Community Flashcards
1
Q
Gross motor development at 1 month
A
Symmetrical movements in all limbs
Normal muscle tone
Head lag when pulled up
2
Q
Gross motor development at 3 months
A
Almost no head lag when pulled to sit
Lifts head and chest when prone
3
Q
Gross motor development at 6 months
A
Rolls from back to front
When held, stands and sits with straight back
Bears most of own weight
4
Q
Gross motor development at 9 months
A
Sits without support
Stands holding onto furniture
Moves around the floor - wriggling, commando crawling
5
Q
Gross motor development at 12 months
A
Stands without support
Crawls, bottom shuffles or bear walks
Cruises along furniture
May walk unsteadily
6
Q
Gross motor development at 15 months
A
Generally walks without support
Crawls upstairs
7
Q
Gross motor development at 18 months
A
Walks steadily, stopping safely
Squats to pick up a toy
Climbs stairs holding hand or rail
8
Q
Gross motor development at 24 months (2 years)
A
Runs safely
Throws ball overhand
Wlaks up and down stairs, both feet on each step
9
Q
Gross motor development at 30 months
A
Jumps on 2 feet
Kicks ball
10
Q
Gross motor development at 36 months (3 years)
A
Walks backwards and sideways
Rides tricycle
Catches large ball with arms outstreched
11
Q
Gross motor development at 48 months (4 years)
A
Stands, walks and runs on tiptoes
Runs up and down stairs
12
Q
Gross motor development at 5 years
A
Hop
Catches ball
Heel-toe walking
May ride a bike
13
Q
Fine motor development at 1 month
A
Grasps finger when placed in the palm
14
Q
Fine motor development at 3 months
A
Watches their own hands
Brings hands to their mouth
Holds toy brieftly
15
Q
Fine motor development at 6 months
A
Palmer grasp
Reaches for toys
Puts objects in mouth
16
Q
Fine motor development at 9 months
A
Passes toys from one hand to tht other
May have pincer grip
17
Q
Fine motor development at 12 months
A
Fine pincer grip
Points to objects of interest
Releases objects intentionally
18
Q
Fine motor development at 15 months
A
Imitates to and fro scribbles
Builds tower of 2 cubes when demonstrated
19
Q
Fine motor development at 18 months
A
Makes tower of 3 blocks
20
Q
Fine motor development at 24 months (2 years)
A
Builds a tower of 6 blocks
Draws horizontal lines with preferred hand
May draw vertical lines
Turns pages of book individually
21
Q
Fine motor development at 30 months
A
Can thread bead on a string
Makes a tower of 7 or more blocks
Holds pencil in tripod grip
22
Q
Fine motor development at 3 years
A
Builds bridge using blocks
Draws circle
Draws person with a head
23
Q
Fine motor development at 42 months (3.5 years)
A
Draws a cross
24
Q
Fine motor development at 4 years
A
Build stepts using blocks
Draws a square
Draws a person with head/face, arms and legs
25
Fine motor development at 5 years
Uses knife and fork competently
Draws triangle
Copies alphabet letters
26
Define speech
Actual sounds of spoken language
| - produced by co-ordinated action of the muscles of the tonuge, lips, jaw and vocal tract
27
Define language
Systems of words and symbols
- use to communicate with each other
- encompassess written, verbal and non-verbal communication
28
Speech/language development a newborn
Cries
29
Speech/language development at 6-8 weeks
Coos
30
Speech/language development at 3 months
Laughs
| Vocalises
31
Speech/language development at 6 months
Understands words such as mama, dada or bye-bye
Babbles spontaneously - initially monosyllables
Uses tuneful, singsong voice
32
Speech/language development at 9 months
Imitates adult sounds, such as coughs
Understands simple commands
Understands no
33
Speech/language development a 12 months
Knows and responds to own name
| Uses 2-6 words and understands many more
34
Speech/language development at 18 months
Uses 6-40 recognisable words
Can point to parts of the body when asked
Tries to sing
35
Speech/language development at 24 months (2 years)
Speaks over 200 words, understands many more
Joins words together
Omits opening or closing consonants
36
Speech/language development at 30 months
Continually asks questions
37
Speech/language development at 36 months (3 years)
Can name 2/3 colours
Knows and repeats songs and nursery rhymes
Counts by rote up to 10
Has simple conversations
38
Speech/language development at 48 months (4 years)
Talks fluently
Counts by rote to 20
Enjoys jokes
39
Speech/language development of at 60 months (5 years)
Fluent in speech and mostly grammatically correct
| Interested in reading and writing
40
Social, emotional and behavioural development of a newborn
Responds to being picked up
| Enjoys feeding and cuddling
41
Social, emotional and behavioural development at 6 weeks
Gazes at adult faces
| Social smiles
42
Social, emotional and behavioural development at 3 months
Smiles at familar faces and strangers
43
Social, emotional and behavioural development at 6 months
Feeds self with fingers
| Shows stranger fear
44
Social, emotional and behavioural development at 9 months
Waves bye
Plays peek-a-boo
Shows likes and dislikes
45
Social, emotional and behavioural development at 12 months
Drinks from a cup with 2 hands
| Has seperation anxiety
46
Social, emotional and behavioural development at 18 months
Uses a spoon
Plays contentedly alone, near familar adult
Eager to be independent
47
Social, emotional and behavioural development at 24 months (2 years)
Displays frustration - temper tantrums
Dresses self
Begins to express feelings
48
Social, emotional and behavioural development at 30 months
Eats skillfully with spoon, may use fork
May use toilet independently
Plays alone and alongside other children - parallel play
Enjoys pretend play
49
Social, emotional and behavioural development at 36 months (3 years)
Shows affection for younger siblings
Probably toilet-trained - may still be wet at night
Enjoys helping adults, imitating household tasks
Has friends
50
Social, emotional and behavioural development at 48 months (4 years)
Eats skillfully with fork and spoon
Brushes own teeth
Shows sensitivity to others
Takes turns
51
Social, emotional and behavioural development at 60 months (5 years)
Very definite likes and dislikes
Shows sympathy and comforts friends
Dressess without help - except laces
Engages in co-operative and imaginative play, observing rules
52
Hearing and vision development of a newborn
Fascinated by human faces
Turns head towards light
Startled by sudden noises
53
Hearing and vision development at 1 month
Turns head towards diffuse light and stares at bright objects
Startles to loud noises
54
Hearing and vision development at 3 months
Focuses eyes on same point
Moves head deliberately to gaze around them
Prefers moving objects to still ones
55
Hearing and vision development at 6 months
Adjusts position to see objects
| Turns towards the source of sounds
56
Hearing and vision development at 12 months
Sees almost as well as an adult
| Knows and responds to own name
57
Hearing and vision development at 18 months
Recognises themselves in a mirror
58
Hearing and vision development at 24 months (2 years)
Recognises familiar people in photographs
| Listens to conversations with interest
59
Hearing and vision development at 30 months
Recognises self in photographs
| Recognises small details in picture books
60
Hearing and vision development at 48 months (4 years)
Matches primary colours
| Listens to long stories with attention
61
Hearing and vision development at 60 months (5 years)
Can match 10 colours
62
Define Autism Spectrum Disorder
Neurodevelopmental disorder that affects a person's social interaction, communication and behaviour
- usually diagnosed in adulthood
- key symptoms being present from age of 3
63
Epidemiology of ASD
1%
More common in boys than girls
More prevenlent in premature children
64
Pathophysiology of ASD
Genetic syndromes - fragile X syndrome, tuberous sclerosis and Angelmann syndrome
Gentic aetiology - chromosonal analsysis gives a diagnosis in around %
Structural changes in the brain
65
Clinical featrues of ASD
Abnormality of social interaction
- poor eye contact, failure to use facial expression of body language
- problems making friends, difficulty reading social situations
Impaired social communication
- delay or failure to develop social language
- failure to initiate or continue conversations
- abnormal use of language
Restrictive or repetitive activities
- preoccupations with unusual subjects/atypical way
- need for routine - upset if disrupted
- motor mannerisms - hand flapping
66
Signs for look for on examination in ASD
Skin stigmata of neurofibromatosis or tuberous sclerosis
Signs of injury - self-harm or child maltreatment
Congenital abnormalities and dysmorphic features
67
Differential diagnosis of ASD
```
Learning difficulties
Attachment disorders
Rett's syndrome - regression of skills at 18 months, most common in females
Schizophrenia
Specific language disorders
```
68
Investigations for ASD
Clinical diagnosis made by MDT team
| - symptoms should be persistent in different environments - both home and school
69
Management for ASD
For milder end diagnosis alone
- allows families to access certain modes of support - parent support groups, community-based services
No medications
Behavioural management strategies - visual timetables, preparation and explanation for changes in routine
Educational measures - diagnosis needed for and Education, Health and Care Plan so school can access extra funding
- most educated in main school streaming
70
Define ADHD
```
Attention Deficit Hyperactivity Disorder
Neurobehavioral disorder that is characterised by
- hyperactivity
- inattention
- impulsivity
```
71
Epidemiology of ADHD
7%
More common in boys than girls
Up to 50% have co-morbid condition - ASD, learning difficulties, communication disorders, depression, anxiety, Tourette Syndrome
72
Pathophysiology of ADHD
Evidence suggests structural and functional changes in brain as well as changes in levels of dopamine
Genetic component
73
Clinical features of ADHD (ICD-10)
```
Early onset - before 6 years
Main features
- impaired attention
- over-activity
Disinhibition, recklessness and lack of adherence to social norms may be present but not necessary for diagnosis
```
74
DSM-V criteria for ADHD
3 subtypes - combined, predominantly inattentive, predominantly hyperactive
Diagnosis made when at least 6 criteria from either category are met and present from before age of 12 for at least 6 months
- must be present in more than one setting
75
Differential diagnosis for ADHD
Auditory processing disorder - brain has difficulty interpreting sounds and information heard
Oppositional-defiant disorder - features of anger, vindictiveness and being argumentative
Conduct disorder - marked features of aggression
- those with ADHD tend to not want to get into trouble
76
Investigations for ADHD
Conner's questionnaire
| School observation
77
Management of ADHD
```
Pre-school
- medication not recommended
- parent training/education programme
Mild/moderate
- 1st line is behavioural strategies - parent education, CBT, social skills training, teacher education
Severe
- Medication 1st line
```
78
Medications used in ADHD
Methylphenidate - stimulant
- immediate and mixed preparations
- start small dose and titrate up
Atomoxetine
- used if methylphenidate not effective, associated tic or anxiety disorder, risk of stimulant abuse
- SE of liver damage
Lisdexamfetamine - newer stimulant medication
- used when methylphenidate not effective at max dose
Guanfacine - non-stimulant
- used when stimulant not suitable, not tolerated or not effective
Antipsychotics - should not be used in children
79
Aim of medication in ADHD
Improve attention and concentration to allow them to achieve their educational potential
80
SE of ADHD medication
```
Raised BP
Palpitations
Disturbed sleep
Impaired growth and appetite suppression
Problems with aggression or increased emotion - anxious or depressed
```
81
Define child protection
Process of protecting individual children identified as either suffering, or likely to suffer, significant harm as a result of abuse or neglect
- involves measures and structures designed to prevent and respond to abuse and neglect
82
Types of child abuse
```
Physical
- especially children under 2
Sexual
Emotional
Neglect
```
83
Risk factors for child abuse
```
Child factors
- unable to fulfil parental expectations
- crying persistently
- children under 4
- disability
- low birth weight
- chronic ill health
- prematurity
- being unwanted
Adult factors
- mental illness
- postnatal depression
- lack of support network
- drugs
- own child abuse
- alcohol misuse
- learning disability
- criminal activity
- financial difficulties
```
84
Features of non-accidental injuries
Mechanism of injury not compatible with injury sustained
Child's developmental stage inconsistent with the injury presented
Child sustained significant injury with little or on explanation
Inconsistent histories given
Delay in presenting child to health care providers
Recurrent injuries
Parents reaction not appropriate to the situation
85
Presentations of physical abuse
```
Bruising
- coagulation screen
- FBC
Fractures
- full skeletal survey
- CT scan
- bone biochemistry
Presentation in under 2 years
- full skeletal survey
- CT head
- expert ophthalmological examination
- coagulation screen
```
86
Differential diagnosis for bruising
```
Bleeding disorder
Birthmark
Vasculitic disorders
Infection - meningococcal septicaemia
Drug related - NSAIDs
Erythema nodosum
Malignancy
Striae
Contact dermatitis
```
87
Differential diagnsosis of fractures
```
Birth injury - clavicular fracture
Infection - osteomyelitis
Malignancy
Osteogenesis imperfecta
Nutritional - vitamin D deficiency
Copper deficiency
```
88
What is a HEADSSS assessment
Tool used to structure the assessment of an adolescent patient
- Home
- Education/Employment
- Activities
- Drugs
- Sex and relationships
- Self harm and depression
- Safety and abuse
89
Define adolescence
Transition period where child becomes an adult
- physical changes of puberty
- psychological and sociological changes associated with finding your identity and gaining independence from parents/carers
90
Presentation of neglect
Medical
- unimmunised
- failure to attend appointments
- poor compliance with medication
- failure to seek appropriate timely medical advice
Nutritional
- faltering growth due to failure to provide an appropriate and or sufficient diet
- obesity due to failure to control diet and lifestyle
Emotional
- poor school attendance
Physical
- inadequate hygiene
- severe and or persistent infestations/infections
- inappropriate clothing for childs size and weather
Failure to supervise
- frequent A&E attendances
- injury that suggests lack of care such as sunburn, scalds, burns, falls
- ingestion of harmful substances
91
Symptoms of emotional abuse in an infant
```
Developmental delay
Poor sleep
Feeding difficulties
Persistent
Crying
Irritable
```
92
Symptoms of emotional abuse in a toddler
Difficult/violent behaviour
| Delayed social and language skills
93
Symptoms of emotional abuse in a school child
Poor attendance
Truancy
Antisocial behaviour
Academic failure
94
Symptoms of emotional abuse in an adolescent
```
Depression
Self harm
Relationship difficulties
Substance abuse
Criminal activity
Eating disorders
Aggressive behaviour
```
95
Presentation of sexual abuse
```
Allegation
Pregnancy
STI
Ano-genital injury
Unexplained vaginal bleeding
Unexplained rectal bleeding
Recurrent vaginal discharge
Soiling, bowel problems, enuresis
Behavioural difficulties
Any children close proximity with an adult identified as a risk to children
When perpetrator is child
```
96
Consequences of child abuse
```
Attachment disorder
PTSD
Somatic symptoms
Sexual dysfunction
Emotional disorders
Self-harm
Alcohol misuse
Drug abuse
Antisocial personality
Aggressive behaviour
```
97
Medical professional response to concerns of child abuse
Document everything clearly in the patients notes - Clearly attribute who said what/when plus actions taken – including any discussions at handover
Sign, date and time all entries
Seek advice from senior colleague/consultant on how to proceed
If you are unhappy with the advice given consult further – go up a level of seniority or contact the named doctor/nurse for safe guarding
Communicate with nursing staff
Keep the child safe
DON’T DO NOTHING
98
Medical professional responding to disclosure of child abuse
```
Try not to look shocked
Let the child know you believe them
Tell them they are not in trouble
Listen to what they have to say, don’t make an excuse to leave
Don’t ask leading questions – this may affect the case if it goes to court
Don’t make promises you cant keep
Be honest at all times
Inform your senior
```
99
Define life limiting conditions
Conditions for which there is no reasonable hope of cure
- from which children/young people will die
- include life-threatening for which curative treatment may be feasible but can fail
100
Define life threatening conditions
Curative treatment may be feasible but can fail
- palliative care services may be necessary when treatment fails or during an acute crisis
- cancer
101
Define conditions where premature death is inevitable
May be long periods of intensive treatment aimed at prolonging life and allowing participation in normal activities
- cystic fibrosis
- duchenne muscular dystrophy
102
Define progressive conditions without curative treatment options
Treatment is exclusively palliative and may commonly extend over many years
- Batten disease
- mucopolysaccharidoses
103
Define irreversible but non-progressive conditions causing severe disability, leading to suceptilbitly to health complications and likelihood of premature death
Children have complex health care needs and are at high risk of an unpredictable life-threatening event or episode
- cerebral palsy
- spinal cord injury
104
Key differences of child vs adult palliative care
Small number of children die
Many conditions rare and genetic
May only be needed for short period of time and may be on and off for a number of years
Importance of physical, emotional and cognitive development
Provision of play and education vital
105
Features of advanced care planning
Helps create advance statements about wishes and preferences such as preferred place of care, withdrawal of treatment and resuscitation status
106
DNACPR forms in paediatrics
Lots of controversy and misunderstanding over their design, use and limitations
107
Features of ReSPECT forms
Recommended Summary Plan for Emergency Care and Treatment
- process supports the creation of these recommendations by initiating conversations to ensure a shared understanding of the condition, current issues and future outlook
- child/families preferences for care and realistic future emergency treatment
- making and recording agreed clinical recommendations for care
108
Key pillars of ethics
Autonomy - right to self-determination
Non-maleficence - need to avoid harm
Beneficence - ability to do good
Justice
109
Ethical issues related to paediatrics
Children represent spectrum from non-verbal infant to fully conversant adolescent striving for independence and self-identity
Child's ability to make informed choices depends on level of development and life experience
Even young children have the right to be informed
As children's competence increases so should their involvement in decision making
110
Normal growth
Acceptable for breastfed babies to lose 10% of birthweight and bottle-fed 5% in first 10 days of life
Babies should have doubled weight by 4 months and tripled by 1 year
111
Red flags for gross motor control
```
No head control at 6 months
Cannot sit unsupported at 12 months
Not weight bearing at 12 months
Not walking at 18 months
Not running by 2.5 years
```
112
Red flags for fine motor and visual skill
Does not hold objects in hand at 5 months
113
Red flags for speech and language skills
```
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
```
114
Red flags for social skills
No gestures at 12 months
| No symbolic play at 18 months
115
Causes of developmental delay
```
Antenatal
- Genetic - down syndrome, duchenne muscular dystrophy
- metabolic/endocrine - hypothyroidism, PKU
- toxins - drugs and alcohol
Peri and postnatal
- infection
- trauma/brain injury -> cerebral palsy
- neglect
```
116
Vaccination schedule
```
8 weeks:
- 6 in 1 vaccine (diphtheria, tetanus, pertussis, polio, haemophilus influenzae type B (Hib) and hepatitis B)
- Meningococcal type B
- Rotavirus (oral vaccine)
12 weeks:
- 6 in 1 vaccine (again)
- Pneumococcal (13 different serotypes)
- Rotavirus (again)
16 weeks:
- 6 in 1 vaccine (again)
- Meningococcal type B (again)
1 year:
- 2 in 1 (haemophilus influenza type B and meningococcal type C)
- Pneumococcal (again)
- MMR vaccine (measles, mumps and rubella)
- Meningococcal type B (again)
Yearly from age 2 – 8:
- Influenza vaccine (nasal vaccine)
3 years 4 months:
- 4 in 1 (diphtheria, tetanus, pertussis and polio)
- MMR vaccine (again)
12 – 13 years:
- Human papillomavirus (HPV) vaccine (2 doses given 6 to 24 months apart)
14 years:
- 3 in 1 (tetanus, diphtheria and polio)
- Meningococcal groups A, C, W and Y
```
117
Types of vaccines
Inactivated
- polio
- flu
- hep A
- rabies
Subunit and conjugate
- Pneumococcus
- Meningococcus
- Hepatitis B
- Pertussis (whooping cough)
- Haemophilus influenza type B
- Human papillomavirus (HPV)
- Shingles (herpes-zoster virus
Live attenuated - still capable of causing infection particularly in immunocompromised patients
- Measles, mumps and rubella vaccine: contains all three weakened viruses
- BCG: contains a weakened version of tuberculosis
- Chickenpox: contains a weakened varicella-zoster virus
- Nasal influenza vaccine (not the injection)
- Rotavirus vaccine
