General Paeds Flashcards
What are the four categories of developmental milestones?
gross motor
vision + fine motor
hearing, speech + language
social, emotional + behavioural
gross motor - What is the median age for sitting unsupported?
7 months
7 months unsupported
red flag if not by 9
gross motor - What is the median age for crawling?
8 months (6-9)
6-9 months crawl
gross motor - What is the median age for pull to stand?
9 months pull to stand
gross motor - What is the median age for walking?
1 yr walk here
(15 months - steadily)
(red flag if no walk by 18)
gross motor - What is the median age for runs + jumps?
2 and a half runs + jumps
Give me two gross motor RedFlags.
- no sitting unsupported by 9 months
- no walking by 18 months
vision+finemotor - What is the median age for fix + follow?
6 wks
week six, follow n fix
(red flag if not by 3)
vision+finemotor - What is the median age for palmar grasp?
5 months palmar grasp
five fingers on palm
vision+finemotor - What is the median age for pincer grip?
10 months pincer grip
red flag if no by 12months
Give me two vision + fine motor RedFlags.
- no fix + follow by 3 months
- no pincer grip by 12 months
Give me 3 hearing, speech + language RedFlags.
- no polysyllabic babble by 7 months
- no 6 words w meaning by 18 months
- no joining words by 2yrs
hearing, speech + language - What is the median age for saying a 2 or 3 words and understanding own name?
1 yr understanding name, 2-3 words
hearing, speech + language - What is the median age for simple phrases?
2 yrs simple phrases
red flag if not
hearing, speech + language - What is the median age for sentences?
3 yrs sentences
hearing, speech + language - What is median age for polysyllabic babble?
7 months polysyllabic babble
red flag if not
Give me 3 hearing, speech + language RedFlags.
no smiling by 8 wks (h8 when no smile by 8)
no spoon feeding by 18 months
no symbolic play by 2 and a half
social, emotional + behavioural- What is median age for smiling?
6 wks
red flag if no smile by 8wks
social, emotional + behavioural - What is median age for waves bye bye and drinks from a cup?
1 yr bye bye + cup drink
social, emotional + behavioural - What is median age for finger feeding?
7 months
eats 7 party rings
social, emotional + behavioural - What is median age for spoon feeding?
18 months
red flag if no spoon feeding by 18 months
social, emotional + behavioural - What is median age for clean and dry, undress w help ?
2 yrs
- no polysyllabic babble by 7 months
- no 6 words w meaning by 18 months
- no joining words by 2yrs
RedFlags for…
hearing, speech + language
no smiling by 8 wks (h8 when no smile by 8)
no spoon feeding by 18 months
no symbolic play by 2 and a half
RedFlags for…
social, emotional + behavioural
- no fix + follow by 3 months
- no pincer grip by 12 months
RedFlags for…
vision + fine motor
- no sitting unsupported by 9 months
- no walking by 18 months
RedFlags for…
gross motor
What’s a squint (a.k.a strabismus)?
misalignment of visual axes such that eyes don’t look in same direction
When is it normal to have a squint?
under 3 months old. common in little babies, esp prems.
What do you need when a squint persists beyond 3 months?
opthalmologist opinion
if the eyes moves, it’s a non-paralytic / ‘concomitant’ squint. If it’s a paralytic squint, that might indicate..
space occupying lesion :/
Causes of squint are multifactorial. Name a few.
refractive errors FHx prematurity Down's / cerebral palsy SoL
What is the commonest cause of squint (a.k.a strabismus)?
refractive errors
e.g. hypermetropia
Sudden onset paralytic squint with other neuro signs. What needs to happen?
urgent neuro referral (SoL)
- MRI / CT brain
What is the difference between manifest and latent squint?
manifest - the eyes points in/out all the time
latent - only apparent when occlude other eye
Describe the cover test.
child looks at toy
place occluder over one eye
if fixing eye covered, squinting eye moves to take up fixation
How do you test visual acuity in
a) toddlers
b) adults
toddlers - picture test
adults - Lobmar test
What investigations for strabismis? (x4)
- corneal light reflex test
- cover test
- visual acuity
- test ocular movements (CN palsies)
What is pseudostrabsimus?
where it looks like they’ve got a squint but they haven’t, e.g. bc eyes too close together
What are the two aims in treating strabismus?
- restore binocular single vision
- restore alignment (for looks)
Describe the management of squint. (x4)
- glasses or patch
- orthoptic exercises
- surgical
- botox injection
Amblyopia is a type of
refractive error
What is amblyopia?
decreased visual acuity (lazy eye)
ambling along - lazy
What’s refractive error?
a lens thing
e.g. myopia, hypermetropia, astigmatism, amblyopia
What is the posh word for short sightedness?
myopia
Benji Percival
What is the posh word for long sightedness?
hypermetopia
lots of metres
What is hypermetopia?
long sightedness
What is myopia?
short sightedness
Lazy eye can come from strabismus. But what else?
stimulus deprivation (e.g. ptosis)
Investigations for amblyopia?
glasses test - check refraction
fundoscopy - exclude
When should you have treated amblyopia by?
age 7!!!
When do you reach visual maturation?
age 7
make sure you treat amblyopia by then
What is treatment for amblyopia (lazy eye)? (x3)
- glasses
- patch
- blurry atropine eye drops
Whaat is astigmatism?
abnormal corneal curvature
Give me four types of refractive error.
myopia
hypermtropia
astigmatism
amblyopia
Give me a genetic cause of visual impairment.
cataracts, retinoblastoma
Give me a perinatal cause of visual impairment.
congenital infection
retinopathy of prematurity
HIE
Give me a post natal cause of visual impairment.
JIA (uveitis)
trauma
What kind of teachers do you think of when you think of visual impairment or special needs
peripatetic teachers.