Download - GROWTH AND DEVELOPMENT
GROWTH AND DEVELOPMENTGROWTH AND DEVELOPMENTGROWTH AND DEVELOPMENTGROWTH AND DEVELOPMENT
Dr.Khalid Hama salih,
Pediatrics specialist M.B.Ch.; D. C.H
F.I.B.M.S.ped
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IntroductionIntroduction::
An estimated 12-16% of children have a An estimated 12-16% of children have a developmental and/or behavior disorderdevelopmental and/or behavior disorder
Only 30% are identified before school Only 30% are identified before school entranceentrance
Those detected after school entrance miss out Those detected after school entrance miss out on early intervention services proven to have on early intervention services proven to have long term health benefitslong term health benefits
DelayDelay - implies slow acquisition of all skills - implies slow acquisition of all skills (global delay) or of one particular field or area (global delay) or of one particular field or area of skill (specific delay), particularly in relation of skill (specific delay), particularly in relation to developmental problems in the 0-5 years to developmental problems in the 0-5 years age group.age group.
Development delayDevelopment delay
the condition where a child does not reach one the condition where a child does not reach one of the stages of development at the expected of the stages of development at the expected For example, if the normal range for learning For example, if the normal range for learning to walk is between 9 and 15 months, and a 20-to walk is between 9 and 15 months, and a 20-month-old child has still not begun walking, month-old child has still not begun walking, this would be considered a developmental this would be considered a developmental delay. delay.
prenatal
geneticChromosome/DNA disorders, e.g. Down's syndrome, fragile X syndrome
Cerebral dysgenesis, e.g. microcephaly, absent corpus callosum, hydrocephalus, neuronal migration disorder, vascular occlusion
metabolicHypothyroidism, phenylketonuria
teratopgenicAlcohol and drug abuse
Congenital infectionRubella, cytomegalovirus, toxoplasmosis
ncsTuberous sclerosis, neurofibromatosis
Perinatal
Extreme prematurityIntraventricular haemorrhage/periventricular leucomalacia
Birth asphyxiaHypoxic-ischaemic encephalopathy
metabolicSymptomatic hypoglycaemia, hyperbilirubinaemia
Postnatal l
infectionMeningitis, encephalitis
anoxiaSuffocation, near drowning, seizures
traumaHead injury - accidental or non-accidental
meabolicHypoglycaemia, inborn errors of metabolism
other
Unknown (about 25%)
The The severityseverity can be categorised as: can be categorised as: mild mild moderate moderate severe severe profoundprofound
Types of delayTypes of delay
1.Global developmental delay implies delay in 1.Global developmental delay implies delay in acquisition of all skill fields (gross motor, acquisition of all skill fields (gross motor, vision and fine motor, hearing and vision and fine motor, hearing and speech/language, social/emotional and speech/language, social/emotional and behaviour). It usually becomes apparent in behaviour). It usually becomes apparent in thefirst 2 years of life.thefirst 2 years of life.
. However, some children present later with, . However, some children present later with, for instance, delay in speech and language but for instance, delay in speech and language but review of their developmental history may review of their developmental history may reveal delayed gross and fine motor Global reveal delayed gross and fine motor Global developmental delay is likely to be associated developmental delay is likely to be associated with cognitive difficulties although these may with cognitive difficulties although these may only become apparent several years later. only become apparent several years later.
2.Specific developmental delay is when one 2.Specific developmental delay is when one field of development or skill area is more field of development or skill area is more delayed than others or is developing in a delayed than others or is developing in a disordered waydisordered way
Abnormal motor developmentAbnormal motor development
This may present as delay in acquisition of This may present as delay in acquisition of motor milestones, e.g. head control, rolling, motor milestones, e.g. head control, rolling, sitting, standing, walking or as problems with sitting, standing, walking or as problems with balance, an abnormal gait, asymmetry of hand balance, an abnormal gait, asymmetry of hand use, involuntary movements or rarely loss of use, involuntary movements or rarely loss of motor skills. Concern about motor motor skills. Concern about motor development usually presents between 6 development usually presents between 6 months and 2 years of age when acquisition of months and 2 years of age when acquisition of motor skills is occurring most rapidlymotor skills is occurring most rapidly
Causes of abnormal motor Causes of abnormal motor development includedevelopment include::
cerebral palsy cerebral palsy congenital myopathy/primary muscle disease congenital myopathy/primary muscle disease spinal cord lesions, e.g. spina bifida spinal cord lesions, e.g. spina bifida global developmental delay as in many global developmental delay as in many
syndromes or of unidentified causesyndromes or of unidentified cause
Fine motore &visionFine motore &vision:: Visual impairment may present in infancy with: loss Visual impairment may present in infancy with: loss
of red reflex from a cataract of red reflex from a cataract a white reflex in the pupil, which may be due to a white reflex in the pupil, which may be due to
retinoblastoma, cataract or retinopathy of retinoblastoma, cataract or retinopathy of prematurity (ROP). prematurity (ROP).
not smiling responsively by 6 weeks post-term not smiling responsively by 6 weeks post-term lack of eye contact with parents lack of eye contact with parents visual inattention, random eye movements visual inattention, random eye movements nystagmus ,squint nystagmus ,squint photophobia photophobia
Hearing speech and languageHearing speech and language
Abnormal speech and language development Abnormal speech and language development A child may have a deficit in either receptive A child may have a deficit in either receptive or expressive speech and language, or both. or expressive speech and language, or both. The deficit may be a delay or a disorder. The deficit may be a delay or a disorder.
Speech and language Speech and language delaydelay may be due may be due::
global developmental delay global developmental delay to hearing lossto hearing loss difficulty in speech production from an difficulty in speech production from an
anatomical deficit, e.g. cleft palate, or anatomical deficit, e.g. cleft palate, or oromotor incoordination, e.g. cerebral palsy oromotor incoordination, e.g. cerebral palsy
environmental deprivation/lack of opportunity environmental deprivation/lack of opportunity for social interaction for social interaction
normal variant/familial patternormal variant/familial patter
Abnormal development of Abnormal development of social/communication skillssocial/communication skills
Children who fail to acquire normal social and Children who fail to acquire normal social and communication skills may have an autistic communication skills may have an autistic spectrum disorder. The prevalence of autistic spectrum disorder. The prevalence of autistic spectrum disorder is 3-6/1000 live births. It is spectrum disorder is 3-6/1000 live births. It is more common in boys. Presentation is usually more common in boys. Presentation is usually between 2 and 4 years of age when language between 2 and 4 years of age when language and social skills normally rapidly expand. The and social skills normally rapidly expand. The children present with a triad of difficulties and children present with a triad of difficulties and associated co-morbiditiesassociated co-morbidities
Developmental Quotient (DQ)Developmental Quotient (DQ) Divide child’s developmental or best Divide child’s developmental or best
milestone age (DA) by child’s chronological milestone age (DA) by child’s chronological age (CA)age (CA)
DQ = DA/CA x 100DQ = DA/CA x 100 DQ of 100 = mean or average rateDQ of 100 = mean or average rate DQ < 70 is approx. 2 standard deviations DQ < 70 is approx. 2 standard deviations
below the meanbelow the mean
Developmental QuotientDevelopmental Quotient
DQ > 80 may be considered normalDQ > 80 may be considered normal DQ 70-80 borderlineDQ 70-80 borderline DQ < 70 is abnormalDQ < 70 is abnormal
abnormal developmTable 4-2. abnormal developmTable 4-2. consider for entconsider for ent
Investigations or assessment to
Chromosome*karyotypeCytogenetic
*Fragile X analysis
DNA FISH analysis, e.g. for chromosome 7, 15 ,
MetabolicoThyroid function tests, liver function tests, bone chemistry, urea and electrolytes, plasma a
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
InfectionCongenital infection screen
ImagingCT and MRI brain scansSkeletal surveyCranial ultrasound in newborn
NeurophysiologyEEG (may be specific for seizures, some progressive neurological disorders)
Nerve conduction studies, EMG, VEP (visual evoked potentials), ERG (electroretinogram
Histopathology/histochemistryNerve and muscle biopsy
otherr
*Hearing
*Vision
Clinical genetics
managementmanagement Assistive technology (devices a child might Assistive technology (devices a child might
need) need) Audiology or hearing services Audiology or hearing services Counseling and training for a family Counseling and training for a family Educational programs Educational programs Medical services Medical services
Nursing services Nutrition services Nursing services Nutrition services Occupational therapy Physical therapy Occupational therapy Physical therapy Psychological services Respite services Psychological services Respite services Speech/Language Speech/Language