Childhood Development

Question 1

Early neurodevelopment

Answer 1

• Early childhood is a time of rapid brain growth when neurons formed prenatally develop new connections
• 80% of brain volume is acquired by 3 years and nearly 90% by 6 years
• This period of early brain development is increasingly recognised as critical for future learning outcomes, health and wellbeing

Question 2

Factors affecting brain development

Answer 2

• Promoting
  
  • Healthy pregnancy
  • Secure attachment to parent
  • Good nutrition
  • Opportunities to play and learn
• Detrimental
  
  • Prenatal exposure to toxins (i.e. alcohol)
  • Preterm birth and low birth weight
  • Maternal depression
  • Chronic illness

Question 3

Importance of detecting developmental problems

Answer 3

• Early identification and early intervention improves the outcome
• Early identification also allows early access to appropriate care and family support

Question 4

Developmental concerns

Answer 4

• Not fixing
• Breach age limit
• Developmental slowing/plateau
• Milestone regression - always refer to paediatric neurologist
• Limb preference early - hemiplegia (CP) or trauma?

Question 5

Developmental milestones

Answer 5

• Median age is when 50% have acquired skill
• Limit age is when 97.5% have acquired skill (within 2 standard deviations of the median)

Question 6

Gross motor development

Answer 6

• 18-24 months - walk up stairs with hand held
• 2-3 years - ride a tricycle

Question 7

Fine motor and vision

Answer 7

• 4 months - reaches out for objects

Question 8

Hearing, speech and language

Answer 8

• 12 months - understands no, bye bye
• 18 months - follows simple comands

Question 9

Social skills

Answer 9

Question 10

Primitive reflexes

Answer 10

Question 11

How to take a developmental history and examination

Answer 11

• Ask parents i they have concerns about their child’s development
• Ask about timing of acquisition of key early milestones in order to assess developmental trajectory
• Consider the child’s progress in relation to the four developmental skill areas

NB - offer the child age appropriate toys to find out more about specific skills

Question 12

Signs of early developmental impairment

Answer 12

• Delayed miletsones - can be only one domain, most commonly speech and language, if two or more domains then termed ‘global developmental delay’
• Abnormal pattern - asymmetrical movement, lack of eye contact, loss of developmental skills at any age

Question 13

Child development services

Answer 13

• Community based paediatric service providing care for children with a range of developmental difficulties/disabilities
• Assessments and therapies are provided

Question 14

Causes of gross motor delay

Answer 14

• Cerebral palsy
• DMD
• Antenatal insult (i.e. stroke)
• Part of global developmental delay

Question 15

Causes of speech delay

Answer 15

• Familial
• Hearing impairment
• Poor social interaction/deprivation
• Autistic spectrum disorder
• DMD
• Part of global developmental delay

Question 16

Approaches to common parental concerns

Answer 16

• Eating
  
  • Aim to exclusively breastfeed for first 6 months
  • No cow’s milk before 1 year
  • Encourage varied diet - good growth is not a proxy for a healthy diet
• Sleep
  
  • Less as child ages
  • 16hr for newborn, 14hr at 1 year, 12hr at 2 years
  • Normal sleep has periods of ‘arousal’ - can awaken but should go back to sleep and should not be stimulated (i.e. lights on/rocked/played with)
  • Children may not sleep for a variety of reasons (i.e. don’t need that much sleep, feel unsafe)
• Behaviour
  
  • 2 periods of transition (terrible two’s and teens) - both normal
  • Worse if child has communication difficulties
• Bruising
  
  • See NAI