This website uses cookies to ensure you get the best experience on our website. Learn more

Medicine Notes Paediatrics Notes

Community And Psychiatry Notes

Updated Community And Psychiatry Notes

Paediatrics Notes

Paediatrics

Approximately 336 pages

Paediatric notes based upon current NICE guidance, The Illustrated Textbook of Paediatrics by Lissauer and Clayden in conjunction with the Oxford Handbook of Paediatrics...

The following is a more accessible plain text extract of the PDF sample above, taken from our Paediatrics Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Community and Psychiatry

Normal Child Development

  • Child development is used to describe the skills acquired between birth and about 5 years

  • Fields of Development:

    • Gross motor

    • Vision and fine motor

    • Hearing, speech and language

    • Social, emotional ad behavioral

  • Developmental Milestones

    • Median age when half of a standard population of children achieve that level

    • Limit ages age by which they should have been achieved (usually 2 SD from the mean)

  • Adjusting for prematurity

    • Calculate from the EDD

    • Thus the anticipated developmental skills of a 9 month old baby (chronological age) born 3 months early at 23 weeks gestation are more like those of a 6 month old baby (adjusted age)

    • Correction is not required after 2 years of age

  • Primitive reflexes present at birth give way to postural reflexes necessary for independent sitting and walking (gross motor development)

  • Primitive Reflexes

    • Moro sudden extension of head causes symmetrical extension then flexion of arms

    • Grasp flexion of fingers when an object is placed on the palm

    • Rooting head turns to stimulus when touched near the mouth

    • Stepping response stepping when held vertically and dorsum of feet touch a surface

    • Asymmetrical tonic neck reflex lying supine the infant adopts an outstretched arm to the side to which the head is turned

  • Postural Reflexes

    • Labyrinthine righting head moves in opposite direction to which the body is tilted

    • Postural support when held upright legs take the weight and may push (bounce)

    • Lateral propping in sitting the arm extends on the side to which the child falls

    • Parachute when suspended face down the arms extend

  • Hearing

    • Checklist for Parents

      • Birth – startles

      • 1 month – notices prolonged sounds and pauses to listen

      • 4 months – quietens or smile to the sound of your voice (even when he cannto see you)

      • 7 months – turns to your voice or very quiet sounds

      • 9 months – listens attentively to familiar everyday sounds and searches for quiet sounds out of sight. Pleasure in babbling

      • 12 months – response to name, may respond

    • Newborn Testing

      • Evoked otoacoustic emission echo from ear if cochlear function is normal

        • Simple and easy to perform

        • Misses auditory neuropathy

      • Auditory brainstem response EEG in response to noise

    • Distraction testing at 7-9 months. Baby locates and turn appropriately to sound

    • Visual reinforcement audiometry between 10-18 months. Child’s head turn toward thresholds is reinforced with visual stimuli

    • Audiometry from 4 years old

  • Vision

    • Newborn acuity is 6/200

    • Peripheral retina is well developed but the fovea is immature and the optic nerve unmyelinated

    • Testing

      • Birth – face fixation and follow

      • 6-8 weeks – fix and follow bright toy

      • 6 months – reaches for toys, preferential looking tests

      • 2.5 years – identify and match pictures (Kay pictures)

      • 4 years – identify and match letters (Crowded LogMAR)

      • 6 years – identify or match letters on LogMAR

Pattern of Development SEE TABLE

Summary

  • The age at which developmental progress accelerates differs in each domain – base questioning around the most appropriate

    • Gross motor – first year

    • Vision and fine motor – 1 year onward

    • Hearing, speech and language – 18 months onward

    • Social, emotional and behavioral – 2.5 years

Child Health Surveillance Overview

Age Screening
Newborn

General examination, weight and head circumference

Red reflex, DDH screening, testes in boys

5-6 days old Guthrie (hypothyroid, PKU, CF, sickle cell and thalassaemia, MCAD)
1st week of life Universal hearing screen
6-8 weeks old

Examination with emphasis on: heart, hips (DDH), testicular descent and red reflex.

Weight, head circumference

8 months Distraction hearing test (phased out due to universal hearing test)
4th and 5th birthdays Orthoptist assessment of vision
School Entry Measure height and weight, hearing screen
Birth 6 weeks 3 months 6 months 9 months 12 months 18 months 2 years 3 4 5
Social Smiling Laughing No stranger anxiety Stranger anxiety Clap, wave, pattacake, use beaker

Use spoon and bowl.

Symbolic play

Dry by day Dry by night Dress themselves Brush teeth

Takes turn

Interactive play

Hearing and

Communication

Startle to noise Single syllable

Double syllable

Turns to quiet noise

Babble Mama, dada and a few words in context 100 words, point to facial features 2 words together Full sentences, identify colours Names colours, know actions Count to 5
Fine motor and vision Fix Fix and follow

Transfer,

Palmar grasp

Raisin pincer Fine pincer, turn page

3 brick tower,

Scribble

Draw a line,

Hand dominance,

Draw a circle,

Tower of 8

Draw cross Draw square

4/12 hand regard

5/12 reach and grab

Gross Motor

Limb flexion in ventral suspension,

Head lag

Hold head in ventral suspension.

Head control

Sit supported, weight bear

Crawl,

Pull to stand

Cruise

Walk,

Stoop

Jump stairs, two feet per step

Tricycle,

Stairs one foot per step

Balance on each foot for 2 seconds,

Hop

Balance on each foot for 5 seconds
7/12 unsupported sit 13/12 walk unsteadily

Global Developmental Delay

  • Delay implies slow acquisition of all skills (global delay) or of one particular field (specific delay)

  • Becomes apparent in the first 2 years of life

  • Likely associated with cognitive difficulties

  • Causes of Global Neurodevelopmental Delay

    • Genetic chromosomal (Downs, fragile X), metabolic (hypothyroid, PKU)

    • Congenital brain anomalies hydrocephalus, microcephaly

    • Prenatal insult teratogens, congenital infection (Rubella, CMV, HIV, toxoplasmosis), hypothyroidism, PKU, vascular, neurocutaneous syndromes

    • Perinatal insult intraventricular haemorrhage, periventricular leucomalacia, birth asphyxia, prematurity, hypoglycaemia or hyperbilirubinaemia

    • Postnatal events brain injury (trauma, anoxia), CNS infection, metabolic (hypoglycaemia, inborn errors of metabolism)

  • Investigations

    • Maternal infection tests (rubella, CMV, toxoplasmosis, HIV)

    • Chromosome karyotype* / DNA FISH / Fragile X analysis*

    • TFT, LFT, U&E,...

Buy the full version of these notes or essay plans and more in our Paediatrics Notes.