inattentiveness
