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
~~~
2
Q
Key motor milestones
A
Motor ◦ 3 months: Head Control ◦ 6 months: Arms ◦ 9 months: Trunk ◦ 12 months: Legs
3
Q
When should be able to roll from side to side
A
6 months
red flag: 9mo
4
Q
When should be able to sit upright
A
6 months
red flag: 9 m
5
Q
When should be able to walk
A
12m
(1st bday 1st steps)
red flag: 18m
6
Q
When should be able to jump``
A
24m
2yo 2feet off the group
7
Q
When should be able to stairs
A
2 y - 2 feet step
3 y - alternating
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
9
Q
when start babbling
A
6months
10
Q
when is language emergence
A
12 months
11
Q
how much speech by 2 years
A
2 word combination, 1/2 intelligible
12
Q
how much speech by 3 years
A
3 word combination, 3/4 intelligible
13
Q
When is language reversal normal until
A
8yo
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
15
Q
Neurologic disorders associated with autism
A
Tuberous Sclerosis Fragile X Rett Syndrome NF Angelman T21
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
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
18
Q
intellectual disability
A
after 5 yo
1) deficits in IQ
2) adaptive function
3) onset <18
19
Q
ADHD: aspects of inattention
A
- Careless mistakes
- Trouble holding attention
- Doesn’t listen
- Doesn’t follow through
- Trouble being organized
- Avoids mental effort
- Loses things
- Easily distracted
- Forgetfu
20
Q
ADHD: aspects of hyperactivity and impulsivity
A
- Fidgets and squirms
- Leaves seat
- Runs about
- Can’t be quiet
- Always on the go
- Talks excessively
- Blurts out answers
- Can’t wait for turn
- Interrupts
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
22
Q
Late onset side effect of stimulants
A
depression
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
Concern for intellectual delay
| - investigations?
• 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
Definition of CP
Disorders of movement and posture
Affects motor function
Due to non-progressive disturbance of the fetal or infant brain
27
Comorbidities for CP
```
• Sensory
– Strabismus
– Hearing impairment
• Epilepsy
• Swallowing and aspiration
• GERD, Constipation
• Sleep difficulties
• Pain
• Hip subluxation/Scoliosis
• Cognitive and learning difficulties
```
28
Which of the following is the greatest risk factor for child maltreatment in Canada?
Caregiver is a victim of intimate partner violence
29
Risk Factors for child maltreatment
```
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
Red flags for bruising
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
First line lab tests for bruising
```
CBC + diff
INR, PTT
Fibrinogen
vWF studies (+ blood group for interpretation) Factors VIII, IX
Liver function tests
Renal function tests
```
32
what is a toddler fracture
typical spiral undisplaced midshaft tibia fracture
| generally very low force mechanism
33
red flags for fractures
* 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
What age to do skeletal survey
2yo
35
Medical conditions causing fractures
```
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
Work up for suspected NAI
- Bleeding workup (CBC, coags, vWF screen, factors...)
- Skeletal survey
- Ophthalmology consult
- AST, ALT, lipase
37
rapid head growth in infants
| subdural hemorrhage
Benign enlargement of the subarachnoid space
38
most common sentinel injuries
```
most common bruises
#2 intra oral injuries
```
39
what age is head banging not normal
>5yo
40
What area of development is correlated with future cognition
Language
41
What are characteristics for consequences of bad actions
age-appropriate, immediate, and consistent
42
Examples of social impairment in ASD
- 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
Examples of restricted repetitive patterns of behaviour, interested, activities in ASD
- sterotyped/repetitive motor movements
- insistence on sameness, routine
- highly restricted, fixated interests
- hyper or hypo reactivity to sensory stimuli
44
Signs of psychosocial deprivation
- 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
Key points to assess readiness for toilet training
```
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
diagnostic criteria for ADHD inattentive type
- 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
diagnostic criteria for ADHD hyperactive/impulsive subtype
- 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
What assessments need to be done to dx intellectual delay
Cognitive
| Adaptive
49
Criteria for intellectual disability
deficits in IQ
adaptive function
onset <18 yo
50
How long for catch up growth in SGA
2 years
51
when is hand preference deteremined
by ~3y
52
Reactive attachment disorder
- Emotionally withdrawn and inhibited with caregivers and strangers
- lack of or incompletely formed attachments to caregivers
53
Disinhibited Social Engagement Disorder
aberrant behaviour in which a child unhesitatingly approaches and interacts with unfamiliar adults
54
Most common head injury in NAI
subdural hemorrhage
55
Most correlated w future cognitive ability
Language
| receptive > expressive
