postnatal and child development Flashcards
what are the sections of the developing brain in the embryo that can be seen by the 4th week?
from the 4th week
can be seen from the dorsal view:
future forebrain (prosencephalon)
future midbrain (mesencephalon)
future hindbrain (rhombencephalon)
future spinal cord
from the side view:
cephalic flexure
pontine flexure
cervical flexure
what are the sections of the developing brain in the embryo that can be seen by the 5th week?
telencephalon (beginning of cerebral hemispheres)
diencephalon (beginning of the bits inside the cerebral hemispheres)
pons
medulla
what are the sections of the developing brain in the embryo that can be seen by the 8th week?
developing hemispheres
with lateral ventricles inside
also third and fourth ventricles
aqueduct
developing cerebellum (in hindbrain)
what is the moro reflex?
occurs when the baby’s head is suddenly extended
the arms then abduct and then adduct
this develops around 28-32 weeks gestation
should disappear between 3 and 6 months
persistence if primitive reflexes can be a sign of impaired development
what is the standing reflex?
on weight bearing the lower extremities are extended, the hips are slightly flexed and just behind the shoulders, head is free to turn
present at 3 moths
what is the grasp reflex?
what an object is placed in the palm of the hand of the newborn, the finger grasp it
stroking the side of the hand then open the hand again
these reflexes are replaced at about 6-9 months with voluntary movement of the hand as part of of fine motor development
what are parachute reflexes?
baby is placed in the forward tilting position and it puts its arms down to protect themselves
also happens if you tilt them to the side
what are some primitive reflexes?
moro reflex
standing reflex
grasp reflex
parachute reflex
what is development?
Global impression of a child encompassing: growth, increase in understanding, acquisition of new skills and more sophisticated responses and behavior
Endows child with increasingly complex skills in order to function in society
who and when observes development?
Who? Parents All doctors Nursery nurses Teachers
When ?
Opportunistically
Planned as part of programme of reviews
what are the four domains of child development?
gross motor skills: position head lag sitting walking running
fine motor skills: use of hands grasp and fine pincer bricks crayon puzzles
social skills: social interaction stranger reaction eating skills dressing
speech and language skills: vocalisation words understanding imaginative play
what is gross motor development like in newborns?
on laying down the baby will have limited flexed and symmetrical posture
when lifted up there will be marked head lag, due to lack of maturity of the neck muscles
by three moths old, the head will lift with the body
at 6-8 weeks, babies can’t really sit up
by 6 months they can sit but with a rounded back
by 8 months they can sit with a straighter back
around 3-5 months babies start being able to roll
around 8-9 month babies start to crawl
around 10 months they start lifting themselves up on furniture
12 months: walks unsteadily, broad gait, hands apart
15 months: walks steadily
there are variations though. some babies commando crawl then walk, some all fours crawl then walk, some bum shuffle then walk
what is vision and fine motor development like in newborns?
they often go together as to move your hands around with purpose you need to be able to use your eyes to see what to follow
6 weeks:
follows moving objects or face by turning the head
4 months:
reaches out for toys
4-6 moths:
palmar grasp
crude, all rasping done as one piece (inferior grasp, holds with the whole hand)
7 months;
transfers toys fro one hand to another
10 months:
mature pincer grip (eg holding a grape)
16-18 months:
makes marks with a crayon
14 moths - 4 years:
can do more
more complex stacking of bricks etc
2-5 years:
can draw progressively more complex things (line, circle, cross, square, triangle)
what is hearing, speech and language development like in newborns?
newborn:
startles to loud noises
3-4 months:
vocalises alone or when spoken to, coos or laughs
7 months:
turns to soft sounds out of sight
7-10 months:
dada, mama. sounds used indiscriminately
1 month, sounds used discriminately to parents
(children with hearing impairments make much more monotone sounds)
12-18 months:
2-3 words other than mama/dada
18 months;
6-10 words, shows parts of the body
20-24 months:
uses two or more words to make simple phrases
2.5-3 years:
talks constantly in 3-4 word sentences
how does social, emotional and behavioural development change as a newborn grows?
feeding
6-8 months:
puts food in mouth
18 months:
holds spoon and gets food safely to mouth
18-24 months: symbolic play (eg. tea parties)
social
6 weeks:
smiles responsively
10-12 months:
waves bye bye and plays peek a boo
12 months:
drinks from a cup with two hands
2.5-3 years:
parallel play, interactive play evolving, takes turns
potty training
2 years:
dry by day, pulls off some clothing
what are the different patters of normal development?
developmental progress types:
basically a spectrum of normal
then slow but steady
then a plateau
then regression
what are the fields of development gross motor development?
acquisition of tone and head control
primitive reflexes disappear
locomotor patters
standing, walking, running
hopping, jumping, peddling
what are limit ages with regards to gross motor development?
ages that might show signs of impaired development if a certain milestone hasn’t been reached
4 months: no head control
9 months: can’t sit unsupported
12 months: can’t stand independently
18 months: can’t walk independently
what are some signs of cerebral palsy?
(disinhibition of the motor neurones) (hyperreflexia)
by age 2
unable to lift her or push up on arms, stiff extended legs, pushing back with head, constantly fisted hands and stiff leg on one side
by 6 months
floppy trunk, arms flexed and held back, stiff, crossed legs
by 9 months
will not take weight on legs, arched back, stiff legs
by 13 months
no interes in pushing to stand
may only use one side of body to move
by 18 months excessive tiptoe gait sits with weight to one side uses predominantly one hand one leg may be stiff
what are the fields of development of vision and fine motor development?
visual alertness, fixing and following
grasp reflex, hand regard
voluntary grasping, pincer, points
handles objects with both hands, transfers between hands
writing, cutting, dressing
what are the limit ages with regards to vision and fine motor development?
by 3 months:
can’t fix and follow visually
by 6 months:
inset reaching for objects
by 9 months:
isn’t transferring objects between hands
by 12 months:
doesn’t have a pincer grip
what are the fields of development of hearing, speech and language development?
sound recognition and vocalisation
babbling
single words, understands simple requests
joining words, phrases
simple and complex conversation
what are the limit ages with regards to hearing, speech and language development?
by 7 months:
no polysyllabic babble
by 10 months:
no consonant babble
by 18 months:
can’t say 6 words with meaning
by 2 years:
can’t Join words
by 2.5 years:
can’t say 3 word sentences
what are the fields of development of social, emotional and behavioural development?
smiling, socially responsive
separation anxiety
self help skills, feeding, dressing, toileting
peer group relationships
symbolic play
social/ communication behaviour
what are limit ages with regards to social, emotional and behavioural development?
by 8 weeks:
can’t smile
by 10 months:
no fear of strangers
by 18 months:
can’t feed self or spoon-feed self
by 2.5 years:
no symbolic play
by 3.5 years:
no interactive play
what is the healthy child programme?
THE HEALTHY CHILD PROGRAMME -3 key components : Screening General examination and immunisation Health education /promotion
what screening is done?
at birth:
newborn bloodspot
hearing
physical
6-8 weeks:
GP physical examination
4-5 years:
vision
what child health reviews are done?
birth visit
2-4 weeks:
10-14 day visit
6-8 week review
first year review
two year review
4-5 years:
school entry review
what health promotion is done?
12 weeks prior to 5 years: relationships breast feeding vaccination weaning social and emotional injury prevention learning physical activity nutrition
5-11 years:
promote healthy weight
11-16:
sexual health
promote healthy weight
16-19:
sexual health
encourage physical activity
how do you evaluate a child with abnormal development?
History:
Parental concern (one of the most sensitive indicators)
Birth history
Family history
PMHX:
Developmental history
Current skills
Examination:
Developmental assessment, + general and neurological examinationa
Investigations:
– as appropriate
what is the general approach to developmental assessment?
ask -> observe -> task
need to assess:
milestones proceeding age
expected milestones for age
next important milestones
Opportunisitc examination – cant always follow a logical sequence with children.
Introduce this as a way to approach the examination – helpeful aide memoire
Use the parents – they know the child best
Watch – you can learn so much from watching the child.
Then ask them to do specific things
what factors may influence developmental delay?
lack of physical/psychologial stimuli -
sensory/motor impairment - eg. visual impairment will effect fine motor development
reduced inherent potential - genes
ill health - middle ear infections may affect speech
some examples:
folate - DNA synthesis
iron - spinal cord development
meningitis
wha tare the types of developmental delay?
specific: Language OR motor OR sensory OR cognitive
global:
deficits in all 4
what are some causes of global delay?
Chromosomal abnormalities
e.g. Down’s syndrome, Fragile X
Metabolic
e.g. hypothyroidism, inborn errors of metabolism
Antenatal and perinatal factors
Infections, drugs, toxins, anoxia, trauma, folate def
Environmental-social issues
Chronic illness
what are some causes of motor delay?
Cerebral palsy (corticospinal tract injury) Global delay eg Down’s syndrome Congenital dislocation hip Social deprivation Muscular dystrophy-Duchenne’s Neural tube defects: spina bifida Hydrocephalus
what are some causes of language delay?
Hearing loss Learning disability Autistic spectrum disorder Lack of stimulation Impaired comprehension of language -Developmental dysphasia Impaired speech production -stammer, dysarthria
what are some commonly used assessment tools?
Standardised tests
Schedule of Growing Skills (II)
Griffiths developmental scale
Bailey developmental scale
Denver developmental screening tests
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