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Child with frightened, withdrawn appearances.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.
Causes of fine motor delay?
Dyspraxia,
Cerebral palsy,
Muscular dystrophy,
Visual impairment,
Cogenital ataxia
Causes of language delay?
Specific social circumstances,
Hearing impairment,
Learning disability,
Neglect,
Autism,
Cerebral palsy
Causes of personal and social delay?
Emotional and social neglect,
Parenting issues,
Autism
Clinical features of autism?
Impaired social communications and repetitive behaviors, interests and activities. Typically evident before age 2-3 years old.
Impaired social communication - playing alone, fail to regulate social interaction with nonverbal cues. Fail to form and maintain relationships.
Repetitive behaviours - inflexible adherence to nonfunctional routines or rituals
Management of autism spectrum disorder?
Early educational and behavioral interventions.
Family support and counselling.
What is dyspraxia?
Developmental co-ordination disorder - More common in boys. It is spcific type of difficulty in physical co-ordination
What is cerebral palsy?
Disorder of movement and posture due to non-progressive lesion of motor pathways in the developing brain.
What are the causes of cerebral palsy?
Antenatal - cerebral malformation or congenital infection.
Intrapartum - birth asphyxia/trauma.
Postnatal - intraventricular haemorrhage, meningitis or head-trauma
Presentation of cerebral palsy?
Abnormal tone in early infancy,
Delayed motor milestones,
Abnormal gait,
Feeding difficulties,
Non motor problems - learning difficulties, epilepsy, squints or hearing impairment
Classification of cerebral palsy?
Spastic - damage to upper motor neurons.
Dyskinetic - Damage to basal ganglia and substantia nigra. Athetoid movement and oro-motor problems. Involuntary movements.
Ataxic - Damage to cerebellum with typical cerebellar signs.
Mixed
Management of cerebral palsy?
Treat spasticity with meds, eg, oral diazepam, baclofen, botulinum toxin, or surgery.
