Developmental milestones/delay 3 Flashcards
What occurs in a brief neurological screen?
o Use common sense to avoid unnecessary examination
o Adapt it to the child’s age
o Take into consideration the parent’s account of developmental milestones
Watch child draw play or write
Language can speech skills
Posture and movement of limbs
Note tone when picking infant up and head control
What can toe walking suggest?
Often idiopathic
pyramidal tract (corticospinal) dysfunction
A foot drop (common or superficial peroneal nerve lesion)
Tight tendo- achilles due to a neuromuscular disease
Children with myopathy can develop tight achilles tendon due to weakness
Look at shoe pattern if unsure
What does a broad gate suggest?
due to an immature gait (normal in a toddler) or secondary to a cerebellar disorder
Proximal muscle weakness around the hip girdle can cause a waddling gait
What do cortical tract lesions give in movement?
a dynamic pattern of movement involving shoulder adduction, forearm pronation, elbow and wrist flexion with burying of the thumb, whereas internal hip rotation and flexion at the hip and knee and plantar flexion at the ankle give a characteristic circumduction pattern of lower limb movement
What do extrapyramidal lesions give?
Fluctuating tone, difficulty in initiating or involuntary movements, look for asymmetry
What are the abnormalities seen when asking children to go from lying down supine to standing?
Children up to 3 years of age will turn prone in order to stand because of poor pelvic muscle fixation; beyond this age, it suggests neuromuscular weakness (e.g. Duchenne muscular dystrophy) or low tone, which could be due to a central (brain) cause
The need to turn prone to rise or, later, as weakness progresses, to push off the ground with straightened arms and then climb up the legs is known as Gowers sign
How is coordination assessed?
o asking the child to build one brick upon another or using a peg-board, and do up and undo buttons, draw, copy patterns, write
o asking the child to hold his arms out straight and close his eyes, and then observing for drift or tremor (this is really looking for asymmetry, position sense, and neglect of one side with visual cues removed)
o finger–nose testing (use teddy’s nose to reach out and touch if necessary)
o rapid alternating movements of hands and fingers
o touching tip of each finger in turn with thumb
o asking the child to walk heel–toe, jump and hop.
What is Fogg’s test?
Looking for subtle asymmetries in gait
Children are asked to walk on their heels, the outside and then the inside of their feet
watch for the pattern of abnormal movement in the upper limbs
What suggests hypotonia in posture?
Sitting in a frog-like way
Abnormal posturing and extension suggests fluctuating tone (dystonia)
What suggests hypertonia in posture?
scissoring of the legs, pronated forearms, fisting, extended legs
What can cause muscle wasting?
secondary to cerebral palsy, meningomyelocele, muscle disorder or from previous poliomyelitis
What can increased muscle bulk indicate?
Duchenne muscular dystrophy, or myotonic conditions
What needs to be looked for in truncal tone?
o In extra-pyramidal tract disorders- the trunk and head tend to arch backwards (extensor posturing)
o In muscle disease and some central brain disorders, the trunk may be hypotonic- the child feels floppy to handle and cannot support the trunk in sitting
• Head lag this is best tested by pulling the child up by the arms from the supine position
What do the reflexes show?
Brisk- anxiety or pyramidal disorder
Absent- neuromuscular problem or lesion within the spinal cord
What is seen in plantar responses?
- In children the responses are often equivocal and unpopular as it is unpleasant- they are unreliable under 1 year of age
- Upgoing plantar responses provide additional evidence of pyramidal dysfunction
