tuesday 17 th february chapter 2 hearing disorders in children/ hala alomari1

Hearing disorders in children/ Hala AlOmari

1

Lecture 7 child developmentTuesday 17th February

Chapter 2


2

To know key milestones of development in early childhood

To be able to recognise important features of developmental delay

To know routes of referral if concerned about a child’s development

To be aware of constraints imposed on audiological assessment by a child’s development

To be aware of the importance of development when assessing a child with HI

objectives


3

All children, normal and abnormal, progress from the helplessness of infancy to

the independence of maturity

Child development


4

Shelter and protection Food Warmth and clothing Fresh air and light Activity and rest Prevention of illness and injury Training in skills necessary for life

Physical needs


5

Affection and continuity of care Security and sense of belonging Sense of personal identity Opportunity to learn from experience Opportunity to achieve success Opportunity to achieve independence Opportunity to take responsibility

Psychological needs


6

Growth is an increase in size. Its progressions are mainly structural and can be measured with some degree of reliability in terms of height, weight, bone-age etc

Development is an increase in complexity. It involves both structure and function. It may manifest many individual variations

Growth and Development


7

Motor

Vision and fine movements

Hearing and speech

Social behaviour and spontaneous play

Human development


8

Little head control

Jerky movements of limbs

“Moro” reflex (https://www.youtube.com/watch?v=s_lAFst43T)

Forward reflex – “walking movement”

Hands closed at rest

Motor development1 month


9

Pull to sit – little or no head lag head held erect briefly

Held sitting – lumbar curve

Hands loosely open – bring together in midline

Prone – supports on forearms

Held standing – sags at knees

Motor development3 months


10

Sits alone for 10-15 minutes

Progresses on floor by rolling or squirming

Attempts to crawl – sometimes succeeds

Pulls to stand

Motor development 8-9 months


11

Walk alone usually –wide based gait

Move around floor rapidly (crawl/bottom shuffle)

May crawl upstairs and sometimes come backwards downstairs

Motor development 12-15 months


12

Walks well

Runs carefully

Pushes and pulls large toys

Walks upstairs with helping hand (and often downstairs)

Motor development 18 months


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Runs

Walks upstairs adult fashion

Usually jumps off bottom step

Rides a trike using pedals

Throws, catches and kicks a ball

Motor development 3 years


14

Turns head and eyes towards light

Watches mothers face when feeding or talking

Defensive blink by 6-8 weeks

Vision and Fine movements1 month


15

Visually very alert Moves head to gaze around Follows adult’s movements Follows dangling ball Watches hands – clasps and unclasps Briefly holds rattle – usually unable to

regard at same time

Vision and Fine movements3 months


16

Visually very attentive to people, objects and events (10-12 feet)

Manipulates objects with interest Uses both hands equally Points at distant objects “inferior pincer grasp” Prods small object

Vision and Fine movements8-9 months


17

Pick up with precise pincer grasp

Watches small toy pulled along the floor

Builds tower of 2 cubes

May show hand preference

Demands objects by finger pointing

Vision and Fine movements12-15 months


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Hand preference

Holds pencil mid-shaft


Enjoys picture books

Vision and Fine movements 18 months


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Can thread large beads

Copies circle and cross

Matches 2 or 3 primary colours

Cuts with scissors

Vision and Fine movements3 years


20

Startled by loud noises (aureopalpebral reflex)

Gutteral noises when content – from 5-6 weeks coos responsively to mother’s talk

(NB deaf babies also cry and vocalize in this reflex fashion)

Hearing and Speech1 month


21

Do not respond to the quietest sounds they can hear

Often unable to turn to sounds – other responses can be noted

Localisation often poor

Vocalizes tunefully – vowel or single and double “syllables” – a-a, muh, goo, der, adah, er-leh, aroo

(deaf babies surprised to see mother)

Hearing and Speech< 6 months


22

Turns head in response to minimal sounds (possible to do distraction test or VRA)

Shouts to attract attention Babbles loudly and tunefully – long

repetitive strings of syllables – dad-dad, mam-mam, adaba, agaga

(deaf babies – meagre and monotonous vocalisaton)

Hearing and Speech8-9 months


23

Immediate response to distraction test – but rapidly habituates

Says 2-3 words with meaning by one year increasing to several by 15 months

Understands meaning of phrases “where is your shoe”

Hearing and Speech 12-15 months


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Performance testing possible

Joins two or three words together in short sentences

Uses I, me and you Asks for drink, toilet and food Talks incessantly Echolalia almost constant

Hearing and Speech 2 years


25

Can do pure tone audiometry

Large vocabulary intelligible even to strangers – but still many infantile phonetic substitutions and unconventional grammatical forms

Constantly asking questions

Hearing and Speech 3 years


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Sucks well

Sleeps most of the time

Expression vague

Social Behaviour and Play1 month


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Fixes unblinkingly of mother’s face

Reacts to familiar situations – smiles and coos

Enjoys bath and caring routines

Social Behaviour and Play3 months


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Everything to mouth

Holds and chews a biscuit

Puts hands round bottle when feeding

Becomes aware of strangers

Social Behaviour and Play8-9 months


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Drinks from cup and holds spoon Objects to mouth less often “Casts” – throws to floor Beginning to help with dressing Beginning to indicate when wet or soiled Emotionally labile and dependent on familiar adult Need constant supervision

Social Behaviour and Play 12-15 months


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Feeds with spoon Toys no longer to mouth Still “casts” in play or anger Takes shoes and socks off May be dry by day Alternates between clingy and resistant

Social Behaviour and Play 18 months


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Spoon feeds and drinks from cup Dry by day Resistive and rebellious Tantrums Cannot share No understanding of deferring satisfaction

of wishes

Social Behaviour and Play 2 years


32

Eats with spoon and fork Dresses and undresses Dry by night (variable) Generally more amenable and affectionate Understand sharing Able to defer satisfaction of wishes

Social Behaviour and Play 3 years


33

To ensure prompt medical or surgical treatment

To give help and guidance to parents

To provide appropriate stimulation and education to the child

Importance of early identification of problems


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Gross motor 8 months – sit unsupported 13 months – walk without help

Speech 1 year – 3 words 2 years – stringing 2-3 words

Key milestones of development


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Mother’s concern (usually right!) Not smiling by 8-10 weeks Visually unaware/squint Abnormal gait Not walking by 18 months Abnormal social behaviour

Warnings


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Use test appropriate for developmental age not chronological age – (make a brief assessment as collect child)

Get as much basic information as quickly as possible, because of child’s attention span

May be better to test first and talk later

Modify test techniques as appropriate

Development and hearing assessment


37

Fluctuating hearing loss – so parental concern and history may be more important than hearing levels in deciding on best management

Development and otitis media with effusion


38

Look at the whole child

Remember

tuesday 17 th february chapter 2 hearing disorders in children/ hala alomari1

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