Development Flashcards by Janell L

When should a child be referred to developmental pediatrics?

When parents concerned
Not responding to name by 9 months
No words or pointing by 12 months
Less than 20 words at 18 months
Social communication concerns

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A 6 year old reverses her letters. The mom is concerned. What do you say?

Reassurance - this is normal between 5-8 years.

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What are the key milestones for GM skills?

Head control 3 months
Arms 6 months
Trunk 9 months
Legs 12 months

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What time period is the moro reflex present?

Birth-4 months

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What time period are the grasping reflexes present?

Birth-4 months

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What time period is the stepping reflexes present?

Birth-6 weeks

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What time period is the parachute reflex present for?

6 months-adulthood

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What time period is the gallant reflex present for?

Birth-6months

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What is sleep onset association disorder and how is it managed?

-Inability to fall asleep on own
-Falls asleep easily when parent present
-Frequent night wakenings
Management: bedtime routine, remove maladaptive sleep assoc., teach child to fall asleep on own

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What are the key/progression of fine motor skills?

4 months transfers objects
6-8 months palmar grasp
7-11 months pincer grasp
2 years uses spoon
4-5years snaps, buttons, zippers

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What are the key/progression speech and language for expression?

3 months cooing
6 months babbling
12 months language emergence
2 years 2 word combination , 50%
3 years 3 word combination, 75%
4 years phrased speech, 100%

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What can you expect from the average 18 month old?

15-25 words
Running
Word explosion
Single step commands
Knows body parts
Lots of gestures, pointing
Symbolic and parallel play

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What can you expect from the average 2 year old?

300-350 words (too many to count)
2-3 word phrases
pronoun use
2 step commands
enjoys other children

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Which features of stuttering increase concern?

Physical tension, concern, frustration/self consciousness, pausing between words, no improvement with initial strategies in 1 month

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What are the features of developmental dysfluency?

Occasional (once every 10 seconds)
Brief (0.5 seconds or less)
Repetition of sounds, syllables or words (no prolongations; at start of word)
Worse when tired, excited, complex language, questions, anxious
NO tension in facial muscles

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What is the diagnostic criteria for developmental coordination disorder?

A. Acquisition and execution of coordinated motor skills are substantially below expectations for a child’s chronological age and opportunities for motor skill learning. (Sx: clumsy, slow, inaccurate).
B. Interferes with ADLs for age, impacts life
C. Onset in early development
D. Deficit not better explained by intellectual disability, visual impairment, or a neurological condition affecting movement

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Which of the following medical conditions is associated with a higher prevalence of ADHD?
A. CHD
B. Epilepsy
C. Celiac disease
D. Hypotonia

Prevalence of ADHD in epilepsy is 2-3x higher - particularly inattentive
Genetic conditions have higher prevalence as well (Fragile X, Turner, TS, NF, 22q11del)

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Which of the following is the most common comorbidity with ADHD?
A. Disruptive behaviour disorders
B. Anxiety/OCD
C. Tic disorders
D. Specific learning disorders

D. Specific learning d/o: MOST common comorbid condition

The other options are all comorbid w/ ADHD but CPS says specific learning d/o is MOST common.

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How do you treat ADHD in a patient <6 years of age?

Parent behaviour training! Psychostimulants are NOT approved in this group.

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What is the DSM5 diagnostic criteria for ADHD?

Symptoms must occur <12 years
Symptoms present in >/=2 settings
Symptoms interfere with social, academic, occupational functioning
Not explained by another d/o
Need >/= 6 inattentive symptoms or hyperactive symptoms

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What is the recurrence risk for ASD in younger siblings when an older sibling has ASD?

7-19% (compared to 1.5% in the general population)

What are some early warning signs of ASD @ 6-12 months?

Less smiling
Limited eye contact
Atypical/reduced babbling, gesturing
Limited response to name when called

What are some early warning signs of ASD @ 9-12 months?

Emerging repetitive behaviours (spinning or lining up objects)
Unusual play (intense visual or tactile exploration of toys)

What are some early warning signs of ASD @ 12-18 months?

No single words
Absence of compensatory gestures (such as pointing)
Lack of pretend play
Limited joint attention (initiating, responding, sharing of interests)

What is an early warning sign of ASD @ 15-24 months?

-Diminished, atypical or no spontaneous or meaningful two word phrases

A school aged child's parents are divorcing. What do you anticipate their response will be?

Strong sense of rules and fairness, prone to loyality and taking sides

A 4yo child's parents are divorcing. What do you anticipate their response will be?

Blame themselves for separation, separation anxiety, excessive fears of abandonment

How many symptoms are required for diagnosis of ADHD?

>/= 6 - Symptoms must be present prior to age 12y, severe and persistent and inappropriate for age/developmental level, associated with impairment

What type of car seat should an infant have?

Rear facing

When can a child have a forward facing car seat?

2 years old w/ 5 point harness until at least 18kg/40lb

When can a child use a booster seat?

4 years old and at least 18kg/40lb

How tall does a child need to be to use an adult seat belt?

145cm - should have high back booster seat if a vehicle's back seat does not have adjustable head rest

What is first line therapy for a child with ADHD <6yo?

Parent behaviour training

What are the benefits associated with ADHD pharmacotherapy?

- Improved academic outcome - Lower comorbid anxiety and depression - Improved function - Reduced morbidity and mortality related to MVAs

Name 3 conditions which are higher risk for ADHD.

-ASD, ID and prematurity

What is the first line management for ODD?

Behavioural parent training, CBT

What are the first line investigations for a child with GDD/ID?

- Hx&PE, if something targeted, investigate that, think about cong. infection - Vision & hearing - Microarray (47% yields dx) - Fragile X - MECP2 to r/o Retts if female & sx of same present - Thyroid (yield is essentially 0 if N NMS) - Lead and ferritin (if PICA/mouthing) - Metabolic (if strongly suspected)

What is often the earliest indication of neuromotor dysfunction (ie. CP)?

Persistent fisting at 3 months of age

Which SSRI is contraindicated in long QT syndrome?

Citalopram

At what age does head banging become concerning?

Child psychiatry referral is recommended if it persists beyond 3 years or if there is a lack of social interaction.

What are the contraindications to breastfeeding per the CPS statement?

- HIV + - Cytotoxic chemotherapy - Radioactive isotopes or radiation therapy - Galactosemia

Name two developmental red flags at 9 months.

1. Not sitting well | 2. Decrease in vocalizations

Name two developmental red flags at 12 months.

1. No words or name recognition | 2. Not pulling to stand

Name two developmental red flags at 18 months.

1. Less than 15 words | 2. Social communication concerns

Name 2 underlying neurologic disorders associated with ASD.

1. Tuberous sclerosis 2. NF-1 - Rett syndrome - Angelman - T21

What are the early onset side effects of stimulants?

Decreased appetite, sleep, exacerbation of tics

What is a late onset side effect of stimulants?

Depression

What are the common early warning signs for cerebral palsy?

- Hand preference before 12 months - Stiffness or tightness in the legs before 12 months - Inability to sit by 9 months - Persistent fisting of hands beyond 4 months - Delays or asymmetry in movement or posture

What is the most likely etiology of spastic unilateral or hemiplegic CP?

Stroke or cerebral malformation

What is the most likely etiology of spastic bilateral CP?

Prematurity typically secondary to periventricular white matter injury

Who is more likely to have seizures? A child with spastic unilateral CP or bilateral CP?

Spastic unilateral CP due to stroke or cerebral malformations are particularly vulnerable to seizures, children with spastic B/L CP from PVL develop seizures less frequently as the cortex is often relatively spared

What is the most common comorbid disorder with ADHD?

Intellectual disability