Child Developement

Question 1

Define the term development.

Question 2

Factors affecting development.

Question 3

List the developmental domains.

Answer 3

The Developmental Domains

• There are 4 domains:
  
  • Gross motor performance (position head lad sitting)
  • Vision and fine motor (hands, grasp and fine pincer, crayon, puzzle)
  • Hearing, speech and language. (vocalizing, words, understanding)
  • Social, emotional and behavioural. (social interactions, stranger interaction, eating, dressing)
• Acquisition of a key performance skill is referred to as a milestone.
• For each skill, normal range of attainment varies widely.
  
  • Constant pattern but variable rate of attainment.
• Definitions:
  
  • Median age – age when half of the standard population of children achieve that level.
  • Limit age – age by which they should have achieved the level and is equal to 2 S. Ds from the mean age.
    
    • Both corrected for prematurity until age 2.
• Primitive reflexes – these are protective and serve to promote support, balance and orientation:
  
  • Reflexes – should disappear by 4-6 months:
    
    • Stepping.
    • Moro.
    • Grasp.
    • Asymmetric tonic reflex – which way babies head is turned, arm outstretches.
    • Rooting.
  • Protective reflexes – seen in table below and develop FROM 5 months.

Question 4

Outline the key developmental milestones and limits.

Answer 4

The Developmental Domains – (1) Gross Motor Performance:

• Developmental milestones:
  
  • New-born – limbs flexed in symmetrical posture, head lag on pulling up.
  • 6-8 weeks – raises head to 45degrees in prone.
  • 6-8 months – sits without support.
  • 8-9 months – crawling.
  • 10 months – cruising around furniture.
  • 12 months – walks unsteadily.
  • 15 months – walks steadily.

(2) Fine Motor & Vision:

• Object permanence is attained at 9 months of age – the idea that when out if sight, not out of mind.
• Milestones:
  
  • 6 weeks – turns head to follow object.
  • 4 months – reaches out to toys.
  • 4-6 months – palmar grasp.
  • 7 months – transfers between hands.
  • 10 months – mature pincer grip.
  • 16-18 months – marks with crayons.
  • 14 months-4 years – towering.
  • 2-5 years – ability to draw without seeing how it’s done (after seeing it can be done 6m earlier).

(3) Language & Hearing:

• Milestones:
  
  • New born – startles.
  • 3-4 months – vocalises alone or when spoken to.
  • 7 months – turns to soft sounds out of sight.
  • 7-10 months – uses sound indiscriminately or discriminately.
  • 12 months – two to three words other than dada or mama.
  • 18 months – six to ten words.
  • 20-24 months – makes simple phrases.
  • 1.5-3 years – talk constantly in 3-4 word sentences.

(4) Social, Behaviour & Play:

• Milestones:
  
  • 6 weeks – smile responsively.
  • 6-8 months – puts food in mouth.
  • 10-12 months – wave bye, play peek-a-boo.
  • 12 months – drink from cut with two hands.
  • 18 months – can eat by themselves.
  • 18-24 months – symbolic play.
  • 2 years – potty trained.
  • 2.5-3 years – parallel play.

Question 5

Recognize when development is following a disordered pattern.

Answer 5

Abnormal Development

• Key facts:
  
  • Delay – slow acquisition of skills.
    
    • May occur in one or more domain.
      
      • One domain affected = domain-specific.
      • >= 2 domains affected = global.
      • All domains affected equally = consonant delay.
      • All domains affected differently = dissonant delay.
  • Disorder – mal-development of a skill.
• Patterns of delay are slow but steady, can plateau or can regress.
  
  • Over time, the gap widens so the deficit becomes more apparent.

Question 6

List how and when developmental delay might present.

Question 7

Examples of development problems

Answer 7

Abnormal Development Examples – Autism:

• Autism – neurobiological disorder characterised by – impairments of _social interactions_ and communication and _restricted_, repetitive, and/or stereotyped _patterns of behaviour_, interests and activities.
• Prevalence – 3-6 per 1000 live births, M > F, presents at 2-4 years of age.
• Co-morbidities include – learning difficulties, attention difficulties and epilepsy.
• Management – intensive support for child and family.

Abnormal Development Examples – Cerebral Palsy:

• Cerebral palsy – disorder of movement and posture due to a non-progressive lesion of motor pathways.
• Features:
  
  • Manifestations emerge over time – reflects balance between normal/abnormal cerebral maturation.
  • Most common cause of motor impairment in children.
  • Prevalence – 2.5-2.7 per 1000 children. Incidence – 2-2.5 per 1000 live births.
• Most causes are antenatal (80%) – genetic syndromes and congenital infection.
  
  • 10% due to hypoxic-ischaemia injury at birth, 10% due to postnatal origin (infection, trauma).
• Presentation:
  
  • Abnormal limb tone and delayed milestones.
  • Feeding difficulties.
  • Abnormal gait once walking achieved.
  • Asymmetric hand function before 12 months.
  • Primitive reflexes persist.

Question 8

Outline the clinical approach to the child with developmental delay.

Answer 8

Clinical Approach to Diagnosis and Management:

• History:
  
  • Antenatal – illnesses/infections, medications, drugs and environmental exposures.
  • Birth – premature, prolonged/complicated labour.
  • Post-natal – illness/infections, trauma.
  • Consanguinity – increased chance of chromosomal/autosomal conditions.
  • Developmental milestones from parents.
• Examination:
  
  • Growth parameters – height, weight, head circumference.
  • Dysmorphic features.
  • Neurological examination and skin examination.
  • Systems examination – identify syndromes and associations.
  • Standardised developmental assessments – SOGSII, Griffiths, Denver, Specialised assessments.
• Management:
  
  • Investigations – cytogenic studies, metabolic screens (function tests and blood profiles), blood ammonia and lactate, urine and blood amino-acids, creatine kinase, imaging and nerve/muscle biopsies.
  • Other professionals – referral to the MDT.

Question 9

Describe the role of the multidisciplinary team (MDT).