Developmental milestones in the first six months of life Flashcards
What is cerebral palsy?
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.
The underlying brain condition is _____ but the clinical manifestation may ______
The underlying brain condition is static but the clinical manifestation may change
What is the prevalance of cerbral palsy in the UK
2 per 1000 live births,
around 40% of children with cerebral palsy were born prematurely.
At what age is there usually clear evidence of cerebral palsy?
1 year of age
What to look out for in a focused history?
Development - Antenatal
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
What is the structure for a focused history in development of child?
Examine th einfant in the domains below broadly divided into
- gross motor
- fine motor
- vision+hearing
- Language + behaviour
What is ventral suspension?
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.
How do you tell if there is reduced muscle tone in the infant?
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)
WHat is hyptonia?
decreased mucle tone
Gross and fine motor in infants
WHat are looking for in newborns
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
Absence or weak suck or gag will have an impact on ______
feeding
The preterm infant has a more ______ posture
The preterm infant has a more extended posture
What might absence or weak palmar grasp in infants suggest?
Peripheral or spinal nerve invovlvement or predict development of athetoid cerebral palsy
Infants with spastic hemi or quadriplegia will have….
hyperactive grasp reflex or persistent grasp reflex beyond normal duration
A reduced or absent plantar grasp can be a sensitive indicator of ….
later development of spasticity
absence or reduced moro relex within 2-3month of age or persistence of the response beyond 6 months of age can be regarded as?
abnormal
What do you see in 4-6 weeks of age?
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
WHat do you expect in 3-4 months of age
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
WHat do you see 5-6 months in babies
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
A delay in development could suggest a _________ condition. This could be ______ or ______
A delay in development could suggest a neruological condition. This could be central or peripheral
Persistence of the palmar grasp+ motor refelx beyond six months of age is abnormal is usually associate dwith ________ ______
Persistence of the palmar grasp+ motor refelx beyond six months of age is abnormal is usually associate dwith delayed milestones
Hands predrence by 6 months of age is __________ and could be a manifestion of _______ or ________
Hands predrence by 6 months of age is abnormal and could be a manifestion of monoplegia or hemiplegia
