Development Flashcards
1
Q
Gross motor milestones
A
By 4 mos: head control (red flag at 6mo)
By 6mo: sit well and roll both ways (red flag at 9 mo)
By 10mo: pull to stand (red flag at 15mo)
By 12 mo: first steps (red flat at 18 mo)
24 mo: run and jump
Stairs: 18mo railing, 24mo no railing
tricycle: 36 mo
hop: 48 mo
skip: 60 mo
2
Q
Fine motor milestones
A
4 mo: hands to midline, reaching 6-8 mo: palmar grasp 9-12 mo: pincer grasp 2 yrs: spoon, copies vertical line 4-5 yrs: dresses without buttons, draws 10+ part person
3
Q
Speech and language milestones
A
2-4 mo: visual attention 6-9 mo: babbling 12 mo: language emergence 2yrs: 2 word combos, 50% intelligible 3 yrs: 3 word combos, 75% intelligible 4 yrs: phrased speech, 100% intelligible
4
Q
Speech and language delay first step
A
Audiology!
5
Q
Social and emotional milestones
fears and friendships
A
- stranger anxiety: 5-6 mo
- separation anxiety: 9-15 months
- monsters: 3-5 yrs
- death:7/8 -10 yrs
- best friend: 4-6 yrs
6
Q
Recurrence rates for autism in younger siblings
A
- 7-19% vs. 1.5%
7
Q
Early autism warning signs
A
- parental concerns around language delay
- lack of response to name
- limited eye contact
8
Q
Child with features of autism, what to do next?
A
- audiology (and vision)
- refer to SLP
- ASD specific screening instrument
- refer to developmental paediatrician or multidisciplinary team
- genetic testing: chromosome microarray and fragile x
9
Q
Work up for intellectual disability to be considered (9)
A
- chromosome microarray
- fragile x
- MECP2 (if female with mod-severe and sx present)
- thyroid
- lead and ferritin (only if mouthing/pica)
- metabolic testing (only if strongly suspicious)
- ophtho and audiology!
- neuroimaging
- EEG (only if sx suspected)
10
Q
Developmental dysfluency
A
- occasional (1x every 10 sentences)
- brief (0.5s or less)
- repetition of sounds, syllables or words (no prolongations)
- worse when tired, excited, anxious, complex language
- no tension in the facial muscles
11
Q
ADHD management by age
A
Ages 4-5: behaviour therapy
- methylphenidate if you need to
Ages 6-18: start with meds and/or behaivour therapy (preferably both)
12
Q
Late onset side effect of stimulants
A
depression!
13
Q
FASD common issues
A
- cognitive and learning disorders
- ADHD (severe and refractory)
- poor judgement, poor sense of cause and effect
14
Q
FASD facial features
A
- microcephaly
- low nasal bridge
- short nose
- short midface
- indistinct philtrum
- short palpebral fissures
- thin upper lip
15
Q
- ADHD plus autism
- ADHD plus ID
- ADHD plus prematurity
A
ASD: > 50% of those with ASD meet criteria for ADHD
ID: 3-4x higher prevalence of ADHD
Prem <1500g, and <26 weeks: 2x as likely to have ADHD
16
Q
Pros of pacifiers
A
- prevention from SIDS
- non-nutritive sucking has benefits
17
Q
Cons of pacifiers
A
- contain microorganisms ?risk factor for OM
- may have negative effect on dentition (but better than finger sucking)
- ?breastfeeding challenges
18
Q
Risks of screen use
A
- decreased opportuniteis for place and face/face interaction
- increased risk of depression and anxiety
- increased risky behaviours
- increases unehalthy eating
- impacts sleep
- distracted driving
19
Q
When to begin sleep training
A
- after 6 months
Most infants sleep through night (uninterrupted sleep for 6-8 hrs) after 6 months
(many can sleep at least 5hrs by 3-4 months)
20
Q
Positional plagiocephaly prevention recommendations and management
A
- Tummy time 10-15min 3x/day
- treat torticollis with physiotherapy if present
- moulding therapy (helments) can be consiered fro severe asymmetry
21
Q
Peak crying time is:
A
up to 3 hours of day (normal)
at 6 weeks of age
22
Q
Readiness for toileting (6)
A
- walk to potty
- sit with stability
- remain dry for several hours
- have appropriate language skills
- have desire for independence
- respond to positive reinforcement
23
Q
Cardiac risk assessment for stimulants for ADHD
- history
A
- decreased exercise tolerance
- extreme SOB with exercise
- fainting or seizures or palpitation with exercise or startle/fright
- family hx: long QT, arrhythmia, WPW, cardiomyopathy, heart transplant, pulmonary HTN, unexplained death, implantable defibrillator
24
Q
Cardiac risk assessment for stimulants for ADHD
- physical
A
- pathologic sounding murmur
- absent or femoral pulses
- sternotomy incision
- hypertension
25
Social history "ITHELPS"
```
income
transportation
housing
education
legal status
literacy
personal safety
support
```
26
GDD criteria
2+ SD below mean in at least 2 developmental domains from:
- GM or FM
- Speech/language
- cognition
- social/personal
- ADL
27
ID criteria
1. deficits in intellectual functioning
2. deficits in adaptive functioning in 1+ of communication, social participation, independent living in across multiple enviornments
3. onset from developmental period
28
Red flags suggestive of IEM
* Fam history of IEM or dev disorder or unexplained infant death
* Consanguinity
* IUGR/FTT
* HC or stature growth abnormality (>2SD)
* Recurrent vomiting, ataxia, seizures, lethargy, coma
* Hx of being severely symptomatic and needing longer to recover with benign illnesses (e.g. URTIs)
* Protein or CHO aversion
* Regression in developmental milestones
* Behavioural or psychiatric problems (psychosis at a young age)
* Movement disorder (dystonia)
* Facial dysmorphism (course facial features)
* Organomegaly
* Severe hypotonia
* Congenital anomalies
* Sensory deficits, especially if progressive (e.g. cataracts, retinopathy)
* Noncongenital progressive spine deformities
* Neuro-imaging abnormalities
29
First investigations for GDD/ID (after hx, physical, audiology and ophtho)
1. chromosome microarray
2. fragile X
3. MECP2 for females with suggestive course
4. brain MR is suggestive micro/macro
Tier 1 tests:
CBC, glucose, gas, urea, Cr, electrolytes, AST, ALT, TSH, CK, ammonia, lactate, amino acids, acylcarnitine profile, carnitine, homocysteine, copper
Urine orgnaic acids, creatine metabolites, purines, pyrimidines, glycosaminoglycans
+/- ferritin, vit B12, lead level, ceruloplasmin, biotinidase
30
Most important investigations in eval of GDD/ID
1. chromosome microarray
| 2. fragile X testing
31
Maternal depression increases risk across ages
- infancy
- toddler/preschools
- school-aged and teens
Infants: insecure attachment, dysregulation
Toddlers/preschoolers: internalizing and externalizing, cognitive, social interactions, self control
Teens: adaptive functioning, learning disabilities, ADHD, psychopathology (anxiety and mood)
32
Three most important factors for a child's well being during separation/divorce
1. quality of parenting
2. quality of parent-child interaction
3. degree, frequency, intensity and duration of hostile conflict
33
Impacts of divorce by age
< 3 yrs: disorganized attachment, reflect caregiver distress
4-5 yrs: often blame themselves, separation anxiety
School age: prone to loyalty conflicts and may take sides
Adolescents: parents need effective communication and consistent limit-setting
34
Three approach to ASD diagnosis
1. Single provider provides diagnosis based on clinical judgment and DSM-5
2. Shared care model e.g. paediatrician and psychologist
3. Multidisciplinary team assessment
35
Medical, behavioural mental health challenges in ASD to assess and manage post diagnosis
- GI conditions
- nutrition
- sleep
- anxiety, depression, mood, psychiatric disorders
- ADHD
36
Medications in ASD
```
Challenging behaviours: risperidone, aripiprazole
Anxiety: fluoxetine or sertraline
ADHD: methylphenidate/stimulant 1st line
Depression: SSRI
Sleep: melatonin
```
37
Disruptive behaviour criteria
1. atypical for developmental age and persists for 5 mo or more
2. impaired functioning
3. significant distress
38
Red flag temper tantrums
1. misbehaves in ways that are dangerous
2. acts aggressively to try to get something he or she wants (vs. when upset)
3. temper tantrums are daily and last > 5minutes
39
Toxic stress (re ACEs)
- major, frequent or prolonged periods of adversity
| - affects neuro, immunologic, psychiatric, behavioural
40
Crying behaviours (infancy)
- developmentally normal
- peaks at 6-8 weeks
- generally settles by 3-4 months
41
Sleep intervention strategies to start at this age
6 months (circadian rhythm develops)
42
Features of "time ins"
- caregiver invites child to sit and talk about feelings and behaviour in age-appropriate way
- emphasizes connection and comfort
