Infant Growth and Development - Ennectgo.ennectmail.com/Resources/TexasChildrensHospital... · •Autism (1/88) •Learning Disabilities (5% of the population) Page 8 Pediatrics xxx00.#####.ppt

Pediatrics

Kathryn K. Ostermaier M.D.

Assistant Professor

Baylor College of Medicine

Department of Pediatrics

Meyer Center for Developmental Pediatrics

Infant Growth and

Development

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Background

•“Infant” is derived from the Latin word “infans”

which means unable to speak.

•Prior to the 1900’s, most people felt that infants

were a “blank tablet”.

•Because they could not tell us what they were

thinking, it was assumed they were devoid of

intelligence.

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Background

•Gesell in the early 1900’s was the first person to

closely observe infants and establish

developmental norms.

•By mid-century, theories that stressed the

importance of nurture began to prevail by Pavlov

(1930’s), Watson (1950’s), and Skinner (1960’s)

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Background

•During the second half of the century, Piaget was

the first to describe the infant as having

intelligence.

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Background

•Infant development occurs in an orderly and predictable

manner.

•It proceeds from cephalic to caudal and proximal to distal.

•Responses to stimuli proceed from general reflexes

involving the entire body to discreet voluntary actions under

cortical control.

•Progression is from dependence to independence.

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Why is development important?

•Early development lays the foundation for future

learning abilities.

•The goals for those caring for children should be to

maximize a child’s growth and development.

•Formal developmental screening is an important

part of every well-child check.

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What are the major problems we

should be looking for?

•Cerebral Palsy (2-2.5/1000)

•Speech Impairment (10/1000)

•Hearing Impairment (6/1000)

•Visual Impairment (12/1000)

• Intellectual Disability (2-3% of the

population)

•Autism (1/88)

•Learning Disabilities (5% of the

population)

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Why is screening important?

•Early intervention has been shown to maximize a child’s potential.

•What are the early intervention options?

-Early Childhood Intervention

-Head Start Program

-Preschool programs for children with disabilities

-Special education programs through the local school district

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What does one look for when

screening development? •There are four major areas of development:

-Physical Growth

-Gross Motor

-Visual Perception and Fine Motor Skills

-Language

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Physical Growth

•Normal Weight Patterns:

Birth weight is

-regained by 2 weeks of age

-doubled by 5 mo.

-tripled by 12 mo.

-quadrupled by 24 mo

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Physical Growth

•Head Growth

--Measured by Frontal Occipital Circumference (FOC)

--Head growth during first 5-6 months is due to neuronal cell

division.

--Later head growth is due to neuronal cell growth and

support tissue proliferation.

--Head is approx. adult-sized by 5 yrs.

http://images.google.com/imgres?imgurl=http://simulconsult.com/resources/images/HeadCircumference.jpg&imgrefurl=http://www.simulconsult.com/resources/ftemp20.html&usg=__egz-EBpwjj5YydK5KqFnCL53ctk=&h=404&w=400&sz=18&hl=en&start=4&tbnid=J1LvDhwhyUYcOM:&tbnh=124&tbnw=123&prev=/images%3Fq%3Dmacrocephaly%26gbv%3D2%26ndsp%3D20%26hl%3Den

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Physical Growth “RED FLAGS”

•Short stature or poor weight gain

•Small head or microcephaly:

Reflects cerebral pathology and has cognitive implications.

•Large head or macrocephaly:

50% is familial and benign

Watch out for hydrocephalus!!!!

http://images.google.com/imgres?imgurl=http://farm3.static.flickr.com/2035/1599622503_2a2104224e.jpg%3Fv%3D0&imgrefurl=http://flickr.com/photos/davsans/1599622503/&usg=__pRTqDJbvV_5Ifn1FOWvvOIX2BwA=&h=500&w=375&sz=98&hl=en&start=69&tbnid=z5veubipHZC1CM:&tbnh=130&tbnw=98&prev=/images%3Fq%3Dmacrocephaly%26gbv%3D2%26ndsp%3D20%26hl%3Den%26sa%3DN%26start%3D60

http://images.google.com/imgres?imgurl=http://cas.bellarmine.edu/tietjen/HumanBioogy/tcge010.jpg&imgrefurl=http://onlineacademics.org/Family/index1.html&usg=__Gr9PO_tZFeKfLR1Ye3VmRIyY0Fs=&h=254&w=228&sz=14&hl=en&start=4&tbnid=WtTwydxO6sOdkM:&tbnh=111&tbnw=100&prev=/images%3Fq%3Dmicrocephaly%26gbv%3D2%26hl%3Den

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Physical Growth “RED FLAGS”

•Dysmorphisms: Minor variations or abnormalities

on physical exam

•Greater than 3 dysmorphisms highly associated

with genetic syndromes

•Greater than 75% of these minor variations can be

found by closely examining the face, hands and

skin.

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http://images.google.com/imgres?imgurl=http://embryology.med.unsw.edu.au/defect/images/trisomy21-hand.jpg&imgrefurl=http://embryology.med.unsw.edu.au/defect/page21.htm&usg=__mEqXPBA9iwNRVdz-7Ghtwol1Bog=&h=295&w=360&sz=12&hl=en&start=2&tbnid=s7O1yluP7_mzDM:&tbnh=99&tbnw=121&prev=/images%3Fq%3Dclinodactyly%26gbv%3D2%26hl%3Den

http://images.google.com/imgres?imgurl=http://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_tools/what_your_skin_says_about_your_health_slideshow/dermnet_rf_photo_of_tuberous_sclerosis.jpg&imgrefurl=http://www.webmd.com/skin-problems-and-treatments/slideshow-what-your-skin-says-about-your-health&usg=__Yv40u9C1cYgusLfXbbv-nH_bbkw=&h=335&w=493&sz=27&hl=en&start=98&tbnid=K4Rf1ph2EKv9jM:&tbnh=88&tbnw=130&prev=/images%3Fq%3Dtuberous%2Bsclerosis%26gbv%3D2%26ndsp%3D20%26hl%3Den%26sa%3DN%26start%3D80

http://images.google.com/imgres?imgurl=http://www.teambone.com/chapters/peds/dysplasia/dysplasia_files/image098.jpg&imgrefurl=http://www.teambone.com/chapters/peds/dysplasia/dysplasia.html&usg=__pWSBMsRH6JzJRJQPjt5vQ8RFY68=&h=360&w=265&sz=8&hl=en&start=145&tbnid=AZy-3bqRGlwejM:&tbnh=121&tbnw=89&prev=/images%3Fq%3Dneurofibromatosis%26gbv%3D2%26ndsp%3D20%26hl%3Den%26sa%3DN%26start%3D140

http://images.google.com/imgres?imgurl=http://dermatology.cdlib.org/94/NYU/Apr2002/041602-2a.jpg&imgrefurl=http://dermatology.cdlib.org/94/NYU/Apr2002/2.html&usg=__rAPd4-iKA1xjgEDqAYIs36q453U=&h=482&w=328&sz=25&hl=en&start=182&tbnid=b-eJnBXmHhDsjM:&tbnh=129&tbnw=88&prev=/images%3Fq%3Dneurofibromatosis%26gbv%3D2%26ndsp%3D20%26hl%3Den%26sa%3DN%26start%3D180

http://www.uwo.ca/cns/resident/pocketbook/pictures/tuberousclinical.jpg

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Gross Motor Development

•Gross motor skills proceed from a sequence of

prone milestones, to sitting, and then through a

standing/ambulating sequence.

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Evolution of Gross Motor Skills

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Gross Motor Development

•Gross motor skills must always be considered in

context of a neurological exam.

•Important to look at postural reactions and primitive

reflexes in addition to a regular neurological exam.

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Infant Neurological Maturation

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Primitive Reflexes

A: Tonic Labyrinthine Reflex C: Positive Support Reflex

B: Asymmetrical Tonic Neck reflex

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Postural Reactions

Parachute Response Righting Postural Reflex

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Gross Motor “RED FLAGS”

•Persistent fisting beyond 3 months

•Spontaneous postures (frog-legging, scissoring)

•Delays in postural reactions

http://images.google.com/imgres?imgurl=http://www.dreamstime.com/baby-fist-thumb5487380.jpg&imgrefurl=http://www.dreamstime.com/baby-fist-image5487380&usg=__0XzPOz79aDMfQyT3uv6Y-CPEK9s=&h=350&w=286&sz=50&hl=en&start=1&tbnid=10-K6Xq7EKA2vM:&tbnh=120&tbnw=98&prev=/images%3Fq%3Dthumb%2Bfisting%2Bbabies%26gbv%3D2%26ndsp%3D20%26hl%3Den%26sa%3DN

http://images.google.com/imgres?imgurl=http://www.fotosearch.com/bthumb/LIF/LIF139/NU118010.jpg&imgrefurl=http://www.fotosearch.com/clip-art/diagnostic.html&usg=__xqBUsH5oR65AIGlbdzlB8mr6tHw=&h=138&w=170&sz=9&hl=en&start=10&tbnid=cFZw5BwghbmYKM:&tbnh=80&tbnw=99&prev=/images%3Fq%3Dfrog%2Bleg%2Bposition%26gbv%3D2%26hl%3Den

http://images.google.com/imgres?imgurl=http://www.dinf.ne.jp/doc/english/global/david/dwe002/dwe002g/dwe00211g14.gif&imgrefurl=http://www.dinf.ne.jp/doc/english/global/david/dwe002/dwe00211.html&usg=__vGcT3DE-jTrDtpmSM_Rs_flxg5I=&h=184&w=187&sz=9&hl=en&start=19&tbnid=_VypFV2pPfs1GM:&tbnh=100&tbnw=102&prev=/images%3Fq%3Dscissor%2Bcerebral%2Bpalsy%26gbv%3D2%26ndsp%3D20%26hl%3Den%26sa%3DG

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Gross Motor “RED FLAGS”

•Abnormal movement patterns:

-persistent head lag/ floppy baby

-pulling directly to a stand at 4 months

-W-sitting

-walking without ever crawling

-persistent toe-walking

•Hand dominance prior to 18 months

http://www.mdconsult.com/das/patient/body/0/0/10041/17229_en.jpg

http://www.lightlink.com/vulcan/benign/benign.jpg

http://images.google.com/imgres?imgurl=http://farm4.static.flickr.com/3005/3531888488_57999c85e2.jpg&imgrefurl=http://www.flickr.com/photos/black_wolf/3531888488/&usg=__77ylGhQjpeoVv7nkdcElKjmsymI=&h=336&w=500&sz=109&hl=en&start=34&tbnid=zoNMDmllvOpWAM:&tbnh=87&tbnw=130&prev=/images%3Fq%3Dtoe%2Bwalking%26gbv%3D2%26ndsp%3D20%26hl%3Den%26sa%3DN%26start%3D20

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Visual Perception and Fine Motor

Skills •As balance improves in the sitting position and as

the infant begins to walk, hands become more

available for manipulation of objects.

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Skills •In the first year of life, fine motor development is

highlighted by the evolution of the pincer grasp and

learning to grasp and explore objects.

•The second year of life is highlighted by the hands

using objects as tools.

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Skills •Problem-solving in the first year through sensory-motor

play: “LEARNING TO MANIPULATE”

-Visual inspection

-Reaching, grasping, and mouthing

-Refinement of the pincer grasp for closer inspection

•Object Permanence

http://images.google.com/imgres?imgurl=http://www.tracyseedassociates.com/USERIMAGES/Baby%2520mouthing(1).jpg&imgrefurl=http://www.tracyseedassociates.com/page5.htm&usg=__ABE18twD5FnxMnxD8OOrJsOrOGk=&h=265&w=400&sz=26&hl=en&start=46&tbnid=fdabN9CYtKCD2M:&tbnh=82&tbnw=124&prev=/images%3Fq%3Dmouthing%2Bobjects%26gbv%3D2%26ndsp%3D20%26hl%3Den%26sa%3DN%26start%3D40

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Skills •Problem-solving in the second year through

functional play: “MANIPULATING TO LEARN”

-Recognition of objects and their functions

through symbolic play

-Matching and categorizing objects

http://images.google.com/imgres?imgurl=http://www.healthofchildren.com/images/gech_0001_0003_0_img0212.jpg&imgrefurl=http://www.healthofchildren.com/P/Play.html&usg=__4Uzcuzrla2qNBDkvR_oROnnym5c=&h=312&w=235&sz=73&hl=en&start=10&tbnid=cg7VlWsrQgiPuM:&tbnh=117&tbnw=88&prev=/images%3Fq%3Dtoddlers%2Bplaying%26gbv%3D2%26hl%3Den

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“RED FLAGS” •Failure to alert to environmental stimuli may

indicate sensory impairment

•Failure to reach for objects may indicate motor,

visual and/or cognitive deficit

•Persistent mouthing past approximately 12 months

•Lack of imitation by 16 months

•Absent symbolic play by 24 months

http://images.google.com/imgres?imgurl=http://www.cakechannel.com/images/kids-baking.gif&imgrefurl=http://www.cakechannel.com/baby-shower-diaper-cake-recipe.html&usg=__5qnxgy038uHgMgLervTd2q-Xg5U=&h=232&w=300&sz=35&hl=en&start=204&tbnid=XFPFHx92g3cETM:&tbnh=90&tbnw=116&prev=/images%3Fq%3Dimitation%2Bplay%2Bbabies%26gbv%3D2%26ndsp%3D20%26hl%3Den%26sa%3DN%26start%3D200

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Language Development

•Delays in language are more common than delays

in other areas.

•Language is the best indicator of future

intelligence.

•Language is the most difficult to screen in the office

therefore history is very important.

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•Language is separated into two domains:

-Expressive Language

-Receptive Language

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•Language development during infancy can be

divided into 3 periods:

-Prespeech Period (0-10 months)

-Naming Period (10-18 months)

-Word Combination Period (18-24 months)

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Language Development:

Pre-speech Period (0-10 months)

•Sound Localization

•Cooing

•Babbling

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Language Development: Naming

Period (10-18 months)

•The infant realizes that people and objects have labels.

•Word counts are important to measure expressive

language.

•Receptive language reflected in understanding simple

commands.

•Pointing

•Jargoning

http://images.google.com/imgres?imgurl=http://scienceblogs.com/notrocketscience/upload/2009/02/babies_gestures_partly_explain_link_between_wealth_and_vocab/Pointing-child.jpg&imgrefurl=http://scienceblogs.com/notrocketscience/2009/02/babies_gestures_partly_explain_link_between_wealth_and_vocab.php&usg=__Zww8eM5k6Cc1zQfKkeih8bA-XwU=&h=217&w=500&sz=27&hl=en&start=11&tbnid=tL8dRx65XOHqoM:&tbnh=56&tbnw=130&prev=/images%3Fq%3Dbabies%2Bpointing%26gbv%3D2%26hl%3Den

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Language Development:

Word Combination Period

(18-24 months)

•Children typically begin to combine words 6-8 months after

they say their first word.

•Giant words

•Holophrases

•Word combinations (usually does not start until the child has

an expressive vocabulary of at least 50 words)

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“RED FLAGS” •Inability to localize sound

•Absent babbling or consonant production

•Lack of pointing by 12-18 months

•Low word counts

•Advanced, non-communicative speech

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How is development screened?

Examples of appropriate

tools include:

The Denver Developmental Screen II

The Capute Scales

The Gesell

Various Parent

Questionaires

•Parents' Evaluation of Developmental

Status (PEDS)

•Ages and Stages Questionnaires

(ASQ)

•Child Development Inventories (CDI)

•Modified Checklist for

Autism in Toddlers (MCHAT)

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Screening Tips

•Start with the visual-perceptual/ fine motor section

of the test and end with gross motor.

•Know your screening test well and have your

testing items organized.

•Do not let children play with the testing materials

ahead of time!

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Screening Tips

•Once you are done with an item, put your testing

materials away so they are not a distraction.

•Give a child several tries to complete a task.

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Conclusions •Infant development is determined by nature AND nurture

•Development follows a predictable course

•Watch for red flags and make referrals early rather than employing “watchful waiting”

•Use a reliable screening tool to get reliable information

Infant Growth and Development - Ennectgo.ennectmail.com/Resources/TexasChildrensHospital... · •Autism (1/88) •Learning Disabilities (5% of the population) Page 8 Pediatrics xxx00.#####.ppt

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