Week 1 Flashcards by Jenna Cook

What are the three main aspects that influence children’s development

Genetics
Nutrition
Environment

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Define a milestone

The median age when 50% of the population achieve a skill

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Define a limit age

When a skill should have been acquired by 97.5% of children

Past this point we begin to be concerned

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What age do we loose primitive reflexes?

3-4 months

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Name some normal variants of crawling. What is their caviate to walking?

Back shuffling
Commando crawling
Butt shuffling

(May take longer to walk)

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At what age would expect your child to have control of their head?

3 months

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What is the natural progression of motor movements of the hands?

Look at them in the midline
Grasp toys in palm 
Scissor grip (three fingers)
Pincer grip (2 fingers)
Tower 3/4 blocks
Tower 6/7 blocks AND scribble 
Tower 9 bricks and copy a circle 
Draw simple man

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What is the normal progression of hearing and language?

Vocalise, babble, imitate sounds, know name, know 5-20 words and body parts, simple instructions and 50+ words, complex instructions and ask questions, can tell stories

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What can lack of a social smile at 8 weeks be a sign of?

Autism

The milestone age is 6 weeks the limit age is 8 weeks

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What are some of the red flags for a child’s development ?

Asymmetry of movement 
Not reaching for objects by 6 months
Unable to sit unsupported by 12 months
Unable to walk by 18 months
No speech by 18 months
Concerns of vision or hearing
Loss of skills

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What is global developmental delay

Delay in 2 or more in gross/ fine motor, sppech/language, cognition, social/personal, ADL

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What is the autism triad?

Communication difficulties, social interactions difficult and dont have flexibility of thought

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What questions in terms of perinatal and birth would you ask a mother whose child is have developmental delays?

Was she well during pregnancy 
Premature baby?
Drink while pregnant/ unknown pregnant
Post natal depression 
Meningitis as a child
Head injury?

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Define a burn

An injury caused by dry heat like hot object, surface or flame. Severity measured by depth

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Define a scald

Caused by moist heat like hot water, oil or steam. Often blister

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What is the classical triad in a shaken child for NAI

Bilateral retinal haemorrhages
Subdural haemorrhage
Encephalopathy

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What features on a child would make you think an injury was NAI

Present on Non mobile child
Symmetrical 
On non-bony area
Scarf/stocking mark 
On area usually covered like back chest

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You suspect cerebral palsy in a child of 18 months. What investigation do you run

MRI of the brain

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Child is not walking by 18months, what investigation would you always do

Creatine kinase for duchennes muscular dystrophy

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What are some of the red flags for abnormal development?

After infection not doing activities were before
Asymmetry of movement
Not reaching for objects by 6 months (vision, motor skills, autism)
Unable to sit unsupported by 12 months
Unable to walk by 18 months
No speech by 18 months
Concerns of vision or hearing (squinting, not seeing objects/ recognising faces)
Loss of skills

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What is global developmental delay

If delayed in 2 or more then global developmental delay

Gross motor
Fine motor
Speech and language
Cognition 
Social and personal

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If a child has global developmental delay what should you screen for?

Downsyndrome
Heart disease
Vision issues
Middle ear effusions
Thyroid function
Breathing disorders (sleep apnoea)
Look at growth charts

What you investigate depends on what delayed

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What are some of the physical characteristics of duchenne muscular dystrophy

Large calfs
Lumbar lordosis
Pelvic girdle muscle loss

Gowlers sign

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During what time period of pregnancy could trauma to the fetus cause cerebral palsy?

34-42 weeks

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Child presents with loss of pigmentation of the skin, hairs and eyes, also has nystagmus and photophobia. What is the diagnosis?

Oculocutaneous albinism

What is the autistic triad?

Poor Communication Poor Social interaction Loss of flexibility of thought and imagination

What are some of the sensory issues with autism

Fussy eater Dont like hair washing/ cutting Loud noises Specific textures of clothes (May find a heavy backpack comforitng)

What are some of the questions you should ask a mom about her pregnancy and birth when presenting with a child with developmental delay

``` Well during pregnancy? Premature child? Drink while didnt know pregnant? Post natal depression? Meningitis child? Head injury? Birth type? Any issues with birth? Have to go to the special care unit? ```

What indicates that a boy is in puberty

Testicular volume 4ml

What is true central precocious puberty in males and females?

Reaching puberty before 8yrs for girls and before 9 yrs for boys In females; breast development before 8 In girls; testicular volume >4ml before 9yrs

What development do you use to stage if a boy has entered puberty?

Testicular volume | Pubic hair

What development do you use to stage if a female has entered puberty?

Breast development | Pubic hair distribution

What is the treatment for precocious puberty?

Give GnRh to block puberty onset to encourage final growth height before epiphyseal plates fuse

On the BMI chart on what centiile is it considered to be at risk of overweight/

>85th centile

On the BMI chart at what centile do you worry about obesity

>95th

If a child is overweight or obese, what is the maximum healthy weight loss a month?

0.5-1kg

For a child under 5yrs and walking how much physical activity should they get a day ?

180 minutes

What are some of the pharmacological options for obesity in children and young people

Orlistat 120mg

What is the daily requirement for vitamin A

350-400mcg

What is the daily requirement for vitamin C

25-30mcg

What is the daily requirement for vitamin d

7-8.5mcg

?What is the daily requirment intake for sodium

0-12 months <400mcg (1gsalt) | 1-3yrs <800mcg (2gsalt)

How long is recommended for exclusive breast feeding?

6 months of life

At what stage should weaning be introduced?

6-9motnhs

Until what age should whole nuts and seeds be avoided?

5 years

From waht age should babies be introduced to drinking from cups or beakers?

6 months

What are the top 5 causes of child mortality?

``` Preterm complications Pneumonia Intrapartum related complications (asphyxia) Diarrhoea Neonatal sepsis ```

Women presents with reccurent colds, oral thrush, cervical lymphadenopathy and persistent fever. She has recently moved from subsaharan africa and engaged in unprotected sex. Likely diagnosis?

HIV

If the mother is positive for HIV at what time periods do you check for HIV in the baby?

Test child at 6 weeks 9 months 18 months 6 months post cessation of breast feeding

What is the treatment for HIV in the mother

Anti-retrovial therapy like abacavir and lamivudine BUT if have TB then must treat first

Man presents with chronic cough, night sweats, cervical lymphadenopathy and weight loss. You do an x-ray that shows apical consolidation. What is the next investigation and likely diagnosis?

Microbiology for acid fast bacilli TB

You are working in africa and a young women prsents with fever, pallor and fatigue. She sleeps without an insecticidal net. What is the likely diagnosis and treatment?

Malaria from plasmodium parasite Artemisinin based combination therapy for 3 days

What is reactive attachment disorder (RAD)?

Disturbed and developmentally inappropriate social relatedness, associated with pathological care typically before 5 years

What are the two types of RAD?

Inhibited | Disinhibited

What is inhibited reactive attachment disorder?

Where a child fails to initiate and respond to social interactions in a developmental way They present as unpredictable, avoid social contact, hypervigilant, highly ambivalent, dont seek comfort from caregivers

What is disinhibited reactive attachment disorder?

Where a child has an inability to display appropriate selective attachments (whose safe and dangerous) Older kids are impulsive, speech delays, dont understand social boundaries OR overseek comfort, hyperactive, food issues, prefer to play alone

What is conduct disorder (oppositional defiant disorder)

Where there are repetitive and persistent patterns of behaviours that violate the basic rights of others, rules, and age appropriate norms. Common in those with parents mental illness, alcohol problems, domestic violence.

What three criteria do you need to diagnose conduct disorder (oppositional defiant disorder)

Aggression to people/ animals e.g bullying, fights, cruel to other physically, forced someone sexually Destruction to property incl fire Deceitfulness or theft Serious violoation of rules Must be in the last 12 months, with one in the last 6months

How can you distinguish between conduct disorder (oppositional defiant disorder) and RAD

In conduct disorder they are still able to form satisfying relationships with peers and adults

What is the treatment for conduct disorder?

Parent training, child focused programmes, multimodal interventions, medication (RISPERIDONE) only for extreme impulsive e and aggressive behaviours

What is the ADHD triad\?

Inattention Hyperactivity Impulsive (Also inable to regulate emotions and learning difficulties)

How can you distinguish between ADHD and RAD?

ADHD difficulties are more persistent and across different settings and are more able to initiate and maintain relationships

What is the neurobiology behind RAD?

High levels of cortisol (stress) in the immature brain can cause neurone pathways to be formed that are fight and flight due to excessive stimulation of neglect.

What is the genetic issue with digeorge syndrome?

Chromosome 22 has a bit missing

Kabuki makeup syndrome is a genetic issue with what?

Mutation in MLL2

What is the genetic normal defined as?

The most common form of gene sequence

What is array genomic hybridisation a test for?

Imbalanced chromosome deletions or additions Sensitive test that looks at chunks of genes NOT FOR BALANCED TRANSLOCWTIOS

What does next generation sequencing look at?

Mutations at base level

What is a de-novo mutation?

Where neither parent has the mutation but the child has it. More likely as paternal age increases

By what age should a child be able to walk? (Milestone and limit)

11 months milestone 18 months limit age

What is the limit age for reaching for objects?

6 months

What is the limit age for sitting unsupported?

12 months

What is the limit age for being able to form words

18 montns

Give some examples of vaccine-preventable infections that require to be reported to public health if diagnosed?

``` Cholera HUS (haemolytic ureamic syndrome) Ecoli Measles Polio Whooping cough Diptheric Hib Rubella Tetanus ```

What is the time period for reporting an infection to public health after diagnoising it?

3 days in writing OR if urgent (like ecoli) then same day

What is the treatment for TB?

RIPE Two months rifampicin and pyrazinamide, isoniazid and ethanbutol Then further 2 months of isoniazid and rifampicin

What is the carrier for the plasmodium parasite?

Mosquitors

What is the treatment for malaria?

Artemisinin based combination therapy (ACT) for three days Orally