GROWTH AND DEVELOPMENT

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GROWTH AND DEVELOPMENT
Dr.Khalid Hama salih, Pediatrics specialist
M.B.Ch. D. C.H
F.I.B.M.S.ped
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Delay developmental mile stone
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Introduction

• An estimated 12-16 of children have a
  developmental and/or behavior disorder
• Only 30 are identified before school entrance
• Those detected after school entrance miss out on
  early intervention services proven to have long
  term health benefits

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• Delay - implies slow acquisition of all skills
  (global delay) or of one particular field or area
  of skill (specific delay), particularly in
  relation to developmental problems in the 0-5
  years age group.

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Development delay

• the condition where a child does not reach one of
  the stages of development at the expected For
  example, if the normal range for learning to walk
  is between 9 and 15 months, and a 20-month-old
  child has still not begun walking, this would be
  considered a developmental delay.

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prenatal
Chromosome/DNA disorders, e.g. Down's syndrome, fragile X syndrome genetic
Cerebral dysgenesis, e.g. microcephaly, absent corpus callosum, hydrocephalus, neuronal migration disorder, vascular occlusion
Hypothyroidism, phenylketonuria metabolic
Alcohol and drug abuse teratopgenic
Rubella, cytomegalovirus, toxoplasmosis Congenital infection
Tuberous sclerosis, neurofibromatosis ncs
Perinatal  
Intraventricular haemorrhage/periventricular leucomalacia Extreme prematurity
Hypoxic-ischaemic encephalopathy Birth asphyxia
Symptomatic hypoglycaemia, hyperbilirubinaemia metabolic
l Postnatal 
Meningitis, encephalitis infection
Suffocation, near drowning, seizures anoxia
Head injury - accidental or non-accidental trauma
Hypoglycaemia, inborn errors of metabolism meabolic
other 
Unknown (about 25)  
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• The severity can be categorised as
• mild
• moderate
• severe
• profound

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Types of delay

• 1.Global developmental delay implies delay in
  acquisition of all skill fields (gross motor,
  vision and fine motor, hearing and
  speech/language, social/emotional and behaviour).
  It usually becomes apparent in thefirst 2 years
  of life.

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• . However, some children present later with, for
  instance, delay in speech and language but review
  of their developmental history may reveal delayed
  gross and fine motor Global developmental delay
  is likely to be associated with cognitive
  difficulties although these may only become
  apparent several years later.

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• 2.Specific developmental delay is when one field
  of development or skill area is more delayed than
  others or is developing in a disordered way

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Abnormal motor development

• This may present as delay in acquisition of motor
  milestones, e.g. head control, rolling, sitting,
  standing, walking or as problems with balance, an
  abnormal gait, asymmetry of hand use, involuntary
  movements or rarely loss of motor skills. Concern
  about motor development usually presents between
  6 months and 2 years of age when acquisition of
  motor skills is occurring most rapidly

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Causes of abnormal motor development include

• cerebral palsy
• congenital myopathy/primary muscle disease
• spinal cord lesions, e.g. spina bifida
• global developmental delay as in many syndromes
  or of unidentified cause

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Fine motore vision

• Visual impairment may present in infancy with
  loss of red reflex from a cataract
• a white reflex in the pupil, which may be due to
  retinoblastoma, cataract or retinopathy of
  prematurity (ROP).
• not smiling responsively by 6 weeks post-term
• lack of eye contact with parents
• visual inattention, random eye movements
• nystagmus ,squint
• photophobia

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Hearing speech and language

• Abnormal speech and language development A child
  may have a deficit in either receptive or
  expressive speech and language, or both. The
  deficit may be a delay or a disorder.

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Speech and language delay may be due

• global developmental delay
• to hearing loss
• difficulty in speech production from an
  anatomical deficit, e.g. cleft palate, or
  oromotor incoordination, e.g. cerebral palsy
• environmental deprivation/lack of opportunity for
  social interaction
• normal variant/familial patter

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Abnormal development of social/communication
skills

• Children who fail to acquire normal social and
  communication skills may have an autistic
  spectrum disorder. The prevalence of autistic
  spectrum disorder is 3-6/1000 live births. It is
  more common in boys. Presentation is usually
  between 2 and 4 years of age when language and
  social skills normally rapidly expand. The
  children present with a triad of difficulties and
  associated co-morbidities

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• Developmental Quotient (DQ)
• Divide childs developmental or best milestone
  age (DA) by childs chronological age (CA)
• DQ DA/CA x 100
• DQ of 100 mean or average rate
• DQ lt 70 is approx. 2 standard deviations below
  the mean

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Developmental Quotient

• DQ gt 80 may be considered normal
• DQ 70-80 borderline
• DQ lt 70 is abnormal

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abnormal developmTable 4-2. consider for ent
Investigations or assessment to
karyotypeCytogenetic Chromosome
Fragile X analysis
DNA FISH analysis, e.g. for chromosome 7, 15,
Thyroid function tests, liver function tests, bone chemistry, urea and electrolytes, plasma a Metabolico
Creatine kinase, blood lactate, VLCFA (very long chain fatty acids), ammonia, blood gases, white cell (lysosomal) enzymes, urine amino and organic acids, urine mucopolysaccharides (GAG) reducing substanc 
Maternal amino acids for raised phenylalanine
Congenital infection screen Infection
CT and MRI brain scans Skeletal survey Cranial ultrasound in newborn Imaging
EEG (may be specific for seizures, some progressive neurological disorders) Neurophysiology
Nerve conduction studies, EMG, VEP (visual evoked potentials), ERG (electroretinogram 
Nerve and muscle biopsy Histopathology/histochemistry
r other
Hearing
Vision
Clinical genetics
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management

• Assistive technology (devices a child might need)
  
• Audiology or hearing services
• Counseling and training for a family
• Educational programs
• Medical services
• Nursing services Nutrition services
• Occupational therapy Physical therapy
• Psychological services Respite services
• Speech/Language

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THANK YOU