Development Flashcards
What are the four domains in which we assess development?
Gross Motor
Fine Motor & Vision
Speech, language and hearing
Social, emotional, behaviour and play
What is the median age when we are talking about a developmental milestone?
The age when half of the population achieve it
What is the limit age when we are talking about a developmental milestone?
The age by which the skill should be obtained (usually 2 standard deviations form the mean)
What should a baby be able to do by 6 weeks in each domain?
Gross Motor - Lift head prone
Fine motor and vision - Looks at faces
Speech and hearing - startles to sound
Social Behaviour and play- smiles
What should a baby be able to do by 6 months in each domain?
Gross motor - Lifts and grasps feet, pulls to sit, can roll from front to back
Fine motor and vision - palmar grasp, passes object from hand to hand
Speech and hearing - double syllable nonsense
Social behaviour and play - not shy, mouths everything
What should a baby be able to do by 9 months in each domain?
Gross motor - pulls to stand, crawls, rolls or shuffles
Fine motor and vision - points with finger. early pincer grip
Speech and hearing - mama, dada, understands no
Social behaviour and play - shy, plays peek a boo, may find hidden toy
At what age does stranger awareness develop?
7-8 months
What should a baby be able to do by 12 months in each domain?
Gross motor - cruising, walks holding one hand, may walk well
Fine motor and vision - good pincer grip, bangs toys together
Speech and hearing - knows and responds to own name
Social behavior and play - waves bye bye, plays pat a cake,
What should a baby be able to do by 13-15 months in each domain?
Gross motor - walks unsupported
Fine motor and vision - builds tower of two bricks
Speech and hearing - Knows about 2 - 6 words
Describe the differences between social behavior and play with other children at different ages.
18 months - will play happily on own
2 years - will play near others but not with them
3 years - make believe play with other children
4 years - understands taking turns
5 years - chooses friends
Describe the different drawing and building capabilities assessed in fine motor and vision at different ages
18 months - 3 brick tower, can draw circular scibble
2 years - 6 brick tower, can copy a vertical line
3 years - 9 brick tower, copys a circle
4 years - copy a cross
5 years - copy a square and triangle
What are the red flags in child development?
Any regression of developmental skills at any age
Any parental/professional concerns about vision, fixing or following
Abnormal tone in baby
Early strong hand preference
Strong discrepancy with growth parameters e.g. height, weight and head circumference
History if an increasing gap between the childs developmental ability and that of his peers
Describe some of the common limit ages which indicate referral is necessary.
No speech by 18 months
Cannot sit unsupported by 12 months
No walking by 18 months
How might we define Cerebral Palsy?
A permanent abnormality of movement and posture often accompanied by disturbances in Cognition Communication Perception Sensation Behaviour and Seizure Disorder e.g. epilepsy
In broad terms discuss when the damage of cerebral palsy occurs.
80% antenatally
10% due to hypoxic injury during birth
10% are post natal in origin
Describe some of the post natal causes of cerebral palsy
Meningitis, encephalitis, encephalopathy, head trauma, symptomatic hypoglycemia, hydrocephalus and hyperbilirubinaemia
Describe some of the antenatal causes of cerebral palsy
Intrauterine infections TORCH, IUGR, Premature birth, Hypoxic Ischaemic damage
Describe some of the early features a baby might demonstrate if he has cerebral palsy.
Abnormal limb and trunk posture and tone
Delayed motor milestones
Slowing in head growth
Feeding difficulties with gagging and vomiting, drooling
Epilepsy: up to 36% of children with cerebral palsy will have onset of seizures within the first year of life
Sleep disturbances
Bladder (infection and incontinence) and bowel (constipation is common)
What are the three main clinical sub-types of cerebral palsy, and how common are each of them.
Spastic 90%
Dyskinetic 6%
Ataxic 4%
N.B. can have a mixed pattern
Describe some of the features of Spastic Cerebral Palsy
Damage to UMN pathway, limb tone persistantly increased with increased reflexes. Can present with hemiplegia, quadraplegia or diplegia.
Describe some of the features of Dyskinetic Cerebral Palsy
Due to damage/dysfunction of basal ganglia
Involuntary, uncontrolled, stereotyped movements. More evident with active movement and stress. May be chorea, athetosis or dystonia
Describe some of the features of Ataxic Cerebral Palsy
Early trunk and limb hypotonia, poor balance and delayed motor development
Uncoordinated movements, intention tremor and an ataxic gait may be evident later.
Describe the genetic defect in Down Syndrome and its incidence
Trisomy 21
1 in 650 live births
Describe the cranio-facial appearance seen in Downs Syndrome
Round face, flat nasal bridge Upslanted palpebral fissures Epicanthic folds Small mouth and protruding tongue Small ears Flat occiput and third fontanelle
Describe some of the other clinical manifestations seen or more prevalent in Downs Syndrome
Single palmar crease Incurved 5th finger Sandle gap toes Hypotonic Increased risk of congenital heart defect Duodenal Atresia Hirshsprung Disease
Describe some of the later medical problems seen in babies with Downs Syndrome
Delayed motor milestones Moderate to severe learning difficulties Small stature Increased susceptibility to infections Increased risk of leukemias and solid tumours Risk of atlanto-axial instability Increased risk of hypothyroidism and coeliac disease Epilespy Alzheimers disease
Describe broadly how causes of weight faltering are classified and how common each of them are.
Classified as organic and non-organic.
Non-organic causes 95% organic causes 5%
Describe some of the causes of organic weight faltering
Inadequate intake - e.g. swallowing difficulties, chronic disease causing anorexia
Inadequate Retention - e.g. vomiting or severe GORD
Malabsorption e.g. coeliac, CF, cows milk protein intolerance
Failure to utilise nutrients e.g. chromosomal and metabolic disorders
Increased requirements e.g thyrotoxicosis, CF, malignancy, infection
Describe some of the causes of non-organic weight faltering
Feeding problems, low socio-economic status e.g. unable to buy food/milk, poor maternal-infant interaction, maternal depression, maternal anorexia, neglect or child abuse
Describe how overweight and obesity is defined in children under 12
Overweight >91st centile, Obese >98th centile
Describe how overweight and obesity is defined in children over 12.
Overweight BMI>25, obese BMI>30
Describe what features would make you consider an endogenous cause of obesity in childhood.
A short obese child (as overnutrition tends to accelerate linear growth and puberty, making children tall and obese)
In severely obese children under 3 gene defects e.g. leptin deficiency, should be considered.
Describe some of the features of Prada-Willi Syndrome
Obesity, hyperphagia, poor linear growth, dysmorphic facial features , hypotonia and undescended testes in males.
Describe what childhood vaccinations are given aged 2 months
Diptheria, tetanus, polio, pertussis, Hib
Pneumococcal
Rotavirus
Describe what childhood vaccinations are given aged 3 months
Diptheria, tetanus, polio, pertussis, Hib
Men C
Rotavirus
Describe what childhood vaccinations are given aged 4 months
Diptheria, tetanus, polio, pertussis, Hib
Pneumococcal
Describe what childhood vaccinations are given aged 12 months
Hib/Men C
Pneumococcal
MMR
Describe what childhood vaccinations are given aged 2, 3 and 4 years old
Influenza (nasal)
Describe what childhood vaccinations are given aged 3 and 4 months
Diptheria, tetanus, polio, pertussis,
MMR
Describe what childhood vaccinations are given to girls aged 12-13
HPV quadrivalent vaccine - GUARDASIL
16 and 18 for cervical cancer
6 and 11 for genital warts
Describe what childhood vaccinations are given to girls aged 14
Tetanus, Diptheria and Polio
Men C
