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Paediatrics (Y4) > 1- Community (Development) > Flashcards

1- Community (Development) Flashcards

1
Q

who assesses a childs development

A

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).

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2
Q

when are children seen by healthcare proffessional to monitor development

A
  • 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.
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3
Q

Developmental milestones are often divided into 4 categories

A
  • Gross motor
  • Vision and fine motor
  • Hearing, speech and language
  • Social, emotional and behavioural
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4
Q

developmental milestones are considered in regards to

A

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.

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5
Q

Developmental milestones are acquired in a

A

serial manner- one after the other- and their achievement follows similar pattern between children

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6
Q

developmental delay background

A

Developmental delay is a broad term referring to a delay in any of the four developmental areas.

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7
Q

Global DD

A

delay in 2 or more of the above areas

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8
Q

risk factors/causes for DD

A
  • 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
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9
Q

presentation for DD

A
  • Child does not hit expected milestone
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10
Q

red flags for DD

A
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11
Q

investigations for DD

A

First line
- bloods
- hearing tests

Second line
- Karyotyping/DNA analysis
- More detailed metabolic screen
- MRI
- EEG

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12
Q

managment of DD

A
  • 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
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13
Q

DD prognosis

A

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.

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14
Q

Global developmental delay
Refers to a child displaying slow development in all developmental domains. This could indicate an underlying diagnosis such as:

A
  • Down’s syndrome
  • Fragile X syndrome
  • Fetal alcohol syndrome
  • Rett syndrome
  • Metabolic disorders
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15
Q

gross motor milestones

A

A delay that is specific to the gross motor domain may indicate underlying:
* Cerebral palsy
* Ataxia
* Myopathy
* Spina bifida
* Visual impairment

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16
Q

social, emotional and behaviour development

A

A delay that is specific to the personal and social domain may indicate underlying:
* Emotional and social neglect
* Parenting issues
* Autism

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17
Q

vision and fine motor milestones

A

A delay that is specific to the fine motor domain may indicate underlying:
* Dyspraxia
* Cerebral palsy
* Muscular dystrophy
* Visual impairment
* Congenital ataxia (rare)

18
Q

Hearing, speech and language development

A

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.

19
Q

red flags by 3 months

A

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

20
Q

red flags by 6 months

A
  • 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
21
Q

red flags by 9 months

A
  • 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
22
Q

red flags by 12 months

A
  • 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
23
Q

red flags by 18 months

A
  • Should be able to walk
  • Poor standing balance, falls frequently
  • Unable to take steps independently by 18 months
  • Walks on toes
  • Does not point
24
Q

red flags summary

A
25
Q

What is the cut-off for an acceptable weight loss in the first 7 days of life?

A
  • 10%
26
Q

At what age should a child be referred to a paediatrician if they have not begun to walk?

A
  • 18 months
  • An infant usually begins to cruise furniture around 10-12 months and can walk alone by 15 months. If walking has not occurred by 18 months the toddler should see a paediatrician
27
Q

At what age should a child develop a mature pincer grip?

A
  • 9-12 months
28
Q

At what age should a child develop a mature pincer grip?

A
  • 9-12 months
29
Q

Which of the following is an example of “Double-syllable babble” displayed by an infant around 9-12 months?

A
  • Ba-ba (usually involves repetition of same syllable)
30
Q

Around what age should a child be able to build a tower of three building blocks?

A
  • The average age for building a 3 block tower is 18 months. This increases to around 6 cubes by 2 years, and 9 cubes by 3 years.
31
Q

In normal fine motor development, which of the following should occur first?
A Drawing a square
B Copying a circle
C Tripod pencil grip
D Copying a cross
E Copying a triangle

A

copying a circle

Children tend to be able to copy a shape 6 months before they can draw it. The usual developmental order of drawing shapes is line, circle, cross, square, triangle. Tripod pencil grip is a more mature grip, occurring between 4 and 6 years of age.

32
Q

which scoring used for puberty

A

Tanner

33
Q

tanner staging

A

Tanner staging for pubic hair (both sexes)
Pre-pubertal: no pubic hair
Some downy hair at the base of the penis in males or over the labia majora in females
Coarser, thicker and curlier hair that spreads laterally to cover more of the pubis
Adult hair, not spreading to the thighs
Adult hair, spread to the medial thighs

Tanner staging for females
Breast changes:
* Prepubertal
* Breast bud
* Juvenile with smooth contour
* Areola and papilla project above breast
* Adult contour

Tanner staging for males
Male genital changes:
* Prepubertal, testicular volume <1.5ml
* Penis grows in length only, testicular volume 1.5-6ml
* Penis grows further in length and circumference, testicular volume 6-12ml
* Development of glans penis, darkening of scrotal skin, testicular volume 12-20ml
* Adult genitalia, testicular volume >20ml

34
Q

An 8 year old boy is brought into the paediatric development clinic by his worried mother after being referred by his GP over concerns regarding premature onset of puberty. On examination today the paediatric registrar notes the following: the glans of the penis has developed and there is notable darkening of the scrotal skin, the pubic hair is dark, coarse and curly and distributed in a dense patch solely at the pubic symphysis.

What would be the most appropriate Tanner staging for the boy based on these findings?

G4, PH3

G1, PH2

G4, PH5

G1, PH5

B1, PH3

A

G4, PH3

Correct. G4 indicates Genitals 4 and is listed as development of glans penis, darkening of scrotal skin. PH3 indicates Pubic Hair 3 and is when the hair becomes more dark, coarser, and curlier

35
Q

What is the first sign of puberty in boys and girls?

A

Enlargement of the testes >4ml in boys and development of the breasts in girls

Testicle enlargement occurs from age 9 years in boys and breast development begins at age 8.5 years in girls

36
Q

what is puberty

A
  • A stage of human development when sexual maturation and growth are completed and results in ability to reproduce- morphological physiological and behaviour development
37
Q

Puberty timings

A

o Age variable
o Order consistent
o Therefore not a function of age

38
Q

who starts puberty first

A
  • Girls begin and end puberty before boys
39
Q

Some key terms related to puberty

A
  • Thelarche- onset of breast development occurring near beginning of puberty in girls
  • Adrenarche- maturation and increased activity of the adrenal glands prior to puberty
  • Gondarache- activation of reproductive glands by pituitary hormone FSH and LH
  • Menarche- onset of menstruation at puberty
40
Q

timing of puberty

A
  • There are many environmental factors that influence onset of puberty
  • Pineal gland is thought to be an important influence on puberty, as disorders of this gland can cause early onset (precocious) puberty
  • Body weight is a key factor in the onset of puberty in girls, as well as nutrition and leptin (released from adipose tissue)
    Age of menarche has declined (from 16.6 to 12.5) over the year
  • Low body weight can cause cessation of menstruation, even after puberty has occurred
  • Onset age differs around globe
  • Economic factors/ disparity may effect onset of puberty

Regardless of age of onset- sequence of events is consistent

41
Q

female puberty

A

9-13
- Starts with
Breast bud (thelarche) and pubic hear
- Leads to (adrenarche)
Growth spurt and onset of menstrual
- Menstruate cycles begins (menarche)
Pubic hair adult
Breast adult

42
Q

male puberty

A

10-14 years
- Starts with
Genital development
- Progresses to
Pubic hair growth
Spermatogenesis
- Completed by
Growth spurt
Genitalia adult
Pubic hair adult

Paediatrics (Y4) (42 decks)

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