targets: medical students and postgraduate

1. Dr Hussein
Abdeldayem
Prof of
Pediatric
Neurology
DEVELOPMENT

2. GROWTH
Increase in physical size ,
height and weight of the body

3. DEVELOPMENT
 FUNCTIONAL and
PHYSIOLOGICAL maturation
of systems and organs
 Leading to developing of new
skills , adaptation ability and
assuming responsibilities
 Denotes maturation of brain.
Leading to increase in Mental,
Physical, Social and
Emotional abilities of the child.

4. Normal development
 The brain comprises 100 billion neurons at birth
, each neuron develop about 15000 synapses
by 3 years of age.

5. CHILD DEVELOPMENT
Age – related development terms are: -
Newborn (1st 4 wks after birth)
Infant (1 – 12 m)
Toddler, early childhood, preschool (1 – 4 yrs)
School – aged child (5 – 12 yrs)
Adolescent (12 – 20 yrs)

6.  1. Directional Pattern:
– Cephalocaudal Pattern ( Head to Tail)
– Proximal to Distal (Midline to peripheral)
– Mass to specific (Differentiation)
 2. Sequential Pattern:.
- Sequence of development is the similar in all
children but differs in rate ( slow in DS)
- There is personal variation
DEVELOPMENT

7. Why emphasize early detection of
Development Delay
1- start early intervention and
treatment.
2- supply the parent an explanation
for their inquiries about difficulties
with their children as feeding,
handling, sleeping, and
temperament.
3- to look for associated findings for
managing

8. Developmental milestones 5’s
COGNITIVE
SKILLS
LANGUAGE
SKILLS
MOTOR
SKILLS
SOCIAL
SKILLS
SELF-
DEPENDENCE
SKILLS

9. Global Developmental Delay
GDD
Significant delay* in two or more of the following
five developmental skills:
cognitive
motor ( fine
and gross)
language
self-
dependence
social

10. Who should be screened for
development delay ?
All young children especially
those with risk factor All young

11. At birth
Gross motor Fine motor Cognitive Social Language
Crying to
indicate need.
Eg. Crying for
breast milk
Follows
moving objects
or light
Crying the only
language

12. At ONE MONTH
Gross motor Fine motor Cognitive Social Language
Raised head
on prone
slightly
Tight palmar
grasp
ALERT TO
SOUND
REGARDS
FACE
Crying

13. At TWO MONTHS
Gross motor Fine motor Cognitive Social Language
Visual fixation
and follows
near by objects
SOCIAL
SMILE
COO

14. At TWO MONTHS
Gross motor Fine motor Cognitive Social Language
Holds head in
midline,then
falls from
supine or to
45º from
prone

15. 3 months
Gross motor Fine motor Cognitive Social Language
Supports head
when held erect
Opens hands
spontaneously
Increase
interest in his
surroundings
e.g.
Swings at and
reaches for
dangling toys

16. At FOUR/ FIVE MONTHS
Gross motor Fine motor Cognitive Social Language
Rolls front to
back, then
back to front
Supports on
wrists when
prone (sphinx
like)
Grasps hands
together
Knows mother LAUGHING

17. 6 months
Gross motor Fine motor Cognitive Social Language
Sits
momentary,
supported.
Transfer
objects from
hand to
hand.use 4
fingers
Understand
objects and
know what to
expect of
them.e.g
Bottle means
feeding time.
Recognizes
strangers
Show likes
and dislike
Babbles
(“ba, ba”
sounds)

18. 7 months
 Sits without support

19. 8 months
 Crawl (Lion like)

20. 9 months
Gross motor Fine motor Cognitive Social Language
Creeps or
crawls or
pulls to stand
Pincer grasp
Shows
interest in
picture books.
Watches
activities of
others with
interest.
Plays
peek-a-
boo
Repetitive
sounds mama
dada
SELF
Dependence
Feeds self

21. 10 months
 Bye-bye,
 Stand supported

22. 11 months
 Walk supported

23. 12 months
Gross motor Fine motor Cognitive Social Language
Stands
unsupported
Release an
object when
commanded
Responds to
simple
instructions.
Uses trial-
and-error to
learn about
objects.
Knows what
"no" means
and reacts.
Comes when
called. Plays
simple game
1-2 meaning
full words
Respond to his name

24. 15 months
 4-6 words
 Follows commands
without gesture
 Scribbles
 Walks
independently
 Drinks from cup
 Imitates activity
 Send kisses

25. 18 months
Gross motor Fine
motor/self
dependence
Cognitive Social language
Walks up
stairs with one
hand held
Seats himself
in small chair
Feeds from a
spoon
Enjoys simple
picture books.
Explores
environment.
Knows the
names of
parts of his
(4)body.
Index pointer
Mimics action
of others
At least 6
words

26. 2years (19-24months)
Gross motor Fine motor Cognitive Social/ self
dependence
Language
Runs. Kicks
large ball.
Squats. Walks
up and down
stairs 2 feet per
step.
Turns picture
book pages
one at a time.
Recognises
details in
pictures. Uses
own name to
refer to self.
Match two
objects
together by
colour, shape
or size.
Builds tower of
6 cubes.
Plays with
others.
Tantrum.
Spoon-fed and
drinks from
cup. Aware of
physical needs.
Joins 2-3 words
in sentences.
Talks to self
continuously.
Speaks >20
words, and
accumulate
new words very
rapidly.

27. 
‫ضحك‬
(
‫اجتماعى‬
)
40
‫يوم‬

‫الرأس‬ ‫رفع‬ ‫و‬ ‫المناغاة‬
2
‫شهر‬

‫الرأس‬ ‫تثبيت‬
3
‫شهور‬

‫االم‬ ‫على‬ ‫التعرف‬
4
‫شهور‬

‫الصدر‬ ‫و‬ ‫الراس‬ ‫رفع‬
4
‫شهور‬

‫النوم‬ ‫من‬ ‫التقلب‬
(
‫الوجه‬
)
4
‫شهور‬

‫لألشياء‬ ‫الوصول‬ ‫محاولة‬
4
‫شهور‬
‫النمو‬ ‫عالمات‬ ‫ظهور‬ ‫فى‬ ‫التأخر‬
‫التطورية‬

28. 
‫بصوت‬ ‫الضحك‬
5
‫شهور‬

‫التقلب‬
(
‫الظهر‬ ‫وضع‬ ‫من‬
)
5
‫شهور‬

‫مستندا‬ ‫الجلوس‬
6
‫شهور‬

‫بمفرده‬ ‫الجلوس‬
7
‫شهور‬

‫االصوات‬ ‫بعض‬ ‫ترديد‬ ‫فى‬ ‫بدء‬
7
‫شهور‬

‫الحبو‬
8
‫شهور‬

‫القلم‬ ‫وضع‬ ‫مسك‬
9
‫شهور‬
‫النمو‬ ‫عالمات‬ ‫ظهور‬ ‫فى‬ ‫التأخر‬
‫التطورية‬

29. 
‫بمساعدة‬ ‫الوقوف‬
10
‫شهور‬

‫باليد‬ ‫التلويح‬
‫با‬ ‫باى‬
10
‫شهور‬

‫بمساعدة‬ ‫السير‬
11
‫شهور‬

‫بمفرده‬ ‫الوقوف‬
/
2
-
3
‫كلمة‬
12
‫شهر‬

‫بمفرده‬ ‫السير‬
/
‫معتدال‬ ‫الجلوس‬
/
‫بمساعدة‬ ‫السالم‬ ‫طلوع‬
18
‫شهر‬

30
–
40
‫من‬ ‫جمل‬ ‫و‬ ‫كلمة‬
2
‫كلمة‬
24
‫شهر‬
‫النمو‬ ‫عالمات‬ ‫ظهور‬ ‫فى‬ ‫التأخر‬
‫التطورية‬

30. 3years (25-36months)
Gross motor Fine motor Cognitive Social Language
Steer tricycle.
Can jump off
lower steps.
Goes upstairs 1
foot per step
and downstairs
2 feet per step.
Relates present
activities and
past
experiences.
Can sort
objects into
simple
categories.
Understand
simple stories.
Plays co-
operatively.
Undresses with
assistance.
Imaginary
companions.
Uses spoon
and fork.
Speaks in
sentences of
4words.
Talks to himself
when playing.
At least 50% of
his words are
understandable.

31. 3 years
 Gives full name, age and sex
 Names 2 colors, , all body parts
 Throws ball overhead
 Walks upstairs, alternating feet
 Puts on shirt
 Copies circle
 Draws person with 3 parts
 Imitates horizontal and vertical lines

32. 4years (37-48months)
Gross motor Fine motor Cognitive Social Language
Knee crossing.
Go downstairs
one foot per
step. Can turn
sharp corners
when running.
Builds a tower
of 10 cubes.
Imitates gate
with cubes.
Copies a cross.
Counts up to
20. Asks
meanings of
words. Draw
recognisable
house.
Argues.
Dresses and
undresses with
assistance.
Attends to own
toilet needs.
Developing a
sense of
humour. Wants
to be
independent.
Uses correct
grammar most
of the time.
Uses
prepositions.
"Why" is a
favourite word
during this
period.

33. 4 years
 Counts 4 objects
 Identifies some numbers and letters
 Copies square
 Draw person with 6 parts
 Hops on one foot
 Dresses with little assistance
 Understands prepositions

34. 5years (49-60months)
Gross motor Fine motor Cognitive Social Language
Well-developed
ball skills. Walk
on thin line.
Hops on both
feet.
Builds steps
with 3-4 cubes.
Copy adult’s
writing.
Colours
pictures
carefully.
Writes name.
Draws a
detailed person.
Matches most
colours.
Understands
numbers.
Chooses own
friends.
Dresses and
undresses
alone. Cares
about others.
Copes well with
personal needs.
Fluent speech.
Talks about the
past, present
and future with
a good sense of
time.

35. 5 years
 Prints first name
 Counts to 10
 Asks meaning of words
 Skips
 Ties shoes
 Plays competitive games

36. 6years (61-72months)
Gross motor Fine motor Cognitive Social Language
Walks heel to
toe along a line.
Knows right
from left and
number of
fingers.
Draws with
precision and to
detail.
Developing
reading skills
well. May write
independently.
Stubborn and
demanding.
Eager for fresh
experiences.
May be
quarrelsome
with friends.
Dramatic group
play.
Talk fluently and
with confidence.
Can pronounce
majority of the
sounds of his
language.

37. Screening
BRAIN MRI
• Denver II,
• Bayley Infant Neuro-development Screen,
• Battelle Development Inventory, Clinical Adaptive Test
(CAT)/Clinical Linguistic and Auditory Milestone Scale
(CLAMS).
• Perform at 3, 6, 9, 12, 18 months and 2, 3, 4 and 5
years.
Screening
instruments:

38. Investigation (cont.)
Delay speech: Hearing assessment
thyroid functions (T4, TSH
Chromosomal study
Urine: screening for organic acids
and amino acids,
mucoplysacharides
Blood: phenylalanine, lactic acid,
ammonia, aminoacids
EEG
FUNDUS /VEP/RETINOGRAM

39. Primitive Reflexes
Reflex Age Disappears Description
Palmar grasp 3-4 mo Pressing against palm causes flexion of the fingers
Plantar grasp 4-6 Pressing against sole of foot causes flexion of the toes
Rooting 3-4 Stroking perioral skin causes mouth to open and turn
Galant 2-3 Stoking along paravertebral area causes lateral flexion of the
trunk to stimulated side
Moro 4-6 Sudden movement of the head causes symmetric abduction and
extension of the arms followed by adduction and flexion
Asymmetric tonic
neck -
Fencing
4-6 Turning the head to one side causes extension of arm on same
side, and flexion on opposite side.
Placing
/stepping
Varies Dorsum of foot touches the underside of the table, the infant
places the foot on the table top.

40.  9 months baby only coo, can’t sit, with
sissoring and increased deep tendon reflexes,
social smile. What is ur diagnosis?
Question
early spastic CP with global developmental delay

41.  9 months baby with ability to hold things
between thumb and index , say dada and papa
, able to crawl. Parents are anxious . what is
ur opinion?
Question
Assure the parent. He is a normal child
as regard his developmental milestones
achievement

42. TREATMENT
Early intervention
Rehabilitation
tt of association

43. Early Intevention Programs
(EIP
 BRAIN
PLASTICITY
Management

44. Management

45. DS Rehabilitation