Development Flashcards
Passing objects hand to hand and sits with support. Age?
6 months
List as many developmental red flags a you know.
**Regression of skills
Early primitive reflexes after 6 mo.
GM:
- rolling < 3 mo.
- fisting persist at 3 mo.
- no sitting by 8-9 mo.
- *- not walking by 18 mo.
FN:
- handedness < 18 mo.
Speech:
- < 3 word at 18 mo.
Social
- no smile at 3 mo.
Cognitive:
- no alert to environmental stimuli by 3 mo.
- no peek a boo at 9 mo.
Pincer grasp. Age?
9 months.
5 mon: rake small object
6 mon: hand to hand
7 mon: radial palmar grasp
Object permanence major milestone once:
9 months
= understanding objects continue to exist even when they can’t be seen
10 month old bites you. True:
- early sign ASD
- abusive fam
- normal and baby excited
Developmentally normal and he is excited
What is most characteristic of 9-12 months:
- object permanence
- imitate scribbling
- transfer object hand to hand
- mama and dada specifically
Mama + dada specifically.
- Transfer object hand to hand by 6 mo.
- Object permanence by 9 mo.
- Scribbling imitated at 18 months.
All are true except:
- walk 3 step by 15 mo
- copy horizontal line at 15 mo
- stack 3 block at 18 mo
- speak 10 word at 18 mo
- climb stairs holding rail at 18 mo.
Copy horizontal line at 15 moon
= imitate vertical stroke at 18 mo and horizontal stroke at 24 month
At 15 mo.
- walk alone
- 3 cube tower
- crayon line
- name object
- hug
At 18 mo.
- walk stair with 1 hand
- imitate scribbling
- 10 words, 1 body part
- feed self
Parachute reflex shown. Which is true:
- primitive reflex disappear by 4 mo
- this is voluntary reflex disappear when child walking
- involuntary reflex; appear at 7-9 mo and never disappear
Involuntary
Appear at 7-9 mo.
Does not disappear
Describe a 2 mo, 4 mo, 6 mo, 8 mo, 9 mo old baby:
2 mo
- lift head 45 degree
- turn to sound + track
- social smile
4 mo
- raise head + chest when prone
- roll over (front to back and then other)
- reach for object
- squeal
6 mo.-8 mo.
- sit
- hand to hand
- babble
- non specific mama/dada
- stranger anxiety
- wave near 8.5 mo.
9 mo.
- crawl/ pull to stand
- pincer grasp
- jabber
- separation anxiety
- peek a boo
Describe 1-5 y.o. milestones:
1 year:
- walk
- age x 3 for cubes= 3 cube towers
- single word
- drink from cup
18 mo.
- walk stair with 1 hand
- imitate scribbling
- 10 words, 1 body part
- feed self
- kick ball
2 y.o.
- climb two steps
- 6 cub tower
- 2 word phrase
- 25% understandable
- two step command
- tell immediate experience
3 y.o.
- tricycle, jump
- circle -> start cross
- 9 cube
- count 3 objects
- repeat 3 digits
- 3 word phrase
- 3/4 understood
- pretend group play
4 y.o.
- alternating stairs
- balance 1 foot x 4sec
- square
- knows name
- 90% understood
- interactive role play
- dress on own
5 y.o.
- skips
- triangle
- name 4 colour
- fluent speech
- play competitive game
What is the developmental tip to learn the order of shapes?
Alphabetical order
Circle - 3
Cross -3 to 4
Square- 4
Triangle- 5
Which milestone do most children achieve first?
- Overhand throw ball
- Kick ball
- Hopping
- Riding tricycle
- Skipping
Kick ball= 18 mo.
- 2= throw overhand
- 3 = tricycle
- 4= hopping
- 5= skip
T or F: bilingualism is an adequate explanation for significant speech delay.
False
T or F: tongue tie can affect acquisition of language.
False.
- can affect articulation but not acquisition
T or F: early language disorder strongly associated with reading disorder.
True.
Also communication disorders overall higher rate of anxiety (social phobia)
T or F: 10% of those with speech delay catch up by 3 y.o.
False.
> 1/2 catch up.
Define global developmental delay:
> 1 area of deficit + cognitive impairment in < 5 y.o. child
Define Autism Spectrum Disorder criteria:
Social communication + Repetitive restricted (2 of)
- Social communication or interaction deficit
> social-emotional reciprocity
> non verbal communication
> developing, maintaining or understanding relationship - Restricted repetitive pattern of behaviour, interest or activity w/ min 2 of:
> stereotyped or repetitive motor movement, object, speech (echolalia i.e.)
> insistence of sadness, finlexible
> highly restricted fixed interest in abN intensity or focus
> sensory hyper or hyperactivity
Symptom present in early development and cause significant impairment.
Not better explained by intellectual dx or GDD>
List as many indications as you remember for SLP:
Any age: no response to sound, environment.
12 month: no mama, dada
15 mo: no 3 word
18 mo: no simple command, no names
24: no point to body parts, not using 25 words
3 y.o.: no 2 step command, vocal < 200 words, echolalia
4 y.o.: stuttering
what is developmental disfluency?
2-3 y.o.
fluency or timing inappropriate (reputation, broken word, silent blocking, tension with words)
Last wk-months
Resolve by 4 y.o.
Do not fill in or interrupt or prompt to slow down.
4 y.o.= REFER
Versus stuttering is usually 4-5 y.o. and SLP.
Child with expressive speech delay, parent do all BUT:
- read at night
- repeat incorrectly pronounced words over and over
- make stop activity and look when you talk
- don’t complete sentences
Make him repeat incorrectly pronounced word over and over
- 5 y.o. referred for SLP and inferior ectopia lentis. Next?
- molecular studie for Marfan Syn
- Echo to R/O aortic root abN
- fibroblast/skin bx for enzyme assay
- quantitive serum a.a.
- plt count and coag for hypercoag
Quantitive serum a.a.
R/O homocysteinuria.
All are true re: vision in newborn EXCEPT:
- newborn sclera thin which cause blue hue
- able to fix on large since birth
- 2 mo. follow 180 degree
- retinal hem rare in newborn and cause permanent deficit
Retinal Hemm rare and cause permanent deficit= RARE
- Superficial retinal hemm observed in MANY and most resolve within 2 wk
T or F: disruption of continuity of care may be potentially detrimental to all children
True
T or F: Joint custody is better for child regardless whether conflict btwn parents.
False.
Parental depression and conflict more likely determine adjustment than custody issue.
T or F: marital conflict causes child distress and mental health issues often LONG before parents actually separate.
True
What are the 3 significant factors impacting child’s well being during a divorce:
- parenting
- parent-child interaction
- degree, f, intensity and duration of hostile conflict
What are kids w/ William Syn learning strength and weakness?
Strength: verbal short term memory
Weak: visual-spatial skills
List traits of Williams Syn
- elfin facies (stellate iris, fullness with hypertelorism)
- supravalvular aortic stenosis
- HTN
- hypercalcemia
- connective tissue abN
- scoliosis
- extreme friendly
- talky +++
- inattention
- phobia
- intellectual disability (mild-moderate)
- Strength: verbal short term memory
- Weak: visual-spatial skills
- Anxiety + ADHD
18 mo. Fragile X. which NOT seen in boys with full FMR mutation:
- delay in fine + motor
- relatively strong expressive communication
- cognitive impairment
- hyperactivity + distractible
- social avoidance + anxiety
Expressive lang usually delayed
How do you define fetal alcohol syndrome:
3 facial traits (short palpebral fissures, thin vermillion border, smooth philtrum)
+ growth retardation (<10th % tile)
+ CNS involvement (structural with microcephaly, neuro signs, functional)
+/- confirmed prenatal exposure.
What are functional abnormalities seen in FASD:
- GDD
- intellectual disability
- executive f’n deficit
- motor delay
- social skill
- problem with ADHD
- sensory problem or memory deficit
Which does not have MR as part of ppt?
- fragile X
- sotos syn
- karyotype XXY (Klinefelter)
- marfan’s
- homocysteinuria
Marfan’s Syn
Tall + DD
- Klinefelter
- Triple X syn
- Fragile X
- Homocysteinuria
- Loeyz-Dietz
- Sotos Syn
- Weaver Syn
Big head, long thin face, receding hairline. DD when older. BIG everything on growth chart. Dx?
Sotos Syndrome
List 3 things on ddx for macrocephaly:
- hydrocephalus
- big brain
> metabolic (MPS)
> anabolic (Sotos)
> Autism, Fragile X, achondroplasia - thickened skull
> hemolytic anemia, dysostosis - space occupying lesion
> AVM, tumour, subdural effusion - familial/ benign
Name 4 biologic determinant of child development:
- genetics
- teratogen exposure
- low BW
- post natal illness (meningitis, TBI, chronic illness)
- malnutrition
- inborn errors of metbaolism
T or F: Early Childhood Resource Specialist consult on behav concern and parenting strategies for kids with special needs.
True
Does not do info on positioning, handling, communication tool or how to practice lang.
T or F: microcephaly out of proportion to other growth parameters is MORE of a red flag than all growth parameter down in new adoption kids.
True.
if all down- think malnutrition.
List 3 aetiologies for microcephaly:
- Familial
- Syndrome (T21, T18 Edward, Cornelia de Lange)
- CMV, Rubella, Toxo
- FAS
- Meningitis, encephalitis
- Metabolic (maternal DM)
- HIE
- Malnutrition
3 y.o. with microcephaly and regression of milestones. abN hand movement. THINK OF:
Rett’s
- normal until 1 y.o. then regression and acquire microcephaly
- MECP2 mutation
- lang and motor gone
- ataxia gait, tremor
- repetitive wringing movement, loss of purposeful hand movement, autistic mvmt
- sz, poot wt
- cardiac arrhythmia possible
Most predictive of intellectual disability
- mom didn’t finish high school
- maternal alcohol in preg
- HTN
- cocaine during preg
- neonatal hypoxia
4X more likely in child in mom who did not finish high school.
list 4 RF for intellectual disability:
Mild IQ:
- Williams, Noonans
- IUGR
- prem
- drugs, alcohol
- fhx low edu
Severe ID if:
- T21, Fragile X, Rett, Prader willi or angel man
- lishencephaly
- IEM (MPS)
Mom used IV heroin. 10 mon. now losing acquire milestones and develop b/l spasticity. Likely cause:
- HIV
- CMV
- CP
- syphilis
?HIV
CC: vary from mild DD to progressive encephalopathy, deterioration with acquired microcephaly and symmetric motor dysfunction
- spastic, hyperreflexia
Which is more likely to be ID in school aged child rather than young?
- LD
- mild cognitive
- mild ASD
- LD + ASD
- all of above
All of above.
T or F: there is an identifiable cause in most cases of intellectual disability
Depends.
- IQ 50-70
= Mild: mental age near 9-11 y.o. - more environment
- other cause in < 50%
- IQ < 50
= Severe: mental age as adult near 3-5 y.o. - cause > 75%
Mother pregnant with 2nd. First child has autism. Risk of 2nd having?
- lower if no MMR vac
- no difference than population risk
- slightly increased risk over general popn
Slightly increased risk over the general population (3-5%)
RF:
- extreme prem (< 26 wk)
- close spacing of preg
- advanced maternal or paternal age
- FHX (sibling)
- FHX of LD, psych, social disability
List two neurological disorders associated with Autism:
- Tuberous Sclerosis
- Rett Syndrome
- Neurofibromatosis 1
- Fragile X
Other: - Angelman Syndrome
- Myotonic Dystrophy
Autism. 3 tests you should order:
- Microarray
- Fragile X
- Hearing Screen
Other:
- Lead test
- FISH for 15q111 in Prader Willi/Angelman
- genetic MECP2 for Rett
- metabolic screen
- EEG if Sz
Autism. What 2 consultants would you involve to help with your dx?
- Developmental Pediatrician
- Psychologist
- Psychiatrist
- Geneticist
Multi-D: SLP, OT, PT
Tx: applied behavioural analysis (ABA) or social skills training if older
List 5 things on DDX for Autism Spectrum Disorder:
Some…
- Communication Disorders
- Intellectual Disability
- Deaf or Sensory impairment
- OCD
- Anxiety (selective mutism)
- ADHD
- Rett Syndrome
- TS
- Fragile X
- Rett Syndrome
- PKU
- Homocystineuria
- Infectious (encephalitis, meningitis)
- Endo (hypothyroid)
- Toxin (FASD)
1 y.o. head banging. P/E normal. Mom worried about brain damage:
- reassure
- EEG
- CT head
- use helmet
- family psych
Reassure
Usually < 2 y.o., resolve over time.
Head banging in 25% of kids but kids > 5 almost always associated with developmental dx.
Ignore, encourage substitute behaviour.
Do not show worry.
Will not hurt themselves.
T or F: head banging over 5 y.o. is normal.
False.
> 5 almost always associated with developmental dx.
7 y.o. with thumb-sucking. Discuss risk and benefit including:
- never causes self esteem issue
- can lead to dental malocclusion and facial growth abN
- topical deterrent very effective
Thumb sucking can lead to dental malocclusion and facial growth abnormalities.
Sucking > 5 associated with paronychia (red, tender, bacterial or fungal infection at base of nail), and anterior open bite (gap between upper and lower front teeth)
4 y.o. suck thumb. What to tell mom:
- put bitter sub on thumb
- reassure
- prescribe mouth appliance
- reward system
Reward system
Management:
- ignore and praise alternate behaviour
- reminder and reinforcement (reward sys)
- rarely necessary to use bitter substance
30 mon old w/ temper tantrum after starting toilet training. What to d:
- time out
- perserve
- take 1-3 mo. break from toilet training
- reward each time on potty
Take 1-3 month from toilet training
Do not engage in battle as can damage relationship and self-image.
If express refusal- take 1-3 mo. break.
How do you tell child ready for toilet training:
Gauge signs of readiness:
- able to walk
- sit on potty
- can stay dry x several hour
- receptive lang to follow simple command
- can express need to potty
- want to please and be independent
Goal: gradual use (sit fully dressed, lead to potty and sit without diaper, potty at certain time etc.)
T or F: do not initiate toileting during a stressful time.
True
When should you try training pants or cotton underpants when toilet training?
Once successful potty x min. 1 wk
Give two pieces of advice re: toddler temper tantrum
- *- Common, express when overwhelmed; emphathsize w/ parent
- Avert defiance by giving child choice
- *- Before highly distressed intervene and put in time out (1 min. per age)
- *- Do not respond w/ anger as can reinforce oppositional; model what you want your child to do
- *- (+) reinforcement when behave well
What should you do if your child has breath holding spells?
- Intercede before distress (time out, consistent discipline)
- Ignore when start
- If high levels of aggression refer to mental health
- Usually self-limited and grow within few years (by 5 y.o. done)
8 month old. Not sleeping through night. Wake 1 hr after down in crib. Which is true:
- falling asleep in crib vs. mom’s arm preventative
- letting baby cry eliminate problem
- giving bb pacifier proven technique
- give bottle of warm milk in bed
Falling asleep in crib vs. mom’s arm will be preventive (she helps learn to fall asleep)
At what age should child be able to self-soothe when awaken at night?
12 months
How do you tell the difference of night terrors from frontal lobe epilepsy?
Frontal lobe epilepsy = older (versus 5-7 y.o. night terrors) = within 30 min. of sleep (versus few hr after sleep in night terror) = limb mvmt = multiple per night = sleep walking rare
Night terrors. Recommend:
**Only intervene if will hurt self
**Can wake 30 mn before usual time x 2-4 week until episodes resolve.
+/- Can use benzo or TCA (suppress slow wake sleep) if excessively violent and at risk of injury.
8 y.o. primary nocturnal enuresis. Tried alarm x 8 wk w/out success. Wants summer camp. Best:
- DDAVP
- amitriptyline
- imipramine at bed
- imipramine TID
DDAVP
Primary nocturnal enuresis: > 2X/wk beyond 5 y.o.
Reassurance, avoid fluid before bed, empty pre bed, no diaper, include in clean up but not in punitive way.
Therapy if distress:
- alarm devices
- pharm (DDAP work best for camp and short term. Avoid fluids 1hr before and 9h after)
- Other: imipramine (TCA) 1-2h pre bed
All are features of sleepwalking EXCEPT:
- occur in stage 4 non REM
- (+) fhx
- can walk around furniture
- do not walk into dangerous area
- resolve in later childhood
CAN walk into dangerous areas.
Most resolve by puberty.
LD with big ears. Mom has LD too. What do you tell her to expect:
- tics
- athetosis
- hyperactivity
- tremor
- nystagmus
Hyperactivity
80% Fragile X have ADHD
List 4 indications for speech therapy in child with speech disfluency.
**Avoidance or escapes (pause, head nod, blinking)
**3 or more disfluencies per 100 syllables.
**Discomfort or anxiety while speaking
Suspicion of associated neuro or psychotic dx
Biggest predictor of difficulty reading in JK:
Early language difficulty. (usually impaired oral development)
4 y.o. who can’t use scissors. Can’t copy square. Worry about developmental coordination disorder. 2 Criteria:
DSM5 Developmental Coordination Disorder
- Acquisition or execution of coordinated motor skill below expected
- Impair daily living
- Onset in early development
- Not better explained by ID, Visual impairment, neuro condition
Late onset side effect of stimulant:
- low appetite
- hard sleep
- tics
- depression
Depression
Which is true of ADHD:
- teacher and parent checklist often agree
- check off lead poisoning for all
- 25% have anxiety dx
- often thyroid issue
25% of kids w/ ADHD have comorbid Anxiety Dx
Comorbidities:
- lang dx
- anxiety
- mood
- learning dx
List ADHD Meds (Stimulant and Non)
Amphetamine: - dexedrine - adderall XR - vyvanse "Vyvanse= A= Adderall= Amph Class"
Methylphenidate - ritalin - biphentin - concerta "Concerta= R= Ritalin"
Non stimulant:
- Atomoxetine= Straterra (good for comorbid anxiety or sub abuse concern)
- Guanfacine= Intuniv= help everything cool down; good for ODD, CD too
ADHD. 14 pound loss. Good control. Best:
- straterra started
- consult psych
- change from 7d to 5d a week
Change form 7d to 5d a week dosing
How many criteria do you need for mixed subtype ADHD:
6 x 6
- 6 of Inattention
- 6 of H/I
- x 6 month each
- Symp <12 y.o.
- in 2 settings
Severe head injury. No evidence of cerebral oedema or bleeding. Upon d/c from ICU, expect child to develop:
- fine motor issue
- sz
- insomnia
- behav issue
- psychiatric dx
Behavioural Problems
** cognition most affected area of f’n in traumatic brain injury
= IQ, attn, LD, Behav
- long term issue:
intellectual, learning, memory, social competence, variety of behavioural concerns
9 y.o. with depression and SI. Which is RF:
- bullying
- recent divorce
- impulsive behav
- poverty
Bullying?
8 y.o. slow to write because writes each letter 3X. No issue with social relationship. Dx?
- Normal
- OCD
- ADHD
- ASD
OCD
When can child use regular seat belt:
- 41 kg
- child > 6 y.o.
- while in booster level of ears over head rest of seat
- child sitting ht at or > 63 cm
When eats over headrest while in booster seat.
Outgrown seat IF:
- Pt reaches top wt or ht allowed for their seat or harness
- Pt shoulders are above top harness slots
- Top of pt ears have reached top of seat
Name 3 features of Factitious disorder imposed on another (previously Munchausen by proxy)
Suspect IF:
- reported symptoms only by 1 parent
- test fail to confirm dx
- appropriate tx ineffective
- evidence of unnecessary or related tests, tx due to parent action
Tx: CAS, choose single medical provider
