Community Flashcards
At what age should a baby sit?
6 months rounded back
8 months straight back
At what age should a baby crawl?
Around 8-9 months
At what age should a baby cruise?
10 months
At what age should a baby walk?
Unsteadily at 12 months and steadily by 15 months
What milestone should occur at 6 weeks?
Follows object with head
What fine motor skill occurs at 4-6 months?
Palmar grasp
When should a child say their first words
7-10 months
Normally Mama / Dada
When should a baby smile?
6 weeks
When should a baby wave?
10-12 months
What is Child Health Surveillance?
Offers families a programme of
Screening tests
Immunisations
Developmental Reviews
Health Promotion (information and guidance)
Define: Delay, Learning Difficulty, Disability
Delay - slow acquisition (specifically or globally)
Learning Difficulty - in relation to children of school age, can be cognitive/physical/both
Disability - Any restriction/lack of ability due to impairment
Give two prenatal/perinatal/postnatal causes of abnormal development
Prenatal - Infection, Alcohol
Perinatal - Asphyxia, Intraventricular Haemorrhage
Post Natal - seizure
Define Developmental Delay
A delay in acquisition of all skill fields, normally becoming apparent in the first two years of life
Give 5 broad categories of investigations that could be done on a child with suspected Developmental Delay
Cytogenic Metabolic Infection Imaging Neurological
Describe some of the types of Abnormal Speech and Language
- Pragmatically (difference between intention and meaning)
- Phonation (Stammering)
- Language Expression
- Communication Skills
- Language Comprehension
Give three causes of abnormal speech and language
Hearing Loss
Global developmental delay
Environmental deprivation
How could you test language in a child?
Early - Symbolic toy test
Pre-School - Reynell test of expressive and receptive language
Give three managements for speech and language delay
Speech and language therapy
Alternate methods of Communication (Makaton, Picture Exchange Communication System)
Learning support
Describe the four classes of Learning Difficulties
Mild - IQ70 to 80 (learning assistance in class)
Moderate - IQ50-70 (only emerge as speech and language do)
Severe - IQ35-50 (minimal self care)
Profound - IQ<35 (no significant language)
Define Dyspraxia and it’s management
Developmental Coordination Disorder
Disorder of motor planning and execution without significant neurological findings
Managed with therapy
Define Dyslexia and how it’s assessed
Disorder of reading skills disproportionate to child’s IQ (>2 years behind chronological age)
Assess vision and hearing, then further assessment by Educational Psychologist
Define Disorders of Executive Function
Responsible for planning,organisation,flexibility and problem solving
Often a consequence of acquired brain injury
Manifests as forgetfulness, volatile mood, poor social skills
Give three reasons a child may refuse meals
Past history of force feeding
Irregular meal times
Unreasonably large portions
Give three reasons a child may have difficulty sleeping
Overstimulation
Use of bedroom as punishment
Too much sleep late afternoon
How should aggressive behaviour be managed?
Often caused by learned behaviour
Unlikely to ‘grow out of it’
Encourage attendance of parenting programmes
Describe four general management recommendations for behavioural problems
Explanation and reassurance
Parenting groups
Family therapy
Psychodynamic psychotherapy
Define Child Protection
Process of protecting individuals as they’re either suffering, or likely to suffer significant harm as a result of abuse or neglect.
Give three child related risk factors and three adult related risk factors for child abuse
Child: Consistent Crying, Disabled, Unwanted
Adult: Mental Illness, Financial Difficulties, Own experience of child abus
When should you suspect physical abuse in a child?
MOA not compatible with injury sustained
Inconsistent histories
Lack of parental concern
Bruising is uncommon in a non mobile child. Give three differentials other than NAI.
Bleeding Disorder (eg Haemophilia A) Mongolian Blue Spot Erythema Nodosum
Name two injuries that can be seen in a ‘Shaken Baby’
Subdural Haematoma
Retinal Haemorrhages
If a child presents with a query NAI to A&E, what four investigations should be carried out?
Skeletal Survey
CT Head
Ophthalmology
Coag Screen
Define Neglect
Persistent failure to meet child’s basic physical or psychological needs that is likely to result in serious impairment of child’s health and development
Define Emotional Abuse
Persistent non physical harmful interactions with child by care giver
Define Sexual Abuse
Physical contact (penetrative and non penetrative) , exposure to explicit material and sexual exploitation
Define ADHD and give three possible aetiologies
Neurobehavioural disorder characterised by Hyperactivity, Inattention and Impulsivity
Neurochemical abnormalities (increased Dopaminergic) Neurodevelopmental abnormalities of prefrontal cortex Social Factors (eg deprivation)
Describe the ICD10 criteria of ADHD
A: Abnormality of attention/impulsivity and hyperactivity at home
B: The above at school
C: The above directly observed
D: Doesn’t meet criteria for mania/depression/anxiety
E: Onset <7y
F: Duration >6 months
G: IQ>50
Give three differentials for ADHD
Auditory Processing Disorder
Oppositional Defiant Disorder
Conduct Disorder
How is suspected ADHD investigated?
Conners Questionnaire
Collateral Histories
Direct Observations
Describe the management of ADHD
Preschool - parent training/education, involvement of teachers
School Age (Mild) - Behavioural Strategies, CBT
School Age (Severe) - Medication
The first line pharmacological management for ADHD is stimulant medication. Give an example and two related side effects.
Methylphenidate
Palpitations, Disturbed sleep
Define Autism Spectrum Disorder
Pervasive developmental disorder characterised by triad of impairment in social interaction, communication and stereotyped interests
Outline the ICD10 criteria for Autism
A - Presence of abnormal/impaired development before the age of 3
B - Qualitative abnormalities in social interaction
C - Qualitative abnormalities in communication
D - Restrictive/Repetitive stereotyped behaviours
E - Not attributable to anything else
Give three differentials for Autism Spectrum Disorder
Learning difficulties
Retts Syndrome
Schizophrenia
How is ASD managed?
Parent support groups
Behavioural techniques (visual timetables, preparation and explanation for changes in routine)
Educational measures
Define Cerebral Palsy
A chronic disorder of movement and or posture that presents early (before the age of two) continuing throughout life due to static injury to brain
After the age of two - acquired brain injury
What are the causes of Cerebral Palsy?
Antenatal - Vascular Occlusion, Genetic Syndromes, Congenital Defects
Hypoxic Ischaemic Injury in Pregnancy
Postnatal- Meningitis, Encephalitis, Hypoglycaemia
Why are premature babies more at risk of Cerebral Palsy?
Due to Periventricular Leukoplacia, secondary to IVH
Give 4 early features of cerebral palsy
Feeding difficulties
Abnormal Gait
Persistence of Primitive Reflexes
Not meeting developmental milestones - not sitting unaided at 8m, not walking by 18m, preference of hand before one year
90% of cases of Cerebral Palsy are ‘Spastic Type’ due to UMN damage. How would this present?
- Velocity dependent resistance to passive stretch
- Increased tone and reflexes
- Clasp Knife Phenomenon
- Hips wrist and elbows often flexed
May involve bulbar muscles (dysphagia and dribbling)
What are the three subtypes of Spastic Cerebral Palsy
Hemiplegic - unilateral arm and leg affected, face spared
Quadriplegia - all four limbs and trunk involved
Diplegia - All four limbs but legs more affected
6% of Cerebral Palsy Cases are the Choreoathetosis Type. How does this present?
Involuntary movements with Chorea and Athetosis (twisting and writhing)
Usually bulbar involvement
Increased reflexes
After being diagnosed by history and MRI, Cerebral Palsy can be classified by ‘Gross Motor Function Classification System’. Outline this
I - Walks without limitations II- Walks with limitations III- Walks using handheld mobility device IV- Self mobility with limitations V- Manual Wheelchair
The majority of management for Cerebral Palsy is non pharmacological and occupational. What surgical management can be done?
Botox to Gastrocnemius
Muscle Lengthening
Osteotomy
Dorsal Rhizotomy - Severing nerve fibres at the spinal cord to reduce spasticity
Define Anorexia Nervosa
Eating disorder characterised by deliberate weight loss, intense fear of fatness, distorted body image and endocrine disturbances
Give a predisposing and perpetuating risk factor for Anorexia Nervosa
Predisposing - Female
Perpetuating - Starvation induces neuroendocrine changes that perpetuate anorexia
Describe the ICD10 criteria for Anorexia Nervosa
- Present for Atleast 3 months in the absence of bingeing
- Fear of weight gain
- Endocrine disturbance resulting in Amenorrhoea/Impotence
- Emaciated (<17.5kg/m2)
- Deliberate weight loss and distorted body image
State four investigations for suspected Anorexia Nervosa
Bloods (Increased Urea, Decreased Electrolytes, Low Albumin)
VBG (Alkalosis from vomit, acidosis if laxatives)
DEXA
ECG
How would you manage Anorexic patients?
Weight gain (0.5kg/week OP or 1kg/week IP)
CBT
Interpersonal Therapy
ANFFT
What forms of Substance Misuse are the most common in adolescents?
Alcohol and Cannabis
Children who are abusing substances may not present directly intoxicated. How else may they present?
Unexplained absences from school
Stealing money
Medical complications associated with use
Name three specific fractures associated with NAI
Metaphyseal Corner Syndrome
Rib fractures
Spiral fractures
Give an outline of the HEADSSS assessment for adolescents
H - Home E - Education/Employment A - Activities D - Drugs/Smoking/Alcohol (particularly ruling out trafficking, slavery or abuse) S - Sex and Relationships S - Self harm and depression S - Safety
