Global Developmental Delay (GDD)

Team Work of 4th Grade Medical Students Al-Azhar University
Pediatric Department .

1. Global developmental delay Pediatric department

2. عمر حاتم محمد إبراهيم 18282 عمر عبدالرحمن مصطفى عنبر 18283 عمر عبدالله محمد عبدالغني 18284 عمر عبدالهادي أحمد عبدالهادي الديب 18285 عمر عماد محمد السيد محمد 18286 عمر مجدى عبدالعزيز عمر محمد احمد محمد عمر نصر سيد أحمد عمرو إبراهيم سند عمرو إبراهيم ميهوب عمرو أحمد سليمان عثمان Pediatric Module Prepared by: Under Supervision of : Prof.Dr : Mosallam Naser 18287 18288 18289 18290 18291 18292 رئيس القسم : أ.د. أحمد السواح منسق السمستر : د.حسين إسحق

3. 1. Introduction and factors affecting development . Omar Nasr & Omar Hatem 2. Development assessment . Omar Abdallah & Omar Magdy 3.Neonatal Reflexes . Omar Mohammed & Amr Othman 4.Delayed sitting ,speech and smiling Omar Abdelhadi & Omar Anbar . 5. Global Developmental Delay Day and Awareness . Omar Emad 5 . Management and summary Amr Mayhoub & Amr Sanad ILOs :

4. Introduction & Factors Affecting Omar Nasr 18289 Omar hatem 18282

5. Introduction. Growth: : increase in mass and dimension of the body, it includes aspects as weight, length and head circumference. Development : maturation of functions and gaining of various skills Domains of Develpoment : gross motor, fine motor, language, and social. Abnormality in one aspects is called monodelay . Abnormality in the more than one aspect is called global developmental delay .

6. Introduction to global developmental delay? Global developmental delay  is an umbrella term used when children are significantly delayed in their cognitive and physical development. It affects 5% of children from after birth till the age of 8 year. It’s more common in boys due to x-linked chromosomal abnormalities, there are five main areas at which the child can show delay. It can be diagnosed when a child is delayed in one or more milestones, categorized into motor skills, speech, cognitive skills, and social and emotional development. There is usually a specific condition which causes this delay, such as  Fragile X syndrome  or other  chromosomal abnormalities. However, it is sometimes difficult to identify this underlying condition.

7. Factors affecting global developmental delay Poverty , malnutrition, and lack of appropriate care. Child abuse and neglect. Congenital infections, meningitis and Iron deficiency anemia. Failure to thrive, maternal substance abuse. Environmental exposures.

8. Global developmental delay Omar Abdallah 18284 Omar Magdy 18287

9. Developmental Assessment Gross motor At birth: Flexion attitude 3months: head support 6months: Sits momentary Supported by his arms 8months: Sits alone, back straight 9months: Creeps or crawls

10. Gross motor 12months:Walks supported with One hand held 13-15months:Walks alone well 18months:-Seats himself in a small chair. -Ascend stairs With: One hand held. 24months:Run Well. Ascend& Descend stairs alone With: 1 step at time 30months:Ascend stairs: With Alternate feet. Developmental Assessment

11. Gross motor 3 years:Rides and pedals tricycle 5years:Jump on one foot. Developmental Assessment

12. Fine motor At birth: blinks to flashing lights 1month:follows moving objects 3months:Opens hands spontaneously. 6months:Transfer objects. (From, hand To Another) 4-6months:palmer grasp Developmental Assessment

13. Fine motor 8months:(Pincer Grasp) 12months:Releases object to mother on request. 18months:Build tower of 3 cubes. Points to parts of body On request. 24months:Build tower of 6 cubes. 18months:feeds him self by aspoon . 24months:Build tower of 6 cubes. 30months:Build tower of 9 blocks 5years:Draws a man Developmental Assessment

14. DEVELOPMENTAL SCREENING TESTS They include: 1. Gesell figures. 2. Denver Developmental screening test. 3. Good enough Draw-a-person Test. Mental age:3+[points Devided by4} Developmental Assessment

15. Mental development (social & speech)

16. Mental development (social & speech)

17. Mental development (social & speech)

18. Vedios

19. Neonatal reflexes Omar Mohamed 18288 Amr Othman 18287

20. Definition: _Reflexes actions originating in central nervous system in neonates and infants in response to particular stimuli,suppressed by development of frontal lobes. _These reflexes help babies survive and thrive. _Asseament of these reflexes is important to detect if there is developmental delay in the infant. _Normal reflexes:means normal CNS. _Absent reflexes:may be there is CNS injury,hemorrhage or depression. _ Exagerrated reflexes:may be there is CNS irritation. _ Persistence:may be because of cerebral palsy or mental retardation.

21. Types: 1_Sucking reflex: Common in all mammals,present in all mammals and disappear at 4months. _It causes the child to suck anything touches his mouth. _2stages: A_expression B_milking

22. 2_Rooting reflex: The infant will return his head toward Anything strokes its cheek or mouth. 3_Stepping reflex: Infant is held and when his soles touch flat surface he will atempt to walk. Cont.:

23. 4_Moro reflex: When the baby’s head is allowed to fall backward on the examiner’s head or exposed to sudden application to cold or painful stimuli,the result is abduction and extension followed by adduction and flexion.

24. Tonic labyrinthine Reflex Palmar grasp reflex

25. Galant reflex Plantar reflex

26. Swimming reflex Babkin reflex

27. Parachute reflex

28. Types Of Developmental Delay : 1- Static Eg. Chronic disease 2- Progressive : Child first develop normally, then a period of failkure to acquire new skills then the child starts to lose the previously acquired new learnt skills ( Developmental regression ) Eg.Gullian Barre syndrome Omar Emad 18286

29. WARNING SIGNS OF DEVELOPMENTAL DELAY Omar Abdelhadi 18285 Omar Anbar 18286

30. 28 weeks gestation Moro Reflex Suckling Rooting Reflex Grasp Reflex Light Reflex At birth -Flexion Attitude -side to side movemnet Blinks to flshing light Crying One Week Absent Moro Reflex Poor Feeding Convulsion 1 month When prone: raise head slightly Follows moving object to midline(90d) Regards face Alert to sound by blinking or startling 6 Weeks No face Regarding 2 Months Raise Head more while prone Fitsts no more clenched Follows 180 degrees by eyes Smile socially Gross Motor Language Social Fine Motor

31. 3 Months On prone : Raise Chest & support weight with forearm On erect :Head support 3 Months Clenched hands No smiling responsively Opens hands spontaneously Smiles appropriately on social contact Anticipate feeding COOS Says “AAH” Laughs loud 4 Months Poor head control No interest in own hands 4 Months 6 months Persistant moro Reflex No interest in toys 6 Months Sits momentary supported by arm Transfer objects Shows like & dislike Bubble “ ba,ba ” sounds Dissapearnce of ( moro , suckling , rooting ) reflexes Interest in own hands Gross Motor Language Social Fine Motor

32. Double Bubble “da,da”,“ ma,ma ” sounds Pincer grasp Plays (peek a boo ) 9 Months Not sitting alone Not reaching or transferring, baulks on solid Sits alone, back straight Creeps or crawls 9 Months Walks supported with one hand held Walks alone well Release object to mother on request 12 Months Comes when called plays 1-2 meaningful words No pincer grasp 11-12 M Poor attend span 18months Mimcs actions of others At least 6 words - Ascend stairs with one hand held - Seats himself in a small chair - Runs stiffingly Not walking 18 Months No usefull speech Gross Motor Language Social Fine Motor Build towes of 3 cubes Points to parts on request Feeds himself by a spoon

33. Run Well. Ascend& Descend stairs alone With: 1 step at time Sentences of 2-3 words Build tower of 6 cubes. Draw a line (not imitate ) Play with other children. 2 Years Sentences of 4 words together Recognizes 4 colors 30 M -Ascend stairs: with alternate feet. -Seats himself in a small chair. Build tower of 9 blocks. Copies circles & Crosses Eats with knife & fork Goes to Toilet alone Know Full name, age & sex. Recognize colors 36 M Rides and pedals Tricycle -Climb up stairs well jump on spot Aimless overactivity 2 Years Cannot draw circle 3 Years Not Comes when called to play Gross Motor Language Social Fine Motor

34. 4-5 years Cannot tell his full Name 6 years No usefull speech Language Social Cannot know colures yellow, green, red, and blue Gross Motor Fine Motor Fluent Speaker. Asking about: Words & Things meaning 60 M Jump on one foot. Walks Heel to Toe along line Draws a man (6 parts) with pencil Chooses own friends. Dramatic group play 2 words مارد وشوشني 1 word قطتي Social smile Social Laughing Walks without support Ascend stairs well Jump on spot So She was 13-15 mothns development language 2 years Gross motor 5 years Fine motor 18 months social

35. Retina develops centrally first then peripherally Grasp Reflex 28 th week gestation Palmar Grasp Rods(1month) before cones(2months)

36. Delayed (Sitting/ Walking): DEFINITION Inability to walk in a child > 1.5 year (i.e. by the age of 18 months) CAUSES : May be due to : Familial predisposition. Systemic disorder e.g.: congenital heart disease. Skeletal disorder e.g.: achondroplasia & rickets. Muscular disorder e.g.: myopathies. CNS disorder e.g.: cerebral palsy & mental handicap. Neurological disorder e.g.: congenital neuropathies, poliomyelitis. Perceptual disorder e.g.: blind child. Nutritional disorder e.g. severe protein energy malnutrition (PEM) Environmental factors e.g.: emotional deprivation and lack of stimulation. -

37. DELAYED SPEECH: DEFINITION: CAUSES: 1.Familial predisposition 2.Environmental factors e.g. emotional deprivation and lack of stimulation by parents 3.Perceptual disorder e g. hearing loss 4.CNS disorder e.g. cerebral palsy, mental handicap, autism. Child > 2.5 with inability to speech with normal ABR (auditory brain stem response), mentality and behavior.

38. DELAYED SMILING: DEFINITION: Beyond 6 weeks of life CAUSES: 1.Perceptual e.g. blind child 2.Mental handicap 3.Autism 4.Environmental factors e.g. emotional deprivation and lack of stimulation

39. MANAGEMENT AND SUMMARY OF GDD Amr Mayhoub18288 Amr Sanad 18288

40. DIAGNOSIS Developmental delay can be difficult to diagnose. There are some types of tests that can be done: Developmental screening & Evaluation tests . Developmental screening: to tell if children are learning basic skills when they should, or if they might have problems Pediatric doctor may ask questions or talk and play with child during an exam to see how he or she learns, speaks, behaves, and moves. Since there is no lab or blood test to tell if the child may have a delay, the developmental screening will help tell if the child needs to see a specialist.

41. TREATMENT The specific management of children with global developmental delay will depend on their individual needs and underlying diagnosis. Early intervention is essential to support the child to reach their full potential. Specialists involved in the management of GDD in children include.... Speech therapists Physical therapists Occupational therapists Hearing specialists (Audiologist) Developmental paediatricians Neurologists Providers of Early Intervention Services (depending on location) As well as involving professionals, parents can support the development of their child by playing with them, reading with them, showing them how to do tasks, and supporting them to participate in activities of daily living such as washing, dressing, and eating.

42. Many developmental delays can be treated early so that by the time a child is in school, he or she has caught up to his or her peers. However, since many delays are not diagnosed until a child is in school, this creates a greater impact on the child since the window for early intervention has been lost. Even if the delay, in fact, is the first sign or symptom of a disability, early identification and treatment, most often, will minimize the problem and maximize the child’s potential. Once a child is diagnosed and a proper treatment plan is in place, many children are still able to overcome the impact of their developmental delays. PROGNOSIS

43. REFFERENCES : - https://nyulangone.org/conditions/developmental-delays-in-children/types - https://www.medscape.com/viewarticle/515575 - Kasr Eleiny Pediatric Book - Al_Azhar Cairo University Department Book - Nelson Textbook of pediatrics

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