Medicine Phase 3a > PAEDIATRICS - 3 > Flashcards

PAEDIATRICS - 3 Flashcards

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1
Q

4 fields of development

A

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

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2
Q

Define median age

A

The age when half the population acquire a skill - normal pattern of development

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3
Q

Define limit age

A

The age when a skill should have been acquired - further assessment required if not achieved by this age

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4
Q

The primitive reflexes

A 
Moro
Grasp
Rooting
Stepping response
Asymmetrical tonic neck reflex
Sucking reflex
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5
Q

The postural reflexes

A

Labyrinthine righting
Postural support
Lateral propping
Parachute

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6
Q

Define moro reflex

A

Sudden extension of the head causes symmetrical extension, then flexion of the arms

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7
Q

Define grasp reflex

A

Flexion of diners when an object is placed in the palm

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8
Q

Define rooting reflex

A

Head turns to stimulus when touched near mouth

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9
Q

Define stepping response

A

Stepping movements when held vertically and dorm of feet touch a surface

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10
Q

Define asymmetrical tonic neck reflex

A

Lying supine, infant adopts an outstretched arm to the side to which the head is turned

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11
Q

Define sucking reflex

A

Child sucks when nipple/ teat placed in their mouth (automatic feeding action)

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12
Q

Define labyrinthine righting

A

Head moves in opposite direction to which the body is tilted

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13
Q

Define postural support

A

When help upright, legs take weight and baby may push up (bounce)

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14
Q

Define lateral propping

A

In sitting, the arm extends on the side to which the child falls as a saving mechanism

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15
Q

Define parachute

A

When suspended face down, the baby’s arm extend as though to save himself

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16
Q

Gross motor development: newborn

A

Limbs flexed, symmetrical posture

Marked head lag on pulling up

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17
Q

Gross motor development: 6-8 weeks

A

Raises head to 45 degrees in prone

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18
Q

Gross motor development: 6-8 months

A

Sits without support
6 months = round back
8 months = straight back

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19
Q

Gross motor development: 8-9 months

A

Crawling

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20
Q

Gross motor development: 10 months

A

Stands independently

Cruises

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21
Q

Gross motor development: 12 months

A

Walks unsteadily, broad gait, hands apart

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22
Q

Gross motor development: 15 months

A

Walks steadily

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23
Q

Vision and fine motor: 6 weeks

A

Follows moving object or face by turning head

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24
Q

Vision and fine motor: 4 months

A

Reaches out for toys

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25
Vision and fine motor: 4-6 months
Palmar grasp
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Vision and fine motor: 7 months
Transfers toys from one hands to another
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Vision and fine motor: 10 months
Mature pincer grip
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Vision and fine motor: 16-18 months
Makes marks with a crayon
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Vision and fine motor: 18 months
Builds tower of 3
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Vision and fine motor: 2 years
Builds tower of 6 | Draws a straight line
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Vision and fine motor: 2.5 years
Builds a tower of 8 or a train with 4 bricks
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Vision and fine motor: 3 years
Builds a bridge | Draws a circle
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Vision and fine motor: 3.5 years
Draws a cross
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Vision and fine motor: 4 years
Builds steps | Draws a square
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Vision and fine motor: 5 years
Draws a triangle
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Hearing, speech and language: newborn
Startles to loud noises
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Hearing, speech and language: 3-4 months
Vocalises alone or when spoken to, coos and laughs
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Hearing, speech and language: 7 months
Turns to soft sounds out of sight
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Hearing, speech and language: 7-10 months
7 months: sounds used indiscriminately | 10 months: sounds used discriminately to parents
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Hearing, speech and language: 12 months
2-3 words other than 'dada' or 'mama'
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Hearing, speech and language: 18 months
6-10 words | Shows 2 parts of the body
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Hearing, speech and language: 20-24 months
Joins 2 or more words to make simple phrases
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Hearing, speech and language: 2.5 years-3 years
Talks constantly in 3-4 word sentences
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Social, emotional and behavioural: 6 weeks
Smiles responsively
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Social, emotional and behavioural: 6-8 months
Puts food in mouth
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Social, emotional and behavioural: 10-12 months
Waves bye | Plays peek-a-boo
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Social, emotional and behavioural: 12 months
Drinks from a cup with 2 hands
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Social, emotional and behavioural: 18 months
Holds spoon and gets food safely to mouth
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Social, emotional and behavioural: 18-24 months
Symbolic play
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Social, emotional and behavioural: 2 years
Dry by day | Pulls off some clothing
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Social, emotional and behavioural: 2.5-3 years
Parallel play Interactive play evolving Takes turn
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Head control: limit age
4 months
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Sitting unsupported: limit age
9 months
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Stands with support: limit age
12 months
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Walking independently: limit age
18 months
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Fix and follow: limit age
3 months
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Reaching for objects: limit age
6 months
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Transfers: limit age
9 months
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Pincer grip: limit age
12 months
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Polysyllable babble: limit age
7 months
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Consonant babble: limit age
10 months
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Saying 6 words with meaning: limit age
18 months
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Joining words: limit age
2 years
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3-word sentences: limit age
2.5 years
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Smiling: limit age
8 weeks
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Fear of strangers: limit age
10 months
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Feeds self/ spoon: limit age
18 months
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Symbolic play: limit age
2-2.5 years
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Interactive play: limit age
3-3.5 years
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Developmental milestones: newborn
``` Fixed posture Follows face or light by 2 weeks Stills to voice Startles to loud noise Smiles by 6 weeks ```
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Developmental milestones: 7 months
``` Sits without support Transfers objects from hand to hand Turns to voice Polysyllabic bable Finger feeds Fears strangers ```
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Developmental milestones: 1 year
``` Stands independently Pincer grip Points 2-3 words Understands name Drinks from cup Waves ```
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Developmental milestones: 15-18 months
``` Walks independently and steadily Immature grip of pencil Random scribble 6-10 words Points to 2 body parts Feeds self with spoon Beginning to help with dressing ```
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Developmental milestones: 2.5 years
``` Runs and jumps Draws 3-word to 4-word sentences Understands 2 joined commands Parallel play Clean and dry ```
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Developmental screening tests
Schedule of growing skills Denver developmental screening test Griffiths and Bailey infant development scales
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Hearing tests: newborn
Otoacoustic emission | Auditory brainstem response audiometry
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Define otoacoustic emission
Earphone produces a sound | This evokes an echo or emission from the ear if cochlear function is normal
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Define auditory brainstem response audiometry
Computer analysis of electroencephalogram waveforms evoked in response to a series auditory stimuli
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Advantages of otoacoustic emission
Simple and quick
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Disadvantages of otoacoustic emission
Only measures cochlear function Doesn't test auditory nerve or brain High false-positive in first 24 hours as amniotic fluid is still in ear canal
81
Vision of a newborn
Low visual acuity - can see large objects at 30cm distance but they appear fuzzy
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Physiology of vision of a newborn
Peripheral retina well developed Fovea is immature Optic nerve is unmyelinated
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Define amblyopia
Eye fails to develop normal visual acuity
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Order in which areas of developmental begin to develop
1. ) Gross motor 2. ) Vision and fine motor 3. ) Hearing speech and language 4. ) Social, emotional and behavioural
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Features suggestive of neurodevelopment delay: prenatal
``` FH US - nuchal thickness Down syndrome Neural tube defects Genetic ```
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Features suggestive of neurodevelopment delay: perinatal
Asphyxia/ neonatal encephalopathy Preterm Dysmorphic and neurocutaneous features Abnormal neurological behaviour
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Features suggestive of neurodevelopment delay: infancy
Global developmental delay Delayed or asymmetric motor development Cataracts Vision or hearing concerns
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Features suggestive of neurodevelopment delay: preschool
``` Speech and language delay Abnormal gait Clumsy Poor social communication Behaviour ```
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Features suggestive of neurodevelopment delay: any age
Acquired brain injury - meningitis - head injury Loss of skills
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Genetic causes of abnormal development and learning difficulty
``` Chromosome/ DNA disorders: - Down's syndrome - Fragile X syndrome Cerebral dysgenesis: - microencephaly - absent corpus callous ```
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Teratogenic causes of abnormal development and learning difficulty
Alcohol and drug abuse
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Infective causes of abnormal development and learning difficulty
Rubella CMV Toxoplasmosis HIV
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Neurocutaneous syndromes a/w abnormal development and learning difficulty
Neurofibromatosis Sturge-Weber Ito syndrome
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Define developmental delay
Slow acquisition of all skills (global) or one field of skill (specific)
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Define impairment
Loss or abnormality of physiological function or anatomical structure
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Define disability
Restriction or lack of ability due to impairment
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Retained reflex and their significance: moro reflex
``` Over sensitive Over reactive to sensory stimulus Poor impulse control Sensory overload Anxiety, emotional and social immaturity Poor balance Poor coordination Easily distracted Unable to adapt well to change Mood swings ```
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Retained reflex and their significance: rooting reflex
Difficulty swallowing solid foods Poor articulation Thumb sucking
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Retained reflex and their significance: palmar reflex
Fine motor skills Stick out tongue whilst writing Messy handwriting
100
Define cerebral palsy
A chronic disorder of movement and/or posture that presents early (i.e before the age of 2) and continues throughout life.
101
Clinical features of cerebral palsy
- Abnormality of movement and posture - Delayed motor milestones, abnormal gait - Slowing of head growth - Asymmetric hand function before 12 months - Persistent primitive reflexes - Feeding difficulties (slow, gagging, vomiting) - Disturbances of cognition, communication, perception, sensation, behaviour - Seizure disorder - MSK problems
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Diagnosing cerebral palsy
1. ) Distribution of the motor disorder 2. ) The movement type 3. ) The cause 4. ) Any associated impairment
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Aetiology of cerebral palsy: antenatal
Vascular occlusion Cortical migration disorders Structural maldevelopment of brain during gestation
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Aetiology of cerebral palsy: delivery
Hypoxic-ischaemic injury
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Aetiology of cerebral palsy: postnatal
``` Meningitis Encephalitis Encephalopathy Head trauma Symptomatic hypoglycaemia Hydrocephalus Hyperbilirubinaemia ```
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Aetiology of cerebral palsy: premature
Periventricular leucomalacia (PVL) secondary to iscahemia or severe intraventricular haemorrhage
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Subtypes of cerebral palsy
SPASTIC DYSKINETIC ATAXIC
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Spastic cerebral palsy: area of lesion
Damage to UMN (pyramidal or corticospinal tract)
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Spastic cerebral palsy: examination findings
Hypertonia of limbs Brisk deep tendon reflexes and extensor plantar responses Spasticity tone therefore velocity dependent
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Types of spastic cerebral palsy
``` Hemiplegia: - Unilateral involvement of arm and leg - Face sparing Quadriplegia: - All 4 limbs Diplegia: - All 4 limbs but legs are affected to a much greater degree than the arms ```
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Dyskinetic cerebral palsy: area of lesion
Damage to basal ganglia (extrapyrimadal)
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Dyskinetic cerebral palsy: examination findings
Involuntary, uncontrolled movements Primitive motor reflex patterns pre-dominate Types = chorea, athetosis and dystonia Impaired intellect, floppiness, poor trunk control, delayed motor development
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Ataxic cerebral palsy: examination findings
Early trunk and limb hypotonia Poor balance Delayed motor development Incoordinate movements, intention tremor, ataxic gait
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Cerebral palsy: professionals involved in care
* Primary therapists * Speech and language therapist * Physiotherapist * Occupational therapist * Community paediatrician * Neurologist/ specialist nurse * Psychologist * Dietician * Orthopaedic surgeon * Social services * Education
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Management of cerebral palsy: non-pharmacological
Speech and language therapist - Communication Physiotherapist - Posture and movement - Optimize function by improving symmetry, joint ranges, muscle length and power - Stretching exercises - Orthoses
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Management of cerebral palsy: pharmacological
Botulinum toxin type A given for: - focal spasticity of UL or LL - Pain - Disturbing sleep --> unlicensed under 2 years
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Assessment used to test language development
``` Symbolic toy test (very early on) Reynell test (preschool) ```
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Define dyspraxia
Developmental coordination disorder
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Clinical features of dyspraxia
``` Awkward, messy handwriting Trouble with: - dressing - cutting up food - copying and drawing - messy eating ```
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Define dyslexia
Disorder of reading skills
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Define ADHD
Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development
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ADHD: diagnostic criteria
* Start <12 years * Occurs in 2 or more settings such as at home and school * Have been present for at least 6 months * Interfere with or reduce quality of social, academic or occupational functioning * Do not occur exclusively during the course of a psychotic disorder and are not better explained by another mental disorder * Must be at least 6 (5 in adults) inattention symptoms +/or at least 6 (5 in adults) hyperactivity-impulsivity symptoms
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Clinical features of inattention
- Wandering off task - Lacking persistence - Having difficulty sustaining focus - Being disorganized
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Clinical features of hyperactivity
``` Children - Excessive motor activity at inappropriate times Adults - Extreme relentlessness - Wearing others out with their activity ```
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Clinical features of impulsivity
- Hasty actions that occur in the moment without forethought - Have high potential for harm to the individual - Interrupting others excessively - Making decisions without considering the long-term consequences
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ADHD: aetiology
``` • Genetics • Environmental factors such as: - Low birth weight - Maternal smoking during pregnancy - Preterm - Epilepsy - Alcohol exposure --> Heterogeneous disorder ```
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Psychiatric conditions a/w ADHD
- ODD - Substance abuse - Depression - Mania
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Inattention symptoms
Careless mistakes/ does not pay close attention to detail in school/ work Difficulty in maintaining concentration when performing tasks/ play activities Appearing not to listen to what is being said Failing to follow through on instructions/ finish a task Can’t organise Reluctant to do tasks that require sustained mental effort Losing items e.g. pencils, wallet, phone Easily distracted by external stimuli Forgetfulness with regards to daily activities
129
Hyperactivity-impulsivity symptoms
Fidgeting with or tapping hands or feet/ squirming when sat Leaving the seat where remaining seated is expected, e.g. in a classroom Running/ climbing in situations where inappropriate Inability to play or engage in leisure activities quietly Acting as if ‘driven by a motor’ Talking excessively Blurting out an answer before a question has been completed Difficulty waiting their turn Interrupting or intruding on others
130
Management of suspected ADHD (children)
1. ) Strengths and difficulties questionnaires for different age groups 2. ) Corners’ rating scale 3. ) Watchful waiting of up to 10 weeks, encouraging self-help and simple behavioural management 4. ) Offer parents/carers a referral to group-based ADHD-focused support 5. ) Refer to CAMHS, specialist paediatrician or child psychiatrist
131
Management of suspected ADHD (adult)
1. ) Assess psychological, social, educational or occupational impact of their symptoms 2. ) Refer people without a prior diagnosis of childhood ADHD for assessment by a mental health specialist trained in the diagnosis and treatment of ADHD 3. ) Refer people who have previously been treated for ADHD as children or young people to general adult psychiatric --> drug treatments initiated and titrated by a specialist may be continued and monitored in primary care
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Advice for amfetamine prescription and driving
- Do not drive if you feel drowsy, dizzy, unable to concentrate, blurrer/double vision - It is an offence to drive if they have more than a specified amount of amfetamines in their body
133
ADHD confirmed management (adults)
1. ) Lisdexamfetamine 2. ) Methylphenidate 3. ) CBT
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ADHD confirmed management (children)
1. ) Group-based support for parents/carers 2. ) Individual parent-training programmes 3. ) Methylphenidate 4. ) CBT
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Pathology of sensorineural hearing loss
Lesion in cochlea or auditory nerve
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Pathology of conductive hearing loss
Abnormalities of ear canal or middle ear - otitis media - effusion
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Management of sensorineural hearing loss
1. ) Hearing aids 2. ) Bone conduction hearing aids 3. ) Cochlear implant
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Management of chronic conductive hearing loss
Depends on cause but generally: 1. ) Long course of antibiotics 2. ) Grommets (insertion of tympanostomy tubes) 3. ) Adenoid removal 4. ) Hearing aids
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Define nystagmus
Repetitive, involuntary, rhythmical eye movement - horizontal - vertical
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Define stabismus (squint)
Misalignment of visual axes
141
Aetiology of strabismus
Refractive error Cataracts Retinoblastoma
142
Stabismus investigations
1. ) Corneal light reflex test - If light reflection does not appear in the same position in the 2 pupils --> squint 2. ) Cover test
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Define hypermetropia
Refractive error - long sighted (can't see objects close) '+' dioptres
144
Define myopia
Refractive error - short sighted (can't see far objects) '-' dioptres
145
Management of hypermetropia
Convex (plus) lenses
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Management of myopia
Concave (minus) lenses
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Aetiology of visual impairment: genetic
Cataract Albinism Retinal dystrophy Retinoblastoma
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Aetiology of visual impairment: antenatal and perinatal
``` Congenital infection Retinopathy of prematurity Hypoxia Ischaemia Cererbal abonrality Optic nerve hypoplasia ```
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Aetiology of visual impairment: postnatal
Trauma Infection Juvenile idiopathic arthritis
Medicine Phase 3a
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