Developmental Milestones Flashcards

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1
Q

Gross motor milestones

A

3 months

  • lies on abdomen with good head control
  • held sitting with lumbar curve

6 months

  • lying on abdomen with arms extended
  • lies on back and grasps feet
  • pulls self to sitting
  • rolls front to back

7 - 8 months
- sits without support

9 months

  • pulls to standing
  • crawls

12 months

  • cruises
  • walks with one hand held

13 - 15 months
- walks unsupported

18 months
- squats

2 yo:

  • runs
  • walks upstairs and downstairs holding on to a rail

3 yo:

  • rides tricycle
  • can walk upstair independently
  • walks on tiptoes

4yo:
- can hop and skip

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2
Q

Fine motor milestones

A

6 weeks - fixated on objects

6 months - reaches for objects and transfers from one hand to another

1 year - pincer grip

18 months - scribbles

2.5 yo - draw lines

3 yo - circle

4 yo - cross

4.5 yo - square

5 yo - triangle

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3
Q

Social behaviour and play milestones

A

6 weeks - smiles

3 months - laughs, enjoys friendly handling

6 months - not shy but stranger anxiety

9 months - shy and takes everything to mouth, object permanence

10 months - waves bye

15 months - requires help with dressing, uses spoon

18 months - indicates toilet needs

2 years - dry during the day

3 years - dry at night

4 - 5 years - dresses alone

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4
Q

Feeding milestones

A

12 - 15 months - drinks from cups, uses spoons

2 years - competent with spoon and doesn’t spill with a cup

3 years - uses spoon and fork

5 years - uses knife and fork

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5
Q

Dressing milestones

A

12 - 15 months - helps getting dressed

18 months - takes off shoes

2 years - puts on hat and shoes

4 years - can dress and undress independently except laces and buttons

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6
Q

Play milestones

A

9 months - peek a boo

10 - 12 months - waves bye

18 months - plays alone

2 years - plays near others but not with them

4 years - plays with other children

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7
Q

When to investigate delayed walking

A

Refer at 18 months

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8
Q

When to investigate sitting

A

Refer at 12 months

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9
Q

When to investigate delayed social behaviour

A

Refer is not smiling at 10 weeks

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10
Q

Grasp milestones

A

6 - 8 weeks - fixes their eyes on an object and follows it

6 months - palmar grasp of objects

9 months - scissor grasp of objects

12 months - pincer grasp

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11
Q

Red flags for development

A
Not smiling at 10 weeks 
Not being able to hold an object at 5 months 
Not sitting unsupported at 12 months 
Not walking at 18 months 
Bot running at 2.5 yo 
No words at 18 months 
No interest in others at 18 months
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12
Q

How is a learning disability assessed?

A

The severity of the learning disability is based on the IQ (intelligence quotient):

55 – 70: Mild
40 – 55: Moderate
25 – 40: Severe
Under 25: Profound

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13
Q

Puberty age in males and females

A

Males: 9 - 15yo
Females: 8 - 14 yo

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14
Q

First and last signs of puberty in females

A

First: Breast bud development and pubic hair
Last: Menstruation

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15
Q

First and last signs of puberty in boys

A

Start: testicular enlargement
Last: deepening of voice

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16
Q

What can be used to determine the pubertal stage of a patient

A

Tanner staging

17
Q

Causes of hypogonadism

A

Hypogonadotrophic hypogonadism: a deficiency of LH and FSH

Hypergonadotrophic hypogonadism: a lack of response to LH and FSH by the gonads (the testes and ovaries)

18
Q

Hypogonadsim meaning

A

Lack of the sex hormones - oestrogen and testosterone

19
Q

Causes of Hypogonadotropic Hypogonadism

A

damage to the pituitary or hypothalamus - radiotherapy, surgery, cancer

  • Hyperprolactinaemia
  • Excessive dieting or exercising
  • Constitutional delay in growth and development
  • Kallman syndrome
20
Q

Causes of Hypergonadotropic Hypogonadism

A

Previous damage to the gonads (e.g. testicular torsion, cancer or infections, such as mumps)

Congenital absence of the testes or ovaries

Kleinfelter’s Syndrome (XXY)

Turner’s Syndrome (XO)

21
Q

Investigations for delayed puberty

A

Bloods - FBC and ferritin for anaemia
U&E - CKD
Anti-TTG / anti-EMA antibodies - coeliac disease
Hormonal blood tests:
- Early morning serum FSH and LH - low in hypogonadotrophic hypogonadism and high in hypergonadotrophic hypogonadism.
- TFTs
- GH and ILGF Insulin-like growth factor I - GH deficiency.
- Serum prolactin

Genetic testing:

  • Kleinfelter’s syndrome (XXY)
  • Turner’s syndrome (XO)

Imaging:

  • Xray of the wrist - bone age for constitutional delay
  • Pelvic USS in girls - ovaries and other pelvic organs
  • MRI of the brain - pituitary pathology and assess the olfactory bulbs in possible Kallman syndrome
22
Q

Tools to monitor development

A

Primary care - ASQ, Denver development screeing

Secondary care - SOGS II, Griffiths

23
Q

Investigations for developmental delay

A

Bloods

  • FBC
  • U+E
  • Bone profile
  • LFT
  • CK - muscular dystrophy
  • TFTs
  • Ferritin
  • Metabolic screen if indicated

Urine tests - urine amino acids and organic acids

Genetic testing - if dysmorphic

EEG/MRI - seizures