Infant Development and Some Disorders csv

Question 1

Why is tracking development important?

Answer 1

Child development is the progress a child makes towards achieving more complex movemnts and actions. Like a VITAL SIGN it lets us learn why a child is acting a certain way. Development is influenced by environment, genetics, and culture.

Question 2

4 Domains of Development used for Development Assessment

Answer 2

(1) Social: learn the skills to have meaningful emotional connection with others (2) Language: the expanding sounds and symbols a child uses to express him/herself (3) Gross motor: control of body and large muscles (3) Fine motor: control of small muscles

Question 3

Markers of Social Development

Answer 3

Adequate development of learning to have emotional connections with others is measured by the following… (A) Baby is born and REGARDS THE FACE (can look up to mom’s face) (B) At 1 month the baby smiles spontaneously ( C) At 2 months the baby smiles RESPONSIVELY (D) *** At 5 months the baby will WORK FOR A TOY; they are interested in watching the world around them like watching their parents eat (E) 8 months: wave goodbye (F) 10 months: INDICATE WANTS by crying and pointing (G) 12 months: will play paty-cake; JOINT ATTENTION

Question 4

Markers of Language Development

Answer 4

Adequate expansion of sound/symbol complexity is measured by the following_ (A) At 1 month they can respond to a bell/vocalize (B) At 2 months they can say oooh/ahhh ( C) At 6 months they can TURN THEIR HEAD TO A VOICE (D) At 9 MONTHS they can say MAMA, DADA, but it is NON specific babble (E) At 12 months they can say mom/dad and SPECIFICALLY mean it! (F) ***By 15 months they should be able to say 3 words…

Question 5

Prosidy

Answer 5

Using TONE to express a question or frustration (think of the video of the twins infants babbling to each other)

Question 6

Babbling

Answer 6

Using the SAME WORD to express a sentence

Question 7

Case 1

Answer 7

See patient who is 18 months who has NOT SAID their first word (should by 9 months), stacks boxes over and over again, doesn’t respond to his name (turns head to voice at 6 months)_ this is abnormal. Differential includes: ear/nerve problem, brain problem, muscle problem.

Question 8

Autism Spectrum Disorder

Answer 8

Autism is defined as an impairment in COMMUNICATION and SOCIAL INTERACTIONS characterized by ** non-functional repetitive actions **. It is more common in BOYS (4:1). Race and ethnicity do NOT matter. 40-70% of children have cognitive impairment. Within the DSM-IV classification, Rett Syndrome is an uncommon cause of very severe autistic behavior in girls (it is X linked and fatal in boys).

Question 9

Epidemiology and Autism

Answer 9

Number of children receiving special education for autism increased 500% from the 1991-1992 to the 1998-1999 school year. [incidence has since remained stable]. However, the PREVALENCE is an URGENT PUBLIC HEALTH CONCERN affecting about 1 in every 120 children.

Question 10

Why did the incidence increase from ‘92 to ‘99?

Answer 10

DSM definitions of autism became more inclusive (i.e. including gross language impairment and inclusion of children with higher IQ such as Aspergers),

Question 11

What came with high prevalence?

Answer 11

SIGNIFICANT SCHOOL SERVICES for those who may not have met criteria before.

Question 12

Etiology of Autism

Answer 12

Twin studies have shown us that there is a very significant genetic component (60-90% risk for identical twins, vs. 10% for fraternal twins or siblings). Autism is associated with genetic disorders such as FRAGILE X, PKU, congenital rubella, tuberous sclerosis, and use of thalidomide. Know that FATHERS >40 years old are 6X MORE LIKELY to have a child with autism than fathers <30 years old.

Question 13

DSM-IV Autism Diagnostic Criteria

Answer 13

Delay in at least one of the following areas with ONSET PRIOR TO 3 YEARS of age (and cannot be explained by Rett’s or Childhood Disintegrative Disorder): social interaction, language used for social communication, symoblic/imaginative play.

Question 14

Can Vaccines cause Autism?

Answer 14

Concern regarding MMR and Thimerosol, which is a vaccine preservative with a trace of Mercury, surfaced in 1998 when a British study of ONLY 12 children published a link bewteen MMR and autism. It I has TAKEN YEARS TO UNDO THIS DAMAGE (In 2004, 10/13 authors retracted the implications they made). In 1999, the american academy of pediatrics recommended REMOVING thimerosol from vaccines even though there was no proof of causality. In 2001, Thimerosol was removed from ALL VACCINES except for some influenza vaccines! ***In 2004, the IOM concluded that there is NO ASSOCIATION between autism and the MMR vaccine (or vaccines with the thimerosal preservative). And a study from california has shown that despite removal of thimerosol from vaccines, rates continue to rise.

Question 15

***Physical Exam Findings and Autism

Answer 15

***See picture in saved images: Look at head circumference, exaggerated facial features, SKIN exam (hypo/hyperpigmented lesions), and neurologic exam (findings with mental status, cranial nerves, tone, reflex, and gait).

Question 16

Screening for Autism

Answer 16

The M-CHAT (modified checklist for autism in toddlers). This is done at 18 and 24 months by asking parents a set of questions. If a parent answers NO to greater than or equal to 2 questions, further evaluation is needed.

Question 17

Therapy for Autism

Answer 17

ABA: Applied Behavioral Analysis. >30 hours/week of ABA may help alter nonfunctional reptitive behaviors. Also occupational therapy, physical therapy, and speech therapy.

Question 18

Markers of Gross Motor Development

Answer 18

Adequate control of body and large muscles is assessed by the baby’s ability to roll over, sit, and stand (A) At 0-3 months baby lifts head but hands are fisted/not being used (B) At 3-5 months, can USE ARMS to support chest and head ( C) At 2-5 months, the baby can ROLL OVER (D) At 6-8 months, baby can sit without support = TRIPOD BABY (E) At 7-8 months baby can stand holding on (F) At 10-13 months can stand on own for 2 seconds (G) ***At 10-16 months (i.e. 1 year) baby can WALK WELL.

Question 19

Case 2

Answer 19

Mom brings in baby is who 20 months old and is not yet walking. Are you concerned? YES. Physical exam reveals that CPK is elevated which implies that there is dealyed walking due to muscle cells breakdown = MYOPATHY.

Question 20

Differential for delayed walking.

Answer 20

Brain (do imaging): i.e. cerebral palsy which is ONLY a motor disorder where there are LESIONS IN THE MOTOR CORTEX (PT can have normal intelligence, etc.). Spinal Cord (do neuro exam), Peripheral Nerve (do neuro exam), Muscle (do exam and check CPK), or Bone issue (do imaging).

Question 21

Muscular Dystrophy

Answer 21

Patient with delayed walking and increased CPK_ diagnosis is Duchenne’s Musclar Dystrophy which is a PROGRESSIVE MYOPATHY due to alteration of dystrophin in the muscle. The disease is X-linked, and consequently predominately found in males. The child is wheelchair bound by age 10 and will only live to their 20’s when respiratory distress develops.

Question 22

Gouer’s Sign

Answer 22

A positive Gouer’s sign is when a child has to walk up his/her legs with their hands in order to get from the ground to standing. It is commonly seen in muscular dystrophy.

Question 23

Markers of Fine Motor Development

Answer 23

Adequate control of small muscles is assessed by the baby’s ability to control the small muscles of their hands and mouth (i.e. the ability to pick something up and eat it without choking). At 0-6 months the baby should be able to flex and extend fingers (at 4 months they can bring their hand to their mouth). At 7-12 months, the baby should be able to make a PINCER GRASP (9 months) between the thumb and index finger which is important for eating and at 10 months they should be able to POINT.

Question 24

Cerebral Palsy

Answer 24

In the vast majority of cases there is NO cause and a NORMAL delivery. Best predictor is ECHODENSITIES in the periventricular white matter. Often hard to pick up before 6 months.