Developmental problems Flashcards
Developmental milestone categories
Personal and social
Gross motor skills
Fine motor skills and vision
Language and hearing
Personal and social milestones
NEWBORN: sleeps + feeds
1-2m: smiles back at parent
1.5-3m: Smiles spontaneously
4-8m: finger feeds
Smiles at self in mirror
5-7m: Chewing
5-10m Shy with strangers
6-16m: drinks from cup
14-20m: takes off clothes
18-38m: Dry during day
20-50m: separates easily from mother
32-50m: knife and fork
6weeks Personal and social milestones
smile at mother
watches faces
6months p+s milestones
Drinks from cup if held to lips
Excited when hearing steps
Dislikes and likes
smiles and talks to mirror
Laugh if head is hidden in towel
friendly to allcomers
9 months P+S milestones
Chews food
Feed self with biscuit
Tries to get toys that are out of reach
keeps lips closed if offered more food than wants
Imitate simple acts
Respond to name
cough or use other method to establish contact.
Fine motor skills and vision
Newborn: fixate on object 20cm away, has primitive grasp reflex.
8-12w - loses primitive grasp reflex
6-12w- follows moving person with eyes
8-16w - holds hands together
10-20w - reaches out for rattle
22-40 w - passes rattle hand to hand
Language and hearing
Newborn: blinks/quiet to sound
0-1m - soft guttaral noises when talked to
1-3m - turns to sound at ear level
6-20w - squeals
14-30w - turns to voice
6-10m - dada/mama to anyone
40-60w - dada/mama to rents
12-20m - 3 words and dada/mama
14-24m - 2words together
2-4y - first and last name
Gross motor
0-6w - head lag evident
8-18w - rolls over
4-6w - holds head up in sitting
18-30w - sits alone
6-10m - pulls up to stand
7-13m walks holding furniture
11-14m walks alone
12-20m jumps with both feet together
14-24m - kicks ball
18-38m - pedals tricycle
34-60m hops skips
72m - skip on both feet
Autism definition
impaired reciprocal social interaction and communication, stereotyped rigid repetitive behaviour and interests, onset <3years old.
ASD
neurodevelopmental disorder - includes autism , atypical autism, asperger syndrome, pervasive developmental disorder, childhood disintegrative disorder.
Symptoms= impaired social communication, restricted, repetitive behaviours or interests.
Affects 1% of children. 4:1 boys. 90% heritable.
typically presents early childhood, can be with change in situation. regression/stasis of language/social behaviour 1/3 of children with autism. 1-2years.
70% also meet criteria for another psychiatric disorder e.g. ADHD, anxiety.
Intellectual disability IQ<70 in 50% children with autism.
Features of autism
need for routine
difficulty understanding other people/their intentions/feelings/perspectives.
Sleeping/eating disturbances
MH problems: Anxiety, depression
attention issues
self injurous behaviour, challenging/aggressive behaviour.
years 1-2 lack of response to name, absent /limited use of body language
preferring to play alone
> 2 years: avoiding eye contact, difficulty learning language
repetitive words and phrases
repetitive movements e.g. rocking, hand flapping.
regression in /loss of speech
non speech vocalisations, odd/flat intonation, echolalia.
refers to slef as you/he/she beyond 3years.
Autism treatment
Children:
Behavioural methods for abnormal behaviour
Social + educational services - e.g. special day schools, resident schooling if severe
Family support services.
Adults:
Without/with mild/mod LD + identified problems with social interaction:
Group based social learning programme
Individually delivered social learning programme
- include - modelling, feedback, discussion and decision making
Pharm mx for challenging behaviour
- if other interventions not delivered - Antipsychotics - specialist.
Prognosis of autism
10-20% of children improve 4-6years- ordinary schools + employment
10-20% live at home, special schools, not ordinary employment
60% little improvement - long term residential care, not independent.
Increased risk of epilepsy
how to manage new onset gait abnormality?
refer immediately acute paeds
Motor development delay
Features:
Not sitting unsupported by 8 months
Not walking independently by 15m (girls) 18m (boys)
Show early assymetry of hand function before 1 year
Management: refer to child development service, physiotherapy/OT, consideration of cerebral palsy .
If boy - measure CK to exclude Duchenne Muscular dystrophy.
Motor development regression
Refer to paeds neurodevelopmental service/paeds neurology depending local pathways
If boy measure CK for duchMuscDys
cerebral palsy definition
Persistent qualitative motor disorder appears <3ears, due to non progressive damage to brain
Abnormality of movement/posture/tone not progressiv, asw sensory abnormalities, cognitive deficits and epilepsy.
Prevalence of cerebral palsy
2-2.5/1000
commonest cause of physical disability in children in developed world.
types of cerebral palsy
Spastic - brisk tendon reflexes and extensor plantar responses.
Choreoathetoid - 10% - often follow kernicterus/hypoxia. involuntary movements, chorea, athetosis, dystonia, trunk/limbs/face/bulbar
Ataxic - 10% - cerebellar ataxia, loss power, hypotonia, tremor
General Features of cerebral palsy
First few months:
poor sucking
increased/decreased muscle tone
Abnormal reflexes
Irritability
convulsions
Drowsines
Infant:
No head control 3monhts
Not sitting alone 10months
Stiff on handling
Development of hand preference before 1 year
Littles disease
Bilateral spasticity cerebral palsy
Legs spastic weak clumsy
held in extension and adduction
scissor gait (severe spasticity)
lesser involvement of arms face bulbar muscles
Frequent falls, clumsy, lack of agility, shoes out on toes, difficulty hopping running. Neuro - brisk tendon reflexes, extensor plantar response, shortened tendoachilles and minimal neuro signs.
Motor development delay, mental retardation
Associated conditions with cerebral palsy
Learning disabilities: 50%
Neurological problems: epilepsy 20-40% (most common in hemi/tetraplegic)
Visual impairment 20% - errors of refraction, diffuse ambylopia or optic atrophy.
Hearing loss- 20% - sensoneurinal
Speech disorders
Management of cerebral palsy in children
Physiotherapy - encourage normal motor development, prevent contractures.
Botox
speech therapy
OT
Management of cerebral palsy in adults
Baclofen for pain, functional impairment, spasms. low dose -> increase over 4weeks.
If not effective - refer to tone/spasticity management service
Discuss other drug tx with tone management specialist
Dont offer diazepam unless acute pain/anxiety
DOnt rapidly withdraw muscle relaxants if >2months at high dose.
Botox - if spasticity in limited no muscle groups - affecting care, causing pain, impairing activity, or tone management specialist agrees
Neurosurgical - intrathecal baclofen
selective dorsal rhizotomy
Dystonia - refer to tone management specialist
Assess for risk of #s secondary to osteoporosis if needing help with moving or having to be moved, for example, hoisting
history of falls
low BMI
history of low-impact fractures
other medical factors, for example steroid use, that may adversely affect bone health
Dexa scan if 2ormore risk factors
refer to bone health team if high frac risk or positive dexa
