Dr. Pradeep DubeyDr. Pradeep Dubey

MD (Ped.), DCH.MD (Ped.), DCH.

Dr. Pradeep DubeyDr. Pradeep Dubey

MD (Ped.), DCH.MD (Ped.), DCH.

DIVERSITY IN CHILDREN’S DEVELOPMENTDIVERSITY IN CHILDREN’S DEVELOPMENT

Children are more living beings, more living than grown up peoplewho have built up shells of habit around themselves therefore it is important for their mental development that they should not have mere schools for their lessons but a whole world ,whose guiding spirit is personal love.

Rabindra nath Tagore

Fastest Growth Rate

Brain growing still faster

hence more prone to injury .

Fastest Growth Rate

Brain growing still faster

hence more prone to injury .

EMBRYOEMBRYOEMBRYOEMBRYO

Age at conception >20 yrs. or < 35 Age at conception >20 yrs. or < 35

yrs.yrs.

Wt. > 40 kgs.Wt. > 40 kgs.

Ht. > 145 cms (4’10”)Ht. > 145 cms (4’10”)

Wt. gain in pregnancy – 10kgs in 9 Wt. gain in pregnancy – 10kgs in 9

mths.mths.

Age at conception >20 yrs. or < 35 Age at conception >20 yrs. or < 35

yrs.yrs.

Wt. > 40 kgs.Wt. > 40 kgs.

Ht. > 145 cms (4’10”)Ht. > 145 cms (4’10”)

Wt. gain in pregnancy – 10kgs in 9 Wt. gain in pregnancy – 10kgs in 9

mths.mths.

NUTRITION OF MOTHERNUTRITION OF MOTHERNUTRITION OF MOTHERNUTRITION OF MOTHER

Iron – Jaggery, Date palms & Apples etc.Iron – Jaggery, Date palms & Apples etc.

Protein – Milk, Cheese, Eggs & nuts etc.Protein – Milk, Cheese, Eggs & nuts etc.

Calcium – Milk & Milk products.Calcium – Milk & Milk products.

Smoking & AlcohalSmoking & Alcohal

Food hygiene & Stay away from pets.Food hygiene & Stay away from pets.

Iron – Jaggery, Date palms & Apples etc.Iron – Jaggery, Date palms & Apples etc.

Protein – Milk, Cheese, Eggs & nuts etc.Protein – Milk, Cheese, Eggs & nuts etc.

Calcium – Milk & Milk products.Calcium – Milk & Milk products.

Smoking & AlcohalSmoking & Alcohal

Food hygiene & Stay away from pets.Food hygiene & Stay away from pets.

D I E TD I E TD I E TD I E T

Mother – Rh negativeMother – Rh negative

Precautions for Rh Precautions for Rh

incompatibility incompatibility

Mother – Rh negativeMother – Rh negative

Precautions for Rh Precautions for Rh

incompatibility incompatibility

MATERNAL BLOOD GROUPMATERNAL BLOOD GROUPMATERNAL BLOOD GROUPMATERNAL BLOOD GROUP

Diabetes, Hypertension, Epilepsy, Diabetes, Hypertension, Epilepsy,

Heart Disease.Heart Disease.

Uncontrolled diabetes Uncontrolled diabetes risk of birth risk of birth

defect.defect.

Change drugs like valproateChange drugs like valproate

Diabetes, Hypertension, Epilepsy, Diabetes, Hypertension, Epilepsy,

Heart Disease.Heart Disease.

Uncontrolled diabetes Uncontrolled diabetes risk of birth risk of birth

defect.defect.

Change drugs like valproateChange drugs like valproate

SYSTEMIC DISEASES OF MOTHERSYSTEMIC DISEASES OF MOTHERSYSTEMIC DISEASES OF MOTHERSYSTEMIC DISEASES OF MOTHER

Prolong low grade fever.Prolong low grade fever.

Burning in micturition – rule out UTIBurning in micturition – rule out UTI

Foul smelling genital discharge.Foul smelling genital discharge.

Fever with rashesFever with rashes

R/O G. U. infections of fatherR/O G. U. infections of father

Vaccination Rubella, TT, Hep. B.Vaccination Rubella, TT, Hep. B.

Prolong low grade fever.Prolong low grade fever.

Burning in micturition – rule out UTIBurning in micturition – rule out UTI

Foul smelling genital discharge.Foul smelling genital discharge.

Fever with rashesFever with rashes

R/O G. U. infections of fatherR/O G. U. infections of father

Vaccination Rubella, TT, Hep. B.Vaccination Rubella, TT, Hep. B.

GENITOURINARY INFECTIONSGENITOURINARY INFECTIONSGENITOURINARY INFECTIONSGENITOURINARY INFECTIONS

400 mcg. Start before conception400 mcg. Start before conception

Birth defects Birth defects by 30% by 30%

Mandatory food fortification in US & Mandatory food fortification in US &

ChileChile

400 mcg. Start before conception400 mcg. Start before conception

Birth defects Birth defects by 30% by 30%

Mandatory food fortification in US & Mandatory food fortification in US &

ChileChile

FOLIC ACIDFOLIC ACIDFOLIC ACIDFOLIC ACID

Early breast feeding – Early breast feeding –

Colostrum helpsColostrum helps

Avoid bottle feeding Avoid bottle feeding

Weaning by 5 - 6 months.Weaning by 5 - 6 months.

Early breast feeding – Early breast feeding –

Colostrum helpsColostrum helps

Avoid bottle feeding Avoid bottle feeding

Weaning by 5 - 6 months.Weaning by 5 - 6 months.

F E E D I N GF E E D I N G F E E D I N GF E E D I N G

Psychosocial support.Psychosocial support.

Good Nutrition – Milk, Ghee, Good Nutrition – Milk, Ghee,

Dry fruits & Jaggery etc.Dry fruits & Jaggery etc.

Isolation and temp. control Isolation and temp. control

Hygiene Hygiene

Psychosocial support.Psychosocial support.

Good Nutrition – Milk, Ghee, Good Nutrition – Milk, Ghee,

Dry fruits & Jaggery etc.Dry fruits & Jaggery etc.

Isolation and temp. control Isolation and temp. control

Hygiene Hygiene

HEALTHY TRADITIONAL PRACTICES HEALTHY TRADITIONAL PRACTICES HEALTHY TRADITIONAL PRACTICES HEALTHY TRADITIONAL PRACTICES

Responsiveness / AlertnessResponsiveness / Alertness

Spontaneous motilitySpontaneous motility

Persistant hyper excitability Persistant hyper excitability

Feeding difficultyFeeding difficulty

Constant fisting after 2 monthsConstant fisting after 2 months

Abnormal movements / convulsions.Abnormal movements / convulsions.

Abnormal posturesAbnormal postures

Abnormal Head circumerence.Abnormal Head circumerence.

Responsiveness / AlertnessResponsiveness / Alertness

Spontaneous motilitySpontaneous motility

Persistant hyper excitability Persistant hyper excitability

Feeding difficultyFeeding difficulty

Constant fisting after 2 monthsConstant fisting after 2 months

Abnormal movements / convulsions.Abnormal movements / convulsions.

Abnormal posturesAbnormal postures

Abnormal Head circumerence.Abnormal Head circumerence.

TWILIGHT SIGNS/CONSTELLATIONSTWILIGHT SIGNS/CONSTELLATIONSTWILIGHT SIGNS/CONSTELLATIONSTWILIGHT SIGNS/CONSTELLATIONS

26

Abnormalities of toneAbnormalities of tone

Primitive reflexes weak / persistent Primitive reflexes weak / persistent

(>6 mths)(>6 mths)

Delayed appearance of postural Delayed appearance of postural

reflexesreflexes

Delayed mile stonesDelayed mile stones

Ocular abnormalitiesOcular abnormalities

Lake of response to sound.Lake of response to sound.

Abnormalities of toneAbnormalities of tone

Primitive reflexes weak / persistent Primitive reflexes weak / persistent

(>6 mths)(>6 mths)

Delayed appearance of postural Delayed appearance of postural

reflexesreflexes

Delayed mile stonesDelayed mile stones

Ocular abnormalitiesOcular abnormalities

Lake of response to sound.Lake of response to sound.

TWILIGHT SIGNS/CONSTELLATIONSTWILIGHT SIGNS/CONSTELLATIONSTWILIGHT SIGNS/CONSTELLATIONSTWILIGHT SIGNS/CONSTELLATIONS

26

A L A R M I N G S I G NA L A R M I N G S I G N A L A R M I N G S I G NA L A R M I N G S I G N

Grossly delayed MSDGrossly delayed MSD

Constant fistingConstant fisting

Abnormal head sizeAbnormal head size

Gross hypotonia or HypertoniaGross hypotonia or Hypertonia

Reduced response to sound Reduced response to sound

Paucity of movementsPaucity of movements

Asymmetrical limb movementAsymmetrical limb movement

Persistance of neonatal reflexesPersistance of neonatal reflexes

Abnormal postureAbnormal posture

Grossly delayed MSDGrossly delayed MSD

Constant fistingConstant fisting

Abnormal head sizeAbnormal head size

Gross hypotonia or HypertoniaGross hypotonia or Hypertonia

Reduced response to sound Reduced response to sound

Paucity of movementsPaucity of movements

Asymmetrical limb movementAsymmetrical limb movement

Persistance of neonatal reflexesPersistance of neonatal reflexes

Abnormal postureAbnormal posture

ALARMING SIGNSALARMING SIGNSALARMING SIGNSALARMING SIGNS

6

Follow up of high risk babiesFollow up of high risk babies

High index of suspicionHigh index of suspicion

Brief account of developmental history Brief account of developmental history

& examination& examination

Detailed neuro developmental Detailed neuro developmental

assessment by child development group.assessment by child development group.

Investigations – metabolic screening, Investigations – metabolic screening,

EEg, CT scan & Chromosomal studies etc.EEg, CT scan & Chromosomal studies etc.

Early & appropriate intervention.Early & appropriate intervention.

Follow up of high risk babiesFollow up of high risk babies

High index of suspicionHigh index of suspicion

Brief account of developmental history Brief account of developmental history

& examination& examination

Detailed neuro developmental Detailed neuro developmental

assessment by child development group.assessment by child development group.

Investigations – metabolic screening, Investigations – metabolic screening,

EEg, CT scan & Chromosomal studies etc.EEg, CT scan & Chromosomal studies etc.

Early & appropriate intervention.Early & appropriate intervention.

EARLY IDENTIFICATION OF DEV. DISORDERS - ?EARLY IDENTIFICATION OF DEV. DISORDERS - ?EARLY IDENTIFICATION OF DEV. DISORDERS - ?EARLY IDENTIFICATION OF DEV. DISORDERS - ?

12

1.1. Early identification of neuro Early identification of neuro

developmental disorders.developmental disorders.

2.2. Minimisation of persistence Minimisation of persistence

abnormalities & detection of transient abnormalities & detection of transient

neurological abnormalitiesneurological abnormalities

3.3. Prevention of asymmetries & Prevention of asymmetries &

abnormalities of development.abnormalities of development.

4.4. Stimulation along channel of normal Stimulation along channel of normal

developmentdevelopment

1.1. Early identification of neuro Early identification of neuro

developmental disorders.developmental disorders.

2.2. Minimisation of persistence Minimisation of persistence

abnormalities & detection of transient abnormalities & detection of transient

neurological abnormalitiesneurological abnormalities

3.3. Prevention of asymmetries & Prevention of asymmetries &

abnormalities of development.abnormalities of development.

4.4. Stimulation along channel of normal Stimulation along channel of normal

developmentdevelopment

EARLY INTERVENTION - AIMSEARLY INTERVENTION - AIMSEARLY INTERVENTION - AIMSEARLY INTERVENTION - AIMS

xi

WE ARE GUILTY OF MANY ERRORS AND FAULTS, BUT OUR WORST CRIME ISWE ARE GUILTY OF MANY ERRORS AND FAULTS, BUT OUR WORST CRIME IS

ABANDONING OUR CHILDREN, NEGLECTING FOUNTAIN OF LIFE.ABANDONING OUR CHILDREN, NEGLECTING FOUNTAIN OF LIFE.

MANY THINGS WE NEED IN LIFE CAN WAIT, THE CHILD CAN NOT. MANY THINGS WE NEED IN LIFE CAN WAIT, THE CHILD CAN NOT.

RIGHT NOW IS THE TIME – HIS BRAIN IS GROWING ,RIGHT NOW IS THE TIME – HIS BRAIN IS GROWING ,

HIS BLOOD IS BEING MADE. HIS SENSES ARE BEING DEVELOPED.HIS BLOOD IS BEING MADE. HIS SENSES ARE BEING DEVELOPED.

TO HIM WE CAN NOT ANSWER TOMORROWTO HIM WE CAN NOT ANSWER TOMORROW

HIS NAME IS “TODAYHIS NAME IS “TODAY””

GABRIELA MISTRAL (NOBEL LAURIET FROM CHILE)GABRIELA MISTRAL (NOBEL LAURIET FROM CHILE)

FOR FURTHER DETAILS :

www.healthychildindia.comwww.healthychildindia.comPLEASE VISITPLEASE VISIT

““DEVCHHAYA” DEVCHHAYA” Early Intervention Centre

Prem Mandir Chowk, Wright Town - Jabalpur