1
Q
What are the 4 domains assessed in Child Development
A
Gross Motor
Fine Motor and Vision
Speech, Language and Hearing
Social Interaction and Self Care Skills
2
Q
What is a hallmark of UMN abnormality
A
- Persistence of Primitive reflexes
- Lack of development of postural reflexes
3
Q
What are gross motor development skills
A
Newborn: Flexed arm and legs 3 month: Lifts Head when on their Tummy 6 months: lift chest with arm support, rolls and sit unsupportive 9 months: Pulls to stand 1 year: walking
4
Q
What are fine, motor and vision skills
A
4 months: grasp object using both hands 8 months: take a cube in each hand 12 months: pincer grip 18 months: build a tower - 2 cubes 3 years build tower of 8 cubes
5
Q
What are the speech, language and hearing skills
A
3 months: laughs and squeals 9 months: two syllable babble 'mama' 'dada' 12 months: 1 word 2 years: 2 word sentences 3 years: speech mainly understandable
6
Q
What are the social/ self care skills
A
6 weeks: smiles spontaneously 6 months: finger feeds 9 months: waves bye-bye 12 months: uses spoon/fork 2 years: helps with dressing and plays with friend
7
Q
What is the healthy child programme snd what does it involve
A
Promotes healthy child development as well as eating and physical activity
ALSO
screens children for disease and disability
Involves growth and development checks:-
- Neonatal exam
- New Baby review (14 days)
- Baby’s 6-8 week examination
- Check at 1 year
- Check between 2- 2 1/2 years
8
Q
What are red flags gross motor
A
Not sitting by a year
Not walking by 18 months
9
Q
What are red flags fine motor
A
No hand preference by 18 months
10
Q
What are speech and language red flags
A
No clear words by 18 months
11
Q
What are social development red flags
A
Not smiling by 3 months
No response to carer interaction by 8 months
No interest in playing with peers by 3 yrs
12
Q
What are other red flags in child development
A
- Regression
- Poor health/growth
- Significant FHx
- Safeguarding indicators
- Findings on Examination e.g microcephaly
13
Q
What are causes of delayed talking
A
- Familial
- Hearing Impairment
- Environmental - deprivation/abuse
- Neuropsychological - Autism
14
Q
Causes of Childhood Development Delay
A
- Genetics: Chromosomal Disorders e.g Downs, Chromosomal disorders/deletions, single gene disorders e.g Duchennes
- Factors in Pregnancy: congenital infections, exposure to drugs/alcohol, MCA infarct e.g cerebral palsy
- Factors in Birth: prematurity, birth asphyxia
- Factors in Childhood: infections, chronic ill health, metabolic conditions, acquired brain injury, hearing/vision impairment
- Environmental Factors e.g abuse/neglect
15
Q
What are the Ix for Development Delay
A
- Developmental Exam and Hx
- Creatine Kinase - boy’s not walking by 18mths - Duchenne Muscular Dystrophy
- Focal Neurological Signs - MRI
- Dysmorphic Features
- Unwell Child - metabolic Ix
16
Q
What is impairment
A
An abnormality or loss of function
17
Q
What is disability
A
Someone who has a physical/mental impairment that results in marked limitation of activity
Disability is determined by there function, activity and ability to participate
18
Q
What sort of impairments are there
A
- Physical e.g Cerebral Palsy, brain injury, neuromuscular disorders
- Sensory Impairment e.g hearing/visual
- Learning e.g low IQ
- Neurodevelopmental Disorders e.g ADHD?Autism
Emotional/Behavioural e.g depression conduct disorder, attachment disorder
19
Q
What is a generic disability/ heath assessment
A
WHODAS
20
Q
What 6 domains of functioning does WHODAS cover
A
Cognition Mobility Self- Care Social Life Activiites Participation
21
Q
What is Williams Syndrome
A
Global Development Impairment Disorder:
Chromesome 7
Presentation: Mental Retardation Hyper sociability and Comfort with strangers Dysmorphic Features - Elfin Facies Visual Impairment Poor Growth Supravalvular Stenosis
22
Q
How is Williams Syndrome managed
A
MDT: Physiotherapy SALT Dieticians Doctors Housing Support
23
Q
What is Cerebral Palsy
A
Chronic Disorder of movement and posture due to a non progressive insult/lesion to the developing brain
24
Q
How does cerebral palsy present
A
Delayed motor Development
Evolving CNS signs
Learning Disability and Epilepsy
25
What are the causes for Cerebral Palsy
Antenatal: TORCH infections, and cerebral malformation
Perinatal: Birth Asphyxia or Trauma, Prematurity
Postnatal: Intraventricular haemorrhage, meningitis, head trauma, neonatal Seizures
26
What are the signs of Cerebral Palsy
Weakness or Paralysis
Delayed motor milestones
Abnormal Gait
```
Other non-motor signs:
Seizures (35-50%)
Intellectual Disability (50%)
Language/Speech and Feeding Problems
Joint Contractures
```
27
What are the 3 main types of cerebral palsy
Spastic cerebral palsy - hemiplegic, diplegia and quadraplegia spasticity
- Dyskinetic - unwanted actions
- Ataxia - tremor, lack of coordination
28
How is Cerebral Palsy treated
```
MDT: Physio and Occupational Therapists
Orthopedic Surgery
Continence, Sleep and Feeding
Callipers may help patent stand and walk
Conductive education
Botulinum Toxin or Diazapam- Helps Spasticity
```
29
How does hearing impatient present and how is it managed
Presentation: Delayed Speech
Management: Hearing aids, consideration for cochlear implant, SALT, alternative forms of communication e.g Sign Language, Social care
30
What can cause neonatal seizures
- Hypoglycaemia
- Infection/ Meningitis
- Head Trauma: Intracranial Infarction/ Haemorrhage
- Pyridoxine Dependency - give IV B6!!!
- Asphyxia
- Benign Neonatal Seizures (5th day)
- Neonatal withdrawal from maternal drugs/substance abuse
31
How can neonatal seizures present
12-48 hrs after brith
- generalised
- focal
- can be tonic, clonic, cyclonic
- may present as lip making, eye deviation, apnoea
- EEG can confirm
32
How are neonatal seizures managed
```
ABC
Rule out reversible causes
Start Abx
Insert IV and take bloods
radiological Ix
Treat Cause
Prolonged or Repeated Seizure consider Phenobarbital
```
33
What is Epilepsy
A tendency to intermittent unprovoked abnormal electrical activity in the brain
34
What are the two broad categories of Seizures due to their location
Generalised
| Focal
35
What are the two broad categories of seizures dependent on consciousness
Simple - Conscious/Aware
| Complex - Reduced Consciousness/Unaware
36
What are the types of generalised seizures
Tonic/Clonic - limb stiffness then jerking
Absence - Brief pauses, eyes may role up
Infantile Spasms/West Syndrome - Clusters of head nodding and arm jerks
Myoclonic Seizure: Thrown suddenly to ground
37
What is infantile spasms/ West Syndrome how is it managed
Brief spasms beginning in first 4-6 months of life
Cause: Hypoxic ischaemic injury, perinatal infection
Presentation:
1. Clusters of symmetrical jerking flexion or extension of neck, torso and limbs
lasting 1-2 seconds and occurring up to 50 times
2. Progressive mental handicap
3. EEG: Hypsarrhythmia
4. Poor Prognosis
Treatment: Prednisolone
38
What are complex focal seizures
Reduced Consciousness
Automatisms - Lip smacking, rubbing face, running
Fits of Pure pleasure
39
What causes epilepsy
Often none found
FHx of Epilepsy
Complex febrile seizure
Neurodevelopmental Disorder e.g ASD, CP
40
What are differentials for epilepsy
```
Arrhythmias e.g prolonged QT
Migraine
Narcolepsy
Night Terrors
Fainting
```
41
Wha texts should be performed for epilepsy
EEG
MRI
Lab Tests to rule out metabolic disturbance, Toxicology
42
What is a simple febrile seizure
- Usually occur early on in viral infection due to rapid rise in temperature
- A single generalised tonic clonic seizure
- lasting < 15 mins
- complete recovery within an hour
- do not recur in 24 hrs
Occur in absence of CNS infection, metabolic abnormalities or Hx of afebrile seizures
43
What is a complex febrile seizure
Usually starts as focal, lasts longer than 15 mins and occurs more than once in 24hrs
44
How are Febrile Seizures managed
Following seizure
- Admit to hospital if first febrile seizure or a complex febrile seizure
- Investigate Cause e.g exclude meningitis
- Recurrent seizures if fit lasting more than 5 mins call ambulance and give IV Lorazepam or PR Diazepam
45
How do you manage an active seizure or status epilepticus
- Call for help - ABC
- Most resolve within 5 - 10 mins
- If fit lasts 5 mins or longer give IV Lorazepam
Status Epilepticus
- 2nd line Phenytonin
- General Anesthesia
46
What drugs are used to treat Epilepsy
Carbamazepine
Sodium Valproate
Lamotrigine
47
What are the primitive reflexes
```
Stepping Reflex
Asymmetrical Tonic Neck Reflex
Plantar Grasp
Palmer grasp
Mono Reflex
Rooting Reflex
Sucking Reflex
Babinski Sign
```
48
What is the stepping reflex and when does it stop
Stepping Motion - 2 months
49
What is asymmetrical tonic neck reflex
Infants head turned to one side - 3 - 4 months
50
What is plantar grasp reflex
Plantar Flexion - Curling in - 3 months
51
What is palmer grasp reflex
Closure of its palm - 3-6 months
52
What is moro reflex
Abduction and Extension of arms when head is suddenly allowed to fall out - 3-6 months
53
What is the rooting reflex
Cheek stroked and head turns to ipsilateral side and opens it mouth - 4 months
54
What is the sucking reflex
infant starts to suck the finger - 4 months
55
What is the Babinski reflex
Dorsiflexion of foot and fanning of the toes - 12 months
Paediatrics
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