Developmental delay

hazel_121
Mind Map by hazel_121, updated more than 1 year ago
hazel_121
Created by hazel_121 over 6 years ago
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Paeds Mind Map on Developmental delay, created by hazel_121 on 02/21/2014.
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Resource summary

Developmental delay
1 Causes / influences
1.1 Biological
1.1.1 Pre-natal
1.1.1.1 Genetic
1.1.1.1.1 Neurocutaneous syndromes
1.1.1.1.1.1 Neurofibromatosis
1.1.1.1.1.2 tuberous sclerosis
1.1.1.1.2 chromosome
1.1.1.1.2.1 downs syndrome
1.1.1.1.2.2 fragile X
1.1.1.2 Vascular
1.1.1.2.1 occlusions
1.1.1.2.2 haemorrhage
1.1.1.3 Metabolic
1.1.1.3.1 hypothyroid
1.1.1.3.2 Phenylketonuria
1.1.1.4 teratogenic
1.1.1.4.1 alcohol
1.1.1.4.2 smoking
1.1.1.4.3 medication
1.1.1.4.3.1 antiepilpetics
1.1.1.4.3.2 cytotoxics
1.1.1.4.4 drug abuse
1.1.1.4.5 pestacides / radiation
1.1.1.5 Infectious
1.1.1.5.1 rubella, CMV, toxoplasmosis, HIV
1.1.1.5.2 varicella, malaria
1.1.2 perinatal
1.1.2.1 extreme prematurity
1.1.2.1.1 intraventicular haemorrhage / periventricular leucomalacia
1.1.2.2 birth asphyxia
1.1.2.2.1 hypoxic-ischaemic encephalopathy
1.1.2.3 metabolic
1.1.2.3.1 symptomatic hypoglycaemia or hyperbilirubinaemia
1.1.3 post-natal
1.1.3.1 infection
1.1.3.1.1 meningitis
1.1.3.1.2 encephalitis
1.1.3.2 anoxia
1.1.3.2.1 suffocation
1.1.3.2.2 near drowning
1.1.3.2.3 seizures
1.1.3.3 trauma
1.1.3.3.1 head injury
1.1.3.4 metabolic
1.1.3.4.1 hypoglycaemia
1.1.3.4.2 hypothyroid
1.1.3.4.3 inborn errors of meatbolism
1.1.3.4.4 hyper / hyponatraemia
1.1.3.4.5 dehydration
1.1.3.5 vascular
1.1.3.5.1 stroke
1.1.3.6 toxins
1.1.3.6.1 lead, mercury, arsenic etc
1.1.4 nutrition
1.1.4.1 Vit D, B12, folate, iron esp
1.1.4.2 protein
1.1.4.3 malabsorption?
1.2 Social
1.2.1 Community
1.2.1.1 resources
1.2.1.2 support
1.2.2 Family
1.2.2.1 parenting capacity
1.2.2.1.1 basic care
1.2.2.1.2 emotional warmth
1.2.2.1.3 stimulation
1.2.2.1.4 guidance and boundries
1.2.2.1.5 stability
1.2.2.2 history and functioning
1.2.3 housing
1.2.4 income
1.2.5 violence and abuse
1.2.6 education
1.2.7 health and access to healthcare
1.3 Psycological
1.3.1 maternal mental health
1.3.1.1 post natal depression
2 investigations
2.1 developmental assessment
2.1.1 put any delays in context of other milestones
2.1.2 red flags
2.1.2.1 general
2.1.2.1.1 loss of previously acquired skill
2.1.2.1.2 parental concern
2.1.2.1.3 poor interaction with others
2.1.2.1.4 abnormal tone
2.1.2.1.5 difference in strength between left and right side
2.1.2.2 2 years
2.1.2.2.1 has less than 50 words
2.1.2.2.2 difficulty handling small objects
2.1.2.2.3 unable to climb stairs
2.1.2.2.4 no interest in feeding or dressing
2.1.2.3 18 months
2.1.2.3.1 no clear words
2.1.2.3.2 uninterested in playing with others
2.1.2.3.3 not walking without support
2.1.2.3.4 not able to hold crayon
2.1.2.3.5 unable to stack two blocks
2.2 cytogenetics

Annotations:

  • chromosome karytopyping,  fragile X analysis, DNA FISH analysis
2.3 metabiloic
2.3.1 TFTs, LFTs, U+Es, bone chemistry, plasma amino acids
2.3.2 creatine kinase (DMD), lactate, VLCFA, ammonia, blood gas, white cell enzymes, urine amino and organic acids etc
2.3.3 maternal amino acids for raised phenylalanine
2.4 congenital infection screen
2.5 imaging
2.5.1 cranial US in neonate
2.5.2 CT / MRI brain
2.5.3 skeletal survey, bone age
2.6 neurophysiology
2.6.1 EEG, VEP, Nerve conduction tc
2.7 nerve and muscle biopsy
2.8 hearing and vision
3 abnormal motor development
3.1 causes
3.1.1 central motor deficit
3.1.1.1 cerebral palsy
3.1.1.1.1 spastic CP

Annotations:

  • damage to corticospinal tract
3.1.1.1.1.1 hemiplegic

Annotations:

  • tip toe walk
  • usually neonatal stroke
3.1.1.1.1.2 quadriplegic

Annotations:

  • sll four limbs, trunk, seizures, microcephaly, intellectual impairment
  • HIE usually cause
3.1.1.1.1.3 diplegic

Annotations:

  • legs much more than arms
  • usually preterm with periventricular brain damage
3.1.1.1.2 clinical features
3.1.1.1.2.1 abnormal limb + / or trunk posture and tone and delyed motor milestonse
3.1.1.1.2.2 feeding difficulties
3.1.1.1.2.3 abnormal gait
3.1.1.1.2.4 asymmetric hand function before 12 months
3.1.1.1.2.5 persisting primitive reflexes
3.1.1.1.3 dyskinetic

Annotations:

  • chorea, athetosis, dystonia
  • floppiness, poor trunk control, delayed motor development
  • HIE and hyperbillirubinaemia with rhesus haemolytic disease
3.1.1.1.4 ataxic

Annotations:

  • early trunk and limb hypotonia, poor balance, delayed motor development, inco-ordination, intention tremor, ataxic gait
  • usually genetic but may be acquired - symptoms depend on site and extent of damage
3.1.1.1.5 mixed
3.1.2 congenital myopathy / primary muscle disease
3.1.2.1 duchenne / beckers muscular dystrophy
3.1.3 spinal cord lesions
3.1.3.1 spina bifida
3.1.4 Part of syndrome causing global developmental delay
4 abnormal speech and language development
4.1 causes
4.1.1 hearing loss
4.1.1.1 secretory otitis media
4.1.2 global developmental delay
4.1.3 motor problem e.g. CP
4.1.4 anatomical problem e.g. cleft palate
4.1.5 environmental deprivation / lack of opportunity for social interaction
4.1.6 normal variant / familial pattern
4.1.7 following meningoencephalitis or head injury
4.1.8 autistic spectrum disorders
4.2 investigations
4.2.1 developmental assessment
4.2.1.1 other developmental problems?
4.2.1.2 if less than 50 words at 3 years
4.2.2 hearing test
4.2.3 language development test
5 abnormal development of social / communication skills
5.1 autistic spectrum disorders
5.1.1 features
5.1.1.1 impaired social interactions
5.1.1.2 speech and language disorders
5.1.1.3 imposition of routines with ritualistic and repetitive behavoir
5.1.1.4 co-morbidities

Annotations:

  • seizures, learning and attention difficulties
5.2 hearing impairment
5.2.1 sensorineural
5.2.1.1 genetic
5.2.1.2 ante and perinatal
5.2.1.2.1 congenital infection
5.2.1.2.2 preterm
5.2.1.2.3 HIE
5.2.1.2.4 hyperbilirubinaemia
5.2.1.3 postnatal
5.2.1.3.1 head injury
5.2.1.3.2 meningitis / encephalitis
5.2.1.3.3 drugs e.g. aminoglycasides
5.2.1.3.4 neurodegenerative disorders
5.2.2 conductive
5.2.2.1 otitis media with effusion
5.2.2.2 Eustachian tube dysfunction
5.2.2.2.1 downs
5.2.2.2.2 pierre robin sequence
5.2.2.2.3 cleft palate
5.2.2.2.4 mid facil hypoplasia
5.2.2.3 wax
5.2.2.4 URTI
6 abnormal vision
6.1 signs
6.1.1 loss of red reflex (cateract)
6.1.2 white reflex (ROP, cateract or retinoblastoma
6.1.3 not smiling by 6 weeks
6.1.4 visual inattention, lack of eye contact
6.1.5 nystagmus, squint, photophobia
6.2 causes
6.2.1 genetic
6.2.1.1 cateract
6.2.1.2 albinism
6.2.1.3 retinal dystrophy
6.2.1.4 retinoblastoma
6.2.2 antenatal and perinatal
6.2.2.1 congential infection
6.2.2.2 ROP
6.2.2.3 HIE
6.2.2.4 cerebral abnormality / damage
6.2.2.5 optic nerve hypoplasia
6.2.3 postnatal
6.2.3.1 trauma
6.2.3.2 infection
6.2.3.3 juvenile idiopathic arthritis
6.3 strabismus (squint)
6.3.1 check red reflex
6.3.2 concomitant

Annotations:

  • non paralytic refractive error
6.3.3 paralytic - paralysis of motor nerves

Annotations:

  • possible underlying SOL
6.3.4 cover test
6.4 refractive errors
6.4.1 hypermetropia

Annotations:

  • long sight
6.4.2 myopia

Annotations:

  • short sighted
6.4.3 astigmatism

Annotations:

  • abnormal corneal curvature
6.4.4 amblyopia

Annotations:

  • potentially permanent loss of visual acuity in the eye that has not received a clear image due to any interference with visual development
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