Development Flashcards
Average HC at birth
35cm
Typical growth of HC
2cm/mo 0-3mo
1cm/mo 3-6mo
0.5cm/mo 6-12mo
>80% of adult size by 2 yr
Weight at birth
3-3.5kg
Regain of weight by when?
2 weeks
Weight doubles when
by 4-6mo
Weight triples when
by 1yr
Average length at birth
51cm
Length 1/2 of adult ht by when
2yr
LIfts head 45 degrees when prone, arms extended
2mo
Follows objest past midline
2mo
Rolls prone to supine
4mo
Chest up, supported on arms when prone
4mo
No head lag when pulled to sit
4mo
Lifts head to 90deg when rpone
4mo
Sits with support
6mo
Chest up, supported on hands
6mo
Starts to crawl
9m
Pulls to stand
9mo
May cruise
9-11mo
Takes a few steps with hand held
12mo
Stand without help or walk independently
12mo
Swipes at objects, hands open
3mo
Hands in midline
4mo
Grasps objects and brings to mouth
4mo
Transfers objects hand-hand
6mo
Reaches unilaterally, raking grasp
6mo
Early pincer grasph
9mo
Eats with fingers
9mo
Mature pincer grasp
12mo
Releases object voluntarily
12mo
orients to voice
4mo
laughs
4mo
babbles
6mo
mama, dada
9mo
responds to name
9mo
mama, dada specifically
12mo
immature jargon
12mo
one or more words with meaning
12mo
understands commands with gestures
12mo
social smile, regards face
2m
laughs
4mo
start of object permanence
6mo
prefers mother, stranger anxiety
6mo
looks over edge, object permanence
9mo
plays beek-a-boo, pat-a-cake
9mo
wave bye bye
9months
uncovers hidden object
9mo
plays simple games
12mo
takes pride in accomplisments
12mo
walks well, walks backwards
15mo
runs well, wide-based gait
24mo
runs clumsily, falls often, walks pushing or pulling toys
18mo
walks on tiptoes
3years
tandem walks
4years
alternating feet
5 years
skips
5years
crawls up stairs
15mo
walks up stairs with hand held; two feet per step
18mo
Climbs up and down stairs alone 2 feet per step
24mo
climbs up stairs alternating feet
3yrs
climbs down stairs alternating feet
4yrs
sits self in chair
18mo
throws ball overhead
18mo
kicks ball forward
2yrs
jumps in place, jumps off step
2yrs
stands on one foot momentarily
2yrs
kicks ball forward
2yrs
stands on 1 foot 1-2 sec
3yrs
hops 2-3 times
3yrs
broad jump
3yrs
stands on 1 foot 3-5 seconds
4yrs
hops 5 times
4yrs
2 cube tower
15mo
3-4 cube tower
18mo
6-7 cube towers
24mo (2+4=6 cubes)
8 cubes
30mo
9-10 cubes
3yrs
Imitates bridge with tube
36months
Gate cubes
48mo
steps of cubes
72mo
scribbles spontaneously
18mo
imitates a stroke
18mo
imitates vertical and circular stokes
24mo
imitates horizontal strokes
30mo
copies circle
3yrs
copies cross
4yrs
copies square
4.5yrs
copies triangle; prints a few letters
5yrs
copies diamond
6yrs
takes off gloves, socks, shoe
18mo
can put on some clostes
24mo
dresses with supervision
3yr
unbutton
3yr
dresses without supervision
4yr
buttons
4yr
can tie shoelaces
5yr
uses covered cups with little spilling
15mo
handles spoon well for solids
18mo
uses spoon well for semi-solids
24mo
eats neatly with spoon and fork
3yrs
spreads with a knife
5-6yrs
starting to cut food with the knife
7yr
2-3 words, immature jargoning
12-13mo (1+2=3)
4-6 words
15mo (1+5=6)
7-20 words
16-17mo (1+7=8)
Mature jargoning
16-17mo
50+ words
21-24mo
2 word sentences
21-24mo
pronouns, telegraphic speech
30mo
3-4 sentences
3yr
250+ words
3yr
4-6 word sentences
4yr
uses past tense
4yr
follows 1 step command with gestures
12mo
follows 1 step command without gestures
15mo
knows 5+ body parts
18mo
names pictures of common objects
18mo
follows 2 step command
24mo
knows sex, first and last name
30-36mo
understands 2 prepositions
30-36mo
names 3-4 colors
4yr
counts 5-10
4yr
understands 4 prepositions
4yr
understands opposites
4yr
intelligibility to strangers 50%
2yr 2/4
intelligibility to strangers 75%
3yr 3/4
intelligibility to strangers 100%
4yr 4/4
parental concerns about development identify about what percentage of kids?
80%
months of child when AALP recommends developmental screening
9mo, 18mo, and 30mo (24mo)
T/F : language milestones more predictive of developmental problems than gross motor milestones
True
T/F: Current developmental level is more accurate than recall of milestones
True
T/F: screening test can predict future potential
False
T/F: Multiple assessments are betther than a single assessment in time
True
T/F: developmental screens can identify specific developmental disorders
False
T/F: a simple checklist can be used for developmental screening
False - use validated instruments
Test name? Parental report of concerns in various domains, 2-5min to complete, parents must have 5th grade reading level, well-validated and available in multiple languages
Parents’ Evaluation of Developmental STatus
What test? Parental reports of acquired skills in various domains, 10-15, well-validated
ASQ
What test? Autism-specific, 16-30 months
M-CHAT
What should you do M-CAT
18 and 24 months
What test? 2wk-6r, 15-30 min, assess 4 domains of development, not as sensitive to mild delays and language difficulties
Denver developmental screeing test
What test? 1-42mo, 1hr, can get developmental quotient = developmental age/chronological age); does not correlate highly with IQ
Bayley scales of infant development - II
Warning signs of language delay at 9mo
no response to name
Warning signs of language delay at 10-12mo
not babbling
Warning signs of language delay at 15mo
Does not respond to “no” or “bye bye”
Warning signs of language delay at 18mo
No words other than mama, dada, does not point to wants
Warning signs of language delay at 24mo
no 2 word phrases or 2 syllable words. Does not understand simple commands
Warning signs of language delay at 3yo
speech not fully intelligible to family, not using pronouns and verbs, no simple sentences, echolalia still present
Warning signs of language delay at 4yr
speech not fully intelligible to strangers
Warning signs of language delay at 5yr
persistent stuttering, frequent letter substitution
Warning signs of language delay at 6yrs
speech errors other than s, ch, sh, z, j, v, th, zh
Warning signs of language delay at 8 years
any speech errors
Name some neonatal risk factors for hearing loss and language delay
NICU admission >48hrs
Craniofacial abnormalities or syndromes
FH of childhood deafness
In utero infections (CMV, HSV, rubella, syphilis, toxoplasmosis)
Risk factors for delayed-onset hearing loss
neonatal risk factors Postnatal infection (meningitis) Recurrent or persistent OM Head trauma with temporal bone fracture Neurodegenerative disorders -Hunter's, Friedrich's ataxia, Charcot-Marie-Tooth
What neurodegenerative disorders are typically associated with hearing loss?
Hunter’s, Friedrich’s ataxia, Charcot-Marie-Tooth
What percentage of sensorineural hearing loss is genetic?
50%
What is the most common mutation associated with sensorineural hearing loss?
Connexin 26 gene on chromosome 13
What inheritance pattern is mutation in connexin 26 generally?
Autosomal recessive
If congenital CMV infection is symptomatic, what percentage is sensorineural hearing loss?
60%
If CMV infection is asymptomatic, what percentage is sensorineural hearing loss?
5%
In pt with connexin 26 gene, at what age can they present SNHL?
at age age
Most common cause of conductive hearing loss
otitis media with effusion
Does early insertion of tympanostomy tubes affect sppech long-term
no
Besides otitis media, what are other causes of conductive hearing loss
craniofacial anomalies (external canal atresia/stenosis, foreign bodies, perofration, tympanosclerosis, ossicular disruptions
What is normal hearing
dB for mild hearing loss
26-40
dB for moderate hearing loss
41-55
dB for mod-severe hearing loss
56-70
dB for severe hearing loss
71-90
dB for profound hearing loss
> 90
Pattern: difficulty with whispers, misses up to 50% speech
mild HL
Pattern: misses 5-100% of speech, often poor voice and speech quality, hearing device required
moderate HL
When is hearing device typically required
w/ moderate hearing loss 41-55dB
Pattern: loud shout heard as whisper, needs hearing aids, educational interventions
mod-severe HL
Pattern: may have difficulty with hearing aids
severe HL
Pattern: feels vibrations only, does not hear, relies on vision for communication
profound HL
profoundly deaf children can vocalize normally up to what months
6-8 months
Define components of expressive language delay
limited vocabulary, poor word recall, poor intelligibility, delayed syntax (normal sentence structure)
Define components of receptive language delay
auditory processing problems, verbal comprehension, short-term auditory memory
Dysfluency is normal during what age group
2.5 to 5 years
Indication for further evaluation of stuttering
- Onset >5yr or persists for >6months
- Child distressed when speaks
- Frequent long pauses, blockaged
- Parents concerned
- Positive family history
Rx for stuttering
speech therapy, selective use of DA agonists (risperidone), SSRIs
Pattern: sudden deterioration in language (receptive, then expresive) aat 3-7 years old, EEG abnormalities (temporal lobe spikes, sharp waves), 80% with clinical seizures
Landau-Kleffner syndrome
What four genetic syndromes can be associated with language delay
Down, Williams, Fragile X, Klinefelter’s
Define clinical and EEG of stage II
sleep spindles, K complexes, slowed HR, RR, eye movements slowed, easily awakened
Define stage III sleep on EEG
20-50% delta waves (high voltage, slow waves)
Define EEG of stage IV sleep
> 50% delta waves, difficult to awaken
When does parasomnias occur?
During Non-REM sleep
NREM occurs when
During first 1/3 of night
REM occurs when
During last 1/2 of night
When do newborns develop day/night differentiation
Not until 2 months
REM occurs when in infants
Onset of sleep
When is nap discontinued
3-4yr
When do parasomnias occur?
within 1-2 hours after sleep onset
Parasomnias occur during what age?
4-12 yr
What can parasomnias be precipitated by?
stress, illness, sleep deprivation
Rx for parasomnias
Not much, scheduled light arousal before event
Most common age with sleep walking
4-8 years, resolves in adolescence
Rx for sleep walking
short nap in afternoon may be helpful to decrease deep sleep at night
Pattern: stage IV sleep, first 1/3 of night, 4-12y, confused, agitate, not consolable, no recall
night terrors
Pattern: REM sleep, second 1/2 of night, peak 3-6y, upset but awake, consolable, may recall
nighmares
Rx for delayed sleep phase
phase advancement or phase delay, oral melatonin, bright light exposure
What is restless legs syndrome exacerbated by?
caffeine, alcohol, nicotine, iron deficiency, pregnancy
What is periodic limb movement disorder
repetitive extension of toe, flexion of ankle, knee
Rx for RLS
DA agonist, clonazepam, opiates, carbamazepine, gabapenin
What can OSAS be associated with
FTT, enuresis, daytime sleepiness
Pattern: Intrusion of REM into your awake state, cataplexy, sleep paralysis, hypnagogic hallucinations, development in adolescent years
narcolepsy
What percentage of children have developmental disability?
15%
Joint attention
9mo
IQ in ID
<70
