child development Flashcards
• Recognise and describe the normal pattern of childhood development. • To be familiar with the principle developmental domains and their key component skills. • Describe the key components of the Child Health/ Healthy Child Programmes. • Know the current UK vaccination schedule. • Understand growth monitoring and a basic approach to a child who has faltering growth
phases of childhood
neonate <4wks infant <12m toddler ~1-2y pre-school ~2-5y school age teenage/adolescent
what are the main objective of childhood
growth development attain optimal health develop independence safety and cared for involved alongside other children
what is child development
gaining functional skills throughout childhood
gradual but changes can happen quickly
fairly consistent but rate varies
sequence of events in each domain
when does child development occur
typically birth-5y but brains develop in utero and continue developing in adolescence
school age - cognitive and thought development (early skills become more refined)
what happens in the brain during development
cell growth
migration
connection
pruning
myelination
what are the 5 key developmental fields
gross motor
fine motor
speech and language
hearing and vision
social and self-help
levels of physical development
think about 6m/o, 12m/o and 24m/o
what are the main skills they should have at each age for each domain
6m/o key milestones for each domain
gross motor fine motor hearing and vision social and self-help speech and language
turn head and shift weight when lying on front
ROLLS BACK TO BELLY
SITS W/ HAND SUPPORT - sits steadily w/o support (8-9mths)
scoots/crawls
reaches and grasps w/ whole hand
TRANSFERS TOY FROM ONE HAND TO THE OTHER
USES 2 HANDS TO PICK UP LARGE OBJECTS
enjoys bright colours/shapes BABBLES and makes sounds like dada, mama, baba etc RESPONDS TO NAME - turns and looks responds to mother's voice brief interest in toys and sounds
recognises several people and reaches for familiar people
pushes things away they don’t want
smiles when smiled at
takes everything to mouth
feeds self biscuits or similar food
plays w/ simple objects
makes simple sounds
12m/o key milestones for each domain
gross motor fine motor hearing and vision social and self-help speech and language
moves and holds head easily in all directions sits well w/o support STANDS W/O SUPPORT takes steps WALKS W/O HELP (by 18mths) runs, some falls
passes objects from one hand to the other
stacks 2 or more blocks
picks up 2 small toys in one hand
eyes focus on far objects
understands simple words
begins to do simple things when asked drinks alone from glass insists on doing things by self e.g. feeding feeds self w/ spoon takes longer interest in toys/activities imitates and copies people copies simple actions gives kisses/hugs shows shared attention/pointing to things of interest
begins to use simple single words - 1 or 2 words with meaning
mama/dada (or similar) for parents
24m/o key milestones for each domain
gross motor fine motor hearing and vision social and self-help speech and language
moves and holds head easily in all directions
twists and moves easily while sitting
walking and running
climbs on play equipment
grasps w/ thumb and forefinger
scribbles w/ circular motion
looks at small things/pictures
hears clearly and understands simple language
likes to be praised after completing simple tasks
takes off simple clothes
takes longer interests in toys/activities
begins to play with other children
points at things when asked
helps w/ simple household tasks
opens doors by turning knobs
begins to use simple single words/words together
30-50 word vocabulary
process for assessing development
think of the sequence with each domain
if what you see is normal, chances are what follows will be normal
if what you see is abnormal, what came before and what comes after may be abnormal
what are milestones
achievement of key development skills
social smile, sitting, walking, first words
there is still a variation of normal
when to refer if milestones aren’t met
refer if not achieved by limit age - 2SDs from mean
correct for prematurity until 2y - e.g. born 2mths early, allow 2mths leeway
what factors influence our development
genetics - family, race, gender
environment
+ve early childhood experience
developing brain is vulnerable to insult - antenatal, post-natal, abuse and neglect
antenatal adverse environmental factors that influence child development
infection:
- CMV
- rubella
- toxo
- VZV
toxins:
- alcohol
- smoking
- anti-epileptics
postnatal adverse environmental factors that influence child development
infection - meningitis, encephalitis
toxins - solvents, mercury, lead
trauma - head injury
malnutrition - iron, folate, vit D
metabolic - hypoglycaemia, hyper/hyponatraemia
maltreatment/under stimulation/domestic violence
maternal mental illness
impact of abuse/neglect on the brain
lower brain activity in unused areas
impacts the child’s development
if the children are taken out of these environments ≤2y/o - much better recovery than if removed later
if removed from environment >4y/o - much more likely to have long term problems into adult life
why is assessment of development important
reassurance and showing expected progress
early diagnosis and intervention
discuss +ve stimulation/parenting strategies
provision of info
improving outcomes w/ optimal development - pre-school yrs are critical
genetic counselling
types of developmental assessment
child surveillance - all children are kept under review
developmental screening - assess at set ages
developmental assessment - detailed assessment for identified issues, assessment of wider skill set
specific groups - premature, syndromes, events
who assesses development
parents and wider family
health visitors, nursery, teachers
GP, A+E, range of healthcare professionals
what to consider in developmental assessment and things to do
HCP - healthy child programme UK
- takes you through a series of screening points
- screening may not always be sensitive/specific
listen to parental concerns/videos etc
opportunistic Qs - target the right area
review red book
observation of play and activity
hx and examination
how to do a developmental assessment - what questions to consider
how do they move their body around?
what do they do with their hands?
how do they communicate?
what can they do for themselves?
use basic toys
watch carefully and let parents help
how to decide what is normal about a child’s development
think about each developmental field (deficiency may predominantly affect one area, but can affect others as well)
what sequence/pattern of development has come before
what skills have been achieved
what has not yet been achieved
is one field falling behind the other?
- GDD vs specific developmental delay
are the skills gained age appropriate
how to decide what is a variation of normal for child development
early developers vs late normal
bottom shufflers typically have a walking delay
bilingual families - apparent language delay (total words may be normal)
familial traits
red flags in child development
- loss of developmental skills
- clinician uncertain/thinks that development may be disordered
- parental/professional concern re. vision/hearing: refer to paeds ophthalmology/ audiology/ENT
- no speech by 18mths, esp if no other communication: also refer for urgent hearing test
- persistent low muscle tone/floppiness
- asymmetry of movements/increased muscle tone
- not walking by 18mths/persistent toe walking
- OFC >99.6th/<0.4th/crossed 2 centiles/disproportionate to parental OFC
practical things to do in developmental assessment
observe play and activity and try to guess age
think about each developmental domain
3y/o key milestones for each domain
gross motor fine motor speech and language hearing and vision social and self-help
rides on tricycle using pedals
build play things with several pieces
walks backwards easily
draws/copies a complete circle
asks questions beginning w/ why/when/how and uses simple sentences
identifies 4 colours by name correctly
follows multiple instructions
sees small shapes clearly at 6m
hears clearly and understands most simple language
gives directions to other children
toilet trained but may need some help wiping etc
bathes and dresses
helps with simple work
interacts w/ adults and children
plays independently with children and toys
