Developmental Presentations Flashcards
Outline learning difficulties, how they present and a DDx
IQ <70, poor adaptive functioning, <18y
S+S = Problems reading/writing/math, poor memory, problems paying attention, trouble following directions, clumsiness, trouble telling time, problems staying organized
DDx = Down’s syndrome, Williams syndrome, Autism and Asperger’s syndrome, fragile X syndrome, global developmental delay, cerebral palsy.
Outline school refusal, how it presents and a DDx
When a child or young person starts to miss school frequently because of vague illnesses or symptoms
S+S = lack of school attendance, anxiety (stomach aches, diarrhoea, nausea, headaches, fatigue, dizziness, vague and general aches/pains), reluctance to get dressed, diff sleeping, less obvious Sx during weekends/holidays
2 main reasons:
- phobic reaction either to the general school situation or to a particular situation or thing within the school
- fear of attending school but the main source of the worry is leaving home or separating from family
What are sleeping problems in childhood and how should they be managed?
- Refusal to go to bed
- Frequent night waking
- Common parasomnias - head banging, sleepwalking, nightmares, night terrors, nocturnal sleep-related eating disorder, teeth grinding
Mx = sleep diary, sleep hygiene, positive bedtime routine, controlled crying, education, melatonin
List some non epileptic behaviours
simple faint breath holding spells temper tantrums hyperventilation infantile colic self stimulatory behaviours
How is problem eating assessed/investigated and managed?
Hx + exam
Ix = monitor growth against projected range, ix for organic causes (severe reflux)
Mx = social reinforcement, avoid coaxing + forcing, avoid using preferred foods as rewards, family mealtime, encourage communal eating with peers, repeated exposure to small quantities
Outline the causes ad Ix of paediatric soiling
Loose = malabsorption, excessive fruit juice Normal = faulty toilet training, neglect, other stressors Combination = overflow
Ix = TFTs, rectal biopsy, serum Ca, serum lead, plasma bicarb
What is developmental regression?
When a child loses an acquired function or fails to progress beyond a prolonged plateau after a period of relatively normal development.
Causes = metabolic disorders, progressive hydrocephalus, worsening of seizures, increased spasticity, worsening of movement disorders or parental misconception of acquired milestones
Outline fabricated illness
A well child presented by a carer as ill or disabled, or presented with a more significant problem than he or she has in reality, and suffering harm as a consequence.
Mx = exclude organic disease, stabilise the child and treat any presenting symptoms, when suspected an MDT approach should be used, involving paediatricians and social services. The police may also need to be contacted
Outline paediatric self-harm and drug abuse
Deliberate self-harm (DSH) is a behaviour in which a person commits an act with the purpose of physically harming himself or herself with or without a real intent of suicide
S+S = scratching, biting, cutting, poisoning, burning, hanging, pinching
Aetiological factors = overt depression, low self-esteem and sense of persistent hopelessness, impulsivity, school influence of intimation (such as bullying), family dysfunction and conflict, poverty, abuse
Study findings indicate an association between DSH and drug and alcohol abuse and eating disorders
Discuss paediatric sexual abuse
Child sexual abuse is the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society
Physical force/violence is very rarely used; rather the perpetrator tries to manipulate the child’s trust and hide the abuse.
The perpetrator is typically a known and trusted caregiver.
Child sexual abuse often occurs over many weeks or even years.
The sexual abuse of children frequently occurs as repeated episodes that become more invasive with time. Perpetrators usually engage the child in a gradual process of sexualizing the relationship over time (i.e. grooming).
Incest/intrafamilial abuse accounts for about one third of all child sexual abuse cases.
What is global developmental delay and its possible causes?
Global developmental delay refers to a child displaying slow development in all developmental domains
Causes
- Down’s syndrome
- Fragile X syndrome
- Fetal alcohol syndrome
- Rett syndrome
- Metabolic disorders
Hoe should suspected global developmental delay be investigated?
Head MRI/CT
EEG if seizures or regression in speech
Chromosome analysis
How does global developmental delay present?
Gross motor delay
Fine motor delay
Language delay
Personal and Social Delay
Outline the management of global developmental delay
Speech + language therapy
Physiotherapy
Occupational therapy
Behavioural intervention (psychologist)
Educational therapy
What is a delay in motor skills and its possible causes?
Motor Delay refers to children showing unusually slow development of fine-motor or gross-motor abilities. Fine motor abilities include things like grasping a pencil or handling a spoon. Gross-motor abilities include things like walking, hoping and climbing stairs.
Gross causes =
- Cerebral palsy
- Ataxia
- Myopathy
- Spina bifida
- Visual impairment
Fine causes =
- Dyspraxia
- Cerebral palsy
- Muscular dystrophy
- Visual impairment
- Congenital ataxia (rare)
