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Paediatrics > Development > Flashcards

Development Flashcards

1
Q

What are the four domains of child development?

A
  1. Gross motor
  2. Fine motor and vision
  3. Hearing, speech and language
  4. Social and personal
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2
Q

What are the developmental milestones seen at 6 weeks?

A

Gross motor: lift head ventrally but not chest, primitive reflexes still present

Fine motor and vision: Baby should stare and follow object horizontally

Hearing, speech and laguage: Startled by loud noises

Social and behavioural: Smiling

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3
Q

What are the developmental milestones seen at 3 months?

A

Gross motor: lift head and chest off surface

Fine motor and vision: play with rattle, follows object 180 deg.

Hearing, speech and language: Turns to noise, vowel sounds, chuckling

Social and behavioural: Recognises mother, anticipates feeding

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4
Q

What are the developmental milestones seen at 6 months?

A

Gross motor: sits with support, pulls to sit

Fine motor and vision: reaches for objects, palmar grasp- able to move objects from palm to palm

Hearing, speech and language: laughing, screaming, consonant sounds - babbling

Social and behavioural: Expresses likes and dislikes, puts objects in mouth, chewing

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5
Q

What are the developmental milestones seen at 9 months?

A

Gross motor: crawl, creep, sit unsupported

Fine motor and vision: immature pincer grip (whole hand), bang 2 cubes

Hearing, speech and language: responds to name, makes repetitive sounds e.g. mama, dada

Social and behavioural: holds bottle, waves, plays peek-a-boo

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6
Q

What are the developmental milestones seen at 12 months?

A

Gross motor: able to stand unsupported and walk unsteadily (broad gait and hands apart)

Fine motor and vision: mature pincer grip- able to hold crayon and draw scribbles

Hearing, speech and language: responds to familiar words, puts together few words with meaning

Social and behavioural: stranger anxiety, can drink from cup

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7
Q

What are the developmental milestones seen at 18 months?

A

Gross motor: able to walk upstairs with hand held, stoop to pick up object

Fine motor and vision: build tower of 3-4 blocks, turn pages

Hearing, speech and language: says 25-50 words but understands many more

Social and behavioural: can take off shoes, indicating when they need toilet

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8
Q

What are the developmental milestones seen at 2 years?

A

Gross motor: Run, jump, climb furniture

Fine motor and vision: Draw lines, stack tower of 7 cubes

Hearing, speech and language: 50+ words spoken, and put together 2-3 word sentences

Social and behavioural: Undress, solitary play, feed themselves with spoon/fork

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9
Q

What are the developmental milestones seen at 3 years?

A

Gross motor: Climb stairs one foot at a time, stand on one leg

Fine motor and vision: Draw circles, stack tower of 9 cubes

Hearing, speech and language: States name and age, asks questions, count to 3

Social and behavioural: Dress, day toilet trained, plays with other children

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10
Q

What are the developmental milestones seen at 4 years?

A

Gross motor: Hop on one foot, kick a ball

Fine motor and vision: Copy cross drawing, draw faces - stick men

Hearing, speech and language: Fluent speech, asking lots of questions

Social and behavioural: brushing teeth, button clothes, pretend play

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11
Q

What are the developmental milestones seen at 5 years?

A

Gross motor: Able to skip, ride bicycle

Fine motor and vision: Draws square, triangle, face with many features

Hearing, speech and language: Read words, complex grammar, can count to 10

Social and behavioural: tie shoelaces, comfort others

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12
Q

Name the main primitive reflexes:

A
  • Moro reflex: head is dropped, which causes arms to symmetrically reach out
  • Palmar grasp reflex: finger curl around object placed in the palm
  • Rooting reflex: corner of the mouth is stroked causing baby to turn to stimulus side and begin suckling
  • Asymmetric tonic neck reflex: baby lying supine - when head is turned to one side, the arm on that side outstretches and contralateral arm flexes
  • Placing and stepping reflex: baby is held up and dorsum of foot touches surface causing baby to initiate stepping movements
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13
Q

Name the main postural reflexes:

A

Postural reflexes gradually succeed primitive reflexes after first few months:
- Labyrinthine righting reflex: tilting baby to one side, will cause head to move to remain in upright position

  • Postural support: holding baby up and allowing feet to touch surface - baby may flex lower limbs then extend - bouncing
  • Lateral propping: when sitting, arm extends out to the side they fall on if pushed over
  • Parachute reflex: baby is suspended in prone position, causing arms and legs to extend in protective fashion
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14
Q

How long should the primitive reflexes last? What may it indicate if they last longer than this?

A

Primitive reflexes normally last around 3 months - if they persist more than this, it may indicate signs of cerebral palsy.

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15
Q

What is the definition of developmental delay,and global developmental delay?

A

Developmental delay = when developmental milestones are not met at the expected times - developmental age does not match chronological age

Global developmental delay = not reached two or milestones in all domains

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16
Q

How is a developmental assessment carried out?

A
  • Developmental assessment is more thorough and comprehensive than developmental screening.
  • Need to assess each domain separately - consider the sequence of skills achieved
  • Compare progress in each domain - any discrepancy?
  • Compare developmental age to chronological age - are they doing what is expected of them at that age?
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17
Q

What is a short cut to developmental assessment?

A

Only check the most actively changing skills for the child’s age:

  • Ask about gross motor skills in <12 months
  • Ask about fine motor and vision in < 18 months
  • Ask about hearing, speech and language in <2.5 years
  • Ask about social and behavioural in >2.5 years
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18
Q

How can the degree of developmental delay be calculated?

A

Development quotient:

Developmental age / Chronological age x 100

19
Q

What are some causes of developmental delay?

A

PRENATAL
Genetic= chromosomal disorder
Neurological= cerebral dysgenesis e.g. microcephaly
Vascular = haemorrhage
Metabolic = PKU, hypothyroidism
Teratogenic = alcohol and drug abuse in pregnancy
Congenital infection = rubella, CMV

PERINATAL
Extreme prematurity
Birth asphyxia - HIE (hypoxic eschaemic encephalopathy)
Metabolic = hypoglycaemia, hyperbilirubinaemia

POSTNATAL
Infection = meningitis, encephalitis
Anoxia = suffocation, near-drowning
Trauma = head trauma 
Metabolic = hypoglycaemia 
Vasular = stroke
20
Q

What are some causes of abnormal motor development?

A

Genetic/ non-modifiable:

  • Central motor deficit e.g. cerebral palsy
  • Primary muscle disease e.g. muscular dystrophy
  • Spinal cord lesions e.g. spin bifida

Environmental:

  • Malnutrition
  • Rickets
  • Head trauma
21
Q

What are some early indications of abnormal motor development?

A
  • Delay in motor skill accquisition

- Early hand dominance i.e. asymmetrical use of motor skills

22
Q

Red flags associated with abnormal motor development…

A 
6 months: cannot hold head up/ floppy 
9 months: cannot sit unsupported 
12 months: cannot weight bear/ stand 
18 months: cannot walk by themselves
2 years: cannot run, persistent toe walking
23
Q

What are some causes of delayed speech?

A
  • Primary speech delay: normally self-limiting and requires moderate intervention
  • Articulation difficulties due to structural abnormalities e.g. cleft palate, tongue tie
  • Deafness
  • Environmental deprivation and neglect
  • Communication difficulties e.g. autism
24
Q

Red flags associated with speech delay…

A

12 months: no double-syllable babble
18 months: <6 words, persistent drooling
2.5 years: no 2-3 word sentences
4 years: speech remains unintelligble to strangers

25
Q

What tests can be used to identify speech and language skill problems?

A

1-3 years: Symbolic toy test - looks at how child interacts with toy and is able to build meaningful connections with the objects

2-7 years: Reynell test- provides diagnostic info about child’s production and understanding of spoken language

26
Q

What are the 3 characteristic features of autism spectrum disorders?

A
  1. Impaired social interaction skills
  2. Speech and language disorder
  3. Repetitive, stereotyped behaviour, interests and activities
27
Q

How is Asperger syndrome different from other autism spectrum disorders?

A
  • Asperger syndrome is a milder developmental disorder - most can live a relatively normal life.
  • Characterised by difficulties with social interaction and nonverbal communication, with restricted, repetitive behaviours.
  • Relatively normal language and intelligence.
28
Q

How is autism diagnosed?

A

At least one of the following features must be present before age of 3:

  1. Reciprocal social interactions:
    - Eye to eye contact is reduced
    - Lack of relationship with peers
    - Poor understanding of humour
  2. Communication:
    - Delay in spoken language
    - Inappropriate volume of speech
    - Odd use of words/ phrases
  3. Behaviour, interests, activities:
    - Compulsive adherence to routine - tantrum if disrupted
    - Imaginitive play is reduced
    - Unusual movements e.g. tiptoe gait
29
Q

What early indications of autism may be seen as a baby?

A
  • Little interaction with the mother
  • Poor feeding
  • Limited speech and language development
30
Q

How is autism managed?

A

Mainstay = applied behavioural analysis (ABA):

  • Helps with development of language skills
  • Reduces difficult behaviours
  • 30 hours of individual therapy per week
  • DOES NOT increase likelihood of independent functioning as an adult
31
Q

Identify some milestones for hearing in the first 12 months of life…

A

From birth: startled to sudden noise
1 month: able to hear prolonged sounds
4 months: turns head to noise
7 months: turns head to noise across the room
9 months: listen attentively to everyday sounds
12 months: able to recognise familiar words and respond

32
Q

What investigations can be used to assess hearing loss of children?

A

Newborns: Otoacoustic emission test = computer generated click is played through a small earpiece - soft echo indicates healthy cochlea

Newborns and infants: Auditory Brainstem Response = if otoacoustic test is abnormal - EEG to auditory stimuli

6-18 months: Distraction test = baby locating and turning head towards sound.

18 - 30 months: Recognition of familiar objects = using familiar objects - asking child “where is teddy?”

> 30 months: Kendall Toy Test = discriminating between similar sounding toys

> 36 months: Pure tone audiometry - like adults. Done at school entry.

33
Q

What are the most common causes of hearing problems in children?

A

Sensorineural: (mainly genetic)

  • Hereditary = Usher syndrome, Pendred syndrome
  • Congenital infections = rubella
  • Acquired = meningitis, head injury
  • Perinatal insult = prematurity, hypoxia, hyperbilrubinaemia

Conductive: (mainly acquired)

  • Otitis media with effusion
  • Eustachian tube dysfunction - seen in Down Syndrome
  • conductive hearing loss is more common and tends to be reversible
34
Q

Definition of delayed puberty…

A

Boys:

  • No enlargement of testes by age 14
  • More than 5 years from start to completion of genital growth

Girls:

  • No breast development by age 13
  • More than 5 years between start of breast growth and menarche
  • No menarche by age 16
35
Q

Causes of delayed puberty…

A
  • Constitiutional delay of puberty = runs in the family, child will eventually proceed normally after delay
  • Chronic disease = CF, IBD, DM
  • Testicular injury e.g. torsion, mumps orchitis
  • Amenorrhoea
  • Genetic disorders = Turners (girls), Klinefelter (boys), Kallmann
36
Q

Key features of Turner’s syndrome…

A
  • Females only affected - 45,X (only one sex chromosome)
  • Short stature
  • Widely spaced nipples
  • Webbed neck
  • Primary amenorrhoea
37
Q

Key features of Klinefelter’s syndrome…

A
  • Males only affected - 47, XXY (extra X chromosome)
  • Often taller than average
  • Lack of secondary sexual characteristics (lack of body and facial hair)
  • Infertility
  • Gynaecomastia
38
Q

Key features of Kallman syndrome…

A
  • X-linked recessive condition causing failure of GnRH neuron migration to hypothalamus
  • Delayed puberty as sex hormone production is decreased
  • Anosmia due to defective formation of olfactory bulb
  • Typically normal/ above average height
39
Q

Treatment for delayed puberty…

A
  • Boys with no signs of puberty by age 14 = 4-6 month course of testosterone injections
  • Girls = low doses of oestrogen - pill/ skin patch
40
Q

What is the definition of precocious puberty?

A

Development of secondary sexual characteristics:

  • before 8 in females
  • before 9 in males
41
Q

Causes of precocious puberty…

A

Central (gonadotrophin dependent):

  • Damage to hypothalamus inhibitory system e.g. infection
  • hypothalamic tumour
  • McCune Albright syndrome

Peripheral (gonadotrophin independent: induced by sex hormones from other sources):

  • Gonadal tumours
  • Adrenal tumours
  • Environmental exogenous hormones
42
Q

What is ADHD?

A

Condition characterised by features if inattention and/or hyperactivity or impulsivity.

43
Q

Diagnostic features of ADHD…

A

Children <16 will show at least 6 features:

Inattention:

  • Does no follow through on instructions
  • Reluctant to engage in mentally intense tasks
  • Easily distracted
  • Difficulty organising tasks
  • Often loses things

Hyperactivity/ impulsivity:

  • Unable to play quietly
  • Talks excessively
  • Often interruptive of others
  • Running and climbing when not appropriate
44
Q

Management of ADHD…

A

CONSERVATIVE:

  • Involvement of specialist in child mental health
  • Parents may attend education and training programmes

MEDICAL:

  • Pharmacotherapy for those who fail to respond:
  • First line = methylphenidate - initially on 6 week trial, weight and height should be measured every 6 months
  • Switch to lisdexamfetamine if no response

Paediatrics (12 decks)

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