Community Paeds Flashcards
Presentation of child abuse?
Repeated/delayed presentations.
Child with frightened, withdrawn appearances.
Bruising.
Fractures - metaphyseal, posterior rib fractures or multiple fractures at different stages of healing.
Torn frenulum - forcing bottle into mouth/
Burns or scalds.
STIs.
Failure to thrive
Development at 6 weeks old
Motor - Good head control, raises head to 45 degrees when on tummy. Stabalises head when raised to seating.
Vision - track objects/faces
Speech - startles at loud noises.
Social - Smiles
Development at 6 months
Motor - sit without support. Rolls onto back (rolling onto tummy slightly later)
Fine motor - palmer grasp and object permanence.
Speech - turns head to loud noise. Understands bye and no. Babbles.
Social - puts objects into mouth, shakes rattle and reaches for bottle/breast.
Development at 9 months
motor - Stands while holding on. Starts to crawl
Fine motor - inferior pincer grip
Language - responds to own name, imitates adult noices.
Social - Stranger fear. Holds and bites food.
Development at 12 months.
Motor - Walks alone (9-18m). Worry if not walking by 18m.
Fine motor - Neat pincer grip (thumb and forefinger). Casting bricks.
Language - Understanding nouns eg, where’s mummy? 3 words and points to own body parts (15m).
Social - Waves bye-bye, hand clapping, drinks from beaker.
Development at 18 months?
Motor - run and jump.
Fine motor - Circular scribble and builds tower of 3. (2 at 15m). Turns pages several at a time.
Language - shows understanding of nouns (show me X). 1-6 words.
Social - imitates every day activities (phone calls)
Development at 2 years?
Motor - runs tiptoe, walks upstairs, throws ball at shoulder level.
Fine motor - vertical line, builds tower of 6. Turns pages one at a time
Language - Understanding of verbs (show me what you eat with). 2 words joined together.
Social - eats skillfully with spoon. Waves to strangers
Development at 2.5 years?
Motor - kicks ball
Fine motor - horizontal line.
Language - 3-4 words joined together
Development at 3 years?
Motor - Hops on one foot for 3 steps. Walks upstairs one foot per stair and down two feet per step. Rides tricycle.
Fine motor - Copies circle, tower of 9 bricks.
Language - Understands negatives eg, which one is NOT an animal. Understands adjectives eg, which one is red.
Social - Eats with fork and spoon, begins to share toys, plays without parents, bowel control.
Development at 3 years?
Understands comparatives - which toy is bigger than this one?
Development at 4 years old?
Motor - walks up and downstairs in adult manner.
Fine motor - draws cross, Square (4.5y), triagnle/person at 5y. Builds steps. Cuts paper in half and uses small beads.
Language - understands instructions (give x to mummy)
Social - empathy, has best friend, bladder control, imaginative play, eats skillfully with little help, dressing and undressing.
Red flags for developmental delat?
Doesn’t smile at 10 weeks
Not holding object at 5 months
Not sitting unsupported at 12 months
Not standing independently at 18m.
No words at 18 months.
No interest in others at 18 months.
Not walking independently at 2 years.
Not running at 2.5 years.
Differential diagnosis for developmental delay?
Autism,
Cerebral palsy,
Fragile X syndrome,
Down’s syndrome,
Fetal alcohol spectrum disorder
Initial management of a child with a suspected developmental delay?
Clinical examination - assess development milestones.
Investigations - Genetic testing, metabolic screening, neuroimaging and hearing/visial assessments.
Referral for specialist assessment
Early intervention services.
Causes of gross motor delay?
Cerebral palsy
Ataxia
Myopathy
Spina bifida
Visual impairment.
