Developmental Delay - Tutorial Flashcards
(35 cards)
When is development normal?
- When within 2 standard deviations from mean
4 main domains of development
- Gross motor
- Fine motor
- Speech and language
- Social and self care
Normal patterns of delay in development
- Can be late talking or walking if family history
- Language development may seem delayed at first in children of bilingual families - count total words in both languages
- Black and indian ethnicity infants more likely to have advanced motor skills
What affects development? - groups
Nature (biological) and nurture (environmental)
Biological split into ante, peri and post natal
Biological factors affecting development
- Genetic disorders
Antenatal - zygotes to delivery
* Early maternal infections - rubella, toxoplasma, CMV - TORCH
* Late maternal - varicella, malaria, HIV
* Toxins - alcohol, pesticides, radiation, smoking
* Drugs - eg cytotoxics, antiepileptics
Perinatal:
* Hypoxic ishcaemic encephalopathy
Post natal:
* Infections - meningitis, encephalitis
* Toxins - lead, mercury
* Trauma inc head injury
* Malnutrition
* Hypothyroidism
Environmental factors affecting development
- Poverty
- Child neglect
- DV
- Low maternal education
- Parental MH issues
- Poor parental skills
- Disadvantaged neighbourhood
Define developmental delay
- Two or more standard deviations away from mean on age appropriate standardised norm
Types of developmental delay
- Isolated - just one area affected
- Global - 2 or more areas affected
- Learning disability - more than 5 years old, intellectual ability affected
- Specific learning difficulties - if more than 5 years old - dyslexia, dyspraxia, dyscalculia
No developmental delay if older than 5 years - changes name
Why is identifying developmental delay important?
- Improves outcomes if picked up earlier
- Provide support
- Genetic counselling
- Prevent problems with social adaptation, difficulties in learning and adverse MH outcomes
Behavioural problems and mental health issues if perceive themselves as different and not sure why
Where can developmental delay be identified?
- Screening programmes - eg health visitor
- Identified risk - prematurity, FH
- Parents concerned
- Professionals in nursery/day care
- Opportunistically at health contacts for another reason
Two types of developmental assessmenrt
- Under 5s and above 5s
- If above 5, this is for learning diability or diffiuculty
What to ask in history for developmental delay?
- As usual
- Pre-natal, perinatal and post-natal events - red book
- Pregnancy and mode of delivery
- Condition at birth
- APGAR
- Newborne screening tests - hearing, blood
SH
* Environment
* Social support
* Cosanguinity - marrying relatives - are parents related?
FH:
* Developmental problems/difficulties
General exam - what to look for?
- Head circumference and weight measurement - micro/macrocephaly, Prader Willi
- Dysmorphic features
- Skin abnormalities - cafe au lait, neurofibromas, hypopigmented patch
- Observe childs movements - unsteadiness, Gower’s sign
- Eyes
- Cardio
- Resp
What is gowers sign?
- Climb themselves to stand up
- Indicates muscle weakness eg duchennes
Down syndrome features phenotype
- Upward slanting eyes
- Large tongue - flops down
Prader willi syndrome phenotype
- Obesity
- Almond eyes
Condition associated with cafe au lait
Neurofibromatosis type 1
Features of tuberous sclerosis
- Ash leaf spot - hypopigmented - glows under woods lamp
- Shagreen patch - thickened skin
Examining babies - different positions
- Prone - should be flexed arms and flexed legs (otherwise hypotonia if limbs straight)
- Pull to sit - via pulling arms - child will help you, back stays straight if few months (initially curved in newborn) - good tone
- Standing - assess tone, can even do for few seconds in baby
- Ventral suspension - hold baby on hand, see position of hands and arms - looking for flexion and extension
Gross motor development milestones
- 6 months - sit to support
- 9 months - pull to stand
- 12 months - start walking
- 18 months - run
- 2 yrs - stairs on own
- 3 yrs - tiptoes, tricycle
- 4 yrs - skip, hop
- 5 yrs - runs on toes
Fine motor milestone
- 6 weeks - fix and follow objects
- 6M - reaches for objects, transfer one to another hand
- 1yr - neat pincer (finger and thumb)
- 18m - scribble
- 2 1/2 - lines
- 3yrs - circle
FINISh
Speech and language normal milestones
- 12 months - first meaningful word eg mama, dada
- 2 years - give name, one colour, two word sentences
- 3 years - full name, gender, 2 colours, 3 sentences, count to 10
- 4 yrs - 3 colours, fluent conversation, 4 word sentences
- 5 years - 4 colours, can tell story, know age
Social/daily self care
- 6 weeks - social smile
- 6-8m - stranger anxiety
- 9M - object permanence
- 10M - wave bye bye
- 15M - help with dressing, use spoon with mess
- 18M - spoon without mess, indicates toilet needs, use cup
- 2yrs - dry by day, dressing
- 3 yrs - dry by night, eat with spoon and fork
- 4-5yrs - dress and undress alone, eat with knife and fork
What could hand preference before 1 year old suggest?
Cerebral palsy
