Pediatric Development (normal and abnormal) .pptx

Pediatric Development (normal and abnormal) .pptx

1. Development

2. Learning Outcomes What are the factors affecting development? 2 What are the fields of development ? 3 D evelopmental screening tests 5 Characteristics of development 1 D evelopmental delay and warning sign 4

3. Definition Development refers to acquisition of skills and abilities (mental, social and motor) Continuous process Predictable Sequence Each child grows in his/her own unique way. Each stage of G&D is affected by the preceding types of development.

4. Development proceeds from the simple to the complex and from the general to the specific. Development occurs in a cephalocaudal and a proximodistal progression. There are critical periods for growth and development. Rates in development vary. Development continues throughout the individual's life span. For infants born prematurely, the developmental level may be compared to ‘corrected chronological age’ during the first two years of life.

5. Development Pattern

6. Factors Affecting Child Development a) Genetic factors: Even though genetic factors are thought to be the final limits of biologic potential, b) Physical factors: Prenatal as well as postnatal physical insults affect growth and development. c) Nutritional factors: early postnatal malnutrition affects development d) Emotional factors: Emotional factors like position of the child in the family, the child rearing practices in the family and community etc., affect growth and development. e) Sociocultural factors: Sociocultural factors either limit or expand the range of behaviour of children.

7. Why developmental assessment? Early detection of deviation in child’s pattern of development Simple and time efficient mechanism to ensure adequate surveillance of developmental progress Domains assessed: cognitive, motor, language, social / behavioral and adaptive

8. Assessment Tools The Denver Developmental Screening Test (DDST)'. The DDST was originally designed as a screening test. It is now being increasingly used as a tool for routine developmental assessment Goodenough’s Draw-A-Man Test : This can be administered in children of 3 to 13 years of age group. The child is asked to draw a man and he/she receives 1 point for each of the items present in the drawing. For each 4 points, 1 year is added to the basal age of 3. mental age : 3 + the NO . of body parts/ 4 Gesell figures

9. The Denver Development Screening Test (DDST) It includes 4 areas of development : 1. Social : the child ability to get along with people and to take care of himself . 2. Fine – motor adaptive : the child ability to see and use his hands to pick up objects and to draw . 3. Language : the child ability to hear , to follow directions and to speak . 4. Gross – motor : the child ability to sit , walk and jump . It was performed on children from birth to 6 years . It has 105 items and the scoring is as follow : P = pass , F = failure , R = refusal , N.O. = no opportunity .

10. Head Control Newborn Age 6 months

11. Sitting Up Age 2 months Age 8 months

12. Ambulation 13 month old Nine to 12-months

13. Fine Motor Development 6-month-old 12-month-old

14. Speech Milestones 1-2 months: coos 2-6 months: laughs and squeals 8-9 months babbles: mama/ dada as sounds 10-12 months: “mama/ dada specific 18-20 months: 20 to 30 words – 50% understood by strangers 22-24 months: two word sentences, >50 words, 75% understood by strangers 30-36 months: almost all speech understood by strangers

15. Hearing BAER hearing test done at birth Ability to hear correlates with ability enunciate words properly Always ask about history of otitis media – ear infection, placement of PET – tubes in ear Early referral to MD to assess for possible fluid in ears (effusion) Repeat hearing screening test Speech therapist as needed

16. Red Flags in infant development Unable to sit alone by age 9 months Unable to transfer objects from hand to hand by age 1 year Abnormal pincer grip or grasp by age 15 months Unable to walk alone by 18 months Failure to speak recognizable words by 2 years.

17. Red flags: preschool Inability to perform self-care tasks, hand washing simple dressing, daytime toileting Lack of socialization Unable to play with other children Able to follow directions during exam Performance evaluation of pre-school teacher for kindergarten readiness

18. Red flags: school age School failure Lack of friends Social isolation Aggressive behavior: fights, fire setting, animal abuse

19. Aetiology of development delay Predominant Speech Delay Hearing loss Infantile autism Histidinemia Predominant Motor delay Hypotonic Infant Ataxia Hemiplegia Paraplegia   Global Delay Chromosomal disturbances Cerebral malformations Intrauterine infection Perinatal disorders Progressive encephalopathies

20. Process of developmental assessment