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Child Development-Pediatrics PowerPoint Presentation

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Description : child development

Tags : child development,pediatrics

Published on : Apr 26, 2021 | Views : 4600 | Downloads : 56

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Slide 1-

Delayed Milestones Supervised by :- Dr. Nebal Wael By :- Mina Ali Mina Ibrahim Omar Abd Mohammed Alaa Mina Mohanad MohammedAli Thamir
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Child Development It is the process by which a child changes over time. It covers the whole period from conception to an individual becoming a fully functioning adult. It’s a journey from total dependence to full independence. Child development incorporates, physical growth as well as intellectual, language, emotional and social development.
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Normal Development
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RED FLAGS
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vs developmental regression Delay in the acquisition of developmental skills beyond limit age. Types: Isolated & Global Loss of developmental milestones previously attained which usually indicates a progressive disease of nervous system Developmental delay
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Global Developmental Delay Also called early developmental impairment. It implies delay in acquisition of early childhood developmental milestones in 2 or more domains of development (gross motor, vision and fine motor, hearing and speech, language and cognition, social/emotional and behavior) It is usually presents in the first 2 years of life There are 2 types Static & Progressive Static Global Delay - Causes Chromosomal disturbances Hypoxic ischemic encephalopathy Infections (TORCH & Brain Infections)
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Chromosomal Disturbances Typical facies Hypotonia Congenital heart disease (trisomy 21) Down syndrome
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Congenital Infections Toxoplasmosis Rubella CMV Herpes simplex (Herpes encephalaitis) Syphilis Presented with: Seizures Motor & cognitive impairment language dysfunction Deafness & blindness
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Progressive Global Delay - Causes Neurocutaneous Disorders: Neurofibromatosis Type 1 Sturge Webber Syndrome Metabolic Brain Disorders: Galactosemia Phenylketonuria Congenital Hypothyroidism: Malnutrition Chronic Illness
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Neurocutaneous Diseases – Neurofibromatosis Type 1
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Metabolic Brain Disorders Galactosemia A disorder that occurs when the body is unable to break down a type of sugar called galactose that is found in milk and milk products 2. Phenylketonuria A genetic disorder in which the body lacks the enzyme that break down the amino acid phenylalanine leading to its accumulation
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Congenital Hypothyroidism Mostly due to Thyroid Dysgenesis. (aplasia, hypoplasia, or an ectopic gland), accounting for 85% of cases 10% are caused by an inborn error of thyroxine synthesis 5% are the result of transplacental maternal thyrotropin-receptor blocking antibody (TRBAb).
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Isolated Developmental Delay Definition Classified into: Gross motor delay Impaired speech and language development Impaired social/communication skills Development Impaired cognition/learning difficulties Hearing Impairment Visual Impairment
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Delay in acquisition of Motor Skills Causes include: central motor deficit e.g. cerebral palsy congenital myopathy/primary muscle disease spinal cord lesions, e.g. spina bifida global developmental delay, as in many syndromes or of unidentified cause. Gross Motor Delay
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Impaired Speech & Language Development Deficit in either receptive or expressive speech and language, or both. Delay vs Disorder: Speech & Language Delay: Hearing Impairment difficulty in speech production from an anatomical deficit environmental deprivation normal variant Speech & Language Disorders: language comprehension language expression Phonation Pragmatics Social/Communication skills
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Impaired social /communication skills Development Failure to acquire normal social and communication skills Features of Autistic Spectrum Disorders
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Impaired cognition / learning difficulties General vs Specific General Learning Difficulty: Borderline & Mild Moderate , Severe & Profound Specific Learning Difficulty: Dyspraxia Dyslexia Dyscalculia Dysgraphia Others
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May be presented as delayed language or speech , Learning difficulties or behavioral problems types: sensorineural – caused by a lesion in the cochlea or auditory nerve and is usually present at birth conductive – from abnormalities of the ear canal or the middle ear, most often from otitis media with effusion. Hearing Impairment
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Presentation not smiling responsively by 6 weeks postterm lack of eye contact with parents visual inattention random eye movements nystagmus squint Photophobia Causes Visual Impairment
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Approach to Child with developmental delay
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History
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Physical Examination A thorough physical examination is important in the assessment of a developmentally delayed child. Characteristic findings on the physical exam may provide clues as to the cause of the developmental delay. Some clinical signs and their corresponding clinical significance are listed below:
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Growth Parameters Microcephaly: any condition that can retard brain growth ( malnutrition, Angelman syndrome) Macrocephaly (hydrocephalus) Short stature: Turner syndrome, malnutrition, William syndrome Obesity: Prader-Willi syndrome
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Head and neck Flat occiput: Down syndrome, Zellweger syndrome Prominent occiput: trisomy 18 Craniosynostosis: Pfeiffer syndrome Midface hypoplasia: Fetal Alcohol syndrome (FAS), Down syndrome Prominent nose and chin: Fragile X syndrome Round facies: Prader-Willi syndrome
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Triangular facies: Turner syndrome Hypertelorism: Fetal hydantoin syndrome Hypotelorism: maternal PKU effect Prominent eyes: Beckwith-Wiedemann syndrome, crouzon syndrome, fragile X syndrome Cataract: Galactosemia, parental rubella, hypothyroidism Cherry- red spot in macula: metachromatic leukodystrophy, tay-sachs disease, Farber lipogranulomatosis Head and neck
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Chorioretinitis: congenital infection with CMV, toxoplasmosis, rubella Pinnae, low set or malformed: trisomies such as 18, Down syndrome, CHARGE association, fetal phenytoin effects Broad nasal bridge: Fragile X syndrome Low nasal bridge: Down syndrome Long philtrum: FAS Head and neck
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Heart Structural anomaly or hypertrophy: CHARGE association, FAS, Down syndrome, maternal PKU, chronic cyanosis may impair cognitive development Liver Hepatomegaly: fructose intolerance, galactosemia, Tay-sachs disease, Guacher disease
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Genitourinary Macro-orchidism: Fragile X syndrome Hypogonadism: Prader-willi syndrome, Klinefelter syndrome, CHARGE syndrome Extremities Small hands: Prader-willi syndrome Clinodactyly: Trisomies including Down syndrome Transverse palmer crease: down syndrome
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Skin Café au lait spots: neurofibromatosis Eczema: phenylketonuria, histiocytosis Hemangioma and telangiectasia: Sturge-Weber syndrome, ataxia-telangiectasia Hypopigmented macules: tuberous sclerosis
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Neurological exam Asymmetry of strength or tone: focal lesion, cerebral palsy Hypotonia: prader-willi syndrome, Down syndrome, angelman syndrome, early cerebral palsy Hypertonia: neurodegenerative conditions, cerebral palsy Ataxia: ataxia-telangectasia, angelman syndrome
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Investigation: Genetics Karyotyping to assess for chromosomal abnormalities Fragile X analysis FISH analysis to assess for microdeletions, telomere screening, whole exome sequencing Many of these investigations will be performed through specialist referral. Medical genetics consultation should be done at this time.
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metabolic Liver function test Thyroid function test Bone chemistry Urea and electrolytes, blood film Metabolic screening- glucose, electrolytes, serum lactate, ammonia, pyruvate, albumin, triglycerides, uric acid, serum quantitative amino acids, lead level, creatine phosphokinase, ferritin, vitamin B6 and B12 Maternal amino acid for raised phenylalanine
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neurology EEG Head CT and MRI Cranial ultrasound for newborn Infection Screening for congenital infection like toxoplasmosis and CMV, etc… Vision and hearing assessment
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Thank you