Human Development 1

Question 1

What is human development?

Answer 1

Human development focuses on the health, development and well-being of a person across their lifespan from pregnancy, during delivery, childhood, adolescence, adulthood and during the end of life

This is different from child health and Pediatrics which focus specifically on the health and well-being of children from newborn through late adolescence

Question 2

Summarize the significance of normal child development

Answer 2

Every child is different and will follow their own unpredictable developmental path.

• “Normal” development is a result of statistical analysis of development from many
children within the same age groups.

a) Markers for normal development are known as developmental milestones
b) Developmental milestone are approximate ages and vary by source

• If a child does not meet their developmental milestones, further assessments are required for possible developmental delays.

Question 3

How can we determine if a newborn requires resuscitation ?

Answer 3

Determine whether the newborn requires resuscitation

• Use the Apgar scale which assesses color, pulse, response to a painful stimuli, activity and respiration.
• The Apgar testing is done at 1 minute and 5 minutes after birth.
• If resuscitation is required, the physician may continue to assess the newborn beyond 5 minutes of life.

Question 4

What are the interpretations of Apgar scales?

Answer 4

A total score of 7–10 at 5 minutes is considered normal; 4–6, intermediate; and 0–3, low

An Apgar score between 7 – 10 at 5 minutes after life indicates that the
newborn had a smooth transition from intrauterine to extrauterine life.

• An Apgar score of 4 to 6 at 5 minutes of life indicates that the newborn requires special attention and care
• An Apgar score of 3 or less indicates a life-threatening situation that requires emergency medical care. Associated with a higher risk of adverse neurological outcomes.

Question 5

Describe the suckling reflex

Answer 5

Sucking reflex:

a) When the roof of the mouth is touched, the newborn begins to suck
b) Purpose: helps with breast feeding or bottle feeding
c) Should disappear by: 4 months

Question 6

Describe the rooting reflex

Answer 6

Rooting reflex:

a) Stroke the corner of the mouth or cheek and the newborn turns towards the stimulated side and opens the mouth
b) Purpose: helps the newborn to find the breast and allow for feeding
c) Should disappear by: 4 months

Question 7

Describe the Palmer grasp reflex

Answer 7

Palmar grasp reflex:

a) Fist clenches when palm is stimulated
b) Should disappear by: 4 – 6 months

Question 8

Describe the Moro (startled) reflex

Answer 8

Moro (startled) reflex:

a) Hold the newborn supine while supporting the head, back and legs. Abruptly lower the entire body about 2 feet. The arms abduct and extend and the legs flex. The newborn may also cry.
b) Should disappear by: 5 – 6 months

Question 9

Describe the Babinski reflex

Answer 9

Babinski reflex:

a) Extension of the toes upon stroking the lateral border of the foot
b) Due to: incomplete myelination of the corticospinal tracts
c) Should disappear by: 2 years

Question 10

What causes disappearance of primitive reflexes?

Answer 10

Disappearance of the primitive reflexes is due to myelination of corticospinal tracts which inhibit these brain stem mediated reflexes.

Persistent primitive reflexes can indicate delays or failures in myelination

Question 11

How is growth measured for the new born?

Answer 11

Weight and Height
• Monitored using growth charts.
• It is normal for newborns to lose weight during the first few days of life then regain the weight by 2 weeks.
• There is rapid weight gain during the first few years.

Failure to thrive occurs when the weight/height for age is less than the 5th percentile for age.

Question 12

Describe head circumference measurement for a newborn

Answer 12

Head Circumference (HC)
• Reflects growth of the brain

• Myelination:
• Begins before birth and continues into later years
• Correlated with achievement of developmental milestones

Important USMLE information:
Increase HC: hydrocephalus, tumor
Decreased HC: microcephaly (infections)

Question 13

What are the interesting neurological findings of the neurological findings?

Answer 13

Interesting Neurological findings
• Adult
T1-weightedMRI: 
1. GM is gray
2. WM is white

• The unmyelinated white matter in the newborn has low signal intensity on the T1 weighted MRI hence, the white matter will appear darker than the gray matter

Question 14

How is gross motor assessed in newborns?

Answer 14

1. Head control
2. Sitting
3. Walking

Question 15

How is head control tested?

Answer 15

Head control:

a) Newborn: the head lags when the child is placed into a sitting position
b) At 6 weeks: lifts head to 450 while lying prone
c) At 4 months: holds head upright when held in a sitting position

Question 16

How is sitting tested?

Answer 16

By 6 – 8 months, the infant usually can sit without support

Question 17

How is walking tested?

Answer 17

B) At 9 months: crawls and pulls to stand

b) At 12 months: walks alone
c) At 2 years: walks up and down stairs, jumps, throws and kicks a ball

Question 18

What are fine motors?

Answer 18

Fine motor skills are dependent on good vision hence vision is assessed along with fine motor skills.

Question 19

How is early visual alertness tested?

Answer 19

Early visual alertness:

a) Newborn: blurry vision, fix and follow a near face or light
b) At 6 weeks: will turn head through 900 to follow an object
c) By 3 – 4 months: spend lots of time watching their hands, reach for objects

Question 20

How is grasp tested?

Answer 20

Grasp:

a) At 6 months: grips using the whole palm, transfers objects from hand to hand
b) At 9 months: immature pincer grip using three fingers
c) At 12 months: mature pincer grasp using thumb and index fingers, use index finger to point to objects

Question 21

How is preschool fine motor skills tested?

Answer 21

Preschool fine motor skills:

a) At 18 months: scribbles, builds 3-block tower, hand preference
b) At 2 years: builds a 6-block tower, uses fork & spoon

Question 22

What are Paiget’s development?

Answer 22

Piaget’s stages of cognitive development:

1. Reflex
2. Sensorimotor (0 – 2 years)
3. Pre-operational (2 – 7 years)
4. Concrete operational (7 – 12 years)
5. Formal operational (12 years – adult)

Question 23

What are the stages of cognitive development

Answer 23

Sensorimotor stage (0 – 2 years):
1. Primary circular: the child engages in behaviors related to their own
body e.g., sucking their finger, playing with their hands

2. Secondary circular: the child interacts with the environment through imitation and repetition of pleasurable behaviors. Examples: accidentally hitting a toy that makes a noise, then continuing to hit the toy so that it makes a noise; cooing makes the parent laugh so the child continues to coo so that the parent can continue to laugh
3. Tertiary circular: the child purposefully explores the world around them and engages in novel or unfamiliar behaviors e.g., throwing a ball down the stairs to see what happens, flushing toys to see where it goes

Question 24

What are the other cognitive domain aspects?

Answer 24

Newborn

i. Loves sweet breast milk and odors
ii. Loves human faces, high contrast, movement, edges, curved lines
iii. Pays attention when infant-directed speech is used→musical, varying pitch, slow, repetitive

Question 25

What is assimilation ?

Answer 25

Assimilation – new experiences fit into existing schema (4-legged animal is a dog; all objects are hard)

Question 26

What is accommodation ?

Answer 26

Accommodation – schema altered to fit new experiences (not all 4-legged animals are
dogs, some might be cows; some objects are softer)

Question 27

What cognitive progressions of the cognitive domains?

Answer 27

Understand object permanence (9 months)

Children develop object permanence by the end of the sensorimotor stage.

The development of object permanence signals the transition to the next stage of cognitive development, preoperational.

Question 28

What are the language skills acquired in the first 2 years?

Answer 28

Cooing- 2 months

6 months- Babbles—> “babababa”

9 month—>” mama” “dada”

12 months—> uses 10 words , 1-word phrase

2 years—> uses 200 words, 2-word phrases, telegraphic sentences, names body parts

Question 29

What are the aspects of the social domain?

Answer 29

Social domain
• Self vs non-self
• Self-care and independence
• Awareness of social rules
• Interaction with the
environment and other
people
• Moral development
• Gender identity

Question 30

What is the clinical significance of the social domain?

Answer 30

Newborn: endogenous smile (primitive reflex)
• Social smile: 2 months
• Stranger anxiety

Distress in the presence of unfamiliar people Typically begins at 6 months, peaks at 8 months Typically lasts until 12 months

  • Separation anxiety   Distress after separation from primary caregiver Typically begins at 9 months Typically lasts until 2 years

• At 2 years:
  
  • Pulls off clothing
  • Sense of right and wrong
  • Self-centered, egocentric

Question 31

What are the stages of play of the social domain?

Answer 31

Stages of play:
1. Solitary play: less than 18 months of age
➢ Child plays alone without showing interest in other children

2. Parallel play: 18 months to 2 years
   ➢ Child plays alongside or near to other children but does not play with them, may occasionally look at them
3. Cooperative play: > 2 years
   ➢ Child plays with other children, engages in role playing, hide-and-seek, tea parties, etc.

Question 32

What are the Well-child cheeks?

Answer 32

All infants and young children should have standardized screening done during wellness visits, typically at 9 months, 18 months and 24 months.

• Failure to meet a developmental milestone during screening is not diagnostic
• A full history and physical examination along with a more detailed evaluation
should be done.
• If there are delays, the child should be referred for early interventional services.