Developmental

Question 1

How many blocks stacked at key ages?

Answer 1

• Stacking blocks
  
  • 2 at 15m.o
  • 3 at 18 m.o
    6 at 2 y.o

Question 2

What age for rake and pincer grasps?

Answer 2

Grasp
* Rake grasp 6 m.o
* Pincer = 9 mo
Refined pincer = 12 mo

Question 3

Eye contact - friendly to all and stranger danger?

Answer 3

Eye contact (6 mo friendly to all, 9 mo fearful strangers)

Question 4

Key milestones + age in personal/social domain?

Answer 4

· Eye contact (6 mo friendly to all, 9 mo fearful strangers)
· Ask child to give toy back
· Peekaboo - 9 m.o
· Wave 12 mo
· Points to picture in book (18 mo)
Feeds self with spoon (2 y.o)

Question 5

Key language milestones by age?

Answer 5

Language
· Receptive - understanding (always before receptive)
· Expressive - saying
· Vocalises and laughs (3mo)
· Mama/Dada (9 mo)
· Mama/Dada + 3 words (1 y.o)
· 5-10 words (18mo)
· 2 word sentences, 50-100 words (2y.o)
3 word sentences (3 y.o)

Question 6

Areas to assess for gross motor assessment?

Answer 6

Gross motor = 180 degrees exam
· Supine/Lying - posture, abnormal posture, rooting reflex, ATNR
· Sitting
- Palmar grasp - pull to sit
- Head lag
- Head and trunk control
- Sit unsupported
- Moro reflex
· Weight bearing
- Stepping reflex
- Lower limb scissoring
- Inappropriate weight bearing
· Ventral suspension
· Prone - head raise and trunk support

Older
· Walk (12 mo) 
· Run (15m, 18m well) 
· Catch/throw ball (overhead 18m)  Jump (3y.o)

Question 7

What are key system DDx for developmental delay?

Answer 7

DDx
Neurological
- Prenatal, intrapartum or post partum event

Genetic/Chromosomal
- Dysmorphic
- Growth

Metabolic
- Growth - head size
- Liver, spleen, cardiac, bones

Chronic illness
Scars

Question 8

Summary structure - developmental?

Answer 8

Summary
· Asked to perform developmental assessment on X ia 2 year old male
· Growth - appropriate/not appropriate
· Pertinent finding
- Isolated/global developmental delay
· With respect to each domain:
- Skills demonstrated today place at a X level
- Fine motor -
- Gross motor -
- Language -
- Social

· With respect to underlying cause: 
- Posturing/tone - CP, neuromuscular 
- Head size - macrocephaly +/- shunt - spina bifida
- Microcephaly - CP, TORCH 
- Dysmorphic features - syndromic, ex prem 
- Hepatosplenomegaly - metabolic

Ix
· Most high yield 
- Brain imaging 
- Microarray 
· Reversible causes
- TFTs, Fe/B12, CK 
Metabolic screen if metabolic disorder
· Other - birth Hx, FHx, results NST

Question 9

How to assess and Ix for developmental delay?

Answer 9

Assessment
Diagnosis - Bayley/Griffith
Cognitive assessment - neuropsychologist
Hearing and vision

Ix
Baseline pathology - FBE UEC LFT CMP, Fe B12, folate, CK, TSH
Genetic - microarray, karyotype, Fragile X
Imaging - MRI brain, EEG

Question 10

Isolated Speech Delay - Ix?

Answer 10

Isolated Speech Delay - Ix
Hx - first words, words at home with meaning, other languages at home
Formal audiology and vision testing
Screening for autism (home and school)
Other reversible causes - FBE, Fe studies, B12, folate, TFT

Question 11

Ix for Isolated Motor delay?

Answer 11

Ix Isolated Motor delay

Examine hips and x-ray - DDH
Genetic panel - dystrophin
CK
MRI brain (focal neurology)

Question 12

What are DDx for global developmental delay?

Answer 12

Chromosomal/Syndromic
Weight = length
Distinctive facial features
Neurological
HC < length and weight
Static (no regression)
Antenatal: maternal toxin, teratogen, TORCH infections
Perinatal: HIE
Post-natal: encephalitis, ABI
Overarching: structural malformation, stroke, genetic/syndromic, epileptic encephalopathy
Degenerative
Grey matter - Niemann Pick, Tay Sachs
White matter - leukodystrophies
Other - Rett’s, ataxia telangiectasia
Metabolic
Weight = length
Distinctive facial features
Growth - micro/macrocephaly, FTT
Complications - cardiac, HSM, bones
Chronic illness
Weight < HC
Signs of chronic disease
Scars - previous surgery
Macronutrient deficiency

Question 13

What are DDx for isolated speech delay?

Answer 13

Isolated Speech Delay DDx

Late bloomers- isolated expressive language delay - 2-3 years, spontaneous improvement
Hearing impairment
Autism
Structural - cleft palate, NGT

Question 14

What are Ix for global developmental delay?

Answer 14

1. Longitudinal growth parameters - acute vs chronic, static vs progressive
2. Further Hx
   correct for prematurity
   Birth/Neonatal Hx: prem, resus - HIE, TORCH
   NST results
   FHx + consanguinity
   Dev Hx: regression, collateral Hx from childcare/kinder/school
3. Formal vision and hearing assessment
4. GDD
   Microarray/Karyotype, Fragile X - Turners, Fragile X,
   MRI brain and spine - micro/macrocephalic, abnormal neuro
5. Ix for reversible causes
   FBE, Fe studies, B12 and folate
   TFTs
   CK (motor, myopathy)
   TORCH screen
   Metabolics - gas, ammonia, urine/serum organic acids (regression, FHx, hypotonia, vomiting/dehydration)
   Mx
   Correct cause
   Early intervention

Question 15

What are primitive reflexes and when should disappear?

Answer 15

Primitive Reflexes
Stepping: Birth - 1.5 months
Palmar grasp: Birth - 3 months
Suck, rooting, Moro: Birth - 4 months
Asymmetric tonic neck reflex: 2 months - 6 months

Question 16

What are red flags for ASD?

Answer 16

Lack of prodeclarative point 18 m.o biggest risk factor (point wanting to share experience)
Restricted interests, sensitivity to sound/light

No babbling/cooing by 12 m.o
No gestures by 12 m.o (point, wave, grasp)
No single word by 16 m.o
No 2 word phrases by 2
Any regression of language or social skills any age

Question 17

What are red flags for CP?

Answer 17

Not walking by 18 m.o
Early hand preference (< 1 yr), fisting of one had
Asymmetric position crawling, limp when walking
Failure to meet motor milestones
Toe walking, scissoring
Not sitting by 8 m.o
Hypotonia initially then hypertonia
Persistent of primitive reflexes
Clonus
Feeding/behavioural abnormalities