Infant and Pediatric Growth and Development

Brenda Beckett, PA-C

Objectives

Normal growth patterns– Height– Weight– Head circumference

Normal development– Gross motor– Fine motor– Language– Personal / Social– Cognitive

Anticipatory Guidance

Important to remember

Kids are not little adults!! Know milestones (normal) Learn to recognize abnormal Listen to parents’ concerns

Role of Pediatric Provider

Relationship with provider can last many years, multiple children

Understand family and background Communication is key to development

of successful relationship Providing educational materials,

anticipatory guidance

Provider/Parent Relationship

Frequent visits the first year of life Identify issues of growth and development Learn about the family’s cultural and

socioeconomic factors Focus on areas of concern to the family Assess importance of factors to family Personal attention to the individual needs of

the child

Parent’s perspective

Well child visit gives chance to assess parent’s perspective

Parents are most important observers Understand their perception of child’s

development Identify concerns and anxieties In this way, provider can attempt to

alleviate concerns

Physical Exam

Dynamic tool to interact with the child and the parent

Can reveal important insights into development beyond physical signs

Parents often add important insight

Anticipatory Guidance and Education

Impact child’s health and development long term

Prepare parents/child for next step in development

Discuss important issues including:nutrition, safety, immunizations, developmental milestones at each visit

Provide positive feedback whenever possible

Hearing

Hearing screen– Indirect screen of hearing, production of normal

sounds• 6wks-cooing• 3mo-laugh out loud• 9mo-echo sound• 12-15mo-1st words

Hearing is essential for normal language development

Audiometric testing

Schedule for Well Child Visits

Newborn, 2 week, 2 months, 4 months, 6 month, 9 months, 12 months, 15 months, 18 months

2 years and then yearly Notice correlation with immunization

schedule

Growth

Length, Weight, Head Circumference– Measured and plotted on growth curves– Explain growth curve to parents

Measure HC until age 2– Relatively large proportionately at birth– Slow growth-Craniosynostosis (cranial

sutures have closed too soon)

Development

Parental concerns Parental questionnaires Observation Direct questions

2 Week WCC

Length, weight and HC Alertness, Tone, Head Control

– Gross motor: Head side to side– Personal-social: regards face– Language: alerts to sound

Any parental concerns?

2 Month WCC

Development– Gross motor: moving limbs, lifts shoulders– Fine motor: Tracks past midline– Personal-social: Smiles responsively– Language: Coos/verbalizes

Observe infant during exam Observe parents with infant

4 Month WCC

Gross Motor– Roll front to back, lifts up on hands

Fine Motor– Reach for object, raking grasp

Personal/Social– Develops a social smile– Regards hand

Language– Vocalizing, begins to babble, laugh

6 Month WCC

Gross motor– Rolls B-F and F-B, sits alone

Fine motor– Transfers objects

Personal/Social– Feeds self

Language– Babbles

9 Month WCC Gross Motor

– Sit without support-crawl, pull to stand, cruise Fine Motor

– Pincer grasp Personal/Social

– Understand bye-bye, and no-no– Peek-a-boo– Stranger anxiety

Language– Babbling, 1-2 vocalizations, Mama Dada

nonspecific

Anticipatory Guidance and Education

Safety-child proofing, water safety, poison control

Milestones Play games with child Introduce cup Bite size pieces of food

12 Month WCC

Gross Motor – Walking or close

Fine Motor – Puts blocks in cup

Personal/Social– Drinks from cup, imitates others

Speech– Mama, dada specific, plus 1-3 other words

15 Month WCC

Gross Motor – Walks well, walks backwards

Fine Motor – Scribbles, stacks two blocks

Personal/Social– Uses spoon/fork, helps in house

Speech– 3-6 words, follows commands

18 Month WCC

Gross Motor – Runs, kicks ball

Fine Motor – Stacks four blocks

Personal/Social– Removes garment

Speech– Says at least 6 words

Toddler 1-2 years

Social/emotional development– Behavioral shifts

• Stubborn independence to clinging to parent• Temper tantrums*/discipline

Cognitive abilities– Early language– Pretend play– Exploration

Physical Development– Walking/running– Slower growth rate

Temper Tantrums How not to fuel frustration, initiate power struggles

and create unnecessary conflict!! Think before you speak, be realistic when you make

a rule or promise Try not to reinforce negative behaviors, just to quiet

your child Talk to your child about how he/she are feeling, and

acknowledge those feelings Try to be as consistent as possible Use your mistakes to help you for the next time…

there will be a next time Praise good behavior...set your child up to be

successful

Preschool 3-5 years

Social/emotional development– Toilet training*– Peer interactions

Cognitive development– Speech – Imagination/fantasy

Physical development– Increased coordination– Steady growth

Toilet Training

Support, educate and encourage parents Developmental process, many steps, before

successful, and setbacks are common Is your child ready?

– Clues to readiness: express interest in toilet training, imitate parents behaviors, communicate need to “go”, demonstrates some independence

– Initiate the discussion with parents at age 1-2

Toilet Training (cont.)

Are the parents ready?– Schedule: Do they have blocks of time to

devote to toilet training?– Encourage them to resist pressures from

grandparents, friends, daycare providers– Ask if they have any previous experiences

with toilet training that they would like to discuss

Important Points to Remember

Do not pressure or punish the child Stress the importance of

parent/caregiver cooperation

Middle Childhood 5-10 years

Social/emotional– School – Peer interactions

Cognitive development– Reading, math

Physical development– Balance– Sports

Child Safety and Injury Prevention

Injuries are the number one cause of death in children ages 1-21

Motor vehicle cause the most deaths, followed by drowning

Car Seats

Safest place in the back seat, in car seat. Rear-facing until 12mo & 20 lb

Car seat/booster must be appropriate size for child, fit properly in the car, and be fastened correctly

Air bags-dangerous for child to be in front seat, even when the car is parked

Other safety issues

Bicycles Skateboarding/Rollerblading Firearms Poisoning And Many More…

Role of the pediatric health care provider

Form relationship with child and the family

Take a history that will elicit age appropriate information

Assess growth and development Examine patient Provide anticipatory guidance and

education of patient and family