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Pediatrics 2 > developmental > Flashcards

developmental Flashcards

1
Q

what is development

A

series of physical, psychological and social changes

interplay between genetics and environmental factors

synapses forming is what coincides with specific skills or milestones

brain has plasticity and can recover but this takes time, intensity and repetition to reorganize the neural system

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2
Q

how does development progress

A

follows a predictable course

later skills depend on attainment of previous ones

can vary in rate between children

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3
Q

what are milestones

A

age by which 50% have reached a skill

varies in rate because there is a window of normal for a milestone

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4
Q

how does physical development of a childs skills progress physically

A

cephalocaudal progression (head to toe)–>ie learn to hold your head up before you can walk

also proximal to distal progression–> grab objects with your whole hand before you develop a pincer grasp

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5
Q

describe the development of locomotion

A

first creep or commando crawl–> crawl–> cruise (two handed support on stationary objects before you move)–> unsupported walking

creeping–> 5-6 months old
crawling–> 6-9 months old
cruising–> 9-10 months old
walking–> 12 months with median age of 9-17 months

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6
Q

what are locomotion RED FLAGS

A

child not sitting by 9 months

child not walking by 18 months

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7
Q

what is the development of the pincer grasp

A

rake(6 mo)–> inferior scissors grasp(7 mo)–> scissors grasp (8 mo)–> inferior pincer grasp (9 mo)–> pincer grasp (10 mo) –> fine pincer grasp (12 mo)

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8
Q

when do you develop the pincer and fine pincer grasps

A

pincer 10 mo

fine pincer 12 mo

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9
Q

why is it important to assess a childs development

A
  1. ID problems early
  2. initiate intervention early
  3. improve outcomes in children

**the earlier you intervene the better the outcomes for kids–> academically, IQ points, increased adult employment, decreased criminality etc

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10
Q

what is the frequency of delays in at least one domain of development

A

12-16% of kids present with delays in at least one domain (1 in 6-8 kids)

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11
Q

what are the overall categories of the developmental history

A
  1. gross and fine motor skills
  2. language
  3. social-emotional
  4. cognition
  5. adaptive/self care skills
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12
Q

what does a typical 18 month old year old do developmentally?

A

GM–> runs
FM–> 4 cube tower
language–> 10-25 words and points to three body parts
cognitive–> matches a pair of socks
self help–> removes a piece of clothing
SE–> engages in pretend play with toys, parallel play

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13
Q

at what age can kids stack 2 blocks

A

15 mo

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14
Q

at what age can kids stack 6 blocks

A

2 years

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15
Q

what can a typical three year old do

A

GM–> goes up stairs, alternating feet, no railing
FM–> copies circle
language–> follows 3 step commands, 200 words, 75% intelligible, 3-4 word phrases
cognition–> states full name, age, gender, counts to 3, IDs shapes
self help–> puts on shoes without laces, unbuttons
SE–> starts to share without prompting, cooperative play, fears imaginary things, uses words to describe what someone else what thinking

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16
Q

what is surveillance

A

longitudinal, continuous process by which knowledgeable professionals ID children who may be at risk for developmental delay

assess medical and psychosocial factors that can put a child at risk for developmental delay at each visit

address parental concerns, maintain devel hx, observe kid

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17
Q

what are the 5 components of surveillance

A
  1. attending to a parents concerns
  2. documenting a patients history
  3. making observations of a child
  4. identifying risk and protective factors
  5. recording
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18
Q

what is screening

A

conduct this if specific concerns are IDed during surveillance and also at recommended screening ages

when you admin a specific assessment or tool to determine or detect developmental issues

large amount of kids will have delays but will not be picked up before kindergarten

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19
Q

when does the AAP suggest screening

A

ages 9, 18 and 24 or 30 months

tools to use: ASQ, child development inventory

20
Q

what is the expected age for the following milestone–

first meaningful word

A

9-10 months

21
Q

what is the expected age for the following milestone–

additional word

22
Q

what is the expected age for the following milestone–

10-25 words

23
Q

what is the expected age for the following milestone–

starts to sound/voice

24
Q

what is the expected age for the following milestone–

coos

25
Q

what is the expected age for the following milestone–

laughs, squeals

26
Q

what is the expected age for the following milestone–

babbles

27
Q

what is the expected age for the following milestone–

follows two step commends and two word phrases

28
Q

what is the expected age for the following milestone–

50 or more words, 50% intelligible

29
Q

what is the expected age for the following milestone–

200 or more words, 3 word sentences, 75% intelligible

30
Q

what is the expected age for the following milestone–

tells stories, 100% intelligible

31
Q

Ddx for possible language delay

A 
hearing impairment 
autism
global developmental delay
language disorder
genetic or neuro condition
anatomical abnormalities
psychosocial factors
32
Q

what is a language disorder

A

impairment in the comprehension (receptive) and/or impairment use of the form, content, function of langauge (expressive)

33
Q

what is a speech disorder

A

impairments of articulation, fluency and voice

34
Q

how common are speech and language impairments in kids

A

as high as 16-22%

in early school age kids–>
7% language disorders
4% speech disorders

35
Q

what do we care about speech and language disorders?

A

increased risk for reading and spelling difficulty, impaired writing (written expression) and attention and social issues

36
Q

how would you manage a child with an expressive language disorder

A
  1. further assessments–> hearing test, speech and language assessment
  2. interventions–> reading, daycare/preschool, encourage oral and nonverbal expression, speech and language therapy
  3. follow up

**watchful waiting may be appropriate if there is a MILD delay BUT be cautious as 2/3 kids younger than 3.5 years with SLP delays will need speech therapy after 1 year without intervention–> no useful predictors to determine which will improve with watchful waiting and which wont. Thus, should always refer is delay is found for SLP assessment

37
Q

can being a boy/being second or third child/being raised bilingual explain a language delay?

A

no

none are adequate explanations for clinically significant delays

boys develop language more slowly than girls in the preschool period but difference is 1-2 months (not clinically significant)–> boys are MORE likely to have SLP issues so their delays should be taken seriously

bilingual enviro slows process of language learning and kids with bilingualism have smaller vocabularies if only one language is assessed but are age appropriate if both are assessed–> can show language mixing

literature inconsistent on birth order

38
Q

what are the DSM V criteria for autism

A
  1. persistent deficits in social communication and social interaction
    - -> deficits in social-emotional reciprocity, non verbal communicative behaviours, deficits in developing, maintaining and understanding relationships
  2. restricted, repetitive patterns of behaviour, interests or activities
    - -> stereotypes or repetitive motor movements or speech, insistence on sameness, restricted/fixated interests, hyper or hypoactivity to sensory input or sensory seeking
39
Q

what aspects of a history may make you suspect autism?

A

motor stereotypies–>lining up of toys, other repetitive play, echolalia, idiosyncratic phrases

  1. inflexibility, adherence to routines, ritualized behaviours, distress at small changes, trouble with transitions
  2. social deficits, losing words
40
Q

how common is autism

A

1/68 kids

more boys than girls

41
Q

when is autism typically recognized

A

second year of life

42
Q

how would you manage an initial dx of autism

A
  1. refer–> SLP, preschool/daycare, early intervention
  2. hearing assessment
  3. autism assessment
43
Q

what should be on your ddx for a child struggling academically in school

A
  1. developmental disorder –> ADHD, specific learning disorder, intellectual disability
  2. sensory impairment (hearing, vision)
  3. neuro disorder (seizures)
  4. chronic medical conditions (OSA, thyroid)
  5. mental health
  6. psychosocial stressors
  7. substance abuse issues
44
Q

how is a specific learning disorder characterized

A

average cognitive skills but academic skills significantly below average

types: reading, writing, math

45
Q

what is the first screen when you suspect language delay

46
Q

what is the frequency of developmental disability in the general population

47
Q

what are the domains of child development

A

motor–gross and fine

language–receptive and expressive

social/behavior

daily living skills

academic

(gross motor, fine motor, social, adaptive)

Pediatrics 2 (19 decks)

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