Community Paediatrics Flashcards
Name 4 domains of development
1) Gross Motor-
2) Fine motor + Vision -
3) Speech + Hearing-
4) Social + Emotional-
New Born 1) 2) 3) 4)
1) Gross Motor-Flexed and toned but no other
2) Fine motor + Vision - minimal
3) Speech + Hearing- New born hearing screening
4) Social + Emotional- just cry
6 Weeks
1) Gross Motor-Hold head up
2) Fine motor + Vision - Fix and Follow
3) Speech + Hearing- N/A
4) Social + Emotional- Smiling (Biggest red flag for vision! And Bell’s palsy)
3 Months
1) Gross Motor-Tummy time, push up with arms, Sleep on back to decrease risk of SIDS (Sudden Infant Death Syndrome)
2) Fine motor + Vision - Palmer grip of objects
3) Speech + Hearing- Babbling! Understand ‘No’
4) Social + Emotional- Playing interest
9 Months
What else is happening around this time?
- weening off milk diet to solids
1) Gross Motor- Crawling, jump with aid
2) Fine motor + Vision - Pincer grip (immature or mature)
3) Speech + Hearing- Mama (without intent), know their own name
4) Social + Emotional- Stranger awareness, everything in mouth, teething!
12 Months
1) Gross Motor-Walk with aid, Red flag if not walking by 18 months!
2) Fine motor + Vision - Copying, Red flag: as only get hand dominance after 1yo so before would be a red flag
3) Speech + Hearing-
4) Social + Emotional- Independence with eating
18 Months
1) Gross Motor- Defo walk! Red flag if not, some running, crawl upstairs
2) Fine motor + Vision - Building blocks
3) Speech + Hearing- Know body parts, handful of words
4) Social + Emotional- Dancing
2 y/o
1) Gross Motor-Run, kick, throw ball, jump
2) Fine motor + Vision - Turn book page (multiple pages at first but then progress)
3) Speech + Hearing- 50 single ward, start to make phrases
4) Social + Emotional- Behaviour challenges ( Terrible 2s by trying to assert independence)
3 y/o (Nursery)
1) Gross Motor- Hopping, tricycle
2) Fine motor + Vision - scissors, building
3) Speech + Hearing- Talk to friends, understands negatives “not cat”
4) Social + Emotional- imaginative play, draw a square
4/5 y/o (School)
When do you finish with the Red Book?
1) Gross Motor- Going upstairs in adult fashion
2) Fine motor + Vision - catch ball
3) Speech + Hearing- tell stories
4) Social + Emotional- toilet trained, undress + dress, write their own name, draw person
Red Book finish at 1 y/o
SCBU Screening Tests 9!
When should the first stool be passed and what’s it called?
1) Hearing check via brain activity
2) Head circumference, ant. Fontanelle soft
3) Eyes: check red light reflex (cataracts or retinoblastoma)
4) Cleft palate
5) Chest wall deformities + breathing issues
6) Listen to heart for murmurs
7) Hips for dysplasia (hip dislocated Test=…
8) Back dimples or spina bifida, hair birth mark, puts at base of back…
9) Intact anus
Meconium should be passed within day 3-5.
Red Flags to look out for:
- At 10 weeks
- At 9 months
- At 19 months
- At 2.5 years old
Other reasons for lack of communication: 4
At 10 weeks not smiling:
Blind, Bells Palsy, Severe post natal depression and neglect
9 Months Left hand Preference:
Shoulder distocia, brachial plexus injury, spasticity (cerebral palsy so check birth notes, was it a difficult birth? Hypoxic?), fracture (NAI therefore safeguarding)
19 Months not walking:
DMD so shuffling on bum, Trendelenburg Gait, Gower’s Sign - getting up with hands as weak adductors, look for increase creatinine kinase
2.5 years not putting words together:
Autism spectrum disorder , look at other communications.
Other reasons for lack of communication:
- Tongue tied
- Cleft palate
- expressive or repressive Language problem
- Global development problem eg learning difficulties
Causes for Global Development delays:
3 and examples!
- Genetic: Down’s syndrome, Fragile X, Trisomy 23
- Injury: pre, peri or post natal
- CNS malformation: Neural tube defect, hydrocephalus, structural abnormality
Clinical Assessment of development
History:
Include birth, family Hx, current developmental skills, social context, parents ICE, any regression (Autism spec at 14 months)
Examination:
General - dysmorphic, head size, growth, signs of neglect
Neurological- Tone, power, asymmetry, reflexes
Investigations:
Check genetic disorders and chromosomal abnormalities
Management
MDT approach
Immunisations:
2 months- 3, which includes?
3 months- 3
4 months- 2
1 y/o- 4
2-7 y/o - 1 which includes?
3 y/o and 4 months- 1
12-13 y/o- 1
14y/o- 1
2 months
- 6 in 1: Diphtheria, tetanus, Pertussis, Polio, Flu type B and Hep B
- Rotavirus
- Meningitis B (Meningococcal type B)
3 months
- 6 in 1
- PCV (pneumococcal conjugate vaccine)
- Rotavirus
4 months
- 6 in 1
- Meningitis B (Meningococcal type B)
1 y/o
- Men B
- Haemophilus Influenza and Men C
- MMR
- Intranasal Flu spray
2-7 y/o
- 4 in 1 (Diphtheria, Tetanus, Polio, Pertussis)
3 y/o and 4 months
- HPV
12-13 y/o
- 3 in 1 (Diphtheria, Polio, Tetanus)
14y/o
- Men C
