Growth, Development, and Endocrinology Flashcards
Why is birth history important to consider when assessing development?
Milestones should be corrected for age eg. 2 months preterm - expect milestones 2 months later
Complications at birth can affect development eg. HIE and CP
What milestones should a child reach by 6 weeks?
Gross motor: Head control (eg. lying on tummy with head up at 45˚)
Fine motor/vision: fixes and follows
Hearing + language: stills to sound
Social: smiles
What milestones should a child reach by 6 months?
Gross motor: sitting unsupported
Fine motor/vision: full hand grip, transference
Hearing + language: turns to sound, babbling
Social: laughs
What milestones should a child reach by 12 months?
Gross motor: pulling to stand, cruising, first steps
Fine motor/vision: mature pincer grip, pointing
Hearing + language: first words, responds to name
Social: plays peek-a-boo, waves, drinks from cup
What milestones should a child reach by 18 months?
Gross motor: walking, running
Fine motor/vision: scribbles, builds small tower, hand preference
Hearing + language: 6-12 word vocabulary, follows instructions
Social: symbolic play, spoon feeding
What milestones should a child reach by 24 months?
Gross motor: runs, climbs stairs 1 at a time, kicks ball
Fine motor/vision: builds bigger tower, circular scribble
Hearing + language: 2 word sentences
Social: toilet training, removes clothes
What milestones should a child reach by 3 years?
Gross motor: climbs stairs well, stand on one leg
Fine motor/vision: draws a circle, copies a bridge
Hearing + language: 3 word sentences
Social: parallel play, shares, interacts
What are the red flags in development and limit ages for different milestones?
Red flags: regression, parents worried
- Hand preference before 1 year
- No smile or head control by 10 weeks
- Not sitting or pincer grip by 12 months
- Not walking, <5 words by 18 months
- No interaction at 3 years
What are some of the primitive reflexes? When do you expect them to regress?
Grasp, rooting + sucking, Moro, stepping, asymmetric tonic neck reflex
Should regress by 6 months or so
What is the grouping approach to screening development?
Based on the fact that certain domains are more actively developing at different ages.
<18 months: gross motor -> hearing + fine motor (hand)
18 mos -2.5 years: fine motor, speech and language
2.5 years +: speech -> social and emotional
What can be included in a developmental assessment?
MDT approach to assessing development
- Assess all 4 domains
- May include paeds, psych, OT, SALT, etc
- May include standardised testing eg. Griffiths and Bailey (global scales) or specific eg. Autism diagnostic interview
- Often play-focussed
What is the healthy child programme?
The HCP is the early intervention and prevention public health programme for children and adolescents. Includes:
- Screening: NIPE, Guthrie, vision + hearing (OAE), growth
- Immunisations
- Developmental reviews (led by health visitor) at 1 year, 2.5 years
- Health promotion
Define: developmental delay, learning disability and learning difficulty
- Developmental delay: slow acquisition of skills, seen as failure to reach developmental milestones by the normal age
- Learning disability: reduced intellectual ability affecting all areas of life
- Learning difficulty: a condition that creates an obstacle to a specific type of learning, without impacting intelligence eg. dyslexia
What is a global developmental delay? What are some causes? What investigations should you consider?
Delay affecting 2+ domains. -Chromosomal: Down's -Metabolic: PKU, hypothyroid -Infectious: congenital rubella syndrome, toxo -Birth asphyxia, kernicterus -Trauma -Abuse/neglect Ix: karyotype, FBC, U+Es, LFTs, TFTs, viral PCR, cranial USS, EEG
What are some causes of motor delay? How does it present?
- CP, myopathy, spinal cord lesions
- In the first 3 mos-2 years. Delay in walking, gait abnormality, poor balance and coordination
Define cerebral palsy
Any permanent disorder of movement +/or posture and motor function due to a non-progressive brain abnormality (that occured <2 years)
What are the causes of cerebral palsy?
- Antenatal: genetic syndrome, infection, vascular
- Hypoxic birth injury
- Postnatal infection, trauma, metabolic
How can CP present?
Gross/fine motor delay
- No head control
- Poor feeding eg. choking, poor suck
- Abnormal posture + tone
- Abnormal gait
- Hand preference <1 years
- May have microcephaly, seizures, low IQ
What are the types of CP? Briefly describe them
- Spastic: unilateral or bilateral UMN lesion. Spastic tone (velocity dependant eg. dynamic catch), brisk reflexes, tiptoe walking, scissoring.
- Dyskinetic: BG and extra-pyramidal damage, kernicterus + HIE. Involuntary movements: chorea (quick jerks), athetosis (slow writhing), dystonia (twisting)
- Ataxic/hypotonic: usually genetic. Poor balance + tone, incoordinate movements, ataxic gait
What is the management of CP?
MDT approach! At child development service bc of wide physical, social and psych needs.
- Paediatrician
- Physio: massage
- OT: aid with various activites eg. dressing, eating, washing, moving about
- SALT: feeding assessment, speech
- Psychologist
- Specialist nurses
What are some causes of speech and language delays and disorders? How are they managed?
Delay:
- Structural: cleft palate
- Hearing loss
- Global delay
- Neglect
Disorders: autism, stammer, dysarthria
Mx: SALT assessment, hearing tests. School support.
Describe the characteristic features of autism
- Speech and language abnormalities:
- Delay, echo, poor comprehension of abstract language, poor nonverbal communication - Repetitive and ritualistic behaviours and restricted interests:
- Disruption causes tantrums, favourite toys/objects, routines - Difficulties with social interaction:
- Likes own company, doesn’t seek out comfort from friends/parents, gaze avoidance, no empathy
Describe the diagnosis and management of autism
Dx: made by specialist neurodevelopmental paeds. Autism diagnostic interview
Mx: MDT approach. Paeds, SALT, psychologist
-Behaviour modification therapy.
-Social skills training
-Educational assessment w/ school involvement
-Family support eg. support groups
Describe the classification of learning disability. What is the management/ability in each?
- Mild: 70-80. May need extra school support.
- Moderate: 50-70. May need special school. Can live independently
- Severe: 35-50. Special school, may do minimal self care, need lots of support.
- Profound: <35. Special school, no independence.
Name some specific learning difficulties
- Development coordination disorder/dyspraxia: poor handwriting, hard to dress, messy eater
- Dyslexia: poor reading skills
- Dyscalculia
Describe the characteristics of ADHD and basis of diagnosis
Need impaired attention + hyperactivity, present since <6 years, in several domains and causing impairment
-Impaired attention: hard time sitting still and focusing on one task, easily distractable
-Hyperactivity: running around, doesn’t sit down for long, fidgety
Also disorganised, interrupt conversations, difficulty in sharing, etc.
Describe the management of ADHD
**If presenting to GP: watchful waiting + parent support groups for 10 weeks / refer straight away if significant impairment
Diagnosis must be made by specialist
Mx: MDT approach (paeds, CAMHS, psychologist)
-Conservative: diet + exercise
1st: ADHD-focused group parenting/support groups
-Parenting strategies, school involvement, education
2nd: medication- methylphenidate (6 week trial), lisdexamphetamine, atomoxetine. Baseline ECG, monitor growth, HR + BP, tics etc
Consider CBT
Explain the diagnosis of ADHD and the management as if to a parent (in a GP setting)
- From what you have described, I think your child may have a condition called ADHD
- Have you heard of this before? What do you think?
- ADHD is a common condition, and means that your child has difficulty with maintaining attention as well as being over-energetic, which is causing problems at home + school
- While this may be the case, there may be other explanations for their behaviour. The first thing we do when we think a child might have ADHD is to watch and wait for 10 weeks. I’ll also refer you to an ADHD support group for parents, which can help you to talk to others going through similar things and get more info, as well as learn some parenting techniques
- In 10 weeks, we’ll review how things have gone and if there are still problems, we’ll refer you to a specialist who will be able to make a diagnosis and advise on how to manage
What are some causes of hearing impairment in children? What is the management?
-Sensorineural: infection, preterm, HIE
-Conductive: otitis media with effusion, Eustachian tube dysfunction (Downs, cleft palate)
Mx: treat conductive eg. grommet, antibiotics
-Early detection and hearing aids, cochlear implant
-MDT with SALT, audiometry
What are some causes of visual impairment? What is the management?
- Malformations
- Cataracts (rubella)
- Retinoblastoma
- Squint/strabismus: due to refractive errors, cataracts etc. Cover test.
- Myopia/hypermetropia: myopia (near-sight, give concave lenses), hypermetropia (far-sight, give convex lenses)
- Nystagmus