Stages of Child Development Flashcards
Why relevant to dentists?
Predict and interpret how a child or young person at a certain age might cognitively, emotionally, behaviourally or physically react within the dental surgery
Modify behavioural management technique/ communication in an age-appropriate and developmentally-appropriate manner
Normative child development
Progresses in different areas simultaneously -physical (gross and fine motor skills) -emotional and social -sensory (hearing and vision) -cognitive and language Every child is an individual Recognised 'milestones'
Infant at 6 months: physical
Sit without support
Reach and grab a toy
Put objects in their mouths
Feed themselves with fingers
Infant at 6 months: emotional and social
Distressed when their mother leaves
Increasing wariness to strangers
Infant at 6 months: sensory
Turn towards noise
Visually very alert - follow activities
Infant at 6 months: cognitive
Understand meaning of words such as ‘bye-bye’
Start to understand objects
Child at 12 months: physical
Can (probably) walk alone
Can turn pages in a book
Throw toys deliberately
Child at 12 months: emotional and social
Emotionally labile
Wary of strangers
Reassurance from familiar adult
Help with daily routines
Child at 12 months: sensory
Know and respond to own name
Enjoy watching television
Child at 12 months: cognitive
Understand simple instructions - wave ‘bye-bye’
Child at 24 months: physical
Can run, jump, climb
Walk up and down stairs
Child at 24 months: emotional and social
May play alongside other children
Easily frustrated leading to tears/ tantrums
Clingy at times/ independent at times
Dress independently
Child at 24 months: sensory
Recognise themselves in photos
Child at 24 months: cognitive
Speaks > 200 words and understand many more (favourite word - no!)
Short attention span
Likes to share songs and conversations
Child at 5 years: physical
Skip, hop, stand on one foot
Ride a bike without stabilisers
Use a knife and fork
Child at 5 years: emotional and social
Like to do things unaided Make-believe play Play with other children and make friends (I am not your friend today) Confuse fact and fiction Help others when distressed
Child at 5 years: cognitive
Interested in reading/ writing
Likes jokes
Fluent in speech
5 years old and beyond
Developmental progress continues
Maturation of skills
Cognitive development
Theories of child development
Cognitive development - Piaget Development of personality - Freud Psychosocial development - Erikson Understand different processes that may be involved in different areas of child development Very broad categories - oversimplified? Other variables ignored Large individual differences
Cognitive development
Development of thinking
Includes language and communication
How children come to learn and understand about their body and their health
Size of the child is a poor indicator
Piaget
Jean Piaget (1896-1980)
Swiss psychologist
Pioneer - first psychologist to make a systematic study of cognitive development
Based on his observations of his own children
Piaget theory - basics
Children think differently to adults (not less competently)
Interested not in if children answered questions correctly, but how they reached their answers
Four discrete stages
Piaget suggested there is a qualitative change in how children think as they progress through stages
A 7yo child down’t just have more info about the world than when they were 2yo, also fundamental change in how they think about world
Schema
Units of knowledge
System of action or mental representation that people use to understand the world
Assimilation
Bringing new info into an existing body of knowledge
Accomodation
Altering body of knowledge to include new knowledge that is inconsistent with what is already known
Equilibrium
Balance between applying previous new knowledge and accounting for new knowledge
Piaget theory - 4 stages
Always occur in same order
Children build upon proceeding stage
Sensorimotor –> pre-operational –> concrete operational –> formal operational
Sensorimotor
Birth to 2 years
Infants explore world through their senses and applying their developing motor skills
Imitate actions they have seen others perform - pretend to feed a toy
Use words to represent objects
Object permanence - understanding objects continue to exist when they cannot be seen
Infants developing motor skills
Birth - 1 month: inborn survival reflexes (gasping and sucking)
Initially look at visual stimuli and turn heads towards a noise, but not interested in object itself
3 months: begin to follow moving objects with eyes
6 months: can grasp and hold objects
12 months: explore objects
Object permanence
understanding objects continue to exist when they cannot be seen
A) Will not look for it
B) Will search in limited way - eyes in direction last seen
C) Search for hidden object - but only where they have seen it to be hidden
D) Search in other places
Per-operational
2 to 7 years
Rapid development of language
Egocentrism - others see the world as they do
-development of symbolism to make sense of the world e.g. respresent horse by making galloping movements
Concrete operational
7 to 12 years
Logical reasoning - real world objects or events
Cause-and-effect
Empathise with others
Understanding that the physical properties of objects stay the same even though the appearance might change (can’t do with hypothetical objects)
-if you pour water from one shape glass into another, is it still the same amount of water?
Formal operational
> 12 years
Need exposure to principles of scientific thinking to reach this stage
Abstract reasoning
Hypothetico-deductive reasoning for complex problem solving
Abstract reasoning
Think and reason about hypothetical objects or events (take a mental representation and reason about them)
Formal-operational egocentrism
Young people believe others are as preoccupied with their appearance and actions as they are themselves
Construct and react to ‘imaginary audience’ where they are centre and focus of attention
‘Audience’ may also contribute to feelings of self-consciousness
Believe in uniqueness of own feelings and own immortality (personal fable)
Criticism of Piaget
Observations based on a few children
If a child is observed not completing a test, does that mean they are cognitively not capable of it?
Is learning really this orderly?
Underestimates children
Social and cultural effect (Vygotsky’s theory)
Vygotsky’s theory
Zone of proximal development
Child learns tasks that are too difficult to manage alone from interactions with another person
Development of personality: Freud’s psychoanalytical theory components
ID
Superego
Ego
ID (Freud)
Contains drives/ needs
No conscious mental processes
Babies/ infants are governed by the ID
Works on pleasure principle (maximum amount of pleasure/ void pain)
Superego (Freud)
Develops from 4 years
Contains moral lessons have learned
Duty, obligation and conscience
Ego (Freud)
Mediator (police) between ID and Superego
Rational and logical
Negotiating more effective way of meeting drives/ needs than ‘I want’
Psychosocial development background
Erik Erikson (1902-1994) American psychoanalyst Theories on how we interact with others 8 stages (5 in childhood/ adolescence) Two options for each stage - success or failure
Psychosocial development stages
Trust vs mistrust - birth to 1 year
Autonomy vs shame and doubt - 1 to 3 years
Initiative vs guilt - 3 to 6 years
Industry vs inferiority - 6 to 12 years
Identity vs role confusion - 12 to 18 years
Individual differences
Disabilities - learning/ physical Psychological variables -intelligence -coping strategies -learned behaviour Family factors - parenting styles
Separation / stranger anxiety
Normal developmental stage (attachment) Lack of strong attachment during infancy can lead to emotional disturbance 6-18 months (can last til 5yo) Fear of strangers Comforted by being in parents arms
Parenting styles
Authoritarian
Authoritative
Permissive
Neglectful/ rejecting
Parenting styles: Authoritarian
Highly controlling, strict and punitive (because I said so..)
Do not allow their child to disagree with their decisions
Leads to anxiety, poor communication skills
Parenting styles: authoritative
Clear and realistic expectations for behaviour
Set high standards for behaviour and encourage children to be indipendent
Lead to children with high self-esteem and self competent
Parenting styles: permissive
Responsive
Makes few demands on behaviour and sets few guidelines
Avoid confrontation
Lead to children who experience problems with authority and lack self-control
Parenting styles: neglectful/ rejecting
Uninvolved in child’s life
Impacts on self-esteem
Role of the parent in the dental surgery
Parents not always helpful
Maternal dental anxiety can > child dental anxiety (child < 8yo)
Highly anxious children are able to co-operate better when parents remain in waiting room
Generally, children and parents comforted by each others presence
Practical tips - toddlers
Generally considered pre-cooperative for dental treatment
Communication skills limited so common response of upset is to cry
Do not separate from parent - examine on parent’s lap
Keep apt times short
Practical tips - terrific 3s and fabulous 4s
Considered potentially co-operative Gain attention with lots of distraction Let them 'help you' where possible Use appropriate language (childrenese) Short attention span so work steadily and avoid pauses
Practical tips - school age
Usually have sufficient co-ordination to brush their own teeth and can follow ‘rules’ about oral care
Try to involve children in what you’re doing
Respond well to positive reinforcement
Use appropriate language and simple explanations, and encourage questions
75% 8-13 yos felt old enough to understand treatment and believe their views should be heard
Giving choice about local
Understanding of pain/ LA varies with age/ cognitive development
Abstract concept
Young child would not understand cause and effect (blame the dentist)
Dentist must make sure as pain-free as possible
Practical tips - teenagers
Develop adult concept of health
Supported to make own health care decisions
May be motivated by concerns about attractiveness
May be easily embarrassed and sensitive to criticism
Seen without parents?
Autistic Spectrum Disorder
Lifelong developmental disability Unknown aetiology Presents in childhood Spectrum - autism, pervasive development disorder, and Asperger syndrome 1:100 children in UK More males (x4_ All cultural backgrounds
Impairment in social communication (autism)
Difficulties communicating with others (expressive language), understanding what is being said to them (receptive language) and non-verbal communication
Language skills vary (speech delay/ loss of speech)
Very literal understanding of language
Difficulties understanding jokes, sarcasm and metaphors
Difficulties with give-and-take (reciprocal) of conversation (talk at length about own interests/ repeat what was said)
Impairment in social interaction (autism)
Difficulty recognising or understanding emotions or feelings in others (and expressing their own)
Do not understand unwritten social rules
Lack of eye contact and social smiling
Reduced social play with others and plays on own
Difficulties in engaging in imaginative play and activities (but not unimaginative)
Unusual restricted or repetitive behaviour (autism)
Strong preferences for familiar routines and things being ‘just right’
Dislike of change, which often leads to anxiety or other forms of distress
A strong adherence to rules or fairness that leads to argument
Highly specific interests or hobbies
Repetitive movements such as hand flapping/ rocking
Repetitive play such as opening and closing doors
Characteristics of ASD
Difficulties processing sensory information (including sight, hearing, taste, touch and smell)
Learning difficulties
Challenges going to the dentist (autism)
Change of routine
New social situation (communication/ interaction)
Difficulties processing sensory information (sensory overload)
Can manifest as behavioural difficulties
Practical tips - ASD
Minimise waiting times
Simple language, short sentences and direct requests (say child’s name first). No metaphors, jokes and sarcasm
If verbal communication difficult consider visual supports (Widgets)
Modify environment if causing distress
Positive reinforcement
Stay calm and relaxed at all times
