development & assessment in a child new.pptx

Assesment of a developing child

1. Development & its Assessment

2. NORMAL DEVELOPMENT: DEVELOPMENT refers to maturation of functions and acquisition of various skills for optimal functioning of an individual. DOMAINS OF DEVELOPMENT: Gross motor development Fine motor skill development Personal and social development and general understanding Language Vision and hearing

3. RULES OF DEVELOPMENT: Development is a continuous process Development depends on the functional maturation of the nervous system The sequence of attainment of milestones is the same in all children The process of development progresses in cephalo-caudal direction Certain primitive reflexes have to be lost before relevant milestones are attained Eg:palmar grasp is lost before voluntary grasp is attained The initial disorganised mass activity is gradually replaced by specific actions. Eg:when a bright toy is shown,a3-4month old squeals loudly and excitedly moves all limbs ,whereas a3-4yr old may just smile and ask for it.

4. KEY GROSS MOTOR DEVELOPMENTAL MILESTONES: AGE. MILESTONES 3MONTHS NECK HOLDING 5MONTHS. ROLLS OVER 6MONTHS. SITS IN TRIPOD FASHION SITTING WITH OWN SUPPORT 8MONTHS SITTING WITHOUT SUPPORT 9months STANDS HOLDING ON WITH SUPPORT 12months CREEPS WELL,WALKS BUT FALL STANDS WITHOUT SUPPORT 15 months WALKS ALONE,CREEPS UPSTAIRS 18months RUNS ,EXPLORES DRAWERS 2years WALKS UP AND DOWNSTAIRS (2FEET/STEP)JUMPS 3years RIDES TRICYCLE, ALTERNATE FEET GOING UPSTAIRS 4years HOPS ON ONE FOOT , ALTERNATE FEET GOING DOWNSTAIRS

5. KEY FINE MOTOR MILESTONES: AGE. MILESTONES 4MONTHS. BIDEXTROUS REACH(reaching out for objects with both hands) 6MONTHS. UNIDEXTROUS REACH(reaching out for objects with one hand ); transfers objects 9MONTHS. IMMATURE PINCER GRASP,PROBES WITH FORE FINGER 12MONTHS. PINCER GRASP MATURE 15MONTHS. IMITATES SCRIBBLING,TOWER OF TWO BLOCKS 18MONTHS. SCRIBBLES,TOWER OF 3 BLOCKS 2YEARS. TOWERS OF 6 BLOCKS VERTICAL AND CIRCULAR STROKE 3YEARS. TOWERS OF 9 BLOCKS: COPIES CIRCLE 4 YEARS. COPIES CROSS, BRIDGE WITH BLOCKS 5YEARS. COPIES TRIANGLE,GATE WITH BLOCKS

6. KEY SOCIAL AND ADAPTIVE MILESTONES: AGE. MILESTONES 2MONTHS. SOCIAL SMILE 3MONTHS. RECOGNIZES MOTHER ANTICIPATES FEEDS 6MONTHS. RECOGNIZES STRANGERS, STRANGER ANXIETY 9MONTHS. WAVES BYE BYE 12MONTHS. COMES WHEN CALLED PLAYS SIMPLE BALL GAMES 15MONTHS. JARGON 18MONTHS. COPIES PARENTS IN TASK(Eg: sweeping) 2YEARS. ASKS FOR FOOD,DRINK, TOILET,PULLS PEOPLE TO SHOW TOYS 3YEARS SHARES TOYS,KNOWS FULL NAME AND GENDER 4YEARS. PLAYS COOPERATIVELY IN A GROUP ; GOES TO TOILET ALONE 5YEARS. HELPS IN HOUSEHOLD TASKS,DRESSES AND UNDRESSES

7. KEY LANGUAGE MILESTONES: AGE. MILESTONES 1 MONTH. ALERT TO SOUND 3 MONTHS. COOS(MUSICAL VOWEL SOUNDS) 4MONTHS. LAUGH LOUD 6MONTHS. MONOSYLLABLES(ba,da,pa)ah-goo sounds 9MONTHS. BISYLLABLES(mama,baba,dada) 12MONTHS. 1-2 WORDS WITH MEANING 18MONTHS. 8-10 WORD VOCABULARY 2YEARS. 2-3 WORD SENTENCES,USES PRONOUNS”I”ME”YOU” 3YEARS. ASKS QUESTIONS,KNOWS FULL NAME AND GENDER 4YEARS. SAYS SONG OR POEM:TELLS STORIES 5YEARS. ASKS MEANING OF WORDS

8. DEVELO PMENTAL ASSESSMENT: Developmental delay is estimated to be present in about 10%of children.It is possible to recognise severe developmental disorders early in infancy. Speech impairment hyperactivity and emotional disturbances are often not detected until child is 3-4yr old.learning disabilities are not picked up until the child starts schooling. PREREQUISITES: ASSESSMENT should be done in a place ,which is free from distractions.It is important that the child should not be hungry tired I'll or irritated at time of development assessment.observation for alertness concentration and skills of the child is an integral part of assessment.

9. EQUIPMENT FOR DEVELOPMENT ASSESSMENT: A RED RING(DIAMETER 6-7CM TIED TO A STRING) NINE RED CUBES PAPER PELLETS SPOON CUP WITH HANDLE A BOOK WITH THICK PAGES PICTURE BOOK RED, PENCIL,PAPER DOLL AND MIRROR

10. HISTORY:A Detailed is the starting point for assessment Determining the details of propable risk factors affecting development. Evaluation of rate of acquisition of skills and differentiating between delay and regression. Forming a gross impression about the developmental age of the child. EXAMINATION : This should be done To assess physical growth and head circumference Do a physical assessment for presence of dysmorphic features ,stigmata of intrauterine infections and signs of hypothyroidism. Assess vision and hearing Conduct neurological examination and examine for primitive reflexes

11. Systemic examination should be done before the developmental assessment so that the child's cooperation is solicited. By end of evaluation one should be able to arrive at a conclusion whether the neurological status and cognitive status are within normal range or not. DQ= AVG AGE AT ATTAINMENT x100 OBSERVED AGE AT ATTAINMENT DQ<70 -Warrants detailed evaluation and >85 is normal. INTERPRETATION: In babies born preterm corrected age rather than postnatal age is used for determining developmental status till 2yrs of age. Eg:-Child born at 32wks GA seen at 12 wks. of age (postnatal age) should be considered as 4wksold(corrected age) child for assessment.

12. At times there can be significant variation in attainment of milestones in individual fields ;this is called Dissociation. Significant delay is an indication for detailed formal assessment of developmental status. By assessment one can assign DQ (Developmental quotient) for any developmental sphere DEVELOPMENT SCREENING TESTS: Screening is a brief assessment to identify children who should receive more intensive diagnosis or assessment. Screening tools are standardized equipment to evaluate development. DEVELOPMENT SURVEILLANCE: Screening tests popular in West are PEDS(Parents evaluation of development status) and ASQ(Ages and stages questionnaire).

13. Screening tools used in INDIA are 1. PHATAKS BARODA - Best known development testing system, applied below 30months 2.ASQ-3; Age based parent completed questionnaires used from 1 month-5 and half yrs 3.DENVER-II: Assess 4 domains-Gross motor; fine motor ,adaptive, language, personal social behavior. 4.TRIVENDRUM DEVELOPMENT SCREENING CHART : Primarily a screening tool between 0-6yrs with developmental delay. 5.CAT/CLAMS: Used to assess child cognitive and language skills used at ages 0-36months. 6.GOOD ENOUGH HARRIS DRAWING TEST: Simple non verbal intelligent test, need a pen and a paper.

14. DEFINITIVE TESTS: These tests are required once screening tests or clinical assessment is abnormal. EARLY STIMULATION PROMOTING DEVELOPMENT BY EFFECTIVE PARENTING TELEVISION VIEWING AND DEVELOPMENT CHILD DEVELOPMENT IN GLOBAL PERSPECTIVE: It is important to provide nutrients and nurturing during the critical first 1000days of life. NURTURING CARE includes health nutrition, responsive care giving, safety and security and early learning

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