Development Flashcards
When should a child be referred to developmental pediatrics?
- When parents concerned
- Not responding to name by 9 months
- No words or pointing by 12 months
- Less than 20 words at 18 months
- Social communication concerns
A 6 year old reverses her letters. The mom is concerned. What do you say?
Reassurance - this is normal between 5-8 years.
What are the key milestones for GM skills?
- Head control 3 months
- Arms 6 months
- Trunk 9 months
- Legs 12 months
What time period is the moro reflex present?
Birth-4 months
What time period are the grasping reflexes present?
Birth-4 months
What time period is the stepping reflexes present?
Birth-6 weeks
What time period is the parachute reflex present for?
6 months-adulthood
What time period is the gallant reflex present for?
Birth-6months
What is sleep onset association disorder and how is it managed?
-Inability to fall asleep on own
-Falls asleep easily when parent present
-Frequent night wakenings
Management: bedtime routine, remove maladaptive sleep assoc., teach child to fall asleep on own
What are the key/progression of fine motor skills?
- 4 months transfers objects
- 6-8 months palmar grasp
- 7-11 months pincer grasp
- 2 years uses spoon
- 4-5years snaps, buttons, zippers
What are the key/progression speech and language for expression?
- 3 months cooing
- 6 months babbling
- 12 months language emergence
- 2 years 2 word combination , 50%
- 3 years 3 word combination, 75%
- 4 years phrased speech, 100%
What can you expect from the average 18 month old?
- 15-25 words
- Running
- Word explosion
- Single step commands
- Knows body parts
- Lots of gestures, pointing
- Symbolic and parallel play
What can you expect from the average 2 year old?
- 300-350 words (too many to count)
- 2-3 word phrases
- pronoun use
- 2 step commands
- enjoys other children
Which features of stuttering increase concern?
Physical tension, concern, frustration/self consciousness, pausing between words, no improvement with initial strategies in 1 month
What are the features of developmental dysfluency?
- Occasional (once every 10 seconds)
- Brief (0.5 seconds or less)
- Repetition of sounds, syllables or words (no prolongations; at start of word)
- Worse when tired, excited, complex language, questions, anxious
- NO tension in facial muscles
What is the diagnostic criteria for developmental coordination disorder?
A. Acquisition and execution of coordinated motor skills are substantially below expectations for a child’s chronological age and opportunities for motor skill learning. (Sx: clumsy, slow, inaccurate).
B. Interferes with ADLs for age, impacts life
C. Onset in early development
D. Deficit not better explained by intellectual disability, visual impairment, or a neurological condition affecting movement
Which of the following medical conditions is associated with a higher prevalence of ADHD? A. CHD B. Epilepsy C. Celiac disease D. Hypotonia
Prevalence of ADHD in epilepsy is 2-3x higher - particularly inattentive
Genetic conditions have higher prevalence as well (Fragile X, Turner, TS, NF, 22q11del)
Which of the following is the most common comorbidity with ADHD? A. Disruptive behaviour disorders B. Anxiety/OCD C. Tic disorders D. Specific learning disorders
D. Specific learning d/o: MOST common comorbid condition
The other options are all comorbid w/ ADHD but CPS says specific learning d/o is MOST common.
How do you treat ADHD in a patient <6 years of age?
Parent behaviour training! Psychostimulants are NOT approved in this group.
What is the DSM5 diagnostic criteria for ADHD?
- Symptoms must occur <12 years
- Symptoms present in >/=2 settings
- Symptoms interfere with social, academic, occupational functioning
- Not explained by another d/o
- Need >/= 6 inattentive symptoms or hyperactive symptoms
What is the recurrence risk for ASD in younger siblings when an older sibling has ASD?
7-19% (compared to 1.5% in the general population)
What are some early warning signs of ASD @ 6-12 months?
- Less smiling
- Limited eye contact
- Atypical/reduced babbling, gesturing
- Limited response to name when called
What are some early warning signs of ASD @ 9-12 months?
- Emerging repetitive behaviours (spinning or lining up objects)
- Unusual play (intense visual or tactile exploration of toys)
What are some early warning signs of ASD @ 12-18 months?
- No single words
- Absence of compensatory gestures (such as pointing)
- Lack of pretend play
- Limited joint attention (initiating, responding, sharing of interests)
What is an early warning sign of ASD @ 15-24 months?
-Diminished, atypical or no spontaneous or meaningful two word phrases
A school aged child’s parents are divorcing. What do you anticipate their response will be?
Strong sense of rules and fairness, prone to loyality and taking sides
A 4yo child’s parents are divorcing. What do you anticipate their response will be?
Blame themselves for separation, separation anxiety, excessive fears of abandonment
How many symptoms are required for diagnosis of ADHD?
> /= 6
- Symptoms must be present prior to age 12y, severe and persistent and inappropriate for age/developmental level, associated with impairment
What type of car seat should an infant have?
Rear facing
When can a child have a forward facing car seat?
2 years old w/ 5 point harness until at least 18kg/40lb
When can a child use a booster seat?
4 years old and at least 18kg/40lb
How tall does a child need to be to use an adult seat belt?
145cm - should have high back booster seat if a vehicle’s back seat does not have adjustable head rest
What is first line therapy for a child with ADHD <6yo?
Parent behaviour training
What are the benefits associated with ADHD pharmacotherapy?
- Improved academic outcome
- Lower comorbid anxiety and depression
- Improved function
- Reduced morbidity and mortality related to MVAs
Name 3 conditions which are higher risk for ADHD.
-ASD, ID and prematurity
What is the first line management for ODD?
Behavioural parent training, CBT
What are the first line investigations for a child with GDD/ID?
- Hx&PE, if something targeted, investigate that, think about cong. infection
- Vision & hearing
- Microarray (47% yields dx)
- Fragile X
- MECP2 to r/o Retts if female & sx of same present
- Thyroid (yield is essentially 0 if N NMS)
- Lead and ferritin (if PICA/mouthing)
- Metabolic (if strongly suspected)
What is often the earliest indication of neuromotor dysfunction (ie. CP)?
Persistent fisting at 3 months of age
Which SSRI is contraindicated in long QT syndrome?
Citalopram
At what age does head banging become concerning?
Child psychiatry referral is recommended if it persists beyond 3 years or if there is a lack of social interaction.
What are the contraindications to breastfeeding per the CPS statement?
- HIV +
- Cytotoxic chemotherapy
- Radioactive isotopes or radiation therapy
- Galactosemia
Name two developmental red flags at 9 months.
- Not sitting well
2. Decrease in vocalizations
Name two developmental red flags at 12 months.
- No words or name recognition
2. Not pulling to stand
Name two developmental red flags at 18 months.
- Less than 15 words
2. Social communication concerns
Name 2 underlying neurologic disorders associated with ASD.
- Tuberous sclerosis
- NF-1
- Rett syndrome
- Angelman
- T21
What are the early onset side effects of stimulants?
Decreased appetite, sleep, exacerbation of tics
What is a late onset side effect of stimulants?
Depression
What are the common early warning signs for cerebral palsy?
- Hand preference before 12 months
- Stiffness or tightness in the legs before 12 months
- Inability to sit by 9 months
- Persistent fisting of hands beyond 4 months
- Delays or asymmetry in movement or posture
What is the most likely etiology of spastic unilateral or hemiplegic CP?
Stroke or cerebral malformation
What is the most likely etiology of spastic bilateral CP?
Prematurity typically secondary to periventricular white matter injury
Who is more likely to have seizures? A child with spastic unilateral CP or bilateral CP?
Spastic unilateral CP due to stroke or cerebral malformations are particularly vulnerable to seizures, children with spastic B/L CP from PVL develop seizures less frequently as the cortex is often relatively spared
What is the most common comorbid disorder with ADHD?
Intellectual disability
