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Plenary review

  • Alex is the brother of Sarah (Down syndrome)
  • William is the cousin of Sarah and Alex. William has Down syndrome as well
  • Genogram shows male, female, deceased female, affected male, affected female, uncertain diagnosis, divorce
    • See picture of genogram in scenario hand out

DVD: First Steps

  • Walking reflex
    • Hip,knee and ankle joints need coordination
    • Appears from a few days old, fade sat 12 weeks
    • Gain the ability to walk at 9-16 months
  • 5 months
    • Bath-time is a good time to practice rhythmic kicking
    • Builds coordination and muscle tone
  • Problem
    • Size of baby’s head means that it is too large relative to the body for balance
    • 2 x adult proportions
  • Ability to roll – can move independently
    • Precursor to crawling
  • Sitting
    • Can sit up briefly before able to get into sitting position
    • Fall backwards
    • Watershed, sitting means infant has the muscle tone to balance own body and have their hands free to do things
  • Crawling
    • Begin by crawling backwards because legs are not as strong as arms
    • Many types of crawling–not pre - programmed
    • Allows exploration
    • Need to decide where to go and keep destination in mind
      • Crawling thus accelerates brain development
    • Fear of falling– acquired 2 weeks after crawling develops
  • Eventually develop ability to crawl up stairs
  • 10 months – can stand/walk with 3 points of balance
    • Known as cruising– eyes > 20 inches from ground
      • Can explore more effectively
    • Once able to balance on 2 legs unaided, baby is weeks away from walking
  • Walking makes use human
    • Initially a duck - like gait, and a lack of foot arches
      • Balance is not good enough to walk otherwise
    • Walking stimulates improved balance/coordination
  • Walking enables exploration
    • Heels strike ground first, joints are more flexible allow variable movement
  • Later, can walk down stairs

Blue book

Blue book link

  • Organises children’s records and allows monitoring of child’s development
    • NB:also shows percentile charts to plot child’s growth
  • Serves as a reminder for things parents need to look for



  • Discuss the reasons for screening for normal development.
  • WHY is this done? What area the general features of screening? 1) To detect abnormalities early and enable investigations early 2) So that intervention (cure/support/developmental assistance) can take place 3) To avoid an impact on the child/family/society
  • WHAT makes a good screening test?
    • Sensitivity = true positives.
    • Specificity = true negatives.
    • Need both sensitivity and specificity to be high (close to 100%)
    • Quick and simple but effective in detection - Both specific and sensitive
    • Reproducible - i.e. standardised so that all tests are carried out in same way
    • Acceptable - to child, parents and health worker - e.g. not painful or scary!
    • --> Better outcomes/results
  • Can you think of any screening tests that babies/children have for their health - e.g. at birth, their GP, at school
    • Newborn screening test (BGDA)
    • Hearing - why and what questions might you ask parents to screen for hearing problems?
    • Vision - why and what questions might you ask parents to screen for vision problems?
    • Height, weight, head circumference
    • Congenital heart disease (CHD)
    • Testes
    • Congenital dislocation of hips
    • Developmental checks: for a child's language, movement and social skills

Screening for development

  • Guthrie Heel Prick test
  • Physical (including reflexes)
  • Hearing
    • NSW statewide infant screening–hearing (SWISH) program in place to screen hearing
  • Vision
  • Children are screened at various times:
    • At birth, 1-4weeks, 6-8weeks, 6months, 12, 18months, 2years, 3, 4years

Hearing

Alex is 3 years, Catherine is 3 months. Know the questions to ask for each of these people (read the Blue Book).

  • Parents to monitor:
    • 1-4weeks
      • Response to sound – startled by loud noises
      • Do you think they can hear?, are they receptive to parents?
    • 6 months
      • Baby turns towards sounds/voices?
      • Hear/listen to your voice?
    • 18 months
      • Simple words, 100 different words in vocabulary
      • Can they understand simple instructions?
      • Ear infections
      • Locate sound?
    • 2.5 years to 3 years
      • Sentences, groups of words
      • Do they ask for repetition?
      • Do they have difficulty with instructions?

Vision

  • 6-8 weeks
    • Do they turn towards light?
  • 6-8 months
    • Do they look at objects?
    • Do they follow you when you leave their sight
    • Do they move both eyes together?
  • 18 months
    • Do they have difficulty in seeing small objects?

Developmental checks

  • Several tests, controversial because recently experts have recommended not using these checks
    • Risk of misclassification and missing diagnoses
  • Tests:
    • Gross motor skills – sitting, standing, walking
    • Fine motor skills – using hands, writing, threading beads
    • Language and cognition – receptive/understanding ability and expressive ability
    • Personal/socialskills–dress/feed themselves, brush hair/teeth, interaction with other people – friends?
    • Growth – head circumference, height, weight, BMI(assessed against percentile charts)

Causes of not reaching milestones

  • Prenatal
    • Genetic diseases – eg: trisomy 21
    • Familial - late walkers often run in families
    • Prematurity
    • Pregnancy related - fetal alcohol syndrome
    • Brain mal-development
  • Perinatal
    • Birth event - asphyxia, nerve injury
  • Postnatal
    • Failure to thrive/malnutrition
    • Medical disease-muscle disease, hypothyroidism
    • Chronic illness and hospitalisation (misses out on learning opportunities)
    • Trauma/accident
    • Vision and hearing problems
    • Intellectual disability
    • Behavioural problems
    • Sleep disorder
  • Environmental
    • Medications - e.g. antiepileptic drugs
    • Lead poisoning
    • Domestic violence
    • Neglect/abuse
    • Quality of family environment


  • Other:
    • Autism
    • Malnutrition
    • Lack of social exposure
    • Stress in household, neglect and abuse
    • Physical injury
    • Illness/infection
    • Neglect/abuse



Physical milestones

  • Birth – 1 month
    • Makes jerky quivering arm movements
    • Head flops back if unsupported
    • Uses sucking, grasping, and rooting reflexes
    • Has strong reflex movements
  • Around 3 months
    • Lifts head when on stomach
    • Pushes down on legs when feet are placed on a firm surface
    • Takes swipes at dangling objects with hands
    • (Smiles at face at around 1-3 months)
    • (Reaches, grasps and puts objects in mouth around 4-6 months)
  • Around 6 months
    • Rolls over both ways
    • Reaches, grasps and puts objects in mouth
  • Around 9 months
    • Sits without support
    • Transfers objects between hands
    • Crawls
    • Pulls to stand
    • Stands - holding on
  • Around 12 months
    • Reaches sitting position without assistance
    • Stands unaided
    • May walk 2-3 steps unaided
    • Walks with aid
    • Picks things up with thumb and 1 finger
    • Drops and picks up toys
  • 1-2 years
    • Walks alone
    • Seats self in a child’s chair
    • Walks up and down stairs with aid
    • Scribbles
  • Around 3 years
    • Jumps in place with both feet together
    • Strings large beads
    • Holds a crayon with the thumb and fingers instead of a fist
    • Can draw a circle
    • Builds at all tower of blocks
    • Rides a tricycle
  • Around 4 years
    • Walks on a line
    • Hops on one foot
  • Around 5 years
    • Walks up and down stairs without assistance alternating feet
    • Prints a few capital letters

Homework

  • See SG guide