Development Flashcards
Positive indicator red flags
- regression
- concerns about vision/fixing/following
- Hearing loss
- Persistently low mm tone/floppiness
- No speech by 18 months
- Asymmetry of movement/features of cerebral palsy
- persistent toe walking
- complex disabilities
- head circumference >96th centile or <0.4centile or crosses 2 centiles compared to rest
Negative indicator red flags
- sit unsupported at 12 mo
- walking by 18M (boy) 2Y (girl)
- Walk other than on tip toes
- run by 2.5
- hold objects in hand by 5years
- reach for objects by 6mo
- point at objects by 2Y
Causes of gross motor delay
- muscular dystrophies (neuromuscular)
- cerebral palsy
- chromosomal anomalies
- antenatal infections
- rickets/malnutrition
- DDH
- neglect
Gross motor red flags
Poor head control or floppiness at 6 months. Unable to sit unsupported at 9 months. Not weight bearing through legs at 12 months. Not walking at 18 months. Not running at 2 years. Not climbing stairs at 3 years. Persistent toe walking. Increased muscle tone.
WHat is the normal Babinski response
at birth extensor
by walking flexor
What investigation should you do in an isolated gross motor developmental delay
CK to rule out MD
What are the most common red flags for cerebral palsy
- Not sitting by 8 months (corrected for gestational age).
- Not walking by 18 months (corrected for gestational age).
- hand preference before 1 year (corrected for gestational age).
What is duchennes muscular dystrophy
- Progressive proximal muscular dystrophy with hypertrophic calves
- All people display symptoms by 3 years old
- Only effects males
What are the clinical features of duchennes muscular dystrophy
- motor milestone delay
- Inability to run - waddles
- toe walking/falls/can’t hop
- gowers sign
How is a diagnosis of duchennes musclar dystrophy made
- Genetic analysis
- Muscle biopsy - with assay for dystrophin protein.
- Clinical observation of muscle strength and function.
What is Beckers Muscular dystrophy
- similar to Duchennes but a clinically milder form,
- average diagnosis age 11 but may be teens early 20s
What are the complications of muscular dystrophy
progressive difficulty walking
dilated cardiomyopathy
arrhythmia
respiratory failure
What tools are used to assess development in under 5
- schedule of growing skills
- Griffths mental development scales
- Bayley scales of infant development
What tools are used to assess development in school aged children
- Wechster intelligence scale for children
- British abilities scale
When would you expect to roll
8-18 weeks
Pulls self up to stand
6-10months
Walks holding furniture
10-13 months
head lag
<6 weeks
walk
11-14 months
Hops, skips:
2.5 - 5
visual fixation
6w
transfers objects between hands
6-8 mo
pincer grip
12mo
tower bricks 2-3 blocks, scribbles
18mo
tower 4-6 bricks, draws verticle line
2 years
draws circle
3 years
draws cross/square
4 years
draws triangle, can do buttons
5 years
startles to loud sounds
6 weeks
babbling/turns to name
6-8 months
understands no
9 months
2-3 words
12 months
25-50 words
18 months
3-4 word sentences
3 years
smiles
6 weeks
holds bottle on feeding
6-8 months
waves bye
12 months
drinks from cup
15 months
uses spoon
18months
interactive play/knife and fork
3 years
potty trained
4
endocrine causes of poor growth
hypothyroidism
hypopituritism
growth hormon deficiency
cushings disease
genetic causes of short stature
Noonan
Turner/Di George
Russel-silver syndrome
systemic causes of short stature
coeliac
inflammatory bowel
renal disease
Approach to someone with short staturs
- accurate measurements of height and weight
2. calcuate mid-parental centile (add 7cm boy, take 7cm for girls) Plot at 18 on growth chart
What is a considered a normal growing child
height centile will be within 2 centile spaces (one above and one below) of mid-parental centile
Nutritional causes of short stature
malnutrition bulimia anorexia chronic disease - malabsorption psychosocial deprivation neglect
Skeletal causes of short stature
achondroplasia
hypochondroplasia
conditions with assoc. spinal/bone abnormalities e.g. rickets
What is constitutional delat of growth and puberty
- deceleration of length/height in first 3 years of life
- near normal height velocity during childhood
- acceleration late in adolescence.
Features of GH DEFICIENCY
- micropenis
- hypoglycaemia at birth
- growth deceleration by age 2
- ‘cherubic’ look
Investigations for ?GH deficiency
bone age - delayed
IGF 1 - low
GH stimulation tests: low; peak GH level <10 micrograms
MRI brain
mNgement GH deficiency
recombinant GH
treat underlying cause
treat other pituitary insufficiencies
