Postnatal and Child Development Flashcards
What are the 4 main sections of the embryo at approximately 4 weeks?
- future forebrain
- future midbrain
- future hindbrain
- future spinal cord
What are the 3 flexures of the embryo at approximately 4 weeks?
- cephalic
- pontine
- cervical
What are the 4 main sections of the embryo brain at approximately 5 weeks?
- telencephalon
- diencephalon
- pons
- medulla
What is the the structure of the brain like at 8 weeks?
- development of the ventricular system
3rd, 4th ventricle and the aqueduct
What is the pre-frontal association area responsible for?
- executive function
- concentration
What is the primary motor cortex responsible for?
skeletal muscle movement
What is the primary somatic sensory cortex responsible for?
- recieving impulses from the periphery
What is the occipital lobe responsible for?
vision
What is the temporal lobe responsible for?
- auditory sensation
- speech
What is the anterior section of grey matter responsible for?
motor neurones
What are the 2 pyramidal tracts?
lateral and anterior corticospinal tracts
What do the lateral and anterior corticospinal tracts supply?
sacral, lumbar, thoracic and cervical nerves in the lateral corticospinal stract
What do the extra-pyramidal tracts do?
co-ordination of movements and the regulation of posture and balance
What are the components of the reflex arc?
- sensory receptor
- sensory neuron
- integrating center and interneuron
- motor neuron
- effector
What are the primitive relexes?
- moro reflex
- standing reflex
- grasp reflex
What is the moro reflex?
when the baby’s neck is suddenly extended and the arma adduct and abduct
When does the moro reflex develop?
28-32 weeks gestation
When does the moro reflex disappear?
3-6 months
What does the persistence of primitive reflexes suggest?
impaired development
When is the standing reflex present?
newborn and at 3 months
What is the standing reflex present?
- extension of the lower extremities
- flexion of the hips (behind the shoulder)
What is the grasp reflex?
when an object is placed in the palm of the hand of a newborn and is grasped very tightly
When is the grasp reflex lost?
at around 6-9 months (due to fine motor development)
When are protective/parachute reflexes developed?
6-9 months
What is a protective/parachute reflex?
- baby is placed in a forward tilting position (upside down)
- protects themselves with outstretched arms
What is development?
- global impression of a child encompassing: growth, increase in understanding, acquisition of new skills, and more sophisticated responses and behaviour
- endows child with increasingly complex skills in order to function in society
How is development assessed?
- opportunistically
- as part of a planned programme of review
What are the 4 domains of child development?
- speech and language skills
- social skills
- gross motor skills
- fine motor skills
What are the main speech and language skills assessed in development?
- vocalisation
- words
- understanding
- imaginative play
What are the main social skills assessed in development?
- social interaction
- stranger reaction
- eating skills
- dressing
What are the main gross motor skills assessed in development?
- position
- head lag
- sitting
- walking
- running
What are the main fine motor skills assessed in development?
- use of hands
- grasp and fine pincer
- bricks
- crayon
- puzzles
What causes head lag?
the lack of the maturity of neck muscles
What is the position of newborns generally?
limited flexed, symmetrical posture
Do new borns have head lag?
marked head lag on pulling up (due to lack of mature neck muscles)
What is the neck position that 6-8 weeks babies are capable of generally?
raise head to 45 degree in prone
What is the position of 6-8 months when sitting generally?
sit without support
- 6 months: round back
- 8 months: straight back
When do babies begin to roll?
3-5 months
When do babies begin to crawl?
8-9 months
When do babies begin to use furniture to move around using furniture?
10 months
Is a baby able to walk at 12 months?
- walks unsteadily
- broad gait
- hards are apart
When is a baby able to walk for distance, reliably?
15 months
What are the variations in which babies can go from sitting to walking?
- commando crawl
- bottom-shuffling
When is a baby able to follow a moving object/face by turning the head?
6 weeks
When does a baby start to reach out for toys?
4 months
When does a baby develop a palmar grasp?
4-6 months
When is a baby able to transfer toys from one hand to another?
at around 7 months
What is an inferior grasp?
when something is held and grasped with the whole hand
When does a baby develop a mature pincer grasp?
10 months
What is a mature pincer grasp?
able to hold a small object with the thumb and index finger
When is a baby able to make marks with a crayon?
16-18 months
How do they assess drawing capability?
ability to copy sheets that increase in complexity
How do they assess cognitive and fine motor skills at 3 years old?
- build a 3 brick bridge
- can they pass an object through the opening of the bridge?
What is the first sign that a baby is able to hear?
startling to loud noises
When do babies begin to startle to loud noises?
as a newborn
When does a baby begin to vocalise alone or when spoken to, coos and laughs?
3-4 months
When do babies begin to turn to soft sounds out of sight?
7 months
When do babies begin to speak?
at 7-10 months
How could you describe a babies first attempts at speech (7 months)?
sounds are used indiscriminately
How could you describe a babies babble (10 months)?
sounds are used discriminately
What is the basis of the hearing distraction test done at 7 months?
turning to soft sounds out of sight
What is polysyllabic babble?
multiple different tones
What does a polysyllablic babble indicated?
ability to hear, those that are HOH produce more monotone babble
When do babies start to speak with around 2-3 words?
12 months
When do babies start to speak with around 6-10 words?
18 months
What should babies at around 18 months be able to do in response to speech?
point to at least 2 different body parts
When will a baby be able to use 2 or more words to make simple phrases?
20-24 months
When will a baby be able to talk constantly in 3-4 word sentances?
21/2 to 3 years
When is a baby able to hold a spoon and get food safely to the mouth?
at around 18 months
When is a baby able to develop imaginative play?
18-24 weeks
When does a baby begin to smile in response?
6 weeks
When does a baby begin to put food in their mouth?
6-8 months
When is a baby able to wave goodbye and play peekaboo?
10-12 months
When is a baby able to drink from a cup with 2 hands?
12 months
What can prolonged bottle use cause?
- delayed speech development
- dental cavities
When is a baby able to start toilet training (dry by day and pulls off some clothing)?
2 years
When is a baby able to partake in parallel and interactive play, and share?
21/2-3 years
When is a baby able to stand independently?
1 year
When is a baby able to walk independently?
15-18 months
When is a baby able to run and jump?
21/2 years
What are the different possible patterns of abnormal development?
- slow but steady
- plateau
- regression
What is the limit age for head control?
4 months
What is the limit age for sitting unsupported?
9 months
What is the limit age for standing independently?
12 months
What is the limit age for walking independently?
18 months
What indicates normal motor development of neck control?
- pushes up on arms
- holds head up
What indicates abnormal motor development of neck control?
- unable to lift head
- stiff extended legs
- constant fisted head
- single stiff leg
- pushing back with head
- difficulty moving out of position
What indicates abnormal motor development of sitting?
- floppy trunk
- stiff arms, extended legs
- crossed legs
- flexed arms
- unable to lift head
What indicates abnormal motor development of pulling to stand?
- stiff legs, pointed toes
- cannot crawl
- only use one side of body to move
- unable to weight bear
What indicates abnormal motor development of standing independantly?
- arms stiff and bent
- excessive tiptoe gait
- sits with weight to one side
- one hand used for play
- one leg may be stiff
What does abnormal motor development suggest?
cerebral palsy
What is the limit age for fixing and following objects visually?
3 months
What is the limit age criteria for gross motor development?
- head control
- sitting unsupported
- standing independently
- walking independently
What is the limit age criteria for vision and fine motor development?
- fixes and follows visually
- reaches for objects
- transfers
- pincer grip
What is the limit age for reaching for objects?
6 months
What is the limit age for object transfers?
9 months
What is the limit age for pincer grip?
12 months
What is the limit age criteria for hearing, speech and language development?
- polysyllabic babble
- consonant babble
- saying 6 words with meaning
- joins words
- 3-word sentances
What is the limit age for polysyllabic babble?
7 months
What is the limit age for consonant babble ?
10 months
What is the limit age for saying 6 words with meaning?
18 months
What is the limit age for joining words?
2 years
What is the limit age for 3 word sentences?
2 1/2 years
What is the limit age criteria for social, emotional behaviour development?
- smiles
- fear of strangers
- feeds self/spoon
- symbolic play
- interactive play
What is the limit age for smiles?
8 weeks
What is the limit age for fear of strangers?
10 months
What is the limit age for feeds self/spoon?
18 months
What is the limit age for symbolic play?
2-2 1/2 years
What is the limit age for interactive play?
3-3 1/2 years
How does gross motor development tend to progress?
- acquisition of tone and head control
- primitive reflexes disappear
- locomotor patterns
- standing, walking, running
- hopping, jumping, peddling
How does vision and fine motor development tend to progress?
- visual alertness, fixing and following
- grasp reflex, hand regard
- voluntary grasping, pincer, points
- handles objects with both hands, transfers from hand to hand
- writing, cutting, dressing
How does hearing, speech and language development tend to progress?
- sound recognition, vocalisation
- babbling
- single words, understands simple requests
- joining words, phrases
- simple and complex conversation
How does social, emotional behaviour development tend to progress?
- smiling, socially responsive
- separation anxiety
- self-help skills, feeding, dressing, toileting
- peer group relationships
- symbolic play
- social/communication behaviour
What are the key components of the Healthy Child Programme?
- screening
- general examination and immunisation
- health education/promotion
What parts of the Healthy Child program are done at <12 weeks pregnancy?
- Hbopathy
- Rhesus
- infections
What parts of the Healthy Child program are done at 12 weeks pregnancy?
US scan dating and nuchal (down syndrome)
What parts of the Healthy Child program are done at 18-20 weeks pregnancy?
US scan detailed
What parts of the Healthy Child program are done at birth?
- newborn bloodspot
- hearing and physical screen
- birth visit
What parts of the Healthy Child program are done at 2-4 weeks post birth?
10-14 day visit
What is involved in the health promotion aspect of the Health Child program?
- relationships
- breast feeding
- vaccination
- weaning
- injury prevention
- physical activity
- nutrition
What parts of the Healthy Child program are done at 6-8 weeks post birth?
- physical examination
- start of immunisation
- 6-8 week review
What parts of the Healthy Child program are done at 8-12 months post birth?
first year review
What parts of the Healthy Child program are done at 2 years post birth?
2 year review
What parts of the Healthy Child program are done at 3 years post birth?
end of initial immunisation program
What parts of the Healthy Child program are done at 4-5 years post birth?
- vision
- school entry review
What parts of the Healthy Child program are done at 5-11 years post birth?
share information about pre-school background
What is involved in the health promotion aspect of the Health Child program at 5-11 years?
promoting a healthy weight
What parts of the Healthy Child program are done at 11-16 years post birth?
- health review at school transition at 10-11 and 15-16 years
- immunisation
What is involved in the health promotion aspect of the Health Child program at 11-16 years?
- sexual health
- promote a healthy weight
What parts of the Healthy Child program are done at 16-19 years post birth?
- share information from school with adult services
- immunisation review
What is involved in the health promotion aspect of the Health Child program at 16-19 years?
- sexual health
- encourage physical activity
How do you evaluate a child with abnormal development?
Hx: - parental concern - birth Hx - family Hx PMHx - developmental Hx - current skills Examination - developmental assessment (general and neurological) - investigations
What is the general approach to a development assessment?
- ask
- observe
- task
What are the key things that need to be considered when taking a developmental assessment?
- milestones proceeding age
- expected milestones for age
- next important milestones
What are the factors that can cause developmental delay?
- ill health
- lack of physical/psychological stimuli
- sensory/motor impairment
- reduced inherent potential
What are the different types of development delay?
- global
- specific
What are the different types of specific development delay?
- language
- motor
- sensory
- cognitive
What are the possible causes of global development delay?
- chromosomal abnormalities
- metabolic
- antenatal and perinatal factors
- environmental-social issues
- chronic illness
What chromosomal abnormalities can cause global development delay?
- downs syndrome
- fragile X
What metabolic issues can cause global development delay?
- hypothyroidism
- inborn errors of metabolism
What antenatal and perinatal factors can cause global development delay?
- infections
- drugs/toxins
- anoxia
- trauma
- folate deficiency
What are the possible causes of motor development delay?
- cerebral palsy
- social deprivation
- congenital hip dislocation
- muscular dystrophy (Duchenne’s)
- neural tube defects (spina bifida)
- hydrocephalus
- global delay
What are the possible causes of language development delay?
- hearing loss
- learning disability
- autistic spectrum disorder
- lack of stimulation
- impaired comprehension of language (developmental dysphasia)
- impaired speech production (stammer, dysarthria)
What are the commonly used assessment tools?
- standardised tests
- schedule of growing skills (II)
- Griffith’s developmental scale
- Bailey developmental scale
- Denver developmental screening tests
