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Okay, so let's have like

so, uh, six weeks.

Usually the child can start tracking an object so

they can start following their parents around the room,

which looks like they're being cute but is actually pretty creepy.

At six months, they can do a Palmer grasp, which is if you've got your hands here

and you know you're bringing your fingers down to meet the bottom of your hand

and you're basically just clapping or waving bye

bye and making this super fun sound.

They can also start transferring objects from hand to hand, which is fab

at nine months. They've got a pincer grip now by inferior pincer grip.

I just mean that it's not very good.

So the pincer grip,

if you grab your thumb and your finger and you

make an OK sign and you make it looks good.

That's your neat pincer grip, which happens at 10 months.

I always remember that the O or the zero that you make when

you're making the okay sign reminds me of the O in 10.

So 10 months. Neat pincer grip.

Now,

if you can make a bad version of that and it looks like you're almost getting there.

You're You're nine months pincer grip

now, going after that, You've got two years. So two years, you can draw a line.

And I remember that you can connect two points.

So two years, two points and you can turn to page two in a bit

so you can enjoy this. You just had a page in a book.

At three years.

You can do three blocks on top of each other,

and you can do a circle circle Always throws

me because I always think circular has one edge.

But it happens that three years.

I just remember,

because that doesn't quite fit with my pattern of remembering things.

Um, but remember that, as you will

four years, they can draw a cross or a square, which is amazing,

because across is four points and a square has four sides.

Um, five years, they can draw a triangle,

which again I remember as it doesn't quite fit the pattern.

Yeah,

so let's have a look at this question.

So we've got a to an 11 month year old girl was

brought into the g p by her grandma for a developmental check.

Her grandma reports that Ada plays with block blocks.

She can use her left thumb and finger to grasp a paintbrush in her left hand.

Since a month ago

that doesn't usually paint anything recognisable,

she was unable to paint a line, square or circle.

She was left handed and use this to eat and move around.

She cannot turn pages in a book.

Her favourite thing to do is watch dock swim around the local pond.

Which of the following is concerning? Regarding ages? Fine motor development,

and I will give you guys a minute to try and answer that one.

Okay, so the correct answer for this is that she is left handed

and we will go through. Why?

So she's 11 months years old to hold that in.

So let's have a look,

because she could only grasp objects between her

finger and her thumb since a month ago.

So that is describing the pincer grip.

Now, we said the pincer grip for the okay sign makes a zero, so it happens at 10 months,

so that's fine.

She's bang on track.

She's unable to paint a line.

That's okay. She's 11 months. She's less than one year.

We said that painting a line is connecting two points, so it happens at two years old,

so that's fine.

Well, Skip left handed. Phenomenal. Come back to it.

But we said that she can't hand pages in a book.

That's fine, because to tend to page two, you have to be two years old, so that's okay.

And she tracks ducks moving around upon so you

can track our objects from six weeks old.

So she's doing fantastically

so the main thing here is that she is left handed

so hand preference before the age of 12 months is concerning.

Usually, Children do not develop hand preference,

so you're not left or right handed until after this point.

Now why is concerning is for hemiplegic cerebral palsy,

and we'll talk a bit more about cerebral palsy at the moment.

But heavy pledge.

It just means that you've got weakness of the arm and leg on one side,

so you've got left arm and left leg weakness.

Which would mean that if I had weakness on my left side,

I would most likely be using my right side to do

everything so I'd exhibit that hand preference on the right side.

So that is something to be aware of.

Other things that are a bit concerning is an abnormal pincer grip,

just because that usually indicates weakness of the fingers

and otherwise anyplace with certain types of toy.

Now,

in terms of social side of things that

can be concerning for autism spectrum disorder.

But in this side of things is a bit more concerning because if a child is,

say constantly only picking up a paintbrush but can't deal with the building toys

it might be.

But they don't have the set of skills,

or they don't have the muscle strength to be able to play with that certain toys set.

Uh huh.

So three Repossi in general is refers to a basically a

heterogeneous group of neuro developmental disorders

that affect movement and coordination.

So it's a broad term,

and in terms of what causes it, usually we couldn't divide it into prenatal,

antenatal and postnatal.

So prenatal we're thinking about our torch infections that we spoke about.

Other ones can be placental insufficiency as well,

antenatal by far the biggest ones.

Hypoxic, ischaemic encephalopathy or he h i E

and post in Italy, we've got things such an infected infection,

meningitis ivy haemorrhage as well, or connect terrorists, which is disease,

from causing Billy Rubin that builds up in the brain.

Usually the more prenatal someone is, the higher the risk.

They are developing cerebral palsy

in terms of how we divide.

Cerebral palsy usually be divided into spastic and non spastic.

Two.

Spastic is the most common by far and usually

happens in about 70% of cerebral palsy cases.

And just to say, spastic usually refers to sort of hyper Tonia.

So it usually velocity velocity dependent hyper Tonia.

So that means if they move their arm, then it will suddenly become rigid.

And usually a baby will present with Hypo Tony a thirst so they'll be floppy.

They will be able to hold their arms up and they'll become hyper tonic or spastic,

usually about 5 to 6 months.

Now, there are three distinct patterns that we usually see.

We spoke about Hemiplegic, which is where you get weakness of

the arm and leg and the trunk all on one side.

Um, the most concerning things for that is hand preference.

Before 12 months or less is a gate.

A scissor gate is essentially the legs will,

while the leg on that side will remain completely extended.

So because they've got that spasticity or the hyper Tonia,

they really lose the ability to be able to flex the

leg because extent has dominate over flexes in the lower limb.

So that means that they have to circum dogs,

so they have to bring the leg completely straight round to be able to walk

now if they had that on both sides.

So they bring their left leg around the right leg around while it is extended,

and it looks a bit like sizzling.

But I fully recommend having a look at a YouTube video.

It's quite a unique walking pattern.

Now die a plea GIC is when it infects all four limbs, as I said,

because it senses dominate over Fletcher's,

usually they'll be walking on their tiptoes.

Quadriplegic is where it's all four limbs, and where is the trunk as well.

So a big sign of quadriplegic cerebral palsy is that they don't they lose that

ability to be able to gain head control

because they have weakness within their trunk.

Um, at the age of six months

now, when we're thinking about the other type, we've got non spastic,

and usually that's divided into this kinetic or a tax IQ.

A tactics are clumsiness.

You're going to get sort of your cerebellum features such as Intention Tremor.

You'll get Hypo Tonia and you'll get basically just

a taxi or poor balance or impaired coordination.

Now this kinetic refers to sort of your movement disorders,

and you'll get one of the three patterns, which is Corey er,

discipline assist or a thought.

Oh, sis.

So that was briefly covering are fine motor and visual developmental skills.

We spoke a little bit about cerebral palsy.

We spoke about the scissoring gait,

and we spoke about hand preference before 12 months and the tiptoe

walking all signs to look out for within medical school exams.

Buzzwords.

And we spoke about the North pattern for fine motor development.

So let's move on.

We're halfway through in terms of our developmental domains,

but we've covered the two main big ones.

So now we're going to move on to talk about speech and language.

So just as before,

get your pen, get your paper, get your timer.

I'm going to give you guys two minutes to sit down and to write down What do you think

are the speech and language domains that child of each

age on the left should be able to do.

So when do you think they should be able to talk?

When do you think that they should be able to combine two words?

When do you think that they will be able to listen to Mom and Dad?

Okay, so 10 more seconds.

Well,

okay, so speech and language domains.

Now, I just like to say I've basically strips them down a little bit.

If you look at the MRC PCH table, it is really complicated,

and there are a lot of domains listed there,

but I've tried to simplify it, basically to ones that tend to come up a lot or,

I felt were tested a lot within question.

Banks

and the way I like to divide it

is into receptive milestones and expressive milestones.

So a big part of speech in languages,

you've got to be able to understand what's going on.

So the hearing side of things,

and then you've got to be able to speak. So there are two stages to language.

If you think well,

there are multiple stages to language but there are

two main ones that we're going to concentrate on.

So you're starting first of all, with listening side of things.

A child can first turned their head to sound at three months,

so that means if a large noises played to say, you drop a plate in a restaurant,

a child is going to look over that way.

At three months

now, at six months, they start using double syllables to let Baba or la LA,

which means the child super, super cute, just as your start,

and get a little bit frustrated with them.

Now, at nine months, we've got the understand no, which is fantastic,

because that's exactly what you need at that age.

And they start to say Mama and Dada and they become

very cute and everyone's super super happy and it's very lovely.

Um, 12 months, they start to know their own name, which is fantastic,

and they can probably save three words,

which is good. I mean, it's a good start,

the main mouth saying that I would say gets tested A

lot is at two years where they can combine two words,

which is super handy.

Two words two years remember that one.

At 2.5 years, the vocabulary is usually about 200 words,

so they've done fantastically in that year and a half to excel their vocabulary

of three years.

They can start to make short sentences, and they can count to 10 as well.

But every parent will tell you that their child is a genius,

and they were doing it long before those milestones.

So let's move on to our clinical question.

So we've got enemy.

A two year old girl is being developmentally

screened by a nursery prior to starting.

New. Me is a quiet child.

She's not very talkative and has a vocabulary of about 30 words.

She can put two words together, however, cannot make a sentence.

She cannot count to 10.

She understands now owns, and she can respond to her own name.

Which of the following is a concern regarding Naimi's development?

Is it a that she is a quiet Charles

B that she knows 30 words?

See that she is unable to form a sentence

D that she's unable to count to 10 or e that she understands her own name

and I'll give you guys a minute to have

C5E1.3

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