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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
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