PAEDIATRICS Flashcards
(151 cards)
1
Q
what are the clinical features of hypogammaglobulinaemia?
A
- recurrent infections
- infections with S.pneumoniae and haemophilia
- failure to thrive
- diarrhoea
- pallor
- lymphadenopathy and hepatosplenomegaly
2
Q
how is hypogammaglubulinaemia diagnosed?
A
-reduced or absent serum IgG, IgM or IgA
3
Q
how is hypogammaglobulinaemia managed?
A
- Offer early antibiotic treatment in infections
- Give IVIG in all primary immunodeficiency syndromes except IgA deficiency
- Offer TNF inhibitors for granulomatous diseases in patients with CVID
- Live vaccines are contraindicated
- Offer bone marrow transplant for Severe Combined Immunodeficiency
4
Q
what are the clinical features of Gaucher’s disease?
A
- hepatosplenomegaly
- corneal clouding
- neurodevelopmental delay
- cataract
- failure to thrive
- eye movement disorder
- joint contracture
- depression
5
Q
what are the clinical features of MPS?
A
- hepatosplenomegaly
- corneal clouding
- large head circumference
- neurodevelopmental delay
- cataract
- hearing impairment
- joint contracture
- spinal gibbus
- hydrocephalus
6
Q
what are the clinical features of Fabry’s disease?
A
- skin rash and cutaneous lesions
- corneal clouding
- hearing impairment
- cataract
7
Q
what are the clinical features of Pompe’s disease?
A
- hepatosplenomegaly
- fatigue
- cataract
- failure to thrive
- joint contracture
- depression
8
Q
what are the clinical features of Tay-Sachs disease?
A
- depression
- failure to thrive
- dementia
- ataxia
- optic atrophy/retinitis pigments
- hyperacusis
- macular cherry red spot
9
Q
what are the clinical features of Niemann-Pick disease?
A
- hepatosplenomegaly
- neurodevelopmental delay
- eye movement disorder
- dementia
- ataxia
10
Q
what are the clinical features of GH deficiency?
A
- Short stature
- Poor growth velocity
- Short for target height
- Absent pubertal growth spurt
- Delayed puberty
- Mid-facial hypoplasia
- Delayed dentition
- Frontal bossing
11
Q
how is GH deficiency diagnoseD?
A
- Wrist xray: delayed bone age
- Low IGF1 and IGFBP3
12
Q
how is GH deficiency managed?
A
-somatotropin
13
Q
what are the clinical features of biliary atresia?
A
- Neonatal jaundice with pale stools, persisting beyond 14 days of life
- Dark urine
- Bruising
14
Q
how is biliary atresia diagnosed?
A
- raised serum bilirubin
- high GGT
- Hepatobiliary scintigraphy: no tracer excretion into bowel within 24 hours
15
Q
how is biliary atresia managed?
A
- Offer hepatoportoenterostomy before 45 to 60 days of life
- Give ursodeoxycholic acid to facilitate bile flow
- If hepatoportoenterostomy is unsuccessful, offer liver transplant
16
Q
what are the clinical features of a haemangioma?
A
- Pink, red or blue lesion
- Rapid growth
- Variable compressibility
- Flat or nodular character
- Islands of normal skin
- Ulceration and bleeding
- Warmth
17
Q
how is a haemangioma managed?
A
- Offer propranolol for infantile haemangiomas
- Offer surgical excision
- If there is ulceration, offer barrier protection and topical antibiotics such as metronidazole
18
Q
what are the clinical features of congenital torticollis?
A
- Head tilt
- Head rotated with decreased active rotation to affected side
- Decreased head righting to contralateral side
- Sternocleidomastoid mass
- Ipsilateral shoulder elevation
19
Q
what are the risk factors for congenital torticollis?
A
- Plagiocephaly
- Complicated birth
- Non-varied supine sleep and resting position
- Decreased prone awake time
20
Q
how is congenital torticollis managed?
A
- For children under 5 months, offer massage and myofascial release physiotherapy
- Offer cranial moulding orthosis for children with plagiocephaly
- Offer BOTOX injection into the sternocleidomastoid or upper trapezius
- As a last resort, offer sternocleidomastoid muscle release surgery
21
Q
what are the risk factors for faecal incontinence in children?
A
- Chronic constipation
- Male sex
- Diet lacking in fibre
- Inadequate fluid intake
- Delayed or inadequate toilet training
- Anorectal malformations
- Hirschsprung’s disease
- Spinal abnormalities
22
Q
what are the clinical features of DiGeorge’s syndrome?
A
- Cyanosis, signs of heart failure and a heart murmur associated with tetralogy of fallot, truncus arteriosus, interrupted aortic arch and VSD
- Bulbous nose tip and prominent ears
- Cleft lip and palate
- Growth failure
- Feeding difficulty
- Speech delay
- Non-verbal learning disorder
- Frequent infection
- Schizophrenia
- Seizures
- Hypoparathyroidism
- CHARGE syndrome: coloboma of the eye, heart defects, atresia of the nasal choanae, retardation of growth, genital or urinary abnormalities and ear abnormalities and deafness
23
Q
what are the clinical features of Dubin-Johnson Syndrome?
A
- Intermittent jaundice
- Lack of pruritus
- Triggered by intercurrent illness, infection, stress, pregnancy or medication including oral contraceptives
24
Q
what is seen on investigation in suspected Dubin-Johnson syndrome?
A
- elevated bilirubin, with more than half conjugated
- all other bloods normal
- Liver biopsy: coarsely granulated pigment in the hepatocyte lysosomes with normal liver histology
25
how is Dubin-Johnson syndrome managed?
-no treatment needed
26
what are the risk factors for SIDS?
- Side, prone or inclined position at last sleep
- Bed-sharing/co-sleeping
- Soft sleeping surface
- Maternal smoking
- Increasing number of smokers in house
- Smoking in the same room as the child
- Non-use of dummy
- Premature birth
27
what are the clinical features of cryptorchidism?
- Malpositioned or absent testis
- Palpable cryptorchid testis
- Non-palpable testis
- Testicular asymmetry
- Scrotal hypoplasia or asymmetry
- Retractile testis
- Ascending cryptorchidism
- Hypospadias
- Micropenis
28
how is cryptorchidism diagnosed?
- Perform USS: Testis can be identified within the inguinal canal or as it emerges into the superficial inguinal pouch
- Perform MRI: testis identifiable along normal path of descent
- Perform hormonal evaluation with hCG stimulation test: no increased in testosterone after hCG, in conjunction with elevated basal rates of LH and FSH signifies that the testes are absent
- Measure Mullerian inhibiting substance, inhibin B and FSH: anorchia if MIS and inhibin B undetectable with raised FSH
29
when should bilateral undescended testes detected at birth be referred?
-within 24 hours
30
when should bilateral undescended testes detected at 6-8 weeks be referred?
-urgently to be seen within 2 weeks
31
how should a suspected unilateral undescended testis be managed according to time of detection?
- At birth — re-examine the infant at 6–8 weeks of age. If both testes are normally descended, no further action is required.
- At 6–8 weeks of age — re-examine the infant at 4–5 months of age.
- At 4–5 months (corrected for gestational age), if the testis remains undescended, arrange referral to paediatric surgery or urology to be seen by 6 months of age.
32
define enuresis
-normal micturition that occurs at an inappropriate or socially unacceptable time or place.
33
what are the clinical features of enuresis?
- Increased fluid intake at night
- Urinary frequency
- Constipation
- Caffeine
- Urinary urgency
- Abnormal voiding habits
34
how is enuresis managed?
- appropriate fluid intake and voiding
- reward chart
- enuresis alarm
- desmopressin
- anticholinergic with desmopressin
- imipramine
35
what are the clinical features of glycogen storage disorders?
- Frequent feeding
- Hepatomegaly
- Distended abdomen
- Hypernoea
- Failure to thrive
- Lethargy
- Hypotonia
- Bleeding tendency
36
what is seen on blood tests in glycogen storage disorders?
- glucose: low
- bicarbonate: raised
- lactic acid: raised
- uric acid: raised
- triglycerides: raised
- LFTs: raised AST and ALT
37
how are glycogen storage disorders managed?
- Orally administered uncooked cornstarch is the mainstay of therapy from early childhood and through adulthood.
- Treat hypoglycaemia as indicated
- Give a xanthine oxidase inhibitor such as allopurinol for hyperuricaemia
- Give fenofibrate for hyperlipidaemia
- Liver transplant may be required for hepatic dysfunction
38
what are the clinical features of meconium aspiration?
- Tachypnoea
- Cyanosis
- Chest wall asymmetry with decreased air entry
- Barrel shaped chest
- Grunting
- Chest retractions
- Tachycardia
- Hypotension
- Crackles
- Meconium stained liquor
39
what are the risk factors for developing meconium aspiration?
- Gestational age >42 weeks
- Foetal distress
- Oligohydramnios
- Thick meconium
- Apgar score <7
- Chorioamnionitis
- Caesarean delivery
40
what is seen on chest x-ray in meconium aspiration?
- irregular pattern
- patchy infiltrations
- atelectasis
- hyperexpanded lung fields
- consolidation
- may show pleural effusion, pneumothorax, or pneumomediastinum
- cardiomegaly may be seen
41
what are the clinical features of infant colic?
- Generally well and thriving
- Normal urine
- Absence of vomiting
- Absence of diarrhoea
- Normal temperature
42
what are the clinical features of kwashiorkor?
- Low weight for height
- Low height for age
- Low mid upper arm circumference
- Bilateral pitting oedema
- Hair discolouration
- Dermatosis/ulceration
43
how is kwashiorkor managed?
- Offer community based therapy with ready to use therapeutic food if the child can eat 30g of RUTF in 15 minutes or less
- If the child cannot eat 30g RUTF in less than 15 mins, inpatient care with regular milk based liquid food is required
- Manage electrolyte imbalances as indicated
- Treat dermatosis with potassium permanganate wash and topical zinc oxide
44
what are the clinical features of lead toxicity?
- Cognitive impairment
- Behavioural changes
- Headaches
- Clumsiness and agitation
- Loss of appetite
- Constipation
- Somnolence
- Cerebellar signs
- Seizures
- Coma
- Colicky abdominal pain
45
how is lead poisoning diagnosed?
- Measure whole blood lead level: blood lead >0.4micromoles/L in children or >1.2micromoles/L in adults
- Perform FBC: microcytic, hypochromic anaemia
46
how is lead poisoning managed?
- Separate from source of exposure
| - Offer chelation therapy with DMSA (Dimercaptosuccinic acid, succimer), sodium calcium edetate or d-penicillamine
47
what are the clinical features of Lesch-Nyhan Disease?
- Orange sand crystals in nappy
- Kidney stones
- Pyramidal signs
- Spasticity and hyper-reflexia
- Testicular atrophy
- Males
- Developmental delay
- Involuntary movements
- Generalised hypotonia
- Self injurious behaviour
- Cognitive disturbances
- Growth retardation
- Action dystonia
- Gout
48
how is Lesch-Nyhan diagnosed?
- Measure hypoxanthine-guanine phosphoribosyltransferase gene analysis: mutation in the coding region of the HPRT gene
- Measure HPRT enzyme activity: reduced
49
what are the clinical features of Trisomy 18, Edwards syndrome?
- low birthweight
- prominent occiput
- small mouth and chin
- short sternum
- flexed overlapping fingers
- rocker bottom feet
- cardiac and renal malformations
50
what are the clinical features of Trisomy 13, Patau's syndrome?
- structural brain defects
- scalp defects
- small eyes
- cleft lip and palate
- polydactyly
- cardiac and renal malformations
51
define kernicterus
-encephalopathy resulting from the deposition of unconjugated bilirubin in the basal ganglia and brainstem nuclei
52
what are the causes of jaundice in a <24 hour old?
- haemolytic disorders
| - congenital infection
53
what are the causes of jaundice in a 2 day to 2 week old?
- physiological
- breast milk
- dehydration
- infection
- crigler najjar
54
what are the causes of jaundice in a >2 week old?
- biliary atresia
- breast milk
- infection
- congenital hypothyroidism
55
how is Noonan syndrome inherited?
-autosomal dominant
56
what are the clinical features of Noonan syndromes?
- Short stature
- Dysmorphic facial features: wide spaced and down slanting eyes with vivid blue or green irides; low-set posteriorly rotated ears; inverted, triangular shaped face with small chin; a broad or webbed neck
- Cryptorchidism
- Cardiac anomalies: pulmonary valve stenosis/dysplasia, septal defects, hypertrophic cardiomyopathy
- Delayed puberty
- Easy bruising or bleeding
- Lymphoedema
- Pigmentary anomalies: café au lait, lentigines, nevi, keratosis
- Sparse or absent eyebrows and lashes
- Splenomegaly
- Chest deformity: pectus carinatum and excavatum
- Developmental delay
- Cubitus valgus; short fingers with blunt fingertips; joint hyperextensibility; talipes equinovarus; joint contractures; scoliosis; radioulnar synostosis
- Muscle weakness
57
how is phenylketonuria inherited?
-autosomal recessive
58
what are the clinical features of phenylketonuria?
- Intellectual disability
- Microcephaly
- Eczema
- Light pigmentation of eyes and hair
- Seizures
- Musty odour of urine
59
how is phenylketonuria managed?
-lifelong dietary phenylalanine restriction
60
what are the criteria for a diagnosis of Reye's syndrome?
- an acute, non-inflammatory encephalopathy with either sterile CSF containing <9 WBC/mL or cerebral oedema without inflammatory cell infiltrate
- hepatic dysfunction documented by either a threefold elevation of serum transaminases and/or serum ammonia, or liver biopsy demonstrating fatty infiltration
- there is no other diagnosis to account for the cerebral and hepatic derangement.
61
what are the clinical features of Reye's syndrome?
- Vomiting
- Altered mental status
- Hyperventilation
- Hepatomegaly
- Abnormal pupillary response
- Hyper/areflexia
- Diminished pain response
- Seizures
62
what is seen on blood gas in Reye's syndrome?
-mixed metabolic acidosis and respiratory alkalosis
63
what is seen on LFTs in Reye's syndrome?
- elevated transaminase and aminotransferase
| - bilirubin mildly elevated
64
what is seen on EEG on Reye's syndrome?
-generalised slowing and flattening of waves
65
how is Reye's syndrome managed?
- anti-emetics
- furosemide
- IV fluids and vasopressors
- IV bicarbonate
- lactulose
66
how is Wiskott-Aldrich syndrome inherited?
-X-linked recessive
67
what are the clinical features of Wiskott-Aldrich syndrome?
- Easy bruising and petechiae
- Recurrent infections
- Eczema
- Lymphadenopathy
- Serious bleeding
- Autoimmunity
68
how is Wiskott-Aldrich syndrome diagnosed?
- thrombocytopenia
- WASp analysis: low or absent
- WASp gene mutation analysis: mutation present
69
how is Wiskott-Aldrich syndrome managed?
- prophylactic co-trimoxazole and azithromycin
- IVIG
- bone marrow transplant
- splenectomy
- rituximab
70
what are the clinical features of a hydrocele?
- Scrotal mass
- Transillumination
- Enlargement of scrotal mass following activity
- Variation in scrotal mass during the day
71
when should a child with a hydrocele be referred to a paediatric surgeon?
- There is an underlying pathology.
- Concomitant inguinal hernia is suspected — an incarcerated hernia may be difficult to distinguish from a hydrocele.
- The hydrocele is localized to the spermatic cord.
- There is also a palpable abdominal mass (suggesting an abdomino-scrotal hydrocele).
- A simple, non-communicating hydrocele either is not decreasing in size, or is still present after 2 years of age.
72
what are the clinical features of oesophageal atresia and trachea-oesophageal fistula?
- Inability to swallow secretions
- Inability to pass an NG tube
- Laboured respiration
- Coughing
- Choking
73
what are the clinical features of turner's syndrome?
- Poor growth
- Short stature
- Delayed/absent pubertal development
- Primary amenorrhoea
- Congenital heart defects: coarctation of the aorta, bicuspid aortic valve
- Skeletal abnormalities: cubitus valgus, short fourth metacarpals or metatarsals, prominent distal ulnar and scoliosis
- Webbed neck
- Secondary amenorrhoea
- Multiple melanocytic naevi
- Recurrent/severe otitis media
74
what are the clinical features of severe combined immunodeficiency syndrome?
- Recurrent and unusually severe infections
- Chronic diarrhoea
- Failure to thrive
- Absent lymphoid tissue
75
how is severe combined immunodeficiency diagnosed?
- absolute lymphocyte <3000cells/mm3
- absence or reduced total number of T cells in flow cytometry
- absent or low immunoglobulins
76
what are the causes of hypoxic-ischaemic encephalopathy?
- excessive or prolonged uterine contractions
- placental abruption
- ruptured uterus
- shoulder dystocia
- cord prolapse
- inadequate maternal placental perfusion
- maternal hypotension or hypertension
77
what are the clinical features of mild HIE?
- irritability
- responds excessively to stimulation
- staring of the eyes
- hyperventilation
- impaired feeding
78
what are the clinical features of moderate HIE?
- marked abnormalities of tone and movement
- cannot feed
- seizures
79
what are the clinical features of severe HIE?
- no normal spontaneous movements or response to pain
- tone fluctuates between hyper and hypotonia
- prolonged seizures refractory to treatment
- multi-organ failure
80
what causes retinopathy of prematurity?
-uncontrolled use of high concentrations of oxygen
81
what is bronchopulmonary dysplasia?
-Infants who still have an oxygen requirement at a post- menstrual age of 36 weeks
82
what is seen on chest xray in bronchopulmonary dysplasia?
- widespread areas of opacification
| - cystic changes
83
what are the clinical features of alcohol poisoning in children?
- hypoglycaemia
- respiratory failure
- coma
84
what are the clinical features of acid and alkali poisoning in children?
-inflammation and ulceration of upper GI tract leading to stenosis
85
what are the clinical features of digoxin poisoning in children?
- arrhythmias
| - hyperkalaemia
86
what are the clinical features of battery poisoning in children?
- mild GI symptoms
- oesophageal stricture
- corrosion of gut wall and perforation
87
what are the clinical features of iron poisoning in children?
- vomiting
- diarrhoea
- haematemesis
- melaena
- acute gastric ulceration
- drowsiness
- coma
- shock
- liver failure with hypoglycaemia and convulsions
- gastric strictures
88
what are the clinical features of paracetamol poisoning in children?
- gastric irritation
| - liver failure
89
what are the clinical features of petroleum poisoning in children?
-aspiration causing pneumonitis
90
what are the clinical features of salicylate poisoning in children?
- tinnitus
- deafness
- nausea
- vomiting
- dehydration
- hyperventialtion causing respiratory alkalosis followed by metabolic acidosis
- hypoglycaemia
91
what are the clinical features of tricyclic poisoning in children?
- sinus tachycardia
- conduction disorders
- dry mouth
- blurred vision
- agitation
- confusion
- convulsions
- hypotension
- respiratory depression
92
where do brain haemorrhages typically occur in neonates?
-germinal matrix above the caudate nucleus
93
how is neonatal brain haemorrhage diagnosed?
-cranial ultrasound
94
how does caput succedaneum present?
- bruising and oedema of the presenting part extending beyond the margins of the skull bones
- resolves in a few days
95
how does a cephalhaematoma present?
- haematoma from bleeding below the periosteum, confined within the margins of the skull sutures.
- usually involves the parietal bone.
- The centre of the haematoma feels soft.
- It resolves over several weeks
96
how does a chignon present?
-oedema and bruising from Ventouse delivery
97
how does a subaponeurotic haemorrhage present?
- diffuse, boggy swelling of scalp on examination
| - blood loss may be severe and lead to hypovolaemic shock and coagulopathy
98
what is seen on chest x-ray in transient tachypnoea of the newborn?
-fluid in the horizontal fissure
99
what are the clinical features of diaphragmatic hernia in neonates?
- failure to respond to resuscitation
- respiratory distress
- apex beat and heart sounds displaced to the right
100
what are the causes of microcephaly?
- familial
- autosomal recessive conditions
- congenital infection
- Acquired after an insult to the developing brain, e.g. perinatal hypoxia, hypoglycaemia or meningitis, when it is often accompanied by cerebral palsy and seizures
101
what are the causes of macrocephaly?
- tall stature
- familial macrocephaly
- raised ICP
- Hydrocephalus
- chronic subdural haematoma
- cerebral tumour
- neurofibromatosis
- cerebral gigantism
- CNS storage disorders
102
what are the clinical features of necrotising enterocolitis?
- infant stops tolerating feeds
- milk is aspirated from the stomach
- bile-stained vomit
- distended abdomen
- bloody stool
- shock
103
what is seen on abdominal x-ray in necrotising enterocolitis?
- distended loops of bowel
- thickening of the bowel wall with intramural gas
- gas in the portal tract
104
how is necrotising enterocolitis managed?
- Stop oral feeding and pass an NG tube to decompress the bowel
- Give IV fluids, TPN and IV antibiotics for 10-14 days.
- Ampicillin/gentamicin or cefotaxime plus metronidazole or clindamycin
- Artificial ventilation and circulatory support are often needed.
- Surgery is performed for bowel perforation.
105
what are the clinical features of neonatal sepsis?
- fever or temperature instability
- poor feeding
- vomiting
- apnoea and bradycardia
- respiratory distress
- abdominal distension
- jaundice
- neutropenia
- hypo/hyperglycaemia
- shock
- irritability
- seizures
- lethargy and drowsiness
106
what are the clinical features of neonatal hypoglycaemia?
- jitteriness
- irritability
- apnoea
- lethargy
- drowsiness
- seizures.
107
what are the clinical features of respiratory distress syndrome?
- within 4 h of birth
- tachypnoea >60 breaths/min
- laboured breathing with chest wall recession (particularly sternal and subcostal indrawing) and nasal flaring
- expiratory grunting in order to try to create positive airway pressure during expiration and maintain functional residual capacity
- cyanosis if severe.
108
how is respiratory distress syndrome managed?
- raised ambient oxygen or CPAP
- surfactant therapy
- ventilation
109
what are the clinical features of homocystinuria?
- developmental delay
- subluxation of the ocular lens (ectopia lentis)
- progressive learning difficulty
- convulsions
- psychiatric disorders
- fair complexion with brittle hair
110
how is homocystinuria managed?
- pyridoxine
| - low methionine diet supplemented with cysteine and betaine
111
what are the clinical features of galactosaemia?
- lactose containing milk feeds started
- poor feeding
- vomiting
- jaundice
- hepatomegaly
- hepatic failure
112
what are the social and emotional milestones at 2 months?
- Begins to smile at people
- Can briefly calm himself (may bring hands to mouth and suck on hand)
- Tries to look at parent
113
what are the language/communication milestones at 2 months?
- Coos, makes gurgling sounds
- Turns head toward sounds
- Baby raising head and chest when lying on stomach
114
what are the cognitive milestones at 2 months?
- Pays attention to faces
- Begins to follow things with eyes and recognize people at a distance
- Begins to act bored (cries, fussy) if activity doesn’t change
115
what are the movement milestones at 2 months?
- Can hold head up and begins to push up when lying on tummy
| - Makes smoother movements with arms and legs
116
what are the social and emotional milestones at 4 months?
- Smiles spontaneously, especially at people
- Likes to play with people and might cry when playing stops
- Copies some movements and facial expressions, like smiling or frowning
117
what are the language/communication milestones at 4 months?
- Begins to babble
- Babbles with expression and copies sounds he hears
- Cries in different ways to show hunger, pain, or being tired baby on floor with toy
118
what are the cognitive milestones at 4 months?
- Lets you know if she is happy or sad
- Responds to affection
- Reaches for toy with one hand
- Uses hands and eyes together, such as seeing a toy and reaching for it
- Follows moving things with eyes from side to side
- Watches faces closely
- Recognizes familiar people and things at a distance
119
what are the movement milestones at 4 months?
- Holds head steady, unsupported
- Pushes down on legs when feet are on a hard surface
- May be able to roll over from tummy to back
- Can hold a toy and shake it and swing at dangling toys
- Brings hands to mouth
- When lying on stomach, pushes up to elbows
120
what are the social and emotional milestones at 6 months?
- Knows familiar faces and begins to know if someone is a stranger
- Likes to play with others, especially parents
- Responds to other people’s emotions and often seems happy
- Likes to look at self in a mirror
121
what are the language/communication milestones at 6 months?
- Responds to sounds by making sounds
- Strings vowels together when babbling (“ah,” “eh,” “oh”) and likes taking turns with parent while making sounds
- Responds to own name
- Makes sounds to show joy and displeasure
- Begins to say consonant sounds (jabbering with “m,” “b”) mother enjoying 7 month old infant
122
what are the cognitive milestones at 6 months?
- Looks around at things nearby
- Brings things to mouth
- Shows curiosity about things and tries to get things that are out of reach
- Begins to pass things from one hand to the other
123
what are the movement milestones at 6 months?
- Rolls over in both directions (front to back, back to front)
- Begins to sit without support
- When standing, supports weight on legs and might bounce
- Rocks back and forth, sometimes crawling backward before moving forward
124
what are the social and emotional milestones at 9 months?
- May be afraid of strangers
- May be clingy with familiar adults
- Has favourite toys
125
what are the language/communication milestones at 9 months?
- Understands “no”
- Makes a lot of different sounds like “mamamama” and “bababababa”
- Copies sounds and gestures of others
- Uses fingers to point at things
- Doctor holding little boy
126
what are the cognitive milestones at 9 months?
- Watches the path of something as it falls
- Looks for things he sees you hide
- Plays peek-a-boo
- Puts things in her mouth
- Moves things smoothly from one hand to the other
- Picks up things like cereal o’s between thumb and index finger
127
what are the movement milestones at 9 months?
- Stands, holding on
- Can get into sitting position
- Sits without support
- Pulls to stand
- Crawls
128
what are the social and emotional milestones at 1 year?
- Is shy or nervous with strangers
- Cries when mom or dad leaves
- Has favourite things and people
- Shows fear in some situations
- Hands you a book when he wants to hear a story
- Repeats sounds or actions to get attention
- Puts out arm or leg to help with dressing
- Plays games such as “peek-a-boo” and “pat-a-cake”
129
what are the language/communication milestones at 1 year?
- Responds to simple spoken requests
- Uses simple gestures, like shaking head “no” or waving “bye-bye”
- Makes sounds with changes in tone (sounds more like speech)
- Says “mama” and “dada” and exclamations like “uh-oh!”
- Tries to say words you say
- Toddler sitting with mom playing xylophone
130
what are the cognitive milestones at 1 year?
- Explores things in different ways, like shaking, banging, throwing
- Finds hidden things easily
- Looks at the right picture or thing when it’s named
- Copies gestures
- Starts to use things correctly; for example, drinks from a cup, brushes hair
- Bangs two things together
- Puts things in a container, takes things out of a container
- Lets things go without help
- Pokes with index (pointer) finger
- Follows simple directions like “pick up the toy”
131
what are the movement milestones at 1 year?
- Gets to a sitting position without help
- Pulls up to stand, walks holding on to furniture (“cruising”)
- May take a few steps without holding on
- May stand alone
132
what are the social and emotional milestones at 18months?
- Likes to hand things to others as play
- May have temper tantrums
- May be afraid of strangers
- Shows affection to familiar people
- Plays simple pretend, such as feeding a doll
- May cling to caregivers in new situations
- Points to show others something interesting
- Explores alone but with parent close by
- Toddler eating you from a blue bowl
133
what are the language/communication milestones at 18months?
- Says several single words
- Says and shakes head “no”
- Points to show someone what he wants
134
what are the cognitive milestones at 18months?
- Knows what ordinary things are for; for example, telephone, brush, spoon
- Points to get the attention of others
- Shows interest in a doll or stuffed animal by pretending to feed
- Points to one body part
- Scribbles on his own
- Can follow 1-step verbal commands without any gestures; for example, sits when you say “sit down”
135
what are the movement milestones at 18 months?
- Walks alone
- May walk up steps and run
- Pulls toys while walking
- Can help undress herself
- Drinks from a cup
- Eats with a spoon
136
what are the social and emotional milestones at 2 years?
- Copies others, especially adults and older children
- Gets excited when with other children
- Shows more and more independence
- Shows defiant behavior (doing what he has been told not to)
- Plays mainly beside other children, but is beginning to include other children, such as in chase games
137
what are the language/communication milestones at 2 years?
- Points to things or pictures when they are named
- Knows names of familiar people and body parts
- Says sentences with 2 to 4 words
- Follows simple instructions
- Repeats words overheard in conversation
- Points to things in a book
- 2 year old playing with big ball
138
what are the cognitive milestones at 2 years?
- Finds things even when hidden under two or three covers
- Begins to sort shapes and colours
- Completes sentences and rhymes in familiar books
- Plays simple make-believe games
- Builds towers of 4 or more blocks
- Might use one hand more than the other
- Follows two-step instructions such as “Pick up your shoes and put them in the closet.”
- Names items in a picture book such as a cat, bird, or dog
139
what are the movement milestones at 2 years?
- Stands on tiptoe
- Kicks a ball
- Begins to run
- Climbs onto and down from furniture without help
- Walks up and down stairs holding on
- Throws ball overhand
- Makes or copies straight lines and circles
140
what are the social and emotional milestones at 3 years?
- Copies adults and friends
- Shows affection for friends without prompting
- Takes turns in games
- Shows concern for crying friend
- Understands the idea of “mine” and “his” or “hers”
- Shows a wide range of emotions
- Separates easily from mom and dad
- May get upset with major changes in routine
- Dresses and undresses self
- Toddler hugging doll
141
what are the language/communication milestones at 3 years?
- Follows instructions with 2 or 3 steps
- Can name most familiar things
- Understands words like “in,” “on,” and “under”
- Says first name, age, and sex
- Names a friend
- Says words like “I,” “me,” “we,” and “you” and some plurals (cars, dogs, cats)
- Talks well enough for strangers to understand most of the time
- Carries on a conversation using 2 to 3 sentences
142
what are the cognitive milestones at 3 years?
- Can work toys with buttons, levers, and moving parts
- Plays make-believe with dolls, animals, and people
- Does puzzles with 3 or 4 pieces
- Understands what “two” means
- Copies a circle with pencil or crayon
- Turns book pages one at a time
- Builds towers of more than 6 blocks
- Screws and unscrews jar lids or turns door handle
143
what are the movement milestones at 3 years?
- Climbs well
- Runs easily
- Pedals a tricycle (3-wheel bike)
- Walks up and down stairs, one foot on each step
144
what are the social and emotional milestones at 4 years?
- Enjoys doing new things
- Plays “Mom” and “Dad”
- Is more and more creative with make-believe play
- Would rather play with other children than by himself
- Cooperates with other children
- Often can’t tell what’s real and what’s make-believe
- Talks about what she likes and what she is interested in
145
what are the language/communication milestones at 4 years?
- Knows some basic rules of grammar, such as correctly using “he” and “she”
- Sings a song or says a poem from memory such as the “Itsy Bitsy Spider” or the “Wheels on the Bus”
- Tells stories
- Can say first and last name
- Child throwing ball
146
what are the cognitive milestones at 4 years?
- Names some colours and some numbers
- Understands the idea of counting
- Starts to understand time
- Remembers parts of a story
- Understands the idea of “same” and “different”
- Draws a person with 2 to 4 body parts
- Uses scissors
- Starts to copy some capital letters
- Plays board or card games
- Tells you what he thinks is going to happen next in a book
147
what are the movement milestones at 4 years?
- Hops and stands on one foot up to 2 seconds
- Catches a bounced ball most of the time
- Pours, cuts with supervision, and mashes own food
148
what are the social and emotional milestones at 4 years?
- Wants to please friends
- Wants to be like friends
- More likely to agree with rules
- Likes to sing, dance, and act
- Shows concern and sympathy for others
- Is aware of gender
- Can tell what’s real and what’s make-believe
- Shows more independence (for example, may visit a next-door neighbour by himself [adult supervision is still needed])
- Is sometimes demanding and sometimes very cooperative
- 5 year old playing guitar
149
what are the language/communication milestones at 4 years?
- Speaks very clearly
- Tells a simple story using full sentences
- Uses future tense; for example, “Grandma will be here.”
- Says name and address
150
what are the cognitive milestones at 4 years?
- Counts 10 or more things
- Can draw a person with at least 6 body parts
- Can print some letters or numbers
- Copies a triangle and other geometric shapes
- Knows about things used every day, like money and food
151
what are the movement milestones at 4 years?
- Stands on one foot for 10 seconds or longer
- Hops; may be able to skip
-Can do a somersault
Uses a fork and spoon and sometimes a table knife
- Can use the toilet on her own
- Swings and climbs
