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Upshot of lecture: You will have to rote learn all the stages of development (both physically and cognitively).

Outline

  • Aims and Key Concepts for Scenario 2
  • View Video of Mary and Sarah
  • View Scenario 2, Alex and William – Summarise case
    • Talk about the concepts generated – Questions

Aims for learning in the next few weeks

• Normal physical development and behaviour in 1-5 year age group • The detection and impact of developmental delay • Socio-cultural influences on normal development and health • Common childhood infections incl viral GIT infections • Clinical genetics • The endocrine system and sexual development • Psycho-social issues re sexuality and gender

Key Concepts

• Normal physical development and detection and causes for delay • Otitis media • Causes of language delay – Hearing, neurological, anatomical • Psychosocial issues of living with intellectual disability • Indigenous child health • Genetic influences on health and development • Endocrine system - development, homeostasis and effect on health

Video

  • http://tv.unsw.edu.au/video/plenary-2-edited-interview-with-mary-givney-clark (only staff can view?)
  • This is an edited version of a longer video (you should go to UNSWTV and look at the rest of the video)
  • Sarah is 7 years old
  • Can say own whole name, likes dancing, reading, goes to school, she's the youngest of four (2 elder brothers at university, and there's a sister who died as a newborn)
  • Kid has Down syndrome (born at 42)
  • No-one prepared her for talking about abortions for child with Down syndrome. Doesn't consider it "risk", but "chance".
    • It was assumed by specialists that they would abort it
    • Rather than information about Down syndrome, specialists gave information about abortion etc (wrong message for this patient)
    • Surprised at the amount of testing
    • Simian creases, epicanthal folds
  • Most common chromosomal change
  • Paediatrician becomes manager. Paediatrician says "I'm not talking to you with a heavy heart"
    • Practice preventative medicine - know some of the things that can go wrong and try to avoid them
  • Celiac disease, small ASD that healed, nystagmus. Basically a healthy child
  • Yearly hearing tests
  • Lower muscle tone all over the body (harder to talk)
  • Noone expects to have a child with special needs, but she has brought the family closer together.
  • There's no reason that her child with Down Syndrome can't grow into an independent adult who is affectionate, loving and a good citizen.
  • "High risk test" - Nuchal translucency: gives you a probability of the child having Down syndrome
    • Some people don't even want to know!

Major issues in video

  • Preconceptions and assumptions about what a parent will do (don't just assume that someone wants an amniocentesis to check if the child has Down syndrome - in fact this puts them at risk of miscarriage)
  • Lack of resources at the time of decision making (she doesn't know that the extra chromosome results in health problems, lots of time at the doctor, and subnormal IQ)
  • The role of the paediatrician in coordinating care
  • Preventative medicine
  • The maze of the medical world
    • Don't forget how little many people know about medicine
  • “Our children”
  • “Typical children”

Scenario 2: Alex and William family tree

Alex and William

  • 2 boys, cousins, both 3 years old
  • Very different with regard to: – Development
    • Medical history
    • Future hopes
  • Discuss the aims and key concepts introduced by the scenario and video

Case Summary

  • Alex 3 year old boy (Catherine’s older brother)
  • Fever/?otitis media/night-time cough
  • Recurrent otitis media over the last 3 months
  • Regression in day-time continence (using toilet during the day is normal for age 3 - maybe not during the night)
    • Possibly thrown into disorder by little sister
    • Possibly UTI

William his cousin 3 yo

  • Child of Alex’s mother’s sister
  • Diagnosed at birth with Down Syndrome
  • Mother 24 and so not sure if had nuchal translucency test or any invasive test

William’s background history

  • Recurrent otitis media like Sarah in the video
  • Pneumonia when he was 2
  • Mild congenital heart defect ? ASD like Sarah
  • Immunisations up to date
  • No medications
  • Eats well

Regular visits with Paediatrician

  • Manages subspecialty appointments (there are guidelines set out in journal articles and books telling you what to test for at different ages)
  • Screens for conditions he is susceptible to
  • Eg Coeliac disease
  • Hypothyroidism
  • Growth hormone deficiency

William’s development and behaviour

  • Does not speak much
  • Gestures and single words
  • Scratching and kicking recently
  • Mother in process of toilet training him
  • Lives with parents and half-brother David who is 16

Clinical genetics

  • A child will be the product of the genetic syndrome and also the family’s genetics
  • Important because there is often well known features to look out for
  • Preventative Medicine
  • Not being judgemental or have preconceptions about how a couple will decide
  • Markers of Down syndrome:
    • Epicanthal folds
    • Protruding tongue
    • Open mouth
    • Head flopped to one side due to visual disturbance

Development 1-5 years

Draw/write, walk, talk, play (imaginative play e.g. playing with dolls), lying, tantrums.

Kids learn to wipe their own bottom around 4-5.

  • Builds on the basic foundation skills acquired in 1st year of life
  • Progression of skills that make us human
  • Increased complexity of expressive and receptive communication
    • Verbal
    • Non-verbal
  • Marked expansion of social skills
  • Marked expansion of social skills
    • Play and imagination
    • Lying
    • Tantrums
      • Targeted Tantrum
        • www.youtube.com/watch?v=Gk-OfmmRaqs&
  • Further complex motor skills
    • Gross motor
      • Running, jumping, hopping, balance, skipping
    • Fine motor
      • Drawing, writing, self care
  • Diet and nutritional issues
    • Difficult eating behaviours
      • Food refusal
    • Nutritional deficiencies
      • Milk and iron deficiency anaemia

Detection and Impact of Developmental Delay

  • Detection: need to know normal development!
  • Some rote learning but also from your clinical experiences in ph 2 and 3.
  • Parents reporting (parents usually know about problems in development as well)
  • GPs/Paediatricians observations
  • Formal testing
  • Impact:
  • On child/family/community

Intellectual disability

Intellectual disability is not typically the same as developmental delay. The intellectually disabled may be stagnant in development at a certain age (not just always x years behind people of their age, but may only ever reach mental age of 12 year old etc)

  • Generally older children to adulthood
  • Usually had formal test but may not have
  • Schools/Outside psychologists do tests
  • Mild will not qualify for special class until year 3-how can they function in normal class?
  • Impact on child/family/classmates

Psychosocial issues around living with intellectual disability

  • Grieving for the child you won’t have
  • Effects on parents and siblings
  • Both good and bad eg Sarah

Socio-cultural influences on normal development and health

  • No extended family around to learn from
  • Chinese grandmothers with 12 layers on a child with a 39 degree temperature
  • Our own families: my grandmother “pity it wasn’t your tongue”
  • My mother-an honorary doctor
  • Obesity-seen as the norm now so that normal BMI is seen as skinny

Common childhood infections

  • Diseases of the respiratory system
    • Upper respiratory tract infections (URTI)
      • “Colds”, otitis media like Alex
    • Lower respiratory tract infections (LRTI)
      • Bronchiolitis, pneumonia
  • Viral infections of the GIT
    • Gastroenteritis

Otitis Media

  • Inflammation of the middle ear
  • Very common
    • 83% of children will have at least one episode of acute otitis media by the age of 3 years
  • Most common cause of hearing loss in children

Otitis media

  • Risk factors

Causes of developmental delay

  • Classify:
  • Language delay alone or together with other areas of delay (global)
  • Congenital eg genetic/infection
  • Acquired eg traumatic/meningitis/gentamicin causing deafness/glue ear

Summary

  • Have we achieved our aims?
  • Please watch full video of Sarah and Mary on unsw tv
  • This scenario doesn’t deal with endocrine system or psycho-social issues re sexuality and gender-will deal with these in SGS