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Flashcards in Development Deck (42)
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1
Q

Gross motor milestones

A

By 4 mos: head control (red flag at 6mo)
By 6mo: sit well and roll both ways (red flag at 9 mo)
By 10mo: pull to stand (red flag at 15mo)
By 12 mo: first steps (red flat at 18 mo)
24 mo: run and jump
Stairs: 18mo railing, 24mo no railing
tricycle: 36 mo
hop: 48 mo
skip: 60 mo

2
Q

Fine motor milestones

A
4 mo: hands to midline, reaching
6-8 mo: palmar grasp
9-12 mo: pincer grasp
2 yrs: spoon, copies vertical line
4-5 yrs: dresses without buttons, draws 10+ part person
3
Q

Speech and language milestones

A
2-4 mo: visual attention
6-9 mo: babbling
12 mo: language emergence
2yrs: 2 word combos, 50% intelligible
3 yrs: 3 word combos, 75% intelligible
4 yrs: phrased speech, 100% intelligible
4
Q

Speech and language delay first step

A

Audiology!

5
Q

Social and emotional milestones

fears and friendships

A
  • stranger anxiety: 5-6 mo
  • separation anxiety: 9-15 months
  • monsters: 3-5 yrs
  • death:7/8 -10 yrs
  • best friend: 4-6 yrs
6
Q

Recurrence rates for autism in younger siblings

A
  • 7-19% vs. 1.5%
7
Q

Early autism warning signs

A
  • parental concerns around language delay
  • lack of response to name
  • limited eye contact
8
Q

Child with features of autism, what to do next?

A
  1. audiology (and vision)
  2. refer to SLP
  3. ASD specific screening instrument
  4. refer to developmental paediatrician or multidisciplinary team
  5. genetic testing: chromosome microarray and fragile x
9
Q

Work up for intellectual disability to be considered (9)

A
  • chromosome microarray
  • fragile x
  • MECP2 (if female with mod-severe and sx present)
  • thyroid
  • lead and ferritin (only if mouthing/pica)
  • metabolic testing (only if strongly suspicious)
  • ophtho and audiology!
  • neuroimaging
  • EEG (only if sx suspected)
10
Q

Developmental dysfluency

A
  • occasional (1x every 10 sentences)
  • brief (0.5s or less)
  • repetition of sounds, syllables or words (no prolongations)
  • worse when tired, excited, anxious, complex language
  • no tension in the facial muscles
11
Q

ADHD management by age

A

Ages 4-5: behaviour therapy
- methylphenidate if you need to
Ages 6-18: start with meds and/or behaivour therapy (preferably both)

12
Q

Late onset side effect of stimulants

A

depression!

13
Q

FASD common issues

A
  • cognitive and learning disorders
  • ADHD (severe and refractory)
  • poor judgement, poor sense of cause and effect
14
Q

FASD facial features

A
  • microcephaly
  • low nasal bridge
  • short nose
  • short midface
  • indistinct philtrum
  • short palpebral fissures
  • thin upper lip
15
Q
  • ADHD plus autism
  • ADHD plus ID
  • ADHD plus prematurity
A

ASD: > 50% of those with ASD meet criteria for ADHD

ID: 3-4x higher prevalence of ADHD

Prem <1500g, and <26 weeks: 2x as likely to have ADHD

16
Q

Pros of pacifiers

A
  • prevention from SIDS

- non-nutritive sucking has benefits

17
Q

Cons of pacifiers

A
  • contain microorganisms ?risk factor for OM
  • may have negative effect on dentition (but better than finger sucking)
  • ?breastfeeding challenges
18
Q

Risks of screen use

A
  • decreased opportuniteis for place and face/face interaction
  • increased risk of depression and anxiety
  • increased risky behaviours
  • increases unehalthy eating
  • impacts sleep
  • distracted driving
19
Q

When to begin sleep training

A
  • after 6 months
    Most infants sleep through night (uninterrupted sleep for 6-8 hrs) after 6 months
    (many can sleep at least 5hrs by 3-4 months)
20
Q

Positional plagiocephaly prevention recommendations and management

A
  • Tummy time 10-15min 3x/day
  • treat torticollis with physiotherapy if present
  • moulding therapy (helments) can be consiered fro severe asymmetry
21
Q

Peak crying time is:

A

up to 3 hours of day (normal)

at 6 weeks of age

22
Q

Readiness for toileting (6)

A
  • walk to potty
  • sit with stability
  • remain dry for several hours
  • have appropriate language skills
  • have desire for independence
  • respond to positive reinforcement
23
Q

Cardiac risk assessment for stimulants for ADHD

- history

A
  • decreased exercise tolerance
  • extreme SOB with exercise
  • fainting or seizures or palpitation with exercise or startle/fright
  • family hx: long QT, arrhythmia, WPW, cardiomyopathy, heart transplant, pulmonary HTN, unexplained death, implantable defibrillator
24
Q

Cardiac risk assessment for stimulants for ADHD

- physical

A
  • pathologic sounding murmur
  • absent or femoral pulses
  • sternotomy incision
  • hypertension
25
Q

Social history “ITHELPS”

A
income
transportation
housing
education
legal status
literacy
personal safety
support
26
Q

GDD criteria

A

2+ SD below mean in at least 2 developmental domains from:

  • GM or FM
  • Speech/language
  • cognition
  • social/personal
  • ADL
27
Q

ID criteria

A
  1. deficits in intellectual functioning
  2. deficits in adaptive functioning in 1+ of communication, social participation, independent living in across multiple enviornments
  3. onset from developmental period
28
Q

Red flags suggestive of IEM

A
  • Fam history of IEM or dev disorder or unexplained infant death
  • Consanguinity
  • IUGR/FTT
  • HC or stature growth abnormality (>2SD)
  • Recurrent vomiting, ataxia, seizures, lethargy, coma
  • Hx of being severely symptomatic and needing longer to recover with benign illnesses (e.g. URTIs)
  • Protein or CHO aversion
  • Regression in developmental milestones
  • Behavioural or psychiatric problems (psychosis at a young age)
  • Movement disorder (dystonia)
  • Facial dysmorphism (course facial features)
  • Organomegaly
  • Severe hypotonia
  • Congenital anomalies
  • Sensory deficits, especially if progressive (e.g. cataracts, retinopathy)
  • Noncongenital progressive spine deformities
  • Neuro-imaging abnormalities
29
Q

First investigations for GDD/ID (after hx, physical, audiology and ophtho)

A
  1. chromosome microarray
  2. fragile X
  3. MECP2 for females with suggestive course
  4. brain MR is suggestive micro/macro

Tier 1 tests:
CBC, glucose, gas, urea, Cr, electrolytes, AST, ALT, TSH, CK, ammonia, lactate, amino acids, acylcarnitine profile, carnitine, homocysteine, copper
Urine orgnaic acids, creatine metabolites, purines, pyrimidines, glycosaminoglycans
+/- ferritin, vit B12, lead level, ceruloplasmin, biotinidase

30
Q

Most important investigations in eval of GDD/ID

A
  1. chromosome microarray

2. fragile X testing

31
Q

Maternal depression increases risk across ages

  • infancy
  • toddler/preschools
  • school-aged and teens
A

Infants: insecure attachment, dysregulation
Toddlers/preschoolers: internalizing and externalizing, cognitive, social interactions, self control
Teens: adaptive functioning, learning disabilities, ADHD, psychopathology (anxiety and mood)

32
Q

Three most important factors for a child’s well being during separation/divorce

A
  1. quality of parenting
  2. quality of parent-child interaction
  3. degree, frequency, intensity and duration of hostile conflict
33
Q

Impacts of divorce by age

A

< 3 yrs: disorganized attachment, reflect caregiver distress
4-5 yrs: often blame themselves, separation anxiety
School age: prone to loyalty conflicts and may take sides
Adolescents: parents need effective communication and consistent limit-setting

34
Q

Three approach to ASD diagnosis

A
  1. Single provider provides diagnosis based on clinical judgment and DSM-5
  2. Shared care model e.g. paediatrician and psychologist
  3. Multidisciplinary team assessment
35
Q

Medical, behavioural mental health challenges in ASD to assess and manage post diagnosis

A
  • GI conditions
  • nutrition
  • sleep
  • anxiety, depression, mood, psychiatric disorders
  • ADHD
36
Q

Medications in ASD

A
Challenging behaviours: risperidone, aripiprazole
Anxiety: fluoxetine or sertraline
ADHD: methylphenidate/stimulant 1st line
Depression: SSRI
Sleep: melatonin
37
Q

Disruptive behaviour criteria

A
  1. atypical for developmental age and persists for 5 mo or more
  2. impaired functioning
  3. significant distress
38
Q

Red flag temper tantrums

A
  1. misbehaves in ways that are dangerous
  2. acts aggressively to try to get something he or she wants (vs. when upset)
  3. temper tantrums are daily and last > 5minutes
39
Q

Toxic stress (re ACEs)

A
  • major, frequent or prolonged periods of adversity

- affects neuro, immunologic, psychiatric, behavioural

40
Q

Crying behaviours (infancy)

A
  • developmentally normal
  • peaks at 6-8 weeks
  • generally settles by 3-4 months
41
Q

Sleep intervention strategies to start at this age

A

6 months (circadian rhythm develops)

42
Q

Features of “time ins”

A
  • caregiver invites child to sit and talk about feelings and behaviour in age-appropriate way
  • emphasizes connection and comfort