Developmental milestones in the first six months of life

Question 1

What is cerebral palsy?

Answer 1

Cerebral aplsy is an umbrella term referring to the name of a group of lifelong conditions that affect movement and coordination. It is caused by a problem with the brain which develops before during or soon after birth.

Question 2

The underlying brain condition is _____ but the clinical manifestation may ______

Answer 2

The underlying brain condition is static but the clinical manifestation may change

Question 3

What is the prevalance of cerbral palsy in the UK

Answer 3

2 per 1000 live births,

around 40% of children with cerebral palsy were born prematurely.

Question 4

At what age is there usually clear evidence of cerebral palsy?

Answer 4

1 year of age

Question 5

What to look out for in a focused history?

Development - Antenatal

Answer 5

Any congenital infections? Toxoplasmosis, rubella, cytomegalovirus (CMV), herpes, human immunodeficiency virus, syphillis

Any non prescription drug use eg cocaine

Any genetic conditon? Eg trisomies

Any intra uterine growth restriction? especially if symmetrical i.e. small head circumference and body weight

Prematurity

Peripartum

Neonatal seizures? meningitis/septicaemia?

neonatal yoerbilirubinaemia

Question 6

What is the structure for a focused history in development of child?

Answer 6

Examine th einfant in the domains below broadly divided into

• gross motor
• fine motor
• vision+hearing
• Language + behaviour

Question 7

What is ventral suspension?

Answer 7

baby is held under the chest by the examiners hand- the head should be at the level of the plane of the body and arms + the legs partly flexed.

Question 8

How do you tell if there is reduced muscle tone in the infant?

Answer 8

it is demonstrated by the pull to sit

WHen there is reduced muscle tone the head is below th eplane of the body and the arms + legs are outstretched (looking like a rag doll)

Question 9

WHat is hyptonia?

Answer 9

decreased mucle tone

Question 10

Gross and fine motor in infants

WHat are looking for in newborns

Answer 10

Noraml posture of term newborn

usually well flexed arms and legs

hands in a fist with the thumb covered by the fingers

Neonatal reflexes, suck, gag, moro, palmar, plantar are normally present

Question 11

Absence or weak suck or gag will have an impact on ______

Answer 11

feeding

Question 12

The preterm infant has a more ______ posture

Answer 12

The preterm infant has a more extended posture

Question 13

What might absence or weak palmar grasp in infants suggest?

Answer 13

Peripheral or spinal nerve invovlvement or predict development of athetoid cerebral palsy

Question 14

Infants with spastic hemi or quadriplegia will have….

Answer 14

hyperactive grasp reflex or persistent grasp reflex beyond normal duration

Question 15

A reduced or absent plantar grasp can be a sensitive indicator of ….

Answer 15

later development of spasticity

Question 16

absence or reduced moro relex within 2-3month of age or persistence of the response beyond 6 months of age can be regarded as?

Answer 16

abnormal

Question 17

What do you see in 4-6 weeks of age?

Answer 17

Grost motor- there may still be some head lag but not as much as in the noenate

Social smile- purposefule smile of response to the parent smiling to the baby

If not present confirm that baby can see by checking the red reflex (which ensures no obstruction to vision like a catarct)

Able to follow bright toys/light

Startle reflex to loud sound is also present

other newborn reflexes still present

Question 18

WHat do you expect in 3-4 months of age

Answer 18

There is minimal head/no head lag- pull to sit. Holds head unsupoorted

prone they can lift their head off the couch with arms outstretched with elbows on the couch

THey can bring their hands to the midline, they watch thei hans, can take their hand to the mouth

They can move their head to follow objects

THey can turn their eyes towards a sound source

they can coo, gurgle, smile/laugh especially at people

Question 19

WHat do you see 5-6 months in babies

Answer 19

No head lag on pull to sit

prone th ebaby can lift the trunk off the cough eith elbows straight at 180 degrees

rokks iver both directions (back and front)

When held up can weight bear on their legs

can reach out to pick objects between hands- palmar grasp

babble gurgle smile laugh

weaning started

palmar grasp and motor reflexes are no longer present

Question 20

A delay in development could suggest a _________ condition. This could be ______ or ______

Answer 20

A delay in development could suggest a neruological condition. This could be central or peripheral

Question 21

Persistence of the palmar grasp+ motor refelx beyond six months of age is abnormal is usually associate dwith ________ ______

Answer 21

Persistence of the palmar grasp+ motor refelx beyond six months of age is abnormal is usually associate dwith delayed milestones

Question 22

Hands predrence by 6 months of age is __________ and could be a manifestion of _______ or ________

Answer 22

Hands predrence by 6 months of age is abnormal and could be a manifestion of monoplegia or hemiplegia