Tuesday 17 th February Chapter 2 Hearing disorders in children/ Hala AlOmari1.
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Transcript of 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
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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
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All children, normal and abnormal, progress from the helplessness of infancy to
the independence of maturity
Child development
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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
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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
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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
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Motor
Vision and fine movements
Hearing and speech
Social behaviour and spontaneous play
Human development
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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
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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
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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
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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
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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
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Turns head and eyes towards light
Watches mothers face when feeding or talking
Defensive blink by 6-8 weeks
Vision and Fine movements1 month
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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
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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
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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
Builds tower of 3 cubes
Enjoys picture books
Vision and Fine movements 18 months
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Builds tower of 9 cubes
Can thread large beads
Copies circle and cross
Matches 2 or 3 primary colours
Cuts with scissors
Vision and Fine movements3 years
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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
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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
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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
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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
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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
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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
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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
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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
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Look at the whole child
Remember