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Child development. Doug Simkiss Senior Lecturer in Paediatrics and Child Health, Warwick Medical School. Aims. Importance of child development Review changes in child health promotion for primary care teams. Objectives. Explain why development is fundamental to paediatric practice

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child development

Child development

Doug Simkiss

Senior Lecturer in Paediatrics and Child Health, Warwick Medical School

slide2
Aims
  • Importance of child development
  • Review changes in child health promotion for primary care teams
objectives
Objectives
  • Explain why development is fundamental to paediatric practice
  • Discuss child development assessment tools
  • Health of all children (Appendix 2 RCGP curriculum statement 8)
objectives4
Objectives
  • National service framework for children and young people (Appendix 3 + 4 RCGP curriculum statement 8)
  • Child health promotion programme (Appendix 5 RCGP curriculum statement 8)
introduction
Introduction

‘Children are in a constant state of growth and development which creates particular needs and demands which are of a different order from those affecting adult patients’.

Prof Sir Ian Kennedy

The Report of the Public Health Inquiry into Children’s Heart Surgery at the Bristol Royal Infirmary 1984-1995

what is normal
What is normal?

“We can never draw the line between normal and abnormal. All we can say is that the further away from the average he is in anything, the less likely he is to be normal”

Prof R Illingworth The Normal Child 1983

normal child development
Normal child development
  • Curiosity is the key
  • Domains include;
  • Gross motor,
  • Fine motor and vision
  • Speech and language (comprehension and expression)
  • Social (self care and interactive)
normal child development8
Normal child development
  • The symphony analogy
  • Highlights from the mother and toddler group perspective
  • Year 0-1;
  • Gross motor
  • Year 1-2;
  • Speech and language
normal child development9
Normal child development
  • Year 2-3;
  • Social especially self care
  • Year 3-4;
  • Fine motor
normal child development10
Normal child development
  • Watch the following video
  • Write down the developmental age of the child and your reasons why.
evaluating development
Evaluating development
  • There are a variety of tools
  • Denver developmental assessment
  • Parental evaluation of developmental status
  • Schedule of growing skills
denver developmental screening test
Denver Developmental Screening Test
  • DDST developed in 1967
  • Revalidated 1992
  • 2000 children, 336 potential items, average use of 540 children / item
  • Denver II has 86% more language items, 2 articulation items and a behaviour score
  • Pediatrics 1992, 89, 91-7
parental concerns
Parental Concerns
  • Frances Page Glascoe
  • Pediatrics 1997; 522-528
  • 2 Screening questions
parental concerns14
Parental Concerns
  • Frank Oberklaid
  • Australian Family Physician 2000; 29, 731-734.
  • Parents Evaluation of Developmental Status (PEDS), a 10 item questionnaire for GP’s
schedule of growing skills
Schedule of Growing Skills
  • Origin as a research tool in the National Child Encephalopathy Study
  • Based on validated items from STYCAR sequences
  • SOGS items validated against Griffiths test
  • SOGS II 1996 standardised on 348 children 18.4% in West Birmingham
new service drivers
New service drivers
  • Health for all children Edition 4
  • National Service Framework for Children, Young People and Maternity Services
  • Right from the Start
  • Sure Start
  • Children’s trusts
health for all children
Health for all children
  • Hall 4 (or Elliman 1)
  • Every child and parent should have access to a universal or core programme of preventative pre-school care. Content depends on
    • Delivery of agreed screening procedures
    • Evidence in favour of some health promotion procedures
    • Establishing families with more complex needs
health for all children18
Health for all children
  • Formal screening should be limited to the evidence based procedures agreed by the Child Health sub group of the National Screening Committee
  • Formal universal screening for S+L delay, global developmental delay, autism and post natal depression is not recommended. ‘Staff should elicit and respond to parental concerns’
health for all children19
Health for all children
  • There is good evidence to support health promotion activity in a number of areas
    • Immunisation
    • Reducing risk of SIDS
    • Supporting breast feeding
    • Encouraging better dental care
    • Informing and advising parents about accidental injury
    • (Not yet in obesity)
health for all children core programme
Health for all children – core programme
  • Antenatal care
  • Newborn examination
  • Support as needed with breast feeding
  • Review at 6 -8 weeks and reviews at 8 (or 12) months, 24 months and between 3-4 years.
  • ‘it is expected that staff will take a flexible approach to the last 3 reviews according to the families needs and wishes, and face to face contact may not be necessary for all families’.
health for all children21
Health for all children
  • There is a growing evidence base for the health care of school age children.
  • Risk taking behaviours and mental health are key areas
  • www.publichealth.nice.org.uk – evidence briefings on most of these areas
nsf for children young people and maternity services
NSF for Children, Young people and maternity services
  • 5 core standards and 6 relating to specific groups of children
  • Standard 1 is the Child Health Promotion Programme
  • This is Hall 4!
to summarise
To summarise
  • Importance of child development
  • Review changes in child health promotion for primary care teams