Child Growth & Development

Rini SekartiniGrowth & Development – Social PediatricsGrowth & Development  Social PediatricsDept. of Child Health Medical  Faculty  University IndonesiaCipto Mangunkusumo National General Hospital 1

ChildChildC ti 18 (C ti f ChildConception – 18 years (Convention of Child Right & Indonesian Child Protection Right)B dBased on :

anatomical growth (epipyphise clossed, d ti t t ti t )reproductive system maturation etc. )

Psychosocial development (adolescent d lth d)adulthood)

Child not a miniature of adult !!S ifi t th d d l tSpecific aspects: growth and development

2

Growth & Development Periods(UUPA 23 h 2002)(UUPA no 23 tahun 2002)

3

Child G thChild Growth

• Increases of physical sizes

1. Height2. Weightg3. Head circumference

Increases of cells, matrixes, connective tissues, bones, muscles, organ systems , , , g yetc.

4

……. growth……. growth

• Determinant factors of growth• Determinant factors of growth– internal :

o genetic : father mother grandpao genetic : father, mother, grandpa, grandma

o intrauterine process : nutritiono intrauterine process : nutrition, disease, drug, pollution, toxin ,

– external : nutrition disease pollutionexternal : nutrition, disease, pollution, exercise, emotional support

5

Development• Increases of all child functions

1 Sensory : auditory visual

p

1. Sensory : auditory, visual2. Motor : gross, fine motor3. cognitive (knowledge, inteligence)g ( g , g )4. communication / language 5. socio-emotional, behavior 6 lf h l6. self help7. creativity8 leadership8. leadership9. spiritual

Increases maturation of organ system : mainly brain and neuromuscular system 6

E b i 8 i Fetus 12 mingguF ili i Embrio 8 minggu Fetus 12 mingguFertilisasi

Fetus 16 minggu Fetus 24 minggu

CHILD GROWTH & DEVELOPMENT

Role of environment : fulfill the basic needs

Mother, Substitute

Father siblings caregiver Father, siblings, caregiver, toys, stimulation, norm,

Health & education servicesBio-psychosocial

needs

WHO, Unicef, Government, professional policy

10(Kobayashi, 1985; Bronfenbrenner, 1986; Sularyo, 1989; Ismael, 1991, Needlman, 2000)

The Basic Needs for Better Growth & Development

1. BIOLOGICAL NEEDS : nutrition (breastfeed exclusively) immunisation hygiene healthexclusively), immunisation, hygiene, health services, clothes, housing, sanitation, plays facility, sport, recreation, and sleep )y, p , , p )

2. PSYCHOSOCIAL & Emotional needs : democratic , parenting love, warm, attention, care, protection, help, support, reward, guidance, models

3 Stimulation / play needs3. Stimulation / play needs 11

Basic Needs for Better Growth & DevelopmentBasic Needs for Better Growth & Development

I. BIOLOGICAL NEEDSI. BIOLOGICAL NEEDS1. Nutrition : since intra-uterine (fetal)

• Balance of : protein, carbohydrate,Balance of : protein, carbohydrate, fat, vitamin, mineral

• Protein : cells & organ growth and function, protection for infection

• Carbohydrat : energy, cells activitiesactivities

• Fat : energy, cells functions & activitiesactivities

• Vitamin & Mineral : regulator12

2. Immunization : since newborn – 18 years– protect for diseases prevent severity– Hepatitis B, BCG, DPT, Polio, Measles

HiB MMR (M M billi R b ll )– HiB, MMR (Mumps, Morbilli, Rubella),– Thypoid Fever, Chicken Pox, Infulenza etc

3. Hygiene :– Personal : wash hand, nail, bath, toilet, , ,– Food : meals, vegetables, fruit, water, snack– House, School, Playground, Transport, Public

AArea– Environment : smoke, dust, waste, toxins, insect13

Immunisation schedule

14

4. Play / physical activities – stimulates growth hormones, apetite, s u a s g o o o s, ap ,

metabolism of protein, carbohydrat, fat– stimulates muscles & bone growth

ti l t d l t l– stimulates developmental

5. Medical services : ti f di i i ti– prevention for diseases : immunization,

education– monitoring growth & developmentmonitoring growth & development– early detection & treatment

• diseasesd l f h & d l• delay of growth & development

15

SleepSleep

16

……emotional……emotional

II. EMOTIONAL NEEDS : since intrauterine (6 months of pregnancy)

• DEMOCRATIC PARENTING love, warmth attention care protection rewardwarmth, attention, care, protection, reward, fair

• guidance, models, less prohibitionguidance, models, less prohibition• no physical punishment• develop basic trust, emotional intelligence, p g

self-esteem, cooperation, creativity17

Basic Needs for Better Growth & Development p(Emotional Needs)

• Parenting styles1. Democratic (authoritative)2 Di t t ( th it i ) i h t b2. Dictator (authoritarian) punishment, abuse3. Permissive no rule 4 Uninvolved neglect4. Uninvolved neglect

• Child Temperament1 Easy1. Easy2. Difficult 3 Slow to warm3. Slow to warm4. Mixed

18

III STIMULATIONS NEEDS : since intra uterineIII. STIMULATIONS NEEDS : since intra uterine (6 mo of pregnancy)

• sensoric motoric cognitive communication -sensoric, motoric, cognitive, communication language, socio-emotional, self-help, creativity, cooperation and leadership, spiritual etc

• through repetitive experiences : parents sounds, music, movement, touch, speak, singing, act,

l b i it dplay, brain gym, write, draw, • repetitive experiences : stimulates complecity

connection (sinaps) between brain cellsconnection (sinaps) between brain cells, • left & right brain• develop multiple intelligencep p g

19

Timing for stimulations synaptogenesis.H tt l h 1987 J i t l 1991 Pf ff b t ll 1994Huttenlocher, 1987; Jernigan, et al, 1991; Pfefferbaum et all, 1994

Cerebral glucose metabolic rateg

Age (in years) (Chugani, 1999)20

poorstimulation

lowbi h i h

poorhousing

Bottle-feeding

Zinc

stimulation birthweight

housing Zinc

iodinelack of

good nutriton,health,

Braindevelopment

ironaffection

stunting

wastingLow parental

d ti

stimulation& care

wasting

hungeri f i

education

?

8

hungerinfection

FIGURE : Nutritional and environmental influences on brain development21

3636

3636

22

Pengaruh Nutrisi, Kasih Sayang & Stimulasi

BayiBayi BaruBaru LahirLahir CukupCukup NutrisiNutrisi && StimulasiStimulasiKurangKurang NutrisiNutrisi, , KasihKasihSayangSayang dandan StimulasiStimulasi

pada Jumlah sel dan Percabangan Sel-sel Otak

BayiBayi BaruBaru LahirLahir CukupCukup NutrisiNutrisi, &, & StimulasiStimulasi SayangSayang dandan StimulasiStimulasi

23

Brain & Sinaps growthp g

24

Multiple intellegencep g

Sinas Batam, 30-31 Juli 2009 25

Berbagai Potensi Kecerdasan AnakBerbagai Potensi Kecerdasan Anak

1. Verbal linguistic : merangkai kalimat, bercerita, 2. Logical-mathematical : pemecahan masalahg p3. Visual spatial : berpikir 3 dimensi, stereometris4. Bodily – kinesthetic : gerak, tari, atlit olahraga5 Musical : bunyi nada irama lagu musik5. Musical : bunyi, nada, irama, lagu, musik6. Intrapersonal : memahami & kontrol diri sendiri7. Interpersonal : memahami & menyesuaikan dengan

orang lain 8. Naturalis : menikmati & memanfaatkan alam9. Moral-Spiritual : etika, moral, budi-pekerti, rohani, agamap , , p , , g

26

• Left brain– logico – mathematic, rational analytic, science– grammar, reading, writing

• Right brainimagination creativity art– imagination, creativity, art

– socio-emotional, musical, singing, spatial– cooperation, leadershipcooperation, leadership – spiritual

• Stimulators : parent, care-giver, siblings, playgroup, school, TV, magazine, books, tools

27

GROWTHGROWTH

28

Proportion of body heightProportion of body height

29

Influence of genetic to body heightInfluence of genetic to body height

Range of prediction final height at 18 years old

Boys = (Father + mother height + 13 cm ) + 8,5 cm2

Girls = (Father + mother height – 13 cm) + 8,5 cm2

32

GROWTH MONITORINGGROWTH MONITORING

33

Length and weight for age precentiles curve 0 – 36 monthFor BODY GROWTH MONITORING

Age (months) A ( th )

BOYS GIRLS

Length Length

Age (months) Age (months)

e gt Length

Weight Weight

34

Age (months) Age (months)

Head circumferrence for age 0 – 36 mo : for brain growth monitoringWeight for length 0 – 36 mo : for nutritional status monitoringg g g

Age (months)

BOYS GIRLS

Age (months)Age (months) g ( )

Head circumferrenceHead circumferrence

Head circumferrence

W i htWeight

Length

Weight

35

Stature and weight percentile for age 0 – 12 yearsFor GROWTH MONITORING

36

Weight and stature for age precentile curve : nutritional status

BOYS GIRLS

Weight

Stature

Stature

37

Body mass index (BMI) for age 2 – 20 year precentile: nutritional statusBody mass index = weight / height in m2y g g

BOYS GIRLS

Body mass index Body mass index

A ( ) Age (years)

38

Age (years) Age (years)

39

40

41

42

NORMAL GROWTH :

NORMAL GROWTHNORMAL GROWTHNORMAL GROWTHNORMAL GROWTH

43

ABNORMAL GROWTHABNORMAL GROWTH

44

45

KMS BARUKMS BARU

BUKU KESEHATAN IBU ANAK (KIA)BUKU KESEHATAN IBU ANAK (KIA)

• Buku pesan‐pesan penting d k h bdan catatan kesehatan ibu dan anak

• 2 bagian: bagian pertama k b i ibmerupakan bagian ibu; 

sedangkan bagian ke‐2 merupakan bagian anak. .

• bagian anak berisi catatan• bagian anak berisi catatan dan pesan‐pesan penting untuk monitoring pertumbuhan/pertumbuhan/ perkembangan, imunisasi, cara mengatasi penyakit yang sering diderita, serta mencegah kecelakaan.

Nutritional Status Table

48

Tabel Berat Badan (BB) terhadap Tinggi Badan (TB)Untuk MENILAI STATUS GIZI

Interpretasi berdasar tabel TB/BBNormal / gizi baik : -2 SD s/d +2 SD Kurus / gizi kurang : <-2 SD - (-3 SD)

/ 3 SKurus sekali / gizi buruk : < - 3 SDGemuk / gizi lebih : > + 2 SD

Gejala KLINIS : udem, rambut, mata, kulit, mulut, perut, hati, lengan, kaki, dll.

Tindakan (Lihat Buku Pedoman Tatalaksana Gizi Buruk)MTBS (Manajemen Terpadu Balita Sakit)

Lingkar KepalaBerhubungan dengan perkembangan volume otak

Lingkar kepala lebih besar dari normal (makrosefali)Lingkar kepala lebih besar dari normal (makrosefali)88% IQ normal, 5 % keterbelakangan mental ringan,5 % keterbelakangan mental ringan,7 % keterbelakangan mental berat

(L b & P i l 1981)(Lober & Priestly, 1981)

Lingkar kepala lebih kecil dari normal (mikrosefali)

53

keterbelakangan mental 53

BOY HEAD CIRCUMFERRENCE

GIRLHEAD CIRCUMFERRENCE

NORMAL NORMAL HEAD CIRCUMFERRENCEHEAD CIRCUMFERRENCE ABNORMAL ABNORMAL HEAD CIRCUMFERRENCEHEAD CIRCUMFERRENCECURVECURVE HEAD CIRCUMFERRENCE HEAD CIRCUMFERRENCE

CURVECURVE

54

55

CHILD DEVELOPMENTCHILD DEVELOPMENT

56

Child Developmental Aspects

57

Corellation between parental concern andCorellation between parental concern and delayed development

Parental concernGeneral ( ..my child left behind.. )Fi

Probability80 %75 %Fine motor

LanguageBehavior

75 %55 %41 %

Academic skill (> 4 ys old)Gross motorSocial skill

40 %nsnsSocial skill

Self helpnsns

(Glascoe, 1996)58

59

60

Piaget's Stages of Cognitive DevelopmentSensory Motor Period

(0 - 24 months)

Developmental StageDevelopmental Stage & Approximate Age Characteristic Behavior

Reflexive Stage(0-2 months)

Simple reflex activity such as grasping, sucking.

Primary Circular Reactions(2-4 months)

Reflexive behaviors occur in stereotyped repetition such as opening and closing fingers repetitively.

Secondary Circular Repetition of change actions to reproduce interesting yReactions (4-8 months)

p g p gconsequences such as kicking one's feet to more a mobile suspended over the crib.

Coordination of Secondary Reactions (8 12 th )

Responses become coordinated into more complex sequences. Actions take on an "intentional" character such as th i f t h b hi d t bt i hidd bj t(8-12 months) the infant reaches behind a screen to obtain a hidden object.

Tertiary Circular Reactions(12-18 months)

Discovery of new ways to produce the same consequence or obtain the same goal such as the infant may pull a pillow toward him in an attempt to get a toy resting on it.

Invention of New Means Through Mental Combination(18-24 months)

Evidence of an internal representational system. Symbolizing the problem-solving sequence before actually responding. Deferred imitation.

61

Tahap sensorimotorTahap sensorimotor• Refleks primitif (0-2 bulan)Refleks primitif (0 2 bulan)• Reaksi sirkular primer (2-4 bulan)• Reaksi sirkular sekunder (6-8 bulan)• Reaksi sirkular sekunder (6 8 bulan)• Koordinasi reaksi sekunder (8-12 bulan)• Reaksi sirkular tersier (12 18 bulan)• Reaksi sirkular tersier (12-18 bulan)• Representasi mental (18-24 bulan)

62

The Preoperational Period(2-7 years)

Developmental Stage & Approximate Age Characteristic Behavior

Preoperational Phase Increased use of verbal representation but speech isPreoperational Phase(2-4 years)

Increased use of verbal representation but speech is egocentric. The beginnings of symbolic rather than simple motor play. Transductive reasoning. Can think about something without the object being present by use of languageof language.

Intuitive Phase(4-7 years)

Speech becomes more social, less egocentric. The child has an intuitive grasp of logical concepts in some areas. However, there is still a tendency to focus attention on one aspect of an object while ignoring others. Concepts formed are crude and irreversible. Easy to believe in magical increase, decrease, disappearance. Reality not firm. Perceptions dominate judgment.

In moral-ethical realm, the child is not able to show principles underlying best behavior Rules of a game notprinciples underlying best behavior. Rules of a game not develop, only uses simple do's and don'ts imposed by authority.

63

Period of Concrete Operations(7-11 years)

Characteristic Behavior:Evidence for organized logical thought There is the ability to performEvidence for organized, logical thought. There is the ability to perform multiple classification tasks, order objects in a logical sequence, and comprehend the principle of conservation. thinking becomes less transductive and less egocentric. The child is capable of concrete problem-solving.

Some reversibility now possible (quantities moved can be restored such as in arithmetic: 3+4 = 7 and 7-4 = 3, etc.)

Class logic-finding bases to sort unlike objects into logical groups where previously it was on superficial perceived attribute such as color. Categorical labels such as "number" or animal" now available.

64

Period of Formal Operations(11-15 years)

Characteristic Behavior:Thought becomes more abstract, incorporating the principles of formal logic. The ability to generate abstract propositions, multiple hypotheses and their possible outcomes is evident Thinking becomes less tied to concrete realityevident. Thinking becomes less tied to concrete reality.

Formal logical systems can be acquired. Can handle proportions, algebraic manipulation, other purely abstract processes. If a + b = x then a = x - b. If ma/ca = IQ = 1.00 then Ma = CA.

Prepositional logic, as-if and if-then steps. Can use aids such as axioms to transcend human limits on comprehensionaxioms to transcend human limits on comprehension.

65

Social development p

Erikson's Eight Stages of Developmentg g p1. Basic Trust vs Basic Mistrust (Hope)2. Autonomy vs Shame 3. Initiative vs Guilt4. Identity vs Identity Diffusion 5. vs inferiority6. Intimacy vs Isolation 7 L i G ti it S lf Ab ti7. Learning Generativity vs Self-Absorption8. Integrity vs Despair

66

Evaluasi perkembanganEvaluasi perkembangan

• AnamnesisAnamnesis• PF• Milestones :• Milestones :

1. Kognitif2 B h2. Bahasa3. Sosial4. Motor kasar dan halus5. Mandiri

67

Cognitive developmentCognitive development

• Bulan 3‐5: mencoba meraih benda • Bulan 4‐8: menarik tali yang berujung gelang• Bulan 4‐8: menarik tali yang berujung gelang • Bulan 8‐15: meniru membelai boneka B l 14 20 k bj k t b i• Bulan 14‐20: menemukan objek  tersembunyi 

• Bulan 18‐28: menyelesaikan puzzles d hsederhana

68

L il tLanguage milestones • Bulan 1 5‐3: mengocehBulan 1.5 3: mengoceh 

• Bulan 3.5‐8: menoleh ke arah suara 

l 9 3 bi d• Bulan 9‐13: bicara Mama atau Dada 

• Bulan 14‐24: Kombinasi 2 kata berbeda 

• Bulan 21‐36: Menggunakan kata majemuk 

69

Milestone emosi‐sosial

• Bulan 1 5‐4: Senyum pada orang lainBulan 1.5 4: Senyum pada orang lain 

• Bulan 4‐9:  Mencari pengasuh utama 

l 8 G li h hd i• Bulan 8‐15: Gelisah thd orang asing 

• Bulan 10‐15: Menunjukan 2 jenis emosi Bulan 11‐20: Bermain eksploratif sendiri 

• Bulan   21‐36: Bermain kooperatif dlm pkelompok kecil

70

Gross motor developmentGross motor development 

• Bulan 3‐4 5 : tengkurapBulan 3 4.5  : tengkurap 

• Bulan 5‐8     : duduk tanpa pegangan 

l 0 b di i di i• Bulan 10‐14 : berdiri sendiri  

• Bulan 14‐20 : menaiki tangga  

• Bulan 21‐28:  mengayuh sepeda 

• Bulan 30‐44: berdiri 1 kakiBulan 30 44:  berdiri 1 kaki 

71

Fine motor developmental milestoneFine motor developmental milestone

• Bulan 2 5‐4: menggengam rattleBulan 2.5 4: menggengam rattle

• Bulan 4.5‐7: pindahkan kubus antar  tangan 

l 8 2 i• Bulan 8‐12 :  pincer grasp

• Bulan 15‐20: susun menara 4 kubus  

• Bulan 18‐24: meniru garis vertikal  

• Bulan 28‐36: menkopi lingkaranBulan 28 36: menkopi lingkaran 

72

Personal social developmental milestonePersonal social developmental milestone

• Bulan 4.5‐8: memasukan biskuit ke mulut 

• Bulan 10‐14: minum dari cangkir g

• Bulan 13‐19: membuka pakaian 

• Bulan 18 28: cuci dan keringkan tangan• Bulan 18‐28: cuci dan keringkan tangan 

• Bulan 30‐42: pakai pakaian tanpa bantuan 

73

Developmental Red FlagsDevelopmental Red Flags

SAAT HARUS BERTINDAK BILA ANAK BELUM DAPAT

MENGERJAKAN BUTIR KEMAMPUAN R RPERKEMBANGAN

PADA UMUR TERTENTUPADA UMUR TERTENTU

74

Red Flags: 0 – 3 blnRed Flags: 0  3 bln

• Rolling prior to 3 months 

l i hi iEvaluasi hipertoni

• Mengepal persistent > 3 bulan 

Evaluasi disfungsi neuromotor  

• Tidak bereaksi thd rangsang lingkunganTidak bereaksi thd rangsang  lingkungan         Evaluasi kelainan sensoris

75

Red Flags: 4 ‐ 6 bulanRed Flags: 4  6 bulan 

• Kontrol leher buruk (head lag) ( g)

Evaluasi hipotoni • Tidak meraih benda pd umur 5 bulan 

Evaluasi kelainan gerak, mata, kognitif • Tidak senyum 

Evaluasi fungsi penglihatan 

Evaluasi masalah perlekatan (attachment)

Evaluasi depresi ibuEvaluasi depresi ibu

Evaluasi kemungkinan child abuse atau child  neglectneglect

76

Red Flags: 12 ‐ 24 bulan (1) g

• Tidak mengucapkan konsonan pd umur 15 bulan g p pEvaluasi gangguan pendengaran (ringan) 

• Tidak meniru pada umur 16 bulan pEvaluasi gangguan pendengaran Evaluasi gangguan sosialisasi atau kognitif 

• Tidak menunjuk ke benda pada umur 18 bulan Problem dalam hubungan sosial 

• Dominasi tangan sebelum 18 bulan Kelemahan kontralateral dengan Hemiparesis

Red Flags: 12 ‐ 24 bulan (2)Red Flags: 12  24 bulan (2)

Tid k d t t ik t d 24 bl• Tidak dapat turun naik tangga pd umur 24 bln 

Mungkin kurang dapat kesempatan 

d d h ( h l l )• Advanced non‐communicative speech (mis. Echolalia) 

Perintah sederhana tidak dimengerti :  abnormal

Evaluasi untuk ASD• Delayed Language Development

Perlu evaluasi gangguan pendengaran 

Monitoring

• Growth monitoring:– Weight, height, head circumferrence– Nutritional status : weight - height

• Development monitoringp g– Gross motor– Fine motor (and vision)– Speech, hearing, communication, cognitionp , g, , g– Social, emotional, behaviour

• Family education and conseling inFamily education and conseling in– Growth and development– Nutrition, immunisation, play, stimulation, education– Protection from risks of :Protection from risks of :

• Bio-physics hazard : infection, polution, accident, addiction• Psychosocial hazard : abuse, neglect, exploitation, 79

Schedule for routine monitoring

• 0 – 1 years : 1 monthly

• 1 – 3 years : 3 monthly1 3 years : 3 monthly

• 3– 5 y ears : 6 monthly

• > 5 years ; 12 monthly

80

81

M i iMonitoring

I. History (+ observation)

II. Physical Examination

III. Developmental Screeningp g

IV. Family Education

82

I TAKE HISTORY f RISK FACTORSI. TAKE HISTORY of RISK FACTORS

Factors influence quality of growth & development :Factors influence quality of growth & development :A. INTRINSIC B. EXTRINSIC

A. INTRINSIC risk factorsbirthweight, Apgar score, asphyxia, convulsion, hyperbilirubinemia, infection, congenital abnormality, temperamenttemperament

83

B. EXTRINSIC risks factors (environment)( )1. MICRO environment (quality of mother, care-giver)

( f f2. MINI environment (quality of father, siblings housing, toys, faciliities, rule, norm, reward)

3 MESO environment (neighbour health &3. MESO environment (neighbour, health & educational services, sanitation)

4. MACRO environment (WHO, Unicef, proffesion4. MACRO environment (WHO, Unicef, proffesion program and services)

84

OBSERVATION : When a child enter :OBSERVATION : When a child enter :

face, head, body proportion, attention, communication, i t ti t b h iinteraction, movement, behavior

.

History - Parental concern about child development- Parental concern about child development

85

II Ph i l i iII. Physical examination1 Height weight head circumferrence1. Height, weight, head circumferrence

2. General physical examination

86

87

CARA MENIMBANG ANAK YANG BENAR 87

T f i h lTypes of weight scale

88

89PENGGUNAAN BATHROOM SCALE

(TIMBANGAN INJAK ORANG DEWASA)(TIMBANGAN INJAK ORANG DEWASA)

XX

TIDAK DIANJURKANTIDAK DIANJURKAN, SKALA KASAR (1 KG ), PER (PEGAS) MENJADI LEMAH SETELAH

DIPAKAI BEBERAPA KALI 89

Body length or height

90

Growth Indicators & ProblemsGrowth Indicators & Problems• Weightg

– Failure to thrive– Malnutrition → under nutrition/over nutrition

• Height– Short stature → < 3rd percentile height for age– Tall stature → >97th percentile height for age

• Head circumferenceMi h l– Microcephaly

– macrocephaly

91

Body length or heightBody length or height

92

Interpretation of nutritional status

• - 2 SD until + 2 SD = well nourished2 SD until 2 SD well nourished• < - 2 SD until – 3 SD = mild-moderate malnutrition• < - 3 SD = severe malnutrition< 3 SD severe malnutrition

93

Head Circumferrence

557 Macrocephaly (follow up 20 ys) :

88 % normal IQ, 5 % mild mental retardation, 7 % severe mental retardation (Lober &7 % severe mental retardation (Lober &

Priestly, 1981)

Microcephaly : mentally retardedMicrocephaly : mentally retarded

94

95

III D l t l S iIII. Developmental Screening

• Pre Developmental Screening Questionaire• DENVER II Developmental Screening Test• DENVER II Developmental Screening Test• Pediatric Symptom Checklist (PSC)

CHAT (Ch kli t f A ti i T ddl )• CHAT (Checklist for Autism in Toddlers)

96

PARENTS’ EVALUATION OF DEVEVELOPMENTAL STATUS (PEDS)

97

9/7/2010 98

KPSPKPSP

9/7/2010 99

9/7/2010 100

9/7/2010 101

9/7/2010 102

9/7/2010 103

9/7/2010 104

9/7/2010 105

Denver II

9/7/2010 106

Two items :• Two items :

– Cognitive Adaptive Cognitive Adaptive Test (CAT) ----Visual-motor

– Clinical Linguistic & Auditory Milestone Auditory Milestone Scale (CLAMS) ----bahasa

9/7/2010 107

9/7/2010 108

2. DENVER II• Gross motor• Fine motor, visual• Speech language hearingSpeech, language, hearing,

communication• Social, emotional, behaviour

109

3. PEDIATRIC SYMPTOMS CHECKLIST(Murphy & Jellineck, 1994)

For ages : 4 – 16 yearsContents : 35 items of child behaviour, answer by parent, 45 minutes

never (score 0)sometimes (score 1)often / always (score 2)often / always (score 2)

Interpretation: score > 28 should be reffered

Good sensitivity & excellent specifity(Glascoe, 1996)( , )

110

4 CHAT (Checklist for Autism in Toddlers)4. CHAT (Checklist for Autism in Toddlers)

• American Academy of Pediatrics y• Autistic Spectrum Disorder (ASD) > 18 mos of age• 9 questions for parents

5 b ti• 5 observation• Interpretation :

– Severe risk of ASDSevere risk of ASD – mild riskASD– others developmental disordersothers developmental disorders– normal

• Sensitivity < Pervasive Develop. Dis. Screen Test

111

Family education – GOBI FFF

• Growth and development monitoring• Oral rehydration• Breastfeeding

I i ti• Immunization• Family planning• Food supplementationpp• Family education

– Protection from risks of :Bi h i h d i f i ll i id• Bio-physics hazard : infection, pollution, accident, addiction

• Psychosocial hazard : abuse neglectPsychosocial hazard : abuse, neglect, exploitation,

– Child Right Convention 112

9/7/2010 113

Summaryy• Take history of (anamnesis) risk factors

– Period• Pregnancy and delivery of birth• Infancy, toddler, underfives• School age, adolescence

– Environmental risks :• Micro (mother), Mini (family)• Meso (neigbour, peer group, school, health services etc)• Macro (gov. policy etc)(g p y )

• Growth monitoring– Body weight, height, head circumferrence

N i i l– Nutritional status

• Developmental monitoring– Pre Screening Developmental Questionairre

114

Thank Youk i i@ hk i i@ hrsekartini@yahoo.comrsekartini@yahoo.com

115