1- Community (Development)

Question 1

who assesses a childs development

Answer 1

health visitor
If the health visitor has any concerns, they will highlight these to the GP for further assessment. Some children will need additional monitoring (e.g. if they were pre-term and/or have known medical problems).

Question 2

when are children seen by healthcare proffessional to monitor development

Answer 2

• Children will normally be seen by their GP/midwife as a newborn and
• by their health visitor at 6 – 8 weeks, 9 – 12 months and 2 – 2.5 years.

Question 3

Developmental milestones are often divided into 4 categories

Answer 3

• Gross motor
• Vision and fine motor
• Hearing, speech and language
• Social, emotional and behavioural

Question 4

developmental milestones are considered in regards to

Answer 4

their ‘median age of acquisition’ and ‘limit age’ by which they should have been achieved. If the skill is not attained by this age then more detailed assessment, investigation or intervention may be required.

Question 5

Developmental milestones are acquired in a

Answer 5

serial manner- one after the other- and their achievement follows similar pattern between children

Question 6

developmental delay background

Answer 6

Developmental delay is a broad term referring to a delay in any of the four developmental areas.

Question 7

Global DD

Answer 7

delay in 2 or more of the above areas

Question 8

risk factors/causes for DD

Answer 8

• Neurological e.g. spina bifida, HIE, intraventricular hameorrhage
• Infection e.g. TORCH, meningitis
• Neuromusuclar disorders e.g. duchenne musuclar dystrophy
• Genetic disorders e.g. down syndrome
• Austism
• Metabolic e.g. Hurle syndrome, Krabbe disease, Phenylketonuria

Question 9

presentation for DD

Answer 9

• Child does not hit expected milestone

Question 10

red flags for DD

Answer 10

Question 11

investigations for DD

Answer 11

First line
- bloods
- hearing tests

Second line
- Karyotyping/DNA analysis
- More detailed metabolic screen
- MRI
- EEG

Question 12

managment of DD

Answer 12

• Referral to community paediatrician
• MDT approach
  o SALT
  o OT
  o Portage practitioner and orthoptists
  o paediatrician
• Detailed developmental assessment e.g. Griddiths scales of child development
• Holistic assessment of child and family

Question 13

DD prognosis

Answer 13

Prognosis
Only a few causes of developmental delay are reversible, most will result in chronic morbidity with the child requiring specialist support for many years.

Question 14

Global developmental delay
Refers to a child displaying slow development in all developmental domains. This could indicate an underlying diagnosis such as:

Answer 14

• Down’s syndrome
• Fragile X syndrome
• Fetal alcohol syndrome
• Rett syndrome
• Metabolic disorders

Question 15

gross motor milestones

Answer 15

A delay that is specific to the gross motor domain may indicate underlying:
* Cerebral palsy
* Ataxia
* Myopathy
* Spina bifida
* Visual impairment

Question 16

social, emotional and behaviour development

Answer 16

A delay that is specific to the personal and social domain may indicate underlying:
* Emotional and social neglect
* Parenting issues
* Autism

Question 17

vision and fine motor milestones

Answer 17

A delay that is specific to the fine motor domain may indicate underlying:
* Dyspraxia
* Cerebral palsy
* Muscular dystrophy
* Visual impairment
* Congenital ataxia (rare)

Question 18

Hearing, speech and language development

Answer 18

A delay that is specific to the speech and language domain may indicate underlying:
* Specific social circumstances, for example exposure to multiple languages or siblings that do all the talking
* Hearing impairment
* Learning disability
* Neglect
* Autism
* Cerebral palsy
Management
- Referral to speech and language, audiology and the health visitor.
- Referral to safeguarding is required if neglect is a concern.

Question 19

red flags by 3 months

Answer 19

learning head control
- Difficulty lifting or holding head
- Stiff legs with little or no movement
- Keeps hands fisted and lacks arm movement
- Not kicking legs or moving arms when lying down
- Doesn’t follow moving objects with head and eyes
- Asymmetric hand movement

Question 20

red flags by 6 months

Answer 20

• Rounded back
• Dpes not roll from tummy onto back or back to tummy
• Unable to life head
• Sems very stiff pr floppy
• Arches back and stiffens legs
• Difficult to bring arms forward to reach out

Question 21

red flags by 9 months

Answer 21

• Unable to sit without support
• Cannot take weight on legs when supported
• Uses one hand more than the other
• Rounded back
• Uses only one side of the body to move
• Inability to straighten back
• Unable t make sounds
• Doesn’t look where you are pointing

Question 22

red flags by 12 months

Answer 22

• Does not crawl
• Needs to use hands to maintain position
• Loses skills wants had
• Does not point to object
• Sits not able and when supported
• Sits with eight on one side
• Stiffly bent or stretch arms
• Is not able to copy and learn gestures such as waving

Question 23

red flags by 18 months

Answer 23

• Should be able to walk
• Poor standing balance, falls frequently
• Unable to take steps independently by 18 months
• Walks on toes
• Does not point

Question 24

red flags summary

Answer 24

Question 25

What is the cut-off for an acceptable weight loss in the first 7 days of life?

Answer 25

- 10%

Question 26

At what age should a child be referred to a paediatrician if they have not begun to walk?

Answer 26

- 18 months - An infant usually begins to cruise furniture around 10-12 months and can walk alone by 15 months. If walking has not occurred by 18 months the toddler should see a paediatrician

Question 27

At what age should a child develop a mature pincer grip?

Answer 27

- 9-12 months

Question 28

At what age should a child develop a mature pincer grip?

Answer 28

- 9-12 months

Question 29

Which of the following is an example of "Double-syllable babble" displayed by an infant around 9-12 months?

Answer 29

- Ba-ba (usually involves repetition of same syllable)

Question 30

Around what age should a child be able to build a tower of three building blocks?

Answer 30

- The average age for building a 3 block tower is 18 months. This increases to around 6 cubes by 2 years, and 9 cubes by 3 years.

Question 31

In normal fine motor development, which of the following should occur first? A Drawing a square B Copying a circle C Tripod pencil grip D Copying a cross E Copying a triangle

Answer 31

copying a circle Children tend to be able to copy a shape 6 months before they can draw it. The usual developmental order of drawing shapes is line, circle, cross, square, triangle. Tripod pencil grip is a more mature grip, occurring between 4 and 6 years of age.

Question 32

which scoring used for puberty

Answer 32

Tanner

Question 33

tanner staging

Answer 33

**Tanner staging for pubic hair (both sexes)** Pre-pubertal: no pubic hair Some downy hair at the base of the penis in males or over the labia majora in females Coarser, thicker and curlier hair that spreads laterally to cover more of the pubis Adult hair, not spreading to the thighs Adult hair, spread to the medial thighs **Tanner staging for females Breast changes:** * Prepubertal * Breast bud * Juvenile with smooth contour * Areola and papilla project above breast * Adult contour **Tanner staging for males Male genital changes:** * Prepubertal, testicular volume <1.5ml * Penis grows in length only, testicular volume 1.5-6ml * Penis grows further in length and circumference, testicular volume 6-12ml * Development of glans penis, darkening of scrotal skin, testicular volume 12-20ml * Adult genitalia, testicular volume >20ml

Question 34

An 8 year old boy is brought into the paediatric development clinic by his worried mother after being referred by his GP over concerns regarding premature onset of puberty. On examination today the paediatric registrar notes the following: the glans of the penis has developed and there is notable darkening of the scrotal skin, the pubic hair is dark, coarse and curly and distributed in a dense patch solely at the pubic symphysis. What would be the most appropriate Tanner staging for the boy based on these findings? G4, PH3 G1, PH2 G4, PH5 G1, PH5 B1, PH3

Answer 34

G4, PH3 Correct. G4 indicates Genitals 4 and is listed as development of glans penis, darkening of scrotal skin. PH3 indicates Pubic Hair 3 and is when the hair becomes more dark, coarser, and curlier

Question 35

What is the first sign of puberty in boys and girls?

Answer 35

Enlargement of the testes >4ml in boys and development of the breasts in girls Testicle enlargement occurs from age 9 years in boys and breast development begins at age 8.5 years in girls

Question 36

what is puberty

Answer 36

- A stage of human development when sexual maturation and growth are completed and results in ability to reproduce- morphological physiological and behaviour development

Question 37

Puberty timings

Answer 37

o Age variable o Order consistent o Therefore not a function of age

Question 38

who starts puberty first

Answer 38

- Girls begin and end puberty before boys

Question 39

Some key terms related to puberty

Answer 39

- Thelarche- onset of breast development occurring near beginning of puberty in girls - Adrenarche- maturation and increased activity of the adrenal glands prior to puberty - Gondarache- activation of reproductive glands by pituitary hormone FSH and LH - Menarche- onset of menstruation at puberty

Question 40

timing of puberty

Answer 40

- There are many environmental factors that influence onset of puberty - Pineal gland is thought to be an important influence on puberty, as disorders of this gland can cause early onset (precocious) puberty - Body weight is a key factor in the onset of puberty in girls, as well as nutrition and leptin (released from adipose tissue) Age of menarche has declined (from 16.6 to 12.5) over the year - Low body weight can cause cessation of menstruation, even after puberty has occurred - Onset age differs around globe - Economic factors/ disparity may effect onset of puberty Regardless of age of onset- sequence of events is consistent

Question 41

female puberty

Answer 41

9-13 - Starts with Breast bud (thelarche) and pubic hear - Leads to (adrenarche) Growth spurt and onset of menstrual - Menstruate cycles begins (menarche) Pubic hair adult Breast adult

Question 42

male puberty

Answer 42

10-14 years - Starts with Genital development - Progresses to Pubic hair growth Spermatogenesis - Completed by Growth spurt Genitalia adult Pubic hair adult