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Child Health > Developmental Milestones > Flashcards

Developmental Milestones Flashcards

1
Q

What are the 8 red flags for development?

A

ARSWSLV

  1. Asymmetry of movement
  2. Not reaching for objects (Autism?)
  3. Unable to sit unsupported at 12 months
  4. Not walking at 18 months- check CK for Duchenne’s
  5. Not speaking at 18 months
  6. Loss of skills
  7. Concerns re. hearing/vision
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2
Q

In terms of child development, what does median age mean?

A

The median age is the age at which 50% of kids have achieved the milestone.

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3
Q

In terms of child development, what is the limit age?

A

The limit age is the age at which the skill should’ve been acquired (97.5% of children)

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4
Q

Which is more useful to assess if a child is developmentally delayed and if investigations are required?

Median age or limit age?

A

Limit age

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5
Q

You’ve been asked by the GP to see a mother and her 6 week old newborn while he goes to make a cup of tea. He wants you to see if the baby has hit her four developmental milestones.

What are you hoping to find?

A
  • Gross motor
    • head control in vertical
  • Fine Motor & Vision
    • follows torch with eyes
  • Language & Hearing
    • stills to voice
  • Social & Play
    • social smile
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6
Q

You see baby Joe in clinic. He’s 3 months and maintain this posture when pulled from supine position to a sitting position.

What developmental milestone has he hit?

A

Gross Motor Skill

No head lag on pulling to sit

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7
Q

In clinic Joe you also notice that when left lying on his back Joe lies like this:

Is this to be expected in a 3 month old baby?

A

Yes

This is Joe achieving his fine motor and vision skills milestone of “regarding hands in midline”

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8
Q

The GP assess Joe’s Language & Hearing and Social & Play development?

What are you hoping he (at 3 months old) displays?

A
  • Language & Hearing
    • vocalises with familar person
    • laughs and coos
  • Social & Play
    • reacts pleasuribly to familiar situations
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9
Q

You see Sophie in Baby Clinic whilst on GP placement. She’s 6 months old. She’s very cute and happily sits in her buggy happily making noises vaguley sounding like “mamama”

Whilst her mum chats to the GP you give Sophie a toy which she clusmily grabs from your palm using her full hand. She starts playing with the toy which she passes from one hand to another before putting it in her mouth. Her mum (a frightfully posh lady who’s disgusted that her little angel is playing with an NHS GP Surgery’s toy) takes the toy off her causing Sophie to scream.

What developmental milestones has Sophie displayed here?

A
  • Language & Hearing
    • babbles tunefully (mamama)
    • screams when annoyed
  • Fine motor vision
    • palmar grasp
    • transfers object hand to hand
    • mouths object
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10
Q

After a minor meltdown Sophie decides she’d rather play with her feet anyway. You’re having a great wee time with Sophie who is very friendly with you while her mum moans and groans about immigrants coming into this country to steal people’s jobs.

The GP is clearly bored of the mum and decides it’s time to assess Sophie’s gross motor skills.

What has she already displayed whilst sitting in her buggy? And what do you hope to see in regards to her gross motor skills?

A

(In the buggy)

Social and Play

  • still friendly with strangers
  • plays with feet

Gross Motor Skills

  • Pushes up on arms in prone
  • Can roll from stomach to back
  • Weight bears on legs
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11
Q

On placement and it’s baby clinic day. You’re absolutely knackered and just want to get this last consultation over and done with. You look at the list and the name of the next baby is Valentino *inner sigh* The GP spots this and reassures you Valentino’s parents are not the rude posh kind but the new-age hippie posh kind and he’s actually a very cute baby- even if they won’t vaccinate him because “they wouldn’t want to risk the health of their baby with unnatural products” (we’ll get to that later)

While the GP chats to Valentino’s parents about the importance of vaccination you play with him in an attempt to assess some developmental milestones.

At first, he’s anxious being left with you rather than his parents but after a quick game of peek-a-boo settles in. He crawls over to the nearest chair and uses it help him stand- for what purpose you’re not sure but hey that’s babies. You get Valentino to sit down and are impressed with how he can sit up and lean forward to reach for the toys you’ve cruelly left just out of reach.

You set him up on the examination table to see if he can pick up a cheerio (which he can’t). He quickly loses interest and points to the larger more manageable toy which he then drops off the table- out of sight. He looks at you as though you might have it rather than over the edge of the table.

What developmental milestones has Valentino displayed and what ones has he missed?

A

He’s hit all his gross motor targets:

  • Sits well and leans forward to reach toys
  • Stands holding on to furniture
  • May crawl

He’s done 50/50 with fine motor & vision:

  • using index finger to point
  • picks up tiny objects between thumb and hand

In terms of social & play he hasn’t quite figured out object permanence (silly Valentino) but has shown:

  • anxious around strangers
  • plays peek-a-boo

The bit you’re more worried about is his language & hearing. He should:

  • localise sound consistently
  • make polysyllabic babble (aghah aghah)
  • imitate sound
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12
Q

After a gruelling PLEASE VACCINATE YOUR CHILD chat the GP turns to you to see how you’re getting on and asks for a quick report

You explain what you’ve noticed about Valentino’s language & hearing milestones. Valentino’s parents admit they haven’t noticed anything unusual at home. The GP points out Valentino hit his 6 month Language & Hearing milestone a bit late and so maybe his 9 month will be a bit “late” too.

Are you still concerned about Valentino’s Language & Hearing development?

A

Not massively

9 months is the median age; not the limit age

Some kids take are a bit slower with certain aspects of the milestones thing.

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13
Q

What gross motor skills would you expect of a 12 month old?

A

“cruises” around furniture

may take first step

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14
Q

What fine motor and vision developmental milestones would you expect of a 12 month old kid?

A
  • neat pincer grip
  • bangs toys together
  • casting toys
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15
Q

What language and hearing developmental milestones would you expect of a 12 month old baby?

A
  • knows and responds to name
  • jargons vowels and consonants
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16
Q

What social and play developmental milestones would you expect of a 12 month old?

A
  • drinks from cup
  • waves bye-bye
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17
Q

What would you expect of an 18 month old toddler in regards to Gross motor skills?

A

Runs

Clims onto adult chair

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18
Q

What would you expect of an 18 month old toddler in regard to fine motor and vision developmental milestones?

A

Builds tower of 3-4 bricks

Hand preferance

Enjoys picture books

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19
Q

What would you expect of an 18 month year old toddler in regards to social & play developmental milestones?

A
  • feeds with spoon
  • initiates adult activities e.g. sweeping
20
Q

What would you expect of an 18 month old toddler in regards to language and hearing developmental milestones?

A
  • 5-20 words
  • points to body parts
21
Q

In baby clinic again on GP placement. The next case is an intersting one, in that it’s two 2 year old twins. Mary-Jane (MJ for short) and John Junior (JJ for short). You go downstairs to get them from the waiting room.

You walk into a waiting room that has descended into chaos upon the arrival of these unruly twins. MJ has just built a tower of 6-7 bricks showing a clear preference for her right hand. Just as she steps back to admire her handiwork her brother JJ throws a ball (who the f*** thought giving him a ball would be a good idea?) overhead which consequently knocks down Anna’s tower.

Before she has a chance to get upset you call their names. Their mum brings them to the bottom of the stairs and tells them to go up. They both clamber upstairs 2 feet per tread.

What developmental milestones have they shown already?

A

Gross motor

  • can throw ball overhead
  • ascends and descends stairs 2 feet per tread

Fine Motor and Vision

  • builds tower of 6-7 bricks
  • hasn’t shown an ability to make a circular scribble yet

Language and Hearing

  • able to understand simple instructions
  • haven’t shown 50+ words; joining 2 words or talking to themselves

Social & play

  • you haven’t had a chance to assess it yet but would hope to see
    • puts on hat and shoes
    • developing symbolic play e.g. feeding teddy
22
Q

MJ and JJ (the two 2 year old twins) finally reach the GP’s room where they’re left to play under your supervision while GP chats to mum about the stress of having twins- oh and she mentions she’s now pregnant with another so that’s exciting/stressful!!

JJ grabs a pencil and paper and draws with his right hand a series of circular scribbles. Meanwhile MJ begins to “feed” a BabyBorn doll.

You have a chat with each of them and they each had 50+ words; even managing to join some of them together. You also notice when you were talking to MJ JJ chatted away to himself admiring his circles and vice versa.

What developmental milestones have the twins clearly hit?

A

Fine Motor and vision

  • circular scribbles
  • (having already shown an ability to build a tower of 6-7 blocks)

Language and Hearing

  • 50+ words
  • joins 2 words
  • talks to self
  • (having already shown they can understand simple instructions)

Social and Play

  • developing symbolic play (e.g. feeding teddy)
  • have yet to show an ability to put on hats and shoes
23
Q

Whilst sitting drawing circular scribbles with JJ and MJ (who’s now lost interest with the doll and wants to show she too can draw circles) you look over to see their mother showing the GP a simply adorable video of her two precious little beings.

The video shows them getting ready to go out for a walk in the snow and putting on their own woolly hats and slipping on their shoes. Adorable!

What is medically relevant in this scenario?

A

You can now confirm MJ and JJ have also achieved a Social and Play developmental milestone by putting on hat and shoes.

Don’t ask me what’s sociable or playful about that.

Also I don’t know what the rules are on ticking off developmental milestones via video but it’s a modern world and I don’t see why not.

24
Q

You’re walking your dogs in the park and notice a kid who looks to be about 3 y/o pedalling a trike. Is this a developmental milestone for his age group?

What are the gross motor skills expected of a 3y/o?

A

Yes!

Gross motor skills for a 3 y/o:

  • pedals a trike
  • stands on one foot momentarily
  • up stairs with alternating feet
25
Q

What fine motor & vision developmental milestone would a 3 y/o be expected to hit?

A

The 3 C’s

  • cuts
    • cuts with scissors
  • copies
    • copies circle
  • castle
    • builds tower of 9-10 bricks
26
Q

You’re queuing up in Primark getting a headache from the kid standing in front of you. She seems to be about 3 y/o and won’t stop asking her mum questions.

Her mum ends up buying her a packet of sweets which the little girl kindly tries to share with her baby brother.

Aaauming she is 3 y/o, what developmental milestones has this random child in Primark shown?

A

Language and Hearing

  • asks lots of questions
  • she hasn’t shown:
    • knows own name and gender
    • carries on simple conversation
    • understands prepositions

Social and Play

  • understands sharing and playing with others (not sure the sweets thing counts but you get the gist)
  • she hasn’t shown:
    • washes hands
    • vivid pretend play
27
Q

What language and hearing developmental milestones would be expected of a 3 y/o?

A

knows own name and gender

asks lots of questions

carries on simple conversatin

understands prepositions

28
Q

What social and play developmental milestones would be expected of a 3y/o?

A

Washes hands

Vivid pretend play

Understands sharing and plays with others

29
Q

You’ve somehow managed to make it to fifth year. You’re on GP placement at the same practice you did your 4th year placement on. In baby clinic you read two very familiar names: MJ and JJ.

The twins are now 4 y/o and still causing havoc in the waiting room. Somehow, once again someone’s been brave/stupid enough to give MJ and JJa sponge football and are kicking, throwing and even catching it all around the waiting room. When called, the ask if you’re the doctor and proudly show you that they can hop; having a competition to see who can hop for the longest. Their exhausted mother (she’s since had baby no. 3) tells them to go upstairs to the GP’s office and off they go, running up the stairs.

Have MJ and JJ stayed on track and hit all their gross motor developmental milestones?

A

Yes

  • runs up and down stairs
  • can kick, throw and catch ball
  • hops on preferred foot
30
Q

Once in the GP’s office MJ and JJ (now 4 y/o) can’t wait to tell the GP all about their new baby brother and manage to recount the stories in sentences of 5+ words.

You give JJ pencil and paper and see if he can copy the cross you’ve drawn (#subtleconversion) which he can. You look over and see MJ has drawn a picture she claims is you; you hope that not what you look like but to be fair to her she’s giving you a head, legs and a trunk.

So far in your assessment, how are MJ and JJ doing in their development?

A

In the GP room they’ve shown they’ve hit all their Languge & Hearing milestones:

  • recounts stories of recent experiences
  • sentences of 5+ words
  • counts to 20

Fine motor and vision

  • copies cross
  • draws a man with ehad, legs and trunk
  • hasn’t shown they can thread beads
31
Q

With JJ and MJ (the 4 y/o twins) you need to see if they can thread beads. You’ve only got one set though- NHS budgets don’t allow for twins I guess.

So the twins take turns threading beads.

Why has this budget issue actually turned out to be useful?

A

You’ve been able to see if they understand the concept of turn-taking (a social & play milestone expected of 4y/o)

Threading beads is a fine motor and vision milestones for a 4y/o

32
Q

The GP interupts you from your bead-threading session with JJ and MJ to see if you’re finished and if you need to ask their mum anything.

Do you?

A

A social & play milestone for 4 y/o is dressing and undressing themselves (except laces)

I’m assuming this is one you’re not encouraged to ask the kids to do so you need to ask their mum about it.

33
Q

Do babies have to lose their primitive reflexes before they start to reach their developmental milestones?

A

Yes

34
Q

What are the primitive reflexes?

A
  1. Sucking and rooting
  2. Palmar and plantar grasp
  3. ATNR
  4. Moro
  5. Stepping and Placing
35
Q

What reflex is shown here?

When will a newborn display it? and when should they lose it?

A

ATNR reflex

Asymmetrical Tonic Neck Reflex

If a baby’s head turns to one side their body shifts with it

They have to lose this reflex when develop conscious movement at about 3-4 months

36
Q

What primitive reflex(es) is shown here?

A

Plantar and palmar grasps

(when you put an object in a newborn’s open hand they’ll grasp it)

37
Q

What is the moro reflex?

A

When a newborn is startled they’ll immediately extend all four limbs.

Can startle them by gently lifting their head up and dropping it (not sure if you’re actually allowed to do this anymore)

They think it comes from baby monkeys falling out of trees and reaching out to grab a branch.

38
Q

What is the stepping and placing reflex?

A

When you hold up a newborn and allow the soles of their feet touch the ground they take steps

39
Q

When do kids lose their primitive reflexes?

A

different for each of them

40
Q

When do babies lose their ATNR?

A

between 3&4 months

41
Q

6 week old baby with projectile vomiting and no wet nappy in last 24 hours. Generally not well.

What are you thinking?

A

Obstruction

42
Q

6 month old baby feeling a bit unwell and occasionally vomiting green and yellow “bile” stuff. Mass in abdomen. Red nappy.

What do they have?

What are you going to do?

A

intussusception

resuscitate them and bring to radiology where see a “target lesion” or something about a kidney? think this is the one that’s like a cinamon swirl.

1st. line = air up the bum

2nd line= 30% kids will need surgery

43
Q

6 year old doesn’t like bumps on the road because of a sore tummy

cant jump

what do they have?

A

peritonitis

44
Q

A child presents with a sore tummy. On X-Ray you can see their appendix. What are you differentials?

A

If you see a child’s appendix on X-Ray they have appendicitis

45
Q

Tiny wee baby presents vomiting green bile. Generally not great.

What do you do and what do they have?

A

malrotated gut

check with contrast and an endoscope if you see a diffuse swirl it’s malrotated

call for senior help immediately

Child Health (4 decks)

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