child development dr arthur paynter community paediatrician (retired!) july 2014

Child Development Child Development

Dr Arthur Paynter Dr Arthur Paynter

Community Paediatrician (retired!)Community Paediatrician (retired!)

July 2014July 2014

Plan for todayPlan for today

Introduction Introduction DemonstrationDemonstration Developmental milestonesDevelopmental milestones

– Development at a glance

– DVD of normal development

Developmental delays and disordersDevelopmental delays and disorders Some common behavioural problemsSome common behavioural problems Learning & thinkingLearning & thinking

Attention Deficit Hyperactivity DisorderAttention Deficit Hyperactivity Disorder

• HyperactivityHyperactivity• ImpulsivityImpulsivity• InattentionInattention• (Note all these are normal in (Note all these are normal in

young pre school children, & young pre school children, & children with learning difficulties) children with learning difficulties) When is it abnormal? (6+)When is it abnormal? (6+)

ADHD ManagementADHD Management

• Understand the whole childUnderstand the whole child• Assessment of child, family, Assessment of child, family,

environmentenvironment• Environmental changes Environmental changes • MedicationMedication

Autistic Spectrum DisordersAutistic Spectrum Disorders

• Triad of impairments:Triad of impairments:– Communication– Social interaction– Imagination

• Attachment to routine & dislike of Attachment to routine & dislike of change change

• Range of ritualistic behavioursRange of ritualistic behaviours• Range of sensory issuesRange of sensory issues

Autistic Spectrum DisordersAutistic Spectrum Disorders

• It's a wide spectrum with classical It's a wide spectrum with classical autism with no communication autism with no communication and severe disability at one end and severe disability at one end to the cleaver but socially to the cleaver but socially awkward individual at the other.awkward individual at the other.

• Management! Management!

(Developmental Coordination (Developmental Coordination Disorder, DCD Dyspraxia )Disorder, DCD Dyspraxia )

• Hopping Tandem walking Throwing Hopping Tandem walking Throwing & catching a ball& catching a ball

• Lack of reciprocal movement arms Lack of reciprocal movement arms & legs& legs

• Associated movementsAssociated movements• 'clumsy ' children have both learning 'clumsy ' children have both learning

& social difficulties at school.& social difficulties at school.

Speech & Language DisordersSpeech & Language Disorders

• Simple speech delaySimple speech delay• Disorders due to sensory or physical Disorders due to sensory or physical

problemsproblems– Hearing impairments– Motor & neurological problems– Cognitive problems

• Specific language impairmentsSpecific language impairments– Semantic pragmatic (overlap ASD)

• Emotional behaviouralEmotional behavioural– Elective mutism

Behavioural problemsBehavioural problems

• TantrumsTantrums• EnuresisEnuresis• EncorpresisEncorpresis• School refusal School refusal • Sleep & the parasomniasSleep & the parasomnias

Stages of communicationStages of communication

TouchTouch MovementMovement Music (melody & rhythm)Music (melody & rhythm) Speech (words & grammar)Speech (words & grammar) Literacy Numeracy (symbolic)Literacy Numeracy (symbolic)

EnuresisEnuresis

• Diurnal or nocturnal? Primary or Diurnal or nocturnal? Primary or secondary?secondary?

– Medical causes UTI Diabetes Renal failure

• Ten% at 5 yrs 5% at 10 yrsTen% at 5 yrs 5% at 10 yrs• More common in boys more More common in boys more

persistent in girlspersistent in girls

Enuresis managementEnuresis management

• Sympathetic & non punitiveSympathetic & non punitive• Bladder training Bladder training • Star Charts & rewardsStar Charts & rewards• Alarms (cautions!)Alarms (cautions!)• MedicationMedication

– Desmopressin Imipramine!

EncorpresisEncorpresis

• Constipation with overflowConstipation with overflow• A fissure may have triggered A fissure may have triggered

withholdingwithholding• Tightly structured toilet & Tightly structured toilet &

behaviour managementbehaviour management• Laxatives Laxatives • Specialist referralSpecialist referral

Sleep disordersSleep disorders

• Obstructive sleep apnoeaObstructive sleep apnoea• Confusional states (deep sleep)Confusional states (deep sleep)• SomnambulismSomnambulism• Night terrorsNight terrors• Nightmares (in REM sleep)Nightmares (in REM sleep)

Sleep EEGSleep EEG