MRCPCH Clinicals > Development > Flashcards

Development Flashcards

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1
Q

What are the pertinent points in the antenatal history to cover for development?

A

Scans
Serology
Maternal alcohol/drug/smoking use
Did mum take her vitamins during pregnancy?

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2
Q

What are the pertinent points in the perinatal history to cover for development?

A

Gestation
Birth type/condition at birth
Birth weight
Resuscitation (help from neonatal doctors)
Vitamin K

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3
Q

What are the pertinent points in the postnatal history to cover for development?

A

If NICU:
- Jaundice
- Infection: any positive results? Meningitis?
- Respiratory: Tubed? Home O2?
- Feeding: NEC? NG?
- Neurological: CrUSS
- ROP
- Surgery?

Hearing: newborn screen and any aminoglycosides
Blood spot
Baby check at 8 weeks
Any health visitor?

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4
Q

What are the pertinent points in the family history to cover for development?

A

Consanguinity
Any other children in special schools/issues with development?
Did you notice any differences between your child and their brother/sister when they were walking?
Maternity leave - is mum still on it or has she gone back to work?

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5
Q

What does BINDS stand for in a developmental history?

A

Birth
Immunisation
Nutrition - growth and eating habits, centiles
Development
Social

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6
Q

What are the pertinent points in the social history to cover for development?

A

Is there anything that makes it difficult to care for your child?
Any social worker/health visitor input?
Any adaptations at home?
What type of flat?
Any social/financial support?
Educational health care plan? If so, what does the child receive? (1 to 1, Speech and language)
Are the other children coping?

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7
Q

When taking the developmental history, what is pertinent to ask about their development?

A
  • Any developmental regression? = Was s/he able to do things in the past that s/he wasn’t able to do now?
  • Hearing/vision concerns? Does your child wear glasses? Have hearing aids?
  • Any concerns about how your child is learning?
  • Is your child generally happy, compliant and cooperative?
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8
Q

What is the screening question for gross motor during the history?

A

Any concerns about how your child walks, runs or does physical activities?
Any difference between the upper and lower limbs? Or between right and left side?
Any equipment/adaptations to the home?

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9
Q

What is the screening question for fine motor during the history?

A

Any concerns about how your child uses his/her hands to do things?
Any hand preference?
Do they wear glasses?

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10
Q

What is the screening question for social during the history?

A

Any concerns about how your child behaves, gets along with others, plays with themselves or does things for themselves?

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11
Q

What are the questions to ask if suspicious of autism?

A

If their routine is disrupted, what happens?
Are they sleeping ok?
How do you know if your child likes something, do they point to it?
- If no, very sensitive for autism

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12
Q

What is the screening question for speech and language during the history?

A

Any concerns about how your child talks and makes speech sounds? Does your child understand what you say?
How many languages do you speak at home?

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13
Q

What is the definition of cerebral palsy?

A

Disorder of movement and posture due to abnormalities in muscle tone from a non-progressive lesion in the developing brain

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14
Q

Development history summary structure

A

I spoke to X, mum of X year old X, referred by X due to concerns regarding….
Briefly summarise PMHx
From my brief history, the child’s developmental age in each domain is (state the developmental age range), suggesting (delay or no delay)
I would like to move onto my developmental assessment.

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15
Q

What 5 x questions do you need to ask at the beginning of a developmental examination?

A

1) What are they doing in the room?
2) Do they look well or unwell? Do I have a set of observations?
3) Are they well grown for their age? Plot their height, weight and head circumference on an appropriate growth chart.
4) Can I appreciate any signs of dysmorphism/coarse facial features?
5) Have they brought anything with them?

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16
Q

What does the pneumonic PGDSM stand for in the context of development differentials?

A

“Please Give Development Some Matter”

  • Premature/perinatal causes (congenital infections/toxin exposure)
  • Genetic
  • Development: autism/ADHD
  • Social: nutritional deficiency, neglect/abuse
  • Medical: hypothyroidism, infection, trauma, cerebral palsy
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17
Q

What 5 x things would you always mention in investigations in a development station?

A

1) Perform a standardised development assessment using Bayley’s scales or Denver

2) Corroborate findings with the red book/report from school or health visitor

3) Further systemic examination

4) Formal hearing and vision assessment

5) Plot height, weight and head circumference

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18
Q

What standardised scale can be used to rate autism?

A

Gilliam autism rating scale

Behavioural rating scale completed by parents, teachers or carers. Designed for children from 3 onwards until 22 yo. Helps assess probability and severity of ASD traits. The higher the score, the greater likelihood of ASD. Not diagnostic but aids diagnosis - must be a multi-disciplinary diagnostic approach.

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19
Q

What standardised assessment tool can be used for development? Name 2.

A

Bayley’s = gold standard developmental assessment in infants (1-42 months)
- Diagnostic
- Used for formal diagnosis; especially in high risk infants (prematurity, HIE)

Denver Developmental Screening Test = screening tool; used to identify children who may need further assessment (birth - 6 years)
- Screening NOT diagnostic

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20
Q

Which standardised developmental screening assessment tool is diagnostic?

A

Bayley Scales of Infant and Toddler Development

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21
Q

Which standardised developmental assessment tool aids in diagnosis but is not diagnostic?

A

Denver Developmental Assessment

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22
Q

What blood tests may you consider doing in a developmental station?

A

Nutritional bloods
Screen for chronic disease/inflammatory pathology
Chromosomal (microarray, Fragile X, DMD/SMD)
TFTs
TORCH
CK
U&Es and bone profile (DiGeorge/Williams)
Lead/biotinidase deficiency

Metabolic screen (if organomegaly, coarse features, FTT, consanguinity, neonatal deaths)

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23
Q

If a child displays neurological symptoms such as micro/macrocephaly, seizures, behavioural, focal neurology, what other investigations would you consider doing?

A

EEG
Neuroimaging (CT/MRI head)
Eye exam

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24
Q

What would your approach to management be in general for development station?

A

1) I would discuss this with my consultant

2) Make a referral to the community paediatrician

3) Biopsychosocial MDT approach led by the community paediatrician:
- Bio: hospital specialists, PT/OT, dietitian, audiology/optometry, genetic counselling
- Psycho: Family respite, educational psychologist
- Social: EHCP with Special Education Needs Co-Ordinator (SENCO); Financial support: disability living allowance; social care input: early help referral, CIN/Safeguarding concerns

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25
For fine motor assessment, what are the 3 x main categories to ask before examination?
1) 5 x general questions: well/unwell? Growth? Obs? Dysmorphism? Brought anything with them? 2) Hand dominance? 3) Vision and if there are any concerns with this?
26
What are the 6 subdomains you would assess in a fine motor assessment?
Books Block Beads Puzzle Paper Scissors BBBPPS
27
What fine motor skill should a 6 week old be able to display?
Fix and follow to 90 degrees
28
What fine motor skill should a 3 month old be able to display?
Fix and follow to 180 degrees Holds rattle
29
What is a red flag if not achieved by 3 months?
Not fixing and following
30
What fine motor skill should a 6 month old be able to display?
Palmar grip Reaches for objects and transfers objects between hands Shakes rattles Mouthing
31
What fine motor skill should a 9 month old be able to display?
Inferior pincer grip Bangs bricks Release objects Looks for fallen objects Object permanence = understanding that objects continue to exist even when they cannot be seen, heard or touched
32
What is object permanence and when should it be established?
Understanding that objects continue to exist even when they cannot be seen, heard or touched Begins around 6-8 months and fully established by 9-12 months
33
What fine motor skill should a 12 month old be able to display?
Points with index finger Neat pincer grip Stack 2 bricks Bangs bricks/casting
34
What fine motor skill should a 18 month old be able to display?
Books: turn many pages together and points Bricks: stack 3-4 cubes Draw: scribble to and fro
35
What is a red flag if this fine motor skill is achieved before 18 months?
Hand dominance
36
What is a red flag if this fine motor skill persists beyond 18 months?
Casting
37
What fine motor skill should a 24 month old be able to display?
Bricks: stack 6-8 blocks Draw: vertical line Puzzle: shape matching > 2 year old
38
What fine motor skill should a 2.5 year old be able to display?
Draw: Horizontal line
39
What fine motor skills should a 3 year old be able to display?
Books: turns one page at a time Beads: Large Griffiths beads Blocks: Bridge/train Draw: Circle Scissors: Single cuts and able to move forward slightly
40
What fine motor skills should a 4 year old be able to display?
Bricks: 3 steps Beads: smaller beads Drawing: Square + cross Scissors: cut along a curvy line + cut paper in half
41
What fine motor skills should a 5 year old be able to display?
Bricks: > 3 steps, stack 15 blocks Draw: triangle, man, multiplication cross
42
What fine motor skills should a 6 year old be able to display?
Draw: diamond
43
What are the 3 general categories of questions to ask initially in a gross motor assessment?
1) 5 x general questions: well/unwell; obs; growth; dysmorphism; brought anything with them? 2) Milestone: age of first steps 3) Impacts on ADLs (GMFCS)
44
What are general things to comment on or ask in a gross motor developmental assessment? x 3
1) DWARFS (Deformities, wasting, asymmetry, rashes, fasciculations 2) Comment on walking, clumsiness, balance and abnormal movements 3) If a child can't do something, ask if they could do it in a different setting
45
What gross motor skills should a 6 week old be able to display?
Head in line with body Raises head to 45 degrees when prone
46
What gross motor skills should a 3 month old be able to display?
No head lag Lifts upper chest when prone
47
What gross motor skills should a 4-5 month old be able to display?
Rolls from front to back
48
What gross motor skills should a 6 month old be able to display?
Sit unsupported with rounded back (6 looks curved) Rolls from back to front
49
What gross motor skills should a 7 month old be able to display?
Sit unsupported with a straight (7 looks straight) Crawls (6-9 months)
50
What gross motor skills should a 9-10 month old be able to display?
Pulls to stand holding on Cruises
51
What is a red flag if this gross motor skill is not achieved by 9 months?
Not being able to sit unsupported by 9 months
52
What is a red flag if this gross motor skill is not achieved by 12 months?
Not pulling to stand by 12 months
53
When do most primitive reflexes disappear by?
6 months Plantar grasp is the last (12 months)
54
What does it suggest if a primitive reflex persists beyond expected age?
UMN pathology
55
What gross motor skills should a 12 month old be able to display?
Walking - Should be able to walk alone by 10-15 months
56
What gross motor skills should a 18 month old be able to display?
Squats - unsupported Walks forward and steady, with toy Runs - unsteadily, falls
57
What gross motor skills should a 2 year old be able to display?
Stands: on tiptoes Walk: backwards Jumps: in place Stairs: both feet per each step Ball: throw and kick inaccurately; can throw at shoulder level
58
What gross motor skills should a 2.5 year old be able to display?
Kicks ball
59
What gross motor skills should a 3 year old be able to display?
Stands: on 1 foot for 1 second Walks: on tiptoes Runs: smoothly, fast Jump: forwards; hops on one foot for 3 steps Stairs: up 1 step per foot, down 1 step using 2 feet Tricycle
60
What screening question could you ask in the history for gross motor?
Do you have any concerns about how your child walks or runs or does physical activities?
61
What screening question could you ask in the history for fine motor?
Do you have any concerns about how your child uses his or her hands to do things?
62
What screening question could you ask in the history for speech and language?
Do you have any concerns about how your child talks and makes speech sounds? Do you have any concerns about how your child understands what you say?
63
What screening question could you ask in the history for hearing and vision?
Do you have any concerns about your child's hearing or vision?
64
What screening question could you ask in the history for social, behaviour and play?
Do you have any concerns about how your child behaves? Do you have any concerns about how your child gets along with others? Do you have any concerns about how your child does things for him or herself? Do you have any concerns about how your child plays by themselves or with others?
65
What screening question could you ask in the history for cognition?
Do you have any concerns about your child's learning?
66
What other vital question is important to ask in a developmental history?
Have there been any loss of skills? Has X learned skills which they are no longer able to do now? Regression
67
What gross motor skills should a 4 year old be able to display?
Walks: forward tandem Runs: on tip toes Jumps: run, climb and jump wall Stairs: Up and down as normal Ball: throws ball overhead/kicks when running; can catch outstretched
68
What are the general questions you want to ask when assessing social domain? x 4
1) General: well/unwell? Growth? Obs? Dysmorphism? Brought anything with them? 2) Mood 3) Behaviour 4) Learning
69
What are the 4 sub domains broadly in social domain?
Toileting Dressing Feeding Play
70
What social skills should a 6 week old be able to display?
Social smile Looks at faces
71
What social skills should a 3 month old be able to display?
Laugh and squeal
72
What social skills should a 6 month old be able to display?
Mouthing (stops at 15 months) Shakes rattle Reaches for bottle
73
What social skills should a 9 month old be able to display?
Stranger anxiety (sense of self) Peek-a-boo Understands "No" and "Bye Bye"
74
What is a red flag if this social skill is not achieved by 9 months?
No shared enjoyment
75
What social skills should a 12 month old be able to display?
Waves bye Claps hands Finger feeds Indicates need to go to the toilet Can drink from lidded cup/beaker
76
What social skills should a 18 month old be able to display?
Indicates need to go the toilet with bowel control Takes off shoes and socks
77
What social skills should a 2 year old be able to display?
Washes hands Helps undress (puts arms up to put shirt on) Can drink with unlidded cup Can use spoon
78
What social skills should a 2.5 year old be able to display?
Uses a spoon and fork (2.5-3 yo) Spectator play, turn taking and pretend/imaginative play
79
What social skills should a 3 year old be able to display?
Toileting alone Undresses independently + fastens velcro/button Uses spoon and fork Plays make believe and shares
80
What social skills should a 4 year old be able to display?
Helps dress Has a best friend, sympathy, reciprocity (is nice)
81
What social skills should a 5 year old be able to display?
Dry by night Dresses independently and ties shoelaces Uses knife
82
What are the general questions to ask in a speech and language examination station? x 3
1) General: well/unwell? Growth? Obs? Dysmorphism? Brought anything with them? 2) Any hearing issues? Swallowing/speech issues? 3) Languages spoken at home?
83
What would you comment on in general inspection for a speech and language examination station? x 3
- Cleft lip, micrognathia, large tongue, drooling, hearing aids, eye contact - Comment on quality (fluency/clarity) and quantity of speech sounds - If the child cannot do something, ask the parent if they are able to in a different setting
84
What aide memoire could you use to help with verbal progression in speech and language?
NVP NACC Nouns Nouns (by 2 years old - 2 x nouns) Verbs Prepositions Negatives Adjectives Comparatives Complex
85
What speech and language skills should a 6 week old be able to display?
Cries Coos Startles to noise
86
What speech and language skills should a 3 month old be able to display?
Quietens to noise Turns to sound/mum's voice
87
What speech and language skills should a 6 month old be able to display?
Monosyllabic babbles Turns head to loud noise
88
What speech and language skills should a 9 month old be able to display?
Bisyllabic babbles (mama, dada, non-specific) Imitates adult noises
89
What speech and language skills should a 12 month old be able to display?
Says a few words Follows simple commands Turns to name Understands nouns: "Where's Mummy?"
90
What speech and language skills should a 15 month old be able to display?
Point to own body parts
91
What speech and language skills should a 18 month old be able to display?
Point to body parts on a doll
92
What is a red flag if this speech and language skill is not achieved by 1-2 weeks?
Not startling to noise
93
What is a red flag if this speech and language skill is not achieved by 12 months?
Not babbling by 12 months
94
What speech and language skills should a 2 year old be able to display?
General: Say their first name Expressive: 2 word sentences 50+ words Receptive: Understands double commands "Can you show me the paper and tell what you draw with?" Understands nouns "Show me the...." Understands verbs "What do you draw with? What do you eat with?"
95
How would you test a 2 year old if they understand nouns and verbs?
"Show me the paper" "What do you draw with?" "What do you eat with?"
96
What speech and language skills should a 2.5 year old be able to display?
Understand prepositions "Put the spoon in the bowl" On --> under --> in front --> behind
97
What speech and language skills should a 3 year old be able to display?
General: Says full name Knows their age and sex Knows 3 x colours Can count from 1-10 Expressive: - 3-4 word sentences - 500-900 words - Plurals, pronouns, preposition (on, off, in), who/what/why Receptive: - Understands triple commands - Understands negative "Which of these is not an animal?" can use car, horse and pig toys - Understands adjectives "Which of these is red?" - take red, yellow and purple crayons
98
What speech and language skills should a 4 year old be able to display?
General: - Knows address - Knows most colours - Knows full alphabet Expressive: - 5 word sentences - Understands stories, past tense - Tell stories Receptive: - Understands complex narratives/sequences/stories
99
What speech and language skills should a 3.5 year old be able to display?
Receptive: - Comparatives "Which circle is bigger?"
100
How would you assess if a 3.5 year old can understand comparatives?
I would draw two circles of different sizes and ask the child to show me which circle is bigger
101
What speech and language skills should a 5 year old be able to display?
General: - Knows own birthday Expressive: - Carry conversation - Defines simple words
102
How would you assess if a 3 year old understands prepositions and a 3 step command?
Can you put the spoon in the bowl, then put the bowl underneath the table and put the cup in front of the bowl?
103
How can you assess if a 3 year old understands negatives?
I would clear the table and place a car, toy horse and toy pig in front of the child. I would ask the child to show me which is not an animal.
104
How can you assess if a 3 year old can understand adjectives?
I would clear the table and place a red, yellow and purple crayon in front of the child. I would then ask the child "Which of these crayons is red?"
105
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