Development Flashcards
Development
Cephalo-caudal and a proximo-distal progression.
developing brain.
Interaction of heredity and the environment on
the Interaction of heredity and the environment on
the developing brain.
Median Age
Limit Age:
• Median Age: is the age when 50% of the
population achieve a milestone • Limit Age: is the age that a milestone should
have been achieved (2SD from the mean)
Walking unsupported
The median age is 12 months The limit age is 18 months (2 SDs from the mean).
Age Groups
Neonate Birth to 1 month • Infant 1 month to 1 year • Toddler 1-3 years • Preschool 3-6 years • School age 6 to 12 years • Adolescent 13 years to 18 years
Corrected age
Instructions*:
• Document the infant’s gestational age in weeks. (Mother/caregiver can self-report, or referral information from medical provider may be used.)
• Subtract the child’s gestational age in weeks from 40 weeks (gestational age of term infant) to determine the adjustment for prematurity in weeks.
• Subtract the adjustment for prematurity in weeks from the child’s chronological postnatal age in weeks to determine the child’s gestation-adjusted age.
∗ For WIC nutrition risk determination, adjustment for gestational age should be calculated for all premature infants for the first 2 years of life.
Visual acuity
Visual acuity is poor in the newborn but increases to adult levels by 4 years of age.
Stranger anxiety
Stranger anxiety – should dissipate by age 2 ½ to 3 years
Temper tantrums
Temper tantrums: occur weekly in 50 to 80% of
children – peak incidence 18 months – most
disappear by age 3
Maturation of reflex sphincter control
myelination of extrapyramidal tracts
Maturation of reflex sphincter control &
myelination of extrapyramidal tracts ( occurs
by 18 months ) which are necessary for bowel
and bladder control.
Developmental age for each stream
Developmental age for each stream
(developmental age/ chronological age) x 100 > 85% is normal, 70 - 85% is suspect, < 70 %is abnormal
Red Flags
• No social smiling by 2 months • Not sitting alone by 9 months • Not crawling by 1 year • Not walking by 18 months • No speech by 18 months • Hand preference development < 1 year (this
usually develops at 18–24 months)
(hemiplegia)
Develpmintal delay
• Mild, moderate or severe • A gradual :steady developmental delay from birth, e.g.
genetic, lack of stimulation, chronic illness • New onset: after previously normal development, e.g.
new-onset deafness or visual impairment, autism, neurodegenerative condition.
Global developmental delay
Genetic disorder or syndrome, e.g. Down syndrome; metabolic disorder, e.g. phenylketonuria; brain abnormality, e.g. hydrocephalus Antenatal disorder – congenital infection; teratogens Birth asphyxia Prematurity Congenital Hypothyroidism Neurological insult – head trauma; meningitis, encephalitis; metabolic, e.g. hypoglycaemia
—
Hand dominance is not acquired until 1–2 years
or later, asymmetry of motor skills during the
first year of life is always abnormal and may
suggest an underlying hemiplegia. • Late walking (>18 months old) needs to be
differentiated from the normal locomotor
variants ( bottom-shuffling or commando
crawling).
Cp
Often accompanied by disturbances of cognition,
communication, perception, sensation, behaviour and seizure
disorder and secondary musculoskeletal problems.
Early detection is crucial for initiating
rehabilitation services and treatment as soon as
possible.
Cp
Significant delay (at least 2 SDs below the mean with standardized tests) in at least two developmental domains
Care for a Child with Developmental Delay
Care for a Child with Developmental Delay
Team: • Neurodevelopmental paediatrician • Speech and language therapist • Physiotherapists, occupational therapist • Teacher, psychologist • Social worker and health visitor
Growth
Development
- quantitative change of child body
- qualitative change in child function and skills
Factors affect growth
Geans
Inviroment
Hormones
Nutrition
Factors affect growth
Geans
Inviroment
Hormones
Nutrition
Height is a highly heritable.
Hormones Involved in Growth
• Growth hormone – Major hormone secreted by pituitary gland
• Insulin-like growth factor-I
– Peptide produced by liver and other tissues in response to GH – Mediates part of GH action in linear growth
• Insulin – Required for substrate utilization
• Thyroid hormone – Critical for normal metabolism and growth
• Sex hormones
– Speed linear growth during puberty – Lead to growth plate fusion at end of growth (estrogen)
• [Cortisol - excess impairs linear growth]
Nutrition and Growth
Nutrition and Growth
• Nutrients fuel growth; protein is especially important • Suboptimal nutrition is the most common cause of
growth failure worldwide
– Usually poverty-related – In developed countries, this most often results from dietary self-
restriction, calorie/macronutrient deficiency or imbalance of
energy intake/utilization
13
• “Picky eaters” (especially toddlers) • Anorexia nervosa/bulemia • Ballerinas, gymnasts, elite athletes • Drugs that reduce appetite (e.g. stimulants for Rx of ADHD)
Nutrition and Growth
Nutrition and Growth
• Nutrients fuel growth; protein is especially important • Suboptimal nutrition is the most common cause of
growth failure worldwide
– Usually poverty-related – In developed countries, this most often results from dietary self-
restriction, calorie/macronutrient deficiency or imbalance of
energy intake/utilization
13
• “Picky eaters” (especially toddlers) • Anorexia nervosa/bulemia • Ballerinas, gymnasts, elite athletes • Drugs that reduce appetite (e.g. stimulants for Rx of ADHD)
Infancy
The infancy phase of ICP model is
assumed to begin at mid-gestation and
tails off at 12 months of age
IGF-1
Many of GH actions are mediated by IGF-1
• GH is the most potent regulator of IGF-1
production in the postnatal life
• IGF- 1 has a negative feed back on GH
secretion • The liver is the principal source of IGF-1 in the
circulation
Classical GH-deficiency
Neonatal hypoglycemia Micropenis Normal growth 4-6 months, thereafter low growth velocity
I ndication for growth hormone therapy
I ndication for growth hormone therapy • Growth hormone deficiency • Turner syndrome • SHOX gene insufficiency • SGA • Noonan syndrome • ISS • Chronic renal inufficiency
Gh
In spite of high GH level, IGF-1 level is decreased
in malnutrition
P uberty
Occurs btw 8 & 14yrs of age in girls and 9 & 14yrs of age
in boys. [range of 12-20yrs]
Measurement of Growth
Accurate height measurements using stadiometer
or recumbent infant box
Normal wt gain
Newborn loses up to 10% of birth weight • Regained wt by 10 days (7-14 day) • Wt gain - 25-30 g/day for the first 3 months of
life. • First year - 400 g gain/month. • Second year - 200 g gain/month • then gains 2 kg /year up to 10 years.
