Typical Childhood Growth & Development: Critical aspects for the Physiotherapist Typical Childhood Growth & Development: Critical aspects for the Physiotherapist Robyn Smith Department of Physiotherapy UFS2012

Objectives for this model: After this module the learner should be able to: Define term typical development Define term typical development Explain what is meant by the term “development” Explain what is meant by the term “development” Identify the goals of gross motor development Identify the goals of gross motor development Recall the characteristics of typical development Recall the characteristics of typical development Identify intrinsic and extrinsic factors that impact on childhood development Identify intrinsic and extrinsic factors that impact on childhood development Explain the basic principles of the well known developmental theories Explain the basic principles of the well known developmental theories Identify the main areas of development Identify the main areas of development Explain why physiotherapists need to be knowledgeable about normal development Explain why physiotherapists need to be knowledgeable about normal development Explain the concept of “developmental milestones” Explain the concept of “developmental milestones” Explain the concept of “developmental sequencing” Explain the concept of “developmental sequencing” Recall important age related milestones Recall important age related milestones Understand the components and sequence of development of motor control Understand the components and sequence of development of motor control

Typical Development

Controversy around the use of the terms “normal” versus “typical” when referring to development Normal Implies conformity to the human standard range ? What is the standard Typical Refers more to the specific qualities of a group e.g. humans More accepted term

What is “development” ? Process that: – –begins at conception, – –and continues throughout life until death Rate of change and growth is greatest in the first 2 years of life

Defining development Increase in the complexity of structure and size. We grow physically in size and stature Increase in the complexity function – human activity that becomes more organised and effective as a result of practice Acquisition and refinement of skills in a specific sequence

Defining development The human’s ability to learn, adapt, and cope with the world largely related to the child’s constant and dynamic interaction with the environment normal developmental cascade or developmental sequence Developmental cascade is characterised by milestones

Motor development occurs in a specific sequence and timing Intrinsic and extrinsic factors impact on the timing of, and reaching of these milestones

Factors that may impact on a child’s development Intrinsic factors Physiology Physiology Anatomy Anatomy Genetics Genetics Personality/motiviation Personality/motiviation Race/ethnicity Race/ethnicity Medical conditions Medical conditions Often cannot avoid internal factors Extrinsic factors Inadequate bonding or nurturing with mother/caregiver Inadequate bonding or nurturing with mother/caregiver Opportunities to learn or practice Opportunities to learn or practice Culture Culture Environmental risks Environmental risks Parental and child-rearing practices Parental and child-rearing practices Nutrition Nutrition Socio-economic factors Socio-economic factors Trauma Trauma Often factors that can be avoided or altered

Some interesting facts …. The child triples his birth weight in the first year of life The child triples his birth weight in the first year of life Achieves 2/3 of his/her brain size in the 1 st 2-3 years Achieves 2/3 of his/her brain size in the 1 st 2-3 years Progress from a completely dependent baby to a verbal, independent being by 2-3 years. Progress from a completely dependent baby to a verbal, independent being by 2-3 years.

What are the requirements for development in a baby? Stable behavioural and physiological states Stable behavioural and physiological states Be able to interact with the environment Be able to interact with the environment Spontaneous movements Spontaneous movements Gradual development of postural and antigravity control Gradual development of postural and antigravity control Balanced muscle activity Balanced muscle activity

The goal of gross motor development? Develop antigravity control, ultimately allowing us as humans to move in an erect posture ….. walk Develop antigravity control, ultimately allowing us as humans to move in an erect posture ….. walk Maintain our center of gravity over our base of support, initially in lower positions such as sitting and ultimately in standing Maintain our center of gravity over our base of support, initially in lower positions such as sitting and ultimately in standing Develop isolated and dissociation of movement Develop isolated and dissociation of movement

What Characterises of typical development? The following may be considered important principles of development: Movement is initially more reflexive after birth as maturation occurs becomes more complex and volitional Movement is initially more reflexive after birth as maturation occurs becomes more complex and volitional Movement is initially generalised and becomes more localised Movement is initially generalised and becomes more localised Developmental maturation was believed to only develop in a cephalo-caudal Developmental maturation was believed to only develop in a cephalo-caudal direction, but we now know that it develops in both directions at the same time. Development is medial to lateral, trunk and head control develop before shoulder and pelvic girdle and then lastly limb control

What Characterises of typical development? Gross motor skills develop before fine motor skills Gross motor skills develop before fine motor skills Develop flexor muscle tone before extensor muscle tone Develop flexor muscle tone before extensor muscle tone Development of antigravity extension before antigravity flexion Development of antigravity extension before antigravity flexion Development is proximal to distal Development is proximal to distal Mobility then stability, then mobility with stability and the development of skills

Theories on motor development

Many developmental theories exist Only going to look at some of the important ones No single theory can explain typical development in its entirety Many theories contain valuable insights

Developmental theories Milestone approach (Illingsworth) –improved postural control dependent on the natural maturation process of the CNS. The order of development is same for all children, rate vary. characterised by milestones Milestone approach (Illingsworth) –improved postural control dependent on the natural maturation process of the CNS. The order of development is same for all children, rate vary. characterised by milestones Neural maturation theory/ hierarchial (Piaget, Gesell, Bayley)– Emphasis on the changes maturation in the CNS which enables development to proceed. Believed the CNS driving force in development. Emphasised the normal developmental sequence common to all humans. nature Neural maturation theory/ hierarchial (Piaget, Gesell, Bayley)– Emphasis on the changes maturation in the CNS which enables development to proceed. Believed the CNS driving force in development. Emphasised the normal developmental sequence common to all humans. nature

Developmental theories Behavioural appraoch (Pavlov) – conditioning of a response to specific stimuli. By manipulating the environment create a response from an individual (used in our therapy) Behavioural appraoch (Pavlov) – conditioning of a response to specific stimuli. By manipulating the environment create a response from an individual (used in our therapy) Dynamic systems theory – CNS only one aspect, and the child’s experience and interaction with his environment (intrinsic and extrinsic factors) are critical to his development. Dynamic systems theory – CNS only one aspect, and the child’s experience and interaction with his environment (intrinsic and extrinsic factors) are critical to his development. No one system is more important than the other. Also sees the CVS, musculoskeletal and peripheral nervous system as important systems. Functional outcomes are the reason human’s perform tasks. nurture nurture

Developmental theories Latest and most widely accepted current theory on development Latest and most widely accepted current theory on development NB √ Neuronal group selection theory NB √ Neuronal group selection theory Suggests that the infant has an inherent capacity for self generated activity, specific motor behaviour repertoires, Suggests that the infant has an inherent capacity for self generated activity, specific motor behaviour repertoires, which are then refined by experience enabling the child to choose the most effective motor plan for the task at hand which are then refined by experience enabling the child to choose the most effective motor plan for the task at hand

Developmental theories Theory also recognises the importance of:  opportunity for experience  Environment extrinsic  trial and error practice  varied practice  interactive nature of all aspects of motor control including sensory, cognitive and intrinsic perceptual behavioral (personality) biomechanical aspects  Ability to learn and adapt to acquire new skills

Areas of Development

Main areas of development: There are 4 main areas of development that need to be assessed Gross motor Gross motor Fine motor Fine motor Speech and language Speech and language Socialization/ behaviour Socialization/ behaviour As physiotherapists our focus is on gross motor development As physiotherapists our focus is on gross motor development Have to now basics of other areas of development to be able to interpret information/ refer Have to now basics of other areas of development to be able to interpret information/ refer

Why must physiotherapists be knowledgeable regarding normal development? Provides a foundation for understanding typical and therefore atypical development Provides a foundation for understanding typical and therefore atypical development Serves as the basis for our developmental/ neurological assessment Serves as the basis for our developmental/ neurological assessment Screening purposes Monitor a child’s developmental progression or regression Monitor a child’s developmental progression or regression Interpret developmental findings Aids us in identifying delays and/ or abnormalities in development as the earliest possible point in time Aids us in identifying delays and/ or abnormalities in development as the earliest possible point in time

Why must physiotherapists be knowledgeable regarding normal development? Aids us in planning and executing our treatment of children, but also adults with motor delays or disturbances Aids us in planning and executing our treatment of children, but also adults with motor delays or disturbances NB !!!! developmental sequencing By being knowledgeable about the developmental sequence we can identify the limiting components and focus on them in treatment to aid the developmental sequence.

Milestones

What are developmental milestones? Defined by Illingworth in his milestone theory as Defined by Illingworth in his milestone theory as –Set of functional skills or age-specific tasks –that most children can do at a certain age range Milestone = standard for skill acquisition Milestone = standard for skill acquisition Defines the child’s “developmental age” Defines the child’s “developmental age” NB norms are based for children of full gestational age NB norms are based for children of full gestational age Although each milestone has an age level, every child is unique, and the impact of intrinsic and extrinsic factors may vary Therefore it is accepted that standard deviation/variation of one month on either side is allowed Although each milestone has an age level, every child is unique, and the impact of intrinsic and extrinsic factors may vary Therefore it is accepted that standard deviation/variation of one month on either side is allowed

So where do I get information on childhood milestones? Many different milestone guidelines in table and picture format Many different milestone guidelines in table and picture format Internet – huge source of information regarding milestones available Internet – huge source of information regarding milestones available Peabody infant development charts Peabody infant development charts

Developmental Screening tests Objective & quantifiable = gives a score Bayley scales III Bayley scales III Denver II Denver II NDS NDS AIMS AIMS Bruininks-Oseretsky test of motor proficiency Bruininks-Oseretsky test of motor proficiency MABC MABC START programme: checklists – not quantifiable START programme: checklists – not quantifiable

Milestones importance: to know by heart Head control in supine (PTS) and in prone Head control in supine (PTS) and in prone Ventral suspension Ventral suspension Rolling Rolling Sitting Sitting 4 point kneeling /crawling 4 point kneeling /crawling Standing Standing Pull to stand Pull to stand Cruising Cruising Walking Walking Running Running Jumping Jumping Grasp Grasp Vision Vision 5/12 5/12 6/12 6/12 Starts 6/12 arm support /well 8/12 Starts 6/12 arm support /well 8/12 Start 7/12 well 9/12 Start 7/12 well 9/12 FWB 6/12 –holding on 10/12 FWB 6/12 –holding on 10/12 7-9/12 7-9/ / / /12 even 24/12 in cases 12-18/12 even 24/12 in cases 24/12 24/12 36/12 36/12 7-9/12 7-9/12 6/12 6/12

Milestones vs. developmental sequence Both are important components to consider when assessing and treating children with developmental concerns Both are important components to consider when assessing and treating children with developmental concerns Developmental sequence refers to the typical pattern or development of the components of movement & timing thereof Developmental sequence refers to the typical pattern or development of the components of movement & timing thereof Need to understand the components and the sequencing of the components in the developmental sequence Need to understand the components and the sequencing of the components in the developmental sequence Whilst when looking at milestones your are assessing the skills or tasks a child has achieved for his age Whilst when looking at milestones your are assessing the skills or tasks a child has achieved for his age

References: Images courtesy of GOOGLE (2009) Images courtesy of GOOGLE (2009) Growth and Development. In Coovadia, H.M. & Wittenberg, D.F. (eds) in Paediatrics and Child Health. A manual for health professionals in developing countries. 4 th ed. Oxford city Press: Cape Town pp Growth and Development. In Coovadia, H.M. & Wittenberg, D.F. (eds) in Paediatrics and Child Health. A manual for health professionals in developing countries. 4 th ed. Oxford city Press: Cape Town pp Van der Vyver, A.E. Normal Growth in Paeditric doctors lectures for Physiotherapy students. (Unpublished) Van der Vyver, A.E. Normal Growth in Paeditric doctors lectures for Physiotherapy students. (Unpublished) Goldson, E. & Reynolds, A. Child development and Behaviour Hay, W.W.; Myron, J. L.; Sondheimer, J.M. & Deterding, R.R. (eds). In current diagnosis and treatment in Paediatrics. 18th ed. McGraw-Hill companies: NewYork pp Goldson, E. & Reynolds, A. Child development and Behaviour Hay, W.W.; Myron, J. L.; Sondheimer, J.M. & Deterding, R.R. (eds). In current diagnosis and treatment in Paediatrics. 18th ed. McGraw-Hill companies: NewYork pp Aubert, E.J. Motor development in the normal child in Pediatric Physical Therapy. Tecklin, J.S. (Eds) in Pediatric Physical Therapy. Lippincott, Williams & Wilkins. Baltimore pp Aubert, E.J. Motor development in the normal child in Pediatric Physical Therapy. Tecklin, J.S. (Eds) in Pediatric Physical Therapy. Lippincott, Williams & Wilkins. Baltimore pp Smith, R Paediatric dictate, UFS (Unpublished). Smith, R Paediatric dictate, UFS (Unpublished). Smith, R Normal development (Unpublished) Smith, R Normal development (Unpublished) Mosby Medical dictionary Mosby Medical dictionary