Development in Children

Question 1

What are some Red Flags for Behaviour?

Answer 1

A: antecedent

• No reasonable trigger
• Multiple environments

B: behaviour

• Developmentally inappropriate
• Regression

C: consequences

• Harmful
• Affecting function

Question 2

What are the three things you have to remember when asking about developmental histories?

Answer 2

• Play
  
  • how do they play and who with? what do they do and play with?
  • developmentally appropriate?
  • Stages of play
    
    • unoccupied,
    • solitary <12 on themselves, bright and light
    • onlooker watches - 2-3years,
    • parallel - mimic others closeby 2-4. Steal others stuff, functional. 2 year old Noisey, cause and effect.
    • associative 3-4 - not organised.
    • cooperative 6+
  • Types
    
    • sensory (<12 years)
    • function (2 years)
    • imaginative - role play and pretend (preschooler)
  • e.g. lining things up repetitively - solitary play, can be normal in toddlers but older can be autism.
• Sleep
  
  • growth, behavioural problems, poor parental mental health
  • where? how much? daytime somnalence? concerns? screens?
• Eat
  
  • fussy eating (only white foods common in Autism)
  • messy eating
  • overeating
  • non-eating
  • textural preferences
  • clinical consequences

Question 3

How do you manage behaviour in children?

Answer 3

1. discourage inappropriate behaviour
2. encourage good behaviour

• whole family approach, depends on the age and stage of the child.
• address the family environment. Positive reinforcement and discourage inappropriate behaviour.

Question 4

What are the areas of development? How can you categorise it?

Answer 4

• Gross motor - large muscle movements (walking, running, jumping, climbing, riding)
• Fine motor - small muscle movements (grasp, release, drawing, speech clarity)
• Language
  
  • Receptive - understanding others
  • Expressive - own thought output
  • Pragmatic - social use, conversations
• Social and daily living
• Others:
  
  • Adult and child interaction
  • Feeding, dressing, washing, toileting

Question 5

Go through the normal ranges for Gross Motor development. What are some warning signs?

Answer 5

Gross Motor:

• 2-4mths - head steady in sitting
• 5-8mths - sits without support
• 9-14mths - cruising/crawling (stands with support)
• 12-16mths - walks well alone
• 15-24mths - walks with steps
• 21-36mths - jumps on the spot
• 3-4.5yrs - balances on one foot for 5 seconds

Warning signs:

RED FLAG is walking at 18mths

• 3mths - Complete head lag
• 6mths - persistent Moro reflex
• 9mths - not sitting with support
• 12mths - not pulling to stand or standing with support
• 18mths - not walking alone
• 24mths - not running
• 36mths - not kicking a ball
• 48mths - pedellaing and hopping

Question 6

Go through the normal ranges for Fine motor and vision development. What are some red flags in this development area?

Answer 6

Vision and fine motor:

• 2-4mths - follows object 180 degrees, palming (grasping a little)
• 5-8mths - transferring (passes cube from hand to hand), reach (grabbing at things), casting/chucking, mouthing
• 9-14mths - neat pincer grasp of raisin, clapping
• 12-16mths - stacks two cubes (to 21 months)
• 15-24mths - scribbles spontaneously
• 21-36mths - draws a vertical line in imitation
• 3-4.5yrs - copies a ladder, draws a face

Red Flags

• 3mths - not following with eyes
• 6mths - prefers one hand, squints
• 9mths - has persistent hand regard
• 12mths - no pincer grasp
• 18mths - not constructive play with blocks, still casting toy
• 24mths - not turning book pages
• 36mths - not drawing lines or prefering one hand
• 48mths - not drawing a face

Question 7

Go through the normal ranges for hearing and language development. What are some red flags?

Answer 7

• 2-4mths - squeals with pleasure
• 5-8mths - turns to soft voice, baba/gaga babble
• 9-14mths - mama or dada specifically
• 12-16mths - three words
• 15-24mths - points to one body part
• 21-36mths - uses plurals and phrases
• 3-4.5yrs - understands cold, tired and hungry. Asks ‘Wh’ questions.

Red Flags

• 3mths - following with eyes
• 6mths - prefers one hand, squints
• 9mths - has persistent hand regard
• 12mths - no pincer grasp
• 18mths - not constructive play with blocks, still casting toy
• 24mths - not turning book pages
• 36mths - not drawing lines or prefering one hand
• 48mths - not drawing a face

Question 8

Go through the normal ranges for development in Social and Daily Living Skills. What are some red flags?

Answer 8

• 2-4mths - smiles
• 5-8mths - feeds self biscuit
• 9-14mths - indicates need by gesture
• 12-16mths - drinks from a cup
• 15-24mths - removes garment
• 21-36mths - puts clothing on, plays tag with other children
• 3-4.5yrs - separates from mother

Red Flags:

• 3mths - not smiling
• 6mths - not interested in people
• 9mths - no awareness of strangers
• 12mths - constant mouthing
• 18mths - pointing at items and finger-feeding
• 24mths - not interest in other children, doesn’t helps with dressing
• 36mths - interactive play with peers
• 48mths - imaginative role play, toilet-trained by day, parallel play
• 3 years old - engage with peers
• 4 years old - cooperative play (sharing)

Question 9

What are some differentials for an odd head shape? What do you need to consider?

Answer 9

• plagiocephaly (newborns skulls are soft, flattened on the preferred side).
  
  • Educate to lie on the other side.
  • Torticolis (birth injury of sternomastoid, might be cause).
• craniocyntosis (premature fusion of sutures)
  
  • Ridging of the suture line, feel frontonelle.

Question 10

You want to talk to a 15 year old girl alone without her parent. How would you go about this?

Answer 10

• At this age we like to encourage proactive health and young people taking independent steps to look after their own health. Talk alone.
• If you have concerns you can come back in in a bit and we can chat about it together.