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Paeds: Child Development > Specific milestone developmental delay > Flashcards

Specific milestone developmental delay Flashcards

1
Q

How will abnormal motor development present? 10 things

A

Delay in acquisition of motor skills e.g.

  1. head control
  2. rolling
  3. sitting
  4. standing
  5. walking
  6. problems with balance
  7. abnormal gait
  8. asymmetry of hand use
  9. involuntary movements
  10. (rarely0 loss of motor skills
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2
Q

Between what ages does concern about motor development usually present?

A

3 months - 2 years (when acquisition of motor skills usually occurs most rapidly)

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3
Q

What are 4 key causes of abnormal motor development?

A
  1. central motor deficit e.g. cerebral palsy (CP)
  2. congenital myopathy/ primary muscle disease
  3. spinal cord lesions e.g. spina bifida
  4. global developmental delay, as in many syndromes, or of unidentified cause
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4
Q

When is hand dominance usually acquired and when is it worrying?

A

1-2 years is normal; asymmetry of motor skills during first year is always abnormal, may suggest underlying hemiplegia

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5
Q

What 2 things should be considered with late walking (>18 months) in addition to a motor development problem?

A

Need to differentiate from children who

  1. display normal locomotor variants of bottom-shuffling or commando crawling where walking occurs later than with crawlers,
  2. and from children with joint hypermobility who may also achieve walking later than average
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6
Q

What should be done if there is concern about abnormal motor development?

A

Assessment by neurodevelopmental paediatrician and physiotherapist. Ongoing physio input and subsequent involvement of occupational therapist also likely to be needed

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7
Q

What is the definition of cerebral palsy?

A

Umbrella term for permanent disorder of movement and/or posture and of motor function due to a non-progressive abnormality in the developing brain

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8
Q

What is the most common cause of motor impairment in children?

A

Cerebral palsy - 2 per 1000 live births

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9
Q

How do the effects of cerebral palsy emerge with time?

A

Emerge gradually over time - despite being static lesion. due to balance between normal and abnormal cerebral maturation

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10
Q

When do the majority (80%) of causes of cerebral palsy occur?

A

antenatally

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11
Q

What are 6 antenatal causes of cerebral palsy?

A
  1. cerebrovascular haemorrhage
  2. cerebrovascular ischaemia
  3. cortical migration disorders
  4. structural maldevelopment of brain during gestation
  5. genetic syndromes
  6. congenital infection
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12
Q

What is the key perinatal cause of cerebral palsy and what proportion of cases does this account for?

A

Hypoxic-ischaemic injury - only 10% of cases

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13
Q

What is a key risk factor for developing cerebral palsy postnatally and why?

A

Prematurity - preterm infants especially vulnerable to brain damage from periventricular leukomalacia secondary to ishcaemia and/or severe intraventricular haemorrhage and venous infarction

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14
Q

In addition to prematurity what are 6 further postnatal causes of cerebral palsy?

A
  1. meningitis
  2. encephalitis/encephalopathy
  3. head trauma - accidental or non-accidental
  4. symptomatic hypoglycaemia
  5. hydrocephalus
  6. hyperbilirubinaemia
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15
Q

What investigations may aid the diagnosis of cerebral palsy?

A

MRI - may assist in identifying cause, directing further investigations and supporting explanations to parents

however not required for diagnosis

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16
Q

What are 6 early features of CP?

A
  1. Abnormal limb and/or trunk posture and tone in infancy with delayed motor milestones
  2. Slowing of head growth
  3. Feeding difficulties, with oromotor incoordination, slow feeding, gagging and vomiting
  4. Abnormal gait once walking is achieved
  5. Asymmetric hand function before 12 months of age
  6. Persistence of primitive reflexes
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17
Q

How is a diagnosis of cerebral palsy made?

A

Clinical examination - with particular attention to assessment of posture and pattern of tone in limbs and trunk, hand function and gait

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18
Q

What are the 5 levels of the gross motor function classification system (GMFCS)?

A
  1. I: walks without limitations
  2. II: walks with limitations
  3. III: walks using a handheld mobility device
  4. IV: self-mobility with limitatations, may use powered mobility
  5. V: transported in a manual wheelchair
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19
Q

How is cerebral palsy categorised and what are 4 examples of categories?

A
  1. Spastic: bilateral, unilateral, not otherwise specified
  2. Dyskinetic
  3. Ataxic
  4. Other
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20
Q

How is gross motor function described in cerebral palsy?

A

Using gross motor function classification system (GMFCS)

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21
Q

Why are some children assessed for cerebral palsy and who carries out the assessment?

A

Children with high-risk factors for brain damage e.g. significant prematurity or difficulties around time of birth

formal standardised assessment of general movements performed by trained therapist or clinician

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22
Q

What causes spastic cerebral palsy?

A

Damage to upper motor neurone (pyramidal or corticospinal tract) pathway

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23
Q

What are 4 features of spastic cerebral palsy?

A
  1. Limb tone persistently increased (spasticity)
  2. associated brisk deep tendon reflexes and extensor plantar responses
  3. tone is velocity dependent - faster muscle is stretched, the greater the resistance. elicits dynamic catch - hallmark of spasticity
  4. limb tone may suddenly yield under pressure ‘ ‘clasp knife’ fashion
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24
Q

How can spastic cerebral palsy be further classified? 3 groups

A
  1. Unilateral (hemiplegia) - unilateral involvement of arm and leg
  2. Bilateral (quadriplegia) - all 4 limbs affected
  3. Bilateral (diplegia) - all four limbs but legs affected to much greater degree
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25
Q

When can spastic cerebral palsy present?

A

Can present in neonatal period

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26
Q

When does unilateral spastic cerebral palsy usually present and what are the key features?

A
  • 4-12 months
  • Fisting of affected hand, flexed arm, pronated forearm, asymmetric reaching, hand function or toe pointing when lifting the chlid
  • Tiptoe walk (toe-heel gait)
  • Sometimes hemianopia on same side as affected limbs
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27
Q

What are 2 possible causes of unilateral (hemiplegic) spastic cerebral palsy?

A
  1. Silent prenatal cause
  2. Neonatal stroke - perinatal middle cerebral artery infarct
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28
Q

What are 4 key features of bilateral quadriplegic spastic cerebral palsy?

A
  1. all 4 limbs affected with trunk involvement (e.g. may see scissoring of legs)
  2. opisthotonus (extensor posturing)
  3. poor head control
  4. low central tone
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29
Q

What is the most severe form of spastic cerebral palsy?

A

Bilateral, quadriplegic form

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30
Q

What is the cause of quadriplegic bilteral spastic CP?

A

Hypoxic ischaemic encephalopathy - extensive damage to periventricular areas of devleoping brain, including cortex

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31
Q

What are 3 things that bilateral (quadriplegic) cerebral palsy may be associated with?

A
  1. Seizures
  2. Microcephaly
  3. Moderate to severe intellectual impairment
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32
Q

What are 2 key features of bilateral, diplegic spastic CP?

A
  1. Motor difficulties in arms most apparent with functional use of hands
  2. Walking abnormal
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33
Q

What is one of the key causes of bilateral, diplegic cerebral palsy?

A

Preterm birth due to periventricular brain damange (MRI shows periventricular leukomalacia)

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34
Q

What is dyskinetic cerebral palsy?

A

dyskinesia = involuntary, uncontrolled, stereotyped movements, more evident with active movement or stress

Muscle tone variable and primitive motor reflex patterns predominate

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35
Q

What are the 3 key things that can be used to describe dyskinetic cerebral palsy?

A
  1. chorea: irregular, sudden and brief non-repetitive movements
  2. athetosis: slow writhing movements occuring more distalling e.g. fanning of fingers
  3. dystonia: simultaneous contraction of agonist and antagonist muscles of trunk and proximal muscles - gives twisting appearance
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36
Q

What are 4 features of dyskinetic CP that patients may present with?

A
  1. unimpaired intellect
  2. floppiness
  3. poor trunk control
  4. delayed motor development in infancy
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37
Q

When may abnormal movements appear in dyskinetic cerebral palsy?

A

towards end of first year of life

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38
Q

What causes dyskinetic cerebral palsy?

A

damage or dysfunction in basal ganglia or extra-pyramidal pathways - most commonly due to hypoxic-ischaemic encephalopathy, due to perinatal asphyxia at term (previously due to kernicterus due to Rh incompatibility)

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39
Q

What is the cause of ataxic (hypotonic) cerebral palsy?

A
  1. mostly geneically determined
  2. also due to acquired brain injury to cerebellum or its connections
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40
Q

If ataxic CP is due to cerebellar injury, what side will signs occur on?

A

same side as injury (but usually relatively symmetrical)

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41
Q

What are 6 features of ataxic cerebral palsy?

A
  1. limb hypotonia
  2. poor balance
  3. delayed motor development
  4. intention tremor
  5. incoordinate movements
  6. ataxic gait
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42
Q

When is prognosis of CP best estimated?

A

when severity and pattern of evolving signs and child’s developmental progress have become clearer over several months or years of life

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43
Q

What are 4 available treatments for hypertonia in CP?

A
  1. botulinum toxin injections to muscles
  2. selective dorsal rhizotomy (proportion of nerve roots in spinal cord selectively cut to reduce spasticity)
  3. intrathecal baclofen (skeletal muscle relaxant)
  4. deep brain stimulation of basal ganglia
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44
Q

What is often the cause of unilateral spastic or dystonic CP?

A

perinatal middle cerebral artery infarct

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45
Q

What are 3 overall features of cerebral palsy?

A
  1. abnormal tone and posture
  2. delayed motor milestones
  3. feeding difficulties
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46
Q

What are 2 ways to categories disordered speech and language development?

A
  1. may be receptive or expressie deficit
  2. may be delay or disorder
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47
Q

What are 5 causes of speech and language delay?

A
  1. hearing loss
  2. global developmental delay
  3. difficulty in speech production from an anatomical deficit e.g. cleft palate, or oromotor incoordination, e.g. CP
  4. environmental deprivation/lack of opportunity for social interaction
  5. normal variant/familial pattern
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48
Q

What are 5 causes of speech and language disorders?

A
  1. Language comprehension
  2. Language expression - inability or difficulty in producing speech whilst knowing what is needing to be said
  3. Intelligibility and speech production such as stammering (dysfluency), dysarthria or verbal dyspraxia
  4. pragmatics (difference between sentence meaning and speaker’s meaning), construction of sentences, semantics, grammar
  5. social/communication skills (autism spectrum disorder)
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49
Q

What is usually the first step in assessment for speech and language problems?

Who should be involved thereafter?

A

Hearing test and assessment by speech and language therapist

Then involve neurodevelopmental paediatrician and paediatric audiological physician

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50
Q

What is the management of speech and language problems in children? 4 aspects

A
  1. Speech and language therapy: continuous, burst or review basis
  2. may involve alternative methods e.g. Makaton or Picture Exchange Communication System
  3. Special Schooling for very few
  4. Learning support at school entry
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51
Q

What are 2 examples of tests of language development?

A
  1. Symbolic toy test - assesses early language development
  2. Reynell test for receptive and expressive language, used for preschool children
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52
Q

What is the IQ range for children with borderline and mild learning difficulties?

A

70-80

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53
Q

What is the usual management for children with borderline and mild learning difficulties?

A

Supported by additionaal helpers in mainstream schools

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54
Q

What is the IQ range for moderate learning difficulty?

A

50-70

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55
Q

What is the IQ range for severe learning difficulty?

A

35-50

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56
Q

What is the IQ range for profound learning difficulty?

A

<35

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57
Q

What is usually needed as the management for children with moderate, severe or profound learning difficulties?

A

Resources of special schools

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58
Q

How will severe or profound learning difficulties present vs how moderate and mild may present?

A

Severe or profound = marked global developmental delay

Moderate = delay in speech and language

Mild = may only become apparent when starting school or much later

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59
Q

How will a child with profound learning difficulty present vs child with severe?

A

Profound = no significant language, completely dependent for all their needs

Severe = able to learn minimal self-care skills and acquire simple speech and language

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60
Q

How does the cause of severe learning difficulties contrast with that of moderate learning difficulty?

A

In severe, most have organic cause, but lower socioeconomic classes over-represented in moderate learning difficulty

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61
Q

What is meant by specific learning difficulty and what are 4 examples?

A

The skill described is more delayed than would be expected for chlid’s level of cognitive ability

  1. Dyspraxia (developmental coordination disorder)
  2. Dyslexia
  3. Dyscalculia (calculation)
  4. Dysgraphia (writing)
  5. Disorder of executive functions
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62
Q

What is developmental coordination disorder/ aka dyspraxia?

A
  • Disorder of motor planning and/or execution with no signficant findings on standard neurological examinations
  • Disorder of higher cortical processes
  • problems with perception, language and putting thoughts together
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63
Q

What are 8 possible features of dyspraxia?

A
  1. handwriting is awkward, messy, slow, irregular, poorly spaced
  2. dressing difficulties with buttons, laces, clothes
  3. cutting up food
  4. poorly established laterality
  5. copying and drawing
  6. messy eating from poor coordination (oromotor dyspraxia), dribbling
  7. impact on educational progress - suggest greater academic difficulties than is the case
  8. poor self-esteem
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64
Q

What are 3 aspects of management of dyspraxia?

A
  1. Assessment and advice from occupational therapist
  2. Speech and language therapist for oromotor skills/speech if necessary
  3. Visual assessment may be helpful
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65
Q

Why might dyspraxia in a milder form go unnoticed in the first few years of life?

A

If mild and child acheives gross motor milestones at normal times

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66
Q

What are 4 things that therapy for dyslexia (with occupational therapist, SALT) may involve?

A
  1. Sensory integration
  2. Sequencing
  3. Executive planning
  4. Speech/language therapy if needed
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67
Q

What type of dyspraxia might raise more specific difficulties/

A

Verbal dyspraxia - more specific difficulties related to speech production in absence of muscle or nerve damage (still part of developmental dyspraxia)

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68
Q

What is the prognosis of dyspraxia?

A

With therapy and maturity, condition should improve

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69
Q

What is dyslexia?

A

Disorder of reading skills disproportionate to child’s IQ - when child’s reading age is more than 2 years behind chronological age

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70
Q

What does the management of dyslexia involve?

A

Assessment includes vision and hearing and involves educational psychologist

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71
Q

What is dyscalculia?

A

Disorder in development of calculation skills

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72
Q

What is dygraphia?

A

Disorder in development of writing skills

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73
Q

What are 5 types of specific learning difficulty?

A
  1. Developmental coordination disorder (dyspraxia)
  2. Dyslexia
  3. Dyscalculia
  4. Dysgraphia
  5. Disorder of executive functions
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74
Q

What are 6 associated comorbidities of specific learning disorders (dyspraxia, dyslexia etc.)?

A
  1. Attention deficity disorder
  2. Hyperactivity
  3. Sensory processing disorder (poor sensory integration skills of touch, balance)
  4. Depression
  5. Conduct disorders
  6. Obsessive compulsive disorder
75
Q

What are 6 overall aspects of the management of specific learning disorders?

A
  1. Assessment of vision and hearing
  2. Occupational therapist
  3. Physiotherapist
  4. Speech and language therapist
  5. Educational psychologist
  6. Identify comorbidities
76
Q

What is the general treatment for specific learning disorders?

A

Aimed at improving skill acquisition, with educational and information technology support as appropriate

77
Q

What are 3 situations when hearing should be tested as a possible underlying cause?

A
  1. Delayed language or speech
  2. Learning difficulties
  3. Behavioural problems
78
Q

When might unilateral hearing loss present?

A

When the good ear has acute infection or glue ear

Also could present with difficulty localising sounds

79
Q

What are the 2 types of hearing loss and what does each mean?

A
  1. Sensorineural: caused by lesion in cochlea or auditory nerve, usually present at birth
  2. Conductive: from abnormalities of ear canal or middle ear, most often from otitis media with effusion
80
Q

What are 9 causes of sensorineural hearing loss?

A
  1. Genetic (majority)
  2. Congenital infection
  3. Preterm
  4. Hypoxic-ischaemic encephalopathy
  5. Hyperbilirubinaemia
  6. Meningitis/encephalitis
  7. Head injury
  8. Drugs e.g. aminoglycosides (gentamicin), furosemide
  9. Neurodegenerative disorders
81
Q

What are 6 causes of conductive hearing loss?

A
  1. Otitis media with effusion (glue ear)
  2. Eustachian tube dysfunction: Down syndrome,
  3. Cleft palate,
  4. Pierre Robin sequence,
  5. Midfacial hypoplasia.
  6. Wax (only rarely)
82
Q

Which type of hearing loss can be more profound, conductive or sensorineural?

A

Sensorineural - e.g. >95dB hearing loss, but conductive ma 60dB hearing loss

83
Q

How does the natural history of sensorineural vs conductive hearing loss differ?

A

Sensorineural does not improve and may progress, conductive is intermittent or resolves

84
Q

What are 2 ways to manage sensorineural hearing loss?

A
  1. Amplification
  2. Cochlear implant if necessary
85
Q

What are 3 ways to manage conductive hearing loss?

A
  1. Conservative
  2. Amplification
  3. Surgery
86
Q

What is the typical audiogram in sensorineural vs conductive hearing loss?

A
87
Q

When can permanent childhood hearing impairment (PCHI) present?

A

Usually present at birth or develops in first few months of life

88
Q

Is permanent childhood hearing impairment reversible?

A

no, irreversible

89
Q

How severe can sensorineural hearing loss be?

A

any severity (including profound)

90
Q

What is the management of a child with severe bilateral sensorineural hearing impairment?

A

Early amplification with hearing aids for optimal speech and language developemtn

91
Q

How should hearing aid use be managed in children?

A

Close supervision, beginning in home together with parents and continuing into school

92
Q

Why do children often resent wearing hearing aids?

A

background noise can be amplified unpleasantly

93
Q

How can hearing aids be used for children with microtia (congenital underdeveloped external ear) and meatal atresia?

A

Bone conduction hearing aids

94
Q

What can be used to treat severe bilateral sensorineural hearing loss if hearing aids are insufficient?

A

Cochlear implants

95
Q

How do cochlear implants?

A

have microphone to detect sound, speech processor and transmitter and receiver/stimulator.

convert speech into electric impulses, which are conveyed to the auditory nerve, bypassing the ear

provides deaf person with representation of sounds

96
Q

What is an important part of the management of children with moderate sensorineural hearing impairment?

A

Can be educated within mainstream schools or in partial hearing units attached to mainstream schools

97
Q

What are 4 general measures for children with sensorineural hearing loss?

A
  1. Specialist teaching and support service in preschool and school years provided by peripatetic teachers for children with hearing impairment
  2. Place near front of classroom so can readily see teacher
  3. Gesture
  4. Visual context
  5. Lip movement

these allow children to develop language concepts

98
Q

What is the effect of sensorineural hearing loss on speech in many cases?

A

speech may be delayed but with appropriate therapy can be of good quality

99
Q

For what group of children can Makaton/ other simplified signing methods can be used?

A

children who are both hearing impaired and learning disabled

100
Q

In terms of education what may be needed for children with profound hearing impairment?

A

attending school for children who are deaf

101
Q

What is the more common type of hearing loss in children?

A

conductive hearing los - usually due to middle ear disease

102
Q

How frequent is conductive hearing loss due to middle ear infection?

A

many children have episodes of hearing loss, usually self-limiting

103
Q

How long can conductive hearing loss due to otitis media with effusion last?

A

Usually short, self-limiting, but may last many months or years

104
Q

What are 3 risk factors for otitis media with effusion?

A

Usually no risk factors

  1. Down syndrome
  2. Cleft palate
  3. Atopy
105
Q

What investigation may be used in conductive hearing loss?

A

Impedance audiometry (tympanometry) - measure air pressure in middle ear and compliance of tympanic membrane

106
Q

What are 4 aspects of management of conductive hearing loss due to OME?

A
  1. Conservative - may improve spontaneously
  2. If not, medical treatment: decongestant, long course of antibiotics or treatment of nasal allergy
  3. If medical fails: surgery with insertion of tympanostomy tubes (grommets) with or without adenoid removal
  4. Hearing aids if problems recur after surgery
107
Q

What determines the decision to intervene surgically (and insert tympanostomy tubes) in conductive hearing loss due to OME?

A

degree of function disability rather than absolute hearing los

108
Q

What are 7 ways that visual impairment may present in an infant or young child?

A
  1. Obvious ocular malformation e.g. anophthalmia
  2. Absent red reflex or white reflex - opacification, corneal abnormalities, retinoblastoma
  3. Not smiling responsively by 6 weeks’ post-term
  4. Concerns about poor visual responses, including poor eye contact
  5. Roving eye movements
  6. Nystamus
  7. Squint
109
Q

What should be done for an infant presenting with ocular abnormality and why?

A

Prompt referral to ophthalmologist - some underlying conditions are sight-threatening, and retinoblastoma is life-threatening

110
Q

What is nystagmus?

A

Repetitive, involunary, rhythmical eye movement

111
Q

In which direction is nystagmus usually?

A

Usually horizontal but can be vertical

112
Q

What are 2 broad causes of nystagmus?

A
  1. Association with structural eye problem (sensory defect nystagmus)
  2. Consequence of problem at cortical level
113
Q

What is the prognosis of nystagmus?

A

if manifestation of an eye problem, may improve over time

114
Q

What diagnosis is made if nystagmus is present with no structural eye or brain problem?

A

Idiopathic nystagmus

115
Q

What is squint/ strabismus?

A

Misalignment of visual axes

116
Q

Why is it important to assess squint in children?

A

To identify the underluing cause and treat where possible

117
Q

What type of squint is common and when?

A

Transient misalignment up to 3 months of age

118
Q

What anatomical featuer can give the appearance of squint/ strabismus?

A

Marked epicanthic folds

119
Q

What should you ask about in the history of a child with squint?

A

any family history

120
Q

When should you refer squint for a specialist ophthalmological opinion?

A

Those which persist beyond 3 months of age

121
Q

What are 2 key diagnostic tests in the examination for squint?

A
  1. Corneal light reflex test
  2. Cover test
122
Q

What is the most common underlying cause of squint and what are 3 further causes?

A

Most common = refractive error

  1. Cataracts
  2. Retinoblastoma
  3. Other inraocular causes
123
Q

What are the 2 groups that squints are commonly divided into?

A
  1. Concomitant (non-paralytic, common)
  2. Paralytic
124
Q

What is usually the cause of concomitant squint?

A

Refractive error in one or both eyes

125
Q

What can often correct a concomitant squint?

A

Correction of refractive error with glasses

126
Q

How might a concomitant squint appear? What is most common?

A

Most often turns inwards (convergent), can be outward (divergent) or rarely, vertical deviation

127
Q

Which of the two types of squints is most common?

A

Concomitant

128
Q

What is meant by paralytic squint?

A

varies with gaze direction due to paralysis of the motor nerves

129
Q

What is the important possible underlying cause of paralytic squint?

A

Underlying space-occupying lesion such as brain tumour

130
Q

What test can be used by non-specialists to detect squints and how?

A

Corneal light reflex test: pen torch held at distance to produe reflections on both corneas simultaneously. If light reflection not in same position in two pupils, squint is present (minor squint may be difficult to detect)

131
Q

In addition to the corneal light reflex test and cover test to assess squint, what is another important key step of the routine examination of eyes to remember?

A

red reflex

132
Q

How does the cover test help to diagnose squint?

A

Child encouraged to look at toy/ light; if fixing eye covered, squinting eye will move to take up fixation

Should eb performed with near (33cm) and distance (at least 6m) objects, as certain squints only present at one distance

133
Q

What is the most common refractive error in young children?

A

hypermetropia - long sight

134
Q

How can hypermetropia be corrected?

A

Convex (plus) lenses - make eye look bigger (may not be needed if mild)

135
Q

At what age does myopia usually present in children?

A

relatively uncommon in young children, presents usually in adolescence

136
Q

What may cause myopia to present at a younger age than adolescence?

A

Preterm children - most common refractive error in this group

137
Q

How can myopia be corrected?

A

Concave (minus) lenses, make eye look smaller

138
Q

What is astigmatism?

A

Abnormal corneal curvature

139
Q

How common is astigmatism and what needs to be done?

A

Minor degrees are common, may not cause problems or require correction

140
Q

What can be a complication of unilateral astigmatism?

A

Can result in amblyopia

141
Q

What is amblyopia?

A

Potentially permanent reduction of visual acuity in an eye that has not received a clear image

142
Q

How common is amblyopia?

A

2-3% of children

143
Q

Is amblyopia uni or bilateral?

A

usually unilateral, can be bilateral

144
Q

What are 3 most common causes of amblyopia?

A
  1. Squint
  2. Refractive errors
  3. Obstruction to visual pathway e.g. cataract
145
Q

How can squint cause amblyopia?

A

brain unable to combine differing images from each eye - vision from squinting eye switched off to avoid double vision

146
Q

What are the 2 key aspects of management of amblyopia?

A
  1. Tackle underlying condition - squint, refractive error, cataract
  2. Patching of goof eye for specific periods of day to force ‘lazy’ eye to work and therefore develop better vision
147
Q

Why is early treatment of amblyopia essential?

A

after 7 years of age improvement is unlikely

148
Q

What is the main target condition for preschool vision screening in the UK and why?

A

Amblyopia as may be asymptomatic

149
Q

What are 12 causes of severe visual impairment in children?

A
  1. Cataract
  2. Congenital infection
  3. Trauma
  4. Albinism
  5. Retinopathy of prematurity
  6. Postnatal infection
  7. Retinal dystrophy
  8. Retinoblastoma
  9. Hypoxic-ischaemic encephlopathy
  10. Juvenile idiopathic arthritis
  11. Cerebral abnormality/damage
  12. Optic nerve hypoplasia
150
Q

What is the top cause of severe visual impairment in children ein the UK?

A

cerebral pathology (up to 50%)

151
Q

What are 3 investigations in severe visual impairment in children?

A
  1. Electroretinogram
  2. Visual evoked potentials
  3. Examination of eye, including pupillary responses (may be normal)
152
Q

In severe visual impairment, when might examination of eye/pupillary reflexes be normal?

A

If impairment of cortical origin resulting from cerebral damage

153
Q

What is the benefit of early detection of severe visual impairment in childre?

A

allows certain elements to be treated and timely advice can be given on supporting developmental progress (although few causes can be cured)

154
Q

Who usually provides advice on supporting developmental progress in severely visually impaired children?

A

Peripatetic teachers for children with visual impairment - work with families from diagnosis irrespective of child’s age

Paediatrician and other members of development team

155
Q

What are 4 aspects of management of children with severe visual impairment?

A
  1. Support from peripatetic teachers
  2. Low vision aids
  3. High-powered magnifiers
  4. Small telescopic devices and computers
156
Q

What coexistent problem is there in at least half of severely visually impaired children?

A

Neurodevelopmental problems

157
Q

What ar e3 key situations when you should refer a child for ophthalmological opinion?

A
  1. absent red reflex
  2. white reflex
  3. squint persisting >3 months
158
Q

Who can use the cover test for squint?

A

Specialists - optometrists, ophthalmologist

159
Q

What type of servies are provided for child development problems?

A

based on geographic areas, secondary care services

160
Q

What is the definition of a child developent service? 8 parts

A

multidiscplinary service with predominantly health professionals - paediatrician, physio, OT, SALT, clinical psychologist, specialist health visitor, dietician, social worker

161
Q

What are 3 things that a psychologist (clinical and educational) can provide to a child with developmental problems?

A
  1. Cognitive testing
  2. Behaviour management
  3. Educational advice
162
Q

What are 4 things that occupational therapists can help children with who have developmental problems?

A
  1. Eye-hand coordination
  2. Activities of daily living - feeding, washing, toileting, dressing, writing
  3. Seating
  4. Housing adaptations
163
Q

What are 4 things that social workers/ social services can help children with who have developmental abnormalities?

A
  1. Advice on benefits: disability, mobility, housing, respite care, voluntary support agencies
  2. Day nursery placements
  3. Advocate for chlid and family
  4. Register of children with special needs
164
Q

What are 2 key things specialist health visitors can do for children with developmental problems?

A
  1. Help coordinate MDT and multi-agency care
  2. Advice on development of play or local authority schemes e.g Portage
165
Q

What are 5 agencies that may be involved of the care of children with developmental needs?

A
  1. Health services
  2. Social services
  3. Education
  4. Voluntary agencies
  5. Parent support groups
166
Q

What are 3 key benefits of a child development service?

A
  1. provides coordinated service with good inter-agency liaison to meet functional needs, optimise care
  2. maintains register of children with disabilities and special needs
  3. emphasis on child’s needs within community (home, nursery, school) regardless of its location
167
Q

Up to what age might child development servies provide support and monitor children?

A

up to school leaving age, 16-19 years

168
Q

What is usually used by child development services in the UK to allow multidisciplinary sharing of information?

A

Common Assessment Framework

169
Q

What are 4 key aims of a child development services and the Common Assessment Framework?

A
  1. Diagnosis
  2. Assessment of functional skills: mobility, hand funciton, vision, hearing, communication, behaviour, social/self care and learning
  3. Provision of therapy
  4. Regular review
  5. Coordinated approach to care (multidisciplinary, multiagency)
170
Q

What must all professionals in the child development team make sure they do and why?

A

keep entries in child’s personal child health record up to date - good inter-professional communication

171
Q

When might specialist neurodisability services be required in addition to local child development services? 12 situations

A
  1. rehab after acquired brain injury
  2. surgery for cerebral palsy, scoliosis
  3. gait analysis
  4. spasticity management e.g. botulinum toxin injections
  5. epilepsy unresponsive to 2or more anticonvulsants/severe cognitive and behavioural regression
  6. complex communication disorders
  7. mixed complex learning problems
  8. provision of communication aids
  9. sensory impairments e.g. cochlear implants
  10. children with severe visual and hearing impairment
  11. specialised seating/ wheelchairs and orthoses
  12. management of movement disorders
172
Q

What are 3 ways that movement disorders can be managed?

A
  1. Continuous infusion of intrathecal baclofen
  2. Selective dorsal rhizotomy
  3. Deep brain stimulation to basal ganglia
173
Q

What are 2 key stages when the needs of children from child development services are likely to change and what should be done at each stage?

A
  1. Transition to school
  2. Transision to adult services

care plan should be developed, including educaiton and social care as well as health

174
Q

What are 3 approaches to education in children with special educational needs?

A
  1. Integration into mainstream schooling whenever possible
  2. More significant learning and/or physical disabilities: special needs’ schools
  3. Specialist educational placements for certain conditions e.g. severe visual or hearing impairment or autism
175
Q

What is the benefit of specialist educational settings for children with special educational needs?

A

access to higher level of therapies e.g. phyio, OT, SALT, and specialist teaching more than are available in mainstream school

176
Q

What are 2 types of professionals who may be involved in the education of a child with development problems and what is their role?

A

Educational and clinical psychologist

Assessment and support for behavioural and learning needs

177
Q

What support is available for young adults with severe learning and physical disabilities?

A

Adult Learning Disability Teams

178
Q

What is a disadvantages about the Adult Learning Disability Teams available for young adults?

A

only limited national provision for those with mild or moderate learning disabilities or predominantly physical disability

179
Q

What are 8 social issues around young adults with disabilities?

A
  1. Care
  2. housing
  3. Mobility
  4. Finance
  5. Leisure
  6. Epmloyment
  7. Genetic
  8. Sexual counselling
180
Q

What is important about the transition of care from child to adult services?

A

Health info must be properly transferred from child to adult health services if reinvestigation of already well-clarified conditions is to be avoided

181
Q

What is the source of information on the rights of disabled children?

A

United Nations Convention on the Rights of the Child - need to be respected irrespective of disability

182
Q

What are 3 things that are helping children with disability to better achieve full potential rather than being held back?

A

Technological advances to improve:

  1. Mbility
  2. Commnication
  3. Emotional expression
183
Q

What does the World Health Organisation state about children with disability?

A

Important outcomes of activity and participants

Paeds: Child Development (8 decks)

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