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Yr4 - Paeds > Community > Flashcards

Community Flashcards

1
Q

Gross motor development at 1 month

A

Symmetrical movements in all limbs
Normal muscle tone
Head lag when pulled up

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2
Q

Gross motor development at 3 months

A

Almost no head lag when pulled to sit

Lifts head and chest when prone

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3
Q

Gross motor development at 6 months

A

Rolls from back to front
When held, stands and sits with straight back
Bears most of own weight

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4
Q

Gross motor development at 9 months

A

Sits without support
Stands holding onto furniture
Moves around the floor - wriggling, commando crawling

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5
Q

Gross motor development at 12 months

A

Stands without support
Crawls, bottom shuffles or bear walks
Cruises along furniture
May walk unsteadily

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6
Q

Gross motor development at 15 months

A

Generally walks without support

Crawls upstairs

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7
Q

Gross motor development at 18 months

A

Walks steadily, stopping safely
Squats to pick up a toy
Climbs stairs holding hand or rail

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8
Q

Gross motor development at 24 months (2 years)

A

Runs safely
Throws ball overhand
Wlaks up and down stairs, both feet on each step

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9
Q

Gross motor development at 30 months

A

Jumps on 2 feet

Kicks ball

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10
Q

Gross motor development at 36 months (3 years)

A

Walks backwards and sideways
Rides tricycle
Catches large ball with arms outstreched

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11
Q

Gross motor development at 48 months (4 years)

A

Stands, walks and runs on tiptoes

Runs up and down stairs

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12
Q

Gross motor development at 5 years

A

Hop
Catches ball
Heel-toe walking
May ride a bike

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13
Q

Fine motor development at 1 month

A

Grasps finger when placed in the palm

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14
Q

Fine motor development at 3 months

A

Watches their own hands
Brings hands to their mouth
Holds toy brieftly

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15
Q

Fine motor development at 6 months

A

Palmer grasp
Reaches for toys
Puts objects in mouth

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16
Q

Fine motor development at 9 months

A

Passes toys from one hand to tht other

May have pincer grip

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17
Q

Fine motor development at 12 months

A

Fine pincer grip
Points to objects of interest
Releases objects intentionally

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18
Q

Fine motor development at 15 months

A

Imitates to and fro scribbles

Builds tower of 2 cubes when demonstrated

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19
Q

Fine motor development at 18 months

A

Makes tower of 3 blocks

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20
Q

Fine motor development at 24 months (2 years)

A

Builds a tower of 6 blocks
Draws horizontal lines with preferred hand
May draw vertical lines
Turns pages of book individually

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21
Q

Fine motor development at 30 months

A

Can thread bead on a string
Makes a tower of 7 or more blocks
Holds pencil in tripod grip

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22
Q

Fine motor development at 3 years

A

Builds bridge using blocks
Draws circle
Draws person with a head

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23
Q

Fine motor development at 42 months (3.5 years)

A

Draws a cross

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24
Q

Fine motor development at 4 years

A

Build stepts using blocks
Draws a square
Draws a person with head/face, arms and legs

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25
Q

Fine motor development at 5 years

A

Uses knife and fork competently
Draws triangle
Copies alphabet letters

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26
Q

Define speech

A

Actual sounds of spoken language

- produced by co-ordinated action of the muscles of the tonuge, lips, jaw and vocal tract

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27
Q

Define language

A

Systems of words and symbols

  • use to communicate with each other
  • encompassess written, verbal and non-verbal communication
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28
Q

Speech/language development a newborn

A

Cries

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29
Q

Speech/language development at 6-8 weeks

A

Coos

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30
Q

Speech/language development at 3 months

A

Laughs

Vocalises

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31
Q

Speech/language development at 6 months

A

Understands words such as mama, dada or bye-bye
Babbles spontaneously - initially monosyllables
Uses tuneful, singsong voice

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32
Q

Speech/language development at 9 months

A

Imitates adult sounds, such as coughs
Understands simple commands
Understands no

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33
Q

Speech/language development a 12 months

A

Knows and responds to own name

Uses 2-6 words and understands many more

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34
Q

Speech/language development at 18 months

A

Uses 6-40 recognisable words
Can point to parts of the body when asked
Tries to sing

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35
Q

Speech/language development at 24 months (2 years)

A

Speaks over 200 words, understands many more
Joins words together
Omits opening or closing consonants

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36
Q

Speech/language development at 30 months

A

Continually asks questions

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37
Q

Speech/language development at 36 months (3 years)

A

Can name 2/3 colours
Knows and repeats songs and nursery rhymes
Counts by rote up to 10
Has simple conversations

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38
Q

Speech/language development at 48 months (4 years)

A

Talks fluently
Counts by rote to 20
Enjoys jokes

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39
Q

Speech/language development of at 60 months (5 years)

A

Fluent in speech and mostly grammatically correct

Interested in reading and writing

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40
Q

Social, emotional and behavioural development of a newborn

A

Responds to being picked up

Enjoys feeding and cuddling

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41
Q

Social, emotional and behavioural development at 6 weeks

A

Gazes at adult faces

Social smiles

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42
Q

Social, emotional and behavioural development at 3 months

A

Smiles at familar faces and strangers

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43
Q

Social, emotional and behavioural development at 6 months

A

Feeds self with fingers

Shows stranger fear

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44
Q

Social, emotional and behavioural development at 9 months

A

Waves bye
Plays peek-a-boo
Shows likes and dislikes

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45
Q

Social, emotional and behavioural development at 12 months

A

Drinks from a cup with 2 hands

Has seperation anxiety

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46
Q

Social, emotional and behavioural development at 18 months

A

Uses a spoon
Plays contentedly alone, near familar adult
Eager to be independent

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47
Q

Social, emotional and behavioural development at 24 months (2 years)

A

Displays frustration - temper tantrums
Dresses self
Begins to express feelings

48
Q

Social, emotional and behavioural development at 30 months

A

Eats skillfully with spoon, may use fork
May use toilet independently
Plays alone and alongside other children - parallel play
Enjoys pretend play

49
Q

Social, emotional and behavioural development at 36 months (3 years)

A

Shows affection for younger siblings
Probably toilet-trained - may still be wet at night
Enjoys helping adults, imitating household tasks
Has friends

50
Q

Social, emotional and behavioural development at 48 months (4 years)

A

Eats skillfully with fork and spoon
Brushes own teeth
Shows sensitivity to others
Takes turns

51
Q

Social, emotional and behavioural development at 60 months (5 years)

A

Very definite likes and dislikes
Shows sympathy and comforts friends
Dressess without help - except laces
Engages in co-operative and imaginative play, observing rules

52
Q

Hearing and vision development of a newborn

A

Fascinated by human faces
Turns head towards light
Startled by sudden noises

53
Q

Hearing and vision development at 1 month

A

Turns head towards diffuse light and stares at bright objects
Startles to loud noises

54
Q

Hearing and vision development at 3 months

A

Focuses eyes on same point
Moves head deliberately to gaze around them
Prefers moving objects to still ones

55
Q

Hearing and vision development at 6 months

A

Adjusts position to see objects

Turns towards the source of sounds

56
Q

Hearing and vision development at 12 months

A

Sees almost as well as an adult

Knows and responds to own name

57
Q

Hearing and vision development at 18 months

A

Recognises themselves in a mirror

58
Q

Hearing and vision development at 24 months (2 years)

A

Recognises familiar people in photographs

Listens to conversations with interest

59
Q

Hearing and vision development at 30 months

A

Recognises self in photographs

Recognises small details in picture books

60
Q

Hearing and vision development at 48 months (4 years)

A

Matches primary colours

Listens to long stories with attention

61
Q

Hearing and vision development at 60 months (5 years)

A

Can match 10 colours

62
Q

Define Autism Spectrum Disorder

A

Neurodevelopmental disorder that affects a person’s social interaction, communication and behaviour

  • usually diagnosed in adulthood
  • key symptoms being present from age of 3
63
Q

Epidemiology of ASD

A

1%
More common in boys than girls
More prevenlent in premature children

64
Q

Pathophysiology of ASD

A

Genetic syndromes - fragile X syndrome, tuberous sclerosis and Angelmann syndrome
Gentic aetiology - chromosonal analsysis gives a diagnosis in around %
Structural changes in the brain

65
Q

Clinical featrues of ASD

A

Abnormality of social interaction
- poor eye contact, failure to use facial expression of body language
- problems making friends, difficulty reading social situations
Impaired social communication
- delay or failure to develop social language
- failure to initiate or continue conversations
- abnormal use of language
Restrictive or repetitive activities
- preoccupations with unusual subjects/atypical way
- need for routine - upset if disrupted
- motor mannerisms - hand flapping

66
Q

Signs for look for on examination in ASD

A

Skin stigmata of neurofibromatosis or tuberous sclerosis
Signs of injury - self-harm or child maltreatment
Congenital abnormalities and dysmorphic features

67
Q

Differential diagnosis of ASD

A 
Learning difficulties
Attachment disorders
Rett's syndrome - regression of skills at 18 months, most common in females
Schizophrenia
Specific language disorders
68
Q

Investigations for ASD

A

Clinical diagnosis made by MDT team

- symptoms should be persistent in different environments - both home and school

69
Q

Management for ASD

A

For milder end diagnosis alone
- allows families to access certain modes of support - parent support groups, community-based services
No medications
Behavioural management strategies - visual timetables, preparation and explanation for changes in routine
Educational measures - diagnosis needed for and Education, Health and Care Plan so school can access extra funding
- most educated in main school streaming

70
Q

Define ADHD

A 
Attention Deficit Hyperactivity Disorder
Neurobehavioral disorder that is characterised by 
- hyperactivity
- inattention 
- impulsivity
71
Q

Epidemiology of ADHD

A

7%
More common in boys than girls
Up to 50% have co-morbid condition - ASD, learning difficulties, communication disorders, depression, anxiety, Tourette Syndrome

72
Q

Pathophysiology of ADHD

A

Evidence suggests structural and functional changes in brain as well as changes in levels of dopamine
Genetic component

73
Q

Clinical features of ADHD (ICD-10)

A 
Early onset - before 6 years
Main features 
- impaired attention
- over-activity
Disinhibition, recklessness and lack of adherence to social norms may be present but not necessary for diagnosis
74
Q

DSM-V criteria for ADHD

A

3 subtypes - combined, predominantly inattentive, predominantly hyperactive
Diagnosis made when at least 6 criteria from either category are met and present from before age of 12 for at least 6 months
- must be present in more than one setting

75
Q

Differential diagnosis for ADHD

A

Auditory processing disorder - brain has difficulty interpreting sounds and information heard
Oppositional-defiant disorder - features of anger, vindictiveness and being argumentative
Conduct disorder - marked features of aggression
- those with ADHD tend to not want to get into trouble

76
Q

Investigations for ADHD

A

Conner’s questionnaire

School observation

77
Q

Management of ADHD

A 
Pre-school
- medication not recommended
- parent training/education programme
Mild/moderate
- 1st line is behavioural strategies - parent education, CBT, social skills training, teacher education
Severe
- Medication 1st line
78
Q

Medications used in ADHD

A

Methylphenidate - stimulant
- immediate and mixed preparations
- start small dose and titrate up
Atomoxetine
- used if methylphenidate not effective, associated tic or anxiety disorder, risk of stimulant abuse
- SE of liver damage
Lisdexamfetamine - newer stimulant medication
- used when methylphenidate not effective at max dose
Guanfacine - non-stimulant
- used when stimulant not suitable, not tolerated or not effective
Antipsychotics - should not be used in children

79
Q

Aim of medication in ADHD

A

Improve attention and concentration to allow them to achieve their educational potential

80
Q

SE of ADHD medication

A 
Raised BP
Palpitations
Disturbed sleep
Impaired growth and appetite suppression
Problems with aggression or increased emotion - anxious or depressed
81
Q

Define child protection

A

Process of protecting individual children identified as either suffering, or likely to suffer, significant harm as a result of abuse or neglect
- involves measures and structures designed to prevent and respond to abuse and neglect

82
Q

Types of child abuse

A 
Physical 
- especially children under 2
Sexual
Emotional
Neglect
83
Q

Risk factors for child abuse

A 
Child factors
- unable to fulfil parental expectations
- crying persistently
- children under 4
- disability
- low birth weight
- chronic ill health
- prematurity
- being unwanted
Adult factors
- mental illness
- postnatal depression
- lack of support network
- drugs
- own child abuse
- alcohol misuse
- learning disability
- criminal activity
- financial difficulties
84
Q

Features of non-accidental injuries

A

Mechanism of injury not compatible with injury sustained
Child’s developmental stage inconsistent with the injury presented
Child sustained significant injury with little or on explanation
Inconsistent histories given
Delay in presenting child to health care providers
Recurrent injuries
Parents reaction not appropriate to the situation

85
Q

Presentations of physical abuse

A 
Bruising
- coagulation screen
- FBC
Fractures
- full skeletal survey
- CT scan
- bone biochemistry
Presentation in under 2 years
- full skeletal survey
- CT head
- expert ophthalmological examination
- coagulation screen
86
Q

Differential diagnosis for bruising

A 
Bleeding disorder
Birthmark
Vasculitic disorders
Infection - meningococcal septicaemia
Drug related - NSAIDs
Erythema nodosum
Malignancy
Striae
Contact dermatitis
87
Q

Differential diagnsosis of fractures

A 
Birth injury - clavicular fracture
Infection - osteomyelitis
Malignancy
Osteogenesis imperfecta
Nutritional - vitamin D deficiency
Copper deficiency
88
Q

What is a HEADSSS assessment

A

Tool used to structure the assessment of an adolescent patient

  • Home
  • Education/Employment
  • Activities
  • Drugs
  • Sex and relationships
  • Self harm and depression
  • Safety and abuse
89
Q

Define adolescence

A

Transition period where child becomes an adult

  • physical changes of puberty
  • psychological and sociological changes associated with finding your identity and gaining independence from parents/carers
90
Q

Presentation of neglect

A

Medical
- unimmunised
- failure to attend appointments
- poor compliance with medication
- failure to seek appropriate timely medical advice
Nutritional
- faltering growth due to failure to provide an appropriate and or sufficient diet
- obesity due to failure to control diet and lifestyle
Emotional
- poor school attendance
Physical
- inadequate hygiene
- severe and or persistent infestations/infections
- inappropriate clothing for childs size and weather
Failure to supervise
- frequent A&E attendances
- injury that suggests lack of care such as sunburn, scalds, burns, falls
- ingestion of harmful substances

91
Q

Symptoms of emotional abuse in an infant

A 
Developmental delay
Poor sleep
Feeding difficulties
Persistent
Crying
Irritable
92
Q

Symptoms of emotional abuse in a toddler

A

Difficult/violent behaviour

Delayed social and language skills

93
Q

Symptoms of emotional abuse in a school child

A

Poor attendance
Truancy
Antisocial behaviour
Academic failure

94
Q

Symptoms of emotional abuse in an adolescent

A 
Depression
Self harm
Relationship difficulties
Substance abuse
Criminal activity
Eating disorders
Aggressive behaviour
95
Q

Presentation of sexual abuse

A 
Allegation
Pregnancy
STI
Ano-genital injury
Unexplained vaginal bleeding
Unexplained rectal bleeding
Recurrent vaginal discharge
Soiling, bowel problems, enuresis
Behavioural difficulties
Any children close proximity with an adult identified as a risk to children
When perpetrator is child
96
Q

Consequences of child abuse

A 
Attachment disorder
PTSD
Somatic symptoms
Sexual dysfunction
Emotional disorders
Self-harm
Alcohol misuse
Drug abuse
Antisocial personality 
Aggressive behaviour
97
Q

Medical professional response to concerns of child abuse

A

Document everything clearly in the patients notes - Clearly attribute who said what/when plus actions taken – including any discussions at handover
Sign, date and time all entries
Seek advice from senior colleague/consultant on how to proceed
If you are unhappy with the advice given consult further – go up a level of seniority or contact the named doctor/nurse for safe guarding
Communicate with nursing staff
Keep the child safe
DON’T DO NOTHING

98
Q

Medical professional responding to disclosure of child abuse

A 
Try not to look shocked
Let the child know you believe them
Tell them they are not in trouble
Listen to what they have to say, don’t make an excuse to leave
Don’t ask leading questions – this may affect the case if it goes to court
Don’t make promises you cant keep
Be honest at all times
Inform your senior
99
Q

Define life limiting conditions

A

Conditions for which there is no reasonable hope of cure

  • from which children/young people will die
  • include life-threatening for which curative treatment may be feasible but can fail
100
Q

Define life threatening conditions

A

Curative treatment may be feasible but can fail

  • palliative care services may be necessary when treatment fails or during an acute crisis
  • cancer
101
Q

Define conditions where premature death is inevitable

A

May be long periods of intensive treatment aimed at prolonging life and allowing participation in normal activities

  • cystic fibrosis
  • duchenne muscular dystrophy
102
Q

Define progressive conditions without curative treatment options

A

Treatment is exclusively palliative and may commonly extend over many years

  • Batten disease
  • mucopolysaccharidoses
103
Q

Define irreversible but non-progressive conditions causing severe disability, leading to suceptilbitly to health complications and likelihood of premature death

A

Children have complex health care needs and are at high risk of an unpredictable life-threatening event or episode

  • cerebral palsy
  • spinal cord injury
104
Q

Key differences of child vs adult palliative care

A

Small number of children die
Many conditions rare and genetic
May only be needed for short period of time and may be on and off for a number of years
Importance of physical, emotional and cognitive development
Provision of play and education vital

105
Q

Features of advanced care planning

A

Helps create advance statements about wishes and preferences such as preferred place of care, withdrawal of treatment and resuscitation status

106
Q

DNACPR forms in paediatrics

A

Lots of controversy and misunderstanding over their design, use and limitations

107
Q

Features of ReSPECT forms

A

Recommended Summary Plan for Emergency Care and Treatment

  • process supports the creation of these recommendations by initiating conversations to ensure a shared understanding of the condition, current issues and future outlook
  • child/families preferences for care and realistic future emergency treatment
  • making and recording agreed clinical recommendations for care
108
Q

Key pillars of ethics

A

Autonomy - right to self-determination
Non-maleficence - need to avoid harm
Beneficence - ability to do good
Justice

109
Q

Ethical issues related to paediatrics

A

Children represent spectrum from non-verbal infant to fully conversant adolescent striving for independence and self-identity
Child’s ability to make informed choices depends on level of development and life experience
Even young children have the right to be informed
As children’s competence increases so should their involvement in decision making

110
Q

Normal growth

A

Acceptable for breastfed babies to lose 10% of birthweight and bottle-fed 5% in first 10 days of life
Babies should have doubled weight by 4 months and tripled by 1 year

111
Q

Red flags for gross motor control

A 
No head control at 6 months
Cannot sit unsupported at 12 months
Not weight bearing at 12 months
Not walking at 18 months
Not running by 2.5 years
112
Q

Red flags for fine motor and visual skill

A

Does not hold objects in hand at 5 months

113
Q

Red flags for speech and language skills

A 
No response to stimuli at 3 months
No babble at 9 months
No words at 18 months
Cannot join 2 words at 2 years
Cannot speak in full sentences at 3 years
114
Q

Red flags for social skills

A

No gestures at 12 months

No symbolic play at 18 months

115
Q

Causes of developmental delay

A 
Antenatal
- Genetic - down syndrome, duchenne muscular dystrophy
- metabolic/endocrine - hypothyroidism, PKU
- toxins - drugs and alcohol
Peri and postnatal
- infection
- trauma/brain injury -> cerebral palsy
- neglect
116
Q

Vaccination schedule

A 
8 weeks:
- 6 in 1 vaccine (diphtheria, tetanus, pertussis, polio, haemophilus influenzae type B (Hib) and hepatitis B)
- Meningococcal type B
- Rotavirus (oral vaccine)
12 weeks:
- 6 in 1 vaccine (again)
- Pneumococcal (13 different serotypes)
- Rotavirus (again)
16 weeks:
- 6 in 1 vaccine (again)
- Meningococcal type B (again)
1 year:
- 2 in 1 (haemophilus influenza type B and meningococcal type C)
- Pneumococcal (again)
- MMR vaccine (measles, mumps and rubella)
- Meningococcal type B (again)
Yearly from age 2 – 8:
- Influenza vaccine (nasal vaccine)
3 years 4 months:
- 4 in 1 (diphtheria, tetanus, pertussis and polio)
- MMR vaccine (again)
12 – 13 years:
- Human papillomavirus (HPV) vaccine (2 doses given 6 to 24 months apart)
14 years:
- 3 in 1 (tetanus, diphtheria and polio)
- Meningococcal groups A, C, W and Y
117
Q

Types of vaccines

A

Inactivated
- polio
- flu
- hep A
- rabies
Subunit and conjugate
- Pneumococcus
- Meningococcus
- Hepatitis B
- Pertussis (whooping cough)
- Haemophilus influenza type B
- Human papillomavirus (HPV)
- Shingles (herpes-zoster virus
Live attenuated - still capable of causing infection particularly in immunocompromised patients
- Measles, mumps and rubella vaccine: contains all three weakened viruses
- BCG: contains a weakened version of tuberculosis
- Chickenpox: contains a weakened varicella-zoster virus
- Nasal influenza vaccine (not the injection)
- Rotavirus vaccine

Yr4 - Paeds (16 decks)

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