Paeds Neuro + Psych (+ dev milestones) Flashcards
What are 4 domains of developmental milestones
Gross motor
Fine motor
Language
Personal and social
What are the developmental milestones for a 2 month old
Gross motor:
Fine motor: fix and follow w eyes
Language: cooing
Personal and social: smile
What are the developmental milestones for a 4 month old
Gross motor: keep head prone, roll over
Fine motor: rattle shake
Language: cooing
Personal and social: laugh
What are the developmental milestones for a 6 month old
Gross motor: maintain sitting position
Fine motor: palmer grasp
Language: noises with consonants
Personal and social: curious and engaged with people
What are the developmental milestones for a 9 month old
Gross motor: sit unsupported & start crawling
Fine motor: scissor grip
Language: babble sounds like talking
Personal and social: cautious about strangers
What are the developmental milestones for a 12 month old
Gross motor: stand on two legs (cruising)
Fine motor: pincer grip
Language: single words
Personal and social: waves bye claps hands, engages with others
What are the developmental milestones for a 18 month old
Gross motor: walk unaided, squat and pick things from floor
Fine motor: use spoon to bring food to mouth, tower of 4 bricks
Language: has 5-10 words
Personal and social: imitates activities
What are the developmental milestones for a 2 year old
Gross motor: run kick a ball
Fine motor: tower of 8 bricks, draw line
Language: combine 2 word phrases
Personal and social: parallel play, dry by day
What are the developmental milestones for a 3 year old
Gross motor: climb stairs one foot at time
Fine motor: circle and build bridge
Language: basic sentences
Personal and social: seek other children to play
What are the developmental milestones for a 4 year old
Gross motor: hop climb and descend stairs like adult
Fine motor: draw cross and square and build steps
Language: tells stories
Personal and social: best friend, dry by night, imaginative play, dresses self
What are red flags for developmental milestones
- Lost developmental milestones
- Not able to hold an object at 5 months
- Not sitting unsupported at 12 months
- Not standing independently, No words and No interest in others at 18 months
- Not walking independently at 2 years
- Not running at 2.5 years
What are two components of language
Expressive language
Receptive language
What is Dyslexia
specific difficulty in reading, writing and spelling.
what is Dysgraphia
specific difficulty in writing.
what is Dyspraxia
developmental co-ordination disorder
delayed gross and fine motor skills
What is auditory processing disorder
specific difficulty in processing auditory information
What is a Non-verbal learning disability
specific difficulty in processing non-verbal information, such as body language and facial expressions
What is a Profound and multiple learning disability
severe difficulties across multiple areas, often requiring help with all aspects of daily life.
What IQ is a mild learning diability
55 – 70
What IQ is a moderate learning diability
40 – 55
What IQ is a severe learning diability
25 – 40
What IQ is a profound learning diability
under 25
What are RF for learning disability.
Family history
abuse, neglect, psychological trauma and toxins
What conditions are strongly associated with learning disability
Genetic disorders such as Downs syndrome
Antenatal problems, such as fetal alcohol syndrome and maternal chickenpox
Problems at birth, such as prematurity and hypoxic ischaemic encephalopathy
Problems in early childhood, such as meningitis
Autism
Epilepsy
who might be involved in management of child with a learning disability
Health visitors
Social workers
Schools
Educational psychologists
Paediatricians, GPs and nurses
Occupational therapists
Speech and language therapists
What is Safeguarding
involves all aspects of ensuring the welfare of a child
What is Child protection
involves the process of protecting a child that is at risk of or suffering harm
What provides the legal framework for child safeguarding
Children Act 1989
what is a “child is need”
refers to a child that is likely to need supportive services to maintain their health and development, or is disabled
What are types of abuse
Physical
Emotional
Sexual
Neglect
Financial
Identity
What are RF for abuse
Domestic violence
Previously abused parent
Mental health problems
Emotional volatility in the household
Social, psychological or economic stress
Disability in the child
Learning disability in the parents
Alcohol misuse
Substance misuse
Non-engagement with services
What are possible signs of abuse
- Change in behaviour or extreme emotional states
- Dissociative disorders (feeling separated from their thoughts or identity)
- Bullying, self harm or suicidal behaviours
- Unusually sexualised behaviours
- Unusual behaviour during examination
- Poor hygiene
- Poor physical or emotional development
- Missing appointments or not complying with treatments
What is available in NHS organisations to assist with safeguarding concerns
safeguarding team or safeguarding lead
where are safeguarding cases referred to
children’s services (social services)
If the child is in immediate danger the police may need to be involved
What measures can be arranged to help support families of children with safe guarding concerns.
- Home visit programmes to support parents
- Parenting programmes to help parents develop parenting skills and manage their child’s behaviour
- Attachment-based interventions to help parents bond and nurture their child
- Child–parent psychotherapy
- Parent–child interaction therapy
- Multi-systemic therapy for child abuse and neglect (MST-CAN)
- Cognitive behavioural therapy for children that have suffered trauma or sexual abuse
What is Global developmental delay
child displaying slow development in all developmental domains
What conditions are associated with global developmental delay
Down’s syndrome
Fragile X syndrome
Fetal alcohol syndrome
Rett syndrome
Metabolic disorders
What conditions are associated with gross motor delay
Cerebral palsy
Ataxia
Myopathy
Spina bifida
Visual impairment
What conditions are associated with fine motor delay
Dyspraxia
Cerebral palsy
Muscular dystrophy
Visual impairment
Congenital ataxia (rare)
What conditions are associated with language delay
Specific social circumstances, for example exposure to multiple languages or siblings that do all the talking
Hearing impairment
Learning disability
Neglect
Autism
Cerebral palsy
How is language delay managed
referral to speech and language, audiology and the health visitor.
Referral to safeguarding is required if neglect is a concern.
What may personal and social delay indicate
Emotional and social neglect
Parenting issues
Autism
What are febrile convulsions
type of seizure that occurs in children with a high fever
only in children ages of 6 months and 5 years
What are Simple febrile convulsions
generalised, tonic clonic seizures
last less than 15 minutes
only occur once during a single febrile illness
What are complex febrile convulsions
consist of partial or focal seizures
last more than 15 minutes
or occur multiple times during the same febrile illness.
What are DDx for febrile seizures
Epilepsy
Meningitis, encephalitis or another neurological infection such as cerebral malaria
Intracranial space occupying lesions, for example brain tumours or intracranial haemorrhage
Syncopal episode
Electrolyte abnormalities
Trauma
What is the fever in febrile seizures usually caused by
an underlying viral illness or bacterial infection such as tonsillitis.
How is febrile seizures diagnosed
diagnosis of exclusion
How are febrile seizures managed
ID & manage the underlying source of infection
first = trip to hospital for assessment
simple = do not require further investigations.
complex = further investigation
How are seizure episodes manahed
stay with the child
safe place
recovery position
don’t pout anything in mouth
call ambulance if >5 min seizure
show how to give PR diazepam or buccal midazolam
what is prognosis for febrile seizures
no lasting damage
1/3 will have another
What is the risk of developing epilepsy in normal population, after a simple febrile seizure and after complex febrile seizure
1.8% for the general population
2-7.5% after a simple febrile convulsion
10-20% after a complex febrile convulsion
What is Epilepsy
umbrella term for a condition where there is a tendency to have seizures
What are Seizures
transient episodes of abnormal electrical activity in the brai
What are tonic clonic seizures
loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) movements
associated tongue biting, incontinence, groaning and irregular breathing.
What is the peroid after seizure called and what are symptoms
post-ictal period
confused, drowsy and feels irritable or low
What is the Management of tonic-clonic seizures
First line: sodium valproate
Second line: lamotrigine or carbamazepine
