Case 28: Developmental Delay, 18 Month Old

Front 1

What to look for on developmental monitoring?

Back 1

• Gross motor
  
• Fine motor
  
• Communication (sometimes broken down into receptive and expressive language)
  
• Personal-social
• Problem-solving (also called self-help, cognitive, or adaptive in some frameworks)

Front 2

When to evaluate developmental milestones?

Back 2

• 9 months
  
• 18 months
  
• 30 months
  

Front 3

Surveillance at every preventive care visit?

Back 3

• maintain developmental history
  
• accurate and informed observations of the child
  
• identifying the presence of risk and protective factors
  
• documenting process and findings
  

Front 4

List some key delays associated by illness?

Back 4

• ASD interferes with social interactions
  
• cerebral palsy, motor dysfunction
  
• genetic and metabolic disorders may cause global delay
  
• psychosocial stressors and developmental delay
  

Front 5

Definition of ASD?

Back 5

developmental disorder that primarily interferes with healthy socialinteraction.

Front 6

Screening tool for ASD?

Back 6

• M-CHAT
  
• modified checklist for autism in toddlers
  
• 16-30 months screening tool
  

Front 7

Risk factors for developmental delay?

Back 7

• effect on bronchopulmonary dysplasia
  
• retinopathy of prematurity
  
• hyperbilirubinemia
  
• periventricular leukomalacia (PVL)
  

Front 8

BPD

Back 8

• may cause poor growth
  
• increased caloric requirements
  
• repeated pulmonary infections
  
• CHF
  

Front 9

ROP

Back 9

• premies under 1500g
  
• extraretinal fibrovascular proliferation and, in severe cases, maycause retinal detachment and blindness
  

Front 10

Hyperbilirubinemia

Back 10

• potential neurotoxin
  
• preterm
  
• critically ill infants
  
• severe may lead to kernicterus
  
• abnormal motor development
  
• sensorineural hearing loss
  

Front 11

PVL

Back 11

• damage to white matter surrounding the ventricles in the brain
  
• result of hypoxia, ischemia, inflammation
  
• correlated with IVH
  
• PVL with cysts highly correlated with cerebral palsy
  

Front 12

What is cerebral palsy?

Back 12

The diagnosis of cerebral palsy (CP) represents a heterogeneous group of non-progressivedisorders, characterized by motor and postural dysfunction.

Front 13

Types of cerebral palsy

Back 13

spastic: increased tone and spasticity

many others

Front 14

List some risks associated with cerebral palsy?

Back 14

• prematurity
  
• intrauterine growth retardation
  
• intrauterine infection
  
• perinatal asphyxia
  

Front 15

What is corrected age?

Back 15

In general, when looking at growth and development in former premature infants, pediatricians usethe "corrected age."

Front 16

How to calculate corrected age?

Back 16

Subtract gestational weeks of a premature infant from the average gestational period of 40weeks.5/13Subtract the result from the chronological age to obtain the "corrected age."

Front 17

How to measure head circumference?

Back 17

Measure the largest circumference possible by making sure that the tape wraps tightly around themost prominent parts of the occiput and forehead.

Front 18

Neuro exam in infants, components?

Back 18

• Mental status
  
• Cranial nerve exam
  
• Muscle tone
  
• Muscle strength
  
• DTRs
  
• Babinski
  
• Cerebellar
  

Front 19

How to evaluate toddler mental status?

Back 19

• How does the child interact with the caregiver?
  
• How does he interact with you (a less reliable measure!)?
• Is he alert, sleepy, arousable, etc.?

Front 20

Cranial nerve exam in toddlers?

Back 20

• move flashlight or two around and watch CN III, IV, and VI
  
• look for facial symmetry as marker for VII
  
• test hearing by crumpling paper
  
• Look carefuly at the palate and tongue
  
• listen to child's voice (IX, X, XII)
  

Front 21

Assess muscle tone in kids?

Back 21

• Play and move arm/legs through full range of motion
  
• notice resting posture
  
• gentle move extremities through passive ROM
  

Front 22

How to assess DTRs?

Back 22

• use finger to tap tendons
  
• note vigorousness of response
  

Front 23

How to assess cerebellar function in the infants?

Back 23

• is his balance normal
  
• does he have smooth, coordinated movments
  
• asymmetry
  

Front 24

How to assess a child with cerebral palsy?

Back 24

• H and P
  
• Screening
  
• EEG
  
• Neuroimaging
  
• Metabolic and genetic testing
  
• developmental testing
  

Front 25

H and p for cerebral palsy?

Back 25

: All children should undergo a detailed history and physical examination. It is particularly important to determine that the condition is static rather than progressive or degenerative. It is alsoimportant to classify the type of CP.

Front 26

EEG for cerebral palsy?

Back 26

EEG is recommended when there are features suggestive of epilepsy.

Front 27

Neuroimaging of child with cerebral palsy

Back 27

Neuroimaging is recommended to both establish an etiology and for prognosticpurposes. MRI is preferred to CT scan and does not expose the child to radiation.

Front 28

Metabolic and genetic testing of the child with cerebral palsy

Back 28

Metabolic and genetic testing are considered if the clinical historyor findings on neuroimaging do not determine a specific structural abnormality or if there areadditional and atypical features in the history or clinical examination.

Front 29

Developmental testing of the child with cerebral palsy?

Back 29

The recommended in-depth developmental testing and assessmenttypically cannot be done in a busy outpatient clinic. Referral to a specialist will help with formaldevelopmental testing and with coordinating services for the child.