Developmental milestones 1.pptx

Development milestone

1. DEVELOPMENTAL MILESTONES , ANTHROPOMETRY ASSESSMENT & NUTRITION HISTORY MODERATOR: PROF.DR.C.S.BALACHANDRAN SIR PRESENToR : DR.A.NIRMAL SMITH

2. A method of evaluation has been developed using an interview technique Parents are asked questions regarding milestones in achievements that most will remember The child’s developmental quotient (DQ) can be determined according to the parents answer

3. It is calculated as Average age at attainment DQ = ______________________*100 Observed age at attainment A DQ less than 70% is taken as delay and warrants detailed evaluation.

4. Domains of development Normal development is a complex process and as a multitude of facets. Domains: Gross motor development Fine motor skill development Personal and social development Language Vision and hearing

5. GROSS MOTOR Gross motor skills can be defined as; Skills that involve the entire body in particular the large muscles of the body. examples of some basic gross motor skills are; Standing , Walking ,Controlling movements of the legs and arms

6. Gross Motor Development AGE MILESTONE 3 /M Neck holding 5 /M Rolls over 6 / M Sits in tripod fashion 8 /M Sitting without Support 9 / M Stands holding on 12 /M Creeps well: Walks but falls; stands without support 15 / M Walks alone; creeps upstairs

7. AGE MILESTONE 18 / M Runs; explores drawers 2 yr Walks up and downstairs 3 yr Ride tricycle; alternate feet going upstairs 4 yr Hopes on one foot; alternate feet going downstairs

8. FINE MOTOR Fine motor skills can be defined as; skills that involve the hand and fingers working together to perform tasks. For example: Writing Weaving Cutting

9. Fine Motor Development AGE MILESTONE 4 / M Bidextrous reach ( Reaching out for objects with both hands) 6 / M Ambidextrous reach (reaching out for objects with one hand);transfer objects 9 / M Immature pincer grasp; probes with forefinger 12 / M Pincer grasp mature 15 / M Imitates scribbling; tower of 2 blocks

10. AGE MILESTONE 18 / M Scribbles; tower of 3 blocks 2 yr Tower of 6 blocks; vertical and circular stroke 3 yr Tower of 9 blocks; copies circle 4 yr Copies cross; bridge with blocks 5 yr Copies triangle; gate with blocks

11. Social motor development AGE MILESTONE 2 / M Social smile(Smile after being talked to) 3 / M Recognizes mother; anticipates feeds 6 / M Recognizes strangers, stranger anxiety 9 / M Waves “Bye Bye” 12 / M Comes when called; plays simple ball game

12. 15 / M Jargon 18 /M Copies parents in task (e.g. Sweeping) 2 yr Asks for food,drink,toilet; pulls people to show toys 3 yr Shares toys; Knows full name and gender 4 yr Plays cooperatively in a group; goes to toilet alone 5 yr Helps in household tasks ,dresses and undresses

13. LANGUAGE MOTOR DEVELOPMENT AGE MILESTONE 1 / Month Alerts to sound 3 / Months Coos (Musical vowel sounds) 4 /Months Laugh loud 6 / Months Monosyllables (ba,da,pa),ah-goo sounds 9 / Months Disyllables ( mama,baba,dada) 12 / Months 1-2 words with meaning

14. AGE MILESTONES 18/ months 8-10 word vocabulary 2 years 2 – 3 word sentences, uses pronouns” I”,”ME”,”YOU” 3 years Asks questions; knows full name and gender 4 years Says song or poem; tells stories 5 years Asks meaning of words

15. DEVELOPMENT SCREENING TEST DEFINITION: If aids early intervention services, making a positive impact on development, behaviour and subsequent school performance . It also provides opportunity for early identification of co morbid developmental disabilities.

16. Some of the screening tools used in india ; Denver II developmental screening test, Phatak’s Baroda screening test, Trivandrum development screening test, CAT (Clinical Adaptive Test),CLAMS(Clinical Linguistic and Auditory Milestone Scale), Good enough – harris draw-a- person test

17. Denver II developmental screening test Adminsitered to children ages birth to six years Assesses a child’s performance on various age appropriate tasks Screens for possible problems Designed to compare a given child’s performance of other children the same age

18. Includes four areas personal –social : getting along with people and caring for personal needs, Fine motor – adaptive : eye hand coordination, manipulation of small objects and problem, Language : hearing , understanding and using language Gross motor: sitting , walking, jumping and overall large muscle movement.

19. Baroda developmental screening test Based on BSID , baroda norms developed by dr.phatak , suitable for indian childern Not required any standardized equpment 25 items Up to 30 months Domains evaluated are gross motor, fine motor, cognitive Take 10 minutes Sensitivity 0.66-0.93 specificity 0.77-0.94

20. TRIVANDRUM DEVELOPMENTAL SCREENING TEST Base on baroda norms Domains are gross motor ,fine motor and cognitive 0-2 years by para medical health worker Take 5 minutes Sensitivity 0.67 specificity 0.79

21. Include 17 items

22. ANTHROPOMETRY

23. INTRODUCTION Anthropos – “man” and metron “measurement” A branch of anthropology that involves the quantitative measurement of the human body. It is the single most portable,universally applicable ,inexpensive and non-invasive technique for assessing the size ,proportions and composition of the human body.

24. It is used to evaluate both under & over nutrition. The measured values reflects the current nutritional status & don’t differentiate between acute & chronic changes.

25. PARAMETERS OF ANTHROPOMETRY Age dependent factors: Weight Height Head circumference Chest circumference Age independent factors: Mid-arm circumference Weight for height Skinfold thickness Mid upper arm /height ratio

26. WEIGHT The measurement of weight is most reliable criteria of assessment of health and nutritional status of children. The weight can be recorded using a: Beam type weighing balance Electronic weighing scales for infants and children Bathroom type of mechanical scale(very unreliable) Salter spring machine ( in field conditions)

27. The periodic recording of weight on a growth chart is essential for monitoring the growth of under – five children Growth velocity 0-4 month 1.kg/month(30g/day) 5-8 months 0.75 kg/month(20gm/day) 9-12 months 0.50kg/month(15g/day) 1-3 years 2.25 kg/yr 4-9 years 2.75kg/yr 10-18 years 5.0-6.0kg/yr(0.5kg/month)

28. Weight at 4-5 months 2 * birth weight Weight at 1 year 3 * birth weight Weight at 2 years 4 * birth weight Weight at 7 years 7 * birth weight

29. WEECH’S FORMULA 3-12 Month Expected weight(kg)=age(months)+9/2 1-6 years Expected weight(kg)=age(years)*2+8 7-12 years Expected weight(kg) =age (years) * 7-5/2

30. Classification of malnutrition by indian Academy of peadiatrics WEIGHT FOR AGE GRADE OF MALNUTRITION > 80% Normal 71-80% Grade 1 (mild) 61-70% Grade 2 (moderate) 51-60% Grade 3 (severe) < 50% Grade 4 (very severe)

31. Height velocity A) AGE APPROXIMATE RATE OF INCREASE IN STATURE Birth to 3 months 3.5 cm/month 3 – 6 months 2.0cm/ month 6 – 9 months 1.5cm/ month 9 – 12 months 1-3cm/year 2 -5 years 6-8cm/year 5 – 12 years 5cm/year

32. years At birth 50cms Gain during 1 st year 25cms Gain during 2 nd year 12.5cms Gain during 3 rd year 7.5 to 10cms Gain during 3 – 12 years 5 to 7.5cms

33. Expected head circumference in children AGE HEAD CIRCUMFERENCE (CM) At birth 34 – 35 2 months 38 3 months 40 4 months 41 6 months 42 – 43 1 year 45 – 46 2 years 47 -48 5 years 50 - 51

34. Head circumference Brain growth takes place 70% during fetal life , during infancy and remaining 10% during pre-school. Head circumference are routinely recorded until 5 years of age. The head circumference is measured by placing the tape over the occipital protuberance at the back and just over the supraorbital ridge and the glabella in front.

35. The term Macrocephaly refers to OFC ofmore than 2SD above the mean while microphaly refers to OFC more than 3SD below the mean for age , sex ,height and weight.

36. Chest circumference It is usually measured at the level of nipples , preferably in mid inspiration. In children, <<= 5years – lying down position =>> 5 years – standing position

37. Relationship between head size with cheat circumference: At birth: head circumferernce > chest circumference by upto 3cms, At around 9 months to 1 year of age:head circumference =chest circumference, But thereafter chest grows more rapidly compared to the brain.

38. Head circumference growth velocity Till 3months 2cm/month 3 months – 1 year 2cm/3 month 1 – 3 years 1cm/6 month 3 – 5 years 1cm/year During 1 st year there is 12cm increase in head circumference , while 1-5 year age , only 5cm gain occur in head size. Adult head size is achieved between 5 to 6years

39. MID – UPPER ARM CIRCUMFERENCE During 1 – 5 years od age it remains reasonably static between 15-17cms among healthy children. It is conventionally measured over the left upper arm, at a point marked midway between acromion (shoulder) and olecranon (elbow) with arm bent at right angle.

40. QUAC stick – Quaker Upper Arm Circumference Stick It is developed on the principle that acute starvation severely affects mid – arm circumference while height is unaffected. It is a height measuring rod, calibrated in MAC, Values of 80% MAC for height are marked on stick at corresponding height levels. MAC(cm) HK(cm) 16.5 133.0 13.5 103.5 12.5 70.0

41. Skinfold thickness Measured with Herpenden’s caliper Triceps or subscapular region Fat thickness > 10mm – healthy children 1-6 years < 6mm – is indicative of moderate to severe degree of mainutrition

42. ARM SPAN It is the distance between the tips of middle fingers both of arms outstretched at right angles to the body measured across the back of the child. In under – 5 children, arm span is 1 to 2cm smaller than body length. During 10-12 years of age , arm span = height. In adults arm span is more in adults by 2cm

43. Body ratios Rao & Singh’s weight – height index: = [weight(kg)/(height)2cms]*100 normal index is more than 0.15 Kanawati index: (during 3m to 4 years) = mid-arm circumference/ head circumference normal 0.331 Mild 0.310 - 0.280 Modreate 0.279 – 0.250 severe <0.250

44. BODY MASS INDEX (BMI) BMI = mass(kg)/(height(m)2 A BIM for age of > 85 th percentile is suggestive of overweight. A BMI for age of > 95 th percentile is or when it is associated with triceps or skinfold thickness for age of >90 th percentile , it is of obesity

45. Ponderal index It is another parameter which is similar to BMI and is used for defining new born babies with intrauterine growth retardation PI = (body weight in grams) * 100 length (cm)2

46. Nutrition history

47. Nutrition value of common foods No. Name of the food kcal Protein ( gms ) 1 Idly (2) 50 2 2 Pooris (2) 50 2 3 chappathi 50 2 4 Araikeerai (100 gm) 44 2.8 5 Cows milk (200 ml) 120 6 6 Butter milk (30 ml) 5 0.25 7 Curd (30 ml) 20 1 8 Egg (1) 70-80 6 9 Biscuit (1) 25 0.5 10 Coffee (100 ml) 60 1.4

48. S.No Name of the food Kcal Protin ( gms ) 11 Green gram whole (100 gm) 348 24.5 12 Bengal gram (100 gm) 369 22.5 13 Wheat (100 gm) 346 11.8 14 Rice flake (100 gm) ( aval ) 346 6.6 15 Brown sugar (1 tsp ) 15 16 Can sugar (1 tsp) 20 17 Honey (1 tsp) 15 18 Tomato (100 gm) 21 1.4