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Exam theory > Overview of Child Development > Flashcards

Overview of Child Development Flashcards

1
Q

For children with spinal pain, imaging techniques have proved to be?

A

poor at distinguishing between adolescents with and without LBP.

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2
Q

MSK pain in primary paediatric care. The most common category was?
a. Knee pain
b. back pain
c. soft tissue pain
d. arthralgia

A

d. arthralgia

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3
Q

For every 10 children, LLB affects how many at a given time?

A

3-4

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4
Q

Conditions commonly seen in a chiropractic paediatric practice include:

A
  • LLB
  • Thoracicspinepain,
  • Scheuermann’sdisease,
  • Neckpain,
  • Scoliosis,and
  • Headache
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5
Q

Reported concerns relating to chiropractic care of children include

A
  • Cervical manipulation
  • repeated radiographic examination
  • delay/prevent treatment or appropriate medical diagnosis
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6
Q

Examples of non-MSK conditions that MUCC can give treatment advice for are?

A
  • colic,
  • asthma,
  • enuresis (bed-wetting) and
  • otitis media.
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7
Q

No HVLA techniques are to be utilised on paediatric patients under the age

A

6

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8
Q
A
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8
Q

No cervical HVLA techniques are to be utilized on paediatric patients under the age of

A

12

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9
Q

The following treatment techniques are allowed for the treatment of paediatric patients at MUCC

A
  1. Mobilisations (grades I-IV only) of the cervical, thoracic, lumbar spine & pelvis and extremities
  2. Soft tissue therapy
  3. Stretches
  4. Advice
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10
Q
A
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11
Q

The average weight and length at birth is?

A

3-3.5kg and 50cm

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11
Q

At what age does primitive reflexes disappear?

A

6 months

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12
Q

When does fine pincer typically begin?

A

12 months

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13
Q

When does head control typically start?

A

6 months

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14
Q

When do first independent steps typically start?

A

1 year (12 months)

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15
Q

Median age in females when growth in stature ceases

A

17.3

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16
Q

Median age in males when growth in stature ceases

A

21.2 years

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17
Q

What percentage of adult stature is attained during 2.5-3 years period

A

20%

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18
Q

Average adolescence growth per year for boys and girls is?

A

10cm/yr for boys
8cm/yr for girls

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19
Q

At what age does length increase about 12 cm?

A

2

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20
Q

Mid growth spurt in height is more common in?

A

females

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21
Q

Obesity in children effects

A
  • emotional development,
  • social development,
  • physical development
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22
Q

What percentage of birth weight is effected during the 1-3 day post natal period? When is it likely to be gained back?

A
  • 7-10% of body weight.
  • Expected to gain this back within ~2 weeks
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23
Q

Besides the menarche and breaking of the voice, the state of maturation can also be evaluated on

A

basis of pubic hair, development of genitals (boys) and breast development (girls).

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24
Q

Menarche and commencement of ossification of iliac crest apophysis occur approx

A

1 year after growth spurt peak.

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25
Q

In endocrinological terms, puberty starts

A

even before the outwardly visible changes with the secretion of gonadotrophins by the anterior lobe of the **pituitary gland **around age 7 in girls, and age 8 in boys.

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26
Q

The gonadotropic hormones stimulate the

A

gonads to secret sex hormones (testosterone and oestrogen) which, in turn, stimulate the secretion of growth hormone (STH = somatotropic hormone) in the pituitary (prepubertal growth spurt).

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27
Q

Domains for assessments of neurological development should include

A
  • cognitive,
  • motor,
  • language,
  • social/behavioraland
  • adaptive
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28
Q

Does gross motor skills or fine motors skills develop first?

A

The acquisition of gross motor skill precedes the development of fine motor skills.

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29
Q

How would you describe the typical route of development for fine and gross motor skills?

A
  • A Cephalo-caudal fashion
    (Head control preceding arm and hand control Followed by leg and foot control)
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30
Q

At what age can infants approx. sit without assistance or support?

A

8 months

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31
Q

```

~~~

What age can infants typically crawl?

A

9 months

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32
Q

At what age can a child stand independently from a crawl position

A

1 year

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33
Q

At 13 month old a child can typically walk and toddle quickly. What age can they run?

A

15 months

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34
Q

Gait in children younger than 2:

A
  • Wider base
  • Shorter stride length with higher cadence
  • No heel strike (flat foot contact)
  • Very little stance phase and knee flexion
  • Entire leg externally rotated in swing phase
  • Absent reciprocal arm swing
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35
Q

Newborn has very little control. Objects will typically be

A

involuntarily grasped and dropped without notice.

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36
Q

At what age does palmar grasp (uses entire hand to pick up an object) develop?

A

6 months

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37
Q

At what age does the pincer grasp – can grasp small objects using thumb and forefinger develop?

A

9 months

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38
Q

When assessing a childs hearing what should you always ask a parent?

A

history of otitis media – ear infection, placement of “tubes” in ear

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39
Q

Red Flags in infant development

A
  • Unable to sit alone by age 9 months
  • Unable to transfer objects from hand to hand by age 1 year
  • Abnormal pincer grip or grasp by age 15 months
  • Unable to walk alone by 18 months
  • Failure to speak recognizable words by 2 years.
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40
Q

What age can a child build a tower of six blocks?

A

2

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41
Q

What ages can a child color within the borders
and write some letters and draw a person with body parts?

A

4 for colour
5 for letters/drawing person

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42
Q

Temper tantrums can occur in

A

50 to 80% of children – peak incidence 18 months – most disappear by age 3

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43
Q

Aggressive behavior towards new infant - peak between

A

1 to 2 years but may be prolonged indefinitely

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44
Q

When does fine motor and cognitive abilities typically begin?

A

Preschool age (toddler)

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45
Q

Red flags: preschool

A
  • Inability to perform self-care tasks, hand washing, simple dressing, daytime toileting
  • Lack of socialization
  • Unable to play with other children
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46
Q

Red flags: school age

A
  • School failure
  • Lack of friends
  • Social isolation
  • Aggressive behavior: fights, fire setting, animal abuse
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47
Q

Adolescent behavioral problems include

A
  1. Anorexia
    2.Attention deficit
    3.Anger issues
    4.Suicidal thoughts or attempts
48
Q

Causes of back pain in children

A
  • Gender
  • Age
  • Obesity/poor posture
  • heavy school bags
  • Incorrectly packed bags
  • sedetary lifestyles
  • injuries by vigorous sport
  • soft tissue injuries
  • competitive sports with intense training
49
Q

Prevention of back pain in children

A
  • Reduce risk of falls
  • spread tanbark around home playground
  • encourage regular walk/stretch
  • Limit TV and computer time
  • teach how to sit in a chair
  • ergonomic chair
  • exercise
  • stress importance of straight posture and regular stretching for strong back and core muscles
50
Q

Low back pain is more common in school-age children with

A
  • high levels of psychosocial difficulties,
  • conduct problems, or
  • other somatic disorders.
51
Q

Tumours are more common in patients with

A

nighttime pain, constant pain, and symptoms lasting less than three months.

52
Q

Reasons in this population for acute back pain

A
  • Herniated discs,
  • Fractures, and
  • Muscle strains present as acute back pain.
53
Q

A slipped apophysis may have a presentation similar to

A

herniated disc, with pain radiating down the legs.

54
Q

Reasons in this population for chronic back pain in children

A
  • Developmental problems
    (e.g., Scheuermann’s disease),
  • Inflammatory spondyloarthropathies,
  • Psychological problems.
55
Q

Pain that occurs with scoliosis may suggest an

A

osteoid osteoma or other tumor, infection, or herniated disk.

56
Q

Underlying disease should be suspected if:

A
  • localized tenderness,
  • exaggerated stiffness of any particular spinal region,
  • pronounced thoracic kyphosis,
  • midline skin defects
  • excessive hamstring tightness,
  • neurological abnormalities (asymmetrics abdominal reflexes, clonus, gait disturbances, and motor or sensory changes)
57
Q

In the spine, ossification begins

A

late fetal period and continues after birth

58
Q

Primary centres of ossification

A

spinous, transverse and articular processes.

59
Q

Secondary centres of ossification

A

vertebral body, spinous & transverse processes, ribs

60
Q

Relatively linear growth of the spine occurs

A

3 years to onset of puberty

61
Q

Classification of Scoliosis

A
  • By age
  • By aetiology
  • Idiopathic
  • Congenital
  • Neuromuscular
  • And by type:
  • Non-structural
  • Structural
62
Q

Aetiology of Scoliosis

A
  • Idiopathic
  • Congenital
  • Neuromuscular
63
Q

The most common type of scoliosis

A

Idiopathic

64
Q

High rate of progression of idiopathic scoliosis is

A

3 yrs – 10 yrs

65
Q

Adolescent
Onset of Idiopathic scoliosis

A

@ puberty (10 yrs)

66
Q

Infantile Idiopathic scoliosis

A

Onset <3 yrs, 80-90%
* 80-90% resolve spontaneously

67
Q

Scoliosis can be termed as a 3D defmority. What are the features?

A
  • Rotation of vertebral body
  • Spinous process ‘disappears’
  • Loss of spinal curves (lateral view)
  • Lateral flexion of trunk
68
Q

Scoliosis is named by

A
  • side of convexity
  • Location
  • Secondary or compensatory curves
69
Q

Non-Structural idiopathic scoliosis

A
  • Fully corrects,
  • No vertebral rotation
  • Non-progressive (usually)
  • Leg length discrepancy
70
Q

Structural idiopathic scoliosis

A
  • Cannot be corrected
  • Vertebral rotation toward convexity,
  • Prominent ribs or para-spinal hump
71
Q

**

Which type of idiopathic scoliosis can be corrected?

A

non-structural

72
Q

The Cobb Angle measures

A

Magnitude of spinal curvature

73
Q

What is the min degree for a cobb angle to be considered a scoliosis

A

min of 10 degrees to be considered a scoliosis

74
Q

Risser’s Sign examines?

A

Determines skeletal maturity by quantifying the amount of ossification at the iliac crest

75
Q

When taking an X-ray, what views are needed for scoliosis assessment and why?

A

Lateral & A-P
To assess the
Magnitude, location & skeletal age

76
Q

When should a child be referred to orthopaedic surgon when taking the Angle of trunk rotation/rotation of the spine?

A

> 7 degrees

77
Q

When taking Measurement of scoliosis what 4 things need to be looked at?

A
  1. Angle of trunk rotation/rotation of the spine
  2. Leg length
  3. Muscle length
  4. Balance
78
Q

Progression of scoliosis is defined as

A

Sustained increase of 5 degrees or more on two consecutive examinations occurring @ 4-6 monthly intervals

79
Q

There is an Increased risk of progression in structural curves if:

A
  • Young @ diagnosis
  • Low skeletal maturity, or pre-menarche
  • Double curves
  • Large Cobb angle
  • Female
80
Q

Management Considerations for scoliosis

A
  • Skeletal maturity
  • Growth potential
  • Curve magnitude
  • Co-existing conditions
  • CP status
  • Psychological factors
  • Risk vs benefits
81
Q

When to refer to an orthopaedic team for review and on going monitoring.
once there is confirmed scoliosis?

A

All types and degrees above 10

82
Q

Management/focuses for Non-structural

A
  • Correct any LLD / other underlying problem
  • Promote physical activity (general fitness)
  • Specific stretch and strength activity if impairments found
  • Monitor child’s growth and any progress of curve
  • Usually disappear when underlying problem treated
83
Q

With structural Scoliosis, what degree should be monitored by ortho team?

A

<25

84
Q

When should conservative Rx (bracing and exercise) occur with structural?

A

25-40 degrees

85
Q

What degree in structural is a patient a candidate for surgery

A

> 40

86
Q

Neuromuscular Scoliosis
develops early and is often rapidly progressive curves are due to:

A
  • Asymmetrical distribution of spasticity
  • Asymmetrical paraplegia
  • Asymmetrical movement patterns
  • Lack of voluntary muscle control
  • Asymmetrical muscle strength
87
Q

Types of Neuromuscular Scoliosis

A
  1. Neuropathic (CP i.e. UMN lesion)
  2. Spinal muscular dystrophy (LMN lesion) & Myopathic (Duchenne muscular dystrophy)
88
Q

Majority of neuromusclar scoliosis are
a. dystophies
b. spina bifida
c. CP

A

a. dystophies

89
Q

Surgical treatment for neuromusclar scoliosis

A
  • Fusion to sacrum common
  • Greater blood loss/increased time in sx
  • A and P fusion
  • Anterior release for long and stiff curve
90
Q

Congenital Scoliosis types

A
  • Anomalous vertebral development
  • Anterolateral deformity = kyphoscoliosis
  • Posterolateral deformity = lordoscoliosis
91
Q

What type of deformity is kyphoscoliosis

A

Anterolateral

92
Q

What type of deformity is lordoscoliosis

A

Posterolateral

93
Q

Characteristics of the growth disorder Scheuermann’s Disease

A
  • Narrowing IVD
  • Wedged vertebrae
  • Collapse endplate
  • Kyphosis
94
Q

Where in the spine does Scheuermann’s Disease occur?

A

thoracic, thoracolumbar or lumbar level

95
Q

Diagnostic criteria for Scheuermann’s Disease include

A
  • thoracic kyphosis of >45°
  • thoracolumbar kyphosis of >30°
  • Wedging > 5°of three adjacent vertebrae
96
Q

Etiology of Scheuermann’s Disease

A
  • Mechanical factors
  • Endogenous factors
  • Posture
  • Psychological factors
  • Osteoporosis
97
Q

Clinical features of Scheuermann’s Disease

A
  • Severe back pain, no hx of trauma
  • fixation of kyphosis doesn’t return to “normal”
  • increased finger-floor distance due to contraction of the hamstrings
  • thoracic form always has contraction of pecs
98
Q

What clinical feature applies in all cases of scoliosis, regardless of the location of the disease?

A

Increased finger-floor distance that is almost invariably measured in Scheuermann patients as a result of contraction of the hamstrings.

99
Q

Radiographic features of Scheurmann’s

A
  • Wedged vertebrae,
  • IVD space narrowing,
  • Schmorl’s nodes,
  • Apophyseal ring herniation
100
Q

Associated diseases for Scheuermann’s

A
  • Scoliosis
  • Spondylosis (thoracic form has increased incidence)
101
Q

When is there a good Prognosis for Scheuermann’s

A
  • Fixed, thoracic kyphoses of < 50° do not represent a problem in adulthood,
102
Q

Scheuermann’s: Fixed, thoracic kyphoses of > 50

A
  • Back pain is no more frequent, but is likely to be more intense than in normal individuals.
  • Lung function may be impaired in very severe kyphoses.
  • Kyphosis of more than 70° can also be progressive in adulthood.
103
Q

Treatment Options for Scheuermann’s

A
  • Bracing
  • Kyphosis >50 °
  • Patient has growth potential
  • Surgery
  • Kyphosis >70 °
  • Mainly for cosmetic reasons
104
Q

Most congenital malformations of the spine are Most congenital malformations of the spine acquired when?

A

During pregnancy

105
Q

The majority of congenital malformations, the causative factor is assumed to be

A

toxic damage during the pregnancy

106
Q

the development of myelomeningocele is due to what deficiency?

A

Folate

107
Q

List 6 associated deformity for congenital malformations of the spine

A
  • fused ribs
  • spinal dysraphism
  • pulmonary dysfunction
  • renal malformations
  • heart defects
  • clubfoot
108
Q

When describing congenital abnormalities, it is important to identify :

A
  • type of malformation,
  • resulting deformity and
  • specific region of the spine where the malformation occurs
109
Q

Malformations of the spine can be classified as

A
  • neural tube defects,
  • defects of segmentation and
  • defects of formation
110
Q

When do neural tube defects occur?

A

the fourth week of embryonic development.

111
Q

What happens with neural tube defects? How does this affect surrounding structures?

A

The tube fails to completely close. Structures overlying these midline abnormalities are severely affected and may be unable to form.

112
Q

With congential malformations, the failures of formation
arise as a result of an absence of

A

structural element of a vertebra

113
Q

The type of congential deformity depends on what? What will this alter?

A

The area of the vertebral ring affected, which will alter normal growth patterns.

114
Q

Typical observable defects are

A

hemivertebrae or wedge vertebrae

115
Q

Bony remnants that did not complete normal development and can be fully segmented, semisegmented or nonsegmented is referred to as?

A

Hemivertebrae

116
Q

Hemivertebrae can be

A
  • segemented
  • semi segmented
  • non segmented
117
Q

What occurs with semisegmented hemivertebra?

A

Fusion with a cranial or caudal vertebra which results in a functional disc on one side only.

118
Q

Which hemivertebrae type is likely to progress during growth?

A

Non segemented

119
Q

Involvement of entire vertebrae creates block vertebrae, whereas defects of specific regions of the vertebral ring create

A

unilateral bars that act as an asymmetric rigid tether to normal growth.

120
Q
A

Exam theory (9 decks)

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