Growth, Development and Health Flashcards
What are the recognised phases of childhood?
Neonate - < 4 weeks Infant - < 12 months/1 year Toddler - around 1-2 years Pre-school - around 2-5 years School age Teenager/adolescent
Main childhood objectives
To grow To develop and achieve their potential To attain optimal health To develop independence To be safe To be cared for To be involved
Features of development
Gaining functional skills throughout childhood
Gradual but rapid process
Typically from birth to 5 years (but brain develops in utero)
Fairly consistent pattern but rate will vary
Cell growth, migration, connection, pruning and myelination
Sequence of events in each domain
School - cognitive and though development, early skills become more refined
Key developmental fields
Gross motor Fine motor Social and self-help Speech and language Hearing and vision
Key milestones
Achievement of key development skills
Social smile, sitting, walking, first words
When do you refer a child for concerns about milestones?
If not achieved by age limit - 2 standard deviations from the mean
For how long do you correct for prematurity?
Until 2 years
What is the median age for walking?
12 months - 50% by this age
When do you refer a child who is not walking?
If not walking by 18 months
Why is development important?
Learning functional skills for later life
Hone skills in a safe environment
Allow brain’s genetic potential to be fully realised
Equip us with tools needed to function as older children and adults
Many are completely automatic
Influencing factors of development
Genetics
- family
- race
- gender
Environment
- use of technology very early on tends to have adverse effect on development
Positive early childhood experience
Developing brain vulnerable to insults
- antenatal
- postnatal
- abuse and neglect
Adverse environmental factors
Antenatal
- infections e.g. CMV, rubella, VZV
- toxins e.g. maternal smoking/drinking/drugs
Postnatal
- infection e.g. meningitis, encephalitis
- toxins e.g. solvents, mercury
- trauma e.g. head injuries
- malnutrition e.g. iron, folate, vitamin D
- metabolic e.g. hypoglycaemia, hyper/hyponatraemia
- maltreatment/under-stimulation/domestic violence
- maternal mental health issues
Why do you assess development?
Reassurance and showing progress
Early diagnosis and intervention
Discuss positive stimulation/parenting strategies
Provision of information
Improving outcomes (pre-school years critical)
Genetic counselling
Co-existent health issues
Who assesses development?
Patients
- Child surveillance vs developmental screening vs developmental assessment
- Specific groups e.g. premature, syndromes, events
Assessors
- Parents and wider family
- Health visitors, nursery, teachers
- GPs, A&E, FYs, STs, students
- Paediatricians and community paediatricians
What are the features/components of assessing development?
Health Child Programme (HCP) UK
Screening may not always be sensitive/specific
Listen to parental concerns/videos on phone
Opportunistic questions - target the right area
Review the red book
Good observation of play and activity
Medical history and examination
Most common mistake is not thinking about it
How do we assess development?
Building blocks - grasping, moving, building
Crayons - just holding, holding and moving, deliberately drawing
Balls - central core stability then throwing then kicking
Tea sets - imaginary play
Colouring books - identify colours, language assessment
How do you decide what is normal in development?
Not always easy
Think about each developmental field - deficiency may predominantly affect one area
What sequence/pattern has come before?
What skills have been achieved?
What has not yet been achieved?
Is one field falling behind the other e.g. global delay vs specific developmental delay
Are the skills gained age-appropriate?
