Child Development

and Developmental Disorders

 Intended learning outcomes

• Understand normal early child development

• Understand how to assess a child’s development

• Recognise signs of early developmental impairment

• Understand how common developmental disorders

are managed
 Child development
• Term used to describe the skills acquired by children between
birth and about 5 years of age

• Reflects brain development and is influenced by both heredity

and the child’s environment
 Early neurodevelopment

• Early childhood is a time of rapid brain growth when neurons formed

prenatally develop new connections

• 80% of brain volume is acquired by 3 years and nearly 90% by 6 years

• This period of early brain development is increasingly recognised as

critical for future learning outcomes, health and well-being
 ‘Genes predict our brain development but it is
experience that sculpts it’ Ref. UNICEF

• In early childhood the brain is maximally sensitive to the influence of

the environment

• Sensory stimulation and positive early experiences can enhance brain

development e.g.
– healthy pregnancy
– secure attachment to parent
– good nutrition
– opportunities to play and learn

• Abnormal experiences can adversely affect brain development e.g.

– prenatal exposure to toxins e.g. alcohol
– preterm birth and low birth weight
– maternal depression
– chronic illness
 Who monitors a child’s early development?

• Parents - guidance provided in Child Health Record (red book)

• Health visitor and GP
• Neonatal service
• Universal screening offered for hearing after birth (UNHS) and
vision at 4 years
• Professionals in nursery or day-care settings

But opportunistic enquiries or observations can be made

by any professional seeing a child
 Importance of detecting developmental
problems

• Good evidence that early identification

and early intervention improves the
outcomes of children with developmental
impairments
e.g. children with sensorineural hearing loss have better
speech outcomes if treated early

• Early detection allows early access to

appropriate care and family support for
children with special needs
 Developmental milestones

• Normal developmental skills are acquired sequentially and can

be considered in four functional areas
– gross motor
– fine motor and vision
– hearing, speech and language
– social skills

• Developmental progress is assessed by key consistent stages

or milestones reached but the rate of development is different
for each child
– Median age is when 50% will acquire skill
– Limit age is when 97.5% will acquire skill

*Remember to adjust for prematurity until 2 years

 Early motor milestones
• Motor development is rapid in 1st year of life and the direction of
motor development is from head to toe
• Be aware of normal variance in motor development e.g. some
infants will bottom shuffle rather than crawl
Gross Motor Development

• Children start walking with a wide

based gait (15 months median,
normal range 9-18 months)

• Age 18-24 months toddlers can

usually run, kick a ball and walk
upstairs with hand held

• 2 - 3 year old children should be able

to jump and may ride a tricycle and
stand on 1 foot briefly

• Pre-school children 4 – 5 years

should be able to walk or run up and
downstairs 1 foot per step and hop
on 1 foot
 Fine motor and vision
• 4 months - reaches out for objects
• 6 months - palmar grasp
• 7 months – transfers from hand to hand
• 10 months - pincer grip
• 15 -18 months - to and fro scribbles with crayon
• 2 years - circular scribbles and builds tower of 6 blocks
• 3 years - copies circle and builds tower of 9 blocks
 Hearing, speech and language

• Language development is more dependent on a child’s

environment than other skill areas

• Infants acquire language only through interaction with

responsive people in their environment

• Key milestones
3 months – turns to sound on level with ear
6 months – tuneful babble
12 months – responds to name, understands no / bye bye, uses 1 – 2 words
18 months – follows simple commands, points to body parts, 10-15 words
2 years – joins words to make simple phrases
3 years – speaks in sentences, asks questions
Social skills
 Normal development milestones

Do you know what developmental skills should be

acquired by the following ages?

• 4 months
• 9 months
• 12 months
• 18 months
• 2 years
 How to take a developmental history

• Ask parents if they have any concerns about their child’s

development
e.g. “Do you have any concerns about how your child is developing? ..
.. how he/she uses moves or uses arms and legs?.. uses hands?
.. understands what you say? …talks?... interacts with other children?
Ref: Glascoe FP, Ambul Child Health 1999

• Ask about the timing of acquisition of key early milestones in

order to assess developmental trajectory
e.g. smiling, sitting, first words, walking

• Consider the child’s progress in relation to the four

developmental skill areas
 How to examine a child’s development

• A child’s development can be assessed informally by observation

and interacting with them in play activities

• Key points to remember for OSCE

– Always introduce yourself to parent and child

– First observe the child’s free play and interaction with parent

– Offer the child age appropriate toys to find out about more specific skills
e.g. fine motor

– Consider each skill area in turn, assessing maximum milestone achieved

– Relate developmental milestones to an approximate chronological age

 Signs of early developmental impairment

• Delayed milestones
– A child may be delayed in just one development domain, most commonly
speech and language

– Developmental delay affecting 2 or more developmental domains is often

termed ‘global developmental delay’

• Abnormal patterns of development e.g.

– Asymmetrical movement patterns such as an early hand preference

– Lack of eye contact and pointing to share interest in 2nd year

– Loss of developmental skills at any age

 Can you think of any causes of
developmental delay or disability?
 Child Development Services

• Community based paediatric service which provides care for children with
wide range of developmental difficulties / disabilities

e.g. cerebral palsy, autism, genetic conditions, learning disability

• Assessments and therapies are provided in child development clinics,

nurseries, schools and family home

• Aim to provide holistic care for child and family

 How are children assessed?

• Child friendly environment

• Paediatric assessment includes formal

developmental assessment

• Investigations arranged to establish

underlying diagnosis

• Multidisciplinary care often required to

promote and support development

• Child development team also work with

education and social services
Managing a child with developmental
impairment and complex needs

Clinical case
 CJ

• Baby CJ was born at 37 weeks gestation

with a birth weight 2.4kg. His mother was
a 20 year old single parent and he was
her first child.

• After birth he had breathing difficulties

and was floppy.

• The neonatal registrar examined him and

thought he had features of Down’s
syndrome.
 Down’s syndrome (Trisomy 21)

CJ has low muscle tone and feeding difficulties.

What other problems are associated with Down’s syndrome?

• Congenital heart disease – especially AVSD

• Cataracts
• Intestinal atresias
• Thyroid dysfunction
• Hearing loss
• Developmental delay
 Down’s Syndrome

• CJ had a normal cardiac echocardiogram and passed his

newborn hearing screening test

• What problems might he have after discharge from hospital?

– Feeding difficulties due to hypotonia

– Delayed developmental milestones

– Consider also the potential impact of parental grief reaction due to

unexpected diagnosis
 Neonatal discharge planning

Who should be involved in follow-up and why?

• Health visitor
• GP
• Paediatrician
• Speech therapist
• Physiotherapist
• Dietician
• ENT and Audiology
 Ongoing follow-up

• CJ is seen regularly by his health visitor, paediatrician and

therapists based in his local child development centre.

• He has also been monitored by Audiology and his hearing

responses have been normal

• His mother has support from his grandparents and is receiving

disability benefits. She is also in touch with other families via the
Down’s Syndrome Scotland Facebook page.
 Paediatric assessment age 18 months

CJ’s weight and length are following the 25th centile on Down’s
syndrome chart and his annual TSH screening is normal.

Developmental assessment
• Gross motor sitting and pulling to stand but not yet walking

• Fine motor pincer grip but not holding crayon or building blocks

• Speech/lang. says ‘mama,’ ‘dada’ but not specifically, shows

understanding of ‘no’ and responds to his name

• Social waves bye bye, holds spoon but not feeding

What age equivalent level is CJ at in his developmental skills?

 In summary…
• Developmental progress is an important indicator of health and well-being

• Need to learn key developmental milestones for first 3 years

• Ask parents about their child’s development when taking a paediatric history

• Consolidate learning by observing and interacting with children