Development Flashcards
(66 cards)
1
Q
Gross Motor Red Flags
A
4m Head control
9m Sits unsupported
12m Stands unsupported
18m Walks independently
2
Q
Vision and Fine Motor Red Flags
A
3m Fixes and follows
6m Reaches for objects
9m Transfers
12m Pincer grip
3
Q
Hearing, Speech and Language Red Flags
A
7m Polysyllabic babble 10m Consonant Babble 18m 6 words with meaning 2y Joins words 2.5y 3-word sentances
4
Q
Social Behaviour Red Flags
A
8w Smiles 10m Fear of strangers 18m Feeds self/spoon 2-2.5y Symbolic play 3-3.5y Interactive play
5
Q
Primitive Reflexes
A
Moro Grasp Rooting Stepping response Asymmetrical tonic neck reflex Sucking reflex
6
Q
Postural Reflexes
A
Labyrinthine Righting
Postural support
Lateral propping
Parachute
7
Q
Childhood thought processes (Piaget)
A
Centre of the world
Inanimate objects are alive and have feelings
Magical element to environment
Everything has purpose
8
Q
Healthy child surveillance programme
A
Provided in primary care
Screening, immunisations, developmental review and health promo
9
Q
Hearing testing
A
Otoacoustic emission- newborn screening
Auditory brainstem- newborns with abnormal screen
Distraction testing- prev. hearing screening at 7-9m (requires object permeance ability)
Visual reinforcement- hearing impairment 10-18m, children with learning disability
Performance speech and discrimination- toy use in younger children.
Audiometry- >4y
10
Q
Vision testing
A
Newborn- aware of light 6w- fix and follow 6m- fixates and visually directed reach 12m - fixates on 1mm crumb 1-2y preferential acuity test .e.g. Cardiff cards 2-3y picture matching .e.g. kay or lea 3y + letter matching .e.g. logMAR
11
Q
Gross motor milestones
A
Newborn- limb flexed, symmetrical posturing, lag head 6w raises head 45' in prone 6m sits unsupported arched back 8m sits unsupported straight back 9m crawling 10m stands and cruises 12m walks unsteady broad based gait 15m walks steadily
12
Q
Vision and fine motor milestones
A
6w fixes and follows 4m reaches for toys 6m palmar grasp 7m transfers toys 10m mature pincer grip 18m marks with crayon
13
Q
Blocks Milestones
A
18m tower of 3 2y tower of 6 2.5y tower of 8 or 4 block train 3y bridge from model 4y steps after demo
14
Q
Drawing shapes milestones
A
2y line 3y circle 3.5y cross 4y square 5y triangle (Drawing from copy 6 m before)
15
Q
Hearing, speech and language milestones
A
Newborn- startles to loud noise
4m vocalises when alone, coos and laughs
7m turns to sound out of sight, sound indiscrimate
10m discriminate sound to mama/dada
12 m 2-3 words
18m 6-10 words, localises 2 parts of body
20-24m joins 2 words for simple sentences
2.5-3y talks constantly 3-4 word sentences
16
Q
Social and behaviour milestones
A
6w smiles 8m food to mouth 10m waves bye-bye, plays peek-a-boo 12m drinks from a cup with 2 hands 18m holds spoon and transfers to mouth 18-24m symbolic play 2y dry by day, pulls off some clothes 2.5-3y parallel play 3-3.5y interactive play
17
Q
Age of presentation- developmental areas
A
Newborn- 18m Motor
18m-3y Speech and language
2-4y Social communication
18
Q
Global developmental delay features
A
Delay in acquisition of all skills
Presents within first 2 years of life
19
Q
Causes abnormal motor development
A
Central motor deficiet .e.g. cerebral palsy
Congenital myopathy/primary muscle disease
Spinal cord lesions .e.g. spina bifida
Global developmental delay
20
Q
Presentation motor delay
A
Between 3m and 2y
Abnormal motor signs
Delay in acquisition of motor skills
Early hand dominance (<1-2y)
21
Q
Definition Cerebral Palsy
A
Non-progressive abnormality of brain development resulting disorder of motor function and posturing
Brain injury must occur before 2 years old
22
Q
Antenatal causes of cerebral palsy
A
- cerebrovascular haemorrhage/ischamia
- cortical migration disorder
- structural maldevelopment
23
Q
Postnatal causes of cerebral palsy
A
Meningitis Encephalitis Encephalopathy Head trauma symptomatic hypoglycaemia hydrocephalus hyperbilirubinemia
24
Q
Preterm complications causing CP
A
Periventricular leukomalacia associated with ischaemia or severe intraventricular haemorrhage and venous infarction
25
Presentation cerebral palsy
```
Abnormal limb/trunk posture and tone
Delayed infancy milestones
Slowing of head growth
Feeding difficulties: oromotor co-ordination, slow feeding, gagging, vomiting
Asymmetric hand function <12m
Persisting primitive reflexes
```
26
Categories of cerebral palsy
Spastic: bilateral, unilateral and not specified (90%)
Dyskinetic (6%)
Ataxic (4%)
Other
27
Gross motor function classification
I walking without limitation
II walking with limitation
III walking with handheld mobility device
IV self-mobility with limitation .e.g. uses powered mobility aid
V transported in manual wheelchair
28
Spastic Cerebral Palsy Types
Bilateral (quadriplegia)
Unilateral (hemiplegia)
Bilateral (diplegia)
29
Pathology Spastic Cerebral Palsy
Damage to UMN
| Pyrimidal or corticospinal tracts
30
Signs Spastic Cerebral Palsy
```
Brisk deep reflexes
Extensor plantar reflex
Velocity dependant spasticity
Dynamic catch (hallmark feature)
Presents early: seen in newborn period
Initial hypotonia of head and trunk
```
31
Features unilateral hemiplegia CP
```
Unilateral involvement of arm and leg
Arm>>leg
Sparing of face
Present at 4-12m
Fisting of affected hand
Flexed, pronated arm
Asymmetric reaching
Tip-toe walking on affected side
Typically due to neonatal stroke
```
32
Features bilateral quadriplegia CP
All 4 limbs affected
Trunk involvement- opisthotonus (extensor posturing)
Poor head control
Low central control
Associated with seizures and microcephaly
Perinatal hypoxic-ischaemic encephalopathy
33
Features bilateral diplegic CP
```
All 4 limbs affected
Legs>>arms
Normal hand function
Abnormal walking
Associated with prematurity (periventricular brain damage)
```
34
Features Dyskinetic CP
```
Involuntary uncontrolled movements (>1y)
Chorea/athetosis/dystonia
Variable muscle tone
Primitive motor reflexes
Unimpaired intellect
Basal ganglia damage- usually bilateral
Associated with kernicterus
```
35
Features Ataxic CP
```
Usually genetically determined
Early trunk and limb hypotonia
Poor balance
Delayed motor development
Inco-ordinated movements
Intention tremor
```
36
Mx Cerebral Palsy
MDT approach
Early diagnosis and counselling for parents
Botulinum Toxin (hypertonia)
Dorsal rhizotomy (selective cutting of spinal cord nerve)
Intrathecal baclofen
Deep brain stimulation for basal ganglia
37
Causes of Speech and Language Delay
```
Hearing loss
Global developmental delay
Difficulty in production due to anatomy
Environmental deprivation/neglect
Normal variant/familial pattern
```
38
Testing language development
Symbolic toy test: early language development
| Reynell test: receptive and expressive language (pre-school children)
39
Mx Speech and Language delay
```
Hearing test
Assessment by SALT
Neurodevelopmental paeds referral
Audiology physician involvement
SALT
Alternative methods of communication
Specialist schooling
```
40
ASD Impaired social interaction Features
```
Does not seek comfort/share pleasure
Does not form friendships
Prefers own company
No interest in interaction with peers
Gaze avoidance
Lack of joint attention
Socially and emotionally inappropriate behaviour
No appreciation of others thoughts and feelings
Lack appreciation of social cues
```
41
ASD Speech and Language Features
Delayed development
Limited use of gestures and facial expression
Formal pedantic language, monotonous voice
Impaired comprehension with over literal interpretation
Echos questions, repeats instruction, refers to self as 'you'
Superficially good expressive speech
42
ASD Routines and ritualistic behaviour
```
Violent temper tantrums if disrupted
Imposition on self and others
Unusual stereotypical movements
Concrete play
Poverty of imagination
Peculiar interests and repetitive adherence
Restriction of behavioural repertoire
```
43
ASD Co-morbidities
General learning and attention difficulties
Seizures- presenting in adolescence
Affective disorders .e.g. anxiety, sleep disturbance
Mental health disorder .e.g. ADHD
44
ASD Epidemiology
3-6/1000 live births
More common in boys
Presentation aged 2-4 (social development)
45
Asperger's Syndrome Features
```
Milder version of ASD
Near-normal speech development
Difficulty in give/take social interaction
Stilted speaking
Narrow, unusual and intense interests
```
46
Mx ASD
Parental support
Behavioural modification: 25-30h individual therapy
Appropriate educational placement
47
Learning Disability and IQ
IQ 70-80 Mild, requires learning support, mainstream school
IQ 50-70 Moderate
IQ 30-50 Severe
IQ <35 Profound
48
Dyspraxia Features
Disorder of motor planning
Higher cortical processing disorder
Perception problems, use of language and putting thoughts together
49
Dyspraxia Presentation
```
Awkward, messy, slow, irregular, poorly spaced writing
Difficulty dressing
Difficulty cutting up food
Poorly established laterality
Problems copying and drawing
Messy eating
Dribbling of saliva
```
50
Mx Dyspraxia
SALT assessment
Visual assessment
Therapy on sensory integration, sequencing, executive planning
Improvement with maturity
51
Verbal dyspraxia definition
Difficulty with speech production in the absence of muscle or nerve damage
52
Dyslexia Features
Disorder of reading skills disproportionate to IQ
| Child's reading age is more than 2 years behind chronological age
53
Features of ADHD
```
Overactive in most situations
Impaired concentration
Unable to sustained attention and complete tasks
Socially disinhibited
Difficulty taking turns/sharing
Interrupt and butt into others conversations and play
Worse in unfamiliar or boring situations
Lose possessions and generally disorganised
Short tempers
Form poor relationships
Poor school performance
Low self-esteem
```
54
Behavioural Mx ADHD
Promotion of behavioural and educational progress
Parenting intervention
Clear rules and expectations
Consistent rewards and consequences for behaviour
55
Medical Mx ADHD
Children >6y
Stimulants .e.g. methylphenidate, dexamphetamine
Non-stimulants .e.g. Atomoxetine (reduces excessive motor activity)
Annual off-medication trial to assess need
56
Causes sensorineural hearing loss
```
Genetic (most common)
Antenatal/perinatal infection
Prematurity
Hyperbilirubinaemia
Hypoxic-ischemic encephalopathy
Meningitis/encephalitits
Head injury
Medications .e.g. aminoglycosides, furosemide
Neurodegenerative disorder
```
57
Causes conductive hearing loss
Otitis media with effusion
Eustachian tube dysfunction .e.g. Down's, Pierre Robin, midfacial hypoplasia
Wax (rare)
58
Mx Sensorineural hearing loss
Amplification or cochlear implantation
Specialist schooling
Use of makaton
School adjustments: placed in front of the classroom
59
Mx Conductive hearing loss
Insertion of tympanostomy tubes
Removal of adenoids
Hearing aids used if recurrence following surgery
60
Audiogram in hearing loss
Sensorineural >95dB hearing loss
| Conductive maximum 60dB hearing loss
61
Presentation of visual impairment
```
Obvious ocular malformation
Absent red reflex or leukocoria
Not smiling by 6w post-term
Concerns re poor visual responses
Poor eye contact
Roving eye movements
Nystagmus
Squint
```
62
Features Nystagmus
Repetitive involuntary rhythmical eye movement
Usually horizontal
May be associated with structural or cortical defect
63
Types of squint
Concomitant- nonparalytic, common, due to refractive error
Paralytic- rare, due to paralysis of motor nerve
Transient misalignement- common until 3m
64
Causes of squint
Refractive error (most common)
Cataracts
Retinoblastoma
Intra-ocular
65
Ix Squint
Corneal light reflex test- torch at a distance, asymmetry of reflection
Cover test- covering fixing eye causes movement of squinting eye to take up fixation
66
Refractive errors
Hypermetropia (long sighted)- most common
Myopia (short-sighted)- presents in adolescents/preterms
Astigmatism (abnormal corneal curvature)- unilateral may cause amblyopia
Amblyopia- permanent reduction of visual acuity in an eye which has not received a clear image (Mx<7y)
