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Community And Psychiatry Notes

Medicine Notes > Paediatrics Notes

This is an extract of our Community And Psychiatry document, which we sell as part of our Paediatrics Notes collection written by the top tier of University Of Nottingham students.

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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:

*

*

o

Gross motor

o

Vision and fine motor

o

Hearing, speech and language

o

Social, emotional ad behavioral

Developmental Milestones

o

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

o

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

Adjusting for prematurity

o

Calculate from the EDD

o

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)

o

*

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

o

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

o

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

o

Rooting head turns to stimulus when touched near the mouth

o

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

o

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

*

*

Postural Reflexes

o

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

o

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

o

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

o

Parachute when suspended face down the arms extend

Hearing

o

Checklist for ParentsBirth - startles1 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 sounds9 months - listens attentively to familiar everyday sounds and searches for quiet sounds out of sight. Pleasure in babblingo

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

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Misses auditory neuropathy

Auditory brainstem response EEG in response to noise

o

Distraction testing at 79 months. Baby locates and turn appropriately to sound

o

Visual reinforcement audiometry between 1018 months. Child's head turn toward thresholds is reinforced with visual stimuli

o

*

Audiometry from 4 years old

Vision

o

Newborn acuity is 6/200

o

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

o

TestingBirth - face fixation and follow68 weeks - fix and follow bright toy6 months - reaches for toys, preferential looking tests2.5 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

o

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

o

Gross motor - first year

o

Vision and fine motor - 1 year onward

o

Hearing, speech and language - 18 months onward

o

Social, emotional and behavioral - 2.5 years

Child Health Surveillance Overview

Age Newborn

Screening General examination, weight and head circumference

56 days old

Red reflex, DDH screening, testes in boys Guthrie (hypothyroid, PKU, CF, sickle

1st week of life 68 weeks old

thalassaemia, MCAD) Universal hearing screen Examination with emphasis on: heart, hips (DDH),

cell

and

testicular descent and red reflex. 8 months

Weight, head circumference Distraction hearing test (phased out due to universal

4th and 5th birthdays School Entry

hearing test) Orthoptist assessment of vision Measure height and weight, hearing screen

Birth

Social

Hearing and

Startle

Communication

noise

6 weeks Smiling

to

3 months Laughing

6 months No stranger

9 months Stranger

12 months Clap, wave,

18 months Use spoon

anxiety

anxiety

pattacake,

and bowl.

use beaker

Symbolic

Mama, dada

play 100

and

point to facial

Single

Double

syllable

syllable Turns

Fine

motor

and

Fix

Fix

and

Babble to

quiet noise Transfer,

words Raisin pincer

follow Palmar grasp 4/12 hand regard

vision

a

few in

Limb flexion

Hold head in

Sit

Crawl,

in

ventral

supported,

Pull to stand

suspension,

suspension.

weight bear

Head lag

Head control 7/12 unsupported sit

ventral

3 Dry by night

2 words

together

Full

Names

sentences,

colours, know

features

identify

3 brick tower,

Draw a line,

colours Draw

turn page

Scribble

Hand

circle,

dominance,

Tower of 8

Walk,

Jump stairs,

Tricycle,

Stoop

two feet per

Stairs

step

foot

Cruise

13/12 walk unsteadily

4 Dress

5 Brush teeth

themselves

Interactive play

context Fine pincer,

5/12 reach and grab Gross Motor

words,

2 years Dry by day Takes turn

step

a

actions Draw cross

Count to 5

Draw square

Balance on

Balance on

one

each foot for

each

per

2 seconds,

for

Hop

seconds

foot 5

Global Developmental Delay

o

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

o

Becomes apparent in the first 2 years of life

o

Likely associated with cognitive difficulties

o

Causes of Global Neurodevelopmental Delay

o

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

o

Congenital brain anomalies hydrocephalus, microcephaly

o

Prenatal insult

teratogens, congenital infection (Rubella, CMV, HIV, toxoplasmosis),

hypothyroidism, PKU, vascular, neurocutaneous syndromes

o

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

o

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

o

Investigations

o

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

o

Chromosome karyotype* / DNA FISH / Fragile X analysis*

o

TFT, LFT, U&E, plasma amino acids*

o

CK muscular dystrophy in boys

o

Urine glycosaminoglycans (mucopolysaccharidoses)

o

Imaging - Cranial USS, CT/MRI

o

Neurophysiology - EEG, nerve conduction studies, nerve or muscle biopsy

o

Other hearing*, vision*, clinical genetics, cognitive assessment. Etc.

* Marks Basic Screening Tests Abnormal Motor Development

o

Usually presents between 3 months and 2 years

o

Hand dominance develops around 2 years of age asymmetry before this is therefore always abnormal and may suggest an underlying hemiplagia

o

o

Causes include:

o

Central deficit cerebral palsy

o

Congenital myopathy/primary muscle disease

o

Spinal cord lesions spina bifida

o

Global delay

SEE neuro notes for cerebral palsy and muscular dystrophy

Abnormal Speech and Language Development

*

Delay implies slow acquisition of skill

*

Speech and language DELAY may be due to:

o

Hearing loss

o

Global developmental delay

o

Difficulty in speech production due to an anatomical deficit (cleft palate)

o

Environmental deprivation/lack of opportunity for social interaction

o

Normal variant/familial

*

Disorder is a maldevelopment of a skill

*

Speech and language DISORDERS include disorders of:

o

Language comprehension

o

Language expression despite knowing what needs to be said

o

Phonation and speech production such as stammering (fluency), dysarthria or verbal dyspraxia

o

Pragmatics (difference between sentence meaning and speakers meaning), construction of sentences

o

Social / communication disorders

*

Initial steps hearing assessment and SALT

*

Tests include:

*

o

Symbolic toy test assessing early language development

o

Reynell test for receptive and expressive language, used for preschool children

Stammer/stutter

o

Involuntary repetitions and prolongations of sound (vowels), syllables, words or phrases typically primary problem

o

And involuntary silent pauses/blocks during which speech cannot be produced blocks are learned mechanisms to mask repetition

*

o

Typical between 2 and 5 years and many cases resolve by this age

o

60% have family history

Speech Impediment

o

Can includeStutterLispingMutenessArticulation disordersVoice disorders

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