Developmental and behavioral pediatrics

Developmental and Behavioral Developmental and Behavioral pediatricspediatrics

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Knowledge of the normal growth and Knowledge of the normal growth and development of children is essential for development of children is essential for preventing and detecting disease. preventing and detecting disease. “Growth” – increase in the size of the

body or in its separate parts.“Development”- process of changes in

function, which is influenced by the emotional and social environments.

One of the goals of Pediatrics is to help each child achieve his/her individual potential for growth and development and become a mature adult.

The term – ‘child development’ is used to describe the skills acquired by children.

Normal development in first years of life is monitored:

by parents; at regular child health surveillance checksThe main objective of assessing a young child’s

development is the early detection of delayed or abnormal development.

Fields of DevelopmentFields of DevelopmentGross motorVision and fine motorHearing, speech and language (cognitive

development)Social, emotional and behavioral

(psychological development)

Analysis of Developmental ProgressAnalysis of Developmental Progress

The more intense colour bands reflect the age at which particularly rapid progress occurse. Dotted lines represent more subtle progress.

Developmental screening and Developmental screening and assessmentassessmentScreening – checks of whole populations

or groups of children at set ages by trained professionals.

Assessment – detailed analysis of overall development or specific areas of development

Motor development – ability of child to do any actions by using muscles of different groups.

Motor development includes gross and fine motor skills.

Gross development skills – ability of child to control large muscles (head, sit, walk, etc.)

Fine developmental skills – ability of child to control small muscles (fingers, eyes, etc).

Factors Affecting Child’s Motor Factors Affecting Child’s Motor DevelopmentDevelopmentCongenital diseasesAcquired diseases NutritionEnvironment (Stimulation of Physical activity

relevant to age)Prematurity / twins

Assessment of Motor developmentAssessment of Motor development

For assessing motor development muscle tonus, passive and active movements and tendon reflexes are assessed.

Active movement is assessed according to the action of a child, how he sits, walks, stands up, takes toys in hand, etc.

Cognitive development – development of cognition – ability of a child concept, analyze, remember, make decision and solve the problem. Speech development indicates cognitive development in early childhood.

Developmental milestones – the term is to describe the achievements in any field of development relevant to child’s age.

Global inhibition of development – is a state when child (less than 5 years old) is delayed simultaneously in 2 or more spheres. After 5 years is used the term – mental retardation (delayed IQ ).

Developmental milestonesDevelopmental milestones

Pattern of child developmentPattern of child developmentWhen analyzing a young child development: Consider the child’s age and then concentrate your

questions on the areas of likely maximum developmental progress

Offer the child suitable toys to find out about his skills Observe how the child uses the toys and interact with

people. For assessment the child development there are several

instruments recommended: Denver II Developmental Screening test, Baily’s Infant Development Scale for assessment child neurodevelopment, Parents' Evaluations of Developmental Status (PEDS), Pediatric Symptom Checklist, Modified Checklist for Autism in Toddlers (M-CHAT) etc.

Developmental ScreeningDevelopmental ScreeningIf child can’t do the milestone relevant to

the age it is necessary to assess the existence of the danger signs.

Danger sign – Disability of a child to make any action in the given age limit

In case of revealing danger sign - deeply examination of a child and an urgent referral to a specialist is recommended.

Emotional and Social developmentEmotional and Social development

Emotional development – ability of a child to express adequate emotions.

Social development – ability of a child to make close contact with people and environment.

Factors influencing emotional and social development – Adequate feeding (food rich with vitamins and microelements)

- Congenital (genetic diseases, birth trauma), or gained diseases (CNS infections, haematoma)

- Appropriate stimulation

HearingHearing

Summary regarding hearingSummary regarding hearingEarly detection and treatment of hearing

impairment improves the outcome of speech and language and behaviour

Newborn hearing screening is performed for the early identification of hearing impairment

If there is parental concern about hearing, further assessment is warranted.

Hearing checklist for parentsHearing checklist for parentsShortly after birth –startles and blinks at a sudden noise

(slamming of door)By 1 month – Notices sudden prolonged sounds (e.g. a

vacuum cleaner) and listens when they beginBy 4 months – Quietens or smiles to the sound of your

voice even when he cannot see you.By 7 months – Turns immediately to your voice By 9 months – Listens attentively to familiar everyday

sounds and searches for very quiet sounds maid out of site

By 12 months – Shows some response to his own name and to other familiar words. May respond when you say ‘no’.

Vision TestingVision TestingNewborn – Face fixation and following 6 weeks – Optokinetic nystagmus (normal)

demonstrated on looking at a moving target6 months – Reaches well for toys2 years – Can identify pictures of reducing size3 years – Latter matching using single letters charts onwards5 years – Can identify a line of letters on a long chart onwards

Summary regarding visionSummary regarding visionTerm newborn infant can fix and follow

horizontally and prefer to watch facesVisual acuity is poor in newborn but

increases to adult levels by 3 years of age.Vision screening is performed in

preschool children or at school entry

Influence of heredity and Influence of heredity and environmentenvironmentHeredity determines the potential of the

childEnvironment influences the extent to

which that potential is achieved.

EnvironmentEnvironment

Development can be impaired if the environment fails to meet the child’s physical or psychological needs.