Development Flashcards
What are the four domains of child development?
- Gross motor
- Fine motor and vision
- Hearing, speech and language
- Social and personal
What are the developmental milestones seen at 6 weeks?
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
What are the developmental milestones seen at 3 months?
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
What are the developmental milestones seen at 6 months?
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
What are the developmental milestones seen at 9 months?
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
What are the developmental milestones seen at 12 months?
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
What are the developmental milestones seen at 18 months?
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
What are the developmental milestones seen at 2 years?
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
What are the developmental milestones seen at 3 years?
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
What are the developmental milestones seen at 4 years?
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
What are the developmental milestones seen at 5 years?
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
Name the main primitive reflexes:
- 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
Name the main postural reflexes:
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
How long should the primitive reflexes last? What may it indicate if they last longer than this?
Primitive reflexes normally last around 3 months - if they persist more than this, it may indicate signs of cerebral palsy.
What is the definition of developmental delay,and global developmental delay?
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
How is a developmental assessment carried out?
- 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?
What is a short cut to developmental assessment?
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
How can the degree of developmental delay be calculated?
Development quotient:
Developmental age / Chronological age x 100
What are some causes of developmental delay?
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
What are some causes of abnormal motor development?
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
What are some early indications of abnormal motor development?
- Delay in motor skill accquisition
- Early hand dominance i.e. asymmetrical use of motor skills
Red flags associated with abnormal motor development…
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
What are some causes of delayed speech?
- 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
Red flags associated with speech delay…
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
What tests can be used to identify speech and language skill problems?
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
What are the 3 characteristic features of autism spectrum disorders?
- Impaired social interaction skills
- Speech and language disorder
- Repetitive, stereotyped behaviour, interests and activities
How is Asperger syndrome different from other autism spectrum disorders?
- 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.
How is autism diagnosed?
At least one of the following features must be present before age of 3:
- Reciprocal social interactions:
- Eye to eye contact is reduced
- Lack of relationship with peers
- Poor understanding of humour - Communication:
- Delay in spoken language
- Inappropriate volume of speech
- Odd use of words/ phrases - Behaviour, interests, activities:
- Compulsive adherence to routine - tantrum if disrupted
- Imaginitive play is reduced
- Unusual movements e.g. tiptoe gait
What early indications of autism may be seen as a baby?
- Little interaction with the mother
- Poor feeding
- Limited speech and language development
How is autism managed?
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
Identify some milestones for hearing in the first 12 months of life…
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
What investigations can be used to assess hearing loss of children?
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.
What are the most common causes of hearing problems in children?
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
Definition of delayed puberty…
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
Causes of delayed puberty…
- 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
Key features of Turner’s syndrome…
- Females only affected - 45,X (only one sex chromosome)
- Short stature
- Widely spaced nipples
- Webbed neck
- Primary amenorrhoea
Key features of Klinefelter’s syndrome…
- 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
Key features of Kallman syndrome…
- 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
Treatment for delayed puberty…
- Boys with no signs of puberty by age 14 = 4-6 month course of testosterone injections
- Girls = low doses of oestrogen - pill/ skin patch
What is the definition of precocious puberty?
Development of secondary sexual characteristics:
- before 8 in females
- before 9 in males
Causes of precocious puberty…
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
What is ADHD?
Condition characterised by features if inattention and/or hyperactivity or impulsivity.
Diagnostic features of ADHD…
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
Management of ADHD…
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
