Good afternoon ! Everybody!

1. Good afternoon !Everybody!

2. Chapter 3Normal child development , hearing and vision

3. A child is not a small adult ! A infant is not a small child ! A newborn is not a small infant !

4. Contents for today 1. Normal child development • Hearing and Vision • Developmental problems

5. Normal child development • Children development ---The skills acquired by children between birth and about 5 years of age, when there is rapid progress in mobility, speech and language, communication and independence skills.

6. Normal child development • Be monitored: • by parents • at regular child health surveillance checks • at brief opportunistic overview

7. Normal child development • Influence of heredity and environment • Age and stage of development • infants • primary school age children • adolescents

8. Normal child development • Four field of developmental skills • gross motor • vision an fine motor • hearing, speech, and language • social, emotional and behavioural

9. Normal child development • Developmental milestones ---important developmental skills • The median age---the age when half a standard population of children achieve that level. • Limit ages---the age by which they should have been achieved.

10. Developmental milestones • The difference between median and limit ages can be demonstrated by considering the age range for the important developmental milestone of walking unsupported.

11. Developmental milestones • Variation in the pattern of motor development • Adjusting for prematurity

12. Is development normal?

13. Pattern of child development • Be described in detail for each field of development , including key developmental milestones and limit ages • Gross motor development • Vision and fine motor • Hearing, speech and language • Social, emotional and behavioural

14. Cognitive development • Refers to higher mental function • Intelligence testing (IQ) • Formal IQ test • Performance IQ (PIQ) • Verbal IQ (VIQ)

15. Analysing developmental progress • Detailed assessment • The short cut approach ---concentrates on the most actively changing skills for the child’s age • Observation during questioning • Equipment for developmental testing

16. Developmental screening and assessment • Checks of whole populations of children at set ages by trained professionals • A formal progress within the child health surveillance and promotion programme • An essential role of all health professionals to screen a young child’s developmental progress

17. Child health surveillance and promotion programme • Three main elements • Immunisation • Health promotion • Screening for the early detection and intervention of physical and developmental problems

18. Hearing • Age and stage of hearing development • Parental concern

19. Hearing • Hearing test • Newborn • Evoked otoacoustic emission (EOAE) • Auditory brainstem response (ABR) • Distraction testing • Visual reinforcement audiometry • Performance and speech discrimination testing • Audiometry

20. Vision • Age and stage of vision development • Vision testing

21. Chapter 4Developmental problemand the child with special needs

22. Abnormal development • Caused by • neurodevelopmental problems • ill health • physical or psychological needs are not met

23. Terminology Delay Learning difficulty disorder Definitions Impairment Disability Handicap Key concepts

24. Abnormal development • The pattern of abnormal development • Slow but steady • Plateau effect • Showing regression

25. Abnormal development • The severity • Mild • Moderate • Sever • Profound • Other features of developmental delay

26. Development delay • Global development delay implies delay in acquisition of all skills. • Global development delay usually presents in the first years of life.

27. Abnormal motor development • Cerebral palsy • Causes • Clinical presentation • Spastic cerebral palsy • Ataxic hypotonic cerebral palsy • Dyskinetic cerebral palsy • Spastic cerebral palsy • Management

28. Abnormal speech and language development • speech and language disorders: • Language comprehension disorders • Language expression disorders • Phonation and speech production disorders • Disorders of pragmatics,construction of sentences, semantics, grammar • disorders of social/communication skills

29. Abnormal development of social/communication skills • Autistic spectrum disorder • presents at 2~4 years with impaired social interaction, speech and language disorder and imposition of routines with ritualistic and repetitive behaviour • is usually managed by behaviour modification using applied behavioural analysis (ABA)

30. Abnormal development of social/communication skills • Features of autistic spectrum disorders • Impaired social interaction • Speech and language disorders • Imposition of routines with ritualistic and repetitive behaviour • Co-morbidities

31. Hearing impairment • Hearing loss • Sensorineural • Conductive

32. Presents in infancy: loss of red reflex from a cataract a white reflex in the pupil not smiling responsively by 6 weeks post-term lack of eye contact with parents visual inattention random eye movement nystagmus squint photophobia Abnormalities of vision

33. Abnormalities of vision • Severe visual impairment • The causes • Developed country---genetic • Developing country---infection • Early detection is important

34. Abnormalities of vision • Squint ---Misalignment of the visual axes • Concomitant (common) • Paralytic (rare) • Tests • Corneal light reflex test • Cover test

35. Abnormalities of vision • Refractive errors • hypermetropia • myopia • amblyopia

36. Slow acquisition of cognitive skills/general learning difficulty • Learning difficulty ---mental retardation or mental handicap • Classified as • Mild (IQ 70~90) • moderate (IQ 50~70) • sever (IQ 20~50) • profound (IQ less than 20)

37. Specific learning disorders • Developmental coordination disorder (DCD) or dyspraxia ---a disorder of motor planning and/or execution • planning dyspraxia • executive dyspraxia

38. Specific learning disorders • Dyslexia ---a disorder of reading skills disproportionate to the child’s IQ

39. Specific learning disorders • Dyscalculia, dysgraphia --- disorders in the development of calculation or writing skills

40. Specific learning disorders • Associated co-morbidities of specific learning disorders • attention deficit disorder • hyperactivity • poor sensory integration skills • depression, conduct disorders

41. Specific learning disorders • Management of specific learning disorders • Problems with concentration and attention

42. Multidisciplinary child development services • Child development services have been developed nationally on a geographic area as a secondary care service. • Emphasis • diagnosis • assessment of functional skills • provision of therapy • regular review • a coordinated approach to care

43. Education • The 2000 Code of Practice suggests: • cognition and learning • communication and interaction • behaviour, emotional and social development • sensory and/or physical needs

44. Transition of care to adult sevices • Health information must be properly transferred from child to adult health services if reinvestigation of already well-clarified conditions is to be avoided.

45. The right of disabled children • Help them to better achieve their full potential, rather than hold back by their ability.

46. Thank you!