Development Flashcards
What are the 4 fields of development to consider?
- GROSS MOTOR
2) VISION AND FINE MOTOR
3) HEARING,SPEECH, LANGUAGE
4) SOCIAL, EMOTIONAL, BEHAVIOURAL
During development, primitive reflexes as postural reflexes which are essential start to emerge. What are the primitive reflexes?
Moro Grasp Suckling Rooting Stepping Asymmetrical tonic neck reflex
During development, what are the postural reflexes the child develops?
Parachute, labyrinthine, lateral propping, postural support.
What is meant by labyrinthine righting?
This is when the head moves in the opposite direction to which the body is tilted.
What is meant by postural support?
When held upright, the child’s legs take the weight and the baby may bounce/push up
What is lateral propping?
This is when the child is sat and puts an arm out to the direction it is falling, a saving mechanism.
What is parachute reflex?
This is when the baby is face down and the arms extend as though to save themselves.
What is the sequence for gross motor development?
Newborn= symmetrical limbs flexed
Marked head lag on pulling up
6-8 weeks: the head is raised to 45 degrees in prone
6-8 months: sits w/o support
8-9 months: crawling
10 months: stands independently, cruises around furniture
12 months: walks unsteadily and broad gait w/hands apart
15 months: walks steadily
What are the characteristics of ADHD?
Impulsivity
Hyperactivity
Inability to concentrate
What is the management of ADHD?
. A ten week watch and wait period should follow to observe whether symptoms change or resolve
If they persist then referall to secondary care is requires- paediatrician with special interest in behavioural disorders or CAMHS
. Drug therapy is last resort and only give to those over 5
Methylphenidate is first line
Methylphenidate has a potentially serious effect on the body, therefore what should you do?
Potentially cardio to IV and therefore you should perform a baseline ECG before starting treatment and refer to a cardiologist if there is any significant PMH/FH/doubt/ambiguity
What are the side effects of methylphenidate?
Abdominal pain
Nausea and dyspepsia
Weight and height should be monitored every 6 months.
How is growth measured in the UK?
Height
Weight
Head Circumference
Children’s centile lines should be tracked from birth, how many centile lines crossed raise concerns?
If more than 2 centile lines are crossed the concerns should be raised and child investigated.
What are the important numbers to know for normal growth in children?
Weight- it’s acceptable for babies to lose 10% of their birth weight in the first 10 days of life
Babies should have doubled their weight in 4 months and tripled in a year
Length- babies length is typically doubled at 4 years of age
Head circumference- 35cm and increases roughly 1cm a month for the first year
What is the average age for puberty in girls/ boys?
Girls- 11 years
Boys- 18 months later
What is the order of development in girls?
Thelarche (breast development)
Adrenarche (pubic hair)
Menarche (menstruation)
What is used to assess puberty in males?
Tanner staging
What is precocious puberty?
If secondary sexual characteristics (features of puberty) develop at <8 years in girls and <9 years in boys
What May cause precocious puberty?
Central causes- constitutional/ familial early puberty, intracranial, idiopathic (GNRH dependent)
Peripheral- endocrine, hormone secreting adrenal tumours, mcCune-Albright syndrome (GnRH independent)
How would you investigate precocious puberty?
Imaging- brain MRI to rule out central tumour
USS ovaries/testes to assess size and presence of gonadal tumours
Endocrine- serum gonadotropin and sex steroid (oestrogen, testosterone) levels.
What are the key gross motor skills in terms of development?
Develops head control- 6 weeks No head lag when pulled to sit (4-6months) Sits +/- support at 6 months Can sit alone +/- crawling at 9 months Pulls to stand at 10 months Cruises +/- walking at 12 months Walks confidently at 18 months Kicks ball and runs at 2 years
What are the red flags for gross motor skills? (upper limit for gross motor skills)
No head control at 6 months Cannot sit unsupported at 12 months No weight bearing at 12 months Not walking (18 months) Not running (2.5 years)
What are the fine motor and visual skills time frames?
3 months- holds objects in palm 6 months- transfers objects from hand to hand 9 months- immature pincer grip 12 months- mature pincer grip 18 months- stacks 2-4 bricks and also has hand dominance 2 years- straight line 3 years- draw circle 4 years- draws a cross 5 years- draws a triangle
What are the red flags for fine motor and visual skills?
If the child is not holding an object in hand by 5 months.
What are the speech and language skills in terms of development?
3 months- turn to sound 3-6 months vocalisations 9 months- double syllable babble (baba or mama) 12 months- 2 to 3 words with meaning 18 months- 10 words with meaning 2 years- links 2 words together 3 years- short, full sentences
What are the red flags for speech and language?
No response to stimuli at 3 months No babble at 9 months No words at 18 months Cannot join 2 words at 2 years Cannot speak in full sentences at 3 years
At what stages are certain social skills developed?
6 weeks% first smile 3 months- laugh out loud 9 months- wave goodbye 12 months- stranger anxiety 18 months- spoon feeds self and imitative play (everyday activities) 3 years- dress self and toilet trained
What are the red flags for development in terms of social skills?
If they are not doing gestures at 12 months and there is no symbolic play by 18 month.
What are the causes of global developmental delay?
Global delay can be due to antenatal, perinatal and postnatal causes.l,
Antenatal:
- Genetic: Down syndrome, neurofibromatosis, fragile X, duchene muscular dystrophy, tuberous sclerosis, many others
- metabolic and endocrine: hypothyroidism, PKU, MCAD, others
- Toxins: drugs and alcohol
Perinatal and postnatal:
- infection
- trauma/ brain injury (cerebral palsy)
- neglect
In terms of causes for specific developmental delay, what may be the causes of the following…
1) GROSS MOTOR
2) FINE MOTOR and VISION
3) speech and language
4) social skills
1) spina bifida/ cerebral palsy
2) retinoblastoma, retinopathy of prematurity
3) hearing problems (otitis media with effusion, deafness of any cause)
4) autism spectrum, fragile X
