Child development Flashcards by Abi S

What are the 4 parts of the embryo in the dorsal view at 4 weeks

Future forebrain (prosencephalon)

Future midbrain (mesencephalon)

Future hindbrain (rhombencephalon)

Future spinal cord

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Using the side view at 4 weeks of life, what are the 3 flexures

Cephalic

Pontine

Cervical

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At 5 weeks, what can be seen

Fore - telencephalon and diencephalon

Mid

Hind - pons and medulla

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What can you see at 8 weeks

Hemispheres and ventricles 3 and 4 developing

Cerebellum developing

Aqueduct developing

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What do you see at term

Fully developed:

Cortex
Ventricular system
Aqueduct
Cerebellum
Pons
Medulla

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What is the grey matter in the anterior section of the cord responsible for

Motor neurones

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Where do the nerves in the pyramidal tract supply

They supply the sacral, lumbar, thoracic and cervical nerves in the lateral corticospinal tract

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What are the extrapyramidal tracts responsible for

Co-ordination of lumens
Regulation of posture and balance

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Components of the reflex arc

Starts with a sensory receptor responding to a stimulus by producing a generator or receptor potential

Moves across dorsal part of spine through the sensory neurones (axon conducts impulses from receptor to integrating centre)

Connects to interneuron and integrating centre (one or more regions within the CNS that relay impulses from sensory to motor neurones)

Then through motor neurones (axon that conducts impulses from integrating centre to effector)

Effector (muscle or gland that responds to motor nerve impulses)

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Primitive reflex - moro reflex?

Extension, abduction and adduction

28-32 weeks gestation

Should disappear between 3-6 months or could be a sign of impaired development if it doesn’t

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Standing primitive reflex?

Present at 3 months

Extension of lower extremities
Hip[s are slightly flexed and somewhat behind shoulder
Head free to turn

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Grasp primitive reflex?

When object placed in palm of new-born hand, fingers grasp very tightly

Stroke on the lateral side of the fingers will open them again

Reflexes are replaced between 6-9months with voluntary movement of hand as part of fine motor development

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Protective reflexes / parachute reflexes

Developed between 6-9 months
When baby placed in forward tilting position, protects themselves with stretched arms

Also occurs when baby is placed on side ; sideway parachute reflex

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What is development

Global impression of a child encompassing: growth, increase in understanding, acquisition of new skills and more sophisticated responses and behavior
Endows child with increasingly complex skills in order to function in society

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What are the 4 domains of developmental assessment

Gross motor skills - position, head lag, sitting, walking and running

Fine motor skills - use of hands, grasp and fine pincer, bricks, crayon and puzzles

Speech and language skills - vocalization, words, understanding and imaginative play

Social skills - social interaction, stranger reaction, eating skills and dressing

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What should the posture of a new born be like

Limited flexed, symmetrical posture lying down
Marked head lag on pulling up due immaturity of neck muscles

How does a baby sit between 6 -8 weeks

Sits without support:

6: Round back
8: Straight back

How does vision and fine motor change from 6 weeks to 4 months

Follows moving object or face by turning head

Reaches out for toys

How does a baby’s grip change form 6 months to 8 months

Palmar grasp , inferior grasp - using whole hand

Transfers toys from one hand to another

How does a babys grip change from 10months to 17 months

Mature pincer grip

Makes mark with crayon

How does a newborns hearing compare to a 3-4month year old

Startles to loud noises

Vocalises alone or when spoken to, coos and laughs

Normal motor development:
Pushes up on arms
Holds head up

Unable to lift head or push up on arms
Stiff extended legs
Pushing back with head
Constantly fisted hand and stiff leg on one side
Difficulty moving out of this position

Sits with support
Holds head up
Rounded back

Unable to lift head
Floppy trunk
Stiff arms, extended legs

Arms flexed and held back
Stiff, crossed legs

Sits without support
Arms free to reach and grasp

Rounded back
Por use of arms for play
Stiff legs, pointed toes

Poor head control
Difficulty getting arms forward
Arches back – stiff legs

Poor ability to lift head and back
Will not take weight on legs

Pulls to stand

Not interested in weight bearing Difficulty in pulling to stand Stiff legs, pointed toes Cannot crawl on hands and knees May use only one side of body to move

Independent standing or walking

Holds arm or both arms stiffly and bent Excessive tiptoe gait Sits with weight to one side Uses predominantly one hand for play One leg may be stiff

What is the healthy child programme

Screening, General examination and immunisation, Health education /promotion

Screening?

Hbopathy, rhesus, infection US scan dating and nuchal (down syndrome) US scan detailed New-born bloodspot, hearing and physical Physical examination Vision

Child health reviews

Birth visit 10-14 day visit 6-8 week review first year review two year review

How to evaluate a child for abnormal development

History Parental concern Birth history Family history PMHX Developmental history Current skills Examination Developmental assessment, + general and neurological examinationa Investigations – as appropriate

How to approach a developmental assessment

Ask, observe and task Need to assess Milestones proceeding age Expected milestones for age Next important milestones

What factors can influence developmental dealy

Ill health Lack of physical / or psychological stimuli Sensory / motor impairment Reduced inherent potential

What are the types of developomental delay

Global (all 4 domains) Specific - language / motor / sensory / cognitive

What are causes of global delay

Chromosomal abnormalities e.g. Down’s syndrome, Fragile X Metabolic e.g. hypothyroidism, inborn errors of metabolism Antenatal and perinatal factors Infections, drugs, toxins, anoxia, trauma, folate def Environmental-social issues Chronic illness

What are causes of motor delay

Cerebral palsy Global delay eg Down’s syndrome Congenital dislocation hip Social deprivation Muscular dystrophy-Duchenne’s Neural tube defects: spina bifida Hydrocephalus

What are causes of language delay

Hearing loss Learning disability Autistic spectrum disorder Lack of stimulation Impaired comprehension of language -Developmental dysphasia Impaired speech production -stammer, dysarthria

What are commonly used assessment tools

Standardised tests Schedule of Growing Skills (II) Griffiths developmental scale Bailey developmental scale Denver developmental screening tests OFFER THE RIGHT TOOLS, OBSERVE, LISTEN