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Medicine year 2 semester 1 > Case 16- Development and Vaccination > Flashcards

Case 16- Development and Vaccination Flashcards

1
Q

The domains of child development

A
  • Gross motor
  • Fine motor and visions- how we use our hands to manipulate stuff
  • Speech, language and hearing
  • Social and emotional- how we relate to ourselves and others
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2
Q

How development should progress

A

Development should always follow the same pattern. The rate at which each development milestone is achieved can be different between children

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3
Q

Define development milestones

A

• The median age a skill is achieved
OR
• The upper limit of normal (98% of children will have developed this milestone by this time)

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4
Q

The primitive reflexes

A
  • Moro
  • Sucking
  • Asymmetric tonic neck
  • Stepping
  • Routing
  • Palmar-grasp
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5
Q

Factors influencing child development

A
  • Health- have they spent a lot of time in hospital or bed
  • Parenting- neglect
  • Deprivation- emotional or physical deprivation
  • Attachment- someone who the child feels secure with
  • Opportunity to practise a skill- for speech and language development especially
  • Neglect
  • Prematurity- may develop at a slower rate or it may be delayed, we correct for prematurity up to two years to gestational age
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6
Q

What do you need to losse in order to develop properly

A

You need to lose your primitive reflexes before you move on to the next stage of development. You develop from head to toe i.e. you first develop neck, also from in to out

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7
Q

Stages of gross motor development up to a year

A
  • 6 weeks - head control developing, primitive reflexes present
  • 3 months - lifts head and shoulders onto forearms when on tummy, no head lag
  • 6 months - rolls over, holds head when sitting, sits with support
  • 9 months- sits well unsupported and pulls up to stand
  • 12 months - gets up to sitting position on own, pulls to stand at furniture, cruising (walking between furniture), crawling. Not all children crawl, some just shuffle their bottom along
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8
Q

Stages of gross motor development after a year

A
  • 18 months - walks alone, crawls up stairs. Pushes or pulls toys while walking
  • 2 years - walks backwards, kicks a ball, walks up stairs 2 feet per step
  • 3 years - stands on one foot briefly, stairs, tricycle, jumps
  • 4 years - down stairs alternate feet, walks in a straight line. Stands on one foot for more then 3 seconds. Very active, can climb on play structures. Jump
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9
Q

Stages of fine motor and vision development (up to a year)

A
  • Birth - primitive reflexes
  • 6 weeks - momentarily holds objects, rolls (till 2 months), fixes and follows (can follow a bright object with their eyes)
  • 3 months - palmer grasp, hold and shakes rattle
  • 6 months - reaches for toys, hand-hand transfer, opens mouth for spoon, finger feeds
  • 12 months – between 9-12 months you develop the pincer grasp, picks up and eats finger food, holds cup with 2 hands
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10
Q

Stages of fine motor and vision development- after a year

A
  • 18 months - helps with dressing, stacks 2 blocks, scribbles, turns pages in book
  • 2 years - takes off shoes, stacks 5 blocks, eats with spoon, draws line
  • 3 years - dress/undress with help, copies a circle
  • 4 years - correctly holds crayon, buttons, scissors, dresses
  • 5 years - draws shapes and stick people, knife and fork
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11
Q

How might a child communicate if they cant hear

A

Through gesturing i.e. pointing. If children arent trying to communicate that is a red flag

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12
Q

Receptive and Expressive language

A

1) Expressive language- what we can say
2) Receptive language- what we can understand i.e. can you get your shoes
Children are more likely to have issues with expressive language then receptive language

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13
Q

Stages of speech, language and hearing development

A
  • 6 weeks – smiles (4 weeks), cooing, startles to loud noise
  • 6 months - babbling
  • 12 months - 1-2 words, pointing
  • 2 years - joins 2 words
  • 3 years - 3-4 word sentences
  • 4 years - tells stories in past tense, counts 1-20
  • 5 years - knows colours / age/ address, strangers can understand what they are saying
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14
Q

Stages of social and emotional development

A
  • 12 months - stranger anxiety
  • 18 months - symbolic play- copies actions they see around them like feeding dolly
  • 2 years - tantrums
  • 3 years - toilet trained, sharing
  • 4 years - parallel play (play with other kids)
  • 5 years - takes turns, plays games with rules
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15
Q

How you start learning to talk

A

Vowels start first from the back of the mouth i.e. ohh. Babble then Raspberries. Noises that sound like pretend conversations. Harder sounds p, m, t. Single words with meaning, putting words together.

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16
Q

Children and emotions

A

Children have different temperaments. However, they should be interested in interacting with some of the people around them. How do they respond to other peoples emotions i.e. concerns if someone is hurt. Can they regulate their own emotions i.e. shouldn’t be having tantrums at 5.

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17
Q

Red flags for child development

A

Loss of skill at any age

Parental concern

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18
Q

Red flags for child development= 0-8 moths

A

Gross motor= Primitive reflexes (6m), Head lag
Fine motor= Not fixing, Hand preference (6m)
Social= No smile (8w), little interest in people

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19
Q

Red flags for child development= 8-18 months

A

Gross motor= No sit (9m), walk (18m)
Fine motor= No pincer grasp (12m)
Speech language= Absence of babbling (12m)/speech

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20
Q

Red flags for child development= 8-18 months

A

Gross motor= No sit (9m), walk (18m)
Fine motor= No pincer grasp (12m)
Speech language= Absence of babbling (12m)/speech

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21
Q

Red flags for child development= 18-24 months

A

Absence of speech

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22
Q

Red flags for child development 2-3 years

A

Gross motor= unstable walking
Fine motor= Avoids crafts
Speech language= No 2-3 word sentences
Social= No pretend play

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23
Q

What is a vaccine

A

A biological preparation that improves immunity to a particular disease

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24
Q

What does a vaccine contain?

A

• An agent that resembles a disease causing microorganism
• Is made from attenuated or killed forms of the microbe
• The toxins or surface proteins of the microbe
It stimulates the immune system to recognise the agent as foreign and provides immune memory

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25
Q

Properties of the ideal vaccine

A

1) Broadly protective against all variants of the organism
2) Prevents disease transmission
3) Induce effective immunity rapidly
4) Be effective in all vaccinated subjects
5) Transmits maternal protection to fetus
6) Cheap and stable
7) Limited side effects
8) Requires few immunisations to induce protection

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26
Q

Immunological prinicpals behind vaccinations

A

Induces effector mechanisms in the immune system that control or destroy pathogens and related toxic componenets

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27
Q

The main mechanisms of vaccination are activated by

A
  • B cells- antibody production
  • CD4+ T-cells- cytokine production causes maintenance of B-cell and CD8+ cell response
  • CD8+ lymphocytes- limits infection spread by killing infected cell or releasing antiviral cytokines
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28
Q

B cell response to vaccines- antibody production

A
  • Dendritic cells recognise foreign antigens
  • Becomes activated
  • Migrates to lymph node
  • Activates B cells in lymph node follicules
  • Plasma B cells produce and secrete antibodies
  • Typically IgM
  • IgG is also produced from long lived plasma B cells which require T helper cells, long lived plasma cells are generated in the germinal centre of the lymph node
  • Central B memory cells also develop
  • These generate long lasting immunity
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29
Q

What can antibodies do to prevent infection?

A
  • Bind to the active sites of toxins or stop diffusion
  • Neutralising viral replication
  • Opsonisation
  • Complement activation
30
Q

T cell response to vaccines

A
  • Dendritic cell recognises foreign antigens
  • Migrates to lymph nodes
  • Activates T cells
  • T cells differentiate into CD4+ cells
  • These produce cytokines and maintain B cells
  • Also, differentiates in to CD8+ T cells
  • These kill infected cells - therefore only works in live vaccines
  • Also some T memory cells which provide long lasting immunity
31
Q

Types of vaccines available

A
  • Inactivated- toxoids i.e. bacterial toxins, viral like particles, killed bacteria or viruses, peptides or polysaccharide units, viral like particles (VLP), RNA vaccines.
  • Live- attenuated, virulent
32
Q

Adjuvants

A

Chemical additives added to vaccines in combination with the antigen to improve effectiveness and produce a more robust immune response

33
Q

When are adjuvants used

A
  • Typically used in inactivated vaccines
  • And weak immunogenicity vaccines
  • Enhances the speed and duration of the immune response
  • Decreasing the dose of antigen required
  • Enhances the immune response in immunologically immature patients
34
Q

Polysaccharide derived vaccines

A

Derived from the bacterial polysaccharide in the cell envelope. Poorly immunogenicity. Not all that effective especially in infants and young children (18-24 months). Some do work. PS vaccines rarely induce a T-cell response. Solution = produce a conjugate vaccine, combining it to a strong immunogenic protein.

35
Q

Properties of a live vaccine

A 
Route- Natural/injection
Doses- few
Adjuvant- no
Protection- long term
T-cell response- good
Side effects- mild symptoms
36
Q

Properties of inactivated vaccine

A 
Route- injection
Doses- many
Adjuvant- yes
Protection- short term
T-cell response- weak
Side effects- site of injection pain
37
Q

Rationale of vaccination programmes

A

Saves millions in healthcare costs, provides herd immunity. However, vaccine development is time consuming and costly and not always successful.

38
Q

How do we choose what to vaccinate against?

A
  • Chose agents which cause significant illness
  • Agents whose infection can be blocked by antibodies
  • Agents which dont have oncogenic protection
  • Agents which exist as only one serotype
  • Vaccine is heat stable
39
Q

Common side effects of any vaccine include

A
  • Injection site reactions (pain, swelling and redness)
  • Mild fever
  • Shivering
  • Fatigue
  • Headache
  • Muscle and joint pain
  • Rare- anaphylaxis
40
Q

Vaccines at 8 weeks

A

6 in 1 vaccine

1) Diptheria
2) Tetanus
3) Whooping cough (pertussis)
4) Polio
5) Haemophilus influenzae type B
6) Hepatitis B

7) Pnemococcal (PCV) vaccine
8) Rotavius vaccine
9) MenB vaccine

41
Q

12 week vaccine

A

6 in 1

Rotavirus

42
Q

16 weeks vaccines

A

6 in 1
Pneumococcal (PCV)
MenB

43
Q

1 year vaccines

A 
Hib 
MenC
MMR
Pneumococcal (PCV)
MenB
44
Q

3 year and 4 months vaccines

A 
MMR
4-in 1 pre-scholl booster
Diptheria
Tetanus
Whooping cough
Polio
45
Q

12-13 year vaccine

A

HPV vaccine

46
Q

14 year vaccine

A 
3-in 1 teenage booster
Diptheria
Tetanus
Polio
MenACWY
47
Q

Vaccine 65+

A

Flu vaccine- every year

48
Q

70 years vaccine

A

Shingles

49
Q

Development

A

The process by which a child evolves from helpless infancy to independent adult

50
Q

Developmental delay

A

The slow aquisition of a skill, in children 0-5 years. Can be:
Global- significant delay in more then 2 domains, usually presents in the first two years of life
Specific- significant delay in 1 domain

51
Q

What happens to the developmental delay over time

A

The gap between normal and abnormal development becomes greater with increasing age

52
Q

Biological factors for gross motor skill delay

A

1) Duschenne muscular dystrophy
2) Cerebral palsy
3) Dyspraxia
4) Spinal cord lesions i.e. spina bifida

53
Q

Biological causes for speech, language and hearing delays

A

1) Deafness
2) Cerebral palsy
3) Autism spectrum disorders
4) Cleft palate
5) Isolated speech and language delay

54
Q

Biological causes- Fine, motor skills and vision

A

1) Squint
2) Refractive errors i.e. astigmatism, short/long sighted
3) Severe visual impairment i.e. congenita cataracts
4) Cerebral palsy

55
Q

Biological causes of social, emotional and behaviour delays

A

Autism spectrum disorders

56
Q

Prenatal causes of a developmental delay

A

1) Genetic disorders: e.g. Down’s syndrome, Fragile X syndrome, Duchenne muscular dystrophy
2) Neurological: Microcephaly, stroke
3) Metabolic: Hypothyroidism, phenylketonuria
4) Teratogenic: Foetal alcohol syndrome, teratogenic drugs, radiation
5) Congenital infection: toxoplasmosis, rubella, cytomegalovirus, HIV

57
Q

Perinatal causes of developmental delay

A

1) Extreme prematurity: intraventricular haemorrhage
2) Birth asphyxia: hypoxic-ischaemic encephalopathy and cerebral palsy
3) Metabolic: kernicterus, symptomatic hypoglycaemia

58
Q

Postnatal causes of developmental delay

A

1) Infection: meningitis, encephalitis
2) Trauma: Head injury – accidental or non-accidental injury (NAI)
3) Metabolic: hypoglycaemia
4) Vascular: stroke
5) Sociological: Abuse and emotional neglect

59
Q

Red flags for developmental delay

A

1) Extremes of occipito-frontal circumference percentile or rapid change in percentile
2) Developmental regression
3) Squint
4) Parental concern

60
Q

The multi-disciplinary tea for a child with a developmental delay

A

1) Physiotherapist
2) Speech and language therapist
3) Paediatrician
4) Educational psychologist
5) Clinical psychologist
6) Social worker
7) Dietician
8) Specialist health visitor
9) Occupational therapist

61
Q

Factors which can cause a delay in normal speech and language development

A

1) Hearing loss
2) Global developmental delay
3) Difficulty in speech production due to anatomical deficit
Interaction with other types of delay i.e. cleft palate
4) Environmental deprivation or lack of opportunity for social interaction
5) Normal variants and family patterns e.g. family history of speech delays

62
Q

Factors which cause a disorder in speech and language development

A

1) Language comprehension and expression disorders
2) Intelligibility e.g. stammering, dysarthria
3) Social communication skills e.g. Autistic Spectrum Disorder

63
Q

Language expression disorder

A

Inability or difficulty in producing specch whilst knowing what is needed to be said

64
Q

Dysarthria

A

Difficult or unclear articulation of speech that is otherwise linguistically normal

65
Q

What is the initial step if the child has abnormal speech and language development

A

A hearing test and assessment by speech and language therapists are the initial steps

66
Q

Define learning difficulty and disorder

A

Learning difficulty- used in relation to children of school age, may be cognitive/physical/both
Disorder- maldevelopment of a skill

67
Q

Define Impairement, Disability and Disadvantage

A

Impairement- loss or abnormality in physiological function or anatomical structure
Disability- any restriction or lack of ability due to impairment
Disadvantage- this results from the disability and limits or prevents fulfilment of a normal role

68
Q

Cerebral palsy

A

Abnormality of movement and posture causing activity limitation due to non progressive disturbance that occurred in the developing fetal/infant brain

69
Q

Causes of cerebral palsy

A 
Antenatal (80%)- structural maldevelopment, vascular occlusion, genetic syndromes
During delivery (10%)- Hypoxic-iscaemic injury
Postnatal (10%)- Meningitis, encephalitis, head trauma, hypoglycaemia
70
Q

Early clinical features of cerebral palsy

A

1) Abnormal limb and or/trunk posture and tone with delayed motor milestones
2) Feeding difficulties (oromotor incoordination) – slow feeding, gagging, vomiting
3) Abnormal gait
4) Asymmetric hand function i.e. hand dominance before 12 months of age

Medicine year 2 semester 1 (53 decks)

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