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Flashcards in Child development Deck (82)
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1

What is development?

- The global impression of a child which encompasses growth, increases in understanding, acquisition of new skills and more sophisticated responses and behaviour
- A dynamic process of growth, transformation, learning and acquisition of abilities to respond to and adapt to the environment in a planned, organised and independent manner
- A process by which each child evolves into an independent adult

2

Antenatal causes of damage to brain development

Infectious agents
Hormones
Drugs

3

What infectious agents can cause antenatal damage?

TORCH:
- Toxicoplasmosis
- Other (syphilis/HIV/HepC)
- Rubella -> cataracts, glaucoma, heart defects, hearing loss, tooth abnormalities
- Cytomegalovirus
- Herpes

4

What hormones can cause antenatal damage?

- Androgenic agents
- DES
- Maternal diabetes -> various: heart and neural tube defects most common
- Maternal obesity

5

What drugs can cause antenatal damage?

- Phenytoin
- Valproic acid -> neural tube defects, heart, craniofacial and limb anomalies
- Trimethadione
- Lithium
- SSRIs
- Amphetamines
- Warfarin
- ACE inhibitors
- Alcohol -> foetal alcohol syndrome, short palpebral fissures, maxillary hypoplasia, heart defects, intellectual disability

6

Postnatal causes of damage to development

Infections, metabolic disorders, toxins, trauma, domestic violence (maltreatment), malnutrition, maternal mental health disorders

7

Complications of spina bifida cystica

- Neurogenic bowel and bladder incontinence
- Lower limb paralysis
- Fractures and joint contractures
- Developmental deformities and learning disabilities
- Hydrocephalus and meningitis

8

What are the developmental domains?

- Gross motor performance
- Vision and fine motor
- Hearing, speech and language
- Social, emotional and behavioural

9

What is a milestone?

Acquisition of a key performance skill

10

Define the median age for development

Age when half of standard population of children achieved that level

11

Define the limit age for development

Age by which children should have achieved that level
= 2.5 SD from mean age

12

What gross motor performance milestone should be seen in a newborn?

Limbs flexed on symmetrical position, head lag on pulling up

13

What gross motor performance milestone should be seen at 6-8 weeks?

Raises head to 45 degrees in prone

14

What gross motor performance milestone should be seen at 6-8 months?

Sits without support

15

What gross motor performance milestone should be seen at 8-9 months?

Crawling

16

What gross motor performance milestone should be seen at 10 months?

Cruising around furniture

17

What gross motor performance milestone should be seen at 12 months?

Walks unsteadily

18

What gross motor performance milestone should be seen at 15 months?

Walks steadily

19

Why do we have primitive reflexes?

Protective and serve to promote support, balance and orientation

20

What are the primitive reflexes?

- Stepping
- Moro (startled, falling reflex - arms outstretched, 'startled' expression)
- Grasp
- Asymmetric tonic reflex (arm outstretches towards where head is turned)
- Rooting (suckling)

21

When should the primitive reflexes disappear?

4-6 months

22

What are protective reflexes?

Develop from 4 to 5 months onwards and can be absent or abnormal in motor disorders

23

What is the downward parachute reflex?

Develops at 5 months
When held and rapidly lowered infant extends and abducts both legs; feet are plantigrade

24

What is the sideward protective reflex?

Develops at 6 months
Infant puts arms out to save if tilted off balance

25

What is the forward protective reflex?

Develops at 7 months
Arms and hands extend on forward descent to ground

26

What is the backward protective reflex?

Develops at 9 months
Backward protective extension of both arms when pushed backwards in sitting position

27

When is object permanence obtained?

9 months

28

What fine motor and vision milestone should be seen at 6 weeks?

Turning head to follow object

29

What fine motor and vision milestone should be seen at 4 months?

Reaching out to toys

30

What fine motor and vision milestone should be seen at 4-6 months?

Palmar grasp

31

What fine motor and vision milestone should be seen at 7 months?

Can transfer toys between hands

32

What fine motor and vision milestone should be seen at 10 months?

Mature pincer grip

33

What fine motor and vision milestone should be seen at 16-18 months?

Making marks with crayon

34

What fine motor and vision milestone should be seen at 14 months - 4 years?

Building towers out of blocks

35

What fine motor and vision milestone should be seen at 2-5 years?

Ability to draw basic shape without seeing it
(Copying shape can be done 6 months earlier)

36

What language and hearing milestone should be seen in a newborn?

Startles to loud noises

37

What language and hearing milestone should be seen at 3-4 months?

Vocalises alone or when spoken to

38

What language and hearing milestone should be seen at 7 months?

Turns to soft sounds out of sight

39

What language and hearing milestone should be seen at 7-10 months?

Uses sound indiscriminately or discriminately

40

What language and hearing milestone should be seen at 12 months?

Two to three words other than dada or mama

41

What language and hearing milestone should be seen at 18 months?

Six to ten words

42

What language and hearing milestone should be seen at 20-24 months?

Makes simple phrases

43

What language and hearing milestone should be seen at 1.5-3 years?

Talk constantly in 3-4 word sentences

44

What social and behavioural milestone should be seen at 6 weeks?

Smile responsively

45

What social and behavioural milestone should be seen at 6-8 months?

Puts food in mouth

46

What social and behavioural milestone should be seen at 10-12 months?

Wave bye, play peek-a-boo

47

What social and behavioural milestone should be seen at 12 months?

Drink from cup with two hands

48

What social and behavioural milestone should be seen at 18 months?

Can eat by themselves

49

What social and behavioural milestone should be seen at 18-24 months?

Symbolic play

50

What social and behavioural milestone should be seen at 2 years?

Potty trained

51

What social and behavioural milestone should be seen at 2.5-3 years?

Parallel play

52

What are the limit age examples at:
- 18 months
- 3 months
- 2 years
- 2-2.5 years

18 months: walking independently
3 months: fixes and follows visually
2 years: joins words
2-2.5 years: symbolic play

53

What is consonant delay?

All developmental domains affected equally

54

What is dissonant delay?

All developmental domains affected differently

55

What is the difference between delay and disorder?

Delay = slow acquisition of skills
Disorder = maldevelopment of a skill

56

What are some causes of abnmormal development?

- Abuse, trauma, drugs, infection
- Autism, deficits in development
- Malnutrition, cerebral palsy etc

57

How/when does delay present?

- Routine surveillance
- Identified risk factors
- Parents/HCPs worried
- Opportunistic worries raised

58

What factors are important in a history of abnormal development?

- Antenatal
- Birth
- Postnatal
- Consanguinity - increased chance of chromosomal/autosomal conditions
- Developmental milestones from parents

59

What factors are important in the examination for abnormal development?

- Growth parameters (height, weight, head circumference)
- Dysmorphic features
- Neurological exam & skin exam
- Systems exam
- Standardises developmental assessments (SOGSII, Griffiths, Denver)

60

What factors are important in the management of abnormal development?

- Investigations - cytogenic studies, metabolic screens, blood ammonia and lactate, urine and blood amino acids, creatine kinase, imaging and nerve/muscle biopsies
- Referral to MDT

61

What is cerebral palsy?

Disorder of movement and posture due to non-progressive lesion of motor pathways

62

Cerebral palsy features

Manifestations emerge over time
Most common cause of motor impairment in children
Prevalence 2.5-2.7 per 1000 children

63

What is the most common cause of cerebral palsy?

Antenatal cause (80%) - genetic syndromes and congenital infection

64

Cerebral palsy presentation

- Abnormal limb tone and delayed milestones
- Feeding difficulties
- Abnormal gait once walking achieved
- Asymmetric hand function before 12 months
- Primitive reflexes persist

65

Types of cerebral palsy

Spastic (70%)
Ataxic hypotonic, dyskinetic, mixed pattern (each 10%)

66

Associated problems with cerebral palsy

Learning difficulty, epilepsy, visual impairment, hearing loss, feeding difficulty, poor growth, respiratory problems

67

Management of cerebral palsy

Minimise spasticity and manage associated symptoms

68

What is autism?

Neurobiological disorder characterised by:
- impairments of social interactions and communication
- restricted, repetitive and/or stereotyped patterns of behaviour, interests and activities

69

What is the prevalence of autism?

3-6 per 1000 live births
M > F
Presents at 2-4 years

70

Comorbidities with autism

Learning difficulties, attention difficulties and epilepsy

71

Management of autism

Intensive support for child and family

72

What are the criteria for diagnosis with attention deficit hyperactivity disorder?

- Inattention
- Hyperactivity
- Impulsivity
- Lasting >6 months
- Commencing <12 years and inconsistent with child's developmental level
- Criteria should be present in more than one setting and cause significant interference at school/socially

73

How is ADHD diagnosed?

- Questionnaires (SDQ - strengths and difficulties questionnaire)
- Exclude medial causes such as hyperthyroidism
- Hearing deficits
- Identify risk factors and comorbidities

74

What other disorders have increased risk with ADHD?

Conduct disorder, anxiety disorder and aggression

75

What are risk factors for ADHD?

M > F, learning difficulties and developmental delay, neurological disorders, first-degree relatives , relatives with depression/ learning disabilities/ antisocial behaviour/ substance abuse

76

Management of ADHD

Psychotherapy - behaviour therapy
Family therapy, drugs - if psychotherapy alone insufficient
Diet - exclusion of some foods

77

How are learning disabilities classified?

Mild, moderate, severe and profound

78

What is the prevalence of mild learning disabilities?

30 per 1000 children

79

What is the prevalence of severe learning disabilities?

4 per 1000 children

80

Common causes of learning disabilities

25% have no identifiable cause
30% chromosome disorder
20% other syndromes
20% postnatal cerebral insults
1% metabolic or degenerative disease

81

Common presentations of learning disabilities

Reduced intellectual functioning
Early delay in milestones
Dysmorphic features and associated problems e.g. ADHD, epilepsy, sensory impairment

82

Management of learning disabilities

MDT for long term and follow up
School recognition of learning disability
SEND (special education needs and disability)