1. Infant and Pediatric Growth and Development Brenda Beckett, PA-C

2. Objectives Normal growth patterns –Height –Weight –Head circumference Normal development –Gross motor –Fine motor –Language –Personal / Social –Cognitive Anticipatory Guidance

3. Important to remember Kids are not little adults!! Know milestones (normal) Learn to recognize abnormal Listen to parents’ concerns

4. Role of Pediatric Provider Relationship with provider can last many years, multiple children Understand family and background Communication is key to development of successful relationship Providing educational materials, anticipatory guidance

5. Provider/Parent Relationship Frequent visits the first year of life Identify issues of growth and development Learn about the family’s cultural and socioeconomic factors Focus on areas of concern to the family Assess importance of factors to family Personal attention to the individual needs of the child

6. Parent’s perspective Well child visit gives chance to assess parent’s perspective Parents are most important observers Understand their perception of child’s development Identify concerns and anxieties In this way, provider can attempt to alleviate concerns

7. Physical Exam Dynamic tool to interact with the child and the parent Can reveal important insights into development beyond physical signs Parents often add important insight

8. Anticipatory Guidance and Education Impact child’s health and development long term Prepare parents/child for next step in development Discuss important issues including:nutrition, safety, immunizations, developmental milestones at each visit Provide positive feedback whenever possible

9. Hearing Hearing screen –Indirect screen of hearing, production of normal sounds 6wks-cooing 3mo-laugh out loud 9mo-echo sound 12-15mo-1 st words Hearing is essential for normal language development Audiometric testing

10. Schedule for Well Child Visits Newborn, 2 week, 2 months, 4 months, 6 month, 9 months, 12 months, 15 months, 18 months 2 years and then yearly Notice correlation with immunization schedule

11. Growth Length, Weight, Head Circumference –Measured and plotted on growth curves –Explain growth curve to parents Measure HC until age 2 –Relatively large proportionately at birth –Slow growth-Craniosynostosis (cranial sutures have closed too soon)

12. Development Parental concerns Parental questionnaires Observation Direct questions

14. 2 Week WCC Length, weight and HC Alertness, Tone, Head Control –Gross motor: Head side to side –Personal-social: regards face –Language: alerts to sound Any parental concerns?

15. 2 Month WCC Development –Gross motor: moving limbs, lifts shoulders –Fine motor: Tracks past midline –Personal-social: Smiles responsively –Language: Coos/verbalizes Observe infant during exam Observe parents with infant

16. 4 Month WCC Gross Motor –Roll front to back, lifts up on hands Fine Motor –Reach for object, raking grasp Personal/Social –Develops a social smile –Regards hand Language –Vocalizing, begins to babble, laugh

17. 6 Month WCC Gross motor –Rolls B-F and F-B, sits alone Fine motor –Transfers objects Personal/Social –Feeds self Language –Babbles

18. 9 Month WCC Gross Motor –Sit without support-crawl, pull to stand, cruise Fine Motor –Pincer grasp Personal/Social –Understand bye-bye, and no-no –Peek-a-boo –Stranger anxiety Language –Babbling, 1-2 vocalizations, Mama Dada nonspecific

19. Anticipatory Guidance and Education Safety-child proofing, water safety, poison control Milestones Play games with child Introduce cup Bite size pieces of food

20. 12 Month WCC Gross Motor –Walking or close Fine Motor –Puts blocks in cup Personal/Social –Drinks from cup, imitates others Speech –Mama, dada specific, plus 1-3 other words

21. 15 Month WCC Gross Motor –Walks well, walks backwards Fine Motor –Scribbles, stacks two blocks Personal/Social –Uses spoon/fork, helps in house Speech –3-6 words, follows commands

22. 18 Month WCC Gross Motor –Runs, kicks ball Fine Motor –Stacks four blocks Personal/Social –Removes garment Speech –Says at least 6 words

23. Toddler 1-2 years Social/emotional development –Behavioral shifts Stubborn independence to clinging to parent Temper tantrums*/discipline Cognitive abilities –Early language –Pretend play –Exploration Physical Development –Walking/running –Slower growth rate

24. Temper Tantrums How not to fuel frustration, initiate power struggles and create unnecessary conflict!! Think before you speak, be realistic when you make a rule or promise Try not to reinforce negative behaviors, just to quiet your child Talk to your child about how he/she are feeling, and acknowledge those feelings Try to be as consistent as possible Use your mistakes to help you for the next time…there will be a next time Praise good behavior...set your child up to be successful

25. Preschool 3-5 years Social/emotional development –Toilet training* –Peer interactions Cognitive development –Speech –Imagination/fantasy Physical development –Increased coordination –Steady growth

26. Toilet Training Support, educate and encourage parents Developmental process, many steps, before successful, and setbacks are common Is your child ready? –Clues to readiness: express interest in toilet training, imitate parents behaviors, communicate need to “go”, demonstrates some independence –Initiate the discussion with parents at age 1-2

27. Toilet Training (cont.) Are the parents ready? –Schedule: Do they have blocks of time to devote to toilet training? –Encourage them to resist pressures from grandparents, friends, daycare providers –Ask if they have any previous experiences with toilet training that they would like to discuss

28. Important Points to Remember Do not pressure or punish the child Stress the importance of parent/caregiver cooperation

29. Middle Childhood 5-10 years Social/emotional –School –Peer interactions Cognitive development –Reading, math Physical development –Balance –Sports

30. Child Safety and Injury Prevention Injuries are the number one cause of death in children ages 1-21 Motor vehicle cause the most deaths, followed by drowning

31. Car Seats Safest place in the back seat, in car seat. Rear-facing until 12mo & 20 lb Car seat/booster must be appropriate size for child, fit properly in the car, and be fastened correctly Air bags-dangerous for child to be in front seat, even when the car is parked

32. Other safety issues Bicycles Skateboarding/Rollerblading Firearms Poisoning And Many More…

33. Role of the pediatric health care provider Form relationship with child and the family Take a history that will elicit age appropriate information Assess growth and development Examine patient Provide anticipatory guidance and education of patient and family