Overview of Child Development Flashcards
1
Q
For children with spinal pain, imaging techniques have proved to be?
A
poor at distinguishing between adolescents with and without LBP.
2
Q
MSK pain in primary paediatric care. The most common category was?
a. Knee pain
b. back pain
c. soft tissue pain
d. arthralgia
A
d. arthralgia
3
Q
For every 10 children, LLB affects how many at a given time?
A
3-4
4
Q
Conditions commonly seen in a chiropractic paediatric practice include:
A
- LLB
- Thoracicspinepain,
- Scheuermann’sdisease,
- Neckpain,
- Scoliosis,and
- Headache
5
Q
Reported concerns relating to chiropractic care of children include
A
- Cervical manipulation
- repeated radiographic examination
- delay/prevent treatment or appropriate medical diagnosis
6
Q
Examples of non-MSK conditions that MUCC can give treatment advice for are?
A
- colic,
- asthma,
- enuresis (bed-wetting) and
- otitis media.
7
Q
No HVLA techniques are to be utilised on paediatric patients under the age
A
6
8
Q
A
8
Q
No cervical HVLA techniques are to be utilized on paediatric patients under the age of
A
12
9
Q
The following treatment techniques are allowed for the treatment of paediatric patients at MUCC
A
- Mobilisations (grades I-IV only) of the cervical, thoracic, lumbar spine & pelvis and extremities
- Soft tissue therapy
- Stretches
- Advice
10
Q
A
11
Q
The average weight and length at birth is?
A
3-3.5kg and 50cm
11
Q
At what age does primitive reflexes disappear?
A
6 months
12
Q
When does fine pincer typically begin?
A
12 months
13
Q
When does head control typically start?
A
6 months
14
Q
When do first independent steps typically start?
A
1 year (12 months)
15
Q
Median age in females when growth in stature ceases
A
17.3
16
Q
Median age in males when growth in stature ceases
A
21.2 years
17
Q
What percentage of adult stature is attained during 2.5-3 years period
A
20%
18
Q
Average adolescence growth per year for boys and girls is?
A
10cm/yr for boys
8cm/yr for girls
19
Q
At what age does length increase about 12 cm?
A
2
20
Q
Mid growth spurt in height is more common in?
A
females
21
Q
Obesity in children effects
A
- emotional development,
- social development,
- physical development
22
Q
What percentage of birth weight is effected during the 1-3 day post natal period? When is it likely to be gained back?
A
- 7-10% of body weight.
- Expected to gain this back within ~2 weeks
23
Besides the menarche and breaking of the voice, the state of maturation can also be evaluated on
basis of pubic hair, development of genitals (boys) and breast development (girls).
24
Menarche and commencement of ossification of iliac crest apophysis occur approx
1 year after growth spurt peak.
25
In endocrinological terms, puberty starts
even before the outwardly visible changes with the secretion of **gonadotrophins** by the **anterior lobe** of the **pituitary gland **around age **7 in girls**, and age **8 in boys**.
26
The gonadotropic hormones stimulate the
gonads to secret sex hormones (testosterone and oestrogen) which, in turn, stimulate the secretion of growth hormone (STH = somatotropic hormone) in the pituitary (prepubertal growth spurt).
27
Domains for assessments of neurological development should include
* cognitive,
* motor,
* language,
* social/behavioraland
* adaptive
28
Does gross motor skills or fine motors skills develop first?
The acquisition of gross motor skill precedes the development of fine motor skills.
29
How would you describe the typical route of development for fine and gross motor skills?
- A Cephalo-caudal fashion
(Head control preceding arm and hand control Followed by leg and foot control)
30
At what age can infants approx. sit without assistance or support?
8 months
31
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What age can infants typically crawl?
9 months
32
At what age can a child stand independently from a crawl position
1 year
33
At 13 month old a child can typically walk and toddle quickly. What age can they run?
15 months
34
Gait in children younger than 2:
* Wider base
* Shorter stride length with higher cadence
* No heel strike (flat foot contact)
* Very little stance phase and knee flexion
* Entire leg externally rotated in swing phase
* Absent reciprocal arm swing
35
Newborn has very little control. Objects will typically be
involuntarily grasped and dropped without notice.
36
At what age does palmar grasp (uses entire hand to pick up an object) develop?
6 months
37
At what age does the pincer grasp – can grasp small objects using thumb and forefinger develop?
9 months
38
When assessing a childs hearing what should you always ask a parent?
history of otitis media – ear infection, placement of “tubes” in ear
39
Red Flags in infant development
* Unable to sit alone by age 9 months
* Unable to transfer objects from hand to hand by age 1 year
* Abnormal pincer grip or grasp by age 15 months
* Unable to walk alone by 18 months
* Failure to speak recognizable words by 2 years.
40
What age can a child build a tower of six blocks?
2
41
What ages can a child color within the borders
and write some letters and draw a person with body parts?
4 for colour
5 for letters/drawing person
42
Temper tantrums can occur in
50 to 80% of children – peak incidence 18 months – most disappear by age 3
43
Aggressive behavior towards new infant - peak between
1 to 2 years but may be prolonged indefinitely
44
When does fine motor and cognitive abilities typically begin?
Preschool age (toddler)
45
Red flags: preschool
* Inability to perform self-care tasks, hand washing, simple dressing, daytime toileting
* Lack of socialization
* Unable to play with other children
46
Red flags: school age
* School failure
* Lack of friends
* Social isolation
* Aggressive behavior: fights, fire setting, animal abuse
47
Adolescent behavioral problems include
1. Anorexia
2.Attention deficit
3.Anger issues
4.Suicidal thoughts or attempts
48
Causes of back pain in children
- Gender
- Age
- Obesity/poor posture
- heavy school bags
- Incorrectly packed bags
- sedetary lifestyles
- injuries by vigorous sport
- soft tissue injuries
- competitive sports with intense training
49
Prevention of back pain in children
- Reduce risk of falls
- spread tanbark around home playground
- encourage regular walk/stretch
- Limit TV and computer time
- teach how to sit in a chair
- ergonomic chair
- exercise
- stress importance of straight posture and regular stretching for strong back and core muscles
50
Low back pain is more common in school-age children with
* high levels of psychosocial difficulties,
* conduct problems, or
* other somatic disorders.
51
Tumours are more common in patients with
nighttime pain, constant pain, and symptoms lasting less than three months.
52
Reasons in this population for acute back pain
* Herniated discs,
* Fractures, and
* Muscle strains present as acute back pain.
53
A slipped apophysis may have a presentation similar to
herniated disc, with pain radiating down the legs.
54
Reasons in this population for chronic back pain in children
* Developmental problems
(e.g., Scheuermann's disease),
* Inflammatory spondyloarthropathies,
* Psychological problems.
55
Pain that occurs with scoliosis may suggest an
osteoid osteoma or other tumor, infection, or herniated disk.
56
Underlying disease should be suspected if:
* localized tenderness,
* exaggerated stiffness of any particular spinal region,
* pronounced thoracic kyphosis,
* midline skin defects
* excessive hamstring tightness,
* neurological abnormalities (asymmetrics abdominal reflexes, clonus, gait disturbances, and motor or sensory changes)
57
In the spine, ossification begins
late fetal period and continues after birth
58
Primary centres of ossification
spinous, transverse and articular processes.
59
Secondary centres of ossification
vertebral body, spinous & transverse processes, ribs
60
Relatively linear growth of the spine occurs
3 years to onset of puberty
61
Classification of Scoliosis
* By age
* By aetiology
- Idiopathic
- Congenital
- Neuromuscular
* And by type:
- Non-structural
- Structural
62
Aetiology of Scoliosis
* Idiopathic
* Congenital
* Neuromuscular
63
The most common type of scoliosis
Idiopathic
64
High rate of progression of idiopathic scoliosis is
3 yrs – 10 yrs
65
Adolescent
Onset of Idiopathic scoliosis
@ puberty (10 yrs)
66
Infantile Idiopathic scoliosis
Onset <3 yrs, 80-90%
* 80-90% resolve spontaneously
67
Scoliosis can be termed as a 3D defmority. What are the features?
* Rotation of vertebral body
* Spinous process ‘disappears’
* Loss of spinal curves (lateral view)
* Lateral flexion of trunk
68
Scoliosis is named by
* side of convexity
* Location
* Secondary or compensatory curves
69
Non-Structural idiopathic scoliosis
* Fully corrects,
* No vertebral rotation
* Non-progressive (usually)
* Leg length discrepancy
70
Structural idiopathic scoliosis
* Cannot be corrected
* Vertebral rotation toward convexity,
* Prominent ribs or para-spinal hump
71
# **
Which type of idiopathic scoliosis can be corrected?
non-structural
72
The Cobb Angle measures
Magnitude of spinal curvature
73
What is the min degree for a cobb angle to be considered a scoliosis
min of 10 degrees to be considered a scoliosis
74
Risser’s Sign examines?
Determines skeletal maturity by quantifying the amount of ossification at the iliac crest
75
When taking an X-ray, what views are needed for scoliosis assessment and why?
Lateral & A-P
To assess the
Magnitude, location & skeletal age
76
When should a child be referred to orthopaedic surgon when taking the Angle of trunk rotation/rotation of the spine?
>7 degrees
77
When taking Measurement of scoliosis what 4 things need to be looked at?
1. Angle of trunk rotation/rotation of the spine
2. Leg length
3. Muscle length
4. Balance
78
Progression of scoliosis is defined as
Sustained increase of 5 degrees or more on two consecutive examinations occurring @ 4-6 monthly intervals
79
There is an Increased risk of progression in structural curves if:
* Young @ diagnosis
* Low skeletal maturity, or pre-menarche
* Double curves
* Large Cobb angle
* Female
80
Management Considerations for scoliosis
- Skeletal maturity
- Growth potential
- Curve magnitude
- Co-existing conditions
- CP status
- Psychological factors
- Risk vs benefits
81
When to refer to an orthopaedic team for review and on going monitoring.
once there is confirmed scoliosis?
All types and degrees above 10
82
Management/focuses for Non-structural
* Correct any LLD / other underlying problem
* Promote physical activity (general fitness)
* Specific stretch and strength activity if impairments found
* Monitor child’s growth and any progress of curve
* Usually disappear when underlying problem treated
83
With structural Scoliosis, what degree should be monitored by ortho team?
<25
84
When should conservative Rx (bracing and exercise) occur with structural?
25-40 degrees
85
What degree in structural is a patient a candidate for surgery
>40
86
Neuromuscular Scoliosis
develops early and is often rapidly progressive curves are due to:
* Asymmetrical distribution of spasticity
* Asymmetrical paraplegia
* Asymmetrical movement patterns
* Lack of voluntary muscle control
* Asymmetrical muscle strength
87
Types of Neuromuscular Scoliosis
1. Neuropathic (CP i.e. UMN lesion)
2. Spinal muscular dystrophy (LMN lesion) & Myopathic (Duchenne muscular dystrophy)
88
Majority of neuromusclar scoliosis are
a. dystophies
b. spina bifida
c. CP
a. dystophies
89
Surgical treatment for neuromusclar scoliosis
* Fusion to sacrum common
* Greater blood loss/increased time in sx
* A and P fusion
* Anterior release for long and stiff curve
90
Congenital Scoliosis types
- Anomalous vertebral development
- Anterolateral deformity = kyphoscoliosis
- Posterolateral deformity = lordoscoliosis
91
What type of deformity is kyphoscoliosis
Anterolateral
92
What type of deformity is lordoscoliosis
Posterolateral
93
Characteristics of the growth disorder Scheuermann’s Disease
- Narrowing IVD
- Wedged vertebrae
- Collapse endplate
- Kyphosis
94
Where in the spine does Scheuermann’s Disease occur?
thoracic, thoracolumbar or lumbar level
95
Diagnostic criteria for Scheuermann’s Disease include
* thoracic kyphosis of >45°
* thoracolumbar kyphosis of >30°
* Wedging > 5°of three adjacent vertebrae
96
Etiology of Scheuermann’s Disease
* Mechanical factors
* Endogenous factors
* Posture
* Psychological factors
* Osteoporosis
97
Clinical features of Scheuermann’s Disease
- Severe back pain, no hx of trauma
- fixation of kyphosis doesn't return to "normal"
- increased finger-floor distance due to contraction of the hamstrings
- thoracic form always has contraction of pecs
98
What clinical feature applies in all cases of scoliosis, regardless of the location of the disease?
**Increased finger-floor distance** that is almost invariably measured in Scheuermann patients as a result of contraction of the hamstrings.
99
Radiographic features of Scheurmann's
- Wedged vertebrae,
- IVD space narrowing,
- Schmorl's nodes,
- Apophyseal ring herniation
100
Associated diseases for Scheuermann's
* Scoliosis
* Spondylosis (thoracic form has increased incidence)
101
When is there a good Prognosis for Scheuermann's
* Fixed, thoracic kyphoses of < 50° do not represent a problem in adulthood,
102
Scheuermann's: Fixed, thoracic kyphoses of > 50
* Back pain is no more frequent, but is likely to be more intense than in normal individuals.
* Lung function may be impaired in very severe kyphoses.
* Kyphosis of more than 70° can also be progressive in adulthood.
103
Treatment Options for Scheuermann's
* Bracing
- Kyphosis >50 °
- Patient has growth potential
* Surgery
- Kyphosis >70 °
- Mainly for cosmetic reasons
104
Most congenital malformations of the spine are Most congenital malformations of the spine acquired when?
During pregnancy
105
The majority of congenital malformations, the causative factor is assumed to be
toxic damage during the pregnancy
106
the development of myelomeningocele is due to what deficiency?
Folate
107
List 6 associated deformity for congenital malformations of the spine
- fused ribs
- spinal dysraphism
- pulmonary dysfunction
- renal malformations
- heart defects
- clubfoot
108
When describing congenital abnormalities, it is important to identify :
* type of malformation,
* resulting deformity and
* specific region of the spine where the malformation occurs
109
Malformations of the spine can be classified as
* neural tube defects,
* defects of segmentation and
* defects of formation
110
When do neural tube defects occur?
the fourth week of embryonic development.
111
What happens with neural tube defects? How does this affect surrounding structures?
The tube fails to completely close. Structures overlying these midline abnormalities are severely affected and may be unable to form.
112
With congential malformations, the failures of formation
arise as a result of an absence of
structural element of a vertebra
113
The type of congential deformity depends on what? What will this alter?
The area of the vertebral ring affected, which will alter normal growth patterns.
114
Typical observable defects are
hemivertebrae or wedge vertebrae
115
Bony remnants that did not complete normal development and can be fully segmented, semisegmented or nonsegmented is referred to as?
Hemivertebrae
116
Hemivertebrae can be
- segemented
- semi segmented
- non segmented
117
What occurs with semisegmented hemivertebra?
Fusion with a cranial or caudal vertebra which results in a functional disc on one side only.
118
Which hemivertebrae type is likely to progress during growth?
Non segemented
119
Involvement of entire vertebrae creates block vertebrae, whereas defects of specific regions of the vertebral ring create
unilateral bars that act as an asymmetric rigid tether to normal growth.
120
