FTP 303 & 304 Child development, milestones, screening and OM Jan 2024.pdf

Childhood development (milestones) Paediatrics and child health Physiotherapy department Anri Human  Outline Introduction Stages, principles and patterns of growth and development Significance of developmental assessment Gross...

Childhood development (milestones) Paediatrics and child health Physiotherapy department Anri Human  Outline Introduction Stages, principles and patterns of growth and development Significance of developmental assessment Gross motor Fine motor Speech, hearing Cognitive Child surveillance (0-24 months) Introduction ?  Stages of growth and development ✓ Infancy (neonate, infant) ✓ Early childhood (toddler, pre-school) ✓ Middle childhood (school age) ? ✓ Late childhood (adolescent)  Principles of growth and development Continuous Orderly, systematic, not a “bundle of reflexes” Rates and patterns of growth (specific patterns) Individuals differ/vary (growth rates) Many factors influence growth and development Such as....? Simple to complex, general to specific (throughout lifespan) Cephalocaudal (proximo-distal) interaction [Growth charts: weight, height, MUAC, head circumference etc.] Growth and development, patterns HORIZONTAL child development -what you practice to achieve a certain skills (milestone) VERTICAL child development -artificial point in time, static -screening (early identification) OVERLAPPING activities Task orientated (CNS) [OM: Alberta Infant Motor Scale (AIMS); Bayley Scale; Hammersmith, Ages & Stages questionnaire] Others? Other outcome measures ▪ Fx rating scale: 10 point scale (mobility) / Fx independence measure for children (WeeFIM) ▪ Energy Expenditure Index/6MWT ▪ Step test ▪ Faces pain scale/Wong-baker; FLACC scale; VAS ▪ Pediatric Balance Scale ▪ Pediatric Reach Test (UL fx/ROM) ▪ Timed Up and Go (TUG) (gait) ▪ Peabody Developmental Motor Scale (fine motor) ▪ Ages & Stages questionnaire; Bayley Scale of Infant Development; Alberta Infant Motor development (gross motor/development) ▪ Movement Assessment battery for Children (M-ABC) (motor fx and coordination) ▪ Child health questionnaire (CHQ); Children’s Assessment of Participation and Enjoyment (CAPE); PedsQL/KINDL (HRQoL)  OUTCOME MEASURES (resources) https://portal.apcp.org.uk/paediatric-measures- database/?fbclid=IwAR08lXdOoyErnvkwXEA3PzAwnvYeHSM2fTmw9Yo0PlYKEB2vb_VtnI LwRU https://pathways.org/ https://www.canchild.ca/ https://www.canchild.ca/en/resources#/#$ http://pediatricapta.org chrome- extension://efaidnbmnnnibpcajpcglclefindmkaj/https://blog.summit -education.com/wp-content/uploads/List-of-Peds-Assessment- Tools-by-ICF-Model.pdf  Why assessment/screening? Early detection (deviation)=early intervention (ECI) Surveillance of developmental progress [Hammersmith: HNNE, HINE; RTHC] Different areas assessed [0-24 months]: -Motor (gross and fine) -Cognitive -Speech/language -Social/behavioural/emotional 3 areas of development (overlap): Physical, mental & behavioural/social (communication & interaction) [Autonomic system, motor, state and social interaction]  Development Developmental milestones: Motor skills expected to be performed by infants/toddlers within a certain point in time (vertical). An infant/toddler’s failure to display certain motor skills within the expected age range, may be indicative of a developmental disorder (screening). Developmental delay: When a child does not achieve developmental milestones compared to normative values of peers of the same age range. (Choo, Agarwal, How & Yeleswarapu, 2019; Petermann & Macha, 2008).  Homework Milestones (self-study, resources provided) Abilities (developmental steps) Warning signs (Check lists) Science of babies video and questionnaire Baby (0-36m): https://pathways.org/growth- development/baby/milestones/ Science of babies Science of babies cont. Gross motor development  Gross motor cont. Precede development of fine motor (refines) “Cephalo-caudate” (but rather integrated process) e.g. distal WB assists with head control Progress: 6m: lifts head, chest, abdomen, WB on arms can sit alone in tripod position [link with reflexes] 8m: sit without support, engage in play Sensation/experience of movement (sensori-motor experience) ☺  Gross motor cont. Ambulation: - 6m: Rolling - 9m: Crawl -12m: Stand independently -13m: Walk and “toddle” -15m: Running “Learn as we do and we do as we learn” Fine motor development Fine motor development cont. Newborn: very little 6m: palmar grasp 9m: pincer grasp (opposition) WB helps to refine (e.g. crawling) [Links with language development]  Speech, hearing (communication) 1-2m: “coos” 2-6m: laugh and squeals 8-9m: babbles, mama/dada as SOUNDS 10-12m: “mama/dada” specific as WORDS 18-20m: 20-30 words (50%) 22-24m: 2 word sentences, >50 words (75%) 30-36m: almost all speech understood  Hearing cont. BAER hearing test (at birth); screening Correlates with speech History of otitis media (“grommets”) Effusion (History taking) Repeathearing screening test Speech therapist/audiologist (MDT)  What to look out for… Red flags (or balloons?) Screening lists (Pathways.org)  Red flags (examples) Unable to sit alone (9m) Unable to transfer objects (12m) Abnormal pincer grip (15m) Unable to walk independently (18m) Fail to speak recognisable words (24m) Numerous reasons: DS, HIV, CP, mm dystrophy, autism (ASD), prematurity, malnutrition Others? IGMST  Child surveillance (Growth and development)  Screening procedure/test Adapt/correct for prematurity (at least up to 2 years) 0-2 months [RTHC; HNNE]: -Routine examination at birth (screening, early identification) (evaluation of the newborn incl. measurements e.g. head circumference) -Monthly weighing -Encourage and support breastfeeding -Encourage immunisation  Surveillance cont. 2-6 months [HINE; AIMS]: Developmental assessment, measurements [e.g. MUAC] Example: Smile (8w), turns to sound (3m), roll-over (5m), No head “lag” on PTS (6m) -Monthly weighing -Support breastfeeding -Encourage immunisation -Support and monitor weaning  Surveillance cont. 6-12 months: -Developmental assessment [HINE; AIMS] Examples: Sits without support (8m), passes cube between hands (8m), stranger anxiety (9m), pull to standing (10m), pincer grip (12m), walks with support (12m) -Monthly weighing -Support breastfeeding -Support and monitor weaning -Encourage immunisation -Screening for hearing (9m)  Surveillance cont. 13-24 months: -Developmental assessment Examples: Walks alone (15m), holds and drinks from cup (18m), throws a ball (18m), runs and walks up steps (24m), short phrases (24m) -2 monthly weighing -Booster immunisation  RTHC APGAR score Head circumference Length Weight MUAC Milestone charts Growth and development (50th percentile) Immunisation (e.g. Smallpox, rubella, mumps, influenza, meningococcus, measles etc) Tttttthat’s all folks! ☺ Any questions? Neonate; infant (0-24 months); Toddler (3-5 years): https://pathways.org/growth- development/toddler/  Quiz (milestones) The following pictures depict the highest level of function that the child is capable of (independently). Analyse these pictures and determine the developmental age of each child  Milestones 1 2 3  Any questions?