Development_Problems_Flashcards
What is developmental delay?
Developmental delay is a significant lag in a child’s physical, cognitive, behavioral, emotional, or social development relative to established growth milestones.
What are common referral points for developmental issues?
Referral points include not smiling by 10 weeks, not sitting unsupported by 12 months, and not walking by 18 months.
What indicates a problem with fine motor skills in children?
Early hand preference before 12 months may indicate cerebral palsy.
What are common causes of gross motor problems in children?
Common causes include normal variants, cerebral palsy, and neuromuscular disorders such as Duchenne muscular dystrophy.
What should always be checked in children with speech and language problems?
Always check hearing first. Other causes can include environmental deprivation and general developmental delay.
What are common causes in the differential diagnosis for developmental delay?
Common causes include Autism Spectrum Disorder, Cerebral Palsy, Fragile X Syndrome, Down Syndrome, and Fetal Alcohol Spectrum Disorders.
What are the initial management steps for a child with suspected developmental delay?
Initial management involves a clinical examination, investigations like genetic testing and neuroimaging, referrals for specialist assessment, and early intervention services.
SUMMARISE
Development problems
Abnormal development or developmental delay refers to a significant lag in a child’s physical, cognitive, behavioural, emotional, or social development, relative to established growth milestones. It is crucial for clinicians to identify and address these delays promptly to improve long-term outcomes.
Background
The process of normal child development is complex and multifaceted, encompassing the maturation of various systems such as motor skills (gross and fine), language (expressive and receptive), cognitive abilities, and adaptive behaviours. Any disruption in this intricate process can lead to abnormal development. The root cause may be genetic disorders, prenatal exposure to toxins/drugs/alcohol, premature birth, nutritional deficiencies or environmental factors.
Example issues
Referral points
doesn’t smile at 10 weeks
cannot sit unsupported at 12 months
cannot walk at 18 months
Fine motor skill problems
hand preference before 12 months is abnormal and may indicate cerebral palsy
Gross motor problems
most common causes of problems: variant of normal, cerebral palsy and neuromuscular disorders (e.g. Duchenne muscular dystrophy)
Speech and language problems
always check hearing
other causes include environmental deprivation and general development delay
Differential Diagnosis
The differential diagnosis for developmental delay is broad; however, some common causes include:
Autism Spectrum Disorder (ASD): Characterised by impairments in social interaction and communication alongside restricted interests and repetitive behaviours.
Cerebral Palsy: A group of permanent movement disorders appearing in early childhood due to abnormal brain development or damage.
Fragile X Syndrome: A genetic condition causing intellectual disability, behavioural challenges and various physical characteristics.
Down Syndrome: A chromosomal disorder leading to intellectual disability and characteristic facial features.
Fetal Alcohol Spectrum Disorders (FASDs): A range of effects that can occur in an individual exposed to alcohol before birth.
Initial Management
The initial management of a child with suspected developmental delay involves the following steps:
Clinical Examination: A thorough physical and neurological examination to assess the child’s developmental milestones.
Investigations: These may include genetic testing, metabolic screening, neuroimaging studies (MRI or CT scan), and hearing/vision assessments.
Referral for Specialist Assessment: If a specific cause is suspected, referral to a paediatric neurologist, geneticist or developmental paediatrician may be necessary.
Early Intervention Services: Regardless of the underlying cause, all children with developmental delays can benefit from early intervention services such as occupational therapy, speech and language therapy, physiotherapy and educational support.
A mother brings her 9-month-old child to surgery. She is concerned he is not developing normally and is ‘falling behind’ the children of her friends. Whilst observing the child you notice he sits without support but makes little effort to move around the room. He has a crude pincer grip, appears shy when you try to interact and says ‘mama’ but little else. What is the most accurate description of his development?
Normal development
50%
Isolated delay in gross motor skills
25%
Global developmental delay
16%
Isolated delay in fine motor skills
6%
Isolated delay in speech
3%
The most accurate description of the child’s development in this scenario is Normal development. This is because, according to the UK NHS guidelines, a 9-month-old child should be able to sit without support and have a crude pincer grip. They may also begin to say simple words like ‘mama’ or ‘dada’. Shyness around strangers is also typical at this age as part of stranger anxiety, which reflects normal social-emotional development.
The option Isolated delay in gross motor skills is incorrect because the child’s ability to sit without support demonstrates that his gross motor skills are developing normally. Gross motor skills refer to movements involving larger muscle groups and typically include milestones such as sitting, crawling, standing and walking. At 9 months, it’s not unusual for a child not to move around much.
Global developmental delay would imply delays in multiple areas of development, including cognitive skills, social and emotional skills, speech and language skills, fine and gross motor skills. However, based on the information provided in the question stem, there doesn’t seem to be evidence of delays across all these domains.
An Isolated delay in fine motor skills would mean that the child has difficulty with tasks requiring precision and control such as picking up small objects or using utensils. However, this child shows a crude pincer grip (ability to hold an object between thumb and index finger), which is expected at his age.
Finally, an Isolated delay in speech refers to when a child does not meet typical language milestones for their age group. According to NHS guidelines again though, saying simple words like ‘mama’ at 9 months old falls within normal speech development parameters.
A 10-month male infant is brought to the GP by his mother with concerns over using his right hand in preference to the left. He was born via vaginal delivery complicated by shoulder dystocia. He is up to date with vaccinations.
What is the appropriate management for this patient?
Reassurance
Refer to physiotherapy
Refer urgently to the paediatrician
Request a shoulder X-ray
Review in 2 months
Refer urgently to the paediatrician
Hand preference before 12 months is abnormal - it could be an indicator of cerebral palsy
Refer to the paediatrician is correct. This boy is presenting with early hand preference which points toward cerebral palsy causing weakness to the left side of the body.
Reassurance is incorrect. Hand preference before the age of 12 months is abnormal and needs to be investigated.
Refer to physiotherapy is incorrect. This boy needs to be investigated for cerebral palsy. Although physiotherapy is an integral part of managing cerebral palsy, a referral now is inappropriate as a proper diagnosis has not been made yet.
Request a shoulder X-ray is incorrect. This boy’s main issue is early hand preference; there is no mention of trauma, and the history of shoulder dystocia is irrelevant here as it usually causes Erb’s palsy where the arm hangs limply from the shoulder with flexion of the wrist and fingers due to weakness of muscles innervated by cervical roots C5 and C6.
Review in 2 months is incorrect. There is no point in delaying investigations given the differential diagnosis of cerebral palsy. Reviewing this boy in 2 months would not aid the diagnosis.
