Child Growth and Development Study Guide

Study Guide Block Growth and Development

CURRICULUM

Aims:
· To assess growth and development in children and adolescents.
· To diagnose, manage, and refer if required, common disorders of growth and
development.
· Awareness of the general means to assess fetal growth (intrauterine growth).
· Awareness of the common health implications of normal and abnormal aging.

Learning outcomes:
· Assess physical growth of children and adolescents.
· Diagnose and manage common nutritional problems in children and adolescents.
· Investigate infant or child with suspect failure to thrive.
· Identify common congenital anomalies in infants and children.
· Assess fetal growth (intrauterine growth).
· Assess development of children in specific domains.
· Awareness of common developmental disorders in children.
· Awareness of the normal sexual developmental sequence in children and
adolescents.
· Capability to evaluate critically the use of medicine in pregnancy, children, and
elderly.
· Detection of developmental deviation in children (Screening & Stimulation).
· Awareness of the impacts of aging on the common health parameters of the elderly.
· Awareness of the common clinical manifestations and disorders in the elderly.
· Diagnose and manage common health problems and disorders in the elderly.

Curriculum contents:
· Normal growth patterns in children and adolescents.
· Nutritional impacts on growth (and development) in infant, children and adolescents.
· Clinical manifestations and diagnosis of failure to thrive.
· Common congenital anomalies in infants and young children.
· Clinical assessment of intrauterine growth (fetal growth).
· Drug recommendation and toxicity on pregnancy and Children.
· Assess development of children and adolescents in specific domains.
· Methods of developmental deviation detection and stimulation.
· Common developmental disorders in children and adolescents.
· Diagnose common sexual developmental problems in children and adolescents.
· Aging and physiologic changes in health parameters.
· Common clinical manifestations and problems and management in the elderly.

Udayana University Faculty of Medicine, MEU 1


PLANNERS TEAM

NO NAME DEPARTMENT
1. dr. I G A Trisna Windiani, SpA (Head) Child Health
2. dr. I Nym Gd Wardana, S.Ked (Secretary) Anatomy
3. Prof. dr. Soetjiningsih, SpAK, IBCLC Child Health

~GROWTH AND DEVELOPMENT LECTURERS ~

NO NAME DEPARTMENT
1 Prof. dr. Soetjiningsih, SpAK, IBCLC Child Health
2 dr. I G A Trisna Windiani, SpA Child Health
3 dr. I Komang Kari, SpA (K) Child Health
4 dr. I Made Kardana, SpA Child Health
5 dr. I KG Suandi, SpA Child Health
6 dr. AAN Prayoga, SpA Child Health
7 dr. W Bikin Suryawan, SpAK Child Health
8 dr. Dharma Artana, SpA Child Health
9 dr. Made Arimbawa, SpA Child Health
10 dr. IGA Endah Ardjana, SpKJ Child Health
11 dr. I Gusti Lanang Sudiartha, SpA Child Health
12 Prof.Dr.dr.I Nym Mangku K, M.Repro Anatomy
13 dr. Eka Putra S, Sp.THT ENT
14 dr. N. Sunerti, SpM Ophthalmology
15 dr. R A Tuty Kuswardhani, SpPD Geriatri
16 dr. Nyoman Astika, SpPD Geriatri
17 dr. Tjok G A Suwardewa, SpOG (K) Obstetri &Gynaecoogy
18 dr. I.G.A.Dewi Ratnayanti Histology
19 dr. Made Jawi, M.Kes Pharmacology
21 Dra. Adijanti Marheni, M.Si Psychology

~CLINICAL SKILL LECTURERS ~

NO NAME DEPARTMENT
1 dr. Ratna Saraswati, SpPD Internal Medicine
2 Prof.Dr.dr.I Nym Mangku K, M.Repro Anatomy
3 dr. AA Wiradewi Lestari, SpPK Clinical Pathology
4 dr. Elysanti Dwi M, SpRad Radiology
5 Dr.dr. Pt Gd Adiatmika, M.Kes Physiology



FACILITATORS

Regular Class:
No Name Department Phone Group Venue
nd
I D.A. Pt. Rasmika Dewi, S.Si, Clinical 3 floor:
1 081338614445 1
Apt Pathology R.3.01
nd
Desak Ketut Ernawati, S.Si, 3 floor:
2 Pharmacy 03618029763 2
Apt, M.Farm R.3.02
nd
I.B.Putra Dwija, S.Si, 3 floor:
3 Microbiology 08179747502 3
M.Biotech R.3.03
Ni Wayan Tianing, S.Si, 3nd floor:
4 Biochemistry 08123982504 4
M.Kes R.3.04
dr. Mahasucipta Merati, 3nd floor:
5 Biochemistry 0811394065 5
Sp.Biok R.3.05
Dra.I.A.Alit Widhiartini, Apt, 3nd floor:
6 Pharmacy 03618550344 6
M.Si R.3.06
dr. Putu Eka Widyadharma, 3nd floor:
7 Neurology 081328049360 7
M.Sc, Sp.S R.3.07
nd
Desak Gde Diah Dharmasanti, Clinical 3 floor:
8 0817569021 8
S.Si, Apt, M.Kes Pathology R.3.08
nd
3 floor:
9 dr. Ni Luh Ariwati Parasitology 08123662311 9
R.3.21
nd
3 floor:
10 Ketut Agus Adrianta,S.F, Apt Pharmacy 03613114425 10
R.3.22

English Class:

No Name Department Phone Group Room
3nd floor:
1 dr. I Kadek Swastika, M.Kes Parasitology 08124649002 1
R.3.01
nd
2 3 floor:
dr. D.A.A. Sri Laksemi Parasitology 08123601782 2
R.3.02
nd
dr. Agung Wiwiek Indrayani, 3 floor:
3 Pharmacology 08886855027 3
M.Kes R.3.03
nd
3 floor:
4 dr. Made Muliarta, M.Kes Fisiology 0361-8087592 4
R.3.04
nd
3 floor:
5 dr. I.G.A.Dewi Ratnayanti Histology 081338710748 5
R.3.05
nd
3 floor:
6 dr. I Made Sudarmaja, M.Kes Parasitology 08123953945 6
R.3.06
nd
Dr.dr. I Putu Gede Adiatmika, 3 floor:
7 Fisiology 08123811019 7
M.Kes R.3.07
nd
Prof.Drs. I Made Budhi, 3 floor:
8 Pharmacy 08123677919 8
Apt.SKM, AFK R.3.08
nd
3 floor:
9 dr. Lely Rahayu, Sp.THT-KL ENT 08174709797 9
R.3.21
nd
dr. I Wayan Sugiritama, 3 floor:
10 Histology 08164732743 10
M.Kes R.3.22



TIME TABLE
ENGLISH CLASS
DAY/
TIME ACTIVITY CONVEYER
DATE

LEARNING OUTCOMES 1: ASSESS PHYSICAL GROWTH OF CHILDREN AND ADOLESCENTS

08.00 - 08.30 Intro: General Concepts of Growth and Prof. Soetji
Development
08.30 - 09.00 Lecture 1: Assessment Physical Growth of Prof. Soetji
1 Children And Adolescents
Monday
09.00 - 10.30 Individual learning
20 Dec 10
10.30 - 12.00 Group discussion Facilitator
12.00 - 12.30 Break
12.30 - 14.00 Student Project (Case Field Preparation)
14.00 – 15.00 Plenary Session Prof. Soetji

LEARNING OUTCOMES 2: ASSESS FETAL GROWTH (INTRAUTERINE GROWTH)

08.00 - 09.00 Lecture 2: The Stages of Prenatal Mangku K
Development
2 10.30 - 12.00 Group discussion Facilitator
Tuesday
21 Dec 10 12.00 - 12.30 Break
14.00 - 15.00 Plenary Session Mangku K
08.00 - 08.30 Lecture 3: Prenatal Genetic Evaluation and Ratnayanti
Counseling
08.30 - 09.00 Lecture 4: USG to Assess Fetal Anatomy Tjok Suwardewa
3 09.00 - 10.30 Individual learning
Wednesday
22 Dec 10
12.00 - 12.30 Break
14.00 - 15.00 Plenary Session Ratnayanti Tjok
Suwardewa
08.00 - 09.00 Lecture 5: Assessment Growth and Dharma A/Kardana
Development in Neonatus
Thursday
23 Dec 10
12.00 - 12.30 Break
14.00 - 15.00 Plenary Session Dharma A/Kardana

LEARNING OUTCOMES 4: CAPABILITY TO EVALUATE CRITICALLY THE USE OF MEDICINE IN
PREGNANCY, CHILDREN, AND ELDERLY

08.00 - 09.00 Lecture 6: Drugs in Pregnancy, Children, and Jawi
Elderly
5 10.30 - 12.00 Group discussion Facilitator
Monday
27 Dec 10 12.00 - 12.30 Break
14.00 - 15.00 Plenary Session Jawi

6 08.00 – 08.30 Lecture: Surface Anatomy and Topography Mangku K
Tuesday 08.30 – 09.00 Lecture: General Principles of Physical Ratna S
28 Dec 10 Examination
09.00 -10.00 Break



10.00 - 12.00 Training Session: Surface Anatomy And Facilitator
Physical Examination
12.00 - 14.00 Individual Learning
14.00 - 15.00 Plenary session Mangku & Ratna

LEARNING OUTCOMES 5: DIAGNOSE AND MANAGE COMMON NUTRITIONAL PROBLEMS IN
CHILDREN AND ADOLESCENTS

08.00 - 09.00 Lecture 7: Principles Breastfeeding for Prof. Soetji
Infants With Normal Delivery
08.30 - 09.00 Lecture 8: Principles Kardana
7 Feeding for Infants With Complicated
Wednesday
Delivery
29 Dec 10
12.00 - 12.30 Break
14.00 - 15.00 Plenary Session Soetji & Kardana
08.00 - 09.00 Lecture 9: Vitamin A, Fe & Iodine Deficiencies Prayoga
Thursday
30 Dec 10
12.00 - 12.30 Break
14.00 - 15.00 Plenary Session Prayoga
08.00 - 09.00 Lecture 10: Protein Energy Malnutrition Lanang/Suandi
(PEM) & Obesity
Friday 10.30 - 12.00 Group discussion Facilitator
31 Dec 10 12.00 - 12.30 Break
14.00 - 15.00 Plenary Session Lanang/Suandi

LEARNING OUTCOMES 6: INVESTIGATE INFANT OR CHILD WITH SUSPECT FAILURE TO THRIVE

08.00 - 09.00 Lecture 11: Failure to Thrive Lanang
Wednesday
05 Jan 11
12.00 - 12.30 Break
14.00 - 15.00 Plenary Session Lanang
08.00 - 09.00 Lecture: Vital Sign Measurement Ratna S
09.00 -10.00 Break
11 10.00 - 12.00 Training Session: Vital Sign Measurement Facilitator
Thursday
06 Jan 11 12.00 - 14.00 Individual Learning
14.00 - 15.00 Plenary session Ratna S

LEARNING OUTCOMES 7: ASSESS DEVELOPMENT OF CHILDREN IN SPECIFIC DOMAINS

08.00 - 08.30 Lecture 12: Assess Development in Motoric Trisna
Domains
08.30 - 09.00 Lecture 13: Assess Development in Prof. Soetji
12 Language Domains
Friday
07 Jan 11
12.00 - 12.30 Break
14.00 - 15.00 Plenary Session Trisna & Soetji



LEARNING OUTCOMES 8: DETECTION OF DEVELOPMENT DEVIATION IN CHILDREN (SCREENING
AND STIMULATION)
08.00 - 08.30 Lecture 14: Cognitive Development Marheni
08.30 - 09.00 Lecture 15: Psychosocial Development
Monday 10.30 - 12.00 Group discussion Facilitator
10 Jan 11 12.00 - 12.30 Break
14.00 - 15.00 Plenary Session Marheni

08.00 - 09.00 Lecture 16: Detection of Developmental Prof. Soetji
Deviation In Children (Screening & & Trisna
Stimulation)
Tuesday 10.30 - 12.00 Group discussion Facilitator
11 Jan 11 12.00 - 12.30 Break
12.30 - 14.00 Student project (Case Field Preparation)
14.00 - 15.00 Plenary Session Soetji & Trisna
15
Wednesday
CASE FIELD
12 Jan 11

LEARNING OUTCOMES 9: AWARENESS OF THE NORMAL SEXUAL DEVELOPMENT SEQUENCE IN
CHILDREN AND ADOLESCENT

08.00 - 09.00 Lecture 17: Sexual Bikin S/Arimbawa
16 Developmental Sequence in Children and
Thursday Adolescent
13 Jan 11 09.00 - 10.30 Individual learning
12.00 - 12.30 Break
12.30 - 14.00 Student Project (Case Field Report Preparation)
14.00 - 15.00 Plenary Session Bikin/Arimbawa

LEARNING OUTCOMES 10: AWARENESS OF COMMON DEVELOPMENTAL DISORDERS IN CHILDREN

08.00 – 08.30 Lecture 18: Visual Impairment Sunerti
08.30 – 09.00 Lecture 19: Hearing Impairment Eka Putra
Friday
14 Jan 11 12.00 - 12.30 Break
14.00 - 15.00 Plenary Session Sunerti & Eka Putra
08.00 – 08.30 Lecture 20: Learning Disorders Endah
08.30 – 09.00 Lecture 21: Down Syndrome and Mental
Retardation
Monday
17 Jan 11 10.30 - 12.00 Group discussion Facilitator
12.00 - 12.30 Break
14.00 - 15.00 Plenary Session Endah
08.00 – 09.00 Lecture: Routine Laboratory Testing Wiradewi L
19 09.00 -10.00 Break
Tuesday
10.00 - 12.00 Training Session: Routine Laboratory Testing Facilitator
18 Jan 11
14.00 - 15.00 Plenary session Wiradewi L
20 08.00 – 09.00 Lecture 22: Attention Deficit/Hyperactivity Trisna/Endah
Wednesday Disorders



19 Jan 11
12.00 - 12.30 Break
14.00 - 15.00 Plenary Session Trisna/Endah
08.00 – 08.30 Lecture 23: Autism Spectrum Disorders Prof. Soetji
08.30 – 09.00 Lecture 24: Cerebral Palsy K Kari
Thursday
20 Jan 11
12.00 - 12.30 Break
14.00 - 15.00 Plenary Session Soetji & K Kari
08.00 – 09.00 Lecture: General Approach to Diagnostic Elysanti D
Imaging
22 09.00 -10.00 Break Facilitator
Friday
21 Jan 11 10.00 - 12.00 Training Session: General Approach to
Diagnostic Imaging
14.00 - 15.00 Plenary session Elysanti D

LEARNING OUTCOMES 11: AGING AND ITS CLINICAL IMPLICATIONS

08.00 – 08.30 Lecture 25: Aging Process RA Tuty K
08.30 – 09.00 Lecture 26: Clinical Implication of Aging Astika
Process
Monday
24 Jan 11 10.30 - 12.00 Group discussion (Lecture 25) Facilitator
12.00 - 12.30 Break
14.00 - 15.00 Plenary Session Tuty K
08.00 – 10.00 Case Field Presentation Team
10.00 - 10.30 Break
24 10.30 - 12.00 Group Discussion (Lecture 26)
Tuesday
25 Jan 11 12.00 - 12.30 Individual learning Facilitator
12.30 – 14.00 Student Project (Case Field Report Preparation) Astika
14.00 - 15.00 Plenary Session
08.00 – 09.00 Lecture: Antropometry Adiatmika
25 09.00 -10.00 Break
Wednesday 10.00 - 12.00 Training Session: Antropometry Facilitator
14.00 - 15.00 Plenary session Adiatmika
26
Friday
28 Jan 11
EXAMINATION



TIME TABLE
REGULAR CLASS

DAY/
TIME ACTIVITY CONVEYER
DATE

LEARNING OUTCOMES 1: ASSESS PHYSICAL GROWTH OF CHILDREN AND ADOLESCENTS

09.00 - 09.30 Intro: General Concepts of Growth and Prof. Soetji
Development
09.30 - 10.00 Lecture 1: Assessment Physical Growth of Prof. Soetji
1 Children And Adolescents
Monday
10.00 - 10.30 Break
20 Dec 10
13.30 - 15.00 Group Discussion Facilitator
15.00 - 16.00 Plenary Session Prof. Soetji

LEARNING OUTCOMES 2: ASSESS FETAL GROWTH (INTRAUTERINE GROWTH)

09.00 - 10.00 Lecture 2: The Stages of Prenatal Mangku K
Development
10.00 - 10.30 Break
2 10.30 - 12.00 Student Project (Case Field Preparation)
Tuesday
21 Dec 10 12.00 - 13.30 Individual learning
15.00 - 16.00 Plenary Session Mangku K
09.00 - 09.30 Lecture 3: Prenatal Genetic Evaluation and Ratnayanti
Counseling
09.30 - 10.00 Lecture 4: USG to Assess Fetal Anatomy Tjok Suwardewa
3 10.00 - 10.30 Break
Wednesday
22 Dec 10 10.30 - 12.00 Student Project (Case Field Preparation) Facilitator
13.30 - 15.00 Group Discussion Ratnayanti
15.00 - 16.00 Plenary Session Tjok Suwardewa
09.00 - 10.00 Lecture 5: Assessment Growth and Dharma A/Kardana
Development in Neonatus
4 10.00 - 10.30 Break
Thursday 10.30 - 12.00 Student Project (Case Field Preparation) Facilitator
13.30 - 15.00 Group Discussion
15.00 - 16.00 Plenary Session Dharma A/Kardana

LEARNING OUTCOMES 4: CAPABILITY TO EVALUATE CRITICALLY THE USE OF MEDICINE IN
PREGNANCY, CHILDREN, AND ELDERLY

09.00 - 10.00 Lecture 6: Drugs in Pregnancy, Children, and Jawi
Elderly
10.00 - 10.30 Break
5 10.30 - 12.00 Student Project (Case Field Preparation)
Monday
15.00 - 16.00 Plenary Session Jawi

09.00 – 09.30 Lecture: Surface Anatomy and Topography Mangku K
6 09.30 – 10.00 Lecture: General Principles Examination Ratna S
Tuesday
28 Dec 10 10.00 – 12.00 Individual Learning
12.00 – 13.00 Break
13.00 – 15.00 Training Session: Surface Anatomy and Facilitator



Physical examination
15.00 – 16.00 Plenary Session Mangku K & Ratna

LEARNING OUTCOMES 5: DIAGNOSE AND MANAGE COMMON NUTRITIONAL PROBLEMS IN
CHILDREN AND ADOLESCENTS

09.00 – 09.30 Lecture 7: Principles Breastfeeding for Prof. Soetji
Infants With Normal Delivery
09.30 - 10.00 Lecture 8: Principles Kardana
7 Feeding for Infants With Complicated
Wednesday
Delivery
29 Dec 10
10.00 - 10.30 Break
15.00 - 16.00 Plenary Session Soetji & Kardana
09.00 - 10.00 Lecture 9: Vitamin A, Fe & Iodine Deficiencies Prayoga
8 10.00 - 10.30 Break
Thursday 10.30 - 12.00 Student Project (Case Field Preparation)
15.00 - 16.00 Plenary Session Prayoga
09.00 - 10.00 Lecture 10: Protein Energy Malnutrition Lanang/Suandi
(PEM) & Obesity
9 10.00 - 10.30 Break
Friday 10.30 - 12.00 Student Project (Case Field Preparation)
15.00 - 16.00 Plenary Session Lanang/Suandi

LEARNING OUTCOMES 6: INVESTIGATE INFANT OR CHILD WITH SUSPECT FAILURE TO THRIVE

09.00 - 10.00 Lecture 11: Failure to Thrive Lanang
10 10.00 - 10.30 Break
Wednesday
05 Jan 11
15.00 - 16.00 Plenary Session Lanang
09.00 – 10.00 Lecture: Vital Sign Measurement Ratna S
10.00 – 12.00 Individual Learning
11 12.00 – 13.00 Break Facilitator
Thursday
06 Jan 11 13.00 – 15.00 Training Session: Vital Sign Measurement
15.00 – 16.00 Plenary session Ratna S

LEARNING OUTCOMES 7: ASSESS DEVELOPMENT OF CHILDREN IN SPECIFIC DOMAINS

09.00 – 09.30 Lecture 12: Assess Development in Motoric Trisna
Domains
12 09.30 - 10.00 Lecture 13: Assess Development in Prof. Soetji
Friday Language Domains
07 Jan 11 10.00 - 10.30 Break
15.00 - 16.00 Plenary Session Trisna & Soetji
13 09.00 – 09.30 Lecture 14: Cognitive Development
Monday 09.30 - 10.00 Lecture 15: Psychosocial Development Marheni
10 Jan 11 10.00 - 10.30 Break



15.00 - 16.00 Plenary Session Plenary Session Marheni

LEARNING OUTCOMES 8: DETECTION OF DEVELOPMENT DEVIATION IN CHILDREN (SCREENING
AND STIMULATION)
09.00 - 10.00 Lecture 16: Detection of Developmental Prof. Soetji
Deviation In Children (Screening & & Trisna
Stimulation)
14 10.00 - 10.30 Break
Tuesday
11 Jan 11 10.30 - 12.00 Student project (Case Field Preparation)
15.00 - 16.00 Plenary Session Soetji & Trisna
15
Wednesday
CASE FIELD
12 Jan 11

LEARNING OUTCOMES 9: AWARENESS OF THE NORMAL SEXUAL DEVELOPMENT SEQUENCE IN
CHILDREN AND ADOLESCENT

09.00 - 10.00 Lecture 17: Sexual Bikin S/Arimbawa
Developmental Sequence in Children and
Adolescent
16 10.00 - 10.30 Break
Thursday
13 Jan 11 10.30 - 12.00 Student Project (Case Field Report Preparation)
15.00 - 16.00 Plenary Session Bikin/Arimbawa

LEARNING OUTCOMES 10: AWARENESS OF COMMON DEVELOPMENTAL DISORDERS IN CHILDREN

09.00 – 09.30 Lecture 18: Visual Impairment Sunerti
09.30 - 10.00 Lecture 19: Hearing Impairment Eka Putra
17 10.00 - 10.30 Break
Friday
14 Jan 11
15.00 - 16.00 Plenary Session Sunerti & Eka Putra
09.00 – 09.30 Lecture 20: Learning Disorders Endah
09.30 - 10.00 Lecture 21: Down Syndrome and Mental
Retardation
18 10.00 - 10.30 Break
Monday
15.00 - 16.00 Plenary Session Endah
09.00 – 10.00 Lecture: Routine Laboratory Testing Wiradewi L
10.00 – 12.00 Individual Learning
19 12.00 – 13.00 Break Facilitator
Tuesday
18 Jan 11 13.00 – 15.00 Training Session: Routine Laboratory Testing
15.00 – 16.00 Plenary session Wiradewi L

09.00 - 10.00 Lecture 22: Attention Deficit/Hyperactivity Trisna/Endah
Disorders
20 10.00 - 10.30 Break
Wednesday 10.30 - 12.00 Student Project (Case Field Report Preparation)
15.00 - 16.00 Plenary Session Trisna/Endah



09.00 – 09.30 Lecture 23: Autism Spectrum Disorders Prof. Soetji
09.30 - 10.00 Lecture 24: Cerebral Palsy K Kari
21 10.00 - 10.30 Break
Thursday 10.30 - 12.00 Student Project (Case Field Report Preparation)
15.00 - 16.00 Plenary Session Soetji & K Kari
09.00 – 10.00 Lecture: General Approach to Diagnostic Elysanti D
Imaging
22 10.00 – 12.00 Individual Learning Facilitator
Friday
12.00 – 13.00 Break
21 Jan 11
13.00 – 15.00 Training Session: General Approach to
Diagnostic Imaging
15.00 – 16.00 Plenary session Elysanti D

LEARNING OUTCOMES 11: AGING AND ITS CLINICAL IMPLICATIONS

09.00 – 09.30 Lecture 25: Aging Process RA Tuty K
09.30 - 10.00 Lecture 26: Clinical Implication of Aging Astika
Process
23 10.00 - 10.30 Break
Monday
13.30 - 15.00 Group Discussion (Lecture 25) Facilitator
15.00 - 16.00 Plenary Session Tuty K/Astika
08.00 - 10.00 Student project (Case Field Report Preparation)
10.00 - 12.00 Case field presentation Team
24 12.00 - 13.30 Break
Tuesday
13.30 - 15.00 Group Discussion (Lecture 26) Facilitator
15.00 - 16.00 Plenary Session Astika
09.00 – 10.00 Lecture: Antropometry Adiatmika
25 10.00 – 12.00 Individual Learning
Wednesday 12.00 – 13.00 Break Facilitator
26 Jan 11 13.00 – 15.00 Training Session: Antropometry
15.00 – 16.00 Plenary session Adiatmika
26
Friday
28 Jan 11
EXAMINATION



~ MEETING ~

Meeting with the student representatives
The meeting between block planners and student group representatives will be held on
Wednesday, 5 January 2011 at 10.30 until 11.00 at Class Room (4.02). In this meeting,
all of the student group representatives are expected to give suggestions and inputs or
complaints to the team planners for improvement. For this purpose, every student group
should choose one student as their representative to attend the meeting.

Meeting with the facilitators
The meeting between block planners and facilitators will take place on Wednesday, 5
January 2011 at 11.00 until 11.30 at Class Room (4.02). In this meeting the facilitators
are expected to give suggestions and inputs to improve the study guide and the
educational process. Because of its importances, all facilitators are expected to attend
and participate in the meeting.

~ ASSESSMENT METHOD ~
Assessment will be carried out on Wednesday, 27 January 2011. There will be 120
questions consisting mostly of Multiple Choice Questions (MCQ). The minimal passing
score for the assessment is 70. Other than the examination score, your performance and
attitude during group discussions will also be considered in the calculation of your final
score. The proportion of examination score are:
Small group discussion : 5%
Case field report : 20%
Final Examination : 75%



~ LEARNING PROGRAMS ~

LECTURE

Introductory lecture: General Concepts of
Growth and Development

Prof. dr. Soetjiningsih, SpAK, IBCLC

Learning outcomes
- To describe the general concept of growth and development
- To describe the stages in lifespan development
- To understand the conceptual differences between growth and development
- To describe the factors that may affect growth and development

Abstract
Lifespan development is a field of study that examines patterns of growth, change, and
stability in behavior that occur throughout the entire life span. The life span is usually divided into
broad age ranges: the prenatal period (the period from conception to birth); infancy and toddler
hood (birth to age 3); the preschool period (ages 3 to 6); middle childhood (ages 6 to 12);
adolescence (ages 12 to 20); young adulthood (ages 20 to 40); middle age (ages 40 to 60); and
late adulthood (age 60 to death).
Lifespan development specialists discuss development in several topics: physical
development (development involving the body’s physical make up, including the brain, nervous
system, muscles, senses, and the need for food, drink and sleep); cognitive development
(development involving the ways that growth and change in intellectual capabilities influence a
person’s behavior); personality development (development involving the ways that enduring
characteristics that differentiate one person from another change over the life span); and social
development ( the way in which individuals’ interactions with others and their social relationships
grow, change, and remain stable over the course of life).
Growth and development are an integral process. Growth refer to the metabolic change by
which an organism increases in size and changes shape. Growth refers to quantitative changes.
Changes in physical size and appearance are visible manifestations of the complex morphologic,
biochemical and physiologic changes taking place during childhood.
Child development is a process, a continuous series of purposeful changes, consisting of
many aspects, moving together at differing paces. Development refers to qualitative and
quantitative changes. There are 10 fundamental principles of development:
1. Development involves change
2. Early development is more critical than later development
3. Development is the product of maturation and learning
4. The developmental pattern is predictable
5. The developmental pattern has predictable characteristics
6. There are individual differences in development
7. There are periods in the developmental pattern
8. There are social expectations for every developmental period
9. Every area of development has potential hazards
10. Happiness varies at different periods in development

Environmental and genetic factors influence growth and development. In Bronfenbrenner’s
ecological system theory, development is influenced at four levels: the microsystem, mesosystem,
exosystem and macrosystem.



Lecture 1:
~ Assessment Physical Growth of
Children and Adolescents ~


Learning outcomes
- Describe the clinical importance of study physical growth
- Describe the normal patterns of the physical growth
- Understand factors that affecting physical growth
- Use of common growth parameter

Abstract
Physical growth usually refers to changes in size or mass. The most people usually think of
growth at the level of the whole child, the cells and internal structures that make up the child,
primarily by increasing in number or size.
Growth assessment is essential because almost any problems within the physiologic,
interpersonal and social domains can adversely affect growth. Anthropometry is an effective and
frequently performed child health screening procedure. The value of physical growth data
depends on their accuracy and reliability, how they are recorded and interpreted, and what follow-
up efforts are made after identification of growth abnormality.
The most powerful tool in growth assessment is the growth chart. Whenever possible, growth
should be assessed by plotting accurate measurements on growth charts and comparing each set
of measurements with previous measurements. The CDC Growth Charts 2000 are used to
measure growth, consist of 16 charts including “Body mass index (BMI) for-age percentile” for
boys and girls aged 2-20 years.
Normal growth patterns have spurts and plateaus, but some shifting on the percentile graphs
can be expected; however, large shifts warrant attention. Large discrepancies among height,
weight, and head circumference percentiles also diserve attention. Deviation in growth patterns
are nonspecific but important indicators of serious medical disorders. Deviations often provide the
first clue that something is wrong, occasionally even when the parents do not suspect a problem.
An accurate measurement of height, weight, and head circumference should be obtained at every
health supervision visit. Serial measurements are much more useful than single measurements
because they can help detect deviations from a particular child’s growth pattern even if the value
remains within statistically defined normal limits.
Factors affecting physical growth and health in infancy and toddlerhood continue to be
influential in early childhood. Heredity affects physical growth by regulating the production of
hormones. Extreme emotional deprivation can interfere with the production of growth hormone,
thereby stunting children's growth. Sleep difficulties, in the form of night waking and nightmares,
are common during the preschool years. Appetite decline is associated with a slower rate of
physical growth. Disease can lead to malnutrition, seriously undermining children's growth, an
effect that is especially common in developing countries.



Lecture 2:
~ The Stages of Prenatal
Development ~

Nym Mangku Karmaya

Learning outcomes
Describe the main stages of embryonic development for use to estimate the gestational age of
embryo.

Abstract
Early embryonic development is describe in stages because of the variable period it takes for
embryos to develop certain morphological characteristics. Stage 1 of development begins at
fertilization and embryonic development ends at stages 23, which occur on day 57 and ends when
he fetus is completely outside the mother. The stages of embryonic development can be
assessed by ultrasonography. In general the period of prenatal development is as follows:
st
§ 1 week : zygote-blastomeres-morula-blastocyst.
nd
§ 2 week : bilaminar germ disc
rd
§ 3 week : trilaminar germ disc
rd th
§ 3 - 8 week : embryonic period/organogenesis
th
§ 8 week-BIRTH : fetal period

Lecture 3:
~ Prenatal Genetic Evaluation and Counseling ~

Ratnayanti

Abstract

When Steele and Breg in 1966 demonstrated that amniotic fluid cells could be cultured to reveal
fetal karyotype, prenatal diagnosis has become a mayor medical genetic service, in the context of
prevention of specific genetic disorder
The demand for genetic testing is sure to rise if a screening procedure is developed to identify
pregnancies at risk of a chromosomal abnormality.
In some minds prenatal diagnosis is equated with the issue of abortion. For families at risk having
a child with condition that can be diagnosed prenatal, the option of monitoring pregnancies allow
the parents to undertake pregnancies that they would otherwise forego. Only about 2% of all
pregnancies in which there is prenatal diagnosis are terminated because of the fetus has genetic
defect. Much more often, the fetus is found to be unaffected and the pregnancy continues.
Indication of prenatal diagnosis:
1. Mother age of 35 years or more
2. Previous child with chromosomal abnormality
3. Present of structural chromosomal abnormality
4. Family history of neural rube defect.
5. X-linked disorder in family

Techniques:
amniocentesis, chorionic villous sampling, ultrasonography, fetoscopy, prenatal
chromosome analysis, alpha-fetoprotein analysis,



Prenatal diagnose require the combined skill of obstetricians, laboratory scientist, geneticists. The
mayor concern in any prenatal diagnosis program is time or week of gestation for prenatal
diagnosis and it should be provided as early in pregnancy as possible.

Learning outcomes: after the lecture, the medical students have a knowledge obout:
a. The history of prenatal diagnosis
b. The aim of prenatal diagnose
c. The indications and techniques of prenatal diagnosis
d. The advantages and disadvantages of technique chosen

Lecture 4:
~ USG to Assess Fetal
Anatomy ~

Tjokorda Gde Agung Suwardewa

Learning outcomes
Apply of USG to assess fetal anatomy:
- Comprehend ultrasound waves generally
- Comprehend compartments of ultrasonography unit (USG)
- Comprehend how USG used for pregnant woman
- Safety ultrasound waves to the fetus
- Comprehend length, frequency, media of ultrasound waves

Abstract
Ultrasound is a sound waves with frequency more than 20,000 HZ. Normally we can
hearing of sound waves by frequency between 16,000-20,000 cycle per second (Hertz) (1
Megahertz=1000,000 Hz). The sound waves length in ultrasound compartment (USG unit) role
play to determine of resolution capacity that unit.
The pictures displayed on the screen is produced by sound waves reflected back from the
imaged structure. Alternating current is applied to a transducer containing piezoelectric crystals,
which converts electric energy to high-frequency sound waves. A water soluble gel applied to the
skin acts as coupling agent. Sound waves pass through layers of tissue, encounter an interface
between tissues of deferent densities, and are reflected back to the transducer. Converted back
into electrical energy, they are displayed on the screen. Dense tissue such as white on the
screen. Fluid is anechoic and appearing black on the screen.
Higher-frequency transducers yield better images resolution, whereas lower frequencies
penetrate tissue more effectively. For examples, abdominal scanning is most commonly
performed with a 3-5 mHz transducer, but in early pregnancy, 7-10 mHz vaginal transducer may
provide excellent resolution because the fetus is close to the transducer.
Since the first obstetrical application of ultrasound imaging by Donald and co-worker
(1958), this technique has become indispensable for evaluation of the fetus. Some indications for
ultrasound examination are: confirm gestation location, fetal number, estimating gestational age,
fetal morphology/anatomy, fetal abnormality, placenta, amniotic fluid volume.



Lecture 5:
~ Assessment of Growth and Development
in Neonatus

Kardana

Learning outcomes
- Apply the New Ballard Score to assess the gestational age of infant: the small for
gestational age (SGA), appropriate for gestational age (AGA), or large for gestational age
(LGA).

Abstract
Since the late 1960s, a variety of methods for assessing the gestational age of the newborn
infant have been developed. Currently, the most widely use system for the postnatal assessment
of gestational age is the New Ballard Score (NBS). This system includes both physical and
neurologic characteristics. The score spans from 10 (correlating with 20 weeks’ gestation) to 50
(correlating with 44 weeks gestation). The examination consists of six neuromuscular criteria and
six physical criteria. The neuromuscular criteria are based on the understanding that passive tone
is more useful than active tone in indicating gestational age. The neuromuscular maturity includes:
posture, square window, arm recoll, popliteal angel, scarf sign, and heal to ear. The physical
maturity includes: skin, lanugo hair, plantar surface, breast, ear and ear, and genitalia. The
examination of NBS is administered twice by two different examiners to ensure objective, and the
data entered on the chart.

Lecture 6:
~ Drugs in Pregnancy, Children,
and Elderly ~

Made Jawi

Learning outcomes
After completing this lecture, the students should be able to:
- Describe the effect of drugs use in pregnancy.
- To Choose the safe drugs for pregnant women, children, and elderly

Abstract
When a woman becomes pregnant, it is very important for her to lead a healthy life: to eat plenty
of nourishing food, get plenty of rest, and exercise regularly. It is also vital that she avoid anything
that might harm her or her baby-to-be. It is especially important to give up alcohol, cigarettes, and
drugs. For a pregnant woman, drug abuse is doubly dangerous. First, drugs may harm her own
health, interfering with her ability to support the pregnancy. Second, some drugs can directly
impair prenatal development. Both prescription and over-the-counter drugs can be harmful, for her
own health and the health of her baby-to-be. So a woman should avoid all of them as much as
possible, from the time she first plans to become pregnant or learns that she is pregnant. Some
drugs can be harmful when used at any time during pregnancy; others, however, are particularly
damaging at specific stages. Most of the body organs and systems of the baby-to-be are formed
within the first ten weeks or so of pregnancy (calculated from the date of the last menstrual
period). During this stage, some drugs and alcohol in particular can cause malformations of such
parts of the developing fetus as the heart, the limbs, and the facial features. After about the tenth
week, the fetus should grow rapidly in weight and size. At this stage, certain drugs may damage
organs that are still developing, such as the eyes, as well as the nervous system. Continuing drug



use also increases the risk of miscarriage and premature delivery. But the greatest danger drugs
pose at this stage is their potential to interfere with normal growth. Intrauterine growth retardation
(IUGR) is likely to result in a low-birth weight baby a baby born too early, too small, or both. Low-
birth weight babies require special care and run a much higher risk of severe health problems or
even death.

Current Categories for Drug Use in Pregnancy
Category Description
A Adequate, well-controlled studies in pregnant women have not shown an
increased risk of fetal abnormalities.
B Animal studies have revealed no evidence of harm to the fetus; however,
there are no adequate and well-controlled studies in pregnant women.
Or
Animal studies have shown an adverse effect, but adequate and well-
controlled studies in pregnant women have failed to demonstrate a risk to
the fetus.
C Animal studies have shown an adverse effect and there are no adequate
and well-controlled studies in pregnant women.
Or
No animal studies have been conducted and there are no adequate and
well-controlled studies in pregnant women.
D Studies, adequate well-controlled or observational, in pregnant women
have demonstrated a risk to the fetus. However, the benefits of therapy may
outweigh the potential risk.
X Studies, adequate well-controlled or observational, in animals or pregnant
women have demonstrated positive evidence of fetal abnormalities. The
use of the product is contraindicated in women who are or may become
pregnant.

Both prescription and over-the-counter drugs can be harmful, for children and elderly.
There are a number of pharmacokinetic and pharmacodynamic differences between children or
pediatric, elderly and adult patients. Neonates ( 0 to 1 month), infants (1 to 12 month) and children
of increasing age are not simply small adult.
The drugs used by the elderly are the same as those that a younger person might take--
yet they can have a far different effect. It doesn’t matter whether a person has heart disease or
arthritis, osteoporosis, or high blood pressure, the story is the same: Because the organ systems
tend to function less efficiently as we age, medications are handled differently by our bodies. Here
are some of the most common changes affecting our health and our response to medicines:
The stomachs may not absorb food and medication as well as they did before. The
kidneys and livers don’t eliminate fluids and toxins in the same efficient manner.
All of the above contribute to the potential harm that medications can cause in the aging body. If a
kidney can’t eliminate a drug after it has done its work, it remains in the body longer, perhaps
causing an overdose or an adverse effect. If someone forgets to take a medication that regulates
the heart or blood pressure, a stroke or heart attack could be the result.
Any person over the age of 65 who is taking medications in the following categories should be
aware of the potential for increased side effects, overdose, and diminished efficacy: Antibiotics,
Anti histamines, Anti hypertensives, Antiulcer medicines, Blood thinners, Bronchodilators, Calcium
or potassium supplements, Cardiac medications, Corticosteroids, Estrogens, Over-the-counter
drugs containing alcohol (cough and cold medications) or caffeine, Pain relievers, Psychiatric
medications, Skin medications and creams
In the lecture will be discuss the effects of drugs to the embryo and how to choose drugs
for pregnant women, Children and Elderly



Lecture 7:
Apply the Principles of Breastfeeding for Infants
with Normal Deliveries


Abstract
Breast-feeding exclusively the recommended method for feeding normal infants during the
first 6 months of life. Breastfeeding should continue with the addition of appropriate foods, for two
years or more.
Breastfeeding has advantages for infants, mothers, families, and society. These advantages
include health, nutritional, immunologic, developmental, psychologic, social, economic, and
environmental benefits. Breast milk contains the right balance of nutrients to help the infant grow
into a strong and healthy toddler. Some of the nutrients in breast milk also help protect the infant
against some common childhood illnesses and infections. While nutrients and antibodies pass to
the baby, beneficial hormones are released from the mother's body. Colostrums, a high protein
and low fat lactose product, are produced in small amounts during the first few postpartum days. It
has some nutritional value but primarily has important immunologic and maturational properties.
The bond between baby and mother can also be strengthened during breastfeeding.
Breastfeeding doesn't always happen easily. Some new mums find it hard to get started, while
others hit problems later on. Breast tenderness, engorgement, and cracked nipples are the most
common problems encountered by mothers who are breast-feeding.

Lecture 8:
~ The Principles of Feeding for Infants with
Complicated Deliveries ~

Kardana

Learning outcomes
- To know indication of enteral and parenteral nutrition
- To know the type nutrition’s for enteral feeding
- To know the routes of enteral feeding and feeding technique
- To know the administration for parenteral nutrition
- To know the contents of total parenteral nutrition

Abstract
Providing adequate nutrition support to newborns is an important to know and understanding
the maturation, functional and physical disturbances to the baby. Optimal nutrition after birth
enhances future neurodevelopmental outcome. For term healthy infants should be breast-fed as
soon as possible within the first hour. Human milk is preferred for feeding term, preterm and sick
infants. The following criteria should usually be met before initiating infant’s feedings: no history of
excessive oral secretions, vomiting, or bilous-stained gastric aspirate, non-distended, soft
abdomen with normal bowel sound, and no respiration distress. If the baby is small or complicated
baby such as baby with the following associated conditions: perinatal asphyxia, hemodynamic
instability, sepsis, frequent episodic apnea and bradycardia etc, initiation of enteral feeding is
often precluded and parenteral nutrition can be initiation. Nutritional requirements in neonate
includes: calories to maintain weight and to induce weight gain, carbohydrates, proteins, fats,
vitamins and minerals and fluids.



Lecture 9:
~ Vitamin A and Fe Deficiency ~
~ Iodine Deficiency ~

A A Ngr Prayoga

~ Vitamin A and Fe Deficiency ~

Learning outcomes
- To understand the sign and symptom of patient with vitamin A and Fe deficiency
- To built diagnosis of patient with vitamin A and Fe deficiency
- To understand the treatment and prevention of patient with vitamin A and Fe deficiency

Abstract
Vitamin A is the generic term used to describe all retinoid having the biologic activity of all-
trans retinol. Vitamin A, a light yellow crystalline alcohol, has been named retinol in reference to
its specific function in the retina of the eye. The yellow-orange-red provitamin carotinoids, are
describe in the term of beta-carotene
A deficiency of Vitamin A is accompanied by keratinization of the mucous membranes that line the
respiratory tract, the alimentary canal, and the urinary tract, and by keratinization of the body skin
and epithelium of the eye, which lowers the barrier role played by these membranes in protection
of the body against infections. Prolonged deficiency may produce skin changes, night blindness,
and corneal ulceration.
Primary deficiencies of vitamin A are the result of dietary inadequacies. Secondary can result from
liver disease, protein-energy malnutrition, abetalipoproteinemia, or malabsorption due to bile acid
insufficiency. Acute deficiency is treated with large oral doses of vitamin A and correction of the
usually concomitant protein-energy malnutrition. Massive intermittent dosing with 200,000 IU of
vitamin A can reduced mortality by 35 to 70 %.
Iron deficiency anemia is characterized by the production of small erythrocytes and
diminished level of circulating hemoglobin.
The three primary causes of iron deficiency anemia are chronic blood lose, faulty iron intake or
absorption and increased iron requirement.
The clinical findings are fatigue, anorexia, pica (pagophagia). Growth abnormalities, epithelial
disorders, and reduction in gastric acidity are common. Defect in structure and function of
epithelial tissue of tongue, nails, mouth, and stomach as deficiency becomes more severe.
The chief treatment for iron deficiency consists of oral administration of inorganic iron in the
ferrous form and nutritional care.

~ Iodine Deficiency ~

Learning outcomes
- To understand the sign and symptom of patient with iodine deficiency.
- To built diagnosis of patient with iodine deficiency.
- To understand the treatment and prevention of patient with iodine deficiency.

Abstract
Iodine is absorbed easily in the form of iodide, in circulation it occurs both as free and
protein-bound iodine. Iodine is stored in the thyroid, where it is used for synthesis of T3 and T4
when needed.



Lack of iodine intake is associated with the development of endemic or simple goiter, which is an
enlargement of thyroid gland. The deficiency may be absolute, especially in areas of subnormal
iodine intake, or relative subsequent to increased need for thyroid hormones, such as in the
female during adolescence, pregnancy, and lactation.
Severe iodine deficiency during gestation and early postnatal growth results in cretinism, a
syndrome characterized by mental deficiency, spastic diplegia, or quadriplegia, deaf mutism,
dysarthria, a characteristic shuffling gait, shortened stature, and hypothyroidism. Early diagnosis
and treatment are needed to prevent more severe of clinical sign and symptom.

Lecture 10:
~ Protein Energy Malnutrition (PEM) ~
~ Obesity ~

Lanang/IKG Suandi

~ Protein Energy Malnutrition (PEM) ~

Learning outcomes
- To understand the sign & symptom of patient with protein energy malnutrition (PEM)
- To built diagnosis of patient with protein energy malnutrition (PEM)
- To understand the treatment and prevention of the patient with protein energy malnutrition
(PEM)

Abstract
Definition
PEM is a spectrum of conditions caused by varying levels of protein and calorie deficiencies. The
common form of primary PEM is marasmus and caused by severe caloric depletion. Kwashiorkor,
presenting with pitting edema caused by inadequate protein intake in the presence of fair to good
caloric intake. Secondary form of PEM is associated with other diseases.

Clinical manifestation
The clinical manifestation of marasmus: The body weight below 60% of expected for age or below
70% of the ideal weight for height and depleted body fat stores. Edema usually is absent. The
head may appear large but generally proportional to the body length. The clinical manifestation of
kwashiorkor: presenting pitting edema that starts in lower extremities and ascends with increasing
severity, may be a complication of critical illness (acute and chronic infections, multiorgan system
failure, anorexia nervosa, etc)

Treatment and prevention
Calories account of nutritional rehabilitation can be safety started at 20% above the child’s recent
intake. The calorie intake can be increased 10-20% per day until appropriate re-growth is initiated.
This may require 150% or more of the recommended calories for an age-matched, well nourished
child.



~ Obesity ~

Learning outcomes
- To understand the sign & symptom of patient with obesity
- To built diagnosis of patient with obesity
- To understand the treatment and prevention of the obesity

Epidemiology
The prevalence of obesity in children has increased in the last 2-3 decades, mainly in children as
young as 4-5 years.

Clinical manifestation
In children BMI (body mass index) age and gender specific percentile curves allow an assessment
2 2
of BMI percentile. In adolescent and adult BMI has been used in weight/height (kg/m ).
The effects of obesity complication; such as psychosocial effect, growth (advanced bone age,
increased height, early menarche), CNS (pseudo tumor cerebri, respiratory (sleep apnea,
pickwickian syndrome), cardiovascular (hypertension, cardiac hypertrophy, ischemic heart
disease, sudden death), orthopedic (slipped capital femoral epiphysis, Blount disease), metabolic
(insulin resistance, type II diabetes mellitus, hypertriglyceridemia, hypercholesterolemia, gout,
hepatic steatosis, ovary disease, cholelithiasis).

The treatment and prevention of obesity includes a combination of education, behavior
modification, exercise and diet.

Lecture 11:
~ Failure to Thrive ~

Lanang

Learning outcomes
1. To apply the diagnostic criteria of patient with failure to thrive (FTT).
2. To discuss the cause or path physiology of patient with FTT.
3. To evaluate and manage a child with FTT.

Definition
The term ‘failure to thrive’ first was used to describe the malnutrition and depressed condition of
many institutionalized infants in early 1900s. It remains a descriptive rather than a diagnostic label
applied to children whose attained weight or rate of weight gain is significantly below that of other
children of similar age and same sex.

Table Definition of failure to thrive

Attained growth
1. Weight < 3rd percentile on NCHS growth chart
2. Weight for height < 5th percentile on NCHS growth chart
3. Weight 20% or more below ideal weight for height
4. Triceps skin fold thickness < 5 mm
Rate of growth
1. Depressed rate of weight gain
< 20 g/d from 0-3 months of age
< 15 g/d from 3-6 months of age
2. Fall-off from previously established growth curve
Downward crossing of > 2 major percentiles on NCHS growth chart
3. Documented weight loss



Patho physiology and clinical manifestation
FTT can result from wide range of factors, including serious medical disease, dysfunctional child-
caregiver interactions, poverty, parental misinformation, and child abuse. The physical
examination of a child who is growing poorly should focus on identifying sign of underlying organic
disease, severity of malnutrition, and important concomitant finding such as evident of physical
abuse/neglect or the presence of deprivational behaviors.

Management of the child with psychosocial failure to thrive must be individualized to the specific
needs of the child and family. Nutritional rehabilitation, efforts are focused on correcting the
dysfunctional child-parent interaction by addressing areas of parental misinformation, providing
and helping to implement specific feeding guidelines, and addressing the larger psychosocial
needs of the family. A multidisciplinary team approach involving the primary-care provider,
nutritionist, social worker, child behavior specialist, and community-based outreach services is
often most beneficial.

Lecture 12 &13:
~ Assess Development in the Motoric and
Language Domains ~

I GA Trisna W

~ Assess Development in The Motoric Domain ~

Learning outcomes:
- Describe gross and motor development
- Determine factors affecting motor development

Abstract
Child developmental consist of several skills like: 1) Gross motor: using large groups of
muscles to sit, stand, walk, run, etc., keeping balance, and changing positions; 2) Fine motor:
using hands to be able to eat, draw, dress, play, write, and do many other things; 3) Language:
speaking, using body language and gestures, communicating, and understanding what others
say; 4) Cognitive: Thinking skills: including learning, understanding, problem-solving, reasoning,
and remembering; 5) Social: Interacting with others, having relationships with family, friends, and
teachers, cooperating, and responding to the feelings of others.
Developmental milestones are a set of functional skills or age-specific tasks that most children
can do at a certain age range. Milestone can be described as what a child accomplishes
throughout the different stages in their life. We can use milestones to help check how our child is
developing. Although each milestone has an age level, the actual age when a normally
developing child reaches that milestone can very quite a bit. Every child is unique. To determine
whether a child has developmental delay, the physician must understand normal milestones
The red flag age is the age at which you would expect almost every child to have already
mastered a particular skill. For example walking, most children walk on their own, without holding
on, around their first birthday. By 15 months--the red flag age for walking--a child who has not
taken his first independent steps is certainly slower to walk than 90 percent of other children. Red
flag milestones are helpful because they put a limit on when you, as a good, concerned parent,
should worry.
Motor development means the development of control over bodily movements through the
coordinated activity of the nerve centers, the nerves and the muscles. This control comes from the
development of the reflexes and mass activity present at birth. Until this development occurs, the
child will remain helpless.



From longitudinal studies of babies and young children, five general principles of motor
development have emerged: 1) motor development depends on neural and muscular
development; 2) learning skills cannot occur until the child is maturationally ready; 3) motor
development follows a predictable pattern; 4) it is possible to establish norms for motor
development; and 5) there are individual differences in rate of motor development.
Motor development is divided into gross motor and fine motor development. Gross motor skills
refer to the ability of children to carry out activities that require large muscles or groups of
muscles. Muscles or groups of muscles should act in a coordinated fashion to accomplish a
movement or a series of movements. Examples of gross motor tasks are walking, running,
throwing something, jumping, standing on 1 leg, playing hopscotch, and swimming. Posture is an
important element to consider in the assessment of gross motor skills. Adequate posture may
make all the difference between being able or not able to execute a movement.
Fine motor skills consist of movements of small muscles that act in an organized and subtle
fashion, for instance, the hands, feet, and muscles of the head (as the tongue, lips, facial
muscles), to accomplish more difficult and delicate tasks. Fine motor skills are the basis of
coordination, which begins with transferring from hand to hand crossing the midline when aged 6
months. Examples of fine motor activities are writing, sewing, drawing, putting a puzzle together,
imitating subtle facial gestures, pronouncing words (which involve coordination of the soft palate,
tongue, and lips), blowing bubbles, and whistling. Many children who have difficulties in their fine
motor skills also have difficulties in articulating sounds or words.
The static and motor development of newborn into adult depends on the maturation process
of the central nervous system. The process of this development is determined by genetically
established patterns of behavior and stimulation from the environment. Some conditions that
influence the rate of motor development. These factors include genetic constitution, prenatal
condition, prematurity, nutrition, physical defects, stimulation, etc. They may contribute to poor
abilities in motor functioning and coordination difficulties
A decrease in movement during the process of motor development in the early stage of
development and abnormal reactions on examination of primary reflexes may reflect early signs
of motor handicaps.


~ Assess Development in The Language Domain ~

Learning outcomes
- Describe language development
- Determine factors affecting language development

Abstract
Speech and language are tools that humans use to communicate or share thoughts, ideas,
and emotions. Language is different from speech. Language is an elaborate system of
communication that uses arbitrary and socially agreed on symbols to transmit and to receive
messages from one human to another. Language is made up of socially shared rules that include
the following: what words mean; how to make new words; how to put words together; and what
word combinations are best in what situations. Speech is the verbal means of communicating.
Speech consists of the following: articulation (how speech sounds are made); voice (use of the
vocal folds and breathing to produce sound); and fluency (the rhythm of speech).
There are many languages in the world, each includes its own set of rules for phonology
(phonemes or speech sounds or, in the case of signed language, hand shapes), morphology
(word formation), syntax (sentence formation), semantics (word and sentence meaning), prosody
(intonation and rhythm of speech), and pragmatics (effective use of language).



The most intensive period of speech and language development for humans is during the first
three years of life, a period when the brain is developing and maturing. These skills appear to
develop best in a world that is rich with sounds, sights, and consistent exposure to the speech and
language of others. Children vary in their development of speech and language. There is,
however, a natural progression or "timetable" for mastery of these skills for each language. The
milestones are identifiable skills that can serve as a guide to normal development. Typically,
simple skills need to be reached before the more complex skills can be learned. There is a
general age and time when most children pass through these periods. These milestones help
doctors and other health professionals determine when a child may need extra help to learn to
speak or to use language.
When a person has trouble understanding others (receptive language), or sharing thoughts,
ideas, and feelings completely (expressive language), then he or she has a language disorder.
Receptive language refers to the ability to understand, encompasses visual (reading, sign
language comprehension) and auditory (listening comprehension) skills. Expressive language
refers to the ability to produce symbolic communication, this output may be either visual (writing,
signing) or auditory (speech)
Delay in speech and language development in children can be defined as a “delay in speech
and / or language development compared with controls matched for age, sex, cultural
background, and intelligence”, or a discrepancy between a child’s potential ability to speak and
the performance that is actually observed. Three common causes of speech delay are mental
retardation, hearing loss and maturation delay.
There are some conditions that contributing to variations in learning to speak i.e. health;
intelligence; socioeconomic status; sex; desire communicate; stimulation; size of family; ordinal
position; child-training methods; multiple birth; contact with peers; personality, etc.

Lecture 14:
~ Cognitive Development ~

Rustika

Learning outcomes:
a. To understand the basic principles of cognitive process.
b. To understand four stages of cognitive development

Abstract:
Most progressive change of human behavior related to cognitive development, so if someone
wants to understand growth and development of human being comprehensively, they should learn
about cognitive development.
Piaget specifies four stages of cognitive development. The major cognitive achievement in the
sensorimotor stage (which lasts from birth to about two years) is the development of the schema
of object permanency. Thus, the attainment of this knowledge is indicative of representational
ability. Such ability is involved in the major cognitive achievements in the preoperational stage
(which lasts from about two through six years). Here, true systems of representation develop (e.g.,
as indexed by language, symbolic play, and delayed imitation). With the emergence of the
concrete operational stage, however (which lasts from about six through twelve years),
conservations are typically seen; thus, operational structures – internalized actions that are
reversible – are evidence. The child cannot think counterfactually or hypothetically. Such ability
characterizes the last stage of cognitive development, the formal operational stage (which lasts
from about year twelve onward).



Lecture 15:
~Psychosocial and Emotional Development~

Marheni

Absract:

Psychosocial development as propounded by Erik Erikson describes eight developmental
stages through which a healthily developing human should pass from infancy to late adulthood. In
each stage the person confronts, and hopefully masters, new challenges. Each stage builds on
the successful completion of earlier stages. The challenges of stages not successfully completed
may be expected to reappear as problems in the future.

Erik Erikson developed the theory in the 1950s as an improvement on Sigmund Freud's
psychosexual stages. Erikson accepted many of Freud's theories (including the id, ego, and
superego, and Freud's infantile sexuality represented in psychosexual development), but rejected
Freud's attempt to describe personality solely on the basis of sexuality. Also, Erikson criticized
Freud for his concept of originology. This states that all mental illness can be traced to early
experiences in childhood. According to Erikson, experience in early childhood is important, but the
individual also develops within a social context. Erikson believed that childhood is very important
in personality development and, unlike Freud, felt that personality continued to develop beyond
five years of age. In his most influential work, Childhood and Society 1950, he divided the human
life cycle into eight psychosocial stages of development.
“ Human personality, in principle, develops according to steps predetermined in the growing person's
readiness to be driven toward, to be aware of, and to interact with a widening social radius. ”

—Erik Erikson

Lecture 16:
~ Detection of Developmental Deviation in
Children (Screening & Stimulation) ~

dr. I GA Trisna Windiani, SpA

Learning outcomes
- Describe the aims of detection developmental deviation
- Recognize the methods of detection developmental deviation
- Apply methods of detection developmental deviation (Denver test, Pediatric Symptom
Checklist / PSC test)
- Describe the aims of stimulation developmental deviation
- Understand the principles of early stimulation
- Recognize the methods of stimulation developmental deviation

Abstract

Developmental screening is a brief evaluation of developmental skills that is applied to a total
population of children to identify children with suspected delays who require further diagnostic
assessment. Developmental screening involves the use of standardized screening tests.
Screening tests can be categorized as general screening tests that cover all behavioral domains
or as targeted screens that focus on one area of developmental. They can administer in the office
setting by professionals or completed at home by parents.



The Pediatric Symptom Checklist is a psychosocial screen designed to facilitate the
recognition of cognitive, emotional, and behavioral problems so that appropriate interventions can
be initiated as early as possible. Included here are two versions, the parent-completed version
(PSC) and the youth self-report (Y-PSC). PSC can be administered to 4-18 years old while Y-
PSC can be administered to adolescents ages 11 and up.
The Denver II is design to be used with apparently well children between birth and six years of
age and is administered by assessing a child’s performance on various age appropriate tasks.
The test is valuable in screening asymptomatic children for possible problem, in continuing
intuitive suspicious with an objective measure, and in monitoring children at risk for developmental
problems, such as those who have experienced perinatal difficulties. The Denver II consist of 125
tasks, or items which arranged on the test form in four sectors to screen areas of function: 1)
personal social; 2) Fine motor adaptive; 3) Language; and 4) gross motor
Early intervention or stimulation is necessary and effective because development is
malleable and readily affected by the environment. In large part, early intervention works by
systematically removing external risk factors. Early intervention programs place children in
developmentally enriching settings; train parents in responsiveness and effectiveness, and
provide continuous positive redirection and focused building of skills. The benefits of early
intervention clearly depend on early detection, which requires that clinicians know how to identify
accurately patients who have disabilities. Because time and reimbursement are limited, clinicians
also should know how to identify patients quickly. Appropriate stimulation in childhood ranks as
one of the most important factors that influence childhood development.

Lecture 17:
~ Sexual Developmental Sequence in Children
and Adolescents ~

W Bikin Suryawan/Arimbawa

Learning outcomes
- To interpret maturation of the hypothalamic-pituitary-gonadal axis and connecting with the
onset of puberty starts.
- To explain positive feedback and negative feedback in puberty regulation.
- To interpret kind of the factors affecting for sexual developmental.
- To explain the pubertal staging in boys and girls.
- To interpret the ovarian development and testicular development.
- To explain the process of adrenarche and gonarche in puberty starts.

Introduction
Puberty can be defined as maturation of the hypothalamic-pituitary-gonadal axis that results in
growth and development of the genital organs, and leads to the capacity to reproduce. Puberty is
characterized by a number of physical and psychological changes. The onset of puberty starts
with slow, frequent releases of gonadotropin releasing hormone (GnRH). GnRH is transported via
the portal system to gonadotropic cells at the pituitary level, where it stimulates the production and
release of the gonadotropins luteinizing hormone (LH) and follicle stimulating hormone (FSH). LH
and FSH then stimulate growth and production of hormones and other factors in the ovaries and
the testes, respectively. These secreted products are inhibitory (via negative feedback) at the
pituitary and hypothalamic levels. During maturation in females, positive feedback occurs, leading
to the mid-cycle LH surge.

Hormonal regulation
The release of the hypothalamic neurotransmitter GnRH is regulated by many factors, and is
subject to negative and positive feedback at the pituitary and hypothalamic levels. During
gestation, GnRH plasma levels increase; maximum levels are attained at 22-25 weeks of


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