Community Paediatrics Flashcards
Give developmental milestone for hearing, speech and language for the following ages:
- Newborn
- 3-4 months
- 7 months
- 12 months
- Newborn = startles to loud noises
- 3-4 months = coos/laughs/vocalises
- 7 months = Eye contact, responding to name
- 12 months = 2-3 words other than dada or mama
Give developmental milestone for hearing, speech and language for the following ages:
- 20-24 months
- 2.5 - 3 years
- 20-24 months = joins 2+ words together
- 2.5-3 years = 3-4 word sentences
Give developmental milestone for social, emotional and behavioural development for the following behaviours:
- Smiling responsively
- Scared of strangers
- Symbolic play
- Taking turns
- 6 weeks
- 10 months
- 18-24 months
- 3-4 years
Give age for vision and fine motor skills for the following developmental milestone:
- Follows moving objects by turning head
- Palmar grasp
- Hand transferring
- Mature pincer grip
- 6 weeks
- 4-6 months
- 7 months
- 10 months
Give age for vision and fine motor skills for the following developmental milestone:
- Drawing with crayon
- Block tower of 3
- Block tower of 8
- Block bridge
- 16-18 months
- 18 months
- 2.5 years
- 3 years
Give age for gross motor development for the following developmental milestone:
- Raises head to 45 degrees when prone
- Sits without support
- Crawling
- Standing
- Walking unsteadily
- 6-8 weeks
- 6-8 months
- 8-9 months
- 10 months
- 12 months
Give age for gross motor development for the following developmental milestone:
- Running
- Pedalling tricycle
- Kicking a ball and hopping
- 2-3 years
- 3-4 years
- 4-5 years
At what age should you be worried if a child hasn’t done the following?
- Standing
- Walking unsteadily
- 12 months
- 18 months
Give 3 differential diagnoses for motor delay
- Cerebral Palsy
- Duchenne Muscular Dystrophy
- Downe’s Syndrome
What is the triad of symptoms seen in ADHD?
- Inattention (hard to follow instructions, can’t listen to small details, easily distracted)
- Impulsivity (interrupting, can’t take turns, ‘on the go’)
- Hyperactivity (restless, lots of talking)
Give 2 other features of ADHD
- Short temper
- Difficulty in forming good relationships
Give 3 diagnostic criteria of ADHD
- Has to be present in 2+ settings e.g. at home and at school
- Has to impact on ADLs/functioning
- Has to have been present for MORE THAN 6 months
What are the screening tests for ADHD? (3)
- Conner’s Tests
- QB Test
- Strengths and weaknesses
Who is involved in the MDT management of a child with ADHD?
- School/teachers
- Community paediatrician
- Educational Psychologist
- ?CAHMS
What is the management for ADHD in UNDER 5s? (2)
- ADHD focussed parent training course
- Only give meds if have second opinion/ as a last resort
What is the management for ADHD in OVER 5s?
- Conservative
- Parental education e.g. strategies/ support groups such as ADHD solutions
- Liaise with school
- Medical
- Stimulants e.g. methylphenidate or lisdexamfetamine
- can have different preparations e.g. short vs long acting
- Atomoxetine is not preferred
What baseline assessments do you need to do before commencing medications for ADHD?
- Height and weight + plot a growth chart (meds can stunt growth)
- Pulse and BP
- CVS exam
- ECG if indicated
Define Autism Spectrum Disorder
A neurodevelopmental condition characterised by:
impairment in social interaction
communication
repetitive stereotyped behaviour, interests, and activities.
What are the symptoms of ASD?
Usually evident before 2-3 years
Impaired social interaction - play alone, can’t regulate social interaction
Repetitive behaviours - stereotyping, stick to routines
+/- intellectual/language impairment
What are 2 associated conditions with ASD?
ADHD
Epilepsy
What are the aims of treatment in a child with ASD?
Decreased disability
Learning and development e.g. improved social skills, communication
Family help!
Give 4 examples of non-pharmacological methods of managing a child with ASD
Parental education
ASD preschool program
Structured teaching method
Applied Behavioural analysis
Give 3 pharmacological methods of managing a child with ASD
SSRIs can help to reduce stereotyped behaviour and anxiety
Antipsychotics can help to reduce anxiety, aggression and self-injury
Methylphenidate if ADHD is co-existing
Define cerebral palsy
a disorder of movement and posture due to a non-progressive lesion of the motor pathways in the developing brain.
What are the 3 groups of causes of cerebral palsy?
Antenatal - Congenital infections (TORCH), cerebral malformation
Intrapartum: birth asphyxia
Post natal: IVH, meningitis
How might cerebral palsy present?
abnormal tone early infancy
delayed motor milestones
abnormal gait (scissor)
feeding difficultie.
Give three examples of potential co-existing conditions with cerebral palsy
Intellectual difficulties
Epilepsy
Squints
What are the 4 classifications of cerebral palsy?
spastic (70%): (hemiplegia, diplegia or quadriplegia)
dyskinetic
ataxic
mixed
What are the pharmacological management options of cerebral palsy?
Diazepam
Baclofen
Botulinum toxin/surgery
Anticonvulsants
PEG
What are the features of patau syndrome? which trisomy is it?
13
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
What are the features of Edward’s syndrome? which trisomy is it?
18
Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers
What are the features of fragile X syndrome?
Learning difficulties Macrocephaly Long face Large ears Macro-orchidism
What are the features of Noonan syndrome?
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
What are the features of Prader-Willi syndrome?
Hypotonia
Hypogonadism
Obesity
What are the 3 main referral points for developmental delay?
doesn’t smile at 10 weeks
cannot sit unsupported at 12 months
cannot walk at 18 months
Give an example of a fine motor skill problem and what it may indicate
Hand preference by 12 months
Cerebral palsy
What are 2 fine motor milestones for 3 months?
Reaches for objects
Fixes and follows to 180 degrees
What are 2 fine motor milestones for 6 months?
Palmar grasp
Can pass objects from one hand to the other
What is a fine motor milestone for 12 months?
Pincer grip
When should a child be able to build a brick tower of 6 blocks?
2 years
When should a child be able to copy a vertical line and a circle respectively?
vertical line = 2 years
circle = 3 years
When should a baby gain head control?
3 months
When should a baby be able to sit without support?
7-8 months
Refer if hasn’t happened by 12
When should a baby be able to crawl and cruise respectively?
Crawl = 9 months
Cruise = 12 months (/walk with a hand held)
Hone should a baby be able to walk unsupported?
13-15 months
Refer if hasn’t happened by 18
When should a baby be able to smile?
6 weeks
Refer if hasn’t happened by 10
When should a baby be able to laugh
3 months
When does a baby become shy around strangers?
9 months
When should a baby be able to play peek a boo and wave bye bye respectively?
PAB = 9 months
BB = 12 months
When should a child be able to play with other children?
4 years
When should a baby be able to say mama and dada
9 months
When should a baby be able to respond to their name
12 months
When should a baby be able to combine 2 words
2 years
Give 4 clinical features of down’s syndrome?
Face = protruding tongue, small low set ears, round face
Single palmar crease
Hypotonia
Pronounced sandal gap
Give 3 congenital features of down’s syndrome
Congenital heart defects (lots of them)
Duodenal atresia
Hirshprung’s
Give 4 examples of later complications of down’s syndrome
Learning difficulties
Hypothyroidism
Alzheimers
Repeated respiratory infections (+ otitis media with effusion = ? hearing impairment)
