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Y2 - BRS - RDA > Postnatal and Child Development > Flashcards

Postnatal and Child Development Flashcards

1
Q

On what plane should the embryo be looked at to see the 4 parts of the foetal brain?

A

Dorsal (front) view of the embryo

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2
Q

At 4 weeks what are the 4 parts of the foetal brain?

A

Prosencephalon (future forebrain)
Mesencephalon (future midbrain)
Rhombencephalon (future hindbrain)
Future spinal cord

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3
Q

On what plane should the embryo be looked at to see the 3 flexures of the foetal brain?

A

Side view

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4
Q

At 4 weeks, what are the 3 flexures present in the foetal brain?

A

Cephalic flexures
Pontine flexures
Cervical flexures

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5
Q

At 5 weeks, what does the dorsal view of the foetal brain reshape to form?

A

Telencephalon
Diencephalon
Pons
Medulla

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6
Q

At 8 weeks, how has the foetal brain developed since?

A

Development of the ventricular system (third and fourth ventricle, and aqueduct)
Developing hemispheres
Developing cerebellum

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7
Q

How has the brain developed by term?

A 
Fully developed cortex
Ventricular system
Aqueduct 
Cerebellum
Pons
Medulla
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8
Q

What are the different functions of the cerebral cortex?

A

Pre-frontal cortex = executive function and concentration

Primary motor cortex = supplying the nerves to the skeletal muscles

Primary somatic sensory cortex = receiving impulses from the periphery

Parietal lobe = sensory information processing

Occipital lobe = visual information processing

Temporal lobe = auditory information processing and speech

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9
Q

What happens if there is malfunctioning in the pre-frontal cortex?

A

Malfunctioning in:

Pre-frontal cortex = ADHD - attention deficit hyperactivity disorder

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10
Q

What 2 matters is the spinal cord made up of? Where are they found and what are they responsible for?

A

White matter and grey matter

White matter =
- Found on the edge of the cross section of the spine

Grey matter =

  • Found in the middle of the cross section of the spine
  • Grey matter in the anterior section of the cord is responsible for motor neurons
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11
Q

How are the nerves organised within the spinal tract and what do they supply?

A

Pyramidal tracts (lateral and anterior corticospinal tracts) = voluntary control

Extrapyramidal tracts = involuntary control, co-ordination of movements, regulation of posture and balance, important in primitive reflexes in small infants

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12
Q

What are the primitive reflexes seen when examining infants?

A

Moro reflex = extension of neck, abduction and then adduction of arms - develops between 28-32 weeks gestations, and should disappear between 3-6 months

Standing reflex = extension of the lower extremeties, hips slightly flexed and behind the shoulder, head free to turn - present in the newborn and at 3 months

Grasp reflex = fingers grasp tightly to objects placed into their palms

Opening of fingers due to stroking on the (pinky finger) side of their hand

Parachute reflexes = outstretched arms when tilted upside down - this protective reflex develops between 6-9 months

Side-ways parachute reflex = same as above but when child is tilted sideways rather than forwards

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13
Q

What is the significance of primitive reflexes?

A

Develops 28-30 weeks gestation
Disappear 3-6 months (Moro)
6-9 months (grasp)
Persistence of these reflexes can demonstrate impaired development

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14
Q

What is developement?

A

Global impression of a child encompassing growth in understanding, acquisition of new skills

Normal development endows a child with increasingly complex skills in order to function in society

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15
Q

Who knows about children’s development?

A

Parents
Doctors
Nursery nurses
Teachers

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16
Q

When is development assessed?

A

Opportunistically

Planned programme of reviews

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17
Q

What are the 4 domains of child developement?

A 
Gross motor skills = 
Position
Head lag
Sitting
Walking
Running 
Fine motor skills =
Use of hands
Grasp and fine pincer
Bricks
Crayon
Puzzles 
Speech and language =
Vocalisation
Words
Understanding
Imaginative play 
Social skills =
Social interaction
Stranger reaction
Eating skills
Dressing
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18
Q

What do you first look at when assessing a newborn?

gross motor

A

See how the baby is positioned

As a newborn they will have a limited, flexed, and symmetrical posture when laying down

When they are lifted up, they have a marked lag of the head due to lack of neck muscle maturity

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19
Q

What is the positioning of the baby by 6-8 weeks postnatally?
(gross motor)

A

Better head control compared to newborn baby

Raises head to 45 degrees in prone

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20
Q

What is the positioning of the baby by 6-8 months postnatally?
(gross motor)

A

Sits without support
At 6 months: with round back, good baseline posture
At 8 months: with straight back

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21
Q

What can a baby do at around 3-5 months? (gross motor)

A

Babies begin to roll independently - from lying on their back to lying on their front
Can pull themselves up and have outstretched arms when lying on their front

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22
Q

What can a baby do at around 8-9 months? (gross motor)

A

Crawl

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23
Q

What can a baby do at around 10 months? (gross motor)

A

Cruise around furniture - pull themselves up onto furniture
Good time to counsel parents on the need of safety around the home as their child’s mobility is increasing rapidly around this stage

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24
Q

What can a baby do at 12 months? (gross motor)

A

Walk unsteadily, broad gait with hands apart

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25
Q

What can a baby do at 15 months? (gross motor)

A

Walk steadily - more steady gait

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26
Q

What is important to note regarding motor development?

A 
Many variations of normal
e.g. sitting to all four crawl to walk
OR
bottom-shuffling before walking
OR
commando crawling before walking
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27
Q

What are the gross motor milestones?

A

Newborn =
See how the baby is positioned
As a newborn they will have a limited, flexed, and symmetrical posture when laying down
When they are lifted up, they have a marked lag of the head due to lack of neck muscle maturity

6-8 weeks =
Better head control compared to newborn baby
Raises head to 45 degrees in prone

3-5 months =
Babies begin to roll independently - from lying on their back to lying on their front
Can pull themselves up and have outstretched arms when lying on their front

6-8 months =
Sits without support
At 6 months: with round back, good baseline posture
At 8 months: with straight back

8-9 months =
Crawl

10 months =
Cruise around furniture - pull themselves up onto furniture
Good time to counsel parents on the need of safety around the home as their child’s mobility is increasing rapidly around this stage

12 months =
Walk unsteadily, broad gait with hands apart

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28
Q

What are the vision and fine motor milestones?

A

6 weeks =
Follow moving objects or face by turning head - track for 180 degrees

4 months =
Reach out for toys

4-6 months =
Palmar grasp
Thumb and fingers grasp as one piece
‘Inferior grasp’ - use of the whole hand to grasp an object

7 months =
Transfer of objects from one hand to the other

10 months =
Hold object between thumb and index finger
‘Mature pincer grip’

16-18 months =
Make marks with a crayon – infant can copy what is being drawn by an adult (i.e. line, circle, cross, square, triangle)

14 months – 4 years =
Improve in sophisticated use of their hands and brain - tested using building blocks e.g. at 18 months, tower of 3, by 4 years, more complex towers by following steps

2-5 years =
Ability to draw without seeing how it is done
Progresses from Line –> Triangle
Can draw after seeing it done 6 months earlier

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29
Q

What can a baby do at 6 weeks? (vision and fine motor)

A

Follow moving objects or face by turning head - track for 180 degrees

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30
Q

What can a baby do at 4 months? (vision and fine motor)

A

Reach out for toys

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31
Q

What can a baby do at 4-6 months? (vision and fine motor)

A

Palmar grasp
Thumb and fingers grasp as one piece
‘Inferior grasp’ - use of the whole hand to grasp an object

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32
Q

What can a baby do at 7 months? (vision and fine motor)

A

Transfer of objects from one hand to the other

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33
Q

What can a baby do at 10 months? (vision and fine motor)

A

Hold object between thumb and index finger

‘Mature pincer grip’

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34
Q

What can a baby do at 16-18 months? (vision and fine motor)

A

Make marks with a crayon

35
Q

In what does a child progressively improve at inbetween 14 months and 4 years?
(vision and fine motor)

A

Improve in sophisticated use of their hands and brain - tested using building blocks e.g. at 18 months, tower of 3, by 4 years, more complex towers by following steps

36
Q

In what does a child progressively improve at inbetween 2-5 years? (vision and fine motor)

A

Ability to draw without seeing how it is done
Progresses from Line –> Triangle
Can draw after seeing it done 6 months earlier

37
Q

What are the hearing, speech and language development milestones?

A

Newborn =
Responds to startling noises

3-4 months =
Vocalise alone or when spoken to, responds to coos and laughs

7 months =
Turns to soft sounds out sight
Sounds used indiscriminately
Hearing distraction test carried out at this age

7-10 months =
Begin to speak polysyllabic babble (sounds at different tones, qualities and volumes)
At 7 months: sounds used indiscrimately
At 10 months: sounds used discriminately to parents
- Babbles of children with hearing impairment = more monotone

12 months =
2-3 words such as ‘dada’ and ‘mama’

18 months =
6-10 words
Show parts of body e.g. where is your nose and then points

20-24 months =
Uses two or more words to make simple phrases

2.5-3 years =
Talks constantly in 3-4 word sentences
At 3 years =
- Normal development of 3 year old = few word sentences
- In a 3 year old child with autism = disordered speech and language development, no words, babble

38
Q

What is apparent in a newborn? (hearing, speech and language)

A

Responds to startling noises

39
Q

What can a baby do at 3-4 months? (hearing, speech and language)

A

Vocalise alone or when spoken to, responds to coos and laughs

40
Q

What can a baby do at 7 months? (hearing, speech and language)

A

Turns to soft sounds out sight
Sounds used indiscriminately
Hearing distraction test carried out at this age

41
Q

What can a baby do at 7-10 months? (hearing, speech and language)

A

Begin to speak at 7-10 months - pol-syllabic babble (sounds at different tones, qualities and volumes)

At 7 months: sounds used indiscrimately
At 10 months: sounds used discriminately to parents

42
Q

How does babble differ between a health child and those with hearing impairments?

A

Babbles of children with hearing impairment = more monotone

43
Q

What can a baby do at 12 months? (hearing, speech and language)

A

2-3 words such as ‘dada’ and ‘mama’

44
Q

What can a baby do at 18 months? (hearing, speech and language)

A

6-10 words

Show parts of body e.g. where is your nose and then points

45
Q

What can a baby do at 20-24 months? (hearing, speech and language)

A

Uses two or more words to make simple phrases

46
Q

What can a baby do at 2.5-3 years? (hearing, speech and language)

A

Talks constantly in 3-4 word sentences

47
Q

How can speech differ between a healthy 3 year old and a child with autism at 3 years old?

A

Disordered speech and language development
No words
Babble

48
Q

What are the social, emotional and behavioural milestones?

A 
•	6-8 weeks = 
Smiles responsively
•	6-8 months = 
Start of self-feeding
Puts food in mouth
•	10-12 months = 
Waves bye-bye
Plays peek a boo
•	12 months = 
Drink from a cup with 2 hands
Often the age at which parents are encouraged to get rid of the bottle to minimise delay in speech and language due to prolonged bottle usage
-	Prolonged bottle usage = dental caries, delayed speech 
•	18 months = 
Hold spoon and gets food safely to mouth, even if food gets splayed on the floor
•	18-24 months = 
Good imaginative play
•	2 years = 
Toilet training
Dry by day
Pulls off some clothing
•	2.5-3 years = 
Parallel play
Interactive play evolving
Takes turns 
Clean and dry

Development patterns
Normal development changes as children get older
- Wide range of normal - particularly as you get older
Abnormal development patterns =
- Slow but steady
- Plateau - stopping of milestones
- Regression - reversible of milestones, early sign of serious illness e.g. neurodevelopmental regeneration

49
Q

What can a baby do at 18 months? (social, emotional and behavioural)

A

Hold spoon and gets food safely to mouth, even if food gets splayed on the floor

50
Q

What can a baby do at 18-24 months? (social, emotional and behavioural)

A

Good imaginative play

51
Q

What can a baby do at 6-8 weeks? (social, emotional and behavioural)

A

Smiles responsively

52
Q

What can a baby do at 6-8 months? (social, emotional and behavioural)

A

Start of self-feeding

Puts food in mouth

53
Q

What can a baby do at 10-12 months? (social, emotional and behavioural)

A

Waves bye-bye

Plays peek a boo

54
Q

What can a baby do at 12 months? (social, emotional and behavioural)

A

Drink from a cup with 2 hands
Often the age at which parents are encouraged to get rid of the bottle to minimise delay in speech and language due to prolonged bottle usage

55
Q

What can prolonged bottle usage cause?

A

Dental caries

Delayed speech

56
Q

What can a baby do at 2 years? (social, emotional and behavioural)

A

Toilet training
Dry by day
Pulls off some clothing

57
Q

What can a baby do at 2.5-3 years? (social, emotional and behavioural)

A

Parallel play
Interactive play evolving
Takes turns
Clean and dry

58
Q

How does normal development change as children get older?

A

Wide range of normal - particularly as you get older

59
Q

What are patterns of abnormal developement?

A

Slow but steady
Plateau - stopping of milestones
Regression - reversible of milestones, early sign of serious illness e.g. neurodevelopmental regeneration

60
Q

What are limit ages?

A

Warning for parents and health professionals of when a child has not reached particular milestones
e.g. head control by latest 4 months or sitting unsupported by latest 9 months or standing independently at 9 months or walking independently at 18 months

61
Q

Give examples of abnormal motor development at 1.5-2 months that may suggest cerebral palsy?

A

Normally baby can push up on arms and lift their head when in the prone position (on their tummy)

BUT in abnormal motor development - 
Unable to lift head or push up on arms
Stiff extended legs
Pushing back with head
Constantly fisted hand and stiff leg on one side
Difficulty moving out of this position?
62
Q

Give examples of abnormal motor development at 3-6 months suggestive of disinhibition of motor neurons to the lower limbs and possible early cerebral palsy?

A

Normally baby sits with support, with a rounded back

BUT in abnormal motor development -
Unable to lift head
Floppy trunk
Stiff arms
Extended legs 
Or stiff crossed legs = excess tone in the lower limbs
Arms flexed and held back
63
Q

Give examples of abnormal motor development 6-9 months that may suggest developmental delay or cerebral palsy?

A

Normally baby sits on their own, and arms are free to reach out and grasp

BUT in abnormal motor development -
Poor head control
Difficulty getting arms forward
Arches back
Pointed toes, stiff legs
Will not take weight on legs
Poor use of arms for play
64
Q

Give examples of abnormal motor development 9-13 months that may suggest developmental delay or cerebral palsy?

A

Normally a baby can pull to stand

BUT in abnormal motor development -
Not interested in weight bearing
Difficulty in pulling to stand
Stiff elgs
Cannot crawl on hands an knees
Uses one side of body to move
65
Q

Give examples of abnormal motor development 12-18 months that may suggest developmental delay or cerebral palsy?

A

Normally a baby can stand and walk independently at this stage

BUT in abnormal motor development - 
Holds arms or both arms stiffly and bent
Excessive tiptoe gait due to excess motor activity that is not inhibited by corticospinal neurons
Sits with weight to one side
Uses predominantly one hand for play
One leg may be stiff
66
Q

For vision and fine motor development, which milestones are a cause for worry?

A

If the baby is not:

  • Fixing and following visually by 3 months
  • Reaching for objects by 6 months
  • Transferring objects by 9 months
  • Pincer gripping by 12 months
67
Q

For speech and language development development, which milestones are a cause for worry?

A

If the baby is not:

  • Saying polysyllabic babble by 7 months
  • Constant babble by 10 months
  • Saying 6 words with meaning by 18 months
  • Joins words by 2 years
  • 3-word sentences by 2.5 years
68
Q

For social, emotional and behavioural development development, which milestones are a cause for worry?

A

If the baby is not:

  • Smiling by 8 weeks
  • Scared / fearing strangers by 10 months
  • Feeding self with a spoon by 18 months
  • Symbolic playing by 2-2.5 years
  • Interactive playing by 3-3.5 years
69
Q

What is the Healthy Child Programme?

A

A planned programmed of review composed of 3 components:

  • Screening
  • General examination and immunisation
  • Health education and promotion
70
Q

When does screening occur?

A

Throughout pregnancy:

  • <12 weeks = Hbopathy, rehsus. infection
  • 12 weeks = USS dating and nuchal (down syndrome)
  • USS detailed - heart defects, kidney defects, brain defects
  • At birth = bloodspot, hearing and physical)
71
Q

When does immunisation occur?

A

Flu jab for the mother

Soon after delivery, at 10-14 days, many vaccinations are given during the child’s first year of life

72
Q

When are there child health reviews?

A 
Birth visit 
10-14 day visit
6-8 week reviews
First year reviews
Two year review
Health review at school
73
Q

When and what health promotion activity is given?

A 
During the early years of the child's life - usually at each health review discussing things like: 
Relationships
Breast feeding
Vaccination
Reading
Weaning
Social and emotional
Injury prevention
Learning
Physical activity
Nutrition
74
Q

What health promotion activity is given during the late years?

A

Healthy weight
Sexual health
Encourage physical activity

75
Q

What are the categories of causes of development impairment?

A

Prenatal
Perinatal
Postnatal

76
Q

What is done when evaluating a child with abnormal development?

A

History

  • parental concern
  • birth history
  • family history

PMHx

  • developmental history
  • current skills

Examination

  • developmental assessment (general and neurological) e.g. dismorphic fet=atures, skin issues,
  • further as required

Investgation
- as appropriate

77
Q

What is the approach to developmental assessment?

A

Ask
Observe
Task

78
Q

What needs to be assessed in a developmental assessment?

A
  • Milestones proceeding age
  • Expected milestones for their age
  • Next important milestones - alert parent of future milestones
79
Q

What factors influence developmental delay?

A

Ill health e.g. ear infections affecting speech
Lack of physical/physiological stimuli
Reduce inherent potential
Sensory/motor impairment

80
Q

What are the types of developmental delay?

A 
Global - delay in all 4 domains
OR
Specific
- Langauge
- Motor
- Sensory
- Cognitive
81
Q

What are some causes of global delay?

A

Chromosomal abnormalities e.g. Down’s Syndrome, Fragile X

Metabolic
e.g. hypothyroidism, inborn errors of metabolism

Antenatal and perinatal factors
e.g. infections, drugs, toxins, anoxia, trauma, folate def

Environmental-social issues

Chronic illness

82
Q

What are causes of motor delay?

A 
Cerebral palsy - e.g. corticospinal injury
Down's Syndrome
Congenital dislocation hip
Social deprivation
Muscular dystrophy
Neural tube e.g. spina bifida
Hydrocephalus
83
Q

What causes language delay?

A

Hearing loss
Learning disability
Autistic spectrum disorder
Lack of stimulation
Impaired comprehension of language - developmental dysphagia
Impaired speech production - stammer, dysarthria

84
Q

What are some commonly used assessment tool?

A 
Standardised tests
Schedule of growing skills
Griffiths developmental scale
Bailey developmental scale
Denver developmental screening tests

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