Postnatal and Child Development Flashcards
development of the brain in a 4 week old embryo: four main sections in dorsal view
future forebrain (prosencephalon) future midbrain (mesencephalon) future hindbrain (rhombencephalon) future spinal cord
list the flexures present in the developing brain in a 4 week old embryo in side on view
cephalic flexure
pontine flexure
cervical flexure
development of the brain in a 5 week old embryo
fore/mid/hind brain develops
fore: telencephalon, diencephalon
mid
hind: pons, medulla
development of the brain in a 8 week old embryo
hemispheres and cerebellum developing
formation of ventricular system: aqueduct, 3rd/4th ventricle
list association cortices in the brain
motor
sensory
visual
prefrontal
features of association cortices
fx less predictable
not organised topographically
left-right symmetry weak or absent
what association cortex is associated with ADHD?
prefrontal
what part of the spinal cord is responsible for motor neurons?
grey matter in the anterior section of the cord
how is the grey matter in the anterior section of the spinal cord divided?
proxima
distal
flexors
extensors
list pyramidal tracts
lateral corticospinal
anterior corticospinal
list extra-pyramidal tracts
rubrospinal
reticulospinal
vestibulospinal
olivospinal
reticulospinal tract is responsible for?
coordinating automated movements of locomotion posture e.g. to painful stimuli
rubrospinal tract is responsible for?
automatic movements of arm in response to posture/balance changes
vestibulospinal tract is responsible for?
regulates posture to maintain balance, facilitates mainly alpha motor neurons of the postural, antigravity (extensor) muscles
anterior corticospinal tract is responsible for?
voluntary movements
list components of the reflex arc
stimulus > sensory receptor > sensory neuron > dorsal column > inteneuron/integrating center > motor neuron > effector
what is the Moro reflex?
when neck suddenly extended, arms abduct then adduct
when does the Moro reflex develop?
28-32 weeks gestation
when does the Moro reflex disappear?
3-6 months
the persistence of primitive reflexes can be a sign of?
impaired development
what is the stepping reflex?
baby appears to take steps or dance when held upright with his or her feet touching a solid surface
how long does the stepping reflex last?
~2months
what is the grasp reflex?
Stroking the palm of a baby’s hand causes the baby to close his or her fingers in a grasp
how long does the grasp reflex last?
5-6 months
9-12 in the toes
what is the tonic neck reflex?
When a baby’s head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow (fencing position)
how long does the tonic neck reflex last?
5-7 months
what is the rooting reflex?
when the corner of the baby’s mouth is stroked / touched, the baby will turn their head and open their mouth to follow and root in the direction of the stroking
how long does the rooting reflex last?
4 months
what is the suck reflex?
When the roof of the baby’s mouth is touched, the baby will start to suck
when does the sucking reflex develop?
32-36 weeks gestation
what are parachute reflexes?
baby protects themselves with outstretched arms when pushed sideways or forward
what is development?
global impression of a child encompassing: growth, ^ understanding, skill acquisition, more sophisticated response and behaviour
who helps monitor child development?
parents
doctors
nursery nurses
teachers
when are children monitored for development?
opportunistically
part of a planned programme of reviews
list the four domains of child development
gross motor skills
fine motor skills
social skills
speech and language skills
gross motor skills include?
position head lag sitting walking running
fine motor skills include?
use of hands grasp and fine pincer bricks crayons puzzles
social skills include?
social interaction
stranger reaction
eating skills
dressing
speech and language skills include?
vocalisation
words
understanding
imaginative play
gross motor development in a new born
limited flexing
symmetrical posture
marked head lag on pulling up
gross motor development in a child that is 6-8 weeks
raises head to 45 degrees in prone
gross motor development in a child that is 6-8 months
sits w/o support
6 months w/ round back
8 months w/ straight back
gross motor development in a child that is 8-9 months
crawling
gross motor development in a child that is 10 months
cruises around furniture
gross motor development in a child that is 12 months
walks unsteadily
broad gait
hands apart
gross motor development in a child that is 15 months
walks steadily
describe the variations in how children go from sitting to sitting to crawling to walking
‘commando’ crawl
crawling on all fours
bottom shuffling
vision and fine motor development in a child that is 6 weeks
follows moving object or face by turning the head
vision and fine motor development in a child that is 4 months
reaches out for toys
vision and fine motor development in a child that is 5-6 months
palmar grasp
vision and fine motor development in a child that is 7 months
transfers toys from one hand to another
vision and fine motor development in a child that is 10 months
mature pincer grip
vision and fine motor development in a child that is 16-18 months
makes marks with a crayon
vision and fine motor development in a child that is 14 months - 4 years (building blocks)
tower of 3 > tower of 6 > tower of eight / train w/ 4 bricks > bridge from a model > steps (after demonstration)
vision and fine motor development in a child that is 2-5 years (drawing shapes)
line > circle > cross > square > triangle
hearing, speech and language development in a child that is a new born
startles to loud noises
hearing, speech and language development in a child that is 3-4 months
vocalises alone or when spoken to, coos and laughs
hearing, speech and language development in a child that is 7 months
turns to soft sounds out of sight
hearing, speech and language development in a child that is 7-10 months
7 months > sounds used indiscriminately
10 months > sounds used discriminately to parents
hearing, speech and language development in a child that is 12 months
two to three words other than ‘dada’ ‘mama’
hearing, speech and language development in a child that is 18 months
6-10 months
shows two parts of the body
hearing, speech and language development in a child that is 20-24 months
uses two or more words to make simple phrases
hearing, speech and language development in a child that is 2.5-3 years
talks constantly in 3-4 word sentences
social, emotional and behavioural development in a child that is 6 weeks
smiles responsively
social, emotional and behavioural development in a child that is 6-8 months
puts food in mouth
social, emotional and behavioural development in a child that is 10-12 months
waves bye
plays peek a boo
drinks from a cup with two hands
social, emotional and behavioural development in a child that is 18-24 months
holds spoon and gets food safely to mouth
symbolic play
social, emotional and behavioural development in a child that is 2 years
dry by day
pulls off some clothing
social, emotional and behavioural development in a child that is 2.5-3 years
parallel play
interactive play evolving
takes turns
list patterns of abnormal development
slow but steady
plateau
regression
limit age for head control
4 months
limit age for sitting unsupported
9 months
limit age for standing independently
12 months
limit age for walking independently
18 months
median and limit ages for being able to push up on arms/hold head up
median age 1.5 months
limit age 2 months
describe abnormal motor development at 1.5/2 months
unable to lift head/push up on arms stiff extended legs pushing back w/ head constantly fisted hand + stiff leg on one side difficulty moving out of that position
median and limit ages for being able to sit w/ support, holds head up, rounded back
median age 3 months
limit age 6 months
describe abnormal motor development at 3/6 months
while seated: unable to lift head, floppy trunk, stiff arms, extended legs
when held up: arms flexed and held back, stiff, crossed legs
median and limit ages for being able to sit w/o support, arms free to reach and grasp
median age 6 months
limit age 9 months
describe abnormal motor development at 6/9 months
while seated: rounded back, poor use of arms, stiff legs, pointed toes
wont take weight on legs
median and limit ages for being able to pull to stand
median age 9 months
limit age 13 months
describe abnormal motor development at 9/13 months
not interested in weight bearing, difficulty pulling to stand, stiff legs, pointed toes
cannot crawl on hands and knees, may use only one side of body to move
median and limit ages for being able to stand or walk independently
median age 12 months
limit age 18 months
describe abnormal motor development at 12/18 months
arms stiff and bent, excessive tiptoe gait
sits w/ weight to one side, predominant use of one hand for play, one leg may be stiff
progression of gross motor development
acquisition of tone + head control > primitive reflexes disappear > locomotor patterns > standing, walking, running > hopping, jumping, peddling
progression of vision and fine motor development
visual alertness, fixing and following > grasp reflex, hand regard > voluntary grasping, pincer points > handles objects w/ both hands, transfers from hand to hand > writing, cutting, dressing
limit age for fixes and follows visually
3 months
limit age for reaching for objects
6 months
limit age for transfers
9 months
limit age for pincer grip
12 months
progression of hearing, speech and language development
sound recognition, vocalisation > babbling > single words, understands simple requests > joining words, phrases > simple + complex conversation
limit age for polysyllabic babble
7 months
limit age for consonant babble
10 months
limit age for saying 6 words w/ meaning
18 months
limit age for joining words
2 years
limit age for 3 words sentences
2.5 years
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
limit age for smiling
8 weeks
limit age for fear of strangers
10 months
limit age for feeding self/spoon
18 months
limit age for symbolic play
2-2.5 years
limit age for interactive play
3-3.5 years
what are the three key components to the ‘healthy child programme’
screening
general examination and immunisation
health education/promotion
progression of screening from <12 weeks gestation to birth
Hbopathy, rhesus, infection > US scan dating and nuchal > US scan detailed > newborn blood spot, hearing and physical
progression of screening from birth to 18
physical exam (GP) > vision > preschool background > health review at school transition
progression of child health reviews
birth visit > 10-14 day visit > 6-8 wk > 1st year > 2 year > school entry
education and health promotion from gestation to 5 years
relationships, breast feeding, vaccination, reading, weaning, social and emotional, injury prevention, learning, physical activity, nutrition
factors can affect the developing human at what points in the life cycle?
prenatal
perinatal
postnatal
evaluating the child with abnormal development
Hx: parental concern, birth hx, family hx
PMHx: dev hx, current skills
Exam: dev assess + gen/neuro assess, Ix as appropriate
approach to developmental assessment
ask > observe > task
need to assess milestones preceding age > expected milestones for age > next important milestones
factors that influence developmental delay
ill health
reduced inherent potential
sensory/motor impairment
lack of physical/psychological stimuli
types of developmental delay
global
specific: language, motor, sensory, cognitive
list causes of global delay
chromosomal abnormalities e.g. Down’s, Fragile X
metabolic e.g. hypothyroidism, inborn errors
antenatal and perinatal factors e.g. infections, drugs, toxins, anoxia, trauma, folate deficiency
environmental-social issues
chronic illness
list causes of motor delay
cerebral palsy global delay e.g. Down's congenital dislocation hip social deprivation muscular dystrophy - Duchenne's neural tube defects: spina bifida hydrocephalus
list causes of language delay
hearing loss
learning disability
autism spectrum disorder
lack of stimulation
impaired comprehension of language (developmental dysphasia)
impaired speech production (stammer, dysarthria)
commonly used assessment tools
standardised tests schedule of growing skills (II) Griffith's developmental scale Bailey developmental scale Denver developmental screening tests