6: Approach to the child with developmental delay Flashcards
(38 cards)
What is the definition of developmental delay?
Failure to achieve developmental milestones for child’s chronological age
What are the two subtypes of developmental delay?
Global
Specific
Apart from developmental delay, what are two other types of developmental disorder?
Deviation or total lack of skills
Regression of skills
How is developmental delay discovered in children?
By health visitors / GP during screening
OR
By parents
By nursery staff
What is an example of a developmental
a) delay
b) deviation
c) regression?
a) Learning disabilities (global or specific e.g dyslexia and dysgraphia)
Down syndrome
b) Autism spectrum disorders
c) Rett’s syndrome (caused progressive regression of eye movement among other things)
What are some developmental red flags?
Asymmetry of movement (i.e hand dominance in the very young)
Not reaching for objects by 6 months
Unable to sit unsupported by 12 months
Unable to walk by 18 months
No speech by 18 months
Vision or hearing problems
LOSS of skills
Failure to achieve developmental milestones is a red flag for developmental disorders. By which age should infants be able to:
a) walk
b) reach for objects
c) sit up properly
d) talk?
a) Walking - 18 months (median is 12)
b) Reaching for objects - 6 months
c) Sit up properly - 6 months (median is 3)
d) Talk - 24 months (median is 18)
Why is asymmetrical movement at a young age an example of a developmental red flag?
Children shouldn’t have dominant hands / sides until later on in development
What should be checked in children who cannot walk by 18 months?
Why?
CK
Screen for muscle-wasting diseases like Duchenne muscular dystrophy
What is global developmental delay?
Delay in two or more of
Gross / fine motor skills
Speech and language
Cognition
Social personal skills
ADL
What is global developmental delay called in children of school age?
Learning disability
Do children with global developmental delay eventually catch up with others?
No, so “delay” is a misnomer
As age increases the gap between affected and unaffected widens
Global developmental delay commonly has a ___ cause.
genetic
What are two genetic diseases which cause global developmental delay?
Down syndrome
Fragile X syndrome
Which genetic defect causes Down syndrome?
Trisomy 21
Apart from a global developmental delay, what is the physical presentation of Down syndrome?
Short stature
Slanted eyes
Excess skin at back of neck
Flat nose
Small mouth and protruding tongue
What are important systemic complications of Down syndrome?
C1/C2 instability
Congenital heart disease (AVSD, VSD, valve disease, Tetralogy of Fallot)
Hypothyroidism
Which genetic disease, characterised by a long face, causes global developmental delay?
Fragile X syndrome
What are some specific motor delays?
Duchenne muscular dystrophy
Cerebral palsy
Coordination disorders e.g dyspraxia
What is the Gower maneouvre?
What causes it?
What specific motor developmental delay is it associated with?
When child stands up, they need to walk their legs together from a crawling position
Pelvic instability
Duchenne muscular dystrophy
What is the mode of inheritance of Duchenne muscular dystrophy?
X-linked recessive
so most commonly affects boys
Apart from the Gower manoeuvre, what is another MSK sign of DMD?
Increased lumbar lordosis
again due to pelvic instability
What is a neurological cause of specific motor developmental delay?
What specific type of the disease causes stiffness and spasticity in the lower limbs?
Cerebral palsy
Spastic diplagia
What type of gait is associated with spastic diplagia?
Intoeing gait
