Community Flashcards
By when should a child be able to hold objects in a hand?
3 months
By when should a child be able to sit unsupported and walk independently?
sit by 12 months
walk by 18 months
When should hand dominance develop?
after 1 yr- before this is concerning
When is lack of speech concerning?
18 months
What are the 4 facets to development?
Gross motor
Fine motor and vision
Hearing, speech and lang
Social, emotional and behaviour
What are the important milestones at 6 weeks?
GM: head lag when pulled up
FM&V: Fixes and follows
HSL: becomes still in response to sound
SEB: smiles
What are the important milestones at 3 months?
GM: little- no head lag when pulled up
FMV: hold an object placed in hand
HSL: turns to sound and statles
SEB: laughs and squeals
What are the important milestones at 6 months?
GM: sits with support
FMV: palmar grasp, transfers objects between hand and puts stuff in mouth
HSL: vocalises, understands mama and papa
SEB: finger feeds, fear of strangers
What are the important milestones at 9 months?
GM: crawls and sits unsupported
FMV: pincer grasp
HSL: 2 syllable babble, understands commands like no
SEB: waves bye, plays peakaboo
What are the important milestones at 12 months?
GM: pulls to stand and cruises
FMV: releases objects, points to interesting objects
HSL: knows and responses to own name, 1-2 words, vision as good as adult
SEB: finds hidden objects, drinks from cup with 2 hands
What are the important milestones at 18 months?
GM: walks well, squats to pick up toy
FMV: builds towers of 2-4 blocks, hand preference
HSL: 6-12 words, recognise themselves in mirror
SEB: uses spoon, plays alone happily
What are the important milestones at 2 yrs?
GM: runs, throws ball over head, kicks ball, climbs stairs with both feet on each step
FMV: builds tower of 6-7 blocks, turns pages of book
HSL: talks in short sentences, names 3 colours, repeat and sing songs
SEB: removes cloths, temper tantrums, expresses feelings
What are the important milestones at 3 yrs?
GM: stand on 1 foot, rides tricycle, catches large ball
FMV: builds 9 block tower, draws circle
HSL: short sentences, 3 colours, repeat and sing songs
SEB: eats with folk and spoon, friends, affection towards siblings, toilet trained, helps with tasks
What are the important milestones at 5 yrs?
GM: hops, catches ball, heel toe walking, rides bike
FMV: draws triangle, coped alphabet letters
HSL: fluent speech, interested in reading and writing
SEB: sympathy/ comforts friends, dresses with no help
Give 2 causes of developmental variation
late walking or talking can be familial
language delay can be seen in bilingual families
Give 4 correctable causes of slow development
undernutrition
iron deficiency anaemia
social isolation of the family or maternal depression
hypothyroidism
name and describe 3 of the primitive reflexes
glabellar reflex- blinks when tap just above nasal bridge
suckling reflex- sucks anything touching roof of mouth
Moro reflex- both upper limbs abduct extend and then flex when head is dropped a few cm
Grasp reflex
Asymmetrical tonic neck reflex- fencing posture when turn head 90 degrees
What is growth velocity through childhood and puberty?
childhood: 5-7 cm/yr
puberty: up to 12 cm/yr
What is first and last sign of puberty in girls and in boys
girls: breast bud development–> menarche
boys: growth in testicle size–> 10ml testes volume
What is defined as short stature?
height <2 standard deviations below the mean or outside target height- mid parental height +/- 10cm
What can cause short height with normal velocity and with slow velocity?
Normal velocity: child abuse, late onset puberty (constitutional delay), familial, medical conditions eg asthma
Slow velocity: chronic disease eg coeliac, GH deficiency, syndromes such as turners and downs, endocrine eg hypothyroid, cushings
What can cause tall stature?
- familial
- early/ precocious puberty
- hyperthroid
- giagantism
- GH secreting adenomas
- marfans
- klinefelters
Describe the clinical features that need to be present for an ASD diagnosis
ALL of:
- lack of social attachments
- abnormal/ delayed receptive or expressive speech development
- abnormal or lack of symbolic play
ONE of:
- abnormal social interaction: poor eye contact, facial expressions or body language, difficulty making friends and reading social situations
- impaired social communication
- restrictive or repetitive activities
- sensory issues (only eat certain foods, not tolerate loud noises, only wear certain materials)
- self harm/ high pain threshold
Need to be present from young age (<3)
How is suspected ASD investigated?
- school report
- home report
- MDT of community paediatricians, child psychiatrist, parents ansd teacher involved
Give 3 risk factors for ASD
- prematurity
- perinatal hypoxia
- advanced maternal or parental age
- genetic syndromes eg fragile x syndrome
Give 4 differentials for ASD
- learning difficulties
- attachment disorders
- retts syndrome (normal development in girls up to 6 months, then regress)
- schizophrenia
- specific language disorders
How is ASD managed?
- no meds available- melatonin can be given if there are issues with sleep
- behaviour management strategies: visual timetables, preparations and explanations for routine changes, ‘applied behavioural analysis’
- education measures: educational health care plan or statement to attend special school if needed
What are the 3 types of ADHD
inattentive, hyperactivity and combined
What are the DSM V criteria for ADHD
- If 6 of criteria are met and present before age 12 for 6 months, in more than 1 setting
- inattention: easily distracted, forgetful, cant sustain attention
- hyperactivity: fidgets, talks alot, on the go as if driven by motor
- impulsivity: difficulty waiting turn, bursts out and answers questions before they’re completed
How is ADHD investigated?
- clinical diagnosis
- conners questionnaire answered by the parents, teachers and self if over 8yrs
- Cardiovascular exam performed before starting meds
- height and weight plotted on growth charts
Give 2 differentials for ADHD
- auditory processing disorder- trouble concentrating in presence of background noise
- oppositional defiant disorder/ conduct disorder- marked features of aggression
How is ADHD managed?
- behavioural strategies: parent and teacher education, CBT, social skills training
- methylphenidate: stimulant med, improved attention and concentration
- Atomoxetine: when above is ineffective or being abused
What are the side effects of ADHD meds?
- raised BP
- palpitations
- disturbed sleep
- impaired growth
- appetitie surpression
- lasts 6 hrs, so no benefit at home
- only improves attention and concentration to allow them to achieve educational potential
What is child abuse
deliberate infliction of harm to a child or failure to prevent harm, and may be physical, sexual, emotional or neglect
List 3 child and adult risk factors for child abuse
Child: unwanted pregnancy, mother <30yrs, prematurity, chonic ill health, low birth weight, disability, child<4yrs, crying persistently
Adult: poverty, mental illness, lack of support network, drugs, own child abuse, alcohol misuse, learning disability, criminal activity
Define neglect and describe some clinical features
Persistent failure to meet the childs basic physcial or psychological needs that is likely to result in serious impairment of the childs health or development.
Eg. poor diet, obesity, poor school attendance, poor hygiene, severe infestations/ infections, inappropriate clothing, poor supervision- frequent A&E attendances, burns, many accidental injuries
When should physical abuse be suspected
- child <2 yrs
- mechanism not compatible with injury
- mechanism not possible considering childs developmental stage
- significant injury with little- no explanation
- inconstant history
- delay in presenting to healthcare
- recurrent injuries
- parents reaction inappropriate (aggressive, little/ too much concern, elusive, vague)
- head injury <6 months
- fractures <18 months
- bruises in non mobile child- esp back, face and buttock
- burns
Give 5 differentials for bruising other than non accidental injury
- bleeding disorder
- birth marks (mongolian blue spot)
- vasculitis disorders
- infections (sepsis,hsp)
- drug related (NSAIDs)
- erythema nodosum
- maligancy
- striae
- contact dermatitis
How should suspected physical abuse in a child be investigated?
- full skeletal survey- check again in 2 weeks for callus
- CT head
- opthalmological exam for retinal haemmorhage
- coagulation screen
How may sexual abuse present?
- allegation
- anogenital injury
- unexplained vaginal or anal bleeding
- recurrent vaginal discharge
- behaviour difficulties
- pregnancy
- STI
How may emotional abuse present?
- developmental delay
- poor sleep
- persistent crying, apathy
- difficult behaviour/ aggression
- poor school attendance
- antisocial behaviour
- academic failure
- depression
- self harm
- relationship difficulties
- substance abuse
- eating disorders
What can cause global developmental delay?
- TORCH infections
- genetic disorders
- cerebral dysgenesis
- neurocutaneou syndromes
- HIE
- PKU
- neonatal stoke/ haemorrhage
- Prem
- hypothyroid
- abuse / neglect
- chronic illness
- meningitis/ encepahlitis
- seizures/ suffocation/ near drowning
- head injury
- hypoglycaemia
- nutritional deficiency
How does motor developmental delay tend to present
- around 18 months
- hand dominance before 1 yr
- late walking
- loss of motor skills
- balance problems
- poor head control/ sitting
What may cause abnormal motor developement?
- CP
- congenital myopathy
- muscular dystrophy
- spinal cord lesion
- familial slow to walk
What may cause speech and lang delay?
- hearing loss/ impairment
- cleft palate/lip
- oromotor problems (CP)
- environemntal deprivation/ poor social interaction/ neglect
- normal variant
What may cause slow cognitive development?
- learning disability
- specific learning difficulty (dyslexia, dyscalculus etc)
- poor vision/ hearing
