Jean-François Lemay, MD FRCPC Professor of Pediatrics Dept of Pediatrics

1. Jean-François Lemay, MD FRCPC Professor of Pediatrics Dept of Pediatrics ACH, University of Calgary Sept 6 2012

2. Learning about Normality

3. Objectives • The participant will learn: • general principles in infant growth and development • essential to understand normal development and acceptable variations in normal developmental patterns

4. Once upon a time …

5. … a miracle was born !

12. Important message • Infant development occurs in an orderly and predictable manner that is determined intrinsically

13. Question: • What is the difference between: • Developmental screening • Developmental assessment • Developmental surveillance

14. General principles • Physician’s role • Performing routine developmental screening, (assessment) and surveillance • Discussion of normal developmental variations with parents and professionals • Explaining test results to parents • Acknowledging parental concerns • Providing referral/facilitating management interventions

15. What areas of development are monitored in any child ?

16. Motor Social Speech-Language Adaptive Sensory Cognitive Developmental Spheres

17. Stages of development • Step 1: Standing • Step 2: Speaking • Step 3: Thinking • Step 4: Practicing

18. Step 1: Standing (0 -1 year) • Innate will to reach the world • This will is the impulse to be alive, to learn, to become • Sitting position: offers a new view of life-can reach for, and grasp objects, etc. • Then, tries to stand with support • By the end of the 1st yr, baby can stand freely and begin his-her first steps

19. 3 goals of the 1st yr of life • Sitting • Grasping • Walking

20. Motor skills: summary FM and GM-first year of life

26. Step 2: Speaking (1-2 years) • Language: • exists and is understood long before it is spoken • follows walking • Develops through imitation • World begins to make sense when speech is developing • 3 periods: pre-speech, naming period, and word combination period

27. Predisposed to make order out of chaos Able to find human faces Able to imitate human actions Process bits of human language They can hear, and they can produce reflexive vocalizations-such as crying, sneezing, and of course burping! Prefer to hear mother ’s voicequite soon in life Distinguish voices at 4 weeks of age—mom and dad Sensitive +++ to language sounds Linguistic stimulation is crucial-contact with human faces +++ Come prepared to learn language Stage 1 : Newborn

28. Stage 2, 3 and 4 • Stage 2: Coos 2-3 months • Stage 3: Gurgles 4-6 months • Stage 4: Babbles 6-7 months • first babbling sounds that sound like real words-gaga, mama, dada, etc. -What is the crucial factor that stimulates this vocalization process? answer… eye gaze!!!!

29. If babies are so capable, why don’t they talk sooner? • Reason: infant vocal tract resembles the vocal tract of non human primates • prevents babies from using the mouth as an instrument in the ways necessary for speech • Oral cavity has lengthened and expanded at 1 yr. of age-first word

30. Stage 5: First word ! • Spent a year preparing for this achievement-enormous mental leap • Around 12 months (10 mo-24 mo.) • Now can communicate and represent objects, actions, and events in his/her mind

32. TABLE A : EXPRESSIVE LANGUAGE DEVELOPMENT: AVERAGE AGE OF ACQUISITION AND AGE INDICATING SIGNIFICANT DELAY OR RED FLAG

33. TABLE B: RECEPTIVE LANGUAGE DEVELOPMENT: AVERAGE AGE OF ACQUISITION AND AGE INDICATING SIGNIFICANT DELAY OR RED FLAG

34. Important tips: Expressive language • Age in months/minimal amount of words • 12 months: 1 x 2 or 1+2 • 15 months: 1 x 5 or 1+5 • 18 months: 1 x 8 or 1+8 • Vocabulary Spurt • 24 months: 24 mo x 2y • 36 months: 36 mo x 3y

36. Step 3 : Learning-Thinking • Infants learn to do virtually everything that is typically human during the first 2 years of life • Defined as a change of behaviour resulting from experience and practice • Exploration-practical reasoning

39. Step 4: Practicing • Now you are ready to use your skills • Kindergarten is starting at age 5: why? • Similarities with medical school students Preparation to medical school • Step I: Year 1 and 2 of Med School • Step 2: Clerkship • Step 3: MCC exam • Step 4: Residency

40. In order to determine if a child is normal or abnormal, you need to do…

41. History and Physical Examination • Detailed history • Family • Prenatal • Perinatal • Postnatal • Detailed Physical Examination

42. Family History • Three generations, maternal and paternal • Consanguinity, Pedigree • Previous pregnancy outcomes: • miscarriages, stillbirths, neonatal or childhood deaths, infertility • Family history of birth defects, childhood deaths, MR, SD, LD, ASD, and known genetic conditions • Ethnic background

43. Prenatal History • Potential teratogens • Alcohol, medications,vitamins, maternal infection (rubella, toxoplasmosis,varicella) • Maternal diabetes, hyperthermia, maternal PKU • Fetal movements • Prenatal tests • Eg. amniocentesis, ultrasound

44. Perinatal History • Gestation, mode of delivery, APGAR, resuscitation • BW, length, HC • Feeding, muscle tone, other problems

45. Postnatal History • Developmental Milestones, school performance • Evidence of regression • Unusual behavior, personality, temperament • Coordination, seizures, unusual movements, increased or decreased tone • Growth, nutrition, sleeping • Vision, Hearing • Previous illnesses • Complete review of systems

46. Physical Examination • Syndromic versus Non-syndromic developmental delay • Growth parameters • Complete physical examination • Careful neurological examination • Careful skin examination

48. Question • At birth… • Head Circumference : • Weight: • Height: At 12 months…

50. Social