Infant and Pediatric Growth and Development

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-1st 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