1- Community (Development) Flashcards
who assesses a childs development
health visitor
If the health visitor has any concerns, they will highlight these to the GP for further assessment. Some children will need additional monitoring (e.g. if they were pre-term and/or have known medical problems).
when are children seen by healthcare proffessional to monitor development
- Children will normally be seen by their GP/midwife as a newborn and
- by their health visitor at 6 – 8 weeks, 9 – 12 months and 2 – 2.5 years.
Developmental milestones are often divided into 4 categories
- Gross motor
- Vision and fine motor
- Hearing, speech and language
- Social, emotional and behavioural
developmental milestones are considered in regards to
their ‘median age of acquisition’ and ‘limit age’ by which they should have been achieved. If the skill is not attained by this age then more detailed assessment, investigation or intervention may be required.
Developmental milestones are acquired in a
serial manner- one after the other- and their achievement follows similar pattern between children
developmental delay background
Developmental delay is a broad term referring to a delay in any of the four developmental areas.
Global DD
delay in 2 or more of the above areas
risk factors/causes for DD
- Neurological e.g. spina bifida, HIE, intraventricular hameorrhage
- Infection e.g. TORCH, meningitis
- Neuromusuclar disorders e.g. duchenne musuclar dystrophy
- Genetic disorders e.g. down syndrome
- Austism
- Metabolic e.g. Hurle syndrome, Krabbe disease, Phenylketonuria
presentation for DD
- Child does not hit expected milestone
red flags for DD
investigations for DD
First line
- bloods
- hearing tests
Second line
- Karyotyping/DNA analysis
- More detailed metabolic screen
- MRI
- EEG
managment of DD
- Referral to community paediatrician
- MDT approach
o SALT
o OT
o Portage practitioner and orthoptists
o paediatrician - Detailed developmental assessment e.g. Griddiths scales of child development
- Holistic assessment of child and family
DD prognosis
Prognosis
Only a few causes of developmental delay are reversible, most will result in chronic morbidity with the child requiring specialist support for many years.
Global developmental delay
Refers to a child displaying slow development in all developmental domains. This could indicate an underlying diagnosis such as:
- Down’s syndrome
- Fragile X syndrome
- Fetal alcohol syndrome
- Rett syndrome
- Metabolic disorders
gross motor milestones
A delay that is specific to the gross motor domain may indicate underlying:
* Cerebral palsy
* Ataxia
* Myopathy
* Spina bifida
* Visual impairment
social, emotional and behaviour development
A delay that is specific to the personal and social domain may indicate underlying:
* Emotional and social neglect
* Parenting issues
* Autism
vision and fine motor milestones
A delay that is specific to the fine motor domain may indicate underlying:
* Dyspraxia
* Cerebral palsy
* Muscular dystrophy
* Visual impairment
* Congenital ataxia (rare)
Hearing, speech and language development
A delay that is specific to the speech and language domain may indicate underlying:
* Specific social circumstances, for example exposure to multiple languages or siblings that do all the talking
* Hearing impairment
* Learning disability
* Neglect
* Autism
* Cerebral palsy
Management
- Referral to speech and language, audiology and the health visitor.
- Referral to safeguarding is required if neglect is a concern.
red flags by 3 months
learning head control
- Difficulty lifting or holding head
- Stiff legs with little or no movement
- Keeps hands fisted and lacks arm movement
- Not kicking legs or moving arms when lying down
- Doesn’t follow moving objects with head and eyes
- Asymmetric hand movement
red flags by 6 months
- Rounded back
- Dpes not roll from tummy onto back or back to tummy
- Unable to life head
- Sems very stiff pr floppy
- Arches back and stiffens legs
- Difficult to bring arms forward to reach out
red flags by 9 months
- Unable to sit without support
- Cannot take weight on legs when supported
- Uses one hand more than the other
- Rounded back
- Uses only one side of the body to move
- Inability to straighten back
- Unable t make sounds
- Doesn’t look where you are pointing
red flags by 12 months
- Does not crawl
- Needs to use hands to maintain position
- Loses skills wants had
- Does not point to object
- Sits not able and when supported
- Sits with eight on one side
- Stiffly bent or stretch arms
- Is not able to copy and learn gestures such as waving
red flags by 18 months
- Should be able to walk
- Poor standing balance, falls frequently
- Unable to take steps independently by 18 months
- Walks on toes
- Does not point
red flags summary
