Typical Childhood Growth & Development: Critical aspects for the Physiotherapist

1. Typical Childhood Growth & Development: Critical aspects for the Physiotherapist Robyn Smith Department of Physiotherapy UFS 2012

3. Objectives for this model: After this module the learner should be able to: • Define term typical development • Explain what is meant by the term “development” • Identify the goals of gross motor development • Recall the characteristics of typical development • Identify intrinsic and extrinsic factors that impact on childhood development • Explain the basic principles of the well known developmental theories • Identify the main areas of development • Explain why physiotherapists need to be knowledgeable about normal development • Explain the concept of “developmental milestones” • Explain the concept of “developmental sequencing” • Recall important age related milestones • Understand the components and sequence of development of motor control

4. Typical Development

5. Normal Implies conformity to the human standard range ? What is the standard Typical Refers more to the specific qualities of a group e.g. humans More accepted term Controversy around the use of the terms “normal” versus “typical” when referring to development

6. What is “development” ? • Process that: • begins at conception, • and continues throughout life until death • Rate of change and growth is greatest in the first 2 years of life

7. Defining development • Increase in the complexity of structure andsize. We grow physically in size and stature • Increase in the complexityfunction – human activity that becomes more organised and effective as a result of practice • Acquisitionand refinement of skills in a specific sequence

8. Defining development • The human’s ability to learn, adapt, and cope with the world largely related to the child’s constant and dynamic interaction with the environment normal developmental cascade or developmental sequence • Developmental cascade is characterised by milestones

9. Motor development occurs in a specific sequence and timing Intrinsic and extrinsic factors impact on the timing of, and reaching of these milestones

10. Intrinsic factors Physiology Anatomy Genetics Personality/motiviation Race/ethnicity Medical conditions Often cannot avoid internal factors Extrinsic factors Inadequate bonding or nurturing with mother/caregiver Opportunities to learn or practice Culture Environmental risks Parental and child-rearing practices Nutrition Socio-economic factors Trauma Often factors that can be avoided or altered Factors that may impact on a child’s development

11. Some interesting facts …. • The child triples his birth weight in the first year of life • Achieves 2/3 of his/her brain size in the 1st 2-3 years • Progress from a completely dependent baby to a verbal, independent being by 2-3 years.

12. What are the requirements for development in a baby? • Stable behavioural and physiological states • Be able to interact with the environment • Spontaneous movements • Gradual development of postural and antigravity control • Balanced muscle activity

13. The goal of gross motor development? • Develop antigravity control, ultimately allowing us as humans to move in an erect posture ….. walk • Maintain our center of gravity over our base of support, initially in lower positions such as sitting and ultimately in standing • Develop isolated and dissociation of movement

14. What Characterises of typical development? The following may be considered important principles of development: • Movement is initially more reflexive after birth as maturation occurs becomes more complex andvolitional • Movement is initially generalised and becomes more localised • Developmental maturation was believed to only develop in a cephalo-caudal direction, but we now know that it develops in both directions at the same time. • Development is medial to lateral, trunk and head control develop before shoulder and pelvic girdle and then lastly limb control

15. What Characterises of typical development? • Gross motor skills develop before fine motor skills • Develop flexor muscle tone before extensor muscle tone • Development of antigravity extensionbefore antigravity flexion • Development is proximal to distal Mobility then stability, then mobility with stability and the development of skills

16. Theories on motor development

17. No single theory can explain typical development in its entirety Many theories contain valuable insights Many developmental theories exist Only going to look at some of the important ones

18. Developmental theories • Milestone approach (Illingsworth) –improved postural control dependent on the natural maturation process of the CNS. The order of development is same for all children, rate vary. characterised by milestones • Neural maturation theory/ hierarchial(Piaget, Gesell, Bayley)– Emphasis on the changes maturation in the CNS which enables development to proceed. Believed the CNS driving force in development. Emphasised the normal developmental sequence common to all humans. nature

19. Developmental theories • Behaviouralappraoch(Pavlov) – conditioning of a response to specific stimuli. By manipulating the environment create a response from an individual (used in our therapy) • Dynamic systems theory – CNS only one aspect, and the child’s experience and interaction with his environment (intrinsic and extrinsic factors) are critical to his development. No one system is more important than the other. Also sees the CVS, musculoskeletal and peripheral nervous system as important systems. Functional outcomes are the reason human’s perform tasks. nurture

20. Developmental theories • Latest and most widely accepted current theory on development • NB √ Neuronal group selection theory • Suggests that the infant has an inherent capacity for self generated activity, specific motor behaviourrepertoires, • which are then refined by experience enabling the child to choose the most effective motor plan for the task at hand

21. Developmental theories Theory also recognises the importance of: • opportunity for experience • Environment extrinsic • trial and error practice • varied practice • interactive nature of all aspects of motor control including sensory, cognitive and intrinsic perceptual behavioral (personality) biomechanical aspects • Ability to learn and adapt to acquire new skills

22. Areas of Development

23. Main areas of development: There are4 main areas of developmentthat need to be assessed • Gross motor • Fine motor • Speech and language • Socialization/ behaviour • As physiotherapists our focus is on gross motor development • Have to now basics of other areas of development to be able to interpret information/ refer

24. Why must physiotherapists be knowledgeable regarding normal development? • Provides a foundationfor understanding typical and therefore atypical development • Serves as the basis for our developmental/ neurological assessment Screeningpurposes Monitor a child’s developmental progression or regression Interpret developmental findings • Aids us in identifying delays and/ or abnormalities in development as the earliest possible point in time

25. Aids us in planning and executing our treatment of children, but also adults with motor delays or disturbances NB !!!! developmental sequencing By being knowledgeable about the developmental sequence we can identify the limitingcomponents and focus on them in treatment to aid the developmental sequence. Why must physiotherapists be knowledgeable regarding normal development?

26. Milestones

27. What are developmental milestones? • Defined by Illingworth in his milestone theory as • Set of functional skills or age-specific tasks • that most children can do at a certain age range • Milestone = standardfor skill acquisition • Defines the child’s “developmental age” • NB norms are based for children of full gestational age • Although each milestone has an age level, every child is unique, and the impact of intrinsic and extrinsic factors may vary Therefore it is accepted that standard deviation/variation of one month on either side is allowed

28. So where do I get information on childhood milestones? • Many different milestone guidelines in table and picture format • Internet – huge source of information regarding milestones available • Peabody infant development charts

29. Developmental Screening tests Objective & quantifiable = gives a score • Bayley scales III • Denver II • NDS • AIMS • Bruininks-Oseretsky test of motor proficiency • MABC • START programme: checklists – not quantifiable

30. Head control in supine (PTS) and in prone Ventral suspension Rolling Sitting 4 point kneeling /crawling Standing Pull to stand Cruising Walking Running Jumping Grasp Vision 5/12 5/12 6/12 Starts 6/12 arm support /well 8/12 Start 7/12 well 9/12 FWB 6/12 –holding on 10/12 7-9/12 10-12/12 12-18/12 even 24/12 in cases 24/12 36/12 7-9/12 6/12 Milestones importance: to know by heart

32. Milestones vs. developmental sequence • Both are important components to consider when assessing and treating children with developmental concerns • Developmental sequence refers to the typical pattern or development of the components of movement & timing thereof • Need to understand the components and the sequencing of the components in the developmental sequence • Whilst when looking at milestones your are assessing the skills or tasks a child has achieved for his age

33. References: • Images courtesy of GOOGLE (2009) • Growth and Development. In Coovadia, H.M. & Wittenberg, D.F. (eds) in Paediatrics and Child Health. A manual for health professionals in developing countries. 4th ed. Oxford city Press: Cape Town pp 21-40 • Van derVyver, A.E. Normal Growth in Paeditric doctors lectures for Physiotherapy students. (Unpublished) • Goldson, E. & Reynolds, A. Child development and Behaviour Hay, W.W.; Myron, J. L.; Sondheimer, J.M. & Deterding, R.R. (eds). In current diagnosis and treatment in Paediatrics. 18th ed. McGraw-Hill companies: NewYork pp65-101 • Aubert, E.J. Motor development in the normal child in Pediatric Physical Therapy. Tecklin, J.S. (Eds) in Pediatric Physical Therapy. Lippincott, Williams & Wilkins. Baltimore pp17 -65 • Smith, R. 2009. Paediatric dictate, UFS (Unpublished). • Smith, R. 2009. Normal development (Unpublished) • Mosby Medical dictionary