Growth & development

1. Growth & development 3
Ismail A-A Hassan (Ph. D., MRCPCH)

2. Developmental assessment
 Includes the quantification of delay in
relation to the child's chronological age.
 The main aim of developmental assessment
is early detection of delayed or abnormal
development
 This helps children achieve their maximum
chance of health and learning. This also
helps early start of treatment.

3. Developmental assessment
The sequence of developmental
milestones is the same.
It is the rate of acquiring
developmental skill that varies.

4. Developmental assessment
 Concentrate on each field of development
separately.
 Determine the stage the child reached for
each field.
 Relate the child developmental
achievement to the child chronological age.
 Relate the progress in each field to the
progress achieved in other fields.

5. Concentrate

6. Causes of developmental delay
 Predisposing factors:
 Congenital brain malformation
 Birth asphyxia
 CNS infections (meningitis & encephalitis)
 hypothyroidism

7. Causes of delayed motor
development:
 Familial
 Environmental factors: emotional
deprivation, lack of opportunity to
practice and malnutrition (rickets)
 Hypotonia (e. g. Down's syndrome)

8. Causes of delayed motor
development:
 Hypertonia (e. g. cerebral palsy)
 Neuromuscular disorders (as
Duchenne muscular dystrophy)
 Blindness

9. Causes of delayed speech or abnormal
language development:
 Familial
 Hearing impairment
 Environmental factors: emotional
deprivation and paucity of spoken
language at home.

10. Causes of delayed speech or
abnormal language development:
 Mental subnormality
 Autism
 Twins
 Cerebral palsy
 Dysphasia

11. Causes of visual impairment:
 Optic atrophy
 Congenital cataract
 Chorido-retinal degeneration
 Reterolental fibroplasia (retinopathy
of prematurity)

12. Causes of delayed sphincter control:
 Familial
 Mental subnormality
 Environmental factors: mismanagement of
toilet training
 Physical causes: meningomyelocele,
urterocele, ectopic ureter and posterior
uretheral valve

16. Hypothyroidism before treatment

17. The same child after treatment

18. How to determine the cause of
developmental delay:
 History:
 Seek family history
 A perinatal and postnatal history may
indicate a brain damaging event.

19. Examination:
 Full systemic examination
 Full neurological examination
 Look for dysmorphic appearance,
head circumference, neurocutaneous
features and spasticity or Hypotonia

20. Investigations:
 Thyroid function
 Serum calcium
 TORCH serology Chromosomal studies
 Blood creatin kinase (CK)
 Urine amino acids and organic acids
 Screen for mucopolysaccharides and blood
lactate.

22. Management of children with
severe developmental delay:
 Multidisciplinary team.
 A sympathetic and sensitive
explanation should be given to the
parents.

23. Management of children with
severe developmental delay:
 Physiotherapy: promoting full range of
movements to prevent deformities.
 Developmental stimulation: guidance in
stimulation and ways of encouraging the
development
 Genetic counseling: information
concerning the chance of recurrence of the
condition in their future children.

24. Education provision:
 Mild to moderate cases should be
encouraged to attend school with
normal children.
 Only severely handicapped children
should attend special schools for
children with special needs.

25. Prognosis of children with
developmental delay:
 Depends on the severity of the condition.
 Mild to moderate cases are capable of
leading independent near normal life.
 Children with severe developmental delay
remain dependents throughout life.
 The aim of education of such children is to
teach them self care ability.