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Year 4- Paediatrics > Development > Flashcards

Development Flashcards

1
Q

What are the 4 fields of development to consider?

A
  1. GROSS MOTOR
    2) VISION AND FINE MOTOR
    3) HEARING,SPEECH, LANGUAGE
    4) SOCIAL, EMOTIONAL, BEHAVIOURAL
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2
Q

During development, primitive reflexes as postural reflexes which are essential start to emerge. What are the primitive reflexes?

A 
Moro 
Grasp 
Suckling 
Rooting 
Stepping 
Asymmetrical tonic neck reflex
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3
Q

During development, what are the postural reflexes the child develops?

A

Parachute, labyrinthine, lateral propping, postural support.

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4
Q

What is meant by labyrinthine righting?

A

This is when the head moves in the opposite direction to which the body is tilted.

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5
Q

What is meant by postural support?

A

When held upright, the child’s legs take the weight and the baby may bounce/push up

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6
Q

What is lateral propping?

A

This is when the child is sat and puts an arm out to the direction it is falling, a saving mechanism.

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7
Q

What is parachute reflex?

A

This is when the baby is face down and the arms extend as though to save themselves.

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8
Q

What is the sequence for gross motor development?

A

Newborn= symmetrical limbs flexed
Marked head lag on pulling up

6-8 weeks: the head is raised to 45 degrees in prone

6-8 months: sits w/o support

8-9 months: crawling

10 months: stands independently, cruises around furniture

12 months: walks unsteadily and broad gait w/hands apart

15 months: walks steadily

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9
Q

What are the characteristics of ADHD?

A

Impulsivity
Hyperactivity
Inability to concentrate

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10
Q

What is the management of ADHD?

A

. A ten week watch and wait period should follow to observe whether symptoms change or resolve
If they persist then referall to secondary care is requires- paediatrician with special interest in behavioural disorders or CAMHS

. Drug therapy is last resort and only give to those over 5
Methylphenidate is first line

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11
Q

Methylphenidate has a potentially serious effect on the body, therefore what should you do?

A

Potentially cardio to IV and therefore you should perform a baseline ECG before starting treatment and refer to a cardiologist if there is any significant PMH/FH/doubt/ambiguity

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12
Q

What are the side effects of methylphenidate?

A

Abdominal pain
Nausea and dyspepsia
Weight and height should be monitored every 6 months.

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13
Q

How is growth measured in the UK?

A

Height
Weight
Head Circumference

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14
Q

Children’s centile lines should be tracked from birth, how many centile lines crossed raise concerns?

A

If more than 2 centile lines are crossed the concerns should be raised and child investigated.

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15
Q

What are the important numbers to know for normal growth in children?

A

Weight- it’s acceptable for babies to lose 10% of their birth weight in the first 10 days of life
Babies should have doubled their weight in 4 months and tripled in a year
Length- babies length is typically doubled at 4 years of age
Head circumference- 35cm and increases roughly 1cm a month for the first year

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16
Q

What is the average age for puberty in girls/ boys?

A

Girls- 11 years

Boys- 18 months later

17
Q

What is the order of development in girls?

A

Thelarche (breast development)
Adrenarche (pubic hair)
Menarche (menstruation)

18
Q

What is used to assess puberty in males?

A

Tanner staging

19
Q

What is precocious puberty?

A

If secondary sexual characteristics (features of puberty) develop at <8 years in girls and <9 years in boys

20
Q

What May cause precocious puberty?

A

Central causes- constitutional/ familial early puberty, intracranial, idiopathic (GNRH dependent)
Peripheral- endocrine, hormone secreting adrenal tumours, mcCune-Albright syndrome (GnRH independent)

21
Q

How would you investigate precocious puberty?

A

Imaging- brain MRI to rule out central tumour
USS ovaries/testes to assess size and presence of gonadal tumours
Endocrine- serum gonadotropin and sex steroid (oestrogen, testosterone) levels.

22
Q

What are the key gross motor skills in terms of development?

A 
Develops head control- 6 weeks 
No head lag when pulled to sit (4-6months) 
Sits +/- support at 6 months 
Can sit alone +/- crawling at 9 months 
Pulls to stand at 10 months 
Cruises +/- walking at 12 months 
Walks confidently at 18 months 
Kicks ball and runs at 2 years
23
Q

What are the red flags for gross motor skills? (upper limit for gross motor skills)

A 
No head control at 6 months 
Cannot sit unsupported at 12 months 
No weight bearing at 12 months 
Not walking (18 months) 
Not running (2.5 years)
24
Q

What are the fine motor and visual skills time frames?

A 
3 months- holds objects in palm 
6 months- transfers objects from hand to hand 
9 months- immature pincer grip 
12 months- mature pincer grip 
18 months- stacks 2-4 bricks and also has hand dominance 
2 years- straight line 
3 years- draw circle 
4 years- draws a cross 
5 years- draws a triangle
25
Q

What are the red flags for fine motor and visual skills?

A

If the child is not holding an object in hand by 5 months.

26
Q

What are the speech and language skills in terms of development?

A 
3 months- turn to sound 
3-6 months vocalisations 
9 months- double syllable babble (baba or mama) 
12 months- 2 to 3 words with meaning 
18 months- 10 words with meaning 
2 years- links 2 words together 
3 years- short, full sentences
27
Q

What are the red flags for speech and language?

A 
No response to stimuli at 3 months 
No babble at 9 months 
No words at 18 months 
Cannot join 2 words at 2 years 
Cannot speak in full sentences at 3 years
28
Q

At what stages are certain social skills developed?

A 
6 weeks% first smile 
3 months- laugh out loud 
9 months- wave goodbye 
12 months- stranger anxiety 
18 months- spoon feeds self and imitative play (everyday activities) 
3 years- dress self and toilet trained
29
Q

What are the red flags for development in terms of social skills?

A

If they are not doing gestures at 12 months and there is no symbolic play by 18 month.

30
Q

What are the causes of global developmental delay?

A

Global delay can be due to antenatal, perinatal and postnatal causes.l,

Antenatal:
- Genetic: Down syndrome, neurofibromatosis, fragile X, duchene muscular dystrophy, tuberous sclerosis, many others

  • metabolic and endocrine: hypothyroidism, PKU, MCAD, others
  • Toxins: drugs and alcohol

Perinatal and postnatal:
- infection

  • trauma/ brain injury (cerebral palsy)
  • neglect
31
Q

In terms of causes for specific developmental delay, what may be the causes of the following…

1) GROSS MOTOR
2) FINE MOTOR and VISION
3) speech and language
4) social skills

A

1) spina bifida/ cerebral palsy
2) retinoblastoma, retinopathy of prematurity
3) hearing problems (otitis media with effusion, deafness of any cause)
4) autism spectrum, fragile X

Year 4- Paediatrics (21 decks)

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