Notes in Milestones

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Status	Last Update	Fields
Published	10/08/2024	The four domains of development are {{c1::gross motor}}, {{c1::vision/fine motor}}, {{c1::hearing/speech}}, {{c1::personal/social}…
Published	10/08/2024	Development at 6 weeks:Gross motor{{c1::- Symmetrical limb movement- Ventral - head in line with body briefly- Supine - fencing posture- Automatic ste…
Published	10/08/2024	Development at 3 months:Gross motor{{c1::- Moves limbs vigorously- No head lag- Prone - Lifts upper chest up::(3)}}Vision/fine motor{{c2::- Plays…
Published	10/08/2024	Development at 6 months:Gross motor{{c1::- Sits without support- Lifts chest up on extended arms- Grasps feet- Rolls front to back::(4)}}Vision/f…
Published	10/08/2024	Development at 9 months:Gross motor{{c1::- Tripod sits - Rights self if pushed and reaches for toy steadily- Pulls to standing- Stands holding on…
Published	10/08/2024	Development at 12 months:Gross motor{{c1::- Cruises around furniture- Walks if held (may take a few steps unsupported::(2)}}Vision/fine motor{{c2…
Published	10/08/2024	Development at 15 months:Gross motor{{c1::- Broad based gait- Kneels- Pushes wheeled toy::(3)}}Vision/fine motor{{c2::- Sees small objects- Tower…
Published	10/08/2024	Development at 18 months:Gross motor{{c1::- Steady purposeful walk- Runs and squats- Walks carrying toy- Pushes and pulls- Creep downstairs::(5)}…
Published	10/08/2024	Development at 2 years:Gross motor{{c1::- Kicks ball- Walks up and down stairs holding on::(2)}}Vision/fine motor{{c2::- Tower of 6 blocks- Copies ver…
Published	10/08/2024	Development at 4 years:Gross motor{{c1::- Walks up and down stairs 1 foot per step- Hops::(2)}}Vision/fine motor{{c2::- Builds steps of bricks- Copies…
Published	10/08/2024	Development at 5 years:Gross motor{{c1::- Skips- Catches a ball- Runs on toes::(3)}}Vision/fine motor{{c2::- Copies triangle::(1)}}Hearing/speech{{c3:…
Published	10/08/2024	The limit age for walking is {{c1::18 months}}, and applies predominantly to children who have had {{c2::crawling}} as their early mobility …
Published	10/08/2024	The median age for walking in children who bottom-shuffle is {{c1::18 months}}
Published	10/08/2024	Correcting for prematurity stops at {{c1::2 years}}
Published	10/08/2024	The 4 fields of development are:1. {{c1::Gross motor}}2. {{c1::Vision and fine motor}}3. {{c1::Hearing, speech and language}}4. {{…
Published	10/08/2024	When trying to determine whether development is normal, first start by looking at the {{c1::sequence}} of progress, then check if progress is&nbs…
Published	10/08/2024	If the child is < 18 months, it is likely to be most useful to begin questions around {{c1::gross motor abilities}}, {{c1::acquisition of…
Published	10/08/2024	If the child is 18 months to 2.5 years, it is likely to be most useful to begin questions around {{c1::speech and language}}, and {{c1::fine moto…
Published	10/08/2024	If the child is 2.5 - 3.5 years, it is likely to be most useful to begin questions around {{c1::speech and language}}, and {{c1::social, emotiona…
Published	10/08/2024	Developmental {{c1::screening}}: Checks of whole populations of children at set ages by trained professionals
Published	10/08/2024	Development of {{c1::speech and language::developmental area}} is the best predictor of cognitive function
Published	10/08/2024	Developmental {{c1::assessment}}: Detailed analysis of overall development or specific areas of development
Published	10/08/2024	{{c1::No card :)::No card :)}}
Published	10/08/2024	What are the two tests used to test hearing in newborns:{{c1::Evoked otoacoustic emission}}{{c1::Auditory brainstem response audiometry}}
Published	10/08/2024	How does evoked otoacoustic emission work?{{c1::Earphone produces a sound which evokes an echo or emission from the ear if cochlear function is normal…
Published	10/08/2024	How does auditory brainstem response audiometry work?{{c1::EEG records response to a series of auditory stimuli}}
Published	10/08/2024	Distraction testing is a method of hearing test that is done at {{c1::7 - 9}} months of age
Published	10/08/2024	Distraction testing is done by {{c1::playing sounds outside the infant's field of view and having them turn towards it}}
Published	10/08/2024	Visual reinforcement audiometry is the most useful between {{c1::10 - 18}} months
Published	10/08/2024	Visual reinforcement audiometry is used between {{c1::6 months and 3 years}}
Published	10/08/2024	Normal audiometry is used starting at age {{c1::4}}
Published	10/08/2024	A newborn infants visual acuity is only about {{c1::6/200}}
Published	10/08/2024	Babies should not have a squint by {{c1::12 weeks}}
Published	10/08/2024	Visual acuity reaches adult levels by {{c1::4}} years of age
Published	10/08/2024	How is the mid-parental height calculated?{{c1::}}
Published	10/08/2024	The target height is the {{c1::mid-parental height +/- 10cm, which gives us the target centile}}
Published	10/08/2024	A {{c2::SHOX gene}} deficiency results in {{c1::disproportionate short stature}}
Published	10/08/2024	How do we measure for short stature?{{c1::We measure the standing and sitting height, then subtract the sitting from standing and are left with the su…
Published	10/08/2024	Puberty depends on the HPA axis, as this secretes {{c1::GnRH}} which in turn releases gonadotrophins {{c1::LH}} and {{c1::FSH}}. These act on the ovar…
Published	10/08/2024	The first signs of puberty in females is {{c1::breast budding}} and in males it is {{c1::testicular enlargement}}.Secondary pubery signs include {{c1:…
Published	10/08/2024	The {{c1::Tanner stage}} is used to assess for progression of puberty
Published	10/08/2024	Pubarche is the {{c1::presence of pubic and axillary hair}}. Gonadarche: {{c1::gonadotrophin-depdendent activation of gonadotropin}}
Published	10/08/2024	If gonarche occurs below 8 in females or 9 in males this is {{c1::precocious puberty}}
Published	10/08/2024	Premature adrenarche is puberty of the {{c1::adrenal gland}} - not true puberty! There are secondary sex characteristiccsGirls <{{c1::8}} year…
Published	10/08/2024	Premature adrenarche should raise suspicion for {{c1::adrenal malignancy}} or {{c1::congenital adrenal hyperplasia}}.
Published	10/08/2024	The completion of puberty happens when {{c1::the growth plates fuse}}
Published	10/08/2024	Telearche is {{c1::breast tissue budding}}
Published	10/08/2024	Investigations done for CAH in children with early onset puberty include: {{c1::DHEAS blood test (dehydroepiandrosterone sulfate),}} an {{c1::Xray to …
Published	10/08/2024	Risk factors for CAH include:{{c1::Low birth weight}}{{c1::Prematurity}}{{c1::Family Hx of PCOS}}{{c1::Central adiposity}}
Published	10/08/2024	In boys presenting with precocious puberty you always want to order an {{c1::MRI as brain tumors can be the cause of this}}
Published	10/08/2024	Growth is a measure of health and wellbeing. It is normal for newborns to lose weight after birth and then regain this by 3 weeks of age. Normal …
Published	10/08/2024	In terms of measuring growth: If a baby is born prematurely, before 37 weeks, then you need to {{c1::correct for this on the centile chart}}
Published	10/08/2024	How is 'faltering growth' defined? (4){{c1::There is a fall across 1 or more weight centiles if the birth weigth was below the 9th centile}}{{c1::Ther…
Published	10/08/2024	Failure to thrive/Faltering growth: In History ask for: (6){{c1::Intake of milk/foodAbnormal losses e.g. vomiting or diarrheaChronic conditions e.g. h…
Published	10/08/2024	What are 4 organic causes of faltering growth?{{c1::Inability to digest/absorb nutrients or excessive nutrient loss e.g. diarrhea}}{{c1::Developmental…
Published	10/08/2024	What are 4 non-organic cuases of faltering growth?{{c1::Reduced appetite}}{{c1::Dental caries}}{{c1::Poor parent-child interaction}}{{c1::Family diffi…
Published	10/08/2024	Signs of malnutrition in infants:{{c1::Subcutaneous fat loss in the axilla & inner thigh}}{{c1::Seeing ribs}}
Published	10/08/2024	Red flags in a child with faltering growth:{{c1::Irregular breast/bottle feeding pattern}}{{c1::Less than 5-6 nappies/24h}}{{c1::Recurrent infections …
Published	10/08/2024	If you are suspecting an organic cause of faltering growth, you should run the following tests: (7){{c1::FBC: SCIDTFTs: hyperthyroidismSweat…
Published	10/08/2024	If a baby is not responding to measures trying to increase their nutritional status, an {{c1::enteral tube feeding}} might be required.
Published	10/08/2024	A {{c1::public health nurse}} and {{c1::community dietician}} are key in assessing and dealing with malnourished children.
Published	10/08/2024	Is short stature always pathological and a problem?{{c1::No! Lots of children will present with this and short stature can be:A normal variantGenetic …
Published	10/08/2024	{{c1::Growth failure}} is pathological and can be due to genetics, underlying illness, slow growth velocity.
Published	10/08/2024	Reasons for growth deficiency in children:{{c1::Nutritional}}Chronic disease: {{c1::celiac, IBD}}Chromosomal: {{c1::Downs, Prader-Willi, Turners}}{{c1…
Published	10/08/2024	What is Turners syndrome?Chromosome: {{c2::complete or partial absence of X chromosome}}Affects: girls/boys? {{c2::girls}}Can present with {{c2::…
Published	10/08/2024	What is Russell-Silver Syndrome?Main symptom: {{c1::Severe post-natal growth failure associated with IUGR/SGA}}De-novo genetic mutationClinical featur…
Published	10/08/2024	Achondroplasia, Hypochondroplasia and SHOX gene deficiency are examples of {{c1::skeletal dysplasia}}
Published	10/08/2024	Noonan Syndrome Clinical features: 4{{c1::Pulmonary stenosisShort statureVisual impairmentFace: hypertelorism (increased distance between eyes) and lo…
Published	10/08/2024	Children with Downs syndrome often have {{c1::congenital hypothyroidism}} and a {{c1::short stature}} and must therefore avoid excess weight gain
Published	10/08/2024	Investigations for short stature: 6 bloods, 1 genetic, 1 imagingBloods (6): {{c1::FBC (anaemia), U&E (renal failure), CRP/ESR (IBD/chronic inflamm…
Published	10/08/2024	Children below the {{c1::3rd}} centile for height should be tested for short stature
Published	10/08/2024	The following children may be treated with GH in the absence of any investigations: (5){{c1::SGA not caught up by 4yoChronic renal failureTurners synd…
Published	10/08/2024	Developmental delay can be due to:{{c1::Frequent illness}}{{c1::Prolonged hospital admission}}{{c1::Lack of support & psychosocial neglet}}
Published	10/08/2024	Developmental delay is defined as {{c1::delay in 2 or more domains of development (i.e. gross, fine, speech/hearing, social) }}
Published	10/08/2024	Questions to ask in History if developmental delay is considered: 5{{c1::Detailed peri- and antenatal historyNeonatal course +/- serious infectionsPre…
Published	10/08/2024	Important aspects of examination if ?developmental delay: 2{{c1::Detailed CNS exam & inspecting proximal musclesHead circumference}}
Published	10/08/2024	Investigations for developmental delay: 3{{c1::Hip X ray: DDHCreatinine Kinase: Duchennes & Beckers Muscular Dystrophy MRI brain: If asymmetr…
Published	10/08/2024	Red flags in developmental delay:In History (2){{c1::Developmental regressionDelay in 1 or more domains}}On examination: (3){{c1::Low central or perip…
Published	10/08/2024	A 'developmental milestone' is the mean/median? {{c1::median}} age at which a milestone is acheived.
Published	10/08/2024	Face examination in a dysmorphic child - what parts of the face are important to look at? (6){{c1::Head shapeEyesEarsNoseOral Chin}}
Published	10/08/2024	What are different types of head shapes: (4){{c1::Mirco & MacrocephalyBrachycephaly: flat at the backPlagiocehpaly: flat in one areaScaphocephaly:…
Published	10/08/2024	What are 2 forehead abnormalities?{{c1::Prominent forehead or frontal bossing}}
Published	10/08/2024	What are some abnormalities in the eyes & eyebrows?Brows: {{c1::Synophrys (meet in the middle)}}Eyes: {{c1::Hypertelorism (eyes wide apart)}}Eyes:…
Published	10/08/2024	Abnormalities of the nose: 2{{c1::T21: Flat nasal bridgeNose: Prominance of the nose (Rubinsteini Taybi syndrome)}}
Published	10/08/2024	Abnormalities of the ears:{{c1::Low set ears}} Eyes are at a normal height if you can draw an imaginary line from the outer cantus of the eye to …
Published	10/08/2024	Abnormalities of the mouth: 3{{c1::Philtrum: absent cupids bow in fetal alcohol syndromeAngles of the mouth: should be vertically below the pupilsSmal…
Published	10/08/2024	Abnormalities of the chin: 2{{c1::Prognathism: prominent chinMicrognathia: small chinChin and forehead should be aligned!}}
Published	10/08/2024	Abnormalities of the neck: 2{{c1::Short/long neck: MarfansWebbed neck: Turners/Noonans}}
Published	10/08/2024	Abnormalities of the hand: 2{{c1::PolydactylyT21: Clinodactyly & single palmar creaseAbsent thumb: Fanconi syndromeSyndactyly: T18}}
Published	10/08/2024	AD/AR?? {{c1::Autosomal recessive}} diseases include CF, phenylketonuria, sickle cell, beta thalassemia
Published	10/08/2024	Haemophilia, Duchennes and Beckers MD, and red-green colour blindess are all {{c1::X-linked recessive}}
Published	10/08/2024	Polygenic inheritence means that {{c1::multiple genes}} are involved and therefore does NOT follow a mendilian inheritance pattern
Published	10/08/2024	Classic clinical features of Down syndrome:Head/Neck (8): {{c1::microcephaly, brachycephaly, brushfield spots, epicathil folds, cataracts, low set ear…
Published	10/08/2024	The 'Gold Rules' of T21: 4{{c1::Placed on specific growth chartsEcho neonatally and early adulthood!!Hypothyroidism & coeliac screen every 2 years…
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Status	Last Update	Fields