Friday, January 30, 2009

Child growth and development

Video Lecture on Child growth and development


Lecture notes for Child growth and development

Growth and Development occurs in the following order

  1. Infancy
  2. Early Childhood
  3. Middle Childhood
  4. Adolescent


Stages of Growth and Development


lInfancy
•Neonate : Birth to 1 month
•Infancy : 1 month to 1 year


lEarly Childhood
•Toddler:1-3 years
•Preschool:3-6 years


lMiddle Childhood
•School age : 6 to 12 years
lLate Childhood
•Adolescent : 13 years to approximately 18 years


Principles of Growth and Development
Growth is an orderly process, occurring in systematic fashion.
Rates and patterns of growth are specific to certain parts of the body.
Wide individual differences exist in growth rates.
Growth and development are influences by are influences by a multiple factors.
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.

Growth Patterns
The child’s pattern of growth is in a head-to-toe direction, or cephalocaudal, and in an inward to outward pattern called proximodistal.


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


Gross Motor Skills
The acquisition of gross motor skill precedes the development of fine motor skills.
Both processes occur in a cephalocaudal fashion
Head control preceding arm and hand control
Followed by leg and foot control.


Gross Motor Development
Newborn: barely able to lift head
6 months: easily lifts head, chest and upper abdomen and can bear weight on arms
Head Control
Sitting up
2months old: needs assistance
6 months old: can sit alone in the tripod position
8 months old: can sit without support and engage in play

Ambulation
9 month old: crawl
1 year: stand independently from a crawl position
13 month old: walk and toddle quickly
15 month old: can run

Fine Motor - Infant
Newborn has very little control. Objects will be involuntarily grasped and dropped without notice.
6 month old: palmar grasp – uses entire hand to pick up an object
9 month old: pincer grasp – can grasp small objects using thumb and forefinger


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


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

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.


Fine Motor - toddler
1 year old: transfer objects from hand to hand
2 year old: can hold a crayon and color vertical strokes
Turn the page of a book
Build a tower of six blocks


Fine Motor – Older Toddler
3 year old: copy a circle and a cross – build using small blocks
4 year old: use scissors, color within the borders
5 year old: write some letters and draw a person with body parts

Toddlers


Issues in parenting - toddlers
Stranger anxiety ( crying when baby sees someone she doesnt know and they are trying to carry her) – should dissipate by age 2 ½ to 3 years
Temper tantrums: occur weekly in 50 to 80% of children – peak incidence 18 months – most disappear by age 3
Sibling rivalry: aggressive behavior towards new infant: peak between 1 to 2 years but may be prolonged indefinitely
Thumb sucking
Toilet Training


Pre-School
Fine motor and cognitive abilities
Buttoning clothing
Holding a crayon / pencil
Building with small blocks
Using scissors
Playing a board game
Have child draw picture of himself

Pre-school tasks


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

School-Age
School Years: fine motor
Writing skills improve
Fine motor is refined
Fine motor with more focus
Building: models – legos
Sewing
Musical instrument
Painting
Typing skills
Technology: computers
School performance
Ask about favorite subject
How they are doing in school
Do they like school
By parent report: any learning difficulties, attention problems, homework
Parental expectations

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


School Age: gross motor
8 to 10 years: team sports
Age ten: match sport to the physical and emotional development

School Age: cognitive
Greater ability to concentrate and participate in self-initiating quiet activities that challenge cognitive skills, such as reading, playing computer and board games.


13 to 18 Year Old
Adolescent
As teenagers gain independence they begin to challenge values
Critical of adult authority
Relies on peer relationship
Mood swings especially in early adolescents
Adolescent behavioral problems
Anorexia
Attention deficit
Anger issues
Suicide

Adolescent Teaching
Relationships
Sexuality – STD’s / AIDS
Substance use and abuse
Gang activity
Driving
Access to weapons