1. Childhood Development

2. 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

3. An Approach to Growth and Development
Extrinsic forces can modulate the velocity and quality of developmental progress

4. Areas of Development Physical growth
Motor (gross and fine motor skills)
Cognitive
Problem-solving
Speech and language
Receptive language
Expressive language
Psychosocial

5. 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

6. 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)

7. 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

8. 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 gm/day

9. 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

10. 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

11. 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

12. 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

13. Motor Development
As development moves from proximal to distal, reaching and manipulative skills are enhanced and manual exploration replaces oral exploration

14. 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

15. Language Development
Language development during infancy can be divided into three periods:
Prespeech period (0-10 months)
Naming period ( months)
Word Combination period (18-24 months)
Expressive language will lag behind receptive language

16. 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”

17. 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

18. 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

19. 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

20. Toddlers: Infants Gone Wild Affective development
Temperament
Attachment
Autonomy/Independence
Impulse control

21. 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

22. 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

23. 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