development + immunisations Flashcards
developmental screening questions
any concerns about:
way child is behaving/learning/developing
way child moves/uses limbs
how child talks + understands speech
how child is learning to do things for self
enjoy playing - how play?
ever stopped doing something could previously do?
get along with others?
hand dominance?
pregnancy - problems, infections, intoxication, prolonged/difficult labour, postnatal infections
whats global developmental delay
sig delay in milestones in 2+ areas
causes of profound disability
chromosomal abnormalities
cerebral palsy
inborn errors of metabolism
cerebral palsy - presentation
hypertonia+reflexia/floppiness delayed motor development tiptoes/abnormal gait hand preference at 6mo floppy at birth jerky, random, uncontrolled or clumsy movements SALT, vision problems
cerebral palsy - RFs
premature
low birth weight
cerebral palsy - managing increased tone
physio +- SALT daily exercises + splints baclofen diazepam botox
age: squeal, turn to sound
3mo
age: mama, dada
9mo
age: knows/responds to name
1y
age: know 2-6 words
when to refer?
12-15mo
refer at 18mo
age: understand simple commands
12-15mo
age: combine 2 words
2y
age: short sentences, what + who Qs
3y
age: count to 10
3y
MMR: age
how feel after?
dose 1 - 12-15mo
dose 2 - 3-4y
malaise, fever, rash can occur 5-10d after dose 1 for 2-3d
what is the 6-1 vaccine?
diphtheria tetanus whooping cough polio HiB hep B
when is the 6-1 vaccine given?
8, 12, 16wk
cerebral palsy - explanation
group of conditions that can affect movement and coordination
‘very tense muscles’
CP - causes
infection in utero
bleed in brain
oxygen deprivation at birth
CP - types
spastic (70%) - contracted muscles eg tiptoes, SALT delay
ataxic - balance problems
dyskinesic (arm movements)
mixed
ADHD - symptoms
restlessness
poor conc
uncontrolled activity
impulsiveness
ADHD - mgmt
refer to specialist
methylphenidate (SEs - abdo pain, nausea, dyspepsia. monitor growth, BP/HR + psych 6-monthly)
autism - diagnostic criteria
global impairment of lang + comm
impaired social relationships
ritualistic + compulsive phenomena
also, most have decreased IQ
what are the associated conditions with CP?
learning difficulties (50%) epilepsy (30%) squints (30%) hearing impairment (20%)
CP - causes
antenatal (80%) - cerebral malformation + congenital infection
intrapartum (10%) - asphyxia/trauma
postnatal (10%) - IVH, meningitis, head trauma
what checks are done on a child’s health?
neonate - examination, hearing test
1st mo - heel prick d5-9 - hypothyroid, metabolic diseases, CF
6-8wk - GP check
ongoing immunisations + monitoring of growth, vision, hearing
what developmental delays constitute referral?
doesn’t smile at 10wk
can’t sit unsupported 12mo
can’t walk 18mo
can’t say 2-6 words 18mo
what are the commonest reasons for developmental delay?
variant of normal
cerebral palsy
duchenne muscular dystrophy
developmental dysplasia of the hip (DDH) - RFs
breech FH firstborn oligohydramnios birth weight > 5kg
DDH - diagnosis
barlow + ortolani tests
USS confirms
DDH - mgmt
should spontaneously resolve 3-6wk
splints + harnesses if <4-5mo
older - surgery eg hip realignment
fine motor + vision milestones
3mo - reach for object, visually alert, fix + follow to 180°
6mo - holds palmar grasp
9mo - points, early pincer
12mo - good pincer
gross motor milestones
3mo - held sitting 6mo - pulls self to sitting 7-8mo - unsupported sitting 9mo - crawl 1y - walks if hand held 13-15mo - walks unsupported 2y - runs
social behaviour + play milestones
6wk - smiles 3mo - laughs 1y - waves bye 18mo - plays alone 4y - plays with others
feeding milestones
12-15mo - drinks from cup, uses spoon
3y - uses spoon + fork
5y - uses knife + fork
dressing - milestones
can dress + undress at 4y
down syndrome - features
upslanting palpebral fissures protruding tongue small ears rounf/flat face single palmar crease, sandal gap hypotonia heart problems eg VSD, ToF, PDA duodenal atresia + hirschprung's
male infertility, female sub
learning probs
short
resp infections
why are kids given oral/IM vitamin K at birth?
newborns deficient, which can impair clotting factor production → haemorrhagic disease of the newborn (minor or severe)
hypotonia (floppiness) - causes
down's prader willi cerebral palsy hypothyroidism muscular dystrophy
immunisations at birth
BCG if risk TB
hep B if RFs
immunisations at 2mo
6-1
PCV
men B
oral rotavirus
immunisations at 3mo
6-1
oral rotavirus
immunisations at 4mo
6-1
PCV
men B
immunisations at 12-13mo
Hib/Men C
MMR
PCV
Men B
when is flu vaccine given to kids?
2-8y
immunisation at 3-4y
4 in 1 preschool booster - diphtheria, tetanus, whooping cough + polio
MMR
immunsation at 12-13y
HPV - girls
immunisation at 13-18y
3-in-1 teenage booster - tetanus, diphtheria, polio
men ACWY
heel prick test - when done? what for?
5-9 days
hypothyroid CF sickle cell PKU, MCADD HCU
how many times is men B given?
3
how many times is MMR given?
2
how many times is polio given?
5
DDH - features
usually found on screening/newborn exam
if unilateral - leg inequality
limp
arthritis
red flags of developmental delay
loss of skills not fixing/following hearing loss low/increased tone no speech by 18mo persistent tip toes can't sit unsupported by 1y can't walk by 18mo (m) or 2y (f) can't hold object 5mo
duchenne’s - presentation + diagnosis
x linked recessive
neuromuscular disorder
progressive proximal muscle weakness from 5y - dystrophin absence
gower’s sign - arms used to stand from squat
CK++, genetic testing
hx tiptoes, speech + walking delay
calf hypertroph
duchenne’s - management + prognosis
steroids can delay progression
feeding, resp + cardiac problems
causes of delayed puberty
short:
turner, prader-willi
normal:
PCOS, klinefelter
male puberty milestones
testicular growth 10-15y
height spurt 14y
female puberty milestones
breasts 9-13y
height spurt 12
menarche 11-15
which strains of HPV cause what?
6 + 11 - warts
16 + 18 - cervical cancer
which HPV strains does current vaccination protect against?
6 + 11 - warts
16 + 18 - cervical cancer
HPV vaccination - how done?
12-13y. done at school
may be done against parental wishes
2 doses - 6mo-2y apart
injection site reactions common
