developmental milestones

Question 1

primary brain

Answer 1

vesicles and flexures

Question 2

6 weeks

Answer 2

more flexures and swellings

Question 3

10 weeks

Answer 3

cerebral explansion and commissures

Question 4

3 months

Answer 4

basic structures established

Question 5

5 months

Answer 5

CNS myelination begins

Question 6

7 months

Answer 6

lobed cerebrum

Question 7

9 months

Answer 7

gyri (ridge) and sulci (furrow)

Question 8

myelination

Answer 8

before PNS/SC/brain
compostion changes
Galactolipids 
Protein components 
Begins ~5th month in humans; 10 days postnatal in rat
At peak, oligos produce 3x ‘body weight’ per day
Most over by 2 years, some in late teens (neocortex)

Question 9

rubella

Answer 9

german measles
heard immunity vaccine
abnormalityoes dependent on time of infection of virus
6th  week- eye malformation e.g. cataract
9th week- deafness - organ of corti
cardiac malformation 5-10th weeks
CNS disorders in 2nd trimester
risk falls after 16 weeks

Question 10

fetal alcohol syndrome

Answer 10

dose dependent (more alc more probs)
difficult to ascertain lower limit of alcohol comsumption
Alcohol crosses placenta. 
Fetus doesn’t clear alcohol well. 
\ Fetal levels higher.

Question 11

fetal alc syndrome symptoms

Answer 11

Microcephaly 
Loss of cells 
Loss fibres e.g. callosal agenesis 
Disturbed migration 
Irritability 
Motor and intellectual impairment

Question 12

FAS facial abnormalities

Answer 12

discriminating features:
short palpebral fissures
flat mid face
short nose
indistinct philtrum
thin upper lip

associated features
epicanthal folds
low nasal bridge
minor ear abnormalities
micrognathia

Question 13

opiates

Answer 13

neonatal withdrawal

Question 14

cocaine

Answer 14

hypoxia, abortion, withdrawal impaired cognition

Question 15

ecstasy

Answer 15

long term effects on hippocampus

Question 16

cannabis

Answer 16

long term cognitive effects

Question 17

maturation of axon conduction velocity

Answer 17

Speed of conduction  with myelination
Neonate peripheral nerve ~ 20 - 25m/s
1 – 6m 32 – 50m/s
6 – 12m 33 – 60m/s
12 – 24m 40 – 60m/s

Question 18

‘when does the foetus feel pain’ - sensation

Answer 18

2 reviews
Royal Coll. Obs. Gynae. 1997 and 2010 reviews.
Somatosensory input e.g. pain, requires connection of receptors, sensory neurons, thalamus and cortex.
Is when pain the circuitry for pain reflex has developed

Question 19

stages of development of sensation

Answer 19

Innervation of dermal skin from 28 weeks / subdermal from 6 - 8 weeks
DRG connection to spinal cord from 8 weeks. Non - noxious.
C – fibre (noxious stimuli) connection from 19+ weeks.
Reflex response to noxious stimuli in 23 week preterm infants.
Facial responses to heel lancing from 28 weeks.
Organised thalamus forms from 8+ weeks.
Retinal inputs arrive at 14 – 16 weeks.
Myelination from 25 weeks.
Connections from the thalamus to cortex from 24 weeks. (Sub-plate 12+)
Evoked potentials in the cortex from 29 weeks (RCOG) or earlier (26 weeks e.g. Taylor et al 1996).
Recent imaging studies suggest 24 week cortical responses.

Question 20

taste and smell

Answer 20

Well developed at birth.
Differentiate mother / non-mother breast pads.
Bottle-fed prefer any lactating female.

Question 21

hearing

Answer 21

Responsive at birth.
Excellent discriminators of phonemes
Locate sounds from 3 days.

Question 22

vision

Answer 22

Eyes open and sensitive from 7 months. 
Vision least well developed at birth. 
Retinal cells sparse and not mature. 
Optic nerves not myelinated. 
Vision blurred – sharper by 6 months. 
Development of ocular dominance columns
Colour vision develops – good at 2 months.

Question 23

motor

Answer 23

Spontaneous muscle twitches
Writhing from E28 – 32.
Increases to birth.

Question 24

postnatal reflexes: moro

Answer 24

(startle) reflex
Baby supine – remove head support.
Trunk extension.
Cycle of limb extension (adbuction - from midline).
And limb flexion (adduction - to midline).
Goes 3+ months

Question 25

stepping reflex

Answer 25

Hold up, feet onto surface.

Goes 6 weeks

Question 26

palmar grasp reflex

Answer 26

May support own weight.
Goes by 3-4 months
Development of inhibition

Question 27

swimming reflexes

Answer 27

not all babies
may swallow
goes by 4-6 months

Question 28

babinski reflex- sign

Answer 28

Neonates fan toes when sole stroked.

adults curl toes.
descending motor tract damage – fan.

Question 29

rooting

Answer 29

stroke cheek
nipple seeking
goes 4-7 months

Question 30

sucking

Answer 30

stroke lips

Question 31

reaching

Answer 31

5th month after birth
around 8-9months attain objects
by 2 year show adult motor patterns