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Laura Paediatrics > Community and development > Flashcards

Community and development Flashcards

1
Q

When is an infant described as being pre-term?

A

When delivered before 37 weeks

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2
Q

What are the 4 main fields that assessment of development can be divided up into?

A

Gross motor
Fined motor and vision
Hearing, speech and language
Emotional, social and behavioural

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3
Q

What is a good way of asking with a child is developmentally normal in an older child?

A

Asking whether they go to school, if they go to mainstream school, whether they require any additional help at school

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4
Q

What are the red flags for hearing, speech and language?

A

Hearing loss

No speech by 18 months

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5
Q

What are some red flags for social, emotional, behavioural?

A

Doesn’t point at object to share interest with others by 2 years
Doesn’t smile at 10 weeks

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6
Q

What are some red flags for gross motor?

A

Low muscle tone/floppy OR increased muscle tone
Can’t sit unsupported by 12 months
Can’t walk by 18 months
Persistent toe walking

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7
Q

What are some fine motor and vision red flags?

A

Not fixing and following an object

Can’t hold object placed in hand by 5 months

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8
Q

What are some correctable causes of slow development?

A

Undernutrition
Iron deficiency anaemia
Social isolation of the family or maternal depression
Hypothyroidism

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9
Q

Fractures of which bones are most common in non-accidental injury of children?

A

Humerus
Radius
Femur

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10
Q

What are the 3 main components that characterise ADHD?

A

Hyperactivity
Inattention
Impulsivity
‘IHI I Happily Interrupt’

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11
Q

What is thought to be the neurochemical cause behind ADHD?

A

Abnormality in the dopaminergic pathways in the brain

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12
Q

In terms of the epidemiology - which gender is ADHD more common in?
What is the typical age of onset? What is it important to remember?
What are some environmental risk factors for ADHD?

A

Males - 3:1
3-7 years, however, adults are not also presenting, wondering whether that have ADHD which was not identified at school

Environmental risk factors = social deprivation, family conflict, parental cannabis, alcohol exposure

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13
Q

What findings may be found suggestive of inattention?

A
  • Not listening when spoken to
  • Dislike of activities that require persistent mental effort e.g school work that contains careless mistakes
  • Highly distractible
  • Forgetting or regularly losing belongings
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14
Q

What findings may be found suggestive of hyperactivity?

A
  • Restlessness and fidgeting or tapping with hands or feet
  • Recklessness
  • Running and jumping around in inappropriate places
  • Difficulty engaging in quiet activities
  • Excessive talking or noisiness
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15
Q

What findings may be found suggestive of impulsivity?

A
  • Difficulty waiting their turn
  • Interrupting others
  • Blurting out answers prematurely
  • Temper tantrums and aggression
  • Disobedient
  • Running into the street without looking
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16
Q

What developmental milestones would you expect in a new born/first few weeks?

A

GM: Flexed posture
V+FM: Follows face or light by 2 weeks
HS+L: Stills to voice, startles to loud noise
SE+B: Smiles by 6 weeks

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17
Q

What developmental milestones would you expect in a 7 month old child?

A

GM: Sits without support
V+FM: Transfers objects from hand to hand
HS+L: Turns to voice, polysyllabic babble
SE+B: Finger feeds, fears strangers

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18
Q

What developmental milestones would you expect in a 1 year old child?

A

GM: Stand independently
V+FM: Pincer grip (10 months) and points
HS+L: 2-3 words, understands name
SE+B: Drinks from cup and waves

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19
Q

What developmental milestones would you expect in a 15-18 month old child?

A

GM: Walks independently and steadily
V+FM: Immature grip or pencil, Random scribble
HS+L: 6-10 words, points to 2 body parts
SE+B: Feeds self with spoon, beginning to help with dressing

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20
Q

What developmental milestones would you expect in a 2.5 year old?

A

GM: Runs and jumps
V+FM: Draws
HS+L: 3 word to 4 word sentences. Understands 2 joined commands
SE+B: Parallel play. Clean and dry

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21
Q

What are some of the problems of developmental screening?

How can the reliability of screening tests be improved?

A
  • It is subjective clinical opinion and therefore has limitations
  • A single observation of development may be limited by the child being tired, hungry, shy or simply not wishing to take part
  • A lot of the early focus on development is revolved around motor development and this is a poor predictor of cognitive function and later school performance

They can be improved by adding in a questionnaire completed by parents beforehand

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22
Q

What is developmental assessment?

When may it be carried out?

A

It is the detailed analysis of particular areas of development
It follows concern after screening that a child’s development may be disordered in some way

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23
Q

When are new born examinations carried out?

A

< 72 hours old

Repeated at 6-8 weeks

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24
Q

What does the child health surveillance and promotion programme involve?

A

Spans from pregnancy to aged 19

It involved screening, immunisation, developmental reviews and health promotion

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25
Q

When is new born hearing screening offered?
What does it entail?
If the test is abnormal what further steps are carried out?

A

Often done before the child leaves hospital after birth or within the first few weeks of life

It is tested using otoacoustic emission - this is where an earphone produces a sound which evokes an echo or emission form the ear if cochlear function is normal

If this is abnormal the infant is referred to an audiologist and auditory brainstem response (ABR) audiometry is carried out.

26
Q

At what age does autism commonly present? Why is this?

A

Age 2-4

Language and social skills normally rapidly expand

27
Q

What is the triad of difficulties that children with autism commonly present with?

A

Impaired social interaction (e.g Inability to understand other people’s feelings and inability or reduced ability to play cooperatively with other children or to make friends
Speech and language disorder
Need for a rigid, highly structured routine and being very distressed by changes in routines.

28
Q

How may eye contact in a child with autism vary to one without?

A

Difficulty keeping eye contact - gaze avoidance

29
Q

How may children with autism view change?

A

Commonly dislike change as have rigid thinking

Difficulty in preparing for change and planning for the future

30
Q

What is meant by the term lack of joint attention or lack of joint connection when referring to children with autism?

A

Joint attention is the share focus of two individuals on an object. It is achieved when one individual alerts another to an object by means of eye-gazing, pointing or other verbal or non-verbal indications.
An individual gazes at another individual, points to an object and then returns their gaze to the individual.

Autistic children have difficulty alternating their attention towards a partner and third object. This difficulty is attributed to their deficiencies in following gaze, resulting in difficulty initiating and maintaining joint attention

31
Q

What is Asperger’s syndrome?

A

It refers to a child with the social impairments of an autism spectrum disorder but at the milder end, and near-normal speech development

32
Q

What does the term theory of mind refer to when thinking about children with autism?

A

Children with autism are said to lack theory of mind - think means that they are said to e unable to put themselves in others shoes

33
Q

What are some of the features of impaired social interaction that children with autism may display?

A
  • Doesn’t seek comfort, share pleasure or form close friendships
  • Prefers own company, no interest or ability in interacting with peers
  • Gaze avoidance
  • Lack of joint attention
  • Socially or emotionally inappropriate behaviour
  • Doesn’t appreciate that others have thoughts and feelings
  • Lack of appreciation of social cues
34
Q

What are some of the features of a speech and language disorder that a child with autism may display?

A
  • Delayed development- may be severe
  • Limited use of gestures and facial expression
  • Formal pedantic language, monotonous voice
  • Impaired comprehension with over-literal interpretation of speech
  • Echoes questions, repeats instructions, refers to self as ‘you’
  • Can have superficially good expressive speech
35
Q

What are some of the features of imposition of routines with ritualistic and repetitive behaviour that may be seen in children with autism?

A
  • On self and others, with violent temper, tantrums if distrupted
  • Unusual stereotypical movement such as hand flapping, twisting, spinning, rocking or hitting oneself.
  • Concrete play
  • Poverty of imagination in play and general activities
  • Peculiar interests and repetitive adherence
  • Restriction in behaviour repertoire
36
Q

What are some co-morbidities that can be associated with autism?

A
  • General learning and attention difficulties (about 2.3)
  • Seizures (1/4, often not until adolescence)
  • Affective disorders (anxiety, sleep disorders)
  • Mental health disorders (ADHD)
37
Q

What does the term global developmental delay imply?
When does it usually become apparent?
When this is present what further things should be done?

A

It implies a delay in all of the skill fields. These include:

  • Gross motor
  • Fine motor and vision
  • Cognition and Language
  • Emotional and social
  • Hearing and speech

It usually becomes apparent in the first 2 years of life

Investigations should be carried out in order to eliminate conditions that cause abnormal development and learning difficulty

38
Q

How may abnormal motor development present?

A

May be a delay in motor skills: e.g head control, rolling, sitting, standing, walking OR
Problems with balance, an abnormal gait, asymmetry of hand use, involuntary movements or rarely loss of motor skills

39
Q

Hand preference before a certain age is abnormal. What is this age and what could this be an indicator of?

A

Before 12 months (e.g if they use their left hand in doing most things)
It could be an indicator of cerebral palsy

40
Q

What is the most common cause of motor impairment in children?
When do concerns about motor development usually present?
What are some other causes of motor impairment in children?

A

Cerebral palsy
Concerns usually present between 3 months - 2 years

Congenital myopathy/primary muscle disease
Spinal cord lesions e.g spina bifida
Global developmental delay

41
Q

See neuro for questions on cerebral palsy

A

See neuro for questions on cerebral palsy

42
Q

When a child with global developmental delay gets older and the clinical picture becomes clearer what terms are preferred rather than the term global developmental delay?

A

It is more appropriate to describe specific difficulties e.g learning disabilities, motor disorder and communication difficulty rather than using the term global developmental delay

43
Q

What are some causes of speech and language delay?

A
  • Hearing loss
  • Global developmental delay
  • Difficulty in speech production from an anatomical deficit (e.g cleft palate or oromotor inco-ordination secondary to CP)
  • Environmental deprivation/lack of opportunity for social interaction
  • Normal variant/familial pattern
44
Q

What are some causes of speech and language disorders?

A
  • Disorders of language comprehension
  • Disorders of language expression (inability or difficulty in producing speech)
  • Disorders of comprehension and speech production e.g stammering (dysfluency), dysarthria or verbal dyspraxia
  • Disorders in pragmatics (this means that there is a difference between the sentence meaning and the speaker’s meaning) or disorders of construction of sentences
  • Disorders or social/communication skills (autistic spectrum disorder)
45
Q

When problems with speech and language are first detected what investigations should be carried out?

A

Hearing test

Investigations by a speech and language therapist (SALT)

46
Q

What other professionals may become involved in a child with speech and language difficulties?

A

Neurodevelopmental paediatrician
(Because in the early years there is a considerable overlap between language and cognitive (intellectual) development)
Paediatric audiological physician

47
Q

What does the term ‘childhood development’ refer to?

A

It refers to the skills acquired by children between birth and about 5 years of age during which there are rapid gains in mobility, speech and language, communication and independence

48
Q

What are the 4 main types of child abuse?

A
  • Physical
  • Emotional
  • Sexual abuse and sexual exploitation
  • Neglect
49
Q

What is the scheme that aims to avoid radicalisation of children?

A

-

50
Q

What is factitious illness by proxy?

A

When the parent of carer pretends that the child has disease, illness of psychological trauma to draw attention, sympathy or reassurance.

51
Q

What does sexual abuse of children encompass?

A

Forcing or enticing a child or young person to take part in sexual activities, including prostitution, whether or not the child is aware of what is happening
It also includes encouraging children to behave inappropriately or to watch pornographic material

52
Q

What things about a fracture should make you think more about non accidental injury?

A

In a non mobile child
Rib fractures
Multiple fractures

53
Q

What things about a bruise should make you think more about non accidental injury?

A

Bruising in the shape of a hand
Bruises on the neck that look like strangulation
Bruises on the wrists or ankles that look like ligature marks
Bruises to the buttocks in a child <2 years without a good explanation
Bruises away from bony prominences
Bruises on the face, back, abdomen, arms, buttocks, ears and hands

54
Q

What things about a burn should make you think more about non accidental injury?

A

If the child is not mobile
In the shape of an implement
Glove or stocking - consistent with forced immersion

55
Q

What things about a bite should make you think more about non accidental injury?

A

Bruising in the shape of a bite

56
Q

Frequent visits to where is more suspicious of child abuse?

A

ED (because more likely to see a different person each time)
- NOT GP -
As likely to see the same person each time

57
Q

What investigations may be carried out in a child that is suspected to be suffering from child abuse?

A

CT head
Bone profile
Full skeletal survey

58
Q

At what age do children usually:

  • Sit without support
  • Crawl/pull to standing
  • Cruise
  • Walk unsupported
A
  • Sit without support = 7-8 months
  • Crawl/pull to standing = 9 months
  • Cruise = 12 months
  • Walk unsupported = 13-15 months
59
Q

What are the 5 autism spectrum disorders?

A
  • Autism
  • Asperger’s syndrome
  • Rett syndrome
  • Childhood disintegrative disorder
  • Pervasive developmental disorder not otherwise specified (PDD-NOS)
60
Q

How is autism differed from the other autism spectrum disorders?

A

Autism is distinguished from the milder autism spectrum disorders as the social impairments are exhibited before the child is 3 yeas old

Laura Paediatrics (20 decks)

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