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Development and NAI Flashcards

1
Q

What is development?

A

Progressive acquisition of skills in line with the maturing central nervous system and emotional development of a child

Encompasses physical, socio-emotional, cognitive and emotional development

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2
Q

What are the developmental domains?

A

Gross motor
Fine motor and vision
Speech and language
Social skills/ emotion/ behaviours/ cognition

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3
Q

Gross motor milestones

A

6 weeks: head lag, head held in same plane in ventral suspension

6 months: can roll over, sits briefly or with some support

1 year: crawling, pulls to stand, cruising, walking in some

2 year: climbs and descending stairs, runs, kick ball

3 year: pedals tricycle, jumps well, momentarily balances on one foot

4 years: stands on one foot well, hops

5 years: walks backwards/ hells/toe,

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4
Q

Fine motor and vision milestones

A

6 weeks: maintains fixation, follows objects through 180degrees horizontal plane

6months: transfers, reaches out for objects, mouths objects

1 years old: pincer grip, bangs 2 bricks together

2 years: copies vertical line, builds tower of 8 bricks

3 years old: copies a circle, matches two colours

4 years old: copies a cross and a square, imitates bridge with 3 bricks, draws man with 3 parts

5 months: copies triangle, draws man with six parts, copies 3 steps from 6 bricks, does buttons

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5
Q

Hearing and speech milestones

A

6 weeks: throaty noises

6 months: babble, turns to name being called

1 year old: two words with meaning, responds to simple instructions, shows recognition of objects

2 years: uses plurals/pronouns, selects toys from others, follows 2 step requests

3 years: 3-4 word sentences, knows three colours, pronouns and plurals, prepositions

4 years: counts to 10, identifies several colours, lots of questions, tells story

5 years: comprehension, understanding of prepositions, opposites

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6
Q

Social milestones

A

6 week: Smiles in response to stimuli

6 months: plays with feet, holds onto bottle when fed

1 year old: waves bye, claps hands, empties cupboards

2 years old: plays alone/ alongside others, eats with spoon

3 years: out of nappies, separates from mother easily, eats with knife and fork

4 years: shares toys, out of nappies at night, brushes teeth, toilets alone

5 years old: chooses friends, acts out role play

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7
Q

Developmental screening/assessment tools

A

Ages and stages questionnaires
Denver developmental assessment and Schedule of growing skills
Bayley and Griffiths

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8
Q

Red flags in developmental assessment

A 
Abnormal muscle tone
Not holding object in hand by 5 months 
Not sitting up supported by 12 months
Not walking independently by 18months
Asymmetry of skills/ early hand dominance 
No speech by 18 months 
Not pointing to objects/ toys to share interest by 2 years
Any loss of skills/ regression
Any new onset of fits/possible seizures
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9
Q

Gross motor development 1 month

A

1 month: symmetrical movement in all limbs, normal muscle tone, head lag when pulled up

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10
Q

Gross motor development 3 months

A

3 months: almost no head lag when pulled to sit, lifts head and chest when prone

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11
Q

Gross motor development 6 months

A

6 months: rolls from back to front, stands and sits with straight back when held, bears most of own weight

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12
Q

Gross motor development 9 months

A

Sits without support
Stands holding onto furniture
Moves around the floor, e.g. wriggling, commando crawling

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13
Q

Gross motor development 12 months

A

Stands without support
Crawls, bottom shuffles or bear walks
Cruises along furniture
May walk unsteadily

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14
Q

Gross motor development 15 months

A

Generally walks without support

Crawls upstairs

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15
Q

Gross motor development 18 months

A

Walks steadily, stopping safely
Squats to pick up a toy
Climbs stairs holding a hand or a rail

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16
Q

Gross motor development 2 years

A

Runs safely
Throws a ball overhand
Walks up and down stairs, both feet on each step

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17
Q

Gross motor development 30months

A

Jumps on 2 feet

Kicks a ball

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18
Q

Gross motor development 3 years

A

Walks backwards and sideways
Rides tricycle
Catches a large ball with arms outstretched

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19
Q

Gross motor development 4 years

A

Stands, walks and runs on tiptoes

Runs up and down stairs

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20
Q

Gross motor development 5 years

A

Hops
Catches a ball
Heel-toe walking
May ride a bike

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21
Q

Fine motor development 1 month

A

Grasps finger when placed in the palm

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22
Q

Fine motor development 3 months

A

Watches their own hands
Brings hands to their mouth
Holds a toy briefly

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23
Q

Fine motor development 6 months

A

Palmar grasp
Reaches for toys
Puts objects into mouth

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24
Q

Fine motor development 9 months

A

Passes toy from one hand to another

May have pincer grip

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25
Fine motor development 12 months
Fine pincer grip Points to object of interest Releases object intentionally
26
Fine motor development 15 months
Imitates to and fro scribbles | Builds a tower of 2 cubes, when demonstrated
27
Fine motor development 18 months
Makes a tower of 3 blocks
28
Fine motor development 2 years
Builds a tower of 6 blocks Draws a horizontal line with preferred hand, may draw vertical lines Turns pages of a book individually
29
Fine motor development 30 months
Thread beads on a string Make a tower of 7 or more blocks Holds a pencil with a tripod grip
30
Fine motor development 3 years
Builds a bridge using blocks Draws a circle Draws a person with a head
31
Fine motor development 42 months | 3.5 years
Draws a cross
32
Fine motor development 4 years
Build steps using blocks Draws a square Draws a person with head/face, arms and legs
33
Fine motor development 5 years
Uses a knife and fork competently Draws a triangle Copies alphabet letter
34
Newborn speech and language
Cries
35
Speech and language 6-8 weeks
Coos
36
Speech and language 3 months
Laughs and vocalises
37
Speech and language 6 months
Understand word such as mama, dada or bye-bye Babbles spontaneously, initially monosyllables Uses a tuneful, singsong voice
38
9 months speech and language
Imitates adult sounds, e.g. coughs Understands simple commands Understands no
39
Speech and language 12 months
Knows and responds to own name | Uses 2-6 words and understands many more
40
Speech and language 18 months
Uses 6-40 recognisable words Can point to parts of body Tries to sing
41
Speech and language 2 years
Speaks over 200 words, understands many more Joins words together Omits opening or closing consonants
42
Speech and language 30 months
Continually asks questions
43
Speech and language 3 years
Can name 2 or 3 colours Knows and repeats song or nursery rhymes Counts to 10 Has simple conversations
44
Speech and language 4 years
Talks fluently Counts to 20 Enjoys jokes
45
Speech and language 5 years
Fluent in speech and mostly grammatically correct | Interested in reading and writing
46
Social, emotional and behavioural newborn
Responds to being picked up | Enjoys feeding and cuddling
47
Social, emotional and behavioural 6 weeks
Gazes at adult faces | Social smile
48
Social, emotional and behavioural 3 months
Smiles at familiar faces and at strangers
49
Social, emotional and behavioural 6 months
Feeds self with fingers | Shows stranger fear
50
Social, emotional and behavioural 9 months
Waves bye Plays peek-a-boo Shows likes and dislikes
51
Social, emotional and behaviour 12 months
Drinks from a cup with2 hands | Has separation anxiety
52
Social, emotional and behavioural 18months
Uses a spoon Plays contentedly alone, near a familiar adult Eager to be independent
53
Social, emotional and behavioural 2 years
Displays frustration Dresses self Begins to express feelings
54
2.5 years social, emotional and behavioural
Eats skilfully with spoon, may use a fork May use the toilet independently Plays along and alongside other children (parallel play) Enjoys pretend play
55
Social, emotional and behavioural 3 years
Shows affection for younger siblings Probably toilet-trained, though may still be wet at night Enjoys helping adults, imitating household tasks Has friends
56
Social, emotional and behavioural 4 years
Eats skilfully with fork and spoon Brushes own teeth Shows sensitivity to others Takes turns
57
Social, emotional and behavioural 5 years
Very definite likes and dislikes Shows sympathy and comforts friends Dresses without help, except laces Engages in co-operative and imaginative play, observing rules
58
Newborn hearing and vision
Fascinated by human faces Turns head towards light Startled by sudden noises
59
Hearing and vision 1 month
Turns head towards diffuse light and stares at bright objects Startles to loud noises
60
Hearing and vision 3 months
Focuses eyes on same point Moves head deliberately to gaze around them Prefers moving objects to still ones
61
Hearing and vision 6 months
Adjusts position to see objects | Turns towards the source of sounds
62
Hearing and vision 12 months
Sees almost as well as an adult | Knows and responds to own name
63
Hearing and vision 18months
Recognises themselves in the mirror
64
Hearing and vision 2 years
Recognises familiar people in photographs | Listen to conversations with interest
65
Hearing and vision 2.5years
Recognises self in photographs | Recognises small details in picture books
66
Hearing and vision 4 years
Matches primary colours | Listens to long stories with attention
67
Hearing and vision 5 years
Can match 10 colours
68
In-toeing gait
Femoral torsion- knees and feet point inwards | Tibial torsion- knees point forward and feet inwards
69
Bowlegs gait
Common from birth to early toddler-hood: resolve by 18months | Often with out-toeing
70
Toe walking
Common up to 3 years
71
Knock knees
Common and associated with in-toeing | Most resolve by 7 years
72
Flat feet
Most children have normal flexible foot and normal arch on tiptoeing Usually resolves by 6 years
73
Ataxic gait signs
Unsteady, broad based | Difficulty heel-toe walking
74
Causes of ataxic gait
Cerebellar cause, e.g. brain tumour, post-viral
75
Spastic hemiplegic gait
Arm held flexed, adducted, internally rotated Leg extended, stiff and in plantar flexion Leg dragged in circumduction (semi-circle)
76
Spastic hemiplegia causes
Cerebral palsy | Acquired brain lesions, e.g. stroke
77
Spastic diplegia signs
Tightness of adduction pulls knees together/ legs to cross the midline; gives ‘scissoring gait.’ Dragging and circumduction of both legs
78
Spastic diplegia causes
Cerebral palsy
79
Waddling gait signs
Results from hip adductor weakness or hip pain Pelvis drops on contralateral side to the leg bring lifted (Trendelenberg sign) Abdomen pushed forward due to lumbar lordosis
80
Waddling gait causes
Hip pain, e.g. DDH, SCFE, Perthes | Proximal myopathy, e.g. Duchenne MD
81
Foot drop ‘high stepping’ neuropathic gait signs
Leg on the side affected has to be lifted high to avoid the foot dragging along the floor
82
Foot drop ‘high stepping’ neuropathic gait causes
Common peroneal nerve palsy | Peripheral neuropathy
83
Dyskinetic gait signs
Irregular, jerky, involuntary movements
84
Dyskinetic gait causes
Basal ganglia lesions
85
Arthrogryposis
This is a heterogeneous group of usually sporadic congenital conditions characterised by joint stiffness and contractures affecting more than one joint in the body. Flexion contractures of the knees, elbows and wrists, dislocation of the hips and other joints and scoliosis is common. The aetiology of these may be multifactorial an d include connective tissue disorders and genetic factors. Whilst some of these conditions may be associated with either a central or peripheral nervous system problem also, the underlying cause of these conditions is not solely neurological.
86
Cerebral palsy
Cerebral palsy is an umbrella term for a permanent disorder of motor movement and/or posture due to a non-progressive abnormality of the developing brain. The key here is that the underlying problem is static but the nature of the child’s motor, neurological or functional impairments may change over time.
87
Cerebral palsy investigation
MRI brain and spine Periventricular leukomalacia Abnormality of the white matter of the brain
88
Role of the occupational therapist
Help people of all ages overcome the effects of disability caused by illness, ageing or accident So that they may carry out everyday tasks or occupations Can give advice and help with the supply of equipment
89
Role of orthotics
Assess patients for the provision of outhouses which fit onto the body to help problems caused but disability, illness or deteriorating conditions
90
Role of physiotherapy
Helps to restore movement and function when someone is affected by injury, illness or disability Can also help to reduce your risk of injury or illness in the future Takes a holistic approach that involves the patient directly in their own care
91
Role of speech and language therapy
Speech: expression and understanding | Swallow
92
Where are some common sites for accidental bruising after 6-9months?
Bony prominences Elbows, knees, shoulders Rare in non-mobile child
93
Typical sites of accidental injury
Head injuries: parietal bones, occiput, forehead Nose, chin Palm of hand Knee, shins
94
Non-accidental injury sites | Head/ neck
Ears- especially pinch marks involving both sides of ear Black eyes, especially if bilateral Soft tissues of cheeks Intra-oral injuries (haemorrhages)
95
Non-accidental injury | Torso
The triangle of safety: ears, side of face and neck, top of shoulders Back and side of trunk except over the bony spine Chest and abdomen Any groin or genital injury
96
Non-accidental injury of limbs
Forearms- when raised to protect self Inner aspects of arms or thigh Soles of feet
97
Child risk factors of abuse
Failure to meet parental expectations and aspirations, e.g. disabled, ‘wrong’ gender, ‘difficult’ child Born after forced, coercive, or commercial sex
98
Parent/carer risk factors for child abuse
Mental health problems Parental indifference, intolerance or over-anxiousness Alcohol, drug abuse
99
Family risk factors for child abuse
``` Step-parents Domestic violence Multiple/closely spaced births Social isolation or lack of social support Young parental age Poverty, poor housing ```
100
Features in history which should rouse suspicion of child abuse
* Plausibility and/or reasonableness of the explanation for the injury * Any background, e.g. previous child protection concerns, multiple attendances to ED/GP. * Delay in reporting the injury * Inconsistent histories from caregivers and from child * Inappropriate reaction of parents or caregivers who are vague, evasive, unconcerned, or excessively distressed or aggressive. It is important to take histories from both parents and, if possible, the child by themselves
101
More subtle presentations of child abuse
``` Inappropriate attachment to caregiver Inappropriate affection towards strangers Persistent nappy rash with broken skin Persistent infestations with lice Poor attendance at school Poor presentation at school Children can often disclose sexual abuse or physical abuse at school Poor educational achievement ```
102
Further tests for child presenting with NAI
Clotting screen Full blood count and film: thrombocytopenia and haematological malignancies, acute lymphocytic leukaemia Factor VIIIc (haemophilia A) VWf: can often present quite late in life Discuss with paediatric haematology
103
Which fractures are associated with NAI?
Humeral and femoral spiral fractures Metaphyseal corner fractures (bucket handle fractures) from shaking Spiral fractures and tibia/fibula are more likely to be accidental Claviclular fractures are most common after birth
104
Which fractures would make you highly suspicious of NAI?
Rib fractures, especially posterior rib Metaphyseal fractures Skull fractures: non-parietal skull fractures, involves multiple bones, crosses sutures, depressed fracture
105
Fractures which are moderately specific for NAI
Bilateral fractures with fractures of differing ages Digital fractures in non-ambulance children Vertebral fractures or vertebral subluxation Spiral humeral fractures Separation of epiphysis
106
Fractures which have low specificity for NAI
Middle clavicular fractures Linear simple fractures of parietal bone (tibia or fibula) Single fractures in diaphysis (spiral humeral fracture is an exception) Greenstick fractures
107
First-line investigations in as child who presents with suspected NAI
Bone profile: calcium, phosphate, alkaline phosphate. Rule out Paget’s, hyperparathyroidism Osteogenesis imperfecta FBC: help identify malabsorption, reduced bone strength Skeletal survey CRP: osteomyelitis
108
What does safeguarding involve
Safeguarding children involves working in partnership with the family and professionals from other agencies. It is the responsibility of the paediatrician to recognise and report when abuse may be occurring and to assist statutory agencies (police, social services, NSPCC). The first agency to contact is often the local social care service as they may have information about the family from other agencies and be aware if the child is on a child protection plan. If a child requires an urgent place of safety due to concerns regarding NAI, they can be placed with another family member that is approved by social care or an emergency foster placement. If such a placement is not possible, then the child may need to be admitted to the hospital while a safe place is found. Medical notes and reports may be formally requested by the police/courts and so it is important to document thoroughly- a body map or photographs may be useful also.
109
Which screening tools are useful in the assessment of ADHD?
Conners questionnaire Dundee difficult times of the day scale SNAP-IV Strengths and difficulties questionnaire
110
Which members of the MDT are involved in the diagnosis of ADHD
community paediatrician Speech and language therapist Educational psychologist
111
When does adult gait and posture occur?
From 8 years old m
112
In-toeing gait
Normal hair variation Femoral torsion- knees and feet point inwards (commonest 3-8 years) Tibial torsion- knees point forward and feet inward
113
Bowlegged gait
Normal gait variation Common from both to early toddler- hood- resolve by 18 months Often with out-toeing
114
Knock knees gait
Common and associated with in-toeing | Most resolve by 7 years
115
Flat feet
Most children have normal flexible foot and normal arch on tiptoeing Usually resolves by 6 years
116
Dyslexia
Difficulty in reading, writing and spelling
117
Dysgraphia
Specific difficulty in writing
118
Dyspraxia
Developmental co-ordination disorder Difficulty in physical coordination More common in boys Delayed gross and fine motor skills and a child that appears clumsy
119
Non-verbal learning disability
Specific difficulty in processing non-verbal information | Body language and facial expressions
120
Classification of learning difficulties
``` IQ 55-70 Mild 40-55 moderate 25-40 severe <25 profound ```
121
Conditions associated with learning disabilities
Down’s syndrome Antenatal problems, fetal alcohol syndrome and maternal chickenpox Problems at birth, prematurity and hypoxic ischaemic encephalopathy Problems in early childhood, such as meningitis Autism Epilepsy
122
Risk factors for learning disability
``` FH Abuse Neglect Psychological trauma Toxins ```

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