Childhood Development

1
Childhood Development
2
An Approach to Growth and Development

• Infant development occurs in an orderly and
  predictable manner that is determined
  intrinsically
• Development proceeds from cephalic to caudal,
  proximal to distal, and from generalized
  reactions to stimuli to specific, goal-directed
  reactions that become increasingly precise

3
An Approach to Growth and Development

• Extrinsic forces can modulate the velocity and
  quality of developmental progress

4
Areas of Development

• Physical growth
• Motor (gross and fine motor skills)
• Cognitive
• Problem-solving
• Speech and language
• Receptive language
• Expressive language
• Psychosocial

5
An Approach to Development

• Each developmental domain must be assessed during
  health supervision visits.
• Generalizations cannot be based on the assessment
  of skills in one domain
• Skills in one domain affect the acquisition and
  assessment of skills in other domains

6
An Approach to Development

• Speech delays are the most common developmental
  concern seen by the general pediatrician
• It is important to distinguish an isolated speech
  or articulation delay from a true language delay(
  which involves problems with both receptive and
  expressive language)

7
An Approach to Development

• It is essential to understand normal development
  and acceptable variations in normal developmental
  patterns to be able to recognize patterns that
  are pathologic and may represent a true
  developmental delay

8
Physical Growth

• Growth milestones are the most predictable
  although each child must be viewed in the context
  of their genetic and ethnic influences
• In general, weight loss occurs within the first
  six days of life
• Regain birth weight by 2 weeks
• Expected weight gain in first six months 5-7
  oz./week or 20-30 gm/day

9
Physical Growth

• Birth-weight doubles by 5 months of age, triples
  by 1 year
• Weight is the first growth parameter to be
  affected by malnutrition, head circumference the
  last
• Height doubles between 3 and 4 years
• By age 2, children have reached about 50 of
  adult height

10
Physical Growth

• At birth, the head is 75 of adult size, close to
  90 by age 2 years
• Head growth in the first 5-6 months is due to
  continued neuronal cell division
• Later, increasing head size is due to neuronal
  cell growth and supporting tissue proliferation

11
Motor Development

• Gross motor development proceeds from a sequence
  or prone milestones to sitting then
  standing/ambulating
• Gross motor milestones do not take quality of
  movements into account
• Quality of movements are best evaluated in the
  motor component of the neurologic exam-
  especially, station and gait

12
Motor Development

• The best clues about motor development can be
  obtained from observation
• Fine motor skills progress as control over
  movements of the upper extremities develop
• Initially upper extremities are used to balance
• Once balance is achieved, hands become available
  for manipulation of objects

13
Motor Development

• As development moves from proximal to distal,
  reaching and manipulative skills are enhanced and
  manual exploration replaces oral exploration

14
Cognitive Development

• Intellectual development depends on learning that
  contains three componentsattention, information
  processing and memory
• Intellectual development is reflected in
  advancing abilities to comprehend, reason and
  make judgments
• In infants, evaluate intelligence by language and
  problem-solving

15
Language Development

• Language development during infancy can be
  divided into three periods
• Prespeech period (0-10 months)
• Naming period ( 10-18 months)
• Word Combination period (18-24 months)
• Expressive language will lag behind receptive
  language

16
Traits that measure Temperament

• Activity level
• The level of physical activity, motion and
  restless or fidgety activity in daily activities
• Adaptability to change
• How a child adjusts to change or new situations
• Positive or negative mood
• Degree of pleasantness or unfriendliness
• The glass is half empty or half full

17
Traits that measure Temperament

• Intensity of emotional responses
• The energy level with which a child responds
• Rhythmicity of biologic functions
• Presence or absence of a regular pattern for
  basic physical functions
• Persistence in the face of environmental
  counterforces (attention span)
• The ability to concentrate or stay on a task

18
Traits that measure Temperament

• Distractibility or ease of soothing
• The ease with which a child can be distracted
  from a task or situation
• Reactions in new situations or to new stimuli
• Rapid vs. slow, hesitant vs. excited
• Sensory threshold
• Amount of stimulation necessary to produce a
  response from a particular child

19
Toddlers Infants Gone Wild

• Physical growth occurs more slowly but still at a
  predictable rate-
• Weight gain 2 kg/year, height 5-7 cm/yr
• A toddlers behavior style or temperament is
  highly visible and influences all interactions
• Toddlers transition from sensorimotor to
  preoperational thinking

20
Toddlers Infants Gone WildAffective development

• Temperament
• Attachment
• Autonomy/Independence
• Impulse control

21
Toddlers Cognitive Development

• Sensorimotor
• Learns by touching, looking and seeing
• Out of sight, out of mind

• Preoperational
• Child can form mental images and solve problems
  by mental trial and error
• One object can represent another
• Imitate past events
• Object permanence

22
Preschoolers Toddlers re-tamed

• Still preoperational
• Egocentric or interprets the world in reference
  to wants, needs or influences
• Associate inanimate objects with human feelings
• Magical thinking-humans cause or create all
  natural events

23
School Aged Children

• Acceleration of separation/individuation
• Begin to move to concrete operational thinking
  which is manipulation of concrete objects
  involving more than one variable
• Children are able to classify, number and order
  objects
• Important tasks in this stage achievement in
  school and acceptance by peers