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Paediatrics > Normal Child Development and Developmental Problems, ENT > Flashcards

Normal Child Development and Developmental Problems, ENT Flashcards

1
Q

Define child development.

A

The biological, psychological and emotional changes that occur between birth and adolescence as the individual progresses from dependency to increasing autonomy. It is a continuous process with a predictable sequence however each child’s development is unique.

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2
Q

Give 5 influences on a child’s development.

A
  1. Genetic factors.
  2. Stimulating environment.
  3. Pregnancy factors e.g. premature? Mum’s health?
  4. Healthy attachment.
  5. Medical conditions.
  6. Abuse/neglect/domestic violence.
  7. Healthy peer relationships.
  8. Education.
  9. Nutrition.
  10. Parenting style.
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3
Q

What are the 4 domains of child development?

A
  1. Gross motor.
  2. Fine motor and vision.
  3. Speech, language and hearing.
  4. Social interaction and self care skills.
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4
Q

What are the developmental milestones for gross motor function?

A
  • 3m: lifts head on tummy.
  • 6m: chest up with arm support, can sit unsupported.
  • 8m: crawling.
  • 9m: pulls to stand.
  • 12m: walking.
  • 2 years: walking up stairs.
  • 3 years: jumping.
  • 4 years: hopping.
  • 5 years: rides a bike.
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5
Q

With regards to gross motor development, at what age would you expect a child to do the following:

a) walking.
b) jumping.
c) crawling.
d) walking up stairs.

A

a) Walking - 12 months.
b) Jumping - 3 years.
c) Crawling - 8 months.
d) Walking up stairs - 2 years.

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6
Q

What are the developmental milestones for fine motor and visual function?

A
  • 4m: grabs an object using both hands.
  • 8m: takes objects in each hand.
  • 12m: scribbles with crayons e.g. circle, cross, square.
  • 18m: builds a tower of 2 cubes.
  • 3 years: builds a tower of 8 cubes.
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7
Q

With regards to fine motor and visual development, at what age would you expect a child to do the following:

a) drawing with crayons.
b) building a tower of 8 cubes.
c) takes an object in each hand.
d) builds a tower of 2 cubes.

A

a) Drawing with crayons - 12m.
b) Building a tower of 8 cubes - 3 years.
c) Takes an object in each hand - 8m.
d) Builds a tower of 2 cubes - 18m.

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8
Q

What are the developmental milestones for speech, language and hearing?

A
  • 3m: laughs and squeals
  • 9m: can make sounds such as ‘dada’ and ‘mama’.
  • 12m: can say one word.
  • 2 years: can form short sentences and name body parts.
  • 3 years: speech is mainly understandable.
  • 4 years: knows colours and can count.
  • 5 years: knows the meaning of words.
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9
Q

With regards to speech, language and hearing, at what age would you expect a child to do the following:

a) form short sentences and name body parts.
b) knows colours and can count.
c) laughs and squeals.
d) has mainly understandable speech.

A

a) Forms short sentences and name body parts - 2 years.
b) Knows colours and can count - 4 years.
c) Laughs and squeals - 3 months.
d) Has mainly understandable speech - 3 years.

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10
Q

What are the developmental milestones for social interaction and self-care skills?

A
  • 6 weeks: smiles.
  • 6 months: finger feeds.
  • 9m: waves bye-bye.
  • 12m: uses cutlery.
  • 2 years: undresses, feeds toys.
  • 3 years: plays with others, names a friend.
  • 4 years: dresses with no help, plays a board game.
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11
Q

What does ‘The healthy child programme’ encourage?

A
  1. Encourages care to keep children healthy and safe.
  2. Promotes healthy eating and activity.
  3. Identifies problems in children’s development.
  4. Identifies ‘at risk’ families for more support.
  5. Ensures children are prepared for school.
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12
Q

Give two examples of concerning child development with regards to gross motor function.

A
  1. Not sitting by 12 months.

2. Not walking by 18 months.

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13
Q

Give an example of concerning child development with regards to fine motor function.

A

Hand preference before 18 months.

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14
Q

Give two speech and language examples that may suggest concerning child development.

A
  1. Not smiling by 3 months - blindness? ASD?

2. No clear words by 18 months - ASD? Language problems?

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15
Q

Give two examples of concerning child development with regards to social development.

A
  1. No response to carers interactions by 8 weeks.

2. No interest in playing by 3 years.

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16
Q

Give 5 red flags in child development.

A
  1. Regression.
  2. Poor health/growth.
  3. Significant family history.
  4. Abnormal findings on examination e.g. microcephaly.
  5. Safeguarding indicators.
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17
Q

Causes of developmental delay: give examples of genetic causes.

A
  1. Chromosomal disorders e.g. Down’s syndrome.
  2. Micro-deletions or micro-duplications.
  3. Single gene disorders e.g. Duchenne.
  4. Polygenic e.g. ASD, ADHD.
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18
Q

Causes of developmental delay: give examples of pregnancy related causes.

A
  1. Congenital infections e.g. CMV, HIV.
  2. Exposure to drugs/alcohol.
  3. MCA infarct.
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19
Q

Causes of developmental delay: give examples of birth related causes.

A
  1. Prematurity.

2. Birth asphyxia (due to hypoxia).

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20
Q

Causes of developmental delay: give examples of childhood related causes.

A
  1. Infections e.g. meningitis.
  2. Chronic ill health.
  3. Acquired brain injury.
  4. Hearing or visual impairment.
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21
Q

How might you investigate someone’s child development if you suspected that there was something wrong?

A

Thorough history and examination. Tailor any investigations to the child e.g.

  • Boys not walking by 18m check creatinine kinase for Duchenne.
  • Focal neurological signs -> MRI brain.
  • Genetic testing.
  • Unwell, failure to thrive -> metabolic investigations.

There is no ‘developmental screen’, investigations need to be tailored towards to the child.

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22
Q

Define childhood disability.

A

Someone who has a physical or mental impairment that results in a marked, pervasive limitation on activity. For example, Down’s syndrome and Cerebral Palsy.

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23
Q

Give 3 clinical features of down’s syndrome.

A
  1. face: upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small low-set ears, round/flat face, flat occiput
  2. single palmar crease, pronounced ‘sandal gap’ between big and first toe
  3. hypotonia
  4. congenital heart defects (40-50%, see below)
  5. duodenal atresia
  6. Hirschsprung’s disease
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24
Q

What is cerebral palsy?

A

A disorder of movement and posture due to a non-progressive lesion of the motor pathways in the developing brain

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25
Q

Give 3 causes of cerebral palsy.

A

80% antenatal - hypoxia, infection, haemorrhage, ischaemia.

10% peri-natal - hypoxia, infection, haemorrhage.

10% postnatal - hypoxia, infection e.g. meningitis, haemorrhage, trauma, hypoxic ischaemic encephalopathy

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26
Q

Describe the support that is offered to someone with cerebral palsy.

A
  1. Physiotherapists for mobility and hand function.
  2. SALT for communication.
  3. Feeding support.
  4. Sleeping support.
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27
Q

Give 3 potential consequences of hearing loss.

A
  1. Speech and language delay.
  2. Social problems e.g. behavioural issues.
  3. Academic underachievement.
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28
Q

How does hearing loss in children often present?

A
  1. Parental concern.
  2. Speech, behavioural or educational problems.
  3. Incidentally on screening.
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29
Q

What are the 3 types of hearing loss?

A
  1. Conductive hearing loss- ear canal/middle ear
  2. Sensori-neural hearing loss- cochlea/auditory nerve
  3. Mixed.
30
Q

Give 3 causes of conductive hearing loss.

A
  1. Glue ear.
  2. Ear wax.
  3. Otitis media.
  4. Perforated ear drum.
31
Q

Describe the management of conductive hearing loss.

A

Conductive hearing loss is usually ENT managed: - Wait and wait - most will resolve on their own.

  • Grommet insertion.
  • Temporary hearing aid.
32
Q

Give 3 risk factors for sensori-neural hearing loss.

A
  1. Family history.
  2. Special care baby unit (SCBU).
  3. Consanguinity.
33
Q

Describe the management of sensori-neural hearing loss.

A

Sensori-neural hearing loss is often managed by a paediatrician. Treatments involve hearing aids or cochlea implants.

34
Q

How would you manage mixed hearing loss?

A

You would address the conductive problem first and then offer a hearing aid.

35
Q

When is hearing tested in children?

A
  1. New-born hearing screen.
  2. School entry hearing test.
  3. Long term monitoring is done in high risk groups.
36
Q

Is the new-born hearing screen an objective or subjective test?

A

It is an objective test - response or no response. If there are concerns, the patient is followed up with evoked response audiometry.

37
Q

What are the 3 aims of hearing testing in children?

A
  1. Measure hearing threshold (dB).
  2. To be frequency specific (Hz).
  3. Obtain single ear information if possible.
38
Q

Name 4 types of subjective hearing testing.

A
  1. Behavioural observational audiometry.
  2. Distraction testing.
  3. Visual reinforcement audiometry.
  4. Performance testing and play audiometry.
39
Q

Name 2 organisms that can cause acute otitis media.

A

S.pneumoniae.

H.influenzae.

40
Q

Give 3 symptoms of acute otitis media.

A
  1. Pain.
  2. Fever.
  3. Generally unwell
  4. Otorrhoea.
41
Q

Give 2 potential complications of acute otitis media.

A
  1. Extra-cranial: mastoiditis, tympanic membrane perforation.
  2. Intra-cranial: meningitis, abscess.
42
Q

Describe the treatment for acute otitis media.

A

Watch and wait.
Analgesia.
If recurrent, offer antibiotics and consider a grommet.

43
Q

What is the function of a grommet?

A

A grommet keeps the middle ear aerated and prevents the accumulation of fluid in the middle ear.

44
Q

When might a grommet be indicated?

A
  1. Recurrent acute otitis media.
  2. Chronic otitis media + effusion.
  3. Ear and throat dysfunction.
45
Q

What is the common name for otitis media + effusion?

A

Glue ear.

46
Q

What causes glue ear?

A

Infection! 45% follow AOM.

47
Q

Give 5 risk factors for glue ear.

A
  1. Older sibling.
  2. Male.
  3. Nursery attendance.
  4. Parental smoking.
  5. Allergies.
48
Q

What are the criteria for considering a tonsillectomy?

A
  1. > 7 episodes of acute tonsilitis in a year.

2. OSA or sleep-deprived breathing.

49
Q

Give a cause of retinopathy of prematurity.

A

Hyperoxic insult. Retinopathy of prematurity can lead to blindness.

50
Q

Breast feeding has many benefits. Give 4 benefits for the infant.

A
  1. Reduces the risk of infection.
  2. Reduces the risk of allergic disease.
  3. Reduces the risk of GORD.
  4. Reduces risk of necrotising encephalitis in preterm infants.
51
Q

Breast feeding has many benefits. Give 3 benefits for the mother.

A
  1. Reduces the risk of breast cancer.
  2. Reduces the risk of PPH and post-natal depression.
  3. Optimum child spacing.
  4. Less food/medical expense.
52
Q

Give 5 medical problems that preterm infants may suffer from.

A
  1. Respiratory distress syndrome
  2. Apnoea and bradycardia.
  3. Patent ductus arteriosus.
  4. Infection.
  5. Jaundice.
  6. Intraventricular haemorrhage.
  7. Cystic periventricular leukomalacia.
  8. Necrotising enterocolitis.
  9. Retinopathy of prematurity.
  10. Hypothermia.
53
Q

Describe the aetiology of strabismus.

A

Multifactorial - hereditary and refractive errors. There is also a higher incidence in infants with cerebral palsy. Febrile illness can be a trigger.

54
Q

Define ambylopia.

A

Defective acuity that persists after correction of refractive error and removal of any pathology.

55
Q

Describe the treatment for ambylopia.

A
  1. Refractive adaptation - wear appropriate glasses for 16w.
  2. Occlusion of better seeing eye.
  3. Atropine drops in better eye.
56
Q

What is the Moro reflex?

A

The Moro (startle) reflex is a primitive reflex that is a response due to a sudden loss of support. Sudden extension of the head causes symmetrical extension then flexion of the arms.

57
Q

Why should primitive reflexes disappear?

A

Primitive reflexes should gradually disappear as postural reflexes, that are essential for motor development, develop.

58
Q

Why is it concerning if primitive reflexes persist?

A

There may be a sign of CNS dysfunction.

59
Q

Name 3 primitive reflexes.

A
  1. Grasp.
  2. Rooting.
  3. Moro.
  4. Asymmetrical tonic neck reflex.
  5. Stepping response
60
Q

How does cerebral palsy often present?

A

Abnormal limb/trunk posture and tone in infancy and delayed milestones.
Feeding difficulties.
Abnormal gait once walking is achieved.
Asymmetric hand function before 12 months.
Primitive reflexes may persist.

61
Q

Cerebral palsy is characterised according to neurological features. What are the categories?

A
  1. Spastic - hemiplegic, quadriplegic, diplegic.
  2. Dyskinetic- chorea, athetosis, dystonia
  3. Ataxic.
62
Q

How might you investigate a child who is presenting with signs of cerebral palsy?

A
  1. Cytogenetic tests.
  2. Metabolic tests.
  3. Imaging e.g. MRI brain.
  4. Neurophysiological tests.
63
Q

Why might the clinical signs of cerebral palsy change over time?

A

The clinical signs may change over time as the brain matures but the underlying aetiology is not progressive.

64
Q

What drug can be used to treat spasticity in children with cerebral palsy?

A
  1. oral diazepam
  2. oral and intrathecal baclofen
  3. botulinum toxin type A
  4. orthopaedic surgery
  5. selective dorsal rhizotomy
65
Q

Which is more concerning: a paralytic or a non-paralytic squint?

A

Paralytic squints are more concerning.

66
Q

What type of squint may require neuro-imaging?

A

Paralytic squints. These may be due to a space occupying lesion e.g. brain tumour.

67
Q

Causes of delayed puberty

A

Delayed puberty with short stature:
Turner’s syndrome
Prader-Willi syndrome
Noonan’s syndrome

Delayed puberty with normal stature: 
polycystic ovarian syndrome 
androgen insensitivity 
Kallman's syndrome 
Klinefelter's syndrome
68
Q

When should antibiotics be considered in otitis media?

A

Symptoms lasting more than 4 days or not improving
Systemically unwell but not requiring admission
Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
Younger than 2 years with bilateral otitis media
Otitis media with perforation and/or discharge in the canal

69
Q

Define enuresis.

A

Involuntary discharge of urine by day or night or both, in a child aged 5 years or older, in the absence of congenital or acquired defects of the nervous system or urinary tract’

70
Q

Describe the mx of nocturnal enuresis.

A
  1. Look for possible underlying causes/triggers (e.g. Constipation, diabetes mellitus, UTI if recent onset)
  2. Advise on fluid intake, diet and toileting behaviour
  3. Reward systems (e.g. Star charts)
  4. An enuresis alarm is first-line for children under the age of 7 years
  5. Desmopressin may be used first-line for children over the age 7 years, particularly if short-term control is needed or an enuresis alarm has been ineffective/is not acceptable to the family
71
Q

What are the causes of precocious puberty in boys?

A

bilateral enlargement = gonadotrophin release from intracranial lesion
unilateral enlargement = gonadal tumour
small testes = adrenal cause (tumour or adrenal hyperplasia)

72
Q

Name 4 postural reflexes.

A
  1. Labyrinthine righting
  2. Postural support
  3. Lateral propping
  4. Parachute

Paediatrics (21 decks)

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