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Paediatrics > Developmental Milestones > Flashcards

Developmental Milestones Flashcards

1
Q

What are the 4 developmental domains?

A

Development should be thought of in the 4 developmental domains. These are:
• Gross motor
• Fine motor and vision
• Speech and Language
• Social skills, emotion, behaviours and cognition

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2
Q

Describe each developmental domain at 6 weeks

A

6 weeks
Head lag still present

Follows eyes past midline

Throaty noises

Smiling (refer at 10 weeks)

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3
Q

Describe each developmental domain at 6 months

A

6 months
Sits with support
Rolls

Reaches out for objects
Transfers
Palmar grasp

Starts babbling with 2 syllables

Not shy

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4
Q

Describe each developmental domain at 12 months

A

Sitting without support (refer)
Crawling/Shuffling
Pulls to stand and walks with on hand held

Pincer grip
Gives toys on request
No Hand dominance until this point (refer)

Responds to simple instructions
Knows and responds to name

Shy
Waves goodbye
Empties cupboards

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5
Q

Describe each developmental domain at 2 years

A

Climbing stairs
Running
Kicking ball

Tower 6 high
Copies a line
Points to objects (refer)

Combines 2-3 words with meaning
Plurals and pronouns
Follows 2 step instructions
Selects toys from other

Play alone or near others
Eats with spoon

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6
Q

Describe each developmental domain at 3 years

A

Tricycle
Jumps
Stands on 1 leg momentarily

Tower 9 high
Draws Circle
Matches two colours

3-4-word sentences
Knows some colours
What and who Qs

Potty trained
Separates easily
Spoon and fork

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7
Q

Describe each developmental domain at 4 years

A

Stands on one foot and hops

Can make bridge with 3 blocks
Draws square and cross
Human +3 parts

Counts to 10 Knows several colours
Why, when and who Qs
Tells a story

Shares toys
No nappies at night
Brushes teeth and toilets alone
Uses knife and fork

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8
Q

Describe each developmental domain at 5 years

A

Bounces and catches ball
Backwards heel to toe

Does buttons
Draws human + 6 parts
Draws triangle

Comprehension
Opposites

Chooses friends
Acts out role play

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9
Q

What are some red flag signs to look out for when assessing development

A

Abnormal muscles tone (floppy or increased)
Not holding object in hand by 5 months
Not sitting unsupported by 12 months
Not walking independently by 18 months
Asymmetry of skills/early hand dominance before 12 months may indicate cerebral palsy
No speech by 18 months
Not pointing to objects by 2 years
Any regression or loss of skill is always a red flag

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10
Q

What are the risk factors for developmental disorders?

A 
Prematurity 
Low birth weight 
Birth asphyxia 
Chronic illness
Hearing/vision impairment

Poverty
Low parental education
Parental illness
Maternal alcohol or other drugs

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11
Q

What questionnaires can be used to assess for problems in development?

A

Usually via screening tools and questionnaires
Parents’ evaluation of Developmental status (10 questions)
The Ages and Stages questionnaire (21 age specific questions)
Modified checklist for Autism in Toddlers (2nd stage questionnaire)
The Brigance Screen II directly administered test

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12
Q

How should eating issues be managed?

A

Food refusal or food fads are common.

Generally, all that is required is reducing parental pressure and overaction and slowly increasing or introducing small proportions of attractive food.

Ferritin and FBC should be checked.

Overeating can occur as a form of comfort for the child either in an environment where they get little comfort or if the mother feels inadequate. Early intervention is important and can prevent obesity. Be aware of the potential for Prader Willi syndrome.

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13
Q

What is pica?

A

Pica – eating non-food object including faeces (coprophagia). Assess for disturbed behaviours, autism and OCD or low IQ. Can be caused by iron or other mineral deficiency.

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14
Q

What is encorpresis?

A

Repeated solid soiling over the age of 4.

5:1 ratio of boys to girls.

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15
Q

What is the most common cause of encorpresis?

A

Most commonly as a result of constipation but can be behavioural usually in response to sexual abuse or emotional disorders.

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16
Q

How should encorpresis be managed?

A

Treat with enema, extra fibre and faecal softeners.

17
Q

What is the most common reason for a delay in talking?

A

Often associated with hearing problems so must be tested before any diagnosis can be made.

18
Q

How should speech be assessed?

A

Speech is divided into receptive and expressive and should be assessed by a speech and language specialist.

19
Q

Describe some causes of speech delay?

A
  • Familial – parents late to speech or had speech therapy
  • Hearing impairment – chronic otitis media common cause of speech problems
  • Environmental – deprivation, poor social interaction and abuse
  • Neuropsychological – GDD, autism (often see regression) and Landau-Kleffner syndrome (epilepsy and progressive loss of language)
20
Q

Describe some common causes and presentations of a reduced vocabulary size

A

Vocabulary size – if less than 50 by 3 years old
• Suspect deafness
• Expressive dysphasia
• Speech dyspraxia – telegraphic tone, poor clarity and deteriorating behaviour
• Audio-premotor syndrome – child cannot reflex sounds heard into motor control. Usually won’t babble, hum or sing.
• Respiro-laryngeal dysfunction – problems with the development of the vocal cords. Voice will be loud and rough

21
Q

Describe some common causes and presentations of poor speech clarity

A

By 2.5 years parents should be able to understand most speech if not:
• Suspect deafness
• Articulatory dyspraxia or tongue tied – easy consonants are b, m and d.
• Audio-premotor syndrome – child cannot reflex sounds heard into motor control. Usually won’t babble, hum or sing.
• Respiro-laryngeal dysfunction – problems with the development of the vocal cords. Voice will be loud and rough

22
Q

Describe some common causes and presentations of poor understanding

A

By 2.5 child should understand simple phrases and follow them if not:
• Suspect deafness
• Cognitive impairment
• Deprivation

23
Q

When should children be walking by?

A

Children should be walking by 18 months. If this hasn’t occurred, then they should be investigated.

24
Q

What are the common causes of problems with walking?

A

Cerebral Palsy
Duchenne Muscular Dystrophy
Developmental Hip dysplasia
Prenatal infection or exposure e.g. alcohol and X-rays
Antepartum haemorrhage with hypoxia
Cerebral dysfunction as a result of metabolic, physical or infection

25
Q

How should walking be assessed and what investigations might be done?

A

Are they physically normal?
Is development delayed in other areas
Family history of late walking?

Investigations
Hip X-rays
Creatine Kinase

26
Q

What is global developmental delay?

A

Describes delay in all 4 skill areas. There are some common causes but it may be idiopathic.

27
Q

Describe the common causes of global developmental delay?

A
  • Genetic – Down’s syndrome, fragile x, Duchenne muscular dystrophy, PKU etc.
  • Congenital brain abnormality – hydrocephalus and microcephaly
  • Prenatal causes – teratogens, congenital infections and hypothyroidism
  • Perinatal causes – extreme prematurity and interventricular haemorrhages, periventricular leukomalacia, birth asphyxia and metabolic disorders such as hyperbilirubinaemia.
  • Postnatal causes – brain injury from suffocation, drowning, head injury, CNS infection and hypoglycaemia.
28
Q

What are the definitions for impairment and cognitive impairment

A

Impairment = pathological process leading to a disability such as wheelchair bound.
Cognitive impairment = IQ below average and so < 70

29
Q

What are the common causes of learning disabilities?

A

Severe – often well-defined cause
Mild – often familial and not finite diagnosis
Congenital – Down’s fragile X, metabolic disorders etc.
Acquired – perinatal infection, birth injury and cerebral palsy, trauma, hypoglycaemia, congenital hypothyroidism and foetal alcohol spectrum disorder
Lead exposure is the leading cause of mild leaning disability

30
Q

How should children with learning disabilities be managed?

A

Referral to a specialist. And family help from MENCAP. Other family members may need support especially siblings who now feel neglected.
If IQ > 35 then aim should be life in the community

Note specific learning difficulties may occur without generalised cognitive impairment e.g. dyslexia, dyscalculia.

31
Q

What features do children who’s mother drank alcohol during pregnancy usually show?

A
  • Short palpebral fissure
  • Thin vermillion border/hypoplastic upper lip
  • Smooth/absent filtrum
  • Learning difficulties
  • Microcephaly
  • Growth retardation
  • Epicanthic folds
  • Cardiac malformations
32
Q

What can happen to babies born to alcoholic mothers directly after birth?

A

Baby may show symptoms of alcohol withdrawal e.g. irritable, hypotonic and tremors.

33
Q

Describe the 4 main primitive reflexes of babies and when they are present until?

A

Moro Head extension causes abduction followed by adduction of the arms
Present from birth to around 3-4 months

Grasp Flexion of fingers when object placed in palm
Present from birth to around 4-5 months

Rooting Assists in breastfeeding
Present from birth to around 4 months

Stepping Also known as walking reflex
Present from birth to around 2 months

34
Q

Describe each developmental domain at 18 months

A

Walking independently (refer)

Tower of 3
Circular scribble

2-6 words (refer)

Takes off shoes
Plays alone

Paediatrics (50 decks)

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