Postnatal and Child Development

Question 1

On what plane should the embryo be looked at to see the 4 parts of the foetal brain?

Answer 1

Dorsal (front) view of the embryo

Question 2

At 4 weeks what are the 4 parts of the foetal brain?

Answer 2

Prosencephalon (future forebrain)
Mesencephalon (future midbrain)
Rhombencephalon (future hindbrain)
Future spinal cord

Question 3

On what plane should the embryo be looked at to see the 3 flexures of the foetal brain?

Answer 3

Side view

Question 4

At 4 weeks, what are the 3 flexures present in the foetal brain?

Answer 4

Cephalic flexures
Pontine flexures
Cervical flexures

Question 5

At 5 weeks, what does the dorsal view of the foetal brain reshape to form?

Answer 5

Telencephalon
Diencephalon
Pons
Medulla

Question 6

At 8 weeks, how has the foetal brain developed since?

Answer 6

Development of the ventricular system (third and fourth ventricle, and aqueduct)
Developing hemispheres
Developing cerebellum

Question 7

How has the brain developed by term?

Answer 7

Fully developed cortex
Ventricular system
Aqueduct 
Cerebellum
Pons
Medulla

Question 8

What are the different functions of the cerebral cortex?

Answer 8

Pre-frontal cortex = executive function and concentration

Primary motor cortex = supplying the nerves to the skeletal muscles

Primary somatic sensory cortex = receiving impulses from the periphery

Parietal lobe = sensory information processing

Occipital lobe = visual information processing

Temporal lobe = auditory information processing and speech

Question 9

What happens if there is malfunctioning in the pre-frontal cortex?

Answer 9

Malfunctioning in:

Pre-frontal cortex = ADHD - attention deficit hyperactivity disorder

Question 10

What 2 matters is the spinal cord made up of? Where are they found and what are they responsible for?

Answer 10

White matter and grey matter

White matter =
- Found on the edge of the cross section of the spine

Grey matter =

• Found in the middle of the cross section of the spine
• Grey matter in the anterior section of the cord is responsible for motor neurons

Question 11

How are the nerves organised within the spinal tract and what do they supply?

Answer 11

Pyramidal tracts (lateral and anterior corticospinal tracts) = voluntary control

Extrapyramidal tracts = involuntary control, co-ordination of movements, regulation of posture and balance, important in primitive reflexes in small infants

Question 12

What are the primitive reflexes seen when examining infants?

Answer 12

Moro reflex = extension of neck, abduction and then adduction of arms - develops between 28-32 weeks gestations, and should disappear between 3-6 months

Standing reflex = extension of the lower extremeties, hips slightly flexed and behind the shoulder, head free to turn - present in the newborn and at 3 months

Grasp reflex = fingers grasp tightly to objects placed into their palms

Opening of fingers due to stroking on the (pinky finger) side of their hand

Parachute reflexes = outstretched arms when tilted upside down - this protective reflex develops between 6-9 months

Side-ways parachute reflex = same as above but when child is tilted sideways rather than forwards

Question 13

What is the significance of primitive reflexes?

Answer 13

Develops 28-30 weeks gestation
Disappear 3-6 months (Moro)
6-9 months (grasp)
Persistence of these reflexes can demonstrate impaired development

Question 14

What is developement?

Answer 14

Global impression of a child encompassing growth in understanding, acquisition of new skills

Normal development endows a child with increasingly complex skills in order to function in society

Question 15

Who knows about children’s development?

Answer 15

Parents
Doctors
Nursery nurses
Teachers

Question 16

When is development assessed?

Answer 16

Opportunistically

Planned programme of reviews

Question 17

What are the 4 domains of child developement?

Answer 17

Gross motor skills = 
Position
Head lag
Sitting
Walking
Running 

Fine motor skills =
Use of hands
Grasp and fine pincer
Bricks
Crayon
Puzzles 

Speech and language =
Vocalisation
Words
Understanding
Imaginative play 

Social skills =
Social interaction
Stranger reaction
Eating skills
Dressing

Question 18

What do you first look at when assessing a newborn?

gross motor

Answer 18

See how the baby is positioned

As a newborn they will have a limited, flexed, and symmetrical posture when laying down

When they are lifted up, they have a marked lag of the head due to lack of neck muscle maturity

Question 19

What is the positioning of the baby by 6-8 weeks postnatally?
(gross motor)

Answer 19

Better head control compared to newborn baby

Raises head to 45 degrees in prone

Question 20

What is the positioning of the baby by 6-8 months postnatally?
(gross motor)

Answer 20

Sits without support
At 6 months: with round back, good baseline posture
At 8 months: with straight back

Question 21

What can a baby do at around 3-5 months? (gross motor)

Answer 21

Babies begin to roll independently - from lying on their back to lying on their front
Can pull themselves up and have outstretched arms when lying on their front

Question 22

What can a baby do at around 8-9 months? (gross motor)

Answer 22

Crawl

Question 23

What can a baby do at around 10 months? (gross motor)

Answer 23

Cruise around furniture - pull themselves up onto furniture
Good time to counsel parents on the need of safety around the home as their child’s mobility is increasing rapidly around this stage

Question 24

What can a baby do at 12 months? (gross motor)

Answer 24

Walk unsteadily, broad gait with hands apart

Question 25

What can a baby do at 15 months? (gross motor)

Answer 25

Walk steadily - more steady gait

Question 26

What is important to note regarding motor development?

Answer 26

``` Many variations of normal e.g. sitting to all four crawl to walk OR bottom-shuffling before walking OR commando crawling before walking ```

Question 27

What are the gross motor milestones?

Answer 27

Newborn = See how the baby is positioned As a newborn they will have a limited, flexed, and symmetrical posture when laying down When they are lifted up, they have a marked lag of the head due to lack of neck muscle maturity 6-8 weeks = Better head control compared to newborn baby Raises head to 45 degrees in prone 3-5 months = Babies begin to roll independently - from lying on their back to lying on their front Can pull themselves up and have outstretched arms when lying on their front 6-8 months = Sits without support At 6 months: with round back, good baseline posture At 8 months: with straight back 8-9 months = Crawl 10 months = Cruise around furniture - pull themselves up onto furniture Good time to counsel parents on the need of safety around the home as their child's mobility is increasing rapidly around this stage 12 months = Walk unsteadily, broad gait with hands apart

Question 28

What are the vision and fine motor milestones?

Answer 28

6 weeks = Follow moving objects or face by turning head - track for 180 degrees 4 months = Reach out for toys 4-6 months = Palmar grasp Thumb and fingers grasp as one piece 'Inferior grasp' - use of the whole hand to grasp an object 7 months = Transfer of objects from one hand to the other 10 months = Hold object between thumb and index finger 'Mature pincer grip' 16-18 months = Make marks with a crayon – infant can copy what is being drawn by an adult (i.e. line, circle, cross, square, triangle) 14 months – 4 years = Improve in sophisticated use of their hands and brain - tested using building blocks e.g. at 18 months, tower of 3, by 4 years, more complex towers by following steps 2-5 years = Ability to draw without seeing how it is done Progresses from Line --> Triangle Can draw after seeing it done 6 months earlier

Question 29

What can a baby do at 6 weeks? (vision and fine motor)

Answer 29

Follow moving objects or face by turning head - track for 180 degrees

Question 30

What can a baby do at 4 months? (vision and fine motor)

Answer 30

Reach out for toys

Question 31

What can a baby do at 4-6 months? (vision and fine motor)

Answer 31

Palmar grasp Thumb and fingers grasp as one piece 'Inferior grasp' - use of the whole hand to grasp an object

Question 32

What can a baby do at 7 months? (vision and fine motor)

Answer 32

Transfer of objects from one hand to the other

Question 33

What can a baby do at 10 months? (vision and fine motor)

Answer 33

Hold object between thumb and index finger | 'Mature pincer grip'

Question 34

What can a baby do at 16-18 months? (vision and fine motor)

Answer 34

Make marks with a crayon

Question 35

In what does a child progressively improve at inbetween 14 months and 4 years? (vision and fine motor)

Answer 35

Improve in sophisticated use of their hands and brain - tested using building blocks e.g. at 18 months, tower of 3, by 4 years, more complex towers by following steps

Question 36

In what does a child progressively improve at inbetween 2-5 years? (vision and fine motor)

Answer 36

Ability to draw without seeing how it is done Progresses from Line --> Triangle Can draw after seeing it done 6 months earlier

Question 37

What are the hearing, speech and language development milestones?

Answer 37

Newborn = Responds to startling noises 3-4 months = Vocalise alone or when spoken to, responds to coos and laughs 7 months = Turns to soft sounds out sight Sounds used indiscriminately Hearing distraction test carried out at this age 7-10 months = Begin to speak polysyllabic babble (sounds at different tones, qualities and volumes) At 7 months: sounds used indiscrimately At 10 months: sounds used discriminately to parents - Babbles of children with hearing impairment = more monotone 12 months = 2-3 words such as 'dada' and 'mama' 18 months = 6-10 words Show parts of body e.g. where is your nose and then points 20-24 months = Uses two or more words to make simple phrases 2.5-3 years = Talks constantly in 3-4 word sentences At 3 years = - Normal development of 3 year old = few word sentences - In a 3 year old child with autism = disordered speech and language development, no words, babble

Question 38

What is apparent in a newborn? (hearing, speech and language)

Answer 38

Responds to startling noises

Question 39

What can a baby do at 3-4 months? (hearing, speech and language)

Answer 39

Vocalise alone or when spoken to, responds to coos and laughs

Question 40

What can a baby do at 7 months? (hearing, speech and language)

Answer 40

Turns to soft sounds out sight Sounds used indiscriminately Hearing distraction test carried out at this age

Question 41

What can a baby do at 7-10 months? (hearing, speech and language)

Answer 41

Begin to speak at 7-10 months - pol-syllabic babble (sounds at different tones, qualities and volumes) At 7 months: sounds used indiscrimately At 10 months: sounds used discriminately to parents

Question 42

How does babble differ between a health child and those with hearing impairments?

Answer 42

Babbles of children with hearing impairment = more monotone

Question 43

What can a baby do at 12 months? (hearing, speech and language)

Answer 43

2-3 words such as 'dada' and 'mama'

Question 44

What can a baby do at 18 months? (hearing, speech and language)

Answer 44

6-10 words | Show parts of body e.g. where is your nose and then points

Question 45

What can a baby do at 20-24 months? (hearing, speech and language)

Answer 45

Uses two or more words to make simple phrases

Question 46

What can a baby do at 2.5-3 years? (hearing, speech and language)

Answer 46

Talks constantly in 3-4 word sentences

Question 47

How can speech differ between a healthy 3 year old and a child with autism at 3 years old?

Answer 47

Disordered speech and language development No words Babble

Question 48

What are the social, emotional and behavioural milestones?

Answer 48

``` • 6-8 weeks = Smiles responsively • 6-8 months = Start of self-feeding Puts food in mouth • 10-12 months = Waves bye-bye Plays peek a boo • 12 months = Drink from a cup with 2 hands Often the age at which parents are encouraged to get rid of the bottle to minimise delay in speech and language due to prolonged bottle usage - Prolonged bottle usage = dental caries, delayed speech • 18 months = Hold spoon and gets food safely to mouth, even if food gets splayed on the floor • 18-24 months = Good imaginative play • 2 years = Toilet training Dry by day Pulls off some clothing • 2.5-3 years = Parallel play Interactive play evolving Takes turns Clean and dry ``` Development patterns Normal development changes as children get older - Wide range of normal - particularly as you get older Abnormal development patterns = - Slow but steady - Plateau - stopping of milestones - Regression - reversible of milestones, early sign of serious illness e.g. neurodevelopmental regeneration

Question 49

What can a baby do at 18 months? (social, emotional and behavioural)

Answer 49

Hold spoon and gets food safely to mouth, even if food gets splayed on the floor

Question 50

What can a baby do at 18-24 months? (social, emotional and behavioural)

Answer 50

Good imaginative play

Question 51

What can a baby do at 6-8 weeks? (social, emotional and behavioural)

Answer 51

Smiles responsively

Question 52

What can a baby do at 6-8 months? (social, emotional and behavioural)

Answer 52

Start of self-feeding | Puts food in mouth

Question 53

What can a baby do at 10-12 months? (social, emotional and behavioural)

Answer 53

Waves bye-bye | Plays peek a boo

Question 54

What can a baby do at 12 months? (social, emotional and behavioural)

Answer 54

Drink from a cup with 2 hands Often the age at which parents are encouraged to get rid of the bottle to minimise delay in speech and language due to prolonged bottle usage

Question 55

What can prolonged bottle usage cause?

Answer 55

Dental caries | Delayed speech

Question 56

What can a baby do at 2 years? (social, emotional and behavioural)

Answer 56

Toilet training Dry by day Pulls off some clothing

Question 57

What can a baby do at 2.5-3 years? (social, emotional and behavioural)

Answer 57

Parallel play Interactive play evolving Takes turns Clean and dry

Question 58

How does normal development change as children get older?

Answer 58

Wide range of normal - particularly as you get older

Question 59

What are patterns of abnormal developement?

Answer 59

Slow but steady Plateau - stopping of milestones Regression - reversible of milestones, early sign of serious illness e.g. neurodevelopmental regeneration

Question 60

What are limit ages?

Answer 60

Warning for parents and health professionals of when a child has not reached particular milestones e.g. head control by latest 4 months or sitting unsupported by latest 9 months or standing independently at 9 months or walking independently at 18 months

Question 61

Give examples of abnormal motor development at 1.5-2 months that may suggest cerebral palsy?

Answer 61

Normally baby can push up on arms and lift their head when in the prone position (on their tummy) ``` BUT in abnormal motor development - Unable to lift head or push up on arms Stiff extended legs Pushing back with head Constantly fisted hand and stiff leg on one side Difficulty moving out of this position? ```

Question 62

Give examples of abnormal motor development at 3-6 months suggestive of disinhibition of motor neurons to the lower limbs and possible early cerebral palsy?

Answer 62

Normally baby sits with support, with a rounded back ``` BUT in abnormal motor development - Unable to lift head Floppy trunk Stiff arms Extended legs Or stiff crossed legs = excess tone in the lower limbs Arms flexed and held back ```

Question 63

Give examples of abnormal motor development 6-9 months that may suggest developmental delay or cerebral palsy?

Answer 63

Normally baby sits on their own, and arms are free to reach out and grasp ``` BUT in abnormal motor development - Poor head control Difficulty getting arms forward Arches back Pointed toes, stiff legs Will not take weight on legs Poor use of arms for play ```

Question 64

Give examples of abnormal motor development 9-13 months that may suggest developmental delay or cerebral palsy?

Answer 64

Normally a baby can pull to stand ``` BUT in abnormal motor development - Not interested in weight bearing Difficulty in pulling to stand Stiff elgs Cannot crawl on hands an knees Uses one side of body to move ```

Question 65

Give examples of abnormal motor development 12-18 months that may suggest developmental delay or cerebral palsy?

Answer 65

Normally a baby can stand and walk independently at this stage ``` BUT in abnormal motor development - Holds arms or both arms stiffly and bent Excessive tiptoe gait due to excess motor activity that is not inhibited by corticospinal neurons Sits with weight to one side Uses predominantly one hand for play One leg may be stiff ```

Question 66

For vision and fine motor development, which milestones are a cause for worry?

Answer 66

If the baby is not: - Fixing and following visually by 3 months - Reaching for objects by 6 months - Transferring objects by 9 months - Pincer gripping by 12 months

Question 67

For speech and language development development, which milestones are a cause for worry?

Answer 67

If the baby is not: - Saying polysyllabic babble by 7 months - Constant babble by 10 months - Saying 6 words with meaning by 18 months - Joins words by 2 years - 3-word sentences by 2.5 years

Question 68

For social, emotional and behavioural development development, which milestones are a cause for worry?

Answer 68

If the baby is not: - Smiling by 8 weeks - Scared / fearing strangers by 10 months - Feeding self with a spoon by 18 months - Symbolic playing by 2-2.5 years - Interactive playing by 3-3.5 years

Question 69

What is the Healthy Child Programme?

Answer 69

A planned programmed of review composed of 3 components: - Screening - General examination and immunisation - Health education and promotion

Question 70

When does screening occur?

Answer 70

Throughout pregnancy: - <12 weeks = Hbopathy, rehsus. infection - 12 weeks = USS dating and nuchal (down syndrome) - USS detailed - heart defects, kidney defects, brain defects - At birth = bloodspot, hearing and physical)

Question 71

When does immunisation occur?

Answer 71

Flu jab for the mother | Soon after delivery, at 10-14 days, many vaccinations are given during the child's first year of life

Question 72

When are there child health reviews?

Answer 72

``` Birth visit 10-14 day visit 6-8 week reviews First year reviews Two year review Health review at school ```

Question 73

When and what health promotion activity is given?

Answer 73

``` During the early years of the child's life - usually at each health review discussing things like: Relationships Breast feeding Vaccination Reading Weaning Social and emotional Injury prevention Learning Physical activity Nutrition ```

Question 74

What health promotion activity is given during the late years?

Answer 74

Healthy weight Sexual health Encourage physical activity

Question 75

What are the categories of causes of development impairment?

Answer 75

Prenatal Perinatal Postnatal

Question 76

What is done when evaluating a child with abnormal development?

Answer 76

History - parental concern - birth history - family history PMHx - developmental history - current skills Examination - developmental assessment (general and neurological) e.g. dismorphic fet=atures, skin issues, - further as required Investgation - as appropriate

Question 77

What is the approach to developmental assessment?

Answer 77

Ask Observe Task

Question 78

What needs to be assessed in a developmental assessment?

Answer 78

- Milestones proceeding age - Expected milestones for their age - Next important milestones - alert parent of future milestones

Question 79

What factors influence developmental delay?

Answer 79

Ill health e.g. ear infections affecting speech Lack of physical/physiological stimuli Reduce inherent potential Sensory/motor impairment

Question 80

What are the types of developmental delay?

Answer 80

``` Global - delay in all 4 domains OR Specific - Langauge - Motor - Sensory - Cognitive ```

Question 81

What are some causes of global delay?

Answer 81

Chromosomal abnormalities e.g. Down's Syndrome, Fragile X Metabolic e.g. hypothyroidism, inborn errors of metabolism Antenatal and perinatal factors e.g. infections, drugs, toxins, anoxia, trauma, folate def Environmental-social issues Chronic illness

Question 82

What are causes of motor delay?

Answer 82

``` Cerebral palsy - e.g. corticospinal injury Down's Syndrome Congenital dislocation hip Social deprivation Muscular dystrophy Neural tube e.g. spina bifida Hydrocephalus ```

Question 83

What causes language delay?

Answer 83

Hearing loss Learning disability Autistic spectrum disorder Lack of stimulation Impaired comprehension of language - developmental dysphagia Impaired speech production - stammer, dysarthria

Question 84

What are some commonly used assessment tool?

Answer 84

``` Standardised tests Schedule of growing skills Griffiths developmental scale Bailey developmental scale Denver developmental screening tests ```