General Paediatrics Flashcards
Builds tower of 2-3 cubes
18 months
Builds tower of 6 cubes
24 months
Builds a “bridge” with cubes
3.5 years
Drawing a random stroke
18 months
Drawing a circle
3 years
Weschler Intelligence Scale for Children (WISC)
The test generates an IQ score independent of reading and writing skills
Can diagnose learning disability
Verbal comprehension, visual spacial, fluid reasoning, working memory, processing speed, verbal comprehension, perceptual organisation, freedom from distractibility, processing speed
Used for kids 6-16 years
Average IQ= 100
<70 = intellectual disability (2 SD below the population mean)
*Weschler preschool and primary scale of intelligence (WPPSI) for ages 2.5 years- 7.5 years
Bailey scale of infant and toddler development (BSID)
formal development tool
often used to follow up premature babies at risk of developmental delay
Age 1month-42 months
Griffith mental development scales
Birth- 6 years
Gross motor skills
Social interaction with others
Hearing and language
Hand eye coordination
Performance (reasoning)
Practical reasoning (2-6 years)
McCarthy scales of children’s abilities (MSCA)-
ages 2-8
Measures cognitive ability rather than IQ
Peabody Picture Vocabulary test
ages >2.5 years
-tests receptive vocabulary
Ages and stages
screening questionare
completed by parents
4 months - 5years
intellectual disability
IQ <70 AND low adaptive functioning
Mild - 50-69
Mod- 35-49
severe 20-34
profound <20
red flags in child development
poor head control by 4 months
not sitting by 9 months
not walking independently by 18 months
no babbling, pointing or gesturing by 12 months
no single words by 16 months
<10 words by 20 months
no two word combinations by 24 months
<50 words by 30 months
regression in language or social skills at any age (25% of ASD)
ADHD assessment tools
Connors
Vanderbilt
M-CHAT
modified checklist autism in toddlers
screening tool
between16 and 30 months of age
Difference between Autism Diagnostic Interview (ADI) and Autism Diagnostic Observation Schedule (ADOS)
ADI-R explores a child’s early developmental history through semi structured parent interview
the ADOS provides information regarding the child’s current functioning in social, communication and play areas through a structured play session
Medications for autism
Usually stimulants for co morbid ADHD
Melatonin + sleep program
Risperidone for agression
Anxiety- SSRI (fluoxetine)
Sertraline - OCD
drawing a line
2 years
builds bridge
36 months
kick a ball
2 years
jump in place
2 years
throw a ball
12-18 months
words by age 2 years
50 -200
50% intelligible
runs well
18 - 24 months
pretend play by
18 months
what age does child turn directly to sound
9-10 months
by what age should conversation be clear for others
4 years
walks alone
12 months
stands alone
11 months
crawls
10 months
sits independantly
6 months
expressive speech milestones
18 months - 25% understood by parents
24 months 50-75% understood by parents
36 months 75-100% understood by parents
4 years- all understood by others
echolalia
repetition of words spoken by others
pointing at wanted items
12 mo
what tests make up newborn hearing screening
otoacoustic emissions (OAE)
automated auditory brainstem responses (AABR)
- not diagnostic
- if test failed, needs audiometry
Major gross motor milestones
2 months - lifts head 45 deg
4 months- roll front to back
6 months- roll both ways, sits without support, drinks from a cup, eats with spoon (held by parent)
9 months- crawls, pulls to stand
12 months- cruising, first steps without support
18 months- throws, runs stiffly, kicks ball, uses spoon/cups independently, throw ball
24 months- runs well, up and down stairs
36 months- catch ball, rides tricycle
4 years- hops, up and down stairs with alternate feet, stands one foot
5 years- skips
Major fine motor milestones
6 weeks- fixes and follows to midline
8 weeks- fixes and follows past the midline
4 months- reaching for objects
6 months- transfers objects, palmar grasp
8 months- raking
9 months- crude pincer grip
12 months- points with index finger, refined pincer grip
18 months- builds tower of 3 cubes, scribbles, handedness
24 months- builds tower of 6 cubes, draw a line
3 years- tower of 9 cubes, bridge with 3 cubes, draws circle, eats with fork and spoon
Major social milestones
6 weeks- smiles
8 weeks- pays attention to faces, cries when bored
4 months- laughs
9 months- stranger and separation anxiety, plays peek a boo, object permanence
12 months- waves, imitates clapping
18 months- points to pictures in book, pretend play
24 months - shares, undresses, parallel play
36 months- dresses self with supervision
4 years- role playing, cooperative play, dresses without supervision
Speech and language milestones
6 months - babbles
12 months - first words, can follow 1 command
18 months- names 3 body parts, 5-20 words
2 years- 2 word phrases, names 6 body parts, can follow simple 2 step commands, 50-200 words, language 1/2 clear
3 years- 1000 words, language 3/4 clear
4 years- 1500 words, full name, colours, songs, fully understandable
ADHD diagnosis
- Inattention: 6 or more symptoms present for at least 6 months, inappropriate for developmental level
- Hyperactivity and impulsivity: 6 or more symptoms, present for at least 6 months
- Additional criteria:
a. Inattentive/ hyperactive symptoms present before age 12 years
b. Present in two or more settings (usually home + school) – social, academic, occupational
c. Interfere with functioning
d. Not explained by something else
Check for ODD (60%), and learning disorders (20-60%), anxiety (30%) and autism (10-20%
Tests for ADHD
Connors
Vanderbilt
- both rating scales for parents to fill out
MOA stimulants
methylphenidate +dexamphetamine = non-competitively block the reuptake of dopamine and noradrenaline by blocking dopamine transporter (DAT) and noradrenaline transporter (NAT), increasing levels of dopamine and noradrenaline in the synaptic cleft.
Dexamphetamine also promotes dopamine (and noradrenaline to a lesser extent) release from synaptic vessels (hence has slightly better effect, but less tolorable)
MOA Atomoxetine
selective noradrenaline reuptake inhibitor
MOA Guanfecine
alpha 2 adrenergic agonist
(same as clonidine)
A/E stimulants
- Anorexia = up to 80%
a. Results in poor weight gain
2. Emotional blunting
3. Anxiety
4. Tics
5. Mood lability
6. Initial insomnia
7. Dizziness
8. Rebound effect- can mitigate this by adding a small afternoon dose
9. Psychosis, suicidality
ii. Long-term
1. Growth - does have an effect on growth (1-2cm overall)10. Cardiac - increases HR and BP, may increase arrythmias (long QT) ii. Long-term 1. Growth - does have an effect on growth (1-2cm overall) 2. ? Cardiac strain – no evidence 3. Substance abuse – protects against smoking, neither protects nor increases risk of later substance abuse disorders iii. Risk of cardiovascular events 1. Mild increase in HR, BP – for most children of no consequences 2. Epidemiological – no increase over background rate of SCD 3. FDA recommends a. History i. Child – syncope, palpitations, SOB, chest pain ii. Family – CVS disease, premature SCD b. Examination c. If known cardiac disease or history/examination raise concern ECG, echo, cardiology consult
Comorbidities with Autism
ID up to 70%
ADHD 50%
Learning difficulties
Epilepsy up to 30%
Screening tools in autism
- ADOS (Autism Diagnostic Observation Schedule) – ages 12 mo to adult; formal observation assessment, gold standard 2.M-CHAT (modified checklist for autism in toddlers) ages 16-30 mo; screening test
- ADI-R – Autism Diagnostic Interview Revised (ages 4+)- structured parent interview
- CARS – Childhood Autism Rating Scale (ages 2+) – diagnostic test; used to gauge severity
- ADEC (autism detection in early childhood)- screen for autistic tendencies 12mo-3 years
- ADIR (Autism diagnosis interview- revised)- formal interview assessment
Adverse effects risperidone
mild sedation
hypotension
akathisia
prolactin elevation (which can cause menstrual irregularities)
weight gain
increased dream activity
Risperidone has moderate risk of extrapyramidal symptoms, such as akathisia and dystonia (muscle stiffness).
what condition is most commonly associated with ADHD
ODD
Otoacoustic emissions
Detection of OAEs during sleep
sounds generated from the cochlea transmitted across the middle ear to the external ear canal, where they can be recorded
“pass” or “refer” result
high likelihood false refer results often due to fluid in the ear
Screening tests in infants and young children for hearing at the 30dB level of hearing loss (ie emissions are absent if >30DB hearing loss)
More sensitive than behavioral tests in young children
If hearing loss is suspected based on the absence of OAEs the ears should be examined for evidence of pathology and then ABR testing should be done for confirmation, identification of type of hearing loss, and lateralise the hearing loss
tests to level of brainstem rather than to cochlear (OAE)
Auditory brainstem reponse
- Screen newborn hearing, confirm hearing loss in yound children, lateralise hearing loss, and test children who wont cooperate with behavioral test methods
- Tests electrical discharges from numerous neurons
- Needs to be done during sleep or sedation/GA- to minimise electrical interference caused by muscle activity
Behavioral observational audiometry
- Infants <6 months of age
- Detects unconditioned, reflexive resonses to complex tests sounds such as noise, speech, music
Visual reinforcement audimetry
6 months - 2.5 years
Child observes for head turning response on activation of animalted toy reinforcer
Not ear specific
Designed to rule out hearing loss that would affect speech and language
Play audiometry
2.5 years - 5 years
primary treatment of manic episode in bipolar
ANTIPSYCHOTIC - usually olanzapine or risperidone
better than mood stabiliser
