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*Review TD 2020 > Development and Child Maltreatment > Flashcards

Development and Child Maltreatment Flashcards

1
Q

Developmental history

A

Gotta Find Strong Coffee Soon (Please)

```
Gross Motor—
Fine Motor
Speech-Language —
Cognitive
Social-Emotional —
Play
~~~

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2
Q

Key motor milestones

A 
— Motor
◦ 3 months: Head Control
◦ 6 months: Arms 
◦ 9 months: Trunk 
◦ 12 months: Legs
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3
Q

When should be able to roll from side to side

A

6 months

red flag: 9mo

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4
Q

When should be able to sit upright

A

6 months

red flag: 9 m

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5
Q

When should be able to walk

A

12m
(1st bday 1st steps)
red flag: 18m

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6
Q

When should be able to jump``

A

24m

2yo 2feet off the group

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7
Q

When should be able to stairs

A

2 y - 2 feet step

3 y - alternating

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8
Q 
Fine motor:
hands to midline 
palmar grasp
pincer grasp
uses spoon
A 
4 months: Hands to midline; reaches for
objects
◦ 6-8 months: Palmar grasp
◦ 9-12 months: Pincer grasp
◦ 2 years: Uses spoon; copies vertical line
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9
Q

when start babbling

A

6months

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10
Q

when is language emergence

A

12 months

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11
Q

how much speech by 2 years

A

2 word combination, 1/2 intelligible

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12
Q

how much speech by 3 years

A

3 word combination, 3/4 intelligible

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13
Q

When is language reversal normal until

A

8yo

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14
Q

Key components for dx of ASD

A

1) Impairment in social communication
2) Restricted and Repetitive Behaviors

  • Symptoms in early developmental period
  • Impact on current functioning
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15
Q

Neurologic disorders associated with autism

A 
Tuberous Sclerosis 
Fragile X
Rett Syndrome
NF
Angelman
T21
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16
Q

Concern for ASD - what is workup

A

◦ Audiology (and vision) testing
◦ Referral to SLP for initiation of therapy
◦ ASD specific screening instrument
◦ Referral to Developmental Pediatrician/Centre for multidisciplinary team assessment
◦ Genetic testing: Chromosomal Microarray + Fragile X

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17
Q

Global developmental delay

  • definition
  • age
A 
Significant delay in 2+ domains (of 5)
– Gross motor / Fine motor 
– Speech and Language
– Social
– Adaptive
– Cognitive

<5yo

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18
Q

intellectual disability

A

after 5 yo

1) deficits in IQ
2) adaptive function
3) onset <18

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19
Q

ADHD: aspects of inattention

A
  1. Careless mistakes
  2. Trouble holding attention
  3. Doesn’t listen
  4. Doesn’t follow through
  5. Trouble being organized
  6. Avoids mental effort
  7. Loses things
  8. Easily distracted
  9. Forgetfu
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20
Q

ADHD: aspects of hyperactivity and impulsivity

A
  1. Fidgets and squirms
  2. Leaves seat
  3. Runs about
  4. Can’t be quiet
  5. Always on the go
  6. Talks excessively
  7. Blurts out answers
  8. Can’t wait for turn
  9. Interrupts
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21
Q

ADHD mgmt

  • preschool
  • school aged
  • adolescents
A

— Preschool (Ages 4-5)
◦ Evidence-based Behaviour Therapy
◦ Methylphenidate if you need to

— School-aged (6-11)
◦ Start with Meds and/or Behaviour Therapy
◦ Preferably both

— Adolescents (12-18)
◦ Start with Meds, maybe Behaviour Therapy
◦ Preferably both

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22
Q

Late onset side effect of stimulants

A

depression

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23
Q

Facial features of FASD

A 
Small HC
Low nasal bridge
Epicanthal folds
Short palpebral fissures
Short nose
Short midface
indistinct philtrum
Thin upper lip
24
Q

Developmental Dysfluency

A

Developmental Dysfluency

  • Occasional (once every 10 sentences) 

  • Brief (0.5 seconds or less) 

  • Repetition of sounds, syllables or words 

  • Worse when tired, excited, complex language, questions, anxious
25
Q

Concern for intellectual delay

- investigations?

A

• Microarray, Fragile X testing
• Hearing and vision
• Consider:
– Metabolic screen:
• Blood: amino acids, homocysteine, acylcarnitine profile
• Urine: organic acids, GAA/creatinine metabolites, purines/pyrimidines, MPS screen, oligosaccharide screen
– X-linked ID, Rett’s syndrome testing – Neuroimaging

26
Q

Definition of CP

A

Disorders of movement and posture
Affects motor function
Due to non-progressive disturbance of the fetal or infant brain

27
Q

Comorbidities for CP

A 
• Sensory
– Strabismus
– Hearing impairment
• Epilepsy
• Swallowing and aspiration
• GERD, Constipation
• Sleep difficulties
• Pain
• Hip subluxation/Scoliosis
• Cognitive and learning difficulties
28
Q

Which of the following is the greatest risk factor for child maltreatment in Canada?

A

Caregiver is a victim of intimate partner violence

29
Q

Risk Factors for child maltreatment

A 
PARENTAL:
Victim of domestic violence
Limited Social supports
Mental health issues
Alcohol abuse
Drug/solvent abuse
Perpetrator of domestic violence
Physical health issues
Foster care/group home
Cognitive impairment
CHILD:
Prematurity
Chronic illness
Developmental disability
Behavioural issues
ENVIRONMENTAL:
low educational attainment
unemployment
non related male in home
Last of supports
30
Q

Red flags for bruising

A

Patterned bruises
Bilateral/symmetrical bruises
Bruises that are unusually large or numerous Bruises that do not fit the mechanism described
Location

Areas:
ears
neck
chest
abdo
genitals
back
buttocks
feet
31
Q

First line lab tests for bruising

A 
CBC + diff
INR, PTT
Fibrinogen
vWF studies (+ blood group for interpretation) Factors VIII, IX
Liver function tests
Renal function tests
32
Q

what is a toddler fracture

A

typical spiral undisplaced midshaft tibia fracture

generally very low force mechanism

33
Q

red flags for fractures

A
  • Fractures in non-mobile children
  • No history of trauma
  • Incompatible mechanism
  • Location - higher specificity fractures include:
  • •• Ribs
  • •• Long-bone metaphases (CMLs)
  • •• Scapula
  • •• Sternum
  • •• Vertebral spinous processes
  • •• Humerus in <18 mo
  • •• Femur in non-mobile
  • Multiple fractures
  • Fractures in different stages of healing
34
Q

What age to do skeletal survey

A

2yo

35
Q

Medical conditions causing fractures

A 
Trauma
••• birth related
••• accidental 
••• inflicted
Genetic bone d/o
••• osteogenesis imperfecta
••• menkes disease
••• infantile cortical hyperostosis
••• hypophosphatasia
Nutritional metabolic d/o
••• vitamin D rickets
••• osteopenia of prematurity
••• copper deficiency
••• chronic renal insufficiency 
••• scurvy
Infection
••• osteomylelitis
••• congenital syphilis
Toxicity
••• hypervitaminosis A
••• Methotrexate toxicity
Neoplastic d/o
••• leukemia
••• langerhans cell histiocytosis
36
Q

Work up for suspected NAI

A
  • Bleeding workup (CBC, coags, vWF screen, factors…)
  • Skeletal survey
  • Ophthalmology consult
  • AST, ALT, lipase
37
Q

rapid head growth in infants

subdural hemorrhage

A

Benign enlargement of the subarachnoid space

38
Q

most common sentinel injuries

A 
most common bruises
#2 intra oral injuries
39
Q

what age is head banging not normal

A

> 5yo

40
Q

What area of development is correlated with future cognition

A

Language

41
Q

What are characteristics for consequences of bad actions

A

age-appropriate, immediate, and consistent

42
Q

Examples of social impairment in ASD

A
  • deficits in socio-emotional reciprocity
  • deficits in nonverbal communication used for social interaction (ex eye contact, gestures, facial exp)
  • deficits in development, maintaining and understanding relationships (peer relations, sharing, imaginative play)
43
Q

Examples of restricted repetitive patterns of behaviour, interested, activities in ASD

A
  • sterotyped/repetitive motor movements
  • insistence on sameness, routine
  • highly restricted, fixated interests
  • hyper or hypo reactivity to sensory stimuli
44
Q

Signs of psychosocial deprivation

A
  • Unusual watchfulness
  • Avoidance of eye contact
  • Absent smiling or vocalization
  • Lack of interest in environment
  • Children over 5 months do not reach for interesting objects
  • Negative response to cuddling
  • Arches back, scissors legs OR lies limp
  • Inability to be comforted
  • Head banging
  • Self stimulation (ano-genital manipulation)
  • Immobility with infantile posturing
  • Inappropriately seeking affection from strangers
  • Flat occiput
45
Q

Key points to assess readiness for toilet training

A 
able to walk to potty
stable while sitting on potty
able to remain dry several hours
desire to please caregivers
desire for independence 
control of bladder and bowel
46
Q

diagnostic criteria for ADHD inattentive type

A
  • fail to give close attention or makes careless mistakes
  • forgetful in daily activities
  • easily distracted
  • trouble holding attn on tasks/activities
  • trouble organizing tasks/activities
  • loses things necessary for tasks and activities
  • avoids/dislikes or is reluctant to do things that require sustained attn
  • does not seem to listen when spoken to directly
  • does not follow through on instructions and failure to finish work/chores
47
Q

diagnostic criteria for ADHD hyperactive/impulsive subtype

A
  • figets w or taps hands/feet or squirms in seat
  • often leaves seat in situations when supposed to stay seated
  • often runs about or climbs in situations where it is not approp
  • blurts out answers
  • often “on the go” or “driven by a motor”
  • often taps excessively
  • trouble waiting turn
  • often interrupts
  • unable to play in leisure activities quietly
48
Q

What assessments need to be done to dx intellectual delay

A

Cognitive

Adaptive

49
Q

Criteria for intellectual disability

A

deficits in IQ
adaptive function
onset <18 yo

50
Q

How long for catch up growth in SGA

A

2 years

51
Q

when is hand preference deteremined

A

by ~3y

52
Q

Reactive attachment disorder

A
  • Emotionally withdrawn and inhibited with caregivers and strangers
  • lack of or incompletely formed attachments to caregivers
53
Q

Disinhibited Social Engagement Disorder

A

aberrant behaviour in which a child unhesitatingly approaches and interacts with unfamiliar adults

54
Q

Most common head injury in NAI

A

subdural hemorrhage

55
Q

Most correlated w future cognitive ability

A

Language

receptive > expressive

*Review TD 2020 (16 decks)

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