PEDS question

• sucking + swallowing

• visually directed reaching

• bears some weight when held in standing

• hold head up in prone

3 month milestone

• independent rolling (prone → supine)

• independent sitting → forward protective response

• unilateral reaching

• radial palmer grasp

6 month milestone

• crawling creeping

• variety of sitting positions

  • smaller BOS

  • lateral protective response

• cruising

• voluntary release of grasp

• feeds self cracker, holds bottle

9 month milestone

• full trunk control in sitting

  • backward protective repsonse

• pulls to stand

• cruising

• walking (falls 17 times/ hr)

• climbs stairs on hands + knees

12 month milestone

• walk up stairs then down while holding

• seldom falls, runs stiffly

• stoops to pick up objects + regains standing

18 month milestone

• jumps down from step

• reciprocal stair climbing

• begins to run

24 month milestone

• hopping on 1 foot

• kick a ball

• stand on 1 foot 1-2 sec

30 month milestone

• rough + tumble play

• “true run” with flight phase

36 months (3 years) milestone

• gallops

• scissors, holds pencil with proper grip (fine motor)

• stands on tip toes

• follows directions

• catch a ball

48 months (4 years) milestone

• stand on 1 foo t → 10 sec without sway

• adult-like grammar

• hops 8-10 steps on 1 foot

60 months (5 years) milestone

• skipping

• sports + games with rules

6 year milestone

mature gait

7 year milestone

What is the primary goal of pediatric PT?

To help children reach their maximal functional level of independence

What is the context in which the examination & evaluation of pediatric patients is performed?

His/her own daily routines and activities

What is IDEA?

Individuals with Disabilities Education Act. Federal legislation stating that all children ages birth-21 who are eligible for early intervention or special education services are therefore entitled to pediatric PT services.

When is the palmar grasp reflex expected to be integrated, and why is this functionally important?

If the palmar grasp reflex does not integrate, a child is likely to have difficulty developing fine motor skills like writing, they also will have impaired voluntary release of objects

Which primitive reflex is the only one that develops AFTER birth, not during gestation?

Symmetrical tonic neck reflex (STNR)

What is the asymmetrical tonic neck reflex (ATNR)?

Turning an infant’s head in one direction will cause the arm and leg on the side that they are facing to extend, while the other arm and leg flex

What functional deficits can occur if ATNR does not integrate?

Impaired ability to perform midline hand movements, poor visual tracking when crossing midline, poor balance when creeping or crawling,

What is the galant reflex?

Also known as the trunk incurvation reflex, stroking the paravertebrals on one side causes the trunk to laterally flex towards the stimulated side

What is the Moro reflex?

Also the startle reflex, a loud noise or a head drop backwards causes the abduction and extension of the arms, splaying of fingers, possibly followed by arm flexion and adduction

What is the symmetrical tonic neck reflex (STNR)?

With head/neck flexion, arms flex and legs extend. With head/neck extension, the arms extend and the legs flex.

What is the functional deficit if STNR does not integrate?

Difficulty developing creeping/crawling skills. Typically results in a “bunny hop” rather than a reciprocal creep.

An infant is startled by a sudden loud noise and responds with abduction and extension of the upper extremities, followed by adduction and crying. At what age should this reflex integrate?

3-5 months

A 7 year old child demonstrates significant difficulty writing and coordinating bilateral hand use because when they turn their head to the left, their left arm extends and their right arm flexes. Which primitive reflex is likely retained?

Asymmetrical Tonic Neck Reflex (ATNR)

What is the Tonic Labyrinthine Reflex (TLR)?

Body position is dependent on the head’s position in space. When in supine (head extended), generalized extensor tone dominates the body. When in prone (head flexed), generalized flexor tone dominates.

Palmar grasp typically develops around ____ months, while plantar grasp doesn’t integrate until ____ months.

4-7 months; 9 months.

How can a retained ATNR reflex impact an infant’s ability to roll?

When looking to one side to roll, the upper extremity on that side will extend which can block the infant from rolling in that direction.

In what “direction” or pattern does general skill acquisition develop?

Head to toe (cephalocaudal) or proximal to distal.

At approximately what age should an infant be able to sit independently

6 months

What is the order of events in which an infant develops rolling skills?

1. Rolls supine to sidelying and rolls prone to side accidentally.

2. Rolls prone to supine with right & left leg performing independent movements.

3. Rolls segmentally prone to supine and back with roll initiated by the head, shoulder, or hips.

What is the difference between creeping and crawling, and which skill develops first?

Crawling is done with the belly on the ground and develops before creeping. Creeping is a reciprocal movement on hands and knees.

When beginning to walk independently, how many times per hour does the average child fall?

17 times per hour

Approximately when does furniture cruising begin?

~8 months

Approximately when does independent walking begin?

12 months

Initial independent walking is characterized by…

1. Excessive hip flexion

2. external rotation

3. abduction with a wide base of support

4. knee flexion through stance

5. no heel strike

6. hyperextension of the swing leg

7. short stride length and swing phase

8. scapular adduction and high hand guard

The ability to stand on one foot is not expected until approximately what age?

31 months (2 years, 7 months)

Which skill develops first, galloping or skipping?

Galloping (3-4 years), skipping develops between 5-6 years

Pulling to stand at furniture occurs when?

6-12 months

When is reciprocal stair climbing expected?

24-30 months

When is “mature walking” expected?

7 years of age

When is “immature walking” expected?

Approximately 2 years of age

How does arm placement differ between initial walking mechanics and immature/mature walking?

Initial walking is done with high hand guard/outstretch arms, immature and mature walking include a reciprocal arm swing

Rolling in which direction is most likely to develop first, and why?

Prone to supine because it requires less core strength and the infant can gain momentum by pushing up with their arms when in prone

According to the neuromaturational view of development, development is closely tied to…

Central nervous system development

Parents (or others) providing environmental challenges to encourage a child to perform a higher level skill is known as…

Scaffolding

What is the earliest age when crawling and creeping are seen?

7 months

What is the order of the directions in which protective responses develop in sitting?

Protective responses forward (5-6 months),

Protective responses sideways (7-8 months),

Protective extension backwards (10-12 months)

Cruising begins to develop around what age?

9 months (first cruising sideways ~8 months)

“Stoops and recovers in play” begins around what age?

10-14 months

“Seldom falls” after learning to walk doesn’t occur until when?

18-20 months

Climbing stairs in which direction is most likely to develop first?

Climbing up develops before climbing down

During the development of grasp, what is the difference between “inferior pincer” “pincer” and “fine pincer” grasps?

• Inferior pincer is when objects are held between the thumb and the middle of the index finger.

• Pincer is when objects are held with the pads of the thumb and index finger.

• Fine pincer is when objects are held using the tips of the thumb and the index finger.

Inferior pincer and pincer grasps are used around ___ months. Fine pincer does not develop until ___ months.

9-10 months. ;12 months.

The hands are predominantly closed during what age range?

Hands are predominantly closed from 0-3 months.

Volitional release of objects develops around what age?

7-9 months

Precise controlled release into small container with wrist extended develops when?

12-15 months

What are the 3 requirements for locomotion?

Progression, postural control, adaptation

As walking skills develop, step length _____ rapidly over the first few months. Lateral distance between the feet _______, single limb support time _______, velocity ________, and the child can move slower and start/stop

• step length increases rapidly over the first few months.

• Lateral distance between the feet decreases

• single limb support time increases

• velocity increases

• the child can move slower and start/stop

What happens to step width, pelvic tilt, abduction and external rotation as gait improves?

They all decrease

Children will refine their gait pattern until what age?

5 to 7 years

At what age does a child’s running pattern mature with a true, consistent flight phase requiring more strength and balance than walking?

3 years

What motor skills are expected at 4 years?

Hopping, galloping, walking down stairs with an alternating pattern, standing on tip toes

What are some examples of immature movement patterns?

Inconsistency of performance, inability to stop when appropriate (perseveration-response repetition), extraneous movements, mirroring or the inability to transpose right-left visual cues, asymmetry and difficulty in bilateral coordination, loss of dynamic balance and falling after finishing a motor task, inability to maintain rhythm or movement patterns, inability to control force (using too much or too little), inappropriate motor planning

Without proper training and fitness, adolescents have a tendency toward…

Injury

In adolescents, major causes of death are…

Unintentional injuries, followed by suicide and homicide in 15-24 year olds

Standing on tip toes is expected at what age?

4 years

Both tendons and ligaments can heal if torn or surgically cut, however, what is a potential complication of this?

The development of fibrous adhesions between the tendon and surrounding tissues, which can prevent the return of normal movement

Why do premature infants often have less calcified bones?

The infant does not weigh enough to promote proper calcification

A majority of secondary centers of ossification in bones develop when?

Postnatally, except the lower end of the femur and upper end of the tibia, which are both present at birth.

Juvenile osteomyleitis begins in which part of the bone?

Diaphysis

Uterine crowding can result in which 2 bony malformations?

Abnormal facies and talipes equinovarus (congenital clubfoot)

Breech positioning can result in which 2 musculoskeletal changes?

Torticollis and hip dysplasia

Children who do not participate in normal physical activities can experience ________

Decreased bone density (osteopenia)

What is one of the risk factors for faulty hip joint alignment in cerebral palsy?

Inability to walk

An infant's spine is initially in a _______ position.

kyphotic position

Initially, infants have very flat feet. The arch of the foot becomes observable in stance by what age?

4 years

What are the 5 major indicators of mature gait?

Single leg stance, velocity, cadence, step length, pelvic span to ankle spread ratio.

Infant motor development can be nonlinear because…

Phases of transition can be affected by factors such as bodyweight, muscle power, health status, experiences, and the environment

The ___ is one of the first functioning organs within the growing fetus

The heart is one of the first functioning organs within the growing fetus

When does cardiac looping occur and what is the importance of it?

Around 3.5 weeks of gestation, it ensures correct anatomical formation of the heart

Fetal heart sounds can be detected by ____ weeks of gestation

Fetal heart sounds can be detected by 8 to 10 weeks of gestation

Because the fetus does not require oxygen from the lungs, what are the 2 alternative circulatory routes in the fetal heart?

Foramen Ovale (one-way door in the atrial septum from RA to LA), Ductus Arteriosus (a link outside the heart from the pulmonary artery to the aorta to bypass the lungs)

What is “coarctation of the aorta”?

A stricture in the descending aorta

The lung bud begins to develop around ______ of gestation

22-26 days

Terminal bronchiole and the pulmonary arterial system begin to form when?

8-16 weeks of gestation

17 weeks of gestation is considered the “first possibility for survival,” why?

The lungs have lobes, airways have completed branching, and the beginning of alveolar capillary membranes are formed

When do type 2 alveolar cells appear and what is their function?

27 weeks, they produce surfactant

At what age of gestation is the potential for gas exchange possible?

28 weeks, when some surfactant is present

Adequate lung inflation at birth can occur when?

Between 28-32 weeks, because sufficient surfactant is present

How do the muscles of ventilation differ in pediatrics vs adults?

Diaphragm is less fatigue-resistant, muscles act as stabilizers rather than mobilizers, decreased length-tension relationship

How does the shape of the ribcage differ in pediatrics vs adults and how does this impact respiration?

The ribs are more horizontally aligned, changing how the diaphragm pulls on the ribs (pulls them inwards)

As kids grow, how does the length-tension relationship of muscles of respiration improve?

Elongation of the cervical spine improves it

Children who do not experience development of upright antigravity head, neck, and trunk control may not develop…

Typical ribcage structure and function → can ultimately impair breathing, digestion, and movement

What is a ventricular septal defect (VSD)?

Abnormal opening between the two ventricles of the heart → increases pressure in the RV and pulmonary circulation due to “leaking” fluid. Results in pulmonary edema & reduced lung compliance.

What are the 3 reasons why CVP conditions from childhood are often not seen in adulthood?

They get surgically corrected, the child outgrows the issue, or the child passes away