Pediatrics Foundations

milestones

ages that we expect certain abilities to be developed

why do we care about milestones

concerned if they've missed milestones because that can indicate if they are developmentally delayed

4 months

lifts head in prone

6 months

raises trunk, reaches, rolls, raking grasp, hand to mouth, prop to sit

12 months

lying to sitting, sitting without prop, crawl, stands with hold

18 months

squat to pick up, walks well, uses cup/spoon

2 years

climb furniture, stairs with holding, jump, run, kick

3 years

catch large ball, pedal tricycle, dresses MinA

4 years

stand on one foot, begin to skip/hop, climbs stairs with alternating feet

5 years

independent with toileting and dressing

4 months mnemonic

alarm goes off at 4am, you lift your head

6 months mnemonic

alarm goes off at 6 am, raise head and trunk, rake grasp phone, roll over and give it a kiss, sit up propping with both arms

12 months mnemonic

12 reps of sit-ups without arms, crawl to side of bed, hold on to bed to standup, walk steadying yourself on furniture

18 months mnemonic

knock diploma off the wall (18 years old), you reminisce about walking across the stage without tripping, while you stir a cup of tea

High/Low

climb up/down furniture

up/down stairs with hold

jump with both feet

build block towers

fast/slow

run

kick

throw ball

Thr-easy

3 strikes you're out

TRI-cycle

3/4 dressed

generally better at 2 yr old milestones

catches large ball

pedals tricycle

dresses with MinA

Four-dinated

stand on 1 ft briefly

begin to skip/hop

alternates feet up stairs

colors within the lines

High 5 for being independent

toilets independently

dresses independently

Moro Reflex

startle reflex

arms wide, palms forward and open

"You surprised me, I wasn't expecting you until tomoro"

Rooting Reflex

turning head in response to touch

specifically to breastfeed

palmar grasp reflex

touching the palm results in grasping

Asymmetric Tonic Neck Reflex (ATNR)

turning head to side results in ipsilateral extension and contralateral flexion

interact with child at midline if late to integrate

Tonic Labyrinthine Reflex (TLR)

laying on floor:

neck flexion = extremity/trunk flexion

neck extension = extremity/trunk extension

develops postural strength and muscles for head/neck/trunk control

Symmetric Tonic Neck Reflex (STNR)

look down, bum up = neck flex, BUE flex, BLE extend

look up, bum down = neck extends, BUE extends, BLE flexes

(STNRsault)

Landau Reflex

when suspended in prone:

neck flex = legs flex

neck extend = legs extend

protective and equilibrium reactions

help avoid falling or hurting yourself when you fall

reflex integration

meant to happen by a certain age

no integration interferes with voluntary movement

makes developmental process difficult

reflex hierarchy

primitive reflexes

righting reflexes

protective responses

Reflex Mnemonics

Mr. Patsland

moro and rooting reflexes

interfere with head control

palmar grasp interferes

releasing objects

ATNR

interferes with rolling and R/L coordination

TLR

interferes with postural control, transitions, tone

STNR

interferes with core and gross motor coordination

landau interferes

sitting/standing upright

intervention

involves encouraging motor patterns and break the reflex pattern

Keyline

Name: Mr. Patsland

Function: "Hey, hey! Real roll-right PCs!

Integrated: "Is it 3? No, four (6). 6+6=6=6=24"

OT Process

Referral

Screening

Evaluation

Goal Setting

Intervention

Reevaluation

Discharge

OT Process Mnemonic

Really

Shouldn't

Eval

Going

In

Really

Drunk

Referral

must know reason for referral

if reason unclear, ask for clarification

COTA referrals

responsible for forwarding referral and educating referral source

Screening

20-30 minutes to determine if comprehensive eval is needed

Can COTAs screen

yes

Evaluation

initial step to develop occupational profile

info about developmental and functional strengths and limitations

COTAs and evaluation

entry level COTAs can assist under supervision

intermediate/advanced COTAs can administer standardized assessments under supervision with proven competencies

Top-Down Approach

looks at participating in functional tasks first

Bottom-up Approach

looks at deficits that hinder performance in functional tasks first

manipulation skills, ROM, attention

standardized assessments

require specific methods of administration

must follow test protocol/manual

must document if deviated from protocol

norm referenced

compares performance to their peers

criterion based

compares performance on specific tasks

non-standardized assessments

can be customized to meet the needs of the child

combining data

standardized tests should not be used alone

full understanding of the child: clinical judgement, observation, caregiver interviews

scoring

standard deviation on a bell curve

2 standard deviations below the mean warrants intervention

Evaluation components

occupational profile

occupational performance

observation

assessments

Evaluation Mnemonic

Professor

Perfectly

Observes

Ass

Discharge

OTR determines when appropriate

when a child has met goals or is no longer benefitting from OT