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Paediatric Interventions > Developmental Delay > Flashcards

Developmental Delay Flashcards

1
Q

What is developmental delay?

A
  • Delayed acquisition of skills within expected time frames
  • May be in one area only, e.g. gross motor skills
  • May have global developmental delay involving 2 or more areas e.g. fine motor delay, language, cognition etc
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2
Q

What are the variable factors of DD diagnosis?

A
  • May be related to specific diagnosis e.g. down syndrome, prematurity etc
  • May not have a specific diagnosis but present with underlying hypotonia or hypermobility
  • May be transient
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3
Q

What is hypotonia?

A
  • Reduced resistance to passive ROM (low muscle tone)
  • Difficulty maintaining postural control & movement against gravity
  • More energy required to activate & sustain muscle contractions
  • Impacts on development of skills
  • Can be present without muscle weakness
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4
Q

What are the potential effects of hypotonia?

A
  • Can affect the whole body (e.g. speech and language, feeding, fine motor development)
  • Effect is increased when associated with cognitive impairment due to decreased motivation to move
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5
Q

What is hypermobility?

A
  • Excessive ROM at one or more joints (more than normal increased ROM in children)
  • Differential diagnosis needed to rule out connective tissue disorder
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6
Q

When is joint hypermobility syndrome diagnosed?

A

When other disorders have been ruled out, but the child is symptomatic for pain, injuries & fatigue

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7
Q

How can DD arise from hypermobility?

A

Because the child has difficulty controlling the extra degrees of freedom at their joints

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8
Q

How is hypermobility assessed?

A

Beighton scale

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9
Q

What is down syndrome (DS)?

A
  • Trisomy 21 resulting in 47 chromosomes instead of 26

- Caused by faulty cell division affecting 21st pair of chromosomes

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10
Q

What are the 3 types of DS?

A
  • Non-dysjunction (95%): Paired chromosomes failed to separate
  • Translocation (3-4%): Piece of one chromosome breaks off & sticks to another
  • Mosaic (1%)
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11
Q

What is the incidence of DS?

A
  • 1 in 1100 live births
  • One of the most common causes of ID
  • No gender bias
  • Incidence increases with age of mother (but 85% are born to mothers <35yo)
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12
Q

What does prenatal testing for DS involve?

A
  • US assessing skin folds at back of neck
  • Chorionic vilus samling at 8-12 weeks
  • Amniocentesis at 15-20 weeks
  • Small risk of miscarriage, may be false positives & negatives
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13
Q

What are the common characteristics of DS?

A
  • Immaturity of the organisation of the CNS
  • Hypotonia & ligamentous laxity (hyper flexibility)
  • Cognitive impairment
  • Congenital heart disease (66%)
  • Hearing impairments (60-80%)
  • Visual defect (60%)
  • Seizures (6%)
  • Obesity/low PA (60%)
  • Hypothyroidism
  • C1/C2 instability
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14
Q

What are the characteristics of delayed gross motor development?

A
  • Difficulties with postural control & balance
  • Usually follows sequence of typical development (TD)
  • Requires more time to learn movements as complexity increases
  • Slower reaction times during movement
  • Reduced strength
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15
Q

What are the other types of DD?

A
  • Oral motor & feeding delay
  • Speech & language delay
  • Fine motor delay
  • Delays in social & behavioural development
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16
Q

What does a child with DS demonstrate?

A
  • Static & symmetrical movement patterns
  • Compensatory & lack of variability (due to poor postural control)
  • But has the potential to develop a range of movement skills & postural control
17
Q

What are examples of compensatory movement patterns performed by children with DS?

A
  • Moves prone to sit by circumducting legs around in prone and then pushes up into sitting
  • Sits with head & neck extended resting on shoulders
  • In standing knees remain in hyperextension
  • Bottom shuffling for mobility
18
Q

What are some of the musculoskeletal issues in DS?

A
  • Shorter stature with shorter length in the long bones
  • C1/C2 instability
  • Recurrent dislocations of patella & occasionally hips
  • Mild-mod scoliosis
19
Q

What does screening for C1/C2 instability involve?

A
  • XR of cervical spine to measure excess movement of C1/C2 during flexion & extension
  • Child needs to be 3yrs or older
  • Recommended if child is doing contact sports which may place stress on the head or neck
20
Q

How should C1/C2 instability be managed in DS?

A
  • Avoid somersaults & whiplash-type movements (e.g. trampoline) which may be due to poor head control
  • Monitor for change in neurological status

Paediatric Interventions (27 decks)

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