Normal Child Development

unikl rcmp pcm yfn v2.2

Normal Child Development

A. Definitions And Some Terms

Growth is increase in size1.1.

It involves change in structural dimensions. We measure it in terms of height, circumference, weight, etc.

Development is increase in complexity1.1.

It involves changes in structure and function. We describe it in terms of developmental milestones.

Child development

The importance of child development is such that it is the most well studied part of human life span development. We shall focus on the first 5 years.

Developmental paediatrics1.1 is the branch of paediatrics which deals with childhood development, with 3 purposes

1. to promote optimal physical and mental health for all children;

2. to ensure early diagnosis and effective treatment of handicapping conditions of body, mind and personality;

3. to discover the cause and means of preventing such handicapping conditions.

Developmental psychology2.2 is the scientific study of the growth, development, and behavioural changes of humans from conception through old age. As mentioned above, child development is the most extensively studied. There is much that we can learn from this branch of psychology.

4 areas of child development1.3

Four outstanding biological characteristics of homo sapiens give us the superiority over all other animals. They are:

1. Our upright posture allows us to use our hands for fine and precise activities.

2. Our highly developed eyes and fingers give us the ability to construct and use hand tools.

3. We have a spoken language.

4. We have evolved complex social cultures for the benefit of the groups and the individuals comprising the groups.

Hence the four corresponding areas of child development are:

1. Posture and large movements

2. Vision and fine movements

3. Hearing and speech

4. Social behaviour and play

Why should we know about child development?

Knowing about child development empowers parents or caretakers of the children and ourselves in helping the children to develop. It is the foundation upon which subsequent life span development progresses. There are 2 objectives:

1. to promote optimal physical and mental health for all children;

2. to ensure early diagnosis and effective treatment of children with handicapping conditions of body, mind and personality.

B. Normal Development

Child development takes place craniocaudally, from proximal to distal movements, and from gross to fine stages.

The child achieves developmental milestones at different ages. There is a normal range for each of these ages.

MILESTONES IN CHILD DEVELOPMENT1.2,3,6,7 - Abridged VersionPosture and Large Movements:

0 - 12 months: The child progresses from spending time almost entirely in the supine position at birth, to standing independently at 1 year. During the year he develops the following milestones: He gains full head control at 4 to 5 months. His trunk control matures, rolling from prone to supine position at 5 to 6 months, rolling from supine to prone position and sitting independently around 7 to 8 months. By then he gains sufficient strength and control of his limbs and starts crawling soon after that. He stands independently at 12 months.13 24 months: This is a period when the child improves his locomotion in an upright posture on ground level, progressing to moving in an upwards direction. He walks independently and creeps upstairs at 15 months. He runs at 18 months, and walks upstairs with helping hand. At 2 years, he climbs onto furniture.

25 months to 5 years: He becomes an expert in ground level locomotion, gains increasing ability to move upwards, and starts mastering the use of transport vehicles. He jumps with both feet at 2 years. At 3 he walks in all directions (including backwards and sideways) and rides tricycle. By 4 he walks up and down stairs in adult fashion, and is even able to jump up on one foot (hops). He progresses to skipping by 5.

Fine Motor and Vision:0 - 12 months: He develops basic use of his hands and fingers during his first year. He loses his reflex palmar grasp by 3 months and has mature voluntary palmar grasp by 6 months. He watches his hands at 3 months (hands regard). Immature pincer grasp of small objects occurs by 9 months, and matures at 12 months. He ends first year by fascination with ability to release an object in his hand (casting).

13 24 months: He perfects his pincer grasp (skillful at 15 months). He stops casting within the year and begins to handle pencil and scribble. From 2 he draws lines by imitating.

25 months to 5 years: He increases his ability to hold and use a pencil; copies a circle by 3, a cross by 4 and a square by 5.

Hearing and Speech:0 - 12 months: He develops use of his speech mechanism and ability to speak his first couple of words. He starts cooing in response to mothers voice just after 1 month. His hearing ability and vocalization increases. He laughs from 4 months, babbles from around 6 months, and is able to gives toy on request, know own name, and say 2 or more words by 1 year.

13 24 months: He increases his vocabulary. He joins 2 words to make phrases at 2, and shows echolalia (repetition of another persons words or phrases).

25 months to 5 years: At 2 he starts asking a lot of Who? and What? and uses I and you correctly. He is able to carry on simple conversations by 3, sings nursery rhymes by 4, and speaks fluently by 5.

Vocabulary gain during first three years2.4YearsmonthsNumber of WordsGain

80

1011

1032

131916

16223

1911896

20272154

26446174

30896450

Social Behaviour and Play:Sensitive or Critical Period2.3A sensitive or critical period is a specific time when an environmental event will have its greatest impact on the developing organism. It is important for the child to have the necessary environmental factors to develop the desired behavioural milestones during these sensitive periods.

Examples of Sensitive PeriodDevelopmental Task

6 months to 18 monthsBonding with the mother or caretaker

18 months to 3 yearsCognitive abilities and early socialization patterns

3 to 6 yearsLearning appropriate modes of behaviour

6 to 10 yearsFurther development of cognitive abilities and socialisation

0 - 12 months: He learns social interaction with others and its first basic rules. He smiles responsively (social smile) just after 1 month, vocalises to show pleasure from 3 months. He takes toys to his mouth at 6 months. He shows stranger anxiety from 9 months. He may understand simple commands at 1 year.

13 24 months: He stops taking toys to his mouth during the year. He is physically restless, intensely curious, and needs constant supervision. He is emotionally dependent upon a familiar adult, especially his mother. He plays by himself, not with other children.

25 months to 5 years: He is terrible at 2, egoistic and throwing tantrums when frustrated. At 3, he is trusting, friendly. He plays with other children. At 4, he is frustrating and strong-willed, but shows dislike verbally instead of physically. By 5, he is fascinating, independent and sensible, has a sense of humour, and abides with social rules.

Bladder & Bowel Control: He rarely soils after 2, and dry by night at 3 years old.

C. Warning Signs

It is estimated that 10-20% of children experience developmental or behavioural problems which are significant enough to interfere with their daily functioning.4Developmental screening tests may not live up to their promise4. This is understandable because of the complex nature of childrens development, and the necessary skill required does not come by easily.

It is hence useful to remember some important milestones in the early part of childhood.

Developmental Warning Signs5

Not smiling at mother8 weeks

Poor head control6 months

Unable to sit unsupported9 months

Not crawling12 months

Unable to stand with help12 months

No babbling12 months

Unable to stand unaided15 months

Not walking independently18 months

Unable to understand simple commands2 years

Not using 2 or 3 words2.5 years

DEVELOPMENTAL ASSESSMENT OF 8-WEEK-OLD AND 12-WEEK-OLD BABYManuvres8 weeks12 weeks

Supine on couchHolds head briefly in midline.

Limbs semi-flexed at rest; extend nearly fully when actively moving.

Keeps head in midline & able to move from side to side.

Moves arms symmetrically and legs in cycling fashion.

Pull to sitPalmar grasp reflex disappearing.

Head lag

In sitting position, holds head up momentarily.

Back curvedPalmar grasp reflex lost.

Shows voluntary grasp.

Little head lag

In sitting position, balances and turns head.

Upper part of back straight

No trunk balance

Vertical suspension (& look at, speak to)Head needs some support.

Eyes show fixation, convergence, & focusing onto examiner8.Social smile & may coo to verbal stimuli.

Holds head well.

Eyes alert and follow examiner from side to side.Social smile & cooing.

Prone on couchHolds head to 450 for up to minute.Raises head to 600 for minutes.

Bears weight well on forearm.

Ventral suspensionHolds head in line with body.

Holds head well above plane of body.

NOTE: Child developmental assessment starts with taking history from the mother. The above table lists only the physical examination part.

Ref:

1. From Birth to Five Years, Childrens Developmental Progress 3rd ed, 1975 Mary D. Sheridan

1.1 P12; 1.2 p19-73

2. Life Span Development 1979 Jeffrey S. Turner & Donald B. Helms

2.1 p4; 2.2 p2; 2.3 p7-8; 2.4 p90

3. The Normal Child 10th ed 1991Ronald S. Illingworth Ch 12

4. Is developmental assessment worthwhile?Frank Oberklaid In: Australian Family Physician August 2000 29:731-734

5. Paediatric Primary Health Care J.D. Ireland et al 1994 P 73

6. Bellman M, Peile E 2006 The Normal Child. Churchill Livingstone, Philadelphia, Appendix 1

7. http://www.fpnotebook.com/Peds/Neuro/DvlpmntlMlstn.htm accessed 2010 July8. Paediatric Protocols For Malaysian Hospitals 1ed 2005 ch3July 2010

Dr Yap Foo Ngan

MBBS(Singapore) DCH(London) FAFP(M) FRACGP

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