Page 1 of 1: OSCE-Buster: Child with delayed walking

sepplabber · Credits: 9520 My Scrapbook

child with delayed walking

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can anybody please post the causes and how to approach in this station

sajida · Credits: 105367 My Scrapbook My Reading List 6 Books

child who didn't walk and his age is now 2 years and his mom is worried

bookworm · Credits: 6268 My Scrapbook

lets put the differential diagnosis:

cerebral palsy
hypothyroidism
downs
floppy infant
constitutional
muscular dystophies

sajida · Credits: 105367 My Scrapbook My Reading List 6 Books

babies usually learn to walk at 1 year old,if this has not occured by 20 months then ask urself 2 question
1--is the child physically normal
2--is development delayd in other areas too
the commonest causes reflect global delay,benign immaturity and generalized joints hypermoblity
-------------in boys consider duchenne muscular dystrophy early( genetic counselling before mother,s next pregnancy)
-------note that congenital dislocation of hip may present as walking delay if the fact of limping is overlooked
The major reason for identifying late walkers is to exclude cerebral palsy

-CEREBRAL PALSY
cerebral palsy comprises a range of chronic disorders of posture and movement caused by non progressive cns leison sustained before 2 years old resulting in poor motor development +-(learning disablity35%)+-epilepsy
most r due to preterm delivery and9-13%r believed to be due to intrapartum events such as fetal hypoxia
ASSESMENT and MANAGEMENT
-can he roll over( both ways)
-ablity to come to sitting position independently
-grasp transfer of objects from hand to hand
-effective head righting
-ablity to shift weight(when prone) e forearm support
-iq
-treat epilepsy
-use calipers to prevent deformity(eg equinovarus,equinovalgus,hip dislocation due to excessive flexion and adduction)
-attempts to show the benefits of neurodevelopmental physiotherapy(directed towards improving equilibrium and righting)
-some parents prefer the Hungarian(peto) approach where one person (the conductor)devotes herself to the child and uses interaction e the child,s peer to reinforce the successes in all areas,manipulation ,art. writing, fine movements,social interaction

sepplabber · Credits: 9520 My Scrapbook

Ms Susan has brought her 2 year old son to see you in A&E. She is worried that he is still not walking. Take a history and explain your management to the parent. (there is a family history of delayed milestones but you need to rule out an organic cause and admit child for examination - congenital dislocation of hip etc.)

sajida · Credits: 105367 My Scrapbook My Reading List 6 Books

Ms Jones has brought her 2 year old Simon with her. She is worried because he is still not walking. Take a history and explain the management to her. You are the Paediatric SHO.
History

Hello, Ms Jones I understand Simon is having difficultly walking. Is it O.K. if I ask some questions to find out why this may be?

Has Simon ever walked before?
Has Simon had any injuries?
What can he do? – can he crawl, stand or walk holding onto furniture?
Have you any concerns about his vision, hearing or speech?
Does he have any other illnesses?
How is he feeding?
Is he been growing fine?
PMH:

What was your pregnancy like?
Any problems during delivery?
Was it a normal delivery?
Has his development otherwise been fine?
Has he had all his immunisations?
Did he have all his check ups with the doctors? (Children in the UK have to be seen by a health professional at certain ages i.e. 8 weeks, 1 year, 4 years etc. This is called Child Health Surveillance).
FH:

Any illnesses in the family (especially any siblings with the same problem)?
Has there been any problem with walking in any family members? (Duchennes).

Explanation:

Ms Jones we would like to admit Simon so that our seniors can assess him. We may need to do certain blood tests after examining him and that will give a better idea of why he is not walking. Please do not worry as sometimes some children are completely normal but walk more slowly that other child.

Differential:

Congenital delayed
Duchenne’s Muscular Dystrophy
Cerebral Palsy
Congenital Dislocation of hip
Any other neurological or muscular problem

kanikadua · Credits: 9353 My Scrapbook

in addition to asking wether the child can stand and move around furniture also ask if he can sit, grasp objects,can he hold a pen or spoon.
rule out epilepsy.
also rule out jaundice and kernicterus.

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