The infant or child with abnormal development or poor school performance Flashcards Preview

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Flashcards in The infant or child with abnormal development or poor school performance Deck (35):
1

Neurological assessment history

1. Pregnancy/neonatal
2. Development
->Regression in developmental milestone
->Pattern of the delay
3. Headache
4. Vomiting early morning
5. Involuntary movements, convulsions, unexplained collapse, ALOC
6. Sensory
7. Bladder and bowel
8. Ataxia, clumsiness, incoordination
9. Hearing and vision
10. Behaviour, mood, apathy, concentration
11. School performance
12. Function
13. Home environment->parents, siblings
14. Additional support->parental respite
15. Family history of neurological->epilepsy, hearing/vision,metabolic, congenital, learning difficulty

2

Neurological physical examination

1. Observation
->AVPU, GCS
->Posture, movement, gait
->Limb deformity
->Growth/HC
->Skin sigs->pigmentation, vascular birth marks
->dysmorphic features, xsomal, CNS malformation, FAS
->equiptment to aid neurological problems
2. Eye->movement, pupils, fundoscopy
3. Peripheral
->Muscle bulk, tone, power, coordination, reflexes
->Sensory
4. Developmental exam
5. Hepatosplenomegaly (metabolic)

3

Neurological examination in infants

1. Moving spontaneously
2. Positioning->hypoT= frogs legs
3. Palpate posterior fontanelle/head circumference
4. Assess tone by posture and handling->ventral position, pull to sit->++tone= resistance, scissoring of legs

4

Define cerebral palsy

Motor impairment
Permanent
Non-preogressive lesion in developing brain->however clinical picture changes

5

Most common form of cerebral palsy and location of lesion

Spastic type

6

Types of cerebral palsy (5)

1. Hemiplegia
2. Diplegia
3. Total body involvement
4. Atatxic
5. Athetoid

7

Features of hemiplegia

Arms more affected than legs
Delayed walking
Tiptoe gait, dystonic posture when running

8

Athetoid cerebral palsy

Basal ganglia
Writhing movement
Intelligence often normal
Major physical impairment

9

Ataxic cerebral palsy

Cerebral damage
Ataxia and poor coordniation

10

Diplegia

Both legs
++Hip adduction, nappy difficult to put on
Scissoring of legs
Feet in equinovarus and walking on tiptoe

11

Total body involment

All limbs
+Learning difficulties
Seizures
Swallowing difficulties and GOR
Flexion contractur es of knees and elbows often present by late childhood

12

Prevalence of cerebral palsy

Is 2 / 1000

13

Etiology- pre, peri, post-natal of cerebral palsy

1. Prenatal
Cerebral malformation
Maternal infection
Metabolic
2. Perinatal
Birth trauma
Hypoxic-ischemic
Prematurity
3. Postnatal
Head injury
Non-accidental injury
Meningitis/encephalitis
Cardiopulmonary arrest

14

Diagnosis of cerebral palsy

Clinical, based on findings abnormalities:
1. Tone->spasticity
2. Patterns of development ->abnormal in quality
3. Motor developmental delay
4. Persistent reflexes

If cause not clear:
1. Urine/plasma metabolic screen
2. Consider congenital infections
3. Xsomal analysis
3. MRI->vascular, malformations, periventricular leucomalacia

15

Associated problems (8) in cerebral palsy

Hearing
Vision->50%, squint
Epilepsy->50%
Respiratory problems
Undernutrition, poor intake
Learning difficulties
Behavioural

16

Multidisciplinary team involved in managment of cerebral palsy

Child development team
1. Pediatrician->support, liason
2. Physiotherapist->handling and mobilising, prevent contractures
3. Occupational therapist->equiptment and play materials
4. Speech and language therapist->feeding and language
5. Health visitor
6. Psychologist

17

Define visual impairment and blind

Impairment= visual acuity

18

Prevalence of blind/partially sighted

1 in 2500

19

Etiology of blindness in children, most common 3

Optic atrophy
Congenital cataracts
Choirodoretinal abnormalities

20

Clinical features of visually impaired children

Eyes may appear different
Smilining inconsistent
Do not turn head toward sound
Slower language development
Pincher, reach abnormal
May have associated hearing/learning difficulties

21

Management of visual impairment

1. Opthalmological referral
2. Advice to parents, adaptations to home, stimulation in non-visual way
3. Mainstream preschool generally appropriate with support
4. Attend to learning difficulties
5. Mobility training

22

Prevalence of hearing deficits

Prevalence 4%

23

Etiology

Most commonly conductive due to OM
Genetic
Pre, peri, post natal problems
Cerebral insult

24

Risk of deafness->neurosensory and conductive

1. Neurosensory
Meningitis
Cerebral palsy
FHx
Aminoglycoside
Congenital CMV

2. Conduction
Cleft palate
Recurrent OM

25

Clinical presentation of hearing impairment

Universal neontal screening
Audiology->at risk, speech, concerns about deafness

1. Lack response to sound
2. Poor speech
3. Behavioural
4. Associated->learning disabilities, neurological, visual

26

management of hearing impairment

1. Grommets in conductive
2. Hearing aids in sensorineuronal
3. Cochlear
4. Genetic counselling may be needed

27

Management considerations for cerebral palsy->3 categories (4, 9, 4)

1. Associated disability
Hearing and vision
Epilepsy and cognitive assessment
2. Health
Growth
Obesity
Reflux
Chronic lung disease
Constipation
VP shunt
Osteoporosis
Dental
Emotional
3. Consequences of motor
Drooling->speech therapy, anticholinergics
Incontinence due to cognition, access, communication, overactive bladder
Orthopedic->contractures, dislocations, scoliosis
Spestcity->diazepam, inhibitory casts, BTA, intrathecal baclofen (GABA), selective dorsal rhizotomy

28

Common presentations to the ED with cerebral palsy

Respiratory problems particularly pneumonia
Uncontrolled seizures / status epilepticus
Unexplained irritability - consider acute infections, oesophagitis, dental disease, hip subluxation, pathological fracture. Review medications.

29

History in speech delay

1. Birth/developmental
2. Family history of speech/hearing
3. Isolated developmental delay->Ages and stages screening
4. Features of ASD present
5. History of saying words in the past

30

Examination in speech delay

1. General, behaviours to suggest ASD
2. Neurocutaneous marking
3. Dysmorphic features
4. Neurological examination
5. Hearing
6. Motor, fine motor, social development

31

What investigation must be done with speech delay and why

Audiogram->a high frequency deafness can only be diagnosed this way

32

Next steps for speech delay

1. Referral to pediatrician
2. Referral to speech and language therapist

33

Causes of developmental delay

1. Idiopathic
2. CNS malformations
3. Xsomal
4. Metabolic
5. Pre/per/post natal

34

Investigations for developmental delay

Xsome analysis
Thyroid function
Urine screen for metabolic abnormalities

35

Follow up for developmental delay

Complete developmental assessment with:
Pediatrician
Psychologist
Speech and language therapist
OT
Physiotherapist

Decks in Pediatrics Class (58):