Postnatal and Child Development Flashcards
LO:
- Embryo-fetal environment: Summarise how the extrauterine environment can impact embryo and fetal development and health across the life-course.
- Child and adolescent development: Summarise the key developmental milestones of child and adolescent development and expected timeframes.
The developing brain
So if we look at the dorsal view of the embryo as it’s developing in utero, there are four main sections, the future forebrain or the prosencephalon, the midbrain or the mesencephalon and rhomebencephalon or the future hind brain and the Future Spinal Cord.
The developing brain-4 weeks
If we take his side on view, you can see that the by four weeks of life. There are three flexors or three bends in the embryo, the cephalic, pontine and cervical flexures
The developing brain at approx 5 weeks
And just one week later, we can see a much more familiar show reshaping of the embryo into the telencephalon, diencephalon, pons and medulla.
The developing brain at 8 weeks
By eight weeks, we are beginning to get development of the ventricular system, the spaces in the brain with the channels, the third ventricle and the fourth ventricle and the aqueduct developing at this stage
The developing brain
One can see this very clearly in this slide.
The developing brain
And by term, we have a fully developed Cortex, the ventricular system, the aqueduct, the cerebellum, the pons and medulla.
Grey Matter:
This slide shows the different functions of the cerebral cortex. I’d like to highlight a few of these for you.
The prefrontal cortex just behind the the the proximal part of the cortex is responsible for executive function and concentration. This is one of the areas that goes wrong in children with attention deficit hyperactivity disorder, otherwise known as ADHD.
Let’s go a bit further round the cortex here You have the primary motor cortex responsible for supplying the nerves to the skeletal muscles.
We have the primary somatic sensory corty talk cortex, which is receiving impulses from the periphery, the parietal lobe, which is important for sensory information.
The occipital lobe responsible for vision and importantly, the temporal lobe, which is responsible for auditory sensation and speech.
Association cortices
- function less predictable
- not organised topographically
- left-right symmetry weak or absent
The alpha motor neuron
You will recall the spinal cord consists of white matter and grey matter.
The grey matter in the anterior section of the cord is responsible for the motor neurones. And here you’ll see how these are divided.
Organisation of the spinal cord – motor tracts
Let us take a closer look at how the nerves are organised within the spinal tract.
In the pyramidal tracks, these are organised in this section here and supply the sacral lumbar, thoracic and cervical nerves in the lateral cortical spinal tract.
The extra pyramidal tracks which are shown here and here are responsible for coordination of movements and the regulation of posture and balance.
And this becomes extremely important when we’re looking at primitive reflexes in small infants.
Components of a reflex arc
It is well worth reminding ourselves of the components of the reflex arc, if you recall, we start with a sensory stimulus here that moves across the dorsal part of the spine through the sensory neurones. Connects to the interneuron and the integrating centre. And then to the motor neurones out to the effect muscles or glands in response to the sensory stimulus.
Gross Motor Development (Primitive reflexes)
The next few slides are going to show you some of the primitive reflexes we see when we examine infants.
The first is the Moro reflex, which occurs when the baby’s neck is suddenly extended and the arms abduct, and then adduct, as you see in this video.
Extension, abduction and adduction.
This reflex develops around 28 thirty two weeks gestation and should disappear between three and six months. The persistence of primitive reflexes can be a sign of impaired development.
Gross Motor Development (Primitive reflexes )
This clip demonstrates the standing reflex, which is present in the newborn at three months.
And Marty from Australia says beautifully here with extension of the lower extremities, the hips slightly further flexed and somewhat behind the shoulder with the head free to turn.
Gross Motor Development (Primitive reflexes )
In this clip, a film shows another primitive reflexes, so-called grasp reflex, which is what happens when an object is placed in the palm of the hand of the newborn and the fingers grasp very tightly.
If we look at the other the opposite hand here, a stroking on the side or the lateral part of the things will open those things up again.
And these primitive reflexes are replaced later on around six months to nine months with voluntary movements of the hand as part of fine motor development.
Gross Motor Development (Primitive reflexes )
Between around six to nine months, the baby has developed protective reflexes, so-called parachute reflexes.
And this is demonstrated in the film here where the baby is placed in the forward tilting position and protects themselves with outstretched arms.
This also occurs when you’ve placed the baby on their side or push them to one side and they have a sideways parachute reflex.
What is development?
- Global impression of a child encompassing: growth (ie physical growth), increase in understanding, acquisition of new skills and more sophisticated responses and behavior
- Endows child with increasingly complex skills in order to function in society
And one of the things we have to learn as paediatricians is how children of different ages develop different skills. And we have to clearly adapt our own practises to the developmental age of the child.
Who and When
Parents are the ones who spend most time with their children and therefore know most about their development.
As doctors, we will see children occasionally, when they come into a general practise or as part of a programme of child health surveillance, similarly nurses, health visitors and others, midwives and teachers later on will have regular contact with children and will be able to make some assessment or will need to make some assessment about their development.
So there are two ways in which this happens, both opportunistically and part of a planned programme of reviews.
The Four Domains
There are four domains of child development. Typically spoken about.
The first is gross motor skills. The locomotor development of the child then includes position headlag, sitting, walking and running.
Fine motor skills, which we’ve been looking at before, which is around the use of hands, grasping, fine pincer movements, the way in which bricks are built, crayons and puzzles.
Then you have speech and language skills, which is around both the understanding of speech and the the production of speech and play.
And then social skills, which is around social interaction, reaction to strangers, eating skills, toileting and dressing, etc.
Gross Motor Development (median ages)
When we look at an infant from a clinical perspective, we look to see how the baby is positioned.
As a newborn, they have rather limited, flexed and symmetrical posture.
You lift them up from the lying position and they will have some degree of lag of the head because of the lack of maturity of the neck muscles.
Videos – Pull to Sit
n this video, you’ll see how this baby is pulled to the sitting position and the position of the head.
And because Marty is approximately three months old, he has good head control compared to a newborn baby.
Gross Motor Development (median ages)
This set of drawings shows the positioning at six to eight weeks and that six to eight months and by six to eight months, the baby is sitting without support, often with quite a round back at six months. But it is much straighter by the time they reach eight months old.
Videos – Head Control
Here is another example of a baby who is showing good head control symmetrically, extension of the upper thoracic spine, but he can only maintain the response briefly.
Videos - Rolling
By around three to five months, babies are beginning to roll. And you will see from this video that this infant is being distracted, reaches out to the object, then rolls independently and easily. And then pulls themselves up to a position where they outstretched their arms and this baby’s around four to five months of age showing that.
And you will also see how well the baby follows the object, which will come to later.
Videos - Sitting
By six months, the infant is sitting quite well with good baseline posture.
And in fact, being able to handle the cups and moving them very nicely between his hands.
Gross Motor Development (median ages)
By around eight to nine months. Babies are beginning to crawl. And by 10 months, they’re beginning to pull themselves up to furniture, which is often a very good time for us to be counselling families about safety in the home, as their mobility is increasing quite rapidly at this stage.
Gross Motor Development (median ages)
By the time the baby’s has his first birthday is typically walking in a rather unsteady, broad gait with hands apart. But over the next two to three months, that becomes a much more steady gait.
Variations of normal
One of the very interesting aspects of child development is how much variation there is of normal.
In this diagram, we see several different ways in which babies go from sitting to crawling to walking. Some will go crawl straight on all fours, and then walk. Others will have a commando crawl and then start walking. Others will actually shuffle on their bottoms for long periods of time before they end up walking. And often these children who are bottom shufflers cause their parents great distress because they don’t walk until a little later on.
Vision and fine motor (median ages)
When looking at development of a child, we often combine the vision and fine motor development together, because in order for you to use your hands properly, you need to have called good coordination of your eyes. So at six weeks, a baby will be able to follow a moving object or face by turning the head by around four months will be reaching out for toys in front of them.
Videos – Fine Motor Vision – Fixes and Follows
This baby, you will see how the object is being followed by the baby right the way round to about 180 degrees.
And he’s able to track that object as it is moved across his visual fields.
Vision and fine motor (median ages)
By four to six months, the baby has developed a Palmar grasp, a grasp of a brick, for example, which is quite crude with the thumb and the fingers grasping as one piece. By the time the baby is six to seven months old, they are transferring objects from one hand to the other.
Videos – Full Hand Grip
Look at how Marty holds the cups with his whole hand.
He’s able to reach one arm at a time, but I want you to particularly focus on the way he holds the objects being given to him with his whole hand. This is what is known as an inferior grasp, as part of the fine motor development of the small child, and this becomes much more sophisticated as the baby gets older.
Vision and fine motor (median ages)
By approximately 10 months, a baby is able to hold a very small object between the thumb and the index finger.
The so-called mature pincer grip by about 16 to 18 months, a child is able to make marks with a crayon.
Vision and fine motor (median ages)
By approximately 10 months, a baby is able to hold a very small object between the thumb and the index finger. The so-called mature pincer grip by about 16 to 18 months, a child is able to make marks with a crayon.
As the child gets older, he’s able to do more.
And at 14 months to four years, you can see here in this diagram how the progression of building blocks occurs over time. So by the time the child reaches four, they really do have quite sophisticated use of their hands and their brain in terms of coordinating building blocks.
If we take the drawing skills on the right hand side of the diagram, we can see how the child develops more sophisticated drawing skills and these make the basis of developmental tests that paediatricians and others use in their day to day clinical practise.
Videos – Drawing a Line and a Circle
This film shows this little girl working with the health visitor and carrying out some task with bricks.
Videos – Building a Bridge
Not only is she built quite a large tower previously, but now she’s being shown how to build a bridge. And this is very important. It is part of a test that is done at three years of age to look for cognitive ability and motor fine motor skills in particular. And this girl is building three brick bridges quite easily. And one of the tasks she will have to do is demonstrate that she can pass an object through the opening in the bridge as shown here.
Hearing, speech and language (median ages)
Now let’s turn to speech and language development, hearing speech and language go together. The newborn baby, the first sign that they are hearing is that they are startled to loud noises by three to four months. They’re beginning to vocalise alone and when spoken to, will begin to respond with cues and laugh.
Video – Turns to Sound
Now watch this piece of film and see how the baby responds to the rattle.
Hearing, speech and language (median ages)
At approximately seven months old, the baby’s turning to soft sounds, which are out of sight. And this is the basis of the so-called hearing distraction tests that is carried out at that age. They’re beginning to speak at seven to 10 months, usually with quite an important finding, which is the so-called poly syllabic babble. So a babble, that’s of different tones and quality and volume at this stage.
Video – Language and Hearing - Babbles
Now, if we listen to this baby’s babble at this age, you will hear lots of different tones and variations in. And this is very much in contrast with children who have hearing impairment, who have a far more monotone sound.
Hearing, speech and language (median ages)
By 12 months, babies are beginning to say two to three words, such as dad or mama.
And by 18 months, about six to 10 words and certainly should be starting to show parts of their body, such as their nose or is, for example.
Hearing, speech and language (median ages)
At age 20 to 24 months, a child is using two or more words to make simple phrases. For example, give me Teddy, a two and a half to three.
This has become very much better with three to four words sentences and the child is often talking constantly.
Now, contrast this with the video in the next clip, which shows a boy with autism at the age of three and the lack of speech in normal speech and language development.
Social, emotional and behavioural development (median ages)
At 18 months, a child is holding a spoon quite well and getting food safely to the mouth.
Even if that food is being sprayed all over the floor.
At 18 to 24 months, children are beginning to develop good, imaginative play.
Social, emotional and behavioural development (median ages)
Now, let us turn to social, emotional and behavioural development.
And in this slide, we see the baby smiling around six to eight weeks of life and then at about six to eight months, a very typical social development will be the start of self-feeding.
Social, emotional and behavioural development (median ages)
At 10 to 12 months, the baby’s able to wave goodbye and plays games such as peekaboo.
They’re also able to drink from a cup with two hands. And this is oftenest an age at which we encourage parents to get rid of the bottle so that to minimise delay in speech and language due to prolonged bottle usage, prolonged bottle usage, particularly with juices, can also cause dental caries.
Video – Spoon Feeding
Social, emotional and behavioural development (median ages)
At two years old, in terms of social, emotional and behavioural development in this particular domain, we would expect the child to start.
Toilet training being dry by day, putting off some clothing and potty training and involved in parallel play with other children.
Video – Playing Together
Developmental milestones by median age
So let us summarise the developmental milestones are shown here on the left hand side of the table, by age. And on the right hand side, we see four columns which delineate the four domains of development, the locomotive of gross motor vision and fine motor hearing, speech and language, social, emotional and behavioural development.
This is a useful table because clinicians can use this to to work out the development of the child that they see opportunistically or by schedule based on their developmental milestones expected at each median age.
Patterns of abnormal development. These may be slow but steady, plateau or regression
What we see very often is the pattern, a very wide range of normal, particularly as you get older in years. So the range of normal development for motor or speech development can be quite wide and still be normal.
But also, we see patterns of abnormal development, such as slow and steady development or the plateau ing the the stopping of milestones, or even worse, the regression and the reversal of milestones.
There can be no early sign of quite serious illness, such as neurodevelopmental degeneration.
Fields of development with limit ages
A very useful concept is that of limited ages, and this is a bit like a traffic light system.
In other words, a warning for both parents and for health professionals. When a child has not reached particular milestones.
So, for example, at four months, if a baby has not reached, had control, has not managed to develop head control, we would be concerned again if a baby was not sitting so unsupported at nine months, we would be worried or standing independently at 12 months or walking at around 18 months, who would start to initiate certain investigations
Normal and Abnormal compared side by side:
The next few slides show a very useful graphic, which is the normal and abnormal development compared side by side.
So here at the age of one and a half months or six weeks, as I mentioned before, and as you’ve seen, the baby can push their head up and they pushed themselves up onto their arms while in the prone position, holding the head in a good position.
Now, on the right hand side of the diagram, you will see the abnormal motor development where the child is unable to lift their head or push up on the arms is rather stiff, with extended legs pushing back with the head, constantly fisting with one hand stiff leg on one side. Difficulty moving out of this position. And that would suggest the possibility of evolving cerebral palsy.
Again, if we look at the left hand side of normal development, the age of three months, we’re getting some sitting with some support and the health head being held up with a rounded back.
But on the right hand side, as you will see here, the abnormal motor development where the child has is unable to lift their head, has a floppy trunk, stiff arms and extended legs.
And that’s stiffening. And the crossing of the legs suggestive of excess tone in the lower limbs. Again, a sign of this inhibition of the motor neurones to the lower limbs and the possibility of early cerebral palsy.
Here we see again, a little older at six months, the normal baby on the left being able to sit without support, the arms free to reach and grasp. But unfortunately, with the abnormal motor development of a child with cerebral palsy, we get poor head control, difficulty getting your arms forward, stiffening of the legs and the poor ability to lift the head and back. And importantly, as you saw before, the baby who is normally developing will be able to take weight on their legs.
But in this particular situation, this is not the case. And again, this would suggest developmental delay or possible evolving cerebral palsy.
Nine months on the left hand side, we see the normally normally developing child pulling to stand.
But again, the on the right hand side, abnormal development with the difficulty of the baby being not in in pulling to stand, not being interested in weight, bearing with very stiff legs and finding it difficult to crawl on the hands and knees.
As I will show you in the next video.
At 12 months. A normally developing baby will be independently standing or beginning to walk. However, a child with developing cerebral palsy will be holding their arms stiffly and bent with excessive tip toe gait due to excess motor activity, which is uninhibited by the cortical spinal neurones. And so we have a child who has hyper reflects here and stiff limbs.
And this is indicated very nicely in the next video, which shows a child at about a year old who is just crawling along the floor compared to his twin brother.
A child with cerebral palsy (14m old)
Fields of development with limit ages-vision and fine motor development
If we turn to the fields of development around vision and fine motor development, and we saw that in the previous videos with the baby’s ability to use their hands and grasp objects, the limit ages here on the right, the traffic light system showing the time where we would be concerned about a possible abnormal development at three months.
If the baby’s not fixing and following with their eyes, that would be very concerning if they weren’t reaching for objects in six months or transferring objects between their hands at nine months or using a pincer grip at 12 months, we would be concerned that the vision and fine motor development had been impaired.
Fields of development with limit ages-hearing, speech and language development
Turning our attention to hearing speech and language development. The first aspect of development is the recognition of sound and being alert to sound and then the development of vocalisation through babbling. Moving on to single words and understanding simple requests. Joining words together with phrases. And then simple, a more complex conversation.
And on the right hand side, we see again these limit ages, which are important for clinicians because they would alert us to the possibility that a child had developed a mental delay in that domain.
Fields of development with limit ages-social and emotional behaviour development:
We have seen a number of babies smiling and being socially responsive. At eight months, the typical development is a separation anxiety. And then a little later on, the development of self-help skills, feeding, dressing and toileting, peer group relationships, the children playing together with toys, then the use of imagination and symbolic play and the importance of social and communication behaviours developing as a toddler and preschooler.
And on the right side, again, these are the limits ages one would expect for smiling at eight weeks. The fear of strangers at 10 months, feeding with the self, feeding themselves with a spoon at 18 months, and the development of symbolic play to two and a half. An interactive play. Three, three and a half. And these would be late ages limit ages for that development and would again signal abnormal development. If the milestones had not been reached by these ages.
Who and When
Now we turn to the question of who should be carrying out developmental assessments and monitoring, and when this should occur. Clearly parents are the most knowledgable about their children, followed by doctors, nurses, nursery nurses, health visitors, teachers. Most of the time clearly is spent with within the family.
So there are two issues here. One is opportunistically picking up on developmental issues, and then the second is part of a planned set of reviews.
And the that’s the programme that we have in the UK is called the Healthy Child Programme. And this consists of a combination of screening tests, neonatal and physical examination tests, blood spot tests and general examination and immunisation and health, education and health promotion.
In the next few slides will indicate exactly how this programme works. And this is a time where doctors and nurses will be particularly overseeing a monitoring child development.
This slide shows the age on the top here, antenatal birth two to four weeks, and the four key programme activities that is screening immunisation, Child health reviews, these are physical reviews of the child. And, of course, health promotion activity.
So if we look at the schedule, we see that the screening takes place antenatally, for hemoglobinopathies, rhesus infection, ultrasonography scans to make sure there are no anomalies such as Down’s syndrome and other congenital anomalies, And then a more detailed scan of that later at 18 to 20 weeks for any heart defects or kidney defects, in particular brain defects.
And then going on to birth, where we are looking at the newborn blood spot testing, hearing and physical examination. Of course, we have immunisation as well. Antenatally. And that would include pertussis and flu in the mother.
Soon after delivery, there is an examination by the doctor, a neonatal examination, followed by a birth visit by the health visitor. And again at 10 to 14 days. And during this period, quite a lot of health promotion activity is taking place, whether it’s around relationships, vaccination, breastfeeding, etc., injury prevention and nutrition.
So these are the key activities in the antenatal and immediate post-natal period.
At six weeks of age, the general practitioner is involved with the physical examination of the child. That’s six to eight weeks. And of course, the immunisation programme starts, which is which is very intense in the first year of life. So it’s very important that families attend for their immunisations.
The child health reviews take place by the health has to date 12 months. And again at two years. And these are two quite important points in the calendar for the baby’s progress to be checked routinely. And again, like in the previous period, health promotion activity is being provided around nutrition, vaccination, physical activity, etc. to encourage the promotion of health in the first two years of life.
The pre-school period is shown here and the pre-school right the way through to the end of school.
And although there are far fewer routine appointments, this is where opportunistic screening, opportunistic reviews in case finding becomes important.
So we see the end of the initial immunisation programme and the pre-school period and then the screening of vision prior to entry in school and then health reviews at 10 to 11 years and 15 to 16 years old.
With health promotion now shifting from the topics that you saw earlier on to the promotion of healthy weight, and as the child gets into the teenage years, sexual health and the encouragement of physical activity and lifelong habits for the future.
So in summary, we have here shown in the last three slides the Healthy Child programme and the four key activities screening, immunisation, child health reviews and health promotion.
However, given that we have a programme, a routine programme, there is no doubt the parents know something is wrong.
Usually before professionals do and seek out reassurance or otherwise from health professionals during the first few years of life in particular.
PARENTS KNOW SOMETHING IS WRONG BEFORE PROFESSIONALS DO
Causes of developmental impairments
One of the questions one has to ask oneself is one of the causes of developmental impairments. And there are a number of factors which affect the developing human at any time in the life cycle.
And these could be prenatally, very likely or postnatal early. And this is a useful framework for you to to think about. And when you’re thinking about follow my footsteps and other longitudinal programmes, where you following up families during the pregnancy period and thereafter you think about the nutrition during pregnancy and how that might affect the child’s development. In particular, you think about folate as an important factor for spinal development, spinal cord development. We think about iron as an important cofactor for brain development.
And then in the perinatal period, the delivery itself becomes very important as a potential traumatic event. In some cases, where oxygen deprivation becomes a key factor in affecting brain development or for that matter drugs used in the neonatal period such as the amino-glycosides which might affect hearing and the sensory neural pathways or postnatal development such as trauma or meningitis. And all those factors will affect a child’s development.
Evaluating the child with abnormal development
What GP’s do and what HV’s do
When evaluating when evaluating the child with abnormal development, we start with a history. We particularly focus on parental concern because parental concern is one of the most sensitive indicators. We take a clear birth history in pregnancy history and we take a clear family history to look for particular genetic predisposition to developmental problems, whether that might be autism or a more sinister disease such as Huntington’s chorea or a neurodegenerative disorders such as Tay Sachs. So we take very careful history, careful genetic history.
We then move on to the past medical history, looking at the developmental history. And you’ve now learnt how roughly how to take a developmental history in the four key domains and look at what is happening with current skills now with the baby or the child in front of you.
And then we move on to the clinical examination where we are looking both at the morphology, the way the baby, the child looks, whether any dysmorphic features, whether any obvious neurological problems or skin problems, as the neuro dermatological syndromes such as neurofibromatosis or tuberous sclerosis may give hints of disease patterns which will affect development.
And then, of course, you are guided through your clinical examination to further investigations as appropriate.
Approach to Developmental Assessment
The general approach to developmental assessment is to ask then to observe the child and then to set some tasks as per a standardised test, for example. And by doing so, we are assessing whether the milestones are proceeding at the right age.
That’s the developmental history we take. We are looking and observing the child to see if expected milestones are there for their particular age. And then we are looking to the future as whether to to alert parents to the next important milestone in the child’s development in the four domains for which they can look out for.
And that is the general approach to developmental assessment.
Opportunisitc examination – cant always follow a logical sequence with children.
Introduce this as a way to approach the examination – helpeful aide memoire
Use the parents – they know the child best
Watch – you can learn so much from watching the child.
Then ask them to do specific things
Factors influencing developmental delay
In the previous slide, we talked about the factors that may be influencing developmental delay prenatally perinatal or post nightly. Here we see a number of these factors reiterated.
And this shows that the importance of ill health and the sort of ill health that may cause delayed development, for example, in speech and language delay. Children who have recurrent otitis media or recurrent middle ear infections with their speech may well be affected by the lack of hearing.
If we look at one of the commonest causes a delay, that is the lack of physical or psychological stimuli in the family home. And this is a common issue, particularly in more deprived and disadvantaged families.
Sensory motor impairment of any sort will develop, will cause developmental delay. So if a child has visual problems, maybe amblyopia or a serious squint or visual maturation difficulties in their cortex. This will affect their general development, particularly fine motor development when we’re talking about vision, but also general development and all these factors, including the genetic tendency that will cause a delay or could cause a delay in child development.
Types of developmental delay
Doctors who are working in this field will sometimes describe developmental delay as being divided into global delay.
That is delay in all four domains or specific issues of delay or impairment of language, motor sensory systems or cognitive delay.
And this this is a useful framework, as you may find very different pathologies affecting each of these issues.
Causes of global delay
An example, an example here of causes of global developmental lane you’ll be familiar with this would be Down’s syndrome, but also Fragile X, which is a very common cause of developmental delay, metabolic problems such as hypothyroidism or inborn errors of metabolism.
And we’ve discussed already possible antenatal factors or environmental social issues or chronic illness. So children who are chronically in hospital for long periods of time due to illness may well have developmental delays as a direct result of that long period of hospitalisation.
Causes of motor delay
So looking at causes of motor delay, this could be neurological. This could be due to the the nerves going from the brain. So cortical spinal tract injury may be during the perinatal period if you’re a premature infant, it could be due to other neurological problems, such as neural tube defects or hydrocephalus, placing pressure on the brain. Or core motor delay may be part of Down’s syndrome, certainly these babies are very slow to sit and walk, or it could be something wrong with the bones themselves. So congenital dislocation of the hip. Or the muscles, muscular dystrophy or Duchenne’s would give you a very good muscular cause of developmental problems from motor development and social deprivation is by far the commonest cause that we see in children typically in our communities.
Causes of language delay
Turning to hearing and speech and language development, hearing loss, whether congenital sensory neural hearing loss or due to middle ear disease, such as otitis media will affect the child’s development of language.
If the pathways in the temporal lobe are affected, then comprehension of language may be impaired. Developmental dysphasia would be a good example of this or the speech production nerves muscles might be problematic here and might create a developmental delay in language, whether impaired speech production such as the Stammer or dysathria would be causes of language delay.
And then the more serious systemic problems such as learning disability or autistic spectrum disorder would be another couple of causes of language delay as well as would lack of stimulation, which we’ve mentioned before.
Commonly used assessment tools
And finally, I thought I’d just mention a couple of commonly used, a number of commonly used assessment tools, which doctors working in this field, doctors and nurses, work in the field of child development are using. And you may come across during your attachments.
And these are standardised tests such as the schedule of growing skills otherwise known as SOGS, The Griffiths Developmental Scale, Bailey Developmental Scale, or the widely used Denver developmental screening tests which are primarily used in the USA. These are some of the tools used formally to assess development of the drug.
SUMMARY
