Postnatal and Child Development

Question 1

Describe brain development at 4 weeks

Answer 1

Future forebrain - prosencephalon 
Future midbrain - mesencephalon
Future hindbrain - rhombencephalon
Future spinal cord 
Cephalic flexure, pontine flexure and cervical flexures developed at this point

Question 2

Describe brain development at 5 weeks

Answer 2

Telencephalon, diencephalon, pons and medulla developed

Question 3

Describe brain development at 8 weeks

Answer 3

Development of ventricular system begins. Lateral ventricles, third ventricle and fourth ventricle formed as well as aqueduct.

Question 4

Describe the components of the reflex arc

Answer 4

1. Sensory receptor - responds to a stimulus by producing a generator or receptor potential
2. Sensory neuron - axon conducts impulses from receptor to integrating centre
3. Integrating centre - one or more regions within CNS that relay impulses from sensory to motor neurons
4. Motor neuron - axon conducts impulses from integrating centre to effector
5. Effector - muscle or gland that responds to motor nerve impulses

Question 5

What is the Moro reflex?

Answer 5

Moro reflex occurs when baby’s neck is suddenly extended so arms abduct and adduct – develops at 28-32 weeks of gestation and disappears between 3-6 months. Persistence of primitive reflexes is a sign of impaired development.

Question 6

When do standing and grasp reflexes develop?

Answer 6

Standing reflex is present in the newborn at 3 months. Grasp reflex in newborns where object placed in fingers of newborn who then grasp it very tightly. Stroking lateral parts of fingers will open them up again. Reflex replaced around 6-9 months with voluntary movements of the hand as part of fine motor development.

Question 7

What is a parachute reflex?

Answer 7

Between 6-9 months baby develops protective reflexes known as parachute reflexes. If placed in forward tilted position, protects itself with outstretched arms.

Question 8

What is development?

Answer 8

Global impression of a child encompassing: growth, increase in understanding, acquisition of new skills and more sophisticated responses and behavior.

Question 9

What are the 4 domains of developmental assessment?

Answer 9

Gross motor skills, fine motor skills, speech and language skills, social skills

Question 10

What do gross motor skills involve?

Answer 10

Head lag, sitting, walking, running

Question 11

What do fine motor skills involve?

Answer 11

Use of hands, grasp and fine pincer, holding bricks, crayons and puzzle solving

Question 12

What do speech and language skills involve?

Answer 12

Vocalisation, words, understanding and imaginative play

Question 13

What do social skills involve?

Answer 13

Social interaction, stranger reaction, eating skills and dressing

Question 14

How do gross motor skills change with age?

Answer 14

As a newborn, have flexed posture (lack of maturity of neck muscles). By 7 months, can sit without support. By 1 year, stand independently. By 15-18 months, walk independently. By 2.5 years run and jump.

Question 15

How do vision and fine motor skills develop with age?

Answer 15

At newborn stage, fixes and follows face. By 7 months, transfers objects from hand to hand. By 1 year, develop pincer grip (at 10 months) and can point. At 15-18 months, immature grip of pencil and random scribble. At 2.5 years, draw.

Question 16

How do hearing, speech and language develop?

Answer 16

At newborn, stills to voice and startles to loud noise. At 7 months, turns to voice and develops a polysyllabic babble. At 1 year, knows 1-2 words and understands name. At 15-18 months, knows 6-10 words and points to 4 body parts. At 2.5 years, can speak 3-4 word sentences and understands 2 joined commands.

Question 17

How do social, emotional and behavioural changes occur with age?

Answer 17

At newborn, can smile by 6 weeks of age. At 7 months, finger feeds and fears strangers. At 1 year, drinks from cup and waves. At 15-18 months, feeds self with spoon and beginning to help with dressing. At 2.5 years, parallel play with other children plus can remain clean and dry.

Question 18

What are patterns of abnormal development?

Answer 18

Range of normal development becomes wider with age. Abnormal development can be slow but steady where pattern of development is normal but milestones achieved late. Plateau indicates initially milestones reached but no more development occured. Regression indicates serious disease - neurodevelopmental degeneration.

Question 19

What are limit ages for gross motor skills?

Answer 19

4 months for head control. 9 months to sit unsupported. 12 months to stand independently. 18 months to walk independently.

Question 20

What milestone is achieved at median age of 1.5 months?

Answer 20

Should be able to push up on arms and hold head up. Limit age is 2 months. Abnormal motor development can indicate cerebral palsy. May be unable to list head or push up on arms - stiff extended legs. Other signs include pushing back with head, constantly fisted hand and unilateral stiff leg. May have difficulty moving out of this position.

Question 21

What milestone is achieved at median age of 3 months?

Answer 21

Sitting with support, holding head up and rounded back. Limit age is 6 months. Problems may include being unable to lift head, floppy trunk and stiff arms + extended legs. Crossed legs and arms flexed + held back also possible.

Question 22

What milestone is achieved by median age of 6 months?

Answer 22

Sitting without support and arms being free to reach and grasp. Limit age is 9 months. Abnormal development markers include: poor head control, difficulty getting arms forward, arched back, stiff legs, poor use of arms for play.

Question 23

What milestone is achieved by median age of 9 months?

Answer 23

Pulls to stand. Limit age is 13 months. Abnormal markers include not being interested in weight bearing, finding it difficult to stand, stiff legs, being unable to crawl and only using one side of body to move.

Question 24

What milestone is achieved by median age of 12 months?

Answer 24

Independent standing/walking. Limit age is 18 months. Abnormal development can include holding arms stiffly
+ bent, excessive tiptoe gait, sitting with weight to one side, using 1 hand for play and stiffness in one leg.

Question 25

What are limit ages for visual development milestones?

Answer 25

3 months for fixing and following objects visually. 6 months for reaching for objects. 9 months for transferring objects between hands. 12 months for Pincer grip.

Question 26

What are limit ages for hearing, speech and language skills?

Answer 26

7 months for polysyllabic babble. 10 months for consonant babble. 18 months for saying 6 words with meaning. 2 years for joining words. 2.5 years for 3 word sentences. `

Question 27

What are limit ages for social skills?

Answer 27

8 weeks for smiling. 10 months for fear of strangers. 18 months for feeding self with spoon. 2-2.5 years for symbolic play. 3-3.5 years for interactive play.

Question 28

What is the healthy child programme?

Answer 28

For the developmental assessment of children. Has 3 components - screening, general examination and immunisations, health education & promotion.

Question 29

What parts of the healthy child programme apply during pregnancy?

Answer 29

Screening - hameoglobinopathies, rhesus determination and infection carried out at below 12 weeks. At 12 weeks, nuchal scan and ultrasound scan dating plus down syndrome testing. At 18-20 weeks, detailed ultrasound scan carried down to check for normal development. Health promotion carried out.

Question 30

What constitutes health promotion?

Answer 30

Relationships, breast feeding, vaccination, reading, weaning, social and emotional, injury prevention, learning, physical activity, nutrition

Question 31

What parts of the healthy child programme apply from birth till 4 weeks?

Answer 31

Screening at birth includes newborn bloodspot, hearing and physical. Child health reviews includes a birth visit and then a visit at 10-14 days.