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children and complex needs Flashcards

1
Q

what is difference between mild LD and severe LD?

A

LD: general umbrella for range of conditions that affect from mild to severe
- Mild: child may need extra time and help with learning new skills
- Severe: significant intellectual impairment and they may need help with ADLs

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2
Q

what is dyslexia?

A

Dyslexia: specific difficulty in reading, writing and spelling

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3
Q

what is dysgraphia?

A

Dysgraphia: specific difficulty in writing

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4
Q

what is dyspraxia?

A

Dyspraxia: developmental co-ordinator disorder
- Specific type in physical co-ordination
- Presents with delayed gross and fine motor skills and child that appears clumsy

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5
Q

who is dyspraxia more common in?

A

boys

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6
Q

what is auditory processing disorder?

A

Auditory processing disorder: specific disability in processing auditory info

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7
Q

what is non-verbal LD?

A

Non-verbal learning disability: difficulty in processing non-verbal information such as body language and facial expression

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8
Q

how is LD classified?

A

based on IQ

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9
Q

what are the classifications of LD based on IQ?

A
  • Mild: 55-70
  • Moderate: 40-55
  • Severe: 25-40
  • Profound: <25
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10
Q

which is the most common IQ bracket for children with LD to be within?

A

mild - 55 to 70
children may be borderline

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11
Q

what can cause LDs?

A
  • May have underlying family Hx
  • Environmental factors:
    genetics
    antenatal probelms
    labour problems
    problems in early childhood
    autism
    epilepsy
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12
Q

what environmental factors can cause LD?

A
  • Environmental factors: abuse, neglect, psychological trauma and toxins (alcohol in-utero) can increase risk
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13
Q

what antenatal problems may cause LD?

A

fetal alcohol, maternal chickenpos

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14
Q

name some labour problems that may cause LDs?

A

preemie, hypoxic ischaemia encephalopathy

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15
Q

what childhood conditions can cause LD?

A

meningitis

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16
Q

who is in MDT to manage childhood LDs?

A

MDT approach to support parents/ child
- Paediatrician
- Social workers
- Health visitors – all under 5 have one
- Schools
- Educational psychologists
- GPs/ nurses
- Ots
- SALT

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17
Q

what is developmental delay?

A

There is flexibility within milestones  children that are slow to achieve all milestone sor lags behind in certain areas  pathological

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18
Q

what is global developmental delay?

A

Global developmental delay: child is displacing slow development in all developmental domains

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19
Q

what conditions can cause global developmental delay?

A
  • Down’s syndrome
  • Fragile X syndrome
  • Fetal alcohol
  • Rett syndrome
  • Metabolic disorders
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20
Q

what conditions can cause gross motor delay?

A

Cerebral palsy
Ataxia
Myopathy
Spina bifida
Visual impairments

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21
Q

what can cause fine motor delay?

A

Dyspraxia
Cerebral palsy
Muscular dystrophy
Visual impairment
Congenital ataxia (rare)

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22
Q

what can cause language delay?

A

specific social - many siblings or multiple languages

Hearing impairment
LD
Neglect
Autism
Cerebral palsy

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23
Q

who should you refer to with language delay?

A

Need referral to SALT, audiology, health visitor and safeguarding?

24
Q

what can cause personal and social delay?

A

Emotional and social neglect

Parenting issues
Autism

25
Q

what is HIE?

A

Hypoxic ischaemic encephalopathy:
HIE: occurs in neonates as a result of hypoxia during birth

26
Q

what is the pathophys of HIE?

A
  • Lack of oxygen causing restriction of blood flow to brain causing encephalopathy (malfunctioning of the brain)
27
Q

what can HIE lead to?

A

cerebral palsy

28
Q

what events can cause hypoxia in neonates?

A
  • Acidosis on umbilical artery blood gas
  • Poor apgar
  • Features of mild/ moderate, severe HIE
  • Multi organ failure
29
Q

what is asphyxia?

A

anything leading to asphyxia (deprivation of oxygen) to brian can cause HIE

30
Q

what can cause asphyxia which can lead to HIE?

A
  • Maternal shock
  • Intrapartum haemorrhage
  • Prolapsed cord
  • nuchal cord
31
Q

what is prolapsed cord?

A

compression of cord during birth

32
Q

what is nuchal cord?

A

cord wrapped around neck of baby

33
Q

what grading system is used for HIE?

A

Sarnat staging

34
Q

what are the three stages within HIE staging

A

Sarnat
mild
moderate
severe

35
Q

how would mild HIE present?

A

Poor feeding, general irritability and hyper-alert
Resolves within 24hrs
Normal prognosis

36
Q

how would moderate HIE present?

A

Poor feeding, lethargic,, hypotonic, seizures
Can take weeks to resolve
Up to 40% go on to develop cerebral palsy

37
Q

how would severe HIE present?

A

Reduced consciousness, apneoas, flaccid, reduced/ absent reflexes
50% mortality
90% develop cerebral palsy

38
Q

how do you manage HIE?

A

need specialist in neonatology
- Supportive care:
therapeutic hypothermia
MDT throughout childhood

39
Q

what is supportive care within HIE?

A

neonatal resus, ongoing optimal ventilation, circulatory support, nutrition, acid-base balance, manage seizures

40
Q

what is therapeutic hypothermia within HIE and why?

A
  • Need therapeutic hypothermia  cooling baby core to 33-34 in NICU for 72hrs and then gradually increased temp back up, can help reduce inflammation, neurone loss, reduced risk of cerebral palsy, developmental delay, blindness and death
41
Q

what is ASD?

A

Autism spectrum disorder: ASD
ASD: refers to full range of people affect by deficit in social interaction, communication and flexible behaviour
- Groups autistic disorder and Aspergers

42
Q

what components make up ASD?

A

social interaction
communication
behaviour

43
Q

what features within social interaction would indicate ASD?

A

Social interaction: lack of eye contact, delay in smiling, avoids physical contact, unabale to read on non-verbal cues, difficulty in establishing cues, difficulty in establishing friendships, not wanting to share attention (no playing with others)

44
Q

what communications skills would indicate ASD?

A

Comms: delay/ regression in language development
- Lack of appropriate non-verbal comms eg smiling, eye contact, responding to others with shared interest
- Difficulty with imaginative/ imitative behaviour
- Repetitive use of words

45
Q

what behavioural attributes would indicate ASD?

A

Behaviour: greater interest in objects, numbers, patterns than people
- Stereotypical behaviour eg self stimulating to comfrot themselves egg hand-flapping/ rocking
- Intensive and deep interests that are persistent and rigid
- Repetitive behaviours + fixed routine
- Anxiety and distress with outside of routine
- Extremely restricted food preferences

46
Q

who can diagnose autism?

A

: made by specialist  paeds psych or peads specialist with interest in developmental and behaviour

47
Q

does an autism diagnosis have to be at school age?

A

no can be before 3yrs

48
Q

who is within MDT of autism management?

A

Management: MDT to provide best environment and support for child and parent
- CAMHS
- SALT
- Dietician
- DR
- Social worker
- Specially trained educators and special school environments
- Charities such as national autistic society

49
Q

what is ADHD?

A

There is a normal spectrum among children and adults in their level of activity throughout day and night and ability to concentrate on a single task for an extended period
ADHD: is extreme end of hyperactivity + inability to concentrate

50
Q

how should ADHA affect child in order for diagnoses?

A
  • Affecting person’s ability to carry out everyday tasks, develop normal skills and perform well in school
  • Should be consistent across various setting  eg only doing this at school but well and behaved at home: environmental problem
51
Q

what are features of ADHD?

A

ADHD is pat of normal spectrum  when it adversely affecting child
- Very short attention span
- Quickly moving from one activity to another
- Quickly losing interest and not being able to persist with challenging tasks
- Constantly moving/ fidgeting
- Impulsive behaviour
- Disruptive / rule breaking

52
Q

how do you manage ADHD?

A

coordination from specialist
- Parental strategies to manage behaviour
- Establishing healthy food and exercise can have significant improvement in symptoms
- Keeping a food diary alongside behaviour eg food colourings
Medications: specialist only

53
Q

what is the moa of ADHD meds?

A
  • Central nervous system stimulants
54
Q

name some examples of medications used in ADHD management?

A
  • Methylphenidate (Ritalin)
  • Dexamphetamine
  • Atomoxetine
55
Q
A

paeds (10 decks)

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