Developmental Notes Flashcards
What are the characterizations of cerebral palsy? Diagnostic test?
motor dysfunction w/ variable impact on other domains
MRI is diagnostic test-shows periventricular leukomalacia.
Spastic diplegia is a form of what?
cerebral palsy
What are the 3 domains where you might see delay in autism?
social: best indicator: no pointing, looking back
language: echolalia, delays, scripting
behavioral: specific routines, rituals, hand flapping
When do you do MCHAT screening?
18-24 mo
failure means that you need some further screening.
Red flags for autism?
no babbling by 1 year
no 1word by 15 months
no 2 word sentences by 2 years
or loss of language/social skills
What is the adjunct workup for autism?
hearing test
lead level
genetic testing (fragile x)
EEG/MRI
Treatment for sleep issues or anxiety?
hydroxyzine H1 antagonist
What is Asperger’s?
autism spectrum disorder w/o language impairment
social interaction is professorial or pedantic.
social difficulties
Rett disorder?
normal development until 5 months
then decreased head growth and loss of previous learned motor skills 5mo-30mo
then hand wringing or washing will begin
What is the abnormal workup for Rett disorder?
EEG abnormal
MECP gene
only seen in females
monozygotic twins 100% concordance.
what are the 3 domains to consider in ADHD? what are the requirements for diagnosis?
domains: inattention, hyperactivity, impulsivity
>6 symptoms in 2 or more settings for at least 6 mo
before age 12
What is one thing that has to be ruled out in ADHD diagnosis?
lead poisoning
What is the definition of intellectual disability?
IQ
What is the number genetic cause of ID?
Trisomy 21
What are the features of Down’s syndrome?
heart defects: AV defect, VSD, ASD GI: duodenal atresia, constipation, Hirsphrung's cryptochordisim hypothyroidism neonatal hypotonia visual hearing issues atlanto-axial instability
what is cryptochordism?
no testes in the scrotum
What are the features of hypothyroidism in down’s syndrome?
prolonged jaundice
hypotonia
constipation
macroglossia
What are some of the physical features of down’s syndrome?
brushfield spots (grey spots on iris) microcephaly epicanthal folds upward slanting palpebral fissures wide spaced toes
What are some of the consequences of atlanto-axial instability in down’s syndrome?
compression of spinal cord
torticollis (head persistently turned to one side)
urinary incontinence
vertebrobasilar symptoms (spasticity, hyperreflexia, + babinski sign)
What is the 2nd most common genetic cause of intellectual disability? Most common inherited form of ID?
Fragile X
What are the features of Fragile X?
large jaw long face large testicles big ears big hands FMR1 trinucleotide expansion
In female carriers of Fragile X… higher rates of what?
psychiatric disorders
What’s the deal with Prader-Willi?
Mom takes over. Dad deletion of chromosome 15 overweight pt, hyperphagia almond-shaped eyes hypogonadism hypotonia argumentative, aggressive
What’s the deal with Angelman syndrome?
Dad takes over, Mom deletion of chromsome 15
Happy puppet
inappropriate laughter, jerky movements, seizures, ataxia
What’s the deal with Williams syndrome?
elfin facies well developed verbal skills hypercalcemia (too much santa milk) extreme friendliness with strangers like will ferrell
What’s the deal with tuberous sclerosis?
seizures
angiofibromas
What are the features of FAS?
microcephaly
smooth philtrum
thin upper lip
ID
What is oppositional defiant disorder?
less bad than conduct disorder
frequent loss of temper
arguments with adults
annoying people, anger, resentment
What is conduct disorder?
antisocial personality disorder for children
persistent violation of the rights of others
What is disruptive mood dysregulation disorder?
severe pervasive irritability and poor frustration tolerance
temper outbursts
unlike ADHD, no hyperactivity, inattention, disorganization
What are the requirements for tourette’s?
multiple motor tics and at least one vocal tic
onset before age 18
tic free period
What brain changes do you see in Tourette’s?
impaired regulation of dopamine in the caudate nucleus
What is the treatment for tourette’s?
atypical antipsychotics
clonidine is first line alpha 2 agonists or guanfacine
pimozide
How do you make the diagnosis of enuresis?
must be older than age 5
at least 2 episodes/wk, 3+ months
have to workup with UA-r/o DM, infections. Need to make sure no clinical suspicion for seizures.
What is the treatment for enuresis?
enuresis alarm
desmopressin
TCAs
oxybutynin (muscarinic receptor antagonist-for daytime incontinence)
What are breath-holding spells?
can be associated with iron deficiency anemia
(think of iron man competitor swimmer holding breath)
sometimes after crying.
workup includes CBC, ferritin.
Freud’s 0-18 mo?
oral stage
sense of security and basic trust of others
failure of this stage: urgent demands, extreme dependence, lack of consideration for others, very low tolerance for frustration
Freud’s 1.5-2.5 yr?
anal stage
control over bodily needs
success: control, independence, pride
failure: problems with self control and rigid behavior patterns. likes ordliness.
Freud’s 2.5-4yr?
phallic stage
explore world autonomously
success: stable sense of self-worth
Freud’s 4-6 yr?
oedipal
develops special relationship with same sex parent
failure: guilt anxiety, depression, phobias, anxieties
perfectionism, hysteria
Freud’s 6-12 yr?
Latency
kids learn to interact with ppers
identify with same sex
failure: poor social skills, ostracism
Freud’s teen years?
adolescence
personal identity
Erikson’s 0-18 mo?
Infancy Trust v. Mistrust
Erikson’s 2-3 yr?
Early Childhood
autonomy v. shame
personal skills and self control
Erikson’s 3-5 yr?
Preschool
initiative v. guilt
children assert control over their environment
success: sense of purpose
Erikson’s 6-11 yr?
School age
industry v. inferiority
success: competence
Erikson’s 12-18 yr?
identity v. role confusion
Erikson’s 19-40 yr?
intimacy v. isolation
Erikson’s 40-65 yr?
generativity v. stagnation
Erikson’s >65 yr?
ego integrity v. despair
Children should triple their weight by which year?
year 1
What is constitutional growth delay?
bone age
What is familial short stature?
bone age=real age
both parents are short
What are some developmental questionnaires?
Ages and stages
PEDS
Denver II
When should you do a screening H&H?
12 months
iron intake may be deficient
Vision screen and hearing screen when?
vision-3
hearing-4
See dentist when?
first tooth eruption or by age 1
Lead screening when? BP screening when?
lead-6 months
bp age 3
Milestones for 2 mo?
- smiles
- looks @ parent
- visual tracking across midline
- holding head up steadily
- coos, gurgles
- pushes up on tummy
Milestones for 4 mo?
- sits with support
- reaches for objects, pushing up on arms
- plays
- copies facial expressions
- babbles
- pushes down on legs
- rolls tummy-back
- check lower milestones too.
Milestones for 6mo?
- ah eh oh
- knows name
- “m”, “b” babbles
- passes object from one hand to the other
- curiosity
- rolls both ways
- stranger anxiety
- sits on its own
- crawls a little
- pincer grasp
Milestones for 9 mo?
- mama, dada
- stranger anxiety
- finger points
- knows a few words
- object permanence: peek a boo
- stands holding things
- crawls
Milestones for 12 mo?
- stacks 3 cubes
- separation anxiety
- walking
- parallel play
- drinks from cup
- waves bye, shakes head
- copies words
- brushes hair
Milestones for 18 mo?
- remove some clothing
- speak six words
- copies others
- able to name common objects 1 word at a time
- 2-4 block towers
Milestones for 2 yrs?
- 2 word phrases, 200 words, 50% understandable
- throw a ball, kick a ball
- jumping
- stairs
- follows 2 step commands
- hops
- imitates
- brushes teeth
Milestones for 3 yrs?
- 3 word sentences
- rides a tricycle
- draws a circle
- 1000 words
- friend affection
- dresses and undresses
- first name, age, sex
- 6 block tower
- make believe
- uses utensils
Milestones for 4 yrs?
- draw a square
- hop
- colors, numbers
- cooperative play, board games
- stories
- scissors
What are the guidelines for eating for infants?
breast feeding: 8-12X/d for 10-20 min
formula: 4-6 oz q3h by 2mo, 6-8 oz q6-8 h by 6 mo + table foods
9mo-75% of calories from breast milk/formula
use cup by 1 year, cow’s milk can start then
T/F it is okay to use a feeding bottle at 2 yo?
False. increased risk for dental carries
Vit D supplement started when?
week 1 of life in infants who are exclusively breastfed.
Meconium should be seen by what age?
24-48 hours
How does the frequency of meconium vary when pt is formula fed v. breastfed?
formula fed: 4-5 stools/d
breastfed: 1 stool/d
How many wet diapers of urination should be produced per day?
first week of life-# of days alive=# of diapers/d
~6/d for infants
What are the expectations for sleeping for infants?
after 4-6 mo: sleep thru the night
by 9 mo->sleep 11 hrs with 1-2 naps/d
Weight gain expectations?
15-30 g/d for 2mo
then 15-20 g/d for 3 mo
then 10-15 g/d for 6-12 mo
double body weight by 5 mo, triple by 12 mo
When should the primary series of vaccines be completed by? Influenza started?
Primary series completed by no later than 24 mo
influenza started at 6 mo
When should you use a rear facing car seat?
until 2yo or until they reach max height and weight
40-50 lb-booster seat with belts. until about 4’9” or 12 yo
teenager to ride in the front seat
What is considered pubertal delay in girls?
lack of breast development by 14
lack of period by 16
>5 years from initial breast tissue to menarche
What is considered pubertal delay in boys?
no testicular enlargement by 14
>5 yrs from initation to completion of genital development
What are the stages for boys puberty development?
growth of testicles pubic hair growth of penis and scrotum first ejaculations growth spurt attainment of adult height (17)
