Childhood Development

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

An Approach to Growth and Development

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

Areas of Development

• Physical growth

• Motor (gross and fine motor skills)

• Cognitive– Problem-solving– Speech and language

• Receptive language• Expressive language

• Psychosocial

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

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)

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

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

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

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

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

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

Motor Development

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

Cognitive Development

• Intellectual development depends on learning that contains three components:attention, 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

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

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”

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

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

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 toddler’s behavior style or temperament is highly visible and influences all interactions

• Toddlers transition from sensorimotor to preoperational thinking

Toddlers: Infants Gone WildAffective development

• Temperament

• Attachment

• Autonomy/Independence

• Impulse control

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

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

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