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Paediatrics > Development > Flashcards

Development Flashcards

1
Q

Gross Motor Red Flags

A

4m Head control
9m Sits unsupported
12m Stands unsupported
18m Walks independently

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2
Q

Vision and Fine Motor Red Flags

A

3m Fixes and follows
6m Reaches for objects
9m Transfers
12m Pincer grip

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3
Q

Hearing, Speech and Language Red Flags

A 
7m Polysyllabic babble
10m Consonant Babble
18m 6 words with meaning
2y Joins words
2.5y 3-word sentances
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4
Q

Social Behaviour Red Flags

A 
8w Smiles
10m Fear of strangers
18m Feeds self/spoon
2-2.5y Symbolic play
3-3.5y Interactive play
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5
Q

Primitive Reflexes

A 
Moro
Grasp
Rooting
Stepping response
Asymmetrical tonic neck reflex
Sucking reflex
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6
Q

Postural Reflexes

A

Labyrinthine Righting
Postural support
Lateral propping
Parachute

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7
Q

Childhood thought processes (Piaget)

A

Centre of the world
Inanimate objects are alive and have feelings
Magical element to environment
Everything has purpose

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8
Q

Healthy child surveillance programme

A

Provided in primary care

Screening, immunisations, developmental review and health promo

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9
Q

Hearing testing

A

Otoacoustic emission- newborn screening
Auditory brainstem- newborns with abnormal screen
Distraction testing- prev. hearing screening at 7-9m (requires object permeance ability)
Visual reinforcement- hearing impairment 10-18m, children with learning disability
Performance speech and discrimination- toy use in younger children.
Audiometry- >4y

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10
Q

Vision testing

A 
Newborn- aware of light
6w- fix and follow
6m- fixates and visually directed reach
12m - fixates on 1mm crumb
1-2y preferential acuity test .e.g. Cardiff cards
2-3y picture matching .e.g. kay or lea
3y + letter matching .e.g. logMAR
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11
Q

Gross motor milestones

A 
Newborn- limb flexed, symmetrical posturing, lag head
6w raises head 45' in prone
6m sits unsupported arched back
8m sits unsupported straight back
9m crawling
10m stands and cruises 
12m walks unsteady broad based gait
15m walks steadily
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12
Q

Vision and fine motor milestones

A 
6w fixes and follows
4m reaches for toys
6m palmar grasp
7m transfers toys
10m mature pincer grip
18m marks with crayon
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13
Q

Blocks Milestones

A 
18m tower of 3
2y tower of 6
2.5y tower of 8 or 4 block train
3y bridge from model
4y steps after demo
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14
Q

Drawing shapes milestones

A 
2y line
3y circle
3.5y cross
4y square
5y triangle
(Drawing from copy 6 m before)
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15
Q

Hearing, speech and language milestones

A

Newborn- startles to loud noise
4m vocalises when alone, coos and laughs
7m turns to sound out of sight, sound indiscrimate
10m discriminate sound to mama/dada
12 m 2-3 words
18m 6-10 words, localises 2 parts of body
20-24m joins 2 words for simple sentences
2.5-3y talks constantly 3-4 word sentences

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16
Q

Social and behaviour milestones

A 
6w smiles
8m food to mouth
10m waves bye-bye, plays peek-a-boo
12m drinks from a cup with 2 hands
18m holds spoon and transfers to mouth
18-24m symbolic play
2y dry by day, pulls off some clothes
2.5-3y parallel play
3-3.5y interactive play
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17
Q

Age of presentation- developmental areas

A

Newborn- 18m Motor
18m-3y Speech and language
2-4y Social communication

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18
Q

Global developmental delay features

A

Delay in acquisition of all skills

Presents within first 2 years of life

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19
Q

Causes abnormal motor development

A

Central motor deficiet .e.g. cerebral palsy
Congenital myopathy/primary muscle disease
Spinal cord lesions .e.g. spina bifida
Global developmental delay

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20
Q

Presentation motor delay

A

Between 3m and 2y
Abnormal motor signs
Delay in acquisition of motor skills
Early hand dominance (<1-2y)

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21
Q

Definition Cerebral Palsy

A

Non-progressive abnormality of brain development resulting disorder of motor function and posturing
Brain injury must occur before 2 years old

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22
Q

Antenatal causes of cerebral palsy

A
  • cerebrovascular haemorrhage/ischamia
  • cortical migration disorder
  • structural maldevelopment
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23
Q

Postnatal causes of cerebral palsy

A 
Meningitis
Encephalitis
Encephalopathy
Head trauma
symptomatic hypoglycaemia
hydrocephalus
hyperbilirubinemia
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24
Q

Preterm complications causing CP

A

Periventricular leukomalacia associated with ischaemia or severe intraventricular haemorrhage and venous infarction

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25
Q

Presentation cerebral palsy

A 
Abnormal limb/trunk posture and tone
Delayed infancy milestones
Slowing of head growth
Feeding difficulties: oromotor co-ordination, slow feeding, gagging, vomiting
Asymmetric hand function <12m
Persisting primitive reflexes
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26
Q

Categories of cerebral palsy

A

Spastic: bilateral, unilateral and not specified (90%)
Dyskinetic (6%)
Ataxic (4%)
Other

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27
Q

Gross motor function classification

A

I walking without limitation
II walking with limitation
III walking with handheld mobility device
IV self-mobility with limitation .e.g. uses powered mobility aid
V transported in manual wheelchair

28
Q

Spastic Cerebral Palsy Types

A

Bilateral (quadriplegia)
Unilateral (hemiplegia)
Bilateral (diplegia)

29
Q

Pathology Spastic Cerebral Palsy

A

Damage to UMN

Pyrimidal or corticospinal tracts

30
Q

Signs Spastic Cerebral Palsy

A 
Brisk deep reflexes
Extensor plantar reflex
Velocity dependant spasticity
Dynamic catch (hallmark feature)
Presents early: seen in newborn period
Initial hypotonia of head and trunk
31
Q

Features unilateral hemiplegia CP

A 
Unilateral involvement of arm and leg
Arm>>leg
Sparing of face
Present at 4-12m
Fisting of affected hand
Flexed, pronated arm
Asymmetric reaching
Tip-toe walking on affected side
Typically due to neonatal stroke
32
Q

Features bilateral quadriplegia CP

A

All 4 limbs affected
Trunk involvement- opisthotonus (extensor posturing)
Poor head control
Low central control
Associated with seizures and microcephaly
Perinatal hypoxic-ischaemic encephalopathy

33
Q

Features bilateral diplegic CP

A 
All 4 limbs affected 
Legs>>arms
Normal hand function
Abnormal walking
Associated with prematurity (periventricular brain damage)
34
Q

Features Dyskinetic CP

A 
Involuntary uncontrolled movements (>1y)
Chorea/athetosis/dystonia
Variable muscle tone
Primitive motor reflexes
Unimpaired intellect
Basal ganglia damage- usually bilateral
Associated with kernicterus
35
Q

Features Ataxic CP

A 
Usually genetically determined
Early trunk and limb hypotonia
Poor balance
Delayed motor development
Inco-ordinated movements
Intention tremor
36
Q

Mx Cerebral Palsy

A

MDT approach
Early diagnosis and counselling for parents
Botulinum Toxin (hypertonia)
Dorsal rhizotomy (selective cutting of spinal cord nerve)
Intrathecal baclofen
Deep brain stimulation for basal ganglia

37
Q

Causes of Speech and Language Delay

A 
Hearing loss
Global developmental delay
Difficulty in production due to anatomy
Environmental deprivation/neglect
Normal variant/familial pattern
38
Q

Testing language development

A

Symbolic toy test: early language development

Reynell test: receptive and expressive language (pre-school children)

39
Q

Mx Speech and Language delay

A 
Hearing test
Assessment by SALT
Neurodevelopmental paeds referral
Audiology physician involvement
SALT 
Alternative methods of communication
Specialist schooling
40
Q

ASD Impaired social interaction Features

A 
Does not seek comfort/share pleasure
Does not form friendships
Prefers own company
No interest in interaction with peers
Gaze avoidance
Lack of joint attention
Socially and emotionally inappropriate behaviour
No appreciation of others thoughts and feelings
Lack appreciation of social cues
41
Q

ASD Speech and Language Features

A

Delayed development
Limited use of gestures and facial expression
Formal pedantic language, monotonous voice
Impaired comprehension with over literal interpretation
Echos questions, repeats instruction, refers to self as ‘you’
Superficially good expressive speech

42
Q

ASD Routines and ritualistic behaviour

A 
Violent temper tantrums if disrupted
Imposition on self and others
Unusual stereotypical movements
Concrete play
Poverty of imagination
Peculiar interests and repetitive adherence
Restriction of behavioural repertoire
43
Q

ASD Co-morbidities

A

General learning and attention difficulties
Seizures- presenting in adolescence
Affective disorders .e.g. anxiety, sleep disturbance
Mental health disorder .e.g. ADHD

44
Q

ASD Epidemiology

A

3-6/1000 live births
More common in boys
Presentation aged 2-4 (social development)

45
Q

Asperger’s Syndrome Features

A 
Milder version of ASD
Near-normal speech development
Difficulty in give/take social interaction
Stilted speaking
Narrow, unusual and intense interests
46
Q

Mx ASD

A

Parental support
Behavioural modification: 25-30h individual therapy
Appropriate educational placement

47
Q

Learning Disability and IQ

A

IQ 70-80 Mild, requires learning support, mainstream school
IQ 50-70 Moderate
IQ 30-50 Severe
IQ <35 Profound

48
Q

Dyspraxia Features

A

Disorder of motor planning
Higher cortical processing disorder
Perception problems, use of language and putting thoughts together

49
Q

Dyspraxia Presentation

A 
Awkward, messy, slow, irregular, poorly spaced writing
Difficulty dressing
Difficulty cutting up food
Poorly established laterality
Problems copying and drawing
Messy eating
Dribbling of saliva
50
Q

Mx Dyspraxia

A

SALT assessment
Visual assessment
Therapy on sensory integration, sequencing, executive planning
Improvement with maturity

51
Q

Verbal dyspraxia definition

A

Difficulty with speech production in the absence of muscle or nerve damage

52
Q

Dyslexia Features

A

Disorder of reading skills disproportionate to IQ

Child’s reading age is more than 2 years behind chronological age

53
Q

Features of ADHD

A 
Overactive in most situations
Impaired concentration
Unable to sustained attention and complete tasks
Socially disinhibited
Difficulty taking turns/sharing
Interrupt and butt into others conversations and play
Worse in unfamiliar or boring situations
Lose possessions and generally disorganised
Short tempers
Form poor relationships
Poor school performance
Low self-esteem
54
Q

Behavioural Mx ADHD

A

Promotion of behavioural and educational progress
Parenting intervention
Clear rules and expectations
Consistent rewards and consequences for behaviour

55
Q

Medical Mx ADHD

A

Children >6y
Stimulants .e.g. methylphenidate, dexamphetamine
Non-stimulants .e.g. Atomoxetine (reduces excessive motor activity)
Annual off-medication trial to assess need

56
Q

Causes sensorineural hearing loss

A 
Genetic (most common)
Antenatal/perinatal infection
Prematurity
Hyperbilirubinaemia
Hypoxic-ischemic encephalopathy
Meningitis/encephalitits
Head injury
Medications .e.g. aminoglycosides, furosemide
Neurodegenerative disorder
57
Q

Causes conductive hearing loss

A

Otitis media with effusion
Eustachian tube dysfunction .e.g. Down’s, Pierre Robin, midfacial hypoplasia
Wax (rare)

58
Q

Mx Sensorineural hearing loss

A

Amplification or cochlear implantation
Specialist schooling
Use of makaton
School adjustments: placed in front of the classroom

59
Q

Mx Conductive hearing loss

A

Insertion of tympanostomy tubes
Removal of adenoids
Hearing aids used if recurrence following surgery

60
Q

Audiogram in hearing loss

A

Sensorineural >95dB hearing loss

Conductive maximum 60dB hearing loss

61
Q

Presentation of visual impairment

A 
Obvious ocular malformation 
Absent red reflex or leukocoria
Not smiling by 6w post-term
Concerns re poor visual responses
Poor eye contact
Roving eye movements
Nystagmus
Squint
62
Q

Features Nystagmus

A

Repetitive involuntary rhythmical eye movement
Usually horizontal
May be associated with structural or cortical defect

63
Q

Types of squint

A

Concomitant- nonparalytic, common, due to refractive error
Paralytic- rare, due to paralysis of motor nerve
Transient misalignement- common until 3m

64
Q

Causes of squint

A

Refractive error (most common)
Cataracts
Retinoblastoma
Intra-ocular

65
Q

Ix Squint

A

Corneal light reflex test- torch at a distance, asymmetry of reflection
Cover test- covering fixing eye causes movement of squinting eye to take up fixation

66
Q

Refractive errors

A

Hypermetropia (long sighted)- most common
Myopia (short-sighted)- presents in adolescents/preterms
Astigmatism (abnormal corneal curvature)- unilateral may cause amblyopia
Amblyopia- permanent reduction of visual acuity in an eye which has not received a clear image (Mx<7y)

Paediatrics (22 decks)

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