1
Q
What is development?
A
- The global impression of a child which encompasses growth, increases in understanding, acquisition of new skills and more sophisticated responses and behaviour
- A dynamic process of growth, transformation, learning and acquisition of abilities to respond to and adapt to the environment in a planned, organised and independent manner
- A process by which each child evolves into an independent adult
2
Q
Antenatal causes of damage to brain development
A
Infectious agents
Hormones
Drugs
3
Q
What infectious agents can cause antenatal damage?
A
TORCH:
- Toxicoplasmosis
- Other (syphilis/HIV/HepC)
- Rubella -> cataracts, glaucoma, heart defects, hearing loss, tooth abnormalities
- Cytomegalovirus
- Herpes
4
Q
What hormones can cause antenatal damage?
A
- Androgenic agents
- DES
- Maternal diabetes -> various: heart and neural tube defects most common
- Maternal obesity
5
Q
What drugs can cause antenatal damage?
A
- Phenytoin
- Valproic acid -> neural tube defects, heart, craniofacial and limb anomalies
- Trimethadione
- Lithium
- SSRIs
- Amphetamines
- Warfarin
- ACE inhibitors
- Alcohol -> foetal alcohol syndrome, short palpebral fissures, maxillary hypoplasia, heart defects, intellectual disability
6
Q
Postnatal causes of damage to development
A
Infections, metabolic disorders, toxins, trauma, domestic violence (maltreatment), malnutrition, maternal mental health disorders
7
Q
Complications of spina bifida cystica
A
- Neurogenic bowel and bladder incontinence
- Lower limb paralysis
- Fractures and joint contractures
- Developmental deformities and learning disabilities
- Hydrocephalus and meningitis
8
Q
What are the developmental domains?
A
- Gross motor performance
- Vision and fine motor
- Hearing, speech and language
- Social, emotional and behavioural
9
Q
What is a milestone?
A
Acquisition of a key performance skill
10
Q
Define the median age for development
A
Age when half of standard population of children achieved that level
11
Q
Define the limit age for development
A
Age by which children should have achieved that level
= 2.5 SD from mean age
12
Q
What gross motor performance milestone should be seen in a newborn?
A
Limbs flexed on symmetrical position, head lag on pulling up
13
Q
What gross motor performance milestone should be seen at 6-8 weeks?
A
Raises head to 45 degrees in prone
14
Q
What gross motor performance milestone should be seen at 6-8 months?
A
Sits without support
15
Q
What gross motor performance milestone should be seen at 8-9 months?
A
Crawling
16
Q
What gross motor performance milestone should be seen at 10 months?
A
Cruising around furniture
17
Q
What gross motor performance milestone should be seen at 12 months?
A
Walks unsteadily
18
Q
What gross motor performance milestone should be seen at 15 months?
A
Walks steadily
19
Q
Why do we have primitive reflexes?
A
Protective and serve to promote support, balance and orientation
20
Q
What are the primitive reflexes?
A
- Stepping
- Moro (startled, falling reflex - arms outstretched, ‘startled’ expression)
- Grasp
- Asymmetric tonic reflex (arm outstretches towards where head is turned)
- Rooting (suckling)
21
Q
When should the primitive reflexes disappear?
A
4-6 months
22
Q
What are protective reflexes?
A
Develop from 4 to 5 months onwards and can be absent or abnormal in motor disorders
23
Q
What is the downward parachute reflex?
A
Develops at 5 months
When held and rapidly lowered infant extends and abducts both legs; feet are plantigrade
24
Q
What is the sideward protective reflex?
A
Develops at 6 months
Infant puts arms out to save if tilted off balance
25
What is the forward protective reflex?
Develops at 7 months
| Arms and hands extend on forward descent to ground
26
What is the backward protective reflex?
Develops at 9 months
| Backward protective extension of both arms when pushed backwards in sitting position
27
When is object permanence obtained?
9 months
28
What fine motor and vision milestone should be seen at 6 weeks?
Turning head to follow object
29
What fine motor and vision milestone should be seen at 4 months?
Reaching out to toys
30
What fine motor and vision milestone should be seen at 4-6 months?
Palmar grasp
31
What fine motor and vision milestone should be seen at 7 months?
Can transfer toys between hands
32
What fine motor and vision milestone should be seen at 10 months?
Mature pincer grip
33
What fine motor and vision milestone should be seen at 16-18 months?
Making marks with crayon
34
What fine motor and vision milestone should be seen at 14 months - 4 years?
Building towers out of blocks
35
What fine motor and vision milestone should be seen at 2-5 years?
Ability to draw basic shape without seeing it
| Copying shape can be done 6 months earlier
36
What language and hearing milestone should be seen in a newborn?
Startles to loud noises
37
What language and hearing milestone should be seen at 3-4 months?
Vocalises alone or when spoken to
38
What language and hearing milestone should be seen at 7 months?
Turns to soft sounds out of sight
39
What language and hearing milestone should be seen at 7-10 months?
Uses sound indiscriminately or discriminately
40
What language and hearing milestone should be seen at 12 months?
Two to three words other than dada or mama
41
What language and hearing milestone should be seen at 18 months?
Six to ten words
42
What language and hearing milestone should be seen at 20-24 months?
Makes simple phrases
43
What language and hearing milestone should be seen at 1.5-3 years?
Talk constantly in 3-4 word sentences
44
What social and behavioural milestone should be seen at 6 weeks?
Smile responsively
45
What social and behavioural milestone should be seen at 6-8 months?
Puts food in mouth
46
What social and behavioural milestone should be seen at 10-12 months?
Wave bye, play peek-a-boo
47
What social and behavioural milestone should be seen at 12 months?
Drink from cup with two hands
48
What social and behavioural milestone should be seen at 18 months?
Can eat by themselves
49
What social and behavioural milestone should be seen at 18-24 months?
Symbolic play
50
What social and behavioural milestone should be seen at 2 years?
Potty trained
51
What social and behavioural milestone should be seen at 2.5-3 years?
Parallel play
52
What are the limit age examples at:
- 18 months
- 3 months
- 2 years
- 2-2.5 years
18 months: walking independently
3 months: fixes and follows visually
2 years: joins words
2-2.5 years: symbolic play
53
What is consonant delay?
All developmental domains affected equally
54
What is dissonant delay?
All developmental domains affected differently
55
What is the difference between delay and disorder?
```
Delay = slow acquisition of skills
Disorder = maldevelopment of a skill
```
56
What are some causes of abnmormal development?
- Abuse, trauma, drugs, infection
- Autism, deficits in development
- Malnutrition, cerebral palsy etc
57
How/when does delay present?
- Routine surveillance
- Identified risk factors
- Parents/HCPs worried
- Opportunistic worries raised
58
What factors are important in a history of abnormal development?
- Antenatal
- Birth
- Postnatal
- Consanguinity - increased chance of chromosomal/autosomal conditions
- Developmental milestones from parents
59
What factors are important in the examination for abnormal development?
- Growth parameters (height, weight, head circumference)
- Dysmorphic features
- Neurological exam & skin exam
- Systems exam
- Standardises developmental assessments (SOGSII, Griffiths, Denver)
60
What factors are important in the management of abnormal development?
- Investigations - cytogenic studies, metabolic screens, blood ammonia and lactate, urine and blood amino acids, creatine kinase, imaging and nerve/muscle biopsies
- Referral to MDT
61
What is cerebral palsy?
Disorder of movement and posture due to non-progressive lesion of motor pathways
62
Cerebral palsy features
Manifestations emerge over time
Most common cause of motor impairment in children
Prevalence 2.5-2.7 per 1000 children
63
What is the most common cause of cerebral palsy?
Antenatal cause (80%) - genetic syndromes and congenital infection
64
Cerebral palsy presentation
- Abnormal limb tone and delayed milestones
- Feeding difficulties
- Abnormal gait once walking achieved
- Asymmetric hand function before 12 months
- Primitive reflexes persist
65
Types of cerebral palsy
Spastic (70%)
| Ataxic hypotonic, dyskinetic, mixed pattern (each 10%)
66
Associated problems with cerebral palsy
Learning difficulty, epilepsy, visual impairment, hearing loss, feeding difficulty, poor growth, respiratory problems
67
Management of cerebral palsy
Minimise spasticity and manage associated symptoms
68
What is autism?
Neurobiological disorder characterised by:
- impairments of social interactions and communication
- restricted, repetitive and/or stereotyped patterns of behaviour, interests and activities
69
What is the prevalence of autism?
3-6 per 1000 live births
M > F
Presents at 2-4 years
70
Comorbidities with autism
Learning difficulties, attention difficulties and epilepsy
71
Management of autism
Intensive support for child and family
72
What are the criteria for diagnosis with attention deficit hyperactivity disorder?
- Inattention
- Hyperactivity
- Impulsivity
- Lasting >6 months
- Commencing <12 years and inconsistent with child's developmental level
- Criteria should be present in more than one setting and cause significant interference at school/socially
73
How is ADHD diagnosed?
- Questionnaires (SDQ - strengths and difficulties questionnaire)
- Exclude medial causes such as hyperthyroidism
- Hearing deficits
- Identify risk factors and comorbidities
74
What other disorders have increased risk with ADHD?
Conduct disorder, anxiety disorder and aggression
75
What are risk factors for ADHD?
M > F, learning difficulties and developmental delay, neurological disorders, first-degree relatives , relatives with depression/ learning disabilities/ antisocial behaviour/ substance abuse
76
Management of ADHD
Psychotherapy - behaviour therapy
Family therapy, drugs - if psychotherapy alone insufficient
Diet - exclusion of some foods
77
How are learning disabilities classified?
Mild, moderate, severe and profound
78
What is the prevalence of mild learning disabilities?
30 per 1000 children
79
What is the prevalence of severe learning disabilities?
4 per 1000 children
80
Common causes of learning disabilities
```
25% have no identifiable cause
30% chromosome disorder
20% other syndromes
20% postnatal cerebral insults
1% metabolic or degenerative disease
```
81
Common presentations of learning disabilities
Reduced intellectual functioning
Early delay in milestones
Dysmorphic features and associated problems e.g. ADHD, epilepsy, sensory impairment
82
Management of learning disabilities
MDT for long term and follow up
School recognition of learning disability
SEND (special education needs and disability)
Y2 RDA
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