Growth & Development
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Transcript Growth & Development
Infant and Pediatric
Growth and Development
Brenda Beckett, PA-C
Objectives
Normal growth patterns
– Height
– Weight
– Head circumference
Normal development
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Gross motor
Fine motor
Language
Personal / Social
Cognitive
Anticipatory Guidance
Important to remember
Kids are not little adults!!
Know milestones (normal)
Learn to recognize abnormal
Listen to parents’ concerns
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
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
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
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
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
Hearing
Hearing screen
– Indirect screen of hearing, production of normal
sounds
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6wks-cooing
3mo-laugh out loud
9mo-echo sound
12-15mo-1st words
Hearing is essential for normal language
development
Audiometric testing
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
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)
Development
Parental concerns
Parental questionnaires
Observation
Direct questions
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?
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
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
6 Month WCC
Gross motor
– Rolls B-F and F-B, sits alone
Fine motor
– Transfers objects
Personal/Social
– Feeds self
Language
– Babbles
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
Anticipatory Guidance and
Education
Safety-child proofing, water safety,
poison control
Milestones
Play games with child
Introduce cup
Bite size pieces of food
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
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
18 Month WCC
Gross Motor
– Runs, kicks ball
Fine Motor
– Stacks four blocks
Personal/Social
– Removes garment
Speech
– Says at least 6 words
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
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
Preschool 3-5 years
Social/emotional development
– Toilet training*
– Peer interactions
Cognitive development
– Speech
– Imagination/fantasy
Physical development
– Increased coordination
– Steady growth
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
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
Important Points to Remember
Do not pressure or punish the child
Stress the importance of
parent/caregiver cooperation
Middle Childhood 5-10 years
Social/emotional
– School
– Peer interactions
Cognitive development
– Reading, math
Physical development
– Balance
– Sports
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
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
Other safety issues
Bicycles
Skateboarding/Rollerblading
Firearms
Poisoning
And Many More…
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