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