Pediatrics and Development Flashcards
Newborn to 1 month Gross Motor Skills
Prone: Physiological flexion, lifts head briefly, head to side.
Supine: Physiological flexion, rolls partly to side.
Sitting: Head lag in pull to sit.
Standing: Reflex standing and walking.
Newborn to 1 month Fine Motor Skills
Regards objects in line of sight Follows moving object to midline Hands fisted Arm movements jerky Purposeful or random movements
2 to 3 months Gross Motor Skills
Prone: Lifts head to 90 deg briefly, chest up in prone with some weight through forearms, rolls prone to supine.
Supine: ATNR, legs kick reciprocally, prefers head to side.
Sitting: Head upright but bobbing, variable head lag in pull to sitting, needs full support to sit.
Standing: Poor weight bearing, hips in flexion behind shoulders.
2 to 3 months Fine Motor Skills
Hands open more
Visually follows through 180 deg
Grasp is reflexive
Uses palmar grasp
4-5 months Gross Motor Skills
Prone: Bears weight on extended arms, pivots in prone to reach.
Supine: Rolls supine to side, plays with feet to mouth.
Sitting: Head steady, turns head, sits alone briefly.
Standing: Bears all weight through legs in supported standing.
4-5 months Fine Motor Skills
Grasps and releases toys
Uses ulnar-palmar grasp
6 to 7 months Gross Motor Skills
Prone: Rolls supine to prone, holds weight on one hand to reach with other.
Supine: Lifts head.
Sitting: Lifts head and helps when pulled from from supine to sitting, gets to sitting position without assist, sits independently
6 to 7 months Fine Motor Skills
Radial-palmar grasp
“Rakes” with fingers to pick up small objects
Voluntary release to transfer objects between hands
8 to 9 months Gross Motor Skills
Prone: Gets into hands and knees position
Supine: Does not tolerate supine
Sitting: Moves from sitting to prone, sits without support for longer, pivots in sitting position
Standing: Stands at furniture, pulls to stand, lowers to sitting.
Mobility: Crawls forward, walks along furniture (cruising).
8 to 9 months Fine Motor Skills
Active supination Digital grasp Inferior pincer grasp Points and pokes with index finger Takes objects out of container
10 to 11 months Gross Motor Skills
Standing: Stands briefly without support, pulls to stand with half-knee intermediate position, picks up objects from floor with support.
Mobility: Walks with both hands held or one hand held, creep (bear walk).
10 to 11 Fine Motor Skills
Fine pincer grasp
Puts objects into container
Grasps crayon
12 to 15 months Gross Motor Skills
Walks without support Fast walking Walking sideways Creeps or hitches upstairs Throw ball in sitting
12 to 15 months Fine Motor Skills
Marks paper with crayon
Builds tower using 2 blocks
Turns over small container to obtain contents
16 to 24 months Gross Motor Skills
Squats Walks backward Walks up/down stairs with one hand held Kicks and throws ball Picks up toys from floor
16 to 24 months Fine Motor Skill
Folds paper Strings beads Stacks six blocks Copies horizontal and vertical strokes on paper Holds crayon with thumb and fingers
Arthrogryposis Multiplex Congenita (AMC)
Definition: non-progressive neuromuscular disorder that occurs during first trimester. Fibrosis of muscles and structures within joints.
Etiology: Unknown, possibly due to poor movement during early development or genetics.
Signs/Symptoms: Cylinder-like extremities with little definition, contractures, dislocations, muscle atrophy.
Treatment: Positioning, stretching, strengthening, splinting, and use of adaptive equipment.
Autism Spectrum Disorder
Definition: Difficulties with social interaction, communication, and repetitive behaviors.
Etiology: Multifactorial including genetic and environmental influences.
Signs/Symptoms: Initially become apparent around ages 2-3. Non-purposeful or absent speech, diminished facial expressions, unable to understand verbal cues, limited interest or awkwardness in social interactions, lack of empathy, defensiveness or indifference towards sensory stimulation, repetitive self-stimulating behaviors, perseverations, routines/rituals, decreased coordination.
Treatment: Sensory integration therapy. Improve social communication and decrease non-purposeful movements and vocalizations.
Cerebral Palsy (CP)
Definition: Movement disorders due to brain damage that are non-progressive and acquired in utero, during birth, or infancy.
Etiology: Lack of oxygen, maternal infections, drug or alcohol abuse, placental abnormalities, toxemia, prolonged labor, prematurity, and Rh incompatibility. Acquired CP due to meningitis, CVA, seizures, and brain injury.
Signs/Symptoms: Abnormal muscle tone, impaired motor control, abnormal reflexes, poor postural control and balance, high risk for hip dislocations. Vision, hearing, and intellect usually altered.
Treatment: Normalization of tone, stretching, strengthening, motor learning, positioning, weight bearing, splinting, AD.
If ambulation will occur, it will occur by age 8.
Normal lifespan for mild to moderate CP. 50% die by age 10 in severe CP.
Down Syndrome
Definition: Genetic abnormality consisting of extra 21st chromosome
Etiology: Incomplete cell division of 21st chromosome.
Signs/Symptoms: Intellectual disability, hypotonia, joint hypermobility, atlantoaxial instability, feeding impairments, flat feet, scoliosis, congenital heart disease, and visual/hearing loss.
Treatment: Exercise and fitness, stability, respiratory function.
Outcome: 80% reach 55 years of age.
Duchenne Muscular Dystrophy
Definition: Progressive disorder caused by absence of gene required to produce muscle proteins dystrophin and nebulin. Fat and connective tissue replace muscle.
Etiology: X-linked recessive trait.
Signs/Symptoms: Characteristics manifest between ages 2 and 5. Waddling gait, progressive weakness, disinterest in running, falling, toe walking, excessive lordosis, pseudohypertrophy, Gower’s sign, slight learning disability in 1/3 of those diagnosed.
Treatment: Respiratory function, submaximal exercise, splinting, orthotics, adaptive equipment. Pharmacology includes immunosuppressants and glucocorticoids.
Outcome: Death usually occurs from cardiopulmonary complications, usually by the teenage years and sometimes into their 20s.
Prader-Willi Syndrome
Definition: Genetic condition diagnosed by physical attributes and behavior rather than genetic testing.
Etiology: Partial deletion of chromosome 15.
Signs/Symptoms: Small hands, feet, and sex organs; hypotonia; almond-shaped eyes; obesity; constant desire for food. Coordination impairments and intellectual disability.
Treatment: Postural control, exercise and fitness, gross and fine motor skills training.
Spina Bifida
Definition: Insufficient closure of neural tube by 28th day of gestation. Types include spina bifida occulta and spina bifida cystica (meningocele or myelomeningocele).
Etiology: Genetic predisposition, environmental influence, low levels of maternal folic acid, maternal hyperthermia, certain drugs.
Incidence: 5 per 10,000 live births in the US
Signs/Symptoms: Myelomeningocele include motor loss below level of defect, sensory deficits, hydrocephalus, Arnold Chiari Type II malformation, osteoporosis, clubfoot, scoliosis, tethered cord syndrome, latex allergy, bowel and bladder dysfunction, learning disabilities.
Treatment: Positioning, handling, ROM, therapeutic exercise. Skin care, strengthening, balance, splinting, orthotics, wheelchair and adaptive equipment prescription.
Outcome: Life expectancy typically normal
Spinal Muscular Atrophy (SMA)
Definition: Progressive degeneration of anterior horn cell. Types include:
1) Acute infantile SMA (Type 1-Werdnig-Hoffman disease) occurs between birth and two months. Motor degeneration occurs quickly and life expectancy is < 1 year.
2) Chronic Childhood SMA (Type 2-Chronic Werdnig-Hoffman disease) presents after 6 months to 1 year and has slower progression. Child can survive into adulthood.
3) Juvenile SMA (Type 3-Kugelberg-Welander SMA) Occurs from 4-17 years of age. Survive into adulthood.
Etiology: Autosomal recessive genetic inheritance.
Signs/Symptoms: Progressive muscle weakness and atrophy, diminished/absent DTR, normal intelligence, intact sensation, end-stage respiratory compromise.
Treatment: Positioning, vestibular and visual stimulation, use of adaptive equipment and AD.
Education for All Handicapped Children Act (EHA) (1975)
Protected rights of, met individual needs of, and improved the results for infants, toddlers, children, and youth with disabilities and their families. Led to IDEA.
Carl D. Perkins Vocational Education Act of 1984
Each state was required to meet the special needs of individuals with handicaps or adults that are disadvantaged, adults in need to training/retraining single parents or homemakers, programs designed to eliminate sex bias, and criminal offenders.
Perkins Vocational and Applied Technology Act (1990)
Reauthorization and modification of EHA. Provides free, appropriate education in least restrictive environment for all individuals with disability from age 3-21.
IDEA (Individuals with Disabilities Education Improvement Act) (1992)
Reauthorized early intervention; established Federal Interagency Coordination Council.
Rehabilitation Act Amendments (1992)
Transition planning at high school graduation includes coordination of assistive technology services and the rehab system.
IDEA Amendments (1997)
Restructured IDEA into 4 parts. Defines the responsibilities of school district so that children with disabilities will have free, appropriate education. School districts must prepare an Individualized Education Program (IEP) for each eligible child.
No Child Left Behind Act (2002)
Goal to close achievement gap between disadvantaged, disabled, and minority students and their peers.
APGAR
Appearance (skin), Pulse, Grimace (reflex irritability), Activity, Respiration.
Taken at 1 and 5 minutes after birth.
Score of 7-10 is good. Score of 3 or below likely required immediate medical attention.
Asymmetrical Tonic Neck Reflex (ATNR)
Stimulus: Head turned to one side
Response: Arm and leg on face side are extended, arm and leg on scalp side are flexed. Spine curved with convexity toward face side.
Normal age of response: birth to 6 months
Symmetrical Tonic Neck Reflex (STNR)
Stimulus: Head flexed or extended
Response: When head is flexed, arms are flexed and legs are extended. When head is extended, arms are extended and legs are flexed.
Normal age of response: 6-8 months
Tonic Labyrinthine Reflex (TLR)
Stimulus: Position of labyrinth in inner ear based on head position
Response: In supine position, body and extremities are held in extension. In prone position, body and extremities are held in flexion
Normal age of response: birth to 6 months
Galant Reflex
Stimulus: Touch to skin along spine from shoulder to hip
Response: Lateral flexion of trunk to side of stimulus
Normal age of response: 30 weeks of gestation to 2 months
Palmar Grasp Reflex
Stimulus: Pressure in palm on ulnar side of hand
Response: Flexion of fingers causing grasp
Normal age of response: birth to 4 months
Plantar Grasp Reflex
Stimulus: Pressure to base of toes
Response: Toe flexion
Normal age of response: 28 weeks of gestation to 9 months
Rooting Reflex
Stimulus: Touch on cheek
Response: Turning head to same side with mouth open
Normal age of response: 28 weeks gestation to 3 months
Moro Reflex
Stimulus: Head dropping into extension suddenly for a few inches
Response: Arms abduct with fingers open then cross trunk into adduction; cry
Normal age of response: 28 weeks of gestation to 5 months
Startle Reflex
Stimulus: Loud, sudden noise
Response: Similar to Moro response but elbows remain flexed and hands closed
Normal age of response: 28 weeks of gestation to 5 months
Positive Support Reflex
Stimulus: Weight placed on balls of feet when upright
Response: Stiffening of legs and trunk into extension
Normal age of response: 35 weeks of gestation to 2 months
Walking (stepping) Reflex
Stimulus: Supported upright position with soles of feet on firm surface
Response: Reciprocal flexion/extension of legs
Normal age of response: 38 weeks of gestation to 2 months
