PAEDS ILA 5&6 Flashcards
what are the four fields of development?
groos motor
fine motor
coral
speech and language
what developmental milestones would you expect to see a child achieve by six months?
gross motor - head control, able to lift head and chest and support onto extended arms, can sit with support, can roll from tummy to back
Fine motor - palmer grasp, transfer objects
speech and language - starts to babble, turns head to loud sounds, understands bye bye
social - puts objects to mouth, shakes rattle, reaches bottle
List the developmental milestones that you expect a child to have achieved by twelve months?
gross motor - independently rises from lying to sitting, walks alone 9-18 months
fine motor - refined pincer grip
Speech and language - shows understanding of nouns (where is mummy) 2-3 words, can point to body parts
social - waves bye bye, hand clapping, drinks from cup with lid with two hands, finger feed
what is the moro reflex?
what is the significance of abnormal persistence of primitive reflexes?
moro reflex is a primitive reflex which presents in all infants/newborns up to 3 or 4 months of age - it is a response to a sudden loss of support, when the infant feels as if it is falling. It involves three distinct components - spreading the arms (abductuion) then unspreading the arms (adduction) and often crying
if there is persistent primitive reflexes usually it means there is an upper motor neurone deficit - commonly cerebral palsy
what are the primitive reflexes?
- Palmar – from birth to 2-3 months
- Rooting – from birth to 3-4 months
- Moro – from birth to 2-4 months
- Asymmetric Tonic neck reflex-from birth to 4-6 months
what is cerebral palsy?
an umbrella term for a permanent disorder of movement and/or posture and of motor function due to a non-progressive abnormality in the developing brain
what can cause cerebral palsy ?
80% are antenatal origin due to cerebrovascular haemorrhage or ischaemia, cortical migration disorders or structural maldevelopment of the brain during gestation. can also be due to an antenatal infection
perinatal - infection, hypoxia or trauma
post natal - trauma, infection, haemorrhage
why do a child symptoms with cerebral palsy change over time?
because as the child grown, what they cannot do become more evident and as you do the signs become more obvious.
what are the different types of cerebral palsy ?
spastic - increased tone (presents early, initial hypotonia) can be hemiplegia, diplegia or quadriplegia
ataxic
dyskinetic
mixed
what investigations would you perform for suspected cerebral palsy?
MRI - may show periventricular leukomalacia, congenital malformation, stroke or haemorrhage, cystic lesions
metabolic screen
genetic testing
who would be involved in the care of a child with cerebral palsy?
MDT approach to care Physio OT dietician paediatrician GP pharmacy neurologist orthopaedic surgeon psychologist social services
when would you prescribe botox for cerebral palsy?
botox reduces spasticity
consider in focal spasticity of libs where it is impeding fine motor function/gross motor function
consider in focal dystonia with postural/functional difficulties
A 6 year old girl is referred to the outpatient clinic because she is having repeated episodes of daydreaming at school. These have been occurring over at least the last year. Since they were highlighted by school, her parents have noticed them occurring at home. There are no concerns about her development, although the school have noticed that her work has deteriorated since these episodes started. Examination is unremarkable; in particular neurological examination is normal.
What possible explanations are there for her symptoms?
absence seizures
learning difficulties
hearing and sight problems
how would you investigate someone presenting with suspected absence seizures?
EEG - WITH AN ABSENCE SEIZURE YOU WOULD FIND 3Hz SPIKE AND WAVE COMPLEX ALL 4 QUADRANTS
hyperventilation - can cause absence seizure
what is the first line treatment for absence seizures?
AND SIDE EFFECTS
1st line: ethosuximid - aggression, agranulocytosis, decreased appetite, bone marrow disorders, depression, dizziness, drowsieness
2nd options = sodium valproate or lamotrigine
sodium valproate side effects: abdominal pain, alopecia, anaemia, abnormal behaviour
lamotrigine side effects: aggression, agitation, diarrhoea , dizziness, drowsiness
what are the different types of squint ?
paralytic vs non-paralytic
paralytic - nerve palsy you can only move your eye in certain. directions
non-paralytic - you can move your eyes in all directions just there is a misalignment
manifesto (all the time) vs talent (just some of the time)
conversion vs diversion
why might children develop a squint?
visual problems - refract error, cataract, retinoblastoma
hereditary
how can you treat squint? what happens if it is not corrected?
Non- Paralytic normally due to refractory error, corrected with glasses or rarely patch
If not corrected, leads to amblyopia
what squint may require imaging of the head and orbitis?
paralytic squints need investigation
how do you manage a preterm baby?
intubation, incubation, put them in a warm plastic bag, keep them warm, monitor sats, if you are intubating then they will need surfactant
IV access for antibiotics
you can put a line in the vein in the umbilical cord and a line in the artery in the umbilical cord (for blood sampling, invasive BP monitoring)
fluids give 10% glucose
CXR to check everything is in the right position
a preterm baby (27 weeks) presents with hard work to breathe and is dependant on oxygen to maintain the saturations. What are the likely causes of his problems?
respiratory distress syndrome
congenital pneumonia/sepsis
pneumothorax
what antibiotics should you give to pre-term babies?
benzypenicillin and gentamycin
who might you feed and extremely premature baby?
total parental nutrition through a PICC line
NG tube
immature gut so may not be able to tolerate milk
can be bottle fed at 32-35 weeks
if a premature infant deteriorates suddenly and looks pale and has low BP, what could have happened?
sepsis cardiac failure shock - hypovolemia, blood volume loss pneumothorax displaced tube obstructed tube equipment failure
