post-natal development Flashcards
What are the 4 parts seen in dorsal view of embryo as the brain develops at about week 4? (from top to bottom)
From top to bottom: prosencephalon (future forebrain), mesencephalon (future midbrain), rhomencephalon (future hindbrain), future spinal cord
By about 4 weeks what flexures are seen in the developing brain?
From front to back: cephalic flexure, pontine flexure, cervical flexure
At about week 5 what is the structure of the developing brain?
From top to bottom: telencephalon (fore), diencephalon (mid), pons, medulla (hind)
What happens to the developing brain at about 8 weeks?
Developing hemisphere (fore), developing aqueduct (mid), developing cerebellum (hind)
By term what is the structure of the brain?
fully developed cortex, ventricular system, cerebellum, pons & medulla
What area of the brain goes wrong in ADHD?
Prefrontal cortex
What is the grey matter anteriorly responsible for?
Alpha motor neurones
What are the functions of the extrapyramidal tracts?
Coordinate automated movements of locomotion & posture (eg to painful stimuli), regulate posture to maintain balance, facilitates mainly a-motor neurones of postural, anti-gravity (extensor) muscles
What are the components of a reflex arc? What happens?
- Sensory receptor responds to stimulus by producing generator or receptor potential.
- Sensory neurone activated and goes to dorsal part of spine, connecting to interneurone & conducting impulse from receptor to integrating centre
- motor neurone activated and goes to effector muscles or glands to produce response to stimulus.
What is the moro reflex? When is it developed/when should it disappear? What if it persists?
- Babies neck suddenly extended & arms abduct & then adduct.
- Reflex develops at 28-30wks gestation & should disappear at 3-6 months.
- Persistence of primitive reflexes can be sign of impaired development
What is development?
- Global impression of child including growth, increase in understanding, acquiring new skills & more sophisticated responses & behaviour.
- Child gets increasingly complex skills to function in society
What is the standing reflex? When is it present?
- New born & at 3 months.
- With extension of lower extremities, hips somewhat flexed, head free to turn
What is the grasp reflex? What is it replaced with and when?
- When object is placed in palm of newborns hand, grasp it tightly.
- Reflex replaced at 6 months with voluntary movement of hand
What is the parachute reflex?
Develops at 6-9 months. Baby put in flying position and protects themselves with outstretched arms
Who knows best about children’s development?
Parents, all doctors, nursery nurses, teachers
When can development assessment happen?
Opportunistically or planned as part of programme of reviews
What are the 4 domains of developmental assessment?
- Speech & language skills (understanding, words, vocalisation, imaginative play),
- social skills (social interaction, stranger reaction, eating, dressing),
- gross motor skills (position, head lag, sitting, walking, running),
- fine motor skills (use of hands, grasp, puzzles, bricks, crayon)
What kind of position would a newborn have and what would happen if you lift them up to sit?
Limited flexed, symmetrical posture. When pull up, marked head lag (immature neck muscles)
When pulled to sit what does a 3month old have?
Good head control compared to newborn when pulled to sitting position
What is position of a baby at 6-8 weeks?
Raises head to 45 degrees when prone
What is position of baby at 6-8 months?
Sits without support. At 6 months with round back, at 8 months with straight back
When does rolling begin?
3-5 months, can roll independently
When does crawling begin?
8-9 months
When does a baby start cruising around furniture? What should be done at this stage?
10 months. Talk to parents about furniture in home
By 12 months, what is the babys walking like?
Walks unsteadily, broad gait, hands apart
At what age does baby walk steadily?
15 months
What are variations of normal from immobile infant to walking?
Before walking can start commando crawl, crawling on all fours, or bottom shuffling
By 6 weeks, what vision/fine motor skill does baby have?
Follows moving object or face by turning head
At 4 months, what fine motor skill does baby have?
Reaches out for toys
When is palmar grasp seen?
4-6 months, thumb and fingers grasping together - crude
When would a baby start transferring a toy from one hand to another?
7 months
When would a mature pincer grip (index and thumb fingers) happen?
10 months
At what age would baby start making marks with a crayon?
16-18 months
How does progression of making building blocks happen?
From 14 months - 4 years.
Tower of 3 (18 months), tower of 6 (2 years), tower of 8 or train with 4 bricks (2.5), bridge from model (3 years), steps (after demonstration - 4 years)
How does progression of drawing shapes go?
1-5 years: Line (2 years), circle (3 years), cross (3.5), square (4), triangle (5). Ability to draw without seeing how it is done, can copy (draw after seeing it done) 6 months earlier
What language skills does a newborn have?
Starts to make loud noises
At 3-4 months, what language skills does a newborn have?
Vocalises alone or when spoken to, coos and laughs
At about 7 months what hearing skills does newborn have?
Turns to soft sounds out of sight
At about 7-10 months what hearing skills does child have?
At 7 months, sounds used indiscriminately, at 10 months, sounds used discriminately to parents
At 12 months, what language skills does child have?
2-3 words other than dada or mama
At 18 months, what language skills does child have?
6-10 words, shows 2 parts of body (eg. Where’s your nose)
At about 20-24 months, what language skills does baby have?
Uses 2 or more works to make simple phrases
At 2.5-3 years how does baby talk?
Talks constantly in 3-4 word sentences
What is heard in children with hearing impairment?
Monotone sound
What would a child with autism show speech wise?
Still babbling and not saying actual words
At 6 weeks what social/behavioural development seen in child?
Smiles responsively
At 6-8 months what social/behavioural development seen in child?
Puts food in mouth
At 10-12 months what social/behavioural development seen in child?
Waves bye bye, plays peek-a boo
At 12 moths what social/behavioural development seen?
Drinks from cup with 2 hands
At 18 months, what social/behavioural skills does baby have?
Holds spoon and gets food safely to mouth
At 18-24 months what social/behavioural skills does child show?
Symbolic play
At 2 years what social/behavioural development seen?
Dry by day, pulls off some clothing, potty training
At 2.5-3 years what social/behavioural development seen?
Parallel play, interactive play evolving, takes turns
What are patterns of abnormal development?
There is wide range of normal. Sometimes see abnormal development: slow but steady, plateau, regression (early sign of serious illness)
What are some limit ages for gross motor development?
Head control (4 months), sits unsupported (9 months), stands independently (12 months), walks independently (18 months)
What is progression of gross motor development?
Acquisition of tone & head control –> primitive reflexes disappear –> locomotor patterns –> standing, walking, running –> hopping, jumping, peddling
At limit age of 2 months what motor development should be present, what is abnormal?
- Normal: pushes up on arms, holds head up.
- Abnormal: cant lift head or push up on arms, stiff extended legs, pushing back with head, constantly fisted hand, stiff leg on one side, difficulty moving out of this position
At limit age of 6m, what motor development should be present? What is abnormal?
- Should sit with support, hold head up, rounded back.
- Abnormal: unable to lift head, floppy trunk, stiff arms, extended legs, arms flexed & held back, stiff, crossed legs
At limit age of 9m, what normal motor development should be present? What is abnormal?
- Sit without support, arms free to reach & grasp.
- Abnormal: rounded back, poor use of arms for play, stiff legs, pointed toes. Poor head control, cant get arms forward, arched back, stiff legs. Poor ability to lift head and back, will not take weight of legs
At limit age of 13 months what motor development should be present? What is abnormal?
- Pulls to stand.
- Abnormal: not interested in weight bearing, difficulty in pulling to stand, stiff legs, pointed toes. Cant crawl on hands & knees, may use only one side of body to move
At limit age of 18 months, what motor skill should be done and what is abnormal
Independent standing or walking.
Abnormal: holds arm or both arms stiffly and bent, excessive tiptoe gait. Sits with weight to one side, uses mainly one hand to play, one stiff leg
What is development of vision/fine motor skills?
Visual alterness, fixing, following –> grasp reflex, hand regard –> voluntary grasping, pincer, points –> handles object with both hands + transferring –> writing, cutting dressing
What are limit ages for vision/fine motor skills?
Fixes & follows visually (3 months), reaches for objects (6 months), transfers (9 months), pincer grip (12 months)
What is progression of hearing, speech and language?
Sound recognition, vocalisation –> babbling –> single words, understands simple requests –> joining words, phrases –> simple & complex conversation
What are limit ages for hearing, speech and language skills?
Polysyllabic babble (7 months), constant babble (10 months), saying 6 words with meaning (18 months), join words (2 years), 3 -word sentences (2.5 years)
What is progression of social, emotional behaviour development?
Smiling, socially responsive –> separation anxiety –> self-help skills, feeding, dressing, toileting –> peer group relationships –> symbolic play –> social/communication behaviour
What are limit ages for social, emotional behaviour development?
Smiles (8 wks), fear of strangers (10 months), feeds self/spoon (18 months), symbolic play (2-2.5 years), interactive play (3-3.5 years)
What is the healthy child programme?
3 components: screening, general examination & immunisation, health education & promotion
What is schedule for <12 weeks of pregnancy ?
Screening for hbopathy, rhesus infection, + health promotion (Relationships, breast feeding, vaccination, reading, weaning, social and emotional, injury prevention, learning, physical activity, nutrition)
What is involved in health promotion at all stages?
Relationships, breast feeding, vaccination, reading, weaning, social and emotional, injury prevention, learning, physical activity, nutrition
What is done at 12 weeks of pregnanacy?
Screening: US scan dating & nuchal (down syndrome) + health promotion
What is done at 18-20 wks pregnancy?
US scan detailed + health promotion
What is done at birth/newborn stage?
Screening: newborn bloodspot, hearing and physical. Child health review - birth visit + health promotion
What is done at 2-4 week stage after birth?
10-14 day visit + health promotion
What is done at 6-8 week stage after brith?
Physical examination by GP, 6-8 week review, health promotion + immunisation
What is done at 2-4 months after birth stage?
Immunisation + health promotion
What is done at 8-12 month stage after brith?
First year review + immunisation + health promotion
What is done at 13 month stage after brith?
Immunisation + health promotion
What is done at 2 year stage after birth?
2 year review + health promotion
What happens at 3 years stage after brith?
Immunisations + health promotion (+ learning, physical activity, nutrition)
What happens at 4-5 yeaers after birth?
Vision screening, school entry review, health promotion
What happens at 5-11 years?
Share info about pre-school background. Promote healthy weight
What happens at 11-16 years?
health review at school transition at 10-11 & 15-16. immunisation. Promote healthy weight + sexual health
What happens at 16-19 years?
Share info from school with adult services, review immunisations, sexual health, encourage physcial activity
Who knows something is wrong first?
Parents know something is wrong before professionals do
What factors affect developing human at ant stage of lifecycle?
Prenatal (nutrition, folate for spinal cord, iron for brain), perinatal (traumatic injury, drugs), post-natal (trauma, meningitis)
How do you evaluate a child with abnormal development?
- history - parental concern, birth history, family history
- past medical history - developmental history, current skills
- examination - developmental assessment + general/neurological exams. Investigations if appropriate
What do we assess during developmental assessment?
Milestones, proceeding age, expected milestones for age, next important milestones
What are some factors influencing developmental delay?
Sensory/motor impairment, reduced inherent potential, ill health., lack of physical or psychological stimuli
What are causes of global delay?
Chromosomal abnormalities (downs, fragile x), metabolic (hypothyroidism, inborn errors of metabolism), antenatal and perinatal factors (infections, drugs, toxins, anoxia, trauma, folate deficiency), environmental - social issues, chronic illnesses
What are some causes of motor delay?
Cerebral palsy, global delay (eg downs), congenital dislocation hip, social deprivation, muscular dystrophy (duchennes), neural tube defects (spina bifida), hydrocephalus
Causes of language delay?
Hearing loss, learning disability, autism, lack of stimulation, impaired comprehension of language (developmental dysphasia), impaired speech production (stammer, dysarthria)
What are commonly used assessment tools?
Standardised tests, schedule of growing skills II, griffiths developmental scale, bailey developmental scale, denver developmental screening tests.
Offer right tools, observe, listen.
