Developmental Paediatrics Flashcards
when do the anterior fontanelles close at?
between 10 and 24 months
what are some causes of delayed closure of the anterior fontanelle?
congenital hypothyroidism, hydrocephalus, rickets, genetic causes (trisomy 21, Russel silver syndrome, achondroplasia
when does macrocephaly occur?
OFC is more than 2 SD than the average head size for age and sex.
what should you ask for in the history of a child with a big head?
vomiting, high pitch cry, developmental delay
RF for hydrocephalus (preterm birth, IVH, meningitis, learning disability (ASD, fragile X) or family history of genetic syndrome as with macrocephaly (neurofibromatosis 1)
what are red flags on examination of an enlarged head?
signs of raised ICP (bulging fontanelle, splaying of sutures, sunsetting of the eyes, papilloedema), evidence of developmental delay
syndromic features
what are the common causes of big head with a normal brain
familial, ASD, neurofibromatosis type 1, fragile X syndrome, benign enlargement of the subarachnoid space.
what are the rarer causes of enlarged head with a normal brain on MRI?
PTEN/ cowden/ proteus like syndrome costello syndrome sanfillipo syndrome glutamic acuduria type 1 langerhans cell histiocytosis peutz jeghers syndrome sotos syndrome
what are the causes of macrocephaly with abnormal brain
hydrocephalus
canavans disease
vanishing white matter syndrome
what is benign enlargement of the subarachnoid space?
enlargement of the subarachnoid space of cranial US, if normal Neuro and developmental exam then just need 6 monthly follow-up to make sure the head circumference is tracking correctly.
what should you do to for urgent OFC with associated features of raised ICP?
ED
what should you do with OFC that has crossed over 1 centile line without developmental delay
peads OPD
macrocephaly with syndromic features
referral to PEADS or genetics
macrocephaly with developmental delay
PEADS for MRI brain
what is the definition for microcephaly
this occurs when the OFC is greater than 2 SD smaller than the average head size and sex
what is the congenital microcephaly?
this is small head size present at birth
what is secondary microcephaly
this is normal OFC at birth with failure of normal head growth post natally.
what are the signs of congenital cytomegalovirus?
microcephaly, cataracts, petechial rash, hepatosplenomegaly
what are features of fetal alcohol syndrome
short palpebral fissures, smooth philtre, and and thin upper lip
what are the causes of microcephaly?
craniosynostosis
familial
genetic (trisomy 13, monogenic disorder, cri du chat)
metabolic (aminoacidurias, organic acidurias, urea acid disorder)
prenatal (congenital infections (TORCH, zika), PKU alcohol syndrome
prenatal brain injury (birth hypoxia)
postnatal brain injury (IVH/infarct)
small head babies when should you order a scan?
head size very small greater than 3 SD below mean
head size not keeping with familial size
developmental delay
microcephaly is post natal onset
when would you do CT over MRI in children with small head?
craniosynostosis, TORCH, Zika virus infections
what should you do with a child that has small head and you suspect an underlying congenital infections
Zika virus (serum and urine for Zika virus RNA, serum for Zika IgM) TORCH (toxplasmosis, syphilis, rubella, CMV, herpes simplex virus)
which of the TORCH infections are associated with microcephaly?
toxoplasmosis, CMV, HSV
what to do with microcephaly with delayed development?
order metabolic studies aminoacidurias, organic acidurias, and or very long chain fatty acids.
isolated or primary microcephaly (greater than 3 SD below the mean) or microcephaly with associated syndromic or dysmorphic features
order genetic testing
what is plagiocephaly?
parallelogram skull.
what is posterior deformational plagiocephaly cause by?
infants position in utero, and sleeping position.
what is the treatment for deformational plagiocephaly
PT, and tummy time.
what is craniosynostosis?
this is a birth defect in which the bones in a baby skull join together too early.
what is the weber part of the hearing test?
there is a web on top of your head… you put the fork on the top of the head.
equal= normal
senorineural: sound louder on the good side
conductive: louder on the bad side
what is the rinne test
this compares bone conduction with air conduction.
tuning fork is places on the mastoid bone.
normal/ sensorineural: air greater than bone
conduction hearing loss: bone is louder than air conduction
what are risk factors for vision problems
prematurity low birth weight downs syndrome marfan syndrome juvenile arthritis diabetes retinopathy history of ocular injury family history of visual problems cataract, squint, medical conditions kwon to be associated with visual problems
what vision checks do a newborn need
red eye reflex
what does a 6 week check baby need to check with eye development
red reflex
fix and follow
visual behaviour
vision check at 6 months
red reflex
fix and follow visual behaviour looking at the own hands, reaching out for toys, recognising parents faces, watch what goes on around them
up to 3 years check vision what to look for?
red reflex
fix and follow eye movements
pupils are they equal and reactive
eye inspection: opening normal Is there ptosis or obvious misalignment
visual behaviour: is the child interested in pictures, do they point at items they want, do they look at windows, recognise people play peek a boo.
what does the red reflex look for
retinoblastoma, cataract
when should you refer to paediatric ophthalmology?
if a child cannot fix and follow by 3 months
what does esotropia mean?
eye turning inwards
what does exotropia mean?
outward facing eye
what does hypertropia mean?
up ward facing eye
what does hypotropia mean?
downward facing eye
what is strabismus
medical term for lazy eye
what causes strabismus
hypermetropia, myopia, and astigmatism
what is the definition of infertile strabismus
before 6 months
what is the definition of acquired strabismus
after 6 months
what should you think of in acute onset squint?
raised ICP, SOL, infraction
what is a comitant squint
this is a non paralytic squint, the degree of misalignment is the same in all directions. This is typical for infantile strabismus
what is incomitant strabismus?
this is a paralytic squint, this misalignment varies depending on the direction of the gaze. ,ay be caused by restriction or paralysis of the extra ocular muscles.
CN VI palsy
abducens nerve (lateral rectus muscle)
moves the eye laterally
esotropia (inward deviation of the eye)
CN IV palsies
trochlear nerve which supplies the superior oblique muscle
moves the eye inferiorly mainly when the eye is adducted. This leads to hypertrophia (upward deviation of the eye)
CRANIAL NERVE 3 palsy
oculomotor nerve which supplies the remaining ocular muscles to allow for visual tracking and gaze fixation.
parasympathetic supple to the pupils and the lens
opposes the action of the lateral rectus muscle and the superior oblique
eyelid opening
this leads to exotropia (outward deviation of the eye) and hypotropia (downward deviation of the eye) down and out.
what should you be thinking about in a child with strabismus?
preterm birth low birth weight medical conditions: graves, orbital fracture, cranio facial syndrome, cranial dysinnervation, craniosynostosis, myasthenia grains, supranuclear palsies. assisted delivery retinopathy of prematurity family history
diplopia
double vision
amblyopia
decreased vision in an anatomically normal eye caused by suppression
what are the causes of sensorineural hearing loss?
noise exposure, acoustic trauma, disease and infections (MMR)
head trauma
tumours
medications
what are the congenital causes of SNHL
hereditary
secondary to CMV, zika, rubella, syphilis
toxin exposure: quinine, alcohol, retinoid acid, maternal thyroid peroxidase autoantibodies, anti-elliptic medications
what is visual reinforcement audiology
6 months to 2 years old
describe the Apgar score: A
appearance: 0 :blue or pale
1 point: acrocyanotic (pink or blue extremities)
2: completely pink
APGAR score: P
pulse: absent 0
1 point: less than 100
2 point: greater than 100
APGAR: G
grimace: no response
1: grimace
2 cry
Apgar score: A (second)
activity: tone
0: floppy
1 point: some flexion
2 points: active motion
APGAR: R
respiration:
0: absent
1: weak cry; hypoventilation
2: vigorous crying
OAE otoacoustic emission test
small probe place in the ear. measures the echo back.
what does the heel prick test pick up
sickle cell disease, CF, congenital hypothyroidism, inherited metabolic conditions
rotten reflex
stroke the cheek near the corner of the mouth, infant turn toward the stimulation disappears by 3 weeks
sucking reflex
put finger in the infants mouth infant sucks rhythmically*3-4 months disappears
stepping reflex
disappears at 2months hold the infant under the arms and let the bare feet touch a flat surface, the infant lifts one foot and then the other.
the palmer grasp reflex
palce finger in infants hand and press fingers into palm, infant will grasp the finger. this disappears by 3 to 4 months
symmetrical tonic reflex (ATNR)
turn infants head to one side while the infant is lying on back. the infant extends one arm in front of the eyes and other arm is flexed (fencing position) disappears in 4 to 6 months
moro reflex
hold infant on back and let head drop, infant should startle. this disappears at 4 to 6 months
swimming reflex
infant will move arms and legs in swimming motion this disappears at 6 months
glant reflex
stroke the skin on the side of the infants back. the infant will tend to move or swing to that side. disappears at 6 months
babinski sign
stroke the bottom of the foot, that baby will curl there toes. disappears at 12 months. a positive test after this will be splaying of the toes.
how much sleep does a one year old need
15 hours
how much sleep does a 2 year old need
14 hours
how much sleep does a newborn need
17 hours
how much sleep does a 10 year old need
12 hours
what is a dyssomnia
the most common sleep disorder in childhood, disturbance of body natural resting and waking cycles.
what is a parasomnia
disturbing sleep related to sleep onset, night mares, night terrors, sleep walking and talking, rhythmic movement disorder
hypersomnia
narcolepsy ]idiopathic hypersonic
recurrent hypersonic
sleep disordered breathing
body thinks the child is chocking and wakes the child up. passes in breathing during sleep, bed wetting, slow growth and irritability during the day.
what is the screening tool used to identify sleep problems in childhood?
bears bedtime problems excessive daytime sleepiness awareness during the night regularity and duration sleep snoring
