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