Paediatrics Flashcards
How would Henoch-schoelien purpura (HSP) present?
Classic triad: Purpura (non blanching), Arthritis or arthralgia (knees and ankles) and Abdo pain.
Often a recent uppert respiratory tract infection.
can also see renal involvment, scrotal oedema and intussusception.
what are the tests and treatment for Henoch-schoelien purpura (HSP)?
tests: high ESR and IgA, proteinuria. high Antistreptiolysin O (ASO) titres. check U&E and BP
treatment: steroids my help with abdo pain.
complications: haemoptysis, massive GI bleed, Ileus, acute renal failure(rare)
outcomes: recurrence in 35% - correlates with high ESR.
can see HSP nephritis
Presentation of Idiopathic Thrombocytopaenic Purpura (ITP)?
acute bruising, purpura, petechiae
recent history of URTI or gastroenteritis
It is the most common aquired bleeding disorder in childhood. acute and chronic forms.
Tests and treatment for Idiopathic Thrombocytopaenic Purpura (ITP)?
Test: blood film
Treatment: first-line options include corticosteroids, intravenous immunoglobulin and intravenous anti-D immunoglobulin.
gradual resolution over 3 months for 80% - manage at home
20% become chronic - Rituximab. splenectomy in chronic with treament failure.
platelet transfusion if life threatening bleeding
CSF findings for meningitis, bacterial vs viral?
Bacterial: Raised cell count
Raised protein
Low glucose
Bacteria identified in blood or CSF culture or PCR
Viral: Raised cell count Normal protein Normal glucose Virus identified in CSF, stool, throat or blood HSV encephalitis
Causes and treatments of meningistis in children <3 months and >3 months?
< 3 months: Group B strep,
Also: Ecoli, Listeria, pneumococcus, meningococcus
Treatment: Cefotaxime & amoxicillin
Herpes simplex treatment: aciclovir, Enterovirus
> 3 months: Meningococcus, pneumococcus ( haemophilus influenza ),
Treatment: Cefotaxime / cetriaxone
Herpes simplex treatment: aciclovir, Enterovirus
An 8 year old presents with a history of a Cold the previous week with New fever and complaining of headache before going to bed. They are Sleepy and confused when woken. Ecxamination reveals neck stiffness, cool peripheries and poor Capillary return. what is the most likely diagnosis?
Meningococcal septicaemia.
Caused by meningococcus, usually GpB in UK now
GpC previously common, GpA common in Africa/ middle east, , W increasing in UK*
May or may not have associated meningitis
Clinical presentation, rapid onset septic shock
Septicaemia with other organisms may mimic: Pneumo, Toxin producing strains GpA Strep, Staph aureus
Presentation of Meningitis vs Meningococcal septicaemia?
Meningitis: Neck stiffness Sensitivity to light.(not reliable in young children) Drowsy/ irritable Vomiting Headache Full fontaelle
Septicaemia: Red/purple non-blanching rash. Cold hands and feet. Tachypnoea. Flu like symptoms
a 4 month old presents with recurrent cough and noisy breathing past 3 days. On examition you notice
sub intercostal recession, RR 60,Temp 37.8 and nasal flaring. There are bilateral crackles and wheeze. The child is alert, well perfused. what is the most likely diagnosis?
Bronchiolitis.
Causative organisms: RSV Para Flu Influenza A/B Rhinovirus Adenovirus
what is the immunoglobulin profile of a newborn?
Normal Newborn infants makes IgM & some IgA, but most of their IgG is maternal
what would the signs and symptoms be of a primary immunodeficiency? what tests would you perform?
S+S: Failure to thrive, skin problems , chronic chest problems ,organomegaly/adenopathy
Tests:
FBC : low total WBC, neutrophil or lymphocytes
Total Ig GAM +/-E
Responses to routine immunisations
Lymphocyte subsets: numbers of T and B cells
Lymphocyte function (Normal infant lymphocyte count >2.5)
1 in 2000 births underlying immune deficiency
1 in 50-60,000 severe Immune defect “SCID”
Severe disease presenting in neonates/ infants, immunological emergency
Primary immune deficiency is rare but consequences of missing are significant
10 signs of a primary immunodeficiency (PI)?
- 4 or more ear infections in 1 year
- 2 or more serious sinus infections in 1 year
- 2 or more months on antibiotics with little affect
- 2 or more pneumonias in 1 year
- Failure to thrive
- Recurrent deep skin or organ abscesses
- Persistent thrush in mounth or fungal skin infections
- Needing IV antibiotics to clear an infection
- 2 or more deep seated infections or septicaemia
- Family history of PI
Treatment for primary immunodeficiency (PI)?
Antibiotic / antiviral prophylaxis
Prompt treatment of infections
Replacement immunoglobulin
Bone marrow transplant
Name a live attenuated vaccine.
MMR, BCG, nasal flu, rotavirus
name an inactivated vaccine.
whole cell pertussis
name an inactivated toxin vaccine
diptheria, tetanus
name a recombinant components vaccine.
acellular pertussis
name a conjugate vaccine.
Bacterial Polysaccharide+protein carrier
Polysaccharide coat of bacteria e.g. pneumo, Hib, MenC, poorly immunogenic
Improved by conjugation to protein
Carrier
Generates:
Immunological memory
Reduced Carriage of organism
name a Cell wall/ envelope components vaccine.
Flu, MenB
what vaccinations should a child receive at 2 months?
Tetanus, Diphtheria, Polio, Purtussis, HiB, Pneumococcal (Prevenar 13), Men B
what vaccinations should a child receive at 3 months?
Tetanus, Diphtheria, Polio, Purtussis, HiB, Men C
what vaccinations should a child receive at 4 months?
Tetanus, Diphtheria, Polio, Purtussis, HiB, Pneumococcal (Prevenar 13), Men B
what vaccinations should a child receive at 12 months?
HiB, Pneumococcal (Prevenar 13), Men B, Men C MMR
what vaccinations should a child receive at 3-4 years?
Tetanus, Diphtheria, Polio, Purtussis, Flu
what vaccinations should a child receive at 13 years?
Tetanus, Men ACWY, HPV (girls)
what age group of children are most likely to have infections?
Young infants more likely to get infections : reduced immunity & lack of immunisation or exposure
what is a cavernous haemangioma?
a strawberry birth mark. absent at birth. disappears by 2 years
what is a capillary haemangioma?
a port wine stain. present at birth. never disappears
How much should new born babies be fed?
150 ml/kg/day.
What is important to note about infant breathing patterns?
infants are obligate nasal breathers (cant breath through mouth) up to 6 months
differences in the causes of early puberty in boys and girls.
early puberty in girls is usually physiological. in boys it is usually a sign of more serious underlying pathology i.e. brain tumour or congenital adrenal hyperplasia
what is the average full term weight of a neonate?
3.5kg.
weight gain is approximately 30g/day or roughly 200-300 g/week
Birth weight should double in 3-4 months and triple by 1 year. From 1 year onwards, weight gain should be 1-2 kg/year.
poor growth in the first years of life is most likely due to poor nutrition.
increased weight is mainly due to overfeeding but can be due to fluid retention in heart failure or congenital nephrotic syndrome
What is the average length of a neonate at birth?
50 cm.
1st year gain 25 cm
2nd year gain 12.5 cm
6-11 years gain 6 cm/year
How would you distinguish between familial, constitutional and pathological short stature?
Perform x-ray of Left wrist to determine bone age.
Familial: bone age the same as patient age
Constitutional: bone age is younger than patient age, therefore there is further growing to do.
Pathological: bone age is older than patient age
Don’t investigate short stature straight away, look at grtowth velocity first.
what is the average pubertal growth spurt in boys and girls?
boys: 35cm
girls: 25cm
what is the average head circumference at birth?
35 cm
1st year growth is 12cm - 6cm by 3 months, 6cm last 9 months
Average adult head circumference 55-56cm
too much growth is hydrocephaly
too little growth is microcrphaly
why is a head ultra sound performed in all preterm neonates born before 28 weeks?
to rule out an intracranial bleed
what fluids would you prescribe a neonate and what rates would you administer them at?
Glucose: Day 1 – 60 mls/kg/day Day 2 – 90 mls/kg/day Day 3 – 120 mls/kg/day Day 4 – 150 mls/kg/day
Electrolytes in neonates: From day 2 Na 3 mmol/kg/day K 2 mmol/kg/day Ca 1 mmol/kg/day (rarely)
what is the formula for the predicted weight of a child?
(Age + 4) x2 = weight in kg
what fluids would you prsecribe an older child?
0.9% sodium chloride + 5% glucose (+/- KCl)
How do you work out the fluid administration rate for a child?
Daily maintanence:
100 mls/kg/day for the first 10 kg
50 mls kg/day for the next 10 kg
20 mls/kg/day for every kg after
Alternatively (hourly rate):
4 mls/kg for first 10kg
2 mls/kg for next 10kg
1 mls/kg for next kg
work out the fluid rates for the following children:
1) 6 kilogram 7 month old boy
2) 9 kilogram 13 month old girl
3) 17kg 3 year old girl
4) 60kg 15 year old boy
1) 6 Kg 7 month old boy
Hourly = 24ml/hr
Daily = 576ml
2) 9 Kg 13 month old girl
Hourly = 36ml/hr
Daily = 864ml
3) 17kg 3 year old girl
Hourly = 54ml/hr
Daily = 1296ml
4) 60kg 15 year old boy
Hourly = 100ml/hr
Daily = 2400ml
How do you correct a fluid deficit in a child that is:
1) Not dehydrated
2) Dehydrated
3) Shocked
Not dehydrated – maintenance
Dehydrated = 50 mls/kg extra
Shocked = 100 mls/kg extra (+ fluid bolus)
Over 24 hours
what is the standard fluid bolus in a child?
20 mls/kg 0.9% sodium chloride
what is the standard fluid bolus in a child presenting with diabetic ketoacidosis?
10 mls/kg 0.9% sodium chloride rhen slow correction over 48 hours. due to the risk of cerebral oedema.
3 reasons why an infants lungs may be overinflated on chest xray?
inflammation (e.g. viral bronchiolitis), heart failure (eg.ventricular septal defect) or fluid overload (transient tachypnoea of the newborn).
may also be due to a foreign body (acting as a ball-valve)
An adults lungs will be overinflated due to the large tidal volume – compliant patients can do the same. Sick infants have a different explanation for their hyperinflation – they breath fast (tachypnoea) and overinflation is due to air-trapping. Airway resistance is higher during expiration (the airways are slightly smaller) and this difference becomes critical with any pathology causing bronchial wall thickening in infants (under 18 months of age). The result is that air goes in easier than it comes out and lung volumes increase “air-trapping”.
The small airways can be irreversibly damaged by inflammation (obliterative bronchiolitis) following viral infection or bone marrow transplantation. Causes of localised overinflation in the newborn include congenital lung problems (e.g. congenital lobar emphysema).
Radio-lucency should trigger a search for a pneumothorax.
how would you identify bronchial wall thickening on xray and in what disease states is it commonest?
a very common finding on a paediatric CXR, sufficiently that the significance is unclear in isolation. Look for “tram-track” parallel lines around the hila – the commonest cause is viral infection or asthma. It is a common finding with cystic fibrosis.
what is the ‘sail sign’?
The mediastinum contains structures between the lungs. The anterior mediastinum in front of the heart contains the thymus gland. This appears largest at around 2 years of age – it carries on growing into adolescence but not as fast as the rest of the body (and so becomes less apparent on the x-ray). The right lobe can rest on the horizontal fissure, often called a ‘Sail sign’
what is the normal pubertal age range for boys and girls?
Delay in girls > 13 years
Delay in boys > 14 years
Early in girls < 8 years
Early in boys < 9 years
Breast buds first sign in girls
Testicular enlargement first sign in boys
Name 4 factors that affect birth weight?
Maternal size & weight
Parity
Gestational diabetes
Smoking
following birth:
A third show catch-up growth
A third maintain birth weight centile
A third show catch-down growth!
Name some common causes of short stature.
Constitutionally small - small parents Ideopathic short stature usually small birth Psychosocial (neglect) Delayed puberty Chronic disease
Endocrine causes – Striae ? Cushings
how would you differentiate between nutritional and endocrine obesity?
Nutritional obesity – tall & fat
Endocrine problem – short & fat
Often early developement
Common causes of a limp in a child age 0-3 years old?
/soft tissue injury (toddler’s #/NAI)
Osteomyelitis or septic arthritis
Developmental dysplasia of the hip
Common causes of a limp in a child age 3-10 years old ?
Trauma
Transient synovitis/irritable hip
Osteomyelitis or septic arthritis
Perthes disease (avascular necrosis of the epiphysis of the femoral head)
Common causes of a limp in a child age 10-15 years old?
Trauma Osteomyelitis or septic arthritis Slipped upper femoral epiphysis Chondromalacia Perthes disease (avascular necrosis of the epiphysis of the femoral head)
Both intra-abdominal pathology and testicular torsion may present simply as a limp – examine abdomen and testicles in boys!!
Examination findings and treatment for transient synovitis?
Usually no pain at rest + passive movements only painful at extreme ranges
FBC + ESR normal or slightly elevated
XR may be normal
USS may show effusion
Main treatment rest + physio
NSAIDs useful, can shorten the duration of symptoms in children, usually resolves within 2 weeks
Acute onset, after a respiratory illness (weak evidence)
Affects young children (boys more than girls) most often
Most common cause of acute hip pain in young children age 3-10
Usually unilateral
May refuse to walk/limp
how would septic arthritis present?
Most often hip, knee, ankle, shoulder, elbow.
Most often children <2yrs.
Early features often non-specific.
Child often very unwell.
Pain often present at rest, resistance to attempted movement of the hip.
Older children usually reluctant to weight bear, may be more aware of referred pain in the knee.
Hip is kept flexed, abducted and externally rotated
BCs +ve, raised WCC + CRP XR show delayed changes Bony changes not evident for 14-21 days By 28 days, 90% show some abnormality. About 40-50% focal bone loss is necessary to cause detectable lucency on plain films
what is Kocher’s criteria?
Criteria for septic arthritis Fever >38.5 Cannot weight bear ESR>40 in 1st hr WCC>12
what is Perthes Disease?
Self-limiting hip disorder caused by varying degrees of ischaemia and subsequent necrosis of the femoral head. Most often affects boys (80%) and those aged 5-10 yrs. Increased risk with: low birth weight short stature low socio-economic class passive smoking. Unilateral in 85% of cases
Presents with pain in hip or knee, causes limp.
Pain (often in knee), + effusion (from synovitis).
On examination all movements at hip limited
No history of trauma.
Roll test; with patient lying supine, roll the hip of the affected extremity into external + internal rotation.
Should invoke guarding or spasm, especially with internal rotation.
what are the classic xray features of Perthes disease?
Classic x-ray features:
Sclerosis, fragmentation and eventual flattening of the proximal femoral epiphysis
Absent in early disease
May be initially misdiagnosed as irritable hip
what is SCFE?
Slipped capital femoral epiphysis (Aka SUFE -Slipped upper femoral epiphysis)
Usually occurs at the onset of puberty and most often in children who are either very tall and thin, or short and obese.
Other risk factors include Afro-Caribbean, boys, family history.
One quarter of cases are bilateral.
Prepubescent male children (12-15 yrs)
Hip, thigh and knee pain.
Often initially a several week history of vague groin or thigh discomfort.
May be able to weight bear, but is painful.
Flexion of hip often also causes external rotation.
May be leg shortening.
What are the xray findings and treatment for SCFE?
XR shows widening and irregularity of the plate of the femoral epiphysis.
The displacement of the epiphyseal plate is medial and superior
Surgical pinning of the hip is usually required and should be done quickly.
what are the risk factors for DDH (Developmental dysplasia of the hip)?
Female Breech position Caesarean section 1st child Prematurity Oligohydramnios Family history Club feet, spina bifida and infantile scoliosis
what are the screening tools for DDH (Developmental dysplasia of the hip)?
Classic screening tests are Barlow and Ortolani
Ortolani assesses if the hip is dislocated
Barlow assesses whether the hip is dislocatable.
DDH Must be detected early
Delayed identification leads to more prolonged morbidity
Signs: Asymmetrical skin creases in the thigh or buttock
Unequal leg length
Up to 60% of abnormal hips become normal without Tx after 1mth
USS usually done
Mx depends on age
How would you distinguish Erythema multiforme from urticaria?
Usually not itchy
Does not move around - individual lesions perist for days
Has target lesions with a central papuler, blister, purpura or ulcer.
Often has mucosal involvement
What is a mongolian blue spot?
Mongolian blue spots, also known as slate gray nevi, are a type of pigmented birthmark. They’re formally called congenital dermal melanocytosis. These marks are flat and blue-gray. They typically appear on the buttocks or lower back, but may also be found on the arms or legs.
they are not present in caucaians
What prodromal sympotoms are usually present in measles?
4 Cs– cough, coryza, conjunctivitis, cranky (irratable) Koplik spots - spots on the palate (these are pathognomic.
these occur before rash (which starts behind the ears and spreads down the body to become confluent)
incubation 7-12 days. infectious from prodrome.
Measles is a notifiable disease
describe the rash associated with rubella and where it would typically be located.
red-pink rash that starts behind the ears and the head and neck.
It may then spread to the chest, stomach, legs and arms
secondary symptoms include swollen lymph nodes
3 weeks incubation. infectious from 5 days before to 5 days after start of rash.
name the chronic complication of measles.
subacute sclerosing parencephalitis.
7-13 yrs post infection. behavior change, myoclonus, choreoathetosis (chorea (irregular migrating contractions) and athetosis (twisting and writhing)), dystonia, dementia, coma and death.
Tests, complications and treatments for measles
tests: IgM and IgG positive. PCR for serotyping (paramyxovirus)
complications: otitis media is most common. tracheitis and croup in infants. pneumonia is the most common cause of death
Treatment: supportive care with adequate nutrition. Abx for secondary infection.
prognosis: good in rich countries. 10% mortality in poor countries.
vaccination 80% effective
what are the complications of rubella in a child and in utero?
child: small joint arthritis
infection during first 4 weeks In utero: cataract (eye anomalies)
infection during weeks 4-8 In utero: cardiac anomalies
infection during weeks 8-12 In utero: deafness.
How would mumps present?
painful parotid swelling
prodromal malaise, high temperature
incubation 14-21 days. infectious 7 days before and 9 days after parotid swelling.
treatment and complications of mumps?
treatment: rest and supportive care
complications: orchitis arthritis meningitis pancreatitis myocarditis deafness
Which virus causes ‘Slapped-cheek’?
Parvovirus B19.
mild, acute infection
treatment rarely needed
Malar (cheek) rash and glove and stocking rash on hands and feet
Infection in pregnancy is serious due to risk of fetal death from hydrops fetalis. (due to inhibition of multiplication and lysis of erythroid progenitors). 10% of those infected before 20 weeks miscarry.
Fetal/neonatal infection also increases risk of growth restriction, meconium peritonitis, myocarditis, glomerulonephritis, placentomegaly, hepatomegaly, pancytopaenia
what is an acute complication of ‘Slapped cheek’ infection?
aplastic crisis - bone marrow stops making red blood cells. this is serious if RBC life sppan is already short (i.e. in sickle cell, thallassaemia, spherocytosis, HIV)
Treatment is transfusion and IV immunoglobulin
Name the mild self-limiting illness in infants that is caused by HHV 6. what is the early sign for this infection?
Name: Roseola infnatum.
Early sign: Uvulo-palatoglossal ulcers may be present
common, mild illness with raised temperature, and a maculopapular rash the presents when the fever subsides after 4 days.
What causes hand, foot and mouth disease and how would it present?
Cause: Cocksackie virus A16 (or enterovirus 71 - suspect this cause in outbreaks with herpangina*, meningitis, flaccid paralysis +/- pulmonary oedema)
Presentation: child is mildly unwell, vesicles are present on palms, soles and mouth (these cause discomfort until they heal - without crusting)
*herpangina is fever, sore throat and vesicles +/- abdo pain and nausea - very contagious
what is impetigo caused by? how is it treated?
In the UK, impetigo is usually due to a germ known as Staphylococcus aureus; in hot climates it may be due to Streptococcus pyogenes, or to a mixture of the two.
Honey-coloured crusting is seen
V.V. contagious
treat with Antibiotic creams such as mupirocin or fusidic acid will usually be prescribed. Retapamulin is a newer antibiotic cream that is occasionally used. due to increased resistance creams containing antiseptics such as povidone iodine or chlorhexidine may be recommended as an alternative.
Oral antibiotics may be needed if the impetigo is wide spread, is slow to respond, or keeps coming back. Flucloxacillin, erythromycin and cephalexin can be effective for widespread infection and are taken for at least 7 days. Penicillin can be added to the treatment if the impetigo is due to a streptococcal infection
what is an abcess?
an abscess is a painful collection of pus, usually caused by a bacterial infection (staphylococcus). Abscesses can develop anywhere in the body.
Which bacteria causes scalded skin syndrome?
Staphylococcal scalded skin syndrome (SSSS) is an illness characterised by red blistering skin that looks like a burn or scald, hence its name staphylococcal scalded skin syndrome. SSSS is caused by the release of two exotoxins (epidermolytic toxins A and B) from toxigenic strains of the bacteria Staphylococcus aureus.
what is scabies and how is it treated?
Scabies is not an infection, but an infestation. Tiny mites called Sarcoptes scabiei set up shop in the outer layers of human skin. The skin does not take kindly to the invasion. As the mites burrow and lay eggs inside the skin, the infestation leads to relentless itching and an angry rash.
Treatment: permethrin 5% dermal cream all over body following hot bath and scrubbing. wash all sheets clothes and towels on a hot wash. repeat at 7 days. treat all household members and close contacts.
What criteria are used to diagnose Kawasaki’s disease?
The american heart association diagnostic criteria:
A 5 day history of fever refractory to antibiotics and 4 of the following signs and symptoms:
bilateral conjunctival injection (non-purulent conjuctivitis)
polymorphous rash
injected lips/pharynx, strawberry tongue
red/swollen palms or soles, cervical lymphadnopathy, desquamation
risk for future myocardial infarction - based on the presence of coronary artery aneurysms and their severity
What is the management for Kawasaki’s disease?
ASOT/Anti DNAase B- look for group A strep (rule out scarlet and rheumatic fever
Echocardiography - at least twice (presentation and at 6-8 weeks) to assess for coronary artery aneurysms
Platelet count - marked thrombocytosis (and desquamation) occurs in 2nd week
Treatment:
IV immunoglobulin 2g/kg over 10 hours (preferably within 1st 10 days - reduces coronary artery aneurysms)
Aspirin 3-5mg/kg once a day for 6-8weeks
usually complete recovery in 6-8 weeks
50% have changes on echo
15-20% have CAA
In Kawasaki’s there is reactivation of BCG vaccination site
What is Reye’s syndrome?
Brain and liver damage when aspirin is given following viral infection in patients <20years
which gender is more likely to have a worse presentation in congenital adrenal hyperplasia?
In CAH, there is a blovk of production of aldersterone and cortisol and excess sex hormone production leading to virilisation, ambiguous genatalia in females and precocious puberty.
CAH is more dangerous for boys because it is less likely to be picked up. In girls it is obvious because of ambiguous genitalia. Boys are more likely to present collapsed and in shock.
How would you manage recurrent UTI in children?
MSU for culture (dipsticks are unreliable in kids)
Ultrasound KUB to check for congenital urinary tract abnormalities
it is important not to miss UTIs in children as it can lead to renal scarring and chronic kidney problems requiring dialysis in the future
Treat UTIs with broad spectrum IV antibiotics (eg. cefuroxime) to start with as children can deteriorate very quickly, switch to orals later
What is the most common causative organism in osteomyelitis?
Staphylococcus Aureus (this is normal nasal flora)
Osteomyelitis is usually from haematogenous spread so take blood cultures. It can also be from trauma.
OM or septic arthritis in children <3months is likely to have multiple joint involvement - IV cefuroxime 1st line
What is the management for suspected meningitis?
give ceftriaxone/cefotaxime
3 investigations:
blood cultures
EDTA bottle (as for FBC) sent to micro for PCR
Lumbar puncture - if well enough
Nisseria meningitidis is sensitive to cefotaxime, ceftriaxone, benzyl penicillin
Prophylaxis is ciprofloxacin/rifampicin
Need to make sure that it is cleared from the upper respiratory tract as well as it is carried nasally and can be passed on this way
What is the most common causative organism in lobar pneumonia?
Streptococcus pneumoniae
what is the 1st line treatment for community acquired pneumonia?
mild: oral amoxicillin
severe: IV benzylpenicillin
which child age group is the most likely to be murdered?
<1 years
at what age should a child be able to lift their head?
3 months
what gross motor movements should a child be able to perform at 6 months?
lift their chest up with arm support
Rolls
Sit unsupported
at what age should a child be able to pull to stand?
9 months
What gross motor movements should a child be able to perform at 1,2,3,4 and 5 years?
1 year
Walking
2 years
Walks up steps
3 years
Jumps
4 years
Hops
5years
Rides a bike
when testing fine motor and vision development in child, what should they be able to do at 4, 8, 12 and 18 months and at 3 years?
4 months
Grasp an object
Uses both hands
8 months
Takes a cube in each hand
12 months
scribbles with a crayon
18 months
Builds a tower of 2 cubes
3 years
Tower of 8 cubes
what level of speech should a child have at 3 months, 9 months and 1, 2, 3, 4, 5 years?
Laughs and squeals
9 months
‘dada, mama’
12 months
1 word
2 years
2 words sentences
Names body parts
3 years
Speech mainly understandable
4 years
Knows colours
Can count 5 objects
5 years
Knows meaning of words e.g what is a lake
what are the developmental milestones for a child social and self care at 6 weeks and 6, 9 and 12 months?
6 weeks
Smiles spontaneously
6 months
Finger feeds
9 months
Waves bye – bye
12 months
Uses spoon/fork
what are the developmental milestones for a child social and self care at 2, 3 and 4 years?
2 years
Take some clothes off
Feed a doll
3 years
Play with others, name a friend
Put on a t-shirt
4 years
Dress no help
Play a board game
What aspects of a developmental history would be concerning for each of the 4 domains: Gross Motor Fine Motor Speech and language Social development
Gross Motor
Not sitting by 1 year
Not walking at 18 months
Fine Motor
Hand preference before 18 months
Speech and language
Not smiling by 3 months
No clear words by 18 months
Social development
No response to carers interactions by 8 weeks
Not interested in playing with peers by 3 years
In boys not walking by 18 months check CK
Focal neurological signs consider MRI brain
Dysmorphic features, family history– genetic investigations
Unwell child, FTT – metabolic investigations
In featureless global developmental delay low yield but generally accepted to do microrarray, TFTs, OA, AA
Name some genetic causes of Childhood Developmental Delay
Chromosomal disorders e.g Down syndrome Microdeletions Microduplications Single gene disorders e.g Rett Syndrome, Duchennes Polygenic ; Autism, ADHD
Name some environmental causes of Childhood Developmental Delay
Abuse and neglect
Low stimulation
Name some factors in pregnancy that could cause Childhood Developmental Delay
Congenital infections e.g CMV, HIV
Exposure to drugs and alcohol
MCA infarct – cerebral palsy
Name some perinatal causes of Childhood Developmental Delay
Prematurity
Birth Asphyxia
Name some factors in childhood that could cause Childhood Developmental Delay
Infections e.g meningitis, encepalitis
Chronic ill health
Metabolic conditions e.g storage disorders
Acquired brain injury – accidental or non-accidental
Hearing impairment
Vision impairment
What is the aetiology for downs syndrome? Name 7 characteristic features of the disease.
TRISOMY 21
1 in 600 – 800 births.
Characteristic features: Learning/ developmental delay Hypotonia Short Stature Congenital Heart Disease (40%) eg. ASD, AVSD VSD, PDA, Tetralogy of Fallot Duodenal Atresia Upward Sloping Palpebral Fissures Epicanthic Folds Brachycephaly (the shape of a skull shorter than typical) Single Palmar Crease Sandal gap between 1st and 2nd toes Brushfield spots (small, white or grayish/brown spots on the periphery of the iris)
What is cerebral palsy and what are the different types?
Cerebral Palsy is a Permanent, non-progressive cerebral pathology. The leading cause of crippling handicap in children.
Prevalence: 2 in 1000.
The cause is damage or malformation affecting those areas of the brain involved in motor function.
Types of Cerebral Palsy Spastic (70%) Athetoid (10%) (dyskinetic) Ataxic (10%) Mixed (10%)
What are the causes of cerebral palsy?
Causes of Cerebral Palsy Cerebral Malformation Hypoglycaemia Trauma Hypoxia Infection Kernicterus Unknown
