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Paediatrics STG > Development > Flashcards

Development Flashcards

1
Q

Ages to remember when considering milestones

A
  • The median age is when 50% of a standard population of children will achieve the milestone
  • The limit age is the limit by which the milestone should have been achieved, these are usually 2 standard deviations from the mean
  • If a child fails to achieve a milestone by this age, there may be a need for more detailed assessment, investigation ± intervention
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2
Q

Age Adjustment

A

If a child has been born pre-term (before 37 weeks’ gestation), then there should be adjustment of milestones for gestational age up to 2 years old.

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3
Q

4 Categories of Milestone Development

A

Gross Motor
Fine Motor and Vision
Hearing, speech and language
Social, emotional and behavioural

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4
Q

Gross Motor

A 
Raises head to 45 degrees when prone: Limit 4 months
Sits without supports: 9 Months
Rolling: 4-5 months (median)
Crawling: 8-9 Months (median)
Cruising: Limit 12 months
Walking unsteadily: 18 months
Walking steadily: 15 months
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5
Q

Fine Motor and Vision

A 
Follows moving object: 3 months limit
Reaches out for toys: 6 months 
Palmar grasp: 4-6 months
Transfers toys between hands: 9 months
Pincer grip: 12 months
Tower of 3 blocks: 18 months 
Writing, cutting and dressing: 2-5 years
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6
Q

Hearing, speech and language

A

Startles to loud noises: Newborn
Vocalises, coos and laughs: Limit 7 months
Turns to soft sounds out of sight: 7 months
Repetitive consonant sounds: 10 months limit
Sounds used discriminately to mean parents: 10 months
2/3 words: 12 months
6-10 words, shows parts of body: 18 months
Uses 2+ words as phases: 20-24 months
Talks in 3-4 word sentences: 2.5-3 years

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7
Q

Social, emotional and behavioural

A 
Smiles responsively: 8 weeks 
Puts food in mouth: 6-8 months
Waves byebye, plays peek-a-boo: 10-12 months
Drinks from a cup: 12 months
Holds a spoon and brings to mouth: 18 months
Symbolic play: 2-2.5 years limit
Dry by day, pulls of clothing: 2 years
Parallel play, takes turn: 3-3.5 years
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8
Q

Moro Reflex

A

The Moro reflex occurs when there is sudden extension of the head, leading to a symmetrical extension and abduction followed by adduction of the arms

  • This may be absent at birth in severe asphyxia
  • Asymmetric Moro reflex indicates injury on one side or differential tone
  • Moro persisting >3 months can indicate cerebral palsy
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9
Q

Palmar Grasp

A

Palmar grasp is the flexion of fingers when an object is placed in the palm

  • This is absent in prematurity of <34 weeks
  • Asymmetric reflex indicates injury or altered tone
  • Persistence past 4 months (particularly with thumb adduction) may be a sign of cerebral palsy
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10
Q

Rooting

A

where the head turns towards a stimulus when touched near the mouth

  • This is absent in prematurity of <34 weeks and in severe asphyxia
  • Asymmetric reflex indicates facial palsy
  • It may persist past 3 months in cerebral palsy
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11
Q

Asymmetric tonic neck reflex

A

occurs when the baby is lying supine and the head is turned to one side, the arm will outstretch on the side where the head is turned and the opposite arm will flex

  • This is absent in prematurity of <36 weeks and severe asphyxia
  • Asymmetric reflex indicated hemiparesis cerebral palsy
  • Persistence of the reflex past 3 months indicates quadriparesis cerebral palsy
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12
Q

Placing Limb Reflex

A

infant produces stepping movements when help vertically, and the dorsum of the feet touch a surface

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13
Q

Startle Reflex

A

The startle reflex is where there is a loud noise, the baby will flex their elbows and clench their hands
- This should persist through life

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14
Q

When is the best time to elicit reflexes in neonates

A

Reflexes in neonates are brisk when crying and decreased when asleep. Therefore, it is best to elicit them when they are awake-alert or fussing

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15
Q

What reflexes follow primitive reflexes?

A

These primitive reflexes gradually disappear as postural reflexes develop

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16
Q

Labyrinthine Righting

A

Head moves in opposite direction to which the body is tilted

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17
Q

Postural Support

A

when held upright the legs take weight and may push up (bounce)

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18
Q

Lateral Propping

A

in sitting the arm extends to the side they are falling to right them

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19
Q

Parachute

A

when suspended face down the arms extend to save themselves

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20
Q

What should an infant be able to do at 6 weeks in terms of gross motor

A
  • The infant should be able to lift their head, but not chest, off a flat surface (prior to 6 weeks there is infantile head lag)
  • The primitive reflexes should all still be present. These will gradually disappear over the first few months as postural reflexes develop
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21
Q

What should an infant be able to do at 6 weeks in terms of fine motor and vision?

A

In terms of fine motor and vision the baby should stare, and follow an object horizontally to 90 degrees (turning the head). Prior to this, babies can only follow objects in the midline.

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22
Q

What should an infant be able to do at 6 weeks in terms of hearing, speech and language

A

the baby should be startled by loud noises

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23
Q

What should an infant be able to do at 6 weeks in terms of social, emotional and behavioural development

A

the baby should be smiling responsively

- If the baby is not smiling by 8 weeks, this is a red flag

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24
Q

What should an infant be able to at 3 months in terms of gross motor development

A

In terms of gross motor development, the infant should be able to lift its head and chest off a flat surface, it should also be able to recognise its own hands (finger play)
- Abnormal tone is a red flag

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25
Q

What should an infant be able to at 3 months in terms of fine motor development

A

it should be able to hold a rattle, and follow an object horizontally to 180 degrees. At 4 months, they should be starting to reach out for toys
- Not fixing and following an object is a red flag

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26
Q

What should an infant be able to at 3 months in terms of hearing and speech development

A

the baby should be turning to sounds and vocalising

27
Q

What should an infant be able to at 3 months in terms of social development

A

In terms of social, emotional and behavioural development the baby should be able to recognize its mother

28
Q

What should an infant be able to at 6 months in terms of gross motor development

A

the child should be able to sit supported, with a rounded back (the back should be straight at around 8 months). It should now be able to weight bear on its feet, and may be able to roll onto its front
- At this stage, a red flag would be the persistence of primitive reflexes, as postural reflexes are beginning to appea

29
Q

What should an infant be able to at 6 months in terms of fine motor development

A

includes reaching out, palmar grasp and transferring objects from hand to hand

30
Q

What should an infant be able to at 6 months in terms of hearing speech and language development

A

In terms of hearing speech and language the infant should be laughing, screaming, and babbling with consonants. At 7 months, they should be turning to soft sounds out of sight
- A red flag is the absence of vocalisation

31
Q

What should an infant be able to at 6 months in terms of social development

A

the baby should be able to express likes and dislikes. They should also be able to chew and put food in their mouth; this is important as babies should be weaned at about 6 months, as at this point breast milk alone will be nutritionally inadequate

  • Babies > 6 months should be able to chew, but they should be started on pureed food (non-wheat cereals, fruit and veg, low salt and sugar) and then move on to soft solids. Cow’s milk can be introduced at 6 months, but shouldn’t be given alone until 1 year
  • This period of time may be associated with increased crying and poor sleeping
32
Q

What should an infant be able to at 9 months in terms of gross motor development

A

the child should be able to stand supported, and will be crawling/ creeping/ bum-shuffling

  • Crawling is variable, some children may never crawl and may ‘creep’, ‘commando crawl’ or ‘bum-shuffle’. Typically, bottom shufflers will walk later
  • Coasting will generally start at 10 months, and the child will pull to stand
  • A red flag here would be the inability to sit unsupported
33
Q

What should an infant be able to at 9 months in terms of fine motor development

A

involve bringing objects together, they may have an immature pincer grip

  • A red flag would be the inability to transfer objects from hand to hand, or showing hand preference
  • Children should not show a dominant hand until over 2 years. Before this stage, it could show a weakness in one side of the body e.g. cerebral palsy
34
Q

What should an infant be able to at 9 months in terms of hearing and speech development

A

In terms of hearing speech and language the infant should be able to respond to its name, and be making repetitive sounds e.g. dada, mama indiscriminately

35
Q

What should an infant be able to at 9 months in terms of social development

A

In terms of social, emotional and behavioural development the baby should be able to hold a bottle, wave, play peek-a-boo, and clap

36
Q

What should an infant be able to at 12 months in terms of gross motor development

A

In terms of gross motor development, the child should be standing unsupported, walking unsteadily (broad based gait, with hands apart), and pulling themselves upright
- A red flag is the inability to weight bear on their feet

37
Q

What should an infant be able to at 12 months in terms of fine motor development

A

include throwing objects away, scribbling with a crayon, and the development of a mature pincer grip (starting at around 10 months)
- A red flag is the absence of pincer grip

38
Q

What should an infant be able to at 12 months in terms of hearing and language development

A

In terms of hearing speech and language the infant should be able to respond to familiar words, and use a few words (2-3) with meaning

39
Q

What should an infant be able to at 12 months in terms of social development

A

In terms of social, emotional and behavioural development they will be starting to develop stranger anxiety, and will be able to drink from a cup using two hands.

40
Q

What should an infant be able to at 18 months in terms of gross motor development

A

they should be able to walk backwards and walk upstairs with one hand held. They should be able to stoop to pick up an object, and recover
- A red flag would be the inability to walk independently

41
Q

What should an infant be able to at 18 months in terms of fine motor development

A

involve the ability to build a tower of 3 – 4 bricks, and should be able to turn book pages

42
Q

What should an infant be able to at 18 months in terms of hearing and language development

A

In terms of hearing speech and language the infant should be able to point to and identify their eyes, nose and mouth. They should have 25 – 50 words, but understand many more
- A red flag would be the inability to say 6 words with meaning

43
Q

What should an infant be able to at 18 months in terms of social development

A

In terms of social, emotional and behavioural development they will be able to take off their shoes and socks. They should be using symbolic play, and should be able to bring a spoon to their mouth
- At 18 months, children will usually start indicating if they need the toilet. Therefore, parents can start to think about toilet training

44
Q

What should an infant be able to at 2-2.5yrs in terms of gross motor development

A

Gross motor development should include running, jumping with two feet, and kicking a ball

45
Q

What should an infant be able to at 2-2.5yrs in terms of fine motor development

A

Fine motor development should involve being able to copy a drawing of a line, and build a tower of 7 cubes

46
Q

What should an infant be able to at 2-2.5yrs in terms of hearing and speech development

A

In terms of hearing speech and language the infant should be using 50+ words, and speaking in 2 – 3 word sentences
- A red flag is having very few words, and not pointing to named objects

47
Q

What should an infant be able to at 2-2.5years in terms of social development

A

In terms of social, emotional and behavioural development they may be dry during the day (it is important to ask about toilet training), and will be able to play alone. They will usually be able to pull off their clothes, and feed themselves with a spoon/fork
- Poor attention is a red flag

48
Q

What should an infant be able to at 3 years in terms of gross motor development

A

Gross motor should include climbing stairs one step per foot, standing on one leg, and pedalling on a tricycle

49
Q

What should an infant be able to at 3 years in terms of fine motor development

A

Fine motor should include threading beads, building a 9 cube tower, making a three brick bridge with a gap, and copying drawings of circles. From 3.5 years they may be able to draw a face
- A red flag is the inability to draw a straight line

50
Q

What should an infant be able to at 3 years in terms of hearing and speech development

A

In terms of hearing speech and language the infant should know their name and age, be able to count to three, and should be asking questions.

51
Q

What should an infant be able to at 3 years in terms of social development

A

In terms of social, emotional and behavioural development they should be dry by day, and may going to the toilet on their own, and using a knife and fork
- If they are solitary, this is a red flag

52
Q

What should an infant be able to at 4 years in terms of gross motor development

A

Gross motor should involve the ability to hop on one foot and kick a ball

53
Q

What should an infant be able to at 4 years in terms of fine motor development

A

Fine motor includes being able to copy a picture of a cross and drawing recognisable faces. They may be able to draw a full stick man
- A red flag would be an inability to stack 9 cubes or copy a circle

54
Q

What should an infant be able to at 4 years in terms of hearing and speech development

A

In terms of hearing speech and language the infant should have fluent speech, be able to respond to instructions, and be asking lots of questions
- A red flag is unintelligible speech

55
Q

What should an infant be able to at 4 years in terms of social development

A

In terms of social, emotional and behavioural development they should be dressing without supervision, brushing teeth and carrying out imaginative play.

56
Q

What should an infant be able to at 5 years in terms of gross motor development

A

Gross motor should include skipping, riding a bike, and walking heel-toe and backward heel-toe

57
Q

What should an infant be able to at 5 years in terms of fine motor development

A

Fine motor should include copying a square and a triangle, and drawing people with many features
- A red flag would be the inability to copy a cross

58
Q

What should an infant be able to at 5 years in terms of hearing and speech development

A

In terms of hearing speech and language the infant should be able to read a few words, count to 10, and use complex grammar
- A red flag is if they do not know colours or letters

59
Q

What should an infant be able to at 5 years in terms of social development

A

In terms of social, emotional and behavioural development they should be playing in groups, comforting others, and be able to tie their shoelaces

60
Q

Developmental Assessment: History

A

Ask parents about the child’s development. They can usually tell you a great deal about what the child can and cannot do. They do NOT always understand the significance of what they see. For instance they may describe the inability of a three year old to understand simple instructions, but NOT realise that this is probably abnormal
Parents are much better at telling you about CURRENT abilities than about past milestones

61
Q

Developmental Assessment: Observation

A

. Watch what the child does, in the playroom, waiting room or wherever the opportunity arises. You should observe behaviour under the following headings, for ease of description:
Gross motor; sitting, standing, walking, running.
Fine motor; handling toys, stacking bricks, doing buttons.
visual impairment or general developmental delay might affect this, as well as conditions that specifically affect movement such as cerebral palsy.
Speech and language; including hearing.
Social behaviour; does the child behave and react appropriately to you as a stranger, for his age?

62
Q

Developmental Assessment: Social Behaviour

A

You can find out more about a child by using specified tasks for which there are data on normal function. These can be regarded as “stimulus” tasks, to elicit behaviour and skills which you would otherwise have to wait a long time to observe, particularly when the child is shy in an unfamiliar place. Examples include building with bricks, using a pencil, doing a puzzle, naming pictures

63
Q

Developmental Assessment: Detailed Assessment

A

When it is thought that a child has some significant developmental problem, a more detailed assessment may be required, by the physiotherapist, speech therapist or psychologist, depending on the nature of the problem.
If the child does in fact have a significant delay in development of speech, movement or some other function, a neurological examination and investigation may be needed.

Paediatrics STG (17 decks)

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