From birth to twelve

1. From birth to twelve Development in a nutshell

2. Child and Adolescent Community Health (Child health, school health and immunisation nurses) CACH works from a primary health care framework Health promoting strategies aimed at protection of health and wellbeing and prevention of illness • Accessibility • Appropriate technology • Emphasis on health promotion • Inter sectoral collaboration • Community participation

3. What are social determinants of health Social determinants of health are the economic and social conditions under which people live which determine their health. Virtually all major diseases are primarily determined by a network of interacting exposures that increase or decrease the risk for the disease. “I think almost all the diseases, except cancers and some birth defects, are higher among those with disadvantage. It's important that we ask why we are seeing this inequity in childhood outcomes in Australia in 2005.” Fiona Stanley

4. Social gradient between groups and within groups Stress Early life Social exclusion Social support Addiction Food Transport Unemployment Work Social determinants of health

5. Importance of early years & brain development The thousand days that matter (conception to 4 years) Developmental Origins of Health and Disease: DOHaD The DOHaD concept is bringing new insights into the pathogenesis of disease. We now know that poor fetal growth and small size at birth are followed by increased risk of coronary heart disease, stroke, hypertension, Type 2 diabetes and osteoporosis. This has led to the hypothesis that these disorders originate through unbalanced nutrition in utero and during infancy. ‘Early brain development is one of the most important pathways to lifelong learning, behavioural competence, positive social relationships and health’

6. Developmental concepts By the 17th week of pregnancy the foetus has 1 billion brain cells proliferating at 50,000/second. The setting down of neuron connections continues rapidly and by 8 months of age there are approximately 1,000 trillion synapses. Pruning of unused connections continues for most of childhood though the brain retains flexibility for future learning. The brain works on a ‘use it or lose it’ principal

7. Developmental concepts Early brain development influences how we are wired up for life. The influence of stress, through the release of cortisol on the developing brain, impacts on children’s self regulation and effort control. Securely attached infants produce less cortisol in response to stress than children who are not having their emotional needs met.

8. Science of brain development • Brain is immature at birth • Brain is changed by experiences • Brains of infants, toddlers and preschoolers develop best in a nurturing environment • Adversity impacts brain development

9. Strategies to improve school readiness trajectories (Halfon and McLearn, 2002)

10. Human Brain Development – Language and Cognition Language Sensing Pathways Higher (vision, hearing) Cognitive Function 9 -3 3 1 0 6 4 8 12 16 -6 Months Years Conception AGE C. Nelson, in From Neurons to Neighborhoods, 2000.

11. How the brain reacts to lack of stimulation http://www.healthychild.ucla.edu/dropdownmenu/Powerpoints/BrownGR2405.pdf

12. Developmental concepts • Early brain development influences how we are wired up for life. • Infants are not blank slates and passive recipients • Parents are their child’s first and most influential teachers.

13. Cycle of early life experiences Developmentally not ready for school Poor health Poor educational & behavioural attainment at school Low-status, low-control jobs Increased risk of unemployment & social marginality

14. Growth and development Put simply • Growth is an increase in size • Development is an increase in complexity

15. Development What affects growth & development • Genetics • Intrauterine environment • Extrauterine environment • Basics of life available • Stimulation, opportunity and encouragement • Health – impact of life course and social determinants of health.

16. Capabilities of the newborn- one smart little vegemite. • Visual – can focus best at cradling distance, likes bright objects, programmed to faces • Hearing – knows parents voice from utero, stills or startles to sound • Taste – can determine salt and sweet, prefers breast over water any day • Smells – can identify mums breast milk within days • Touch – is comforted by touch, able to feel and react to pain. • Communicates through cry, has only needs not wants.

17. Developmental concepts • We all develop in the same sequence but the rate may vary. • Development progresses in a direction of cephlo – caudal and proximo –distal What that means is from top of head down and from the middle of the body out. • We master simple things first before progressing to more complex

18. Learning to walk take solid food to talk to control elimination of body waste Achieving physiological stability Slee,P.T Child, Adolescent and Family Development(2nd ed) Forming simple concepts regarding social and physical reality Learning about sex differences and sexual modesty to relate emotionally to parents, siblings and others to distinguish right and wrong and developing a conscience Developmental tasksEarly childhood

19. The challenges0-5 years • Attachment & bonding • Object permanence • Stranger anxiety • Safety • Play • Referral – who is out there ????

20. Social Behaviour and play

21. Key stages in social development 0-5 years • 0-6 weeks Preference for attending to people Recognition of Mothers voice Intent regard of faces • 6-8 weeks Smiling emerges Imitation of facial expressions

23. Key stages in social development • 3 months Smiling and other facial expressions synchronised with those of caregivers • 5 months Growing interest in objects Some refusal to look at parents • 9 months Using referential gaze to direct parent’s attention to objects

25. Key stages in social development • 10 months Wary of strangers • 1-2 years Reactions to novel situations largely dependent on that of caregivers ( social referencing) Development of teasing – anticipating parents reaction to forbidden actions Protest and tantrums – limit testing

27. Key stages in social development • 2 -3 years Understanding of responsibility – leading to denial of transgressions Asking ‘what’ , ‘where’ questions Captivated by stories – focus shifts from actions of characters to feelings. • 3-4 years Breadth of interest in social world Asking ‘why’ questions Talk about inner states and rules – what is good, bad, naughty, allowed etc Able to adopt emotional states within pretend play.

28. Key stages in social development • 4 -5 years Growing understanding of rules Increasing understanding of the links between people’s mental state and actions – theory of mind.

29. Stages in development of friendships • 18 months Child shows awareness of another child’s distress • 20 months Mutual imitation Beginning to cooperate with a sibling / peer in order to achieve a goal • 2 years Development of preferences for particular companions Cooperating within a shared play theme eg tea party

30. Stages in development of friendships • 2 ½ years Able to adopt complementary roles within play scenarios eg mother – baby, doctor – patient Awareness of what is pretence eg pretending to be in pain, a hungry baby • 3 years Using references to friendship to include and exclude eg ‘I’m not your friend today’ Tendency to label any play companion as a friend so can appear fickle Development of ‘fighting friends’ ie reciprocal relationships that include both harmonious play and conflict Some children develop imaginary friends

32. Stages in development of friendships • 4 years Children are clear about who their friends are and will differentiate between friends and other peers Development of sophisticated sharing of a pretend world. Play includes sustained adventures, often including favourite characters from books or films, or everyday events. Fantasy play with strong emotional components such as fear, abandonment, bravery Alternative types of reciprocal play include sharing physical activities ( chasing, playing football, skipping) or shared mischief

34. Stages in development of friendships • 5 years Increasing understanding of the needs, feelings and wishes of friends Bargaining, compromise and reconciliation Able to talk about what makes someone a friend

35. Middle Childhood Middle childhood is often called a ‘quiet period ‘ developmentally but there’s is still a lot happening

37. The challenges5-12 years • Friendships and growing independence • Transition to school • Literacy acquisition • Safety • Obesity epidemic • Referral – who is out there ????

38. Learning Physical skills necessary for ordinary games To get along with age -mates An appropriate masculine or feminine role Building wholesome attitudes towards themselves as they grow Achieving personal independence Developing Fundamental skills in reading, writing and calculating Concepts needed for everyday living A conscience, morality and a scale of values Attitudes towards social groups and institutions Slee,P.T Child, Adolescent and Family development(2nd ed) Developmental tasksMiddle childhood

40. 7-8 year olds PHYSICAL DEVELOPMENT • Large muscles in arms and legs are more developed than small muscles. Children can bounce a ball and run, but it is difficult to do both at the same time. • There may be quite a difference in the size and abilities of children. This will affect the way they get along with others, how they feel about themselves, and what they do. Seven to nine-year-old children are learning to use their small muscle skills (printing with a pencil) and their large muscle skills (catching a fly ball). • Even though children are tired, they may not want to rest. You will need to plan time for them to rest.

41. 7-8 year olds SOCIAL AND EMOTIONAL DEVELOPMENT • Children want to do things by and for themselves, yet they need adults who will help when asked or when needed. • Seven to nine-year-old children of the same age and sex help each other: • have fun and excitement by playing together, • learn by watching and talking to each other, • in time of trouble by banning together, • by giving support in time of stress, and • understand how they feel about themselves.

42. 7-8 year olds SOCIAL AND EMOTIONAL DEVELOPMENT • Children need guidance, rules, and limits. • They need help in solving problems. • They are beginning to see things from another child's point of view, but they still have trouble understanding the feelings and needs of other people. • Many children need help to express their feelings in appropriate ways when they are upset or worried. • They need more love, attention, and approval from parents and you than criticism.

43. 7-8 year olds INTELLECTUAL DEVELOPMENT • With an increased ability to remember and pay attention, their ability to speak and express ideas can grow rapidly. • Things tend to be black or white, right or wrong, great or disgusting, fun or boring to them. There is very little middle ground. • They are learning to plan ahead and evaluate what they do.

44. 7-8 year olds INTELLECTUAL DEVELOPMENT • With increased ability to think and reason, they enjoy different types of activities, such as clubs, games with rules, and collecting things. • When you suggest something, they may say, "That's dumb," or, "I don't want to do it.“ • They are still very self-centered although they are beginning to think of others. • They often say, "That's not fair!" Often, they do not accept rules that they did not help make.

46. 9-11 years olds SOCIAL AND EMOTIONAL DEVELOPMENT • begins to see parents and authority figures as fallible human beings • rituals, rules, secret codes, and made-up languages are common • enjoys being a member of a club • increased interest in competitive sports • outbursts of anger are less frequent • may belittle or defy adult authority

47. 9-11 years olds PHYSICAL DEVELOPMENT • girls are generally as much as 2 years ahead of boys in physical maturity • girls may begin to menstruate • increases body strength and hand dexterity • improves coordination and reaction time

48. 9-11 years olds INTELLECTUAL DEVELOPMENT • interested in reading fictional stories, magazines, and how-to project books • may develop special interest in collections or hobbies • may be very interested in discussing a future career • fantasizes and daydreams about the future • capable of understanding concepts without having direct hands-on experience

49. Developmental Bingo • From cry to 5000 words and beyond • From scribble to Picasso • From gorgeous slug to junior athlete An amazing journey – the first twelve years babyhood to adolescence.

50. Thanks! Kath Venables Workforce Development Child & Adolescent Community Health Child & Adolescent Health Service