OLFU MED

2012

Pediatrics I
Dra. M san Pedro
08.13/09.08.09

Biological or Neurodevelopmental processes:

Depends on maturation of the CNS but may be
greatly modified by the environment and by
Development experience
Process of development
Neonatal period
Reflected in the acquisition of basic gross and fine
Neonatal reflexes motor skills

contents

Adaptive & Fine motor Cognitive or Intellectual processes:

Self-help skills Depends on both genetic and environmental factors
Personal/social patterns May be difficult to differentiate from neurological
Play
Screening behavior inventory
maturation during early infancy but later ages
Developmental attainment of 5-19 y/o measured by language or communicative skills and
Cognitive process by ability to handle abstract and symbolic material
IQ Socio-emotional or Psychosocial processes:
Gftedness Integrates the biological and cognitive and
Mental retardation
Socio-emotional or psychosocial; incorporates genetics and experience into the
development continuing and ultimate definition of the individual
Speech delay as a unique person and personality
Child development
Theories of development
Developmental Domains
These are categories of development that contain sequences of
changes leading up to particular attainments expected of the
child at certain ages
The childs developmental progress can be tracked through
these domains which are: gross motor, fine motor, language,
social, cognition and emotional
DEVELOPMENT Gross motor, fine motor (adaptive), language and social
(personal/social) are also called areas of behavior reflecting
Specific Objectives neurological maturation or biological development while
To discuss the three processes of development and the factors cognition indicates cognitive development and emotional the
affecting them socio-emotional process of development
To discuss steps and tools in developmental assessment
Discuss developmental domains and the four areas
of behavior
Discuss developmental milestones and normal
patterns
Discuss developmental surveillance and screening
To discuss some common types of developmental disorders
and their risk factors
To discuss the theories of child development
Cognitive Development Theory by Piaget
Psychosexual Development Theory by Freud
(Affective)
Psychosocial Development Theory by Erickson NEONATAL PERIOD
(Affective) First 4 weeks after birth
Moral/Ethical Development Theory by Kohlberg
(Conscience) Brazeltons NBAS
Neonatal Behavioral
Assessment Scale
Processes of Development
Interactive Processes: Orientation, alertness, consolability,
cuddliness
Motor Processes: Muscular tone, motor maturity, defensive
reactions, general activity level, reflexes
Control of physiologic state: Response to bright light, a rattle,
a bell & a pinprick
Response to stress: Tremulousness, lability of skin color &
startle reaction

Behavioral States or
Levels of Arousal of the Newborn
1. Quiet sleep
2. Sleep with Rapid Eye Movement (REM)
3. Drowsy state
4. Quiet, alert state most responsive
5. Fussy
6. Crying

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Neonatal Reflexes

Age Gross M otor Patt erns 1-5 Years

15 Walks alone;
mo
Crawls upstairs

18 Walks upstairs Runs stiffly; Explores

mo wit h one hand drawer s &
Sits on small
held wast ebasket s
Reflexes/
Appears Disappears
chairs
Muscle Tone

Moro 28 weeks wea k, 3 mont hs 24 Walks up & down Runs well; Opens door s
37 weeks complete mo stair s one st ep at Climbs on
a time furnit ure;
Grasp 28 weeks wea k 3 mont hs Jumps
37 weeks complete

LE Crossed Bi rth 1 mont h 30 Goes upstairs

Extensors mo alter nat ing feet

Extensor Pl antar Bi rth 8-12

mont hs 36 Stands Rides tricycle
mo momentarily on
Placing/Stepping 34 weeks 2-4 months one foot

ATNR 35 weeks 3 mont hs Throws ball

48 Climbs well;
overhand;
mo
Flexion of the thighs 30 weeks Hops on one Uses scissors to
at hips (Completely hypotonic at age <28 foot cut out pictures
weeks)

Flexion of all 4 limbs 34 weeks

60 Skips
mo

Four Behavior Areas

1. Gross Motor: Using large groups of muscles to sit, stand,
walk, run, keep balance or play ball
2. Adaptive/Fine Motor: Using fine motor & sensory
coordination to use & manipulate tools such as in feeding &
writing; closely related to intelligence
3. Language: Using words, body language & gestures to
communicate & understand others
4. Personal/Social: Performing self-help skills, interacting &
having relationships with family & friends, cooperating with &
responding to others

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Adaptive and Fine Motor 48 Goes to toilet alone
mo

60 Ask s questions about Dresse s and

mo meaning of words undresses

Play
Period Stages of Play Categories of Play

6 Sensorimotor: Practice play; simple, Solitary Play: Pla y that

mont hs repetitiv e mov ements, e.g. an infant occurs alone, of ten with
shaking a rattle or throwing objects at to ys
random

18 Symbolic: Constructive pla y; Parall el Pl ay: Children

mont hs manipulation of objects to in the same activit y side
represent something, e.g. a child by side but with v ery
using blocks as telephone or car little interaction

3.5 Mastery or Role-play: T he child Asso ciativ e Play: Like

years gains control of his body and
actions although can switch to make-
believ e; e.g. master y is a child in a
swing, blissfully pumping aw a y, later,
to enga ge in role-play such as pla ying
house
parallel play but with
increased l ev els of
interaction in the form
of sharing, turn ta king &
general interest

5 years Games with Rules: A pla y acti vit y in Cooperativ e Play: Pla y
which children recognize and in which children join
confirm to predetermined rules, together to achieve a
generally goal o riented, requires common goal
complex behav iors and logical
thinking such as simple board
games, playgro und g ames or sports

Screenong Behavior Inventory

**table 2

**table 1 Developmental Attainment of 5-19 years old

**table 3

Self-Help Skills

Developmental Surveillance & Screening Algorithm

**table 4

Age Personal/ Social Patterns 1-5 Yea rs

15 Indicates some desi res Hugs parents

mo or needs by pointing

18 Seeks he lp when in Kisses pa rent Feeds self

mo trouble; with pucker
May complain when wet
or soiled

24 Often tells about Handles spoon

mo immediate experien ces; well;
Listens to stories when Helps to undress
shown pictures

30 Helps put things

mo away

36 Unbuttons clothing
mo & puts on shoes;
Washes hands

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**table 1

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***table 2

Screening Behavior Inventory

Derived from developmental norms observed by Santos-Ocampo et. al. in
Filipino infants and children belonging to the middle socio-economic
classes.

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**table 3

Developmental Attainment of 5-19 years old

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**table 4

Developmental Sureveillance & Screening Algorithm

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Page 11 of 17 The positive thinker sees the invisible, feels the intangible, and achieves the impossible. *** loveskeedoo ;-)
Cognitive Process Over-all behavior pattern of an individual at any period of
Intelligence: The aggregate or global capacity of the growth
individual Defines the individual as a unique person & personality
to act purposely
to think rationally Socio-Emotional Dimensions
to deal effectively with his environment 1. Psychic or internal (Intrapsychic) Dimension
Types of Intelligence are: a. Cognitive (intellectual features): perceptual
Formal (academic learning) reasoning, judgment and memory
Contentional (common sense) b. Affective (feelings or emotions): anxiety,
depression, fear, anger, sadness, joy, elation,
Components of Cognition jealousy, calmness and placidity
Recognition: awareness of a concept c. Formation of Conscience and its Exercise: has both
Attention span: the ability to concentrate mentally or focus cognitive and affective features
Retention & Recall: implies short-term & long-term memory 2. Social or external (Interactional) Dimension: Relationships
Reasoning with the environment, people and circumstances within which
Inductive: bottom-up [specific observation the child lives
pattern tentative hypothesis theory]
A classic example: Evaluation Methods
Premise: The sun has risen in the east every morning up until 1. Biological (Behavior Areas)
now. Denver Development Screening Test (DDST)
Conclusion: The sun will also rise in the east tomorrow. Gessel Developmental Test
Deductive: top-down [theory hypothesis Developmental Quotient
observation confirmation (or not)] DQ = maturity x 100
A classic example: chronologic age
Premise 1: All humans are mortal. Goodenough-Harris Draw-A-Person Test
Premise 2: Socrates is a human. 2. Cognitive
Conclusion: Socrates is mortal. IQ Tests: Cattell Test, WISC, Binet-Simon Test
Abstraction & Generalization: the process of formulating 3. Socio-Emotional or PsychoSocial
general (broad) concepts by abstracting (extracting) common E. A. Dolls Vineland Social Maturity Scale
properties of instances J. L. Morenos Sociometric Technique
Organization: to integrate or blend into a functioning or unified
whole Speech Delay
Anatomical problems with vocal cords
Hearing problems
Intelligence Quotient (IQ) Developmental Language Disorders:
IQ = mental x 100 Constitutional speech delay late talkers
chronologic age Mental retardation
Classification IQ Pervasive developmental disorders that includes
Near Genius or Genius 140 & Above autism
Very Superior 130-139
Superior 120-129 Dev elopmental Exceptionalities
Above Average 110-119
Normal or Average 90-109 Condition Prev alence/1 000 Risk Factors
Below Average 80-89
Borderline MR (Dull) 70-79
Giftedness 60 (U.S. Dep Ed) Interplay
Mild MR (Moron) 50-69 between
Moderate MR (Imbecile) 30-49 nature and
Severe MR (Idiot) Below 30 nurture

Cerebral 2 (Nelson) Antenatal

Giftedness palsy (congenital
Concept undergoing evolution: in the past, a score of 130 or anomalies,
higher on an IQ test intrapartum
asphyxia &
Gardners Multiple Intelligences (MI) 1983 maternal
Logical-Mathematical Bodily-Kinesthetic infection),
Linguistic Interpersonal LBWs
Spatial Intrapersonal
Visual 0.3-1.5 (WH O) Prenatal
Musical Naturalist (recent) impairment (autosomal
Golemans Emotional Intelligence (EQ) 1998 recess iv e
Self-awareness Empathy most
common),
Self-regulation Social Skills perinatal/neo
Motivation natal (ROP,
HIE &
infection as
Mental Retardation in rubella
Diagnostic and Statistical Manual of Mental Disorders (DSM- cataract),
IV) 3 criteria: measles &
v itamin A
1. IQ below 70 deficiency
2. Significant limitations in > 2 areas of adaptive
behavior Hearing 1-2 (Nelson) Prematurity,
3. Limitations became apparent in childhood impairment congenital
including
Wechsler Adult Intelligence Scale (WAIS): infections,
Class COM
IQ
Mild mental retardation 5069 Mental 25 (Nelson) Env ironmenta
Moderate mental retardation 3549 retardation l in mild and
Severe mental retardation 2034 biologic in
sev ere
Profound mental retardation Below 20
Three most common inborn causes: Down syndrome, fetal
alcohol syndrome and Fragile X syndrome
Dyslexia 50-100 (Nelson) Familial and
heritable,
Socio-Emotional or Psychosocial Development (Personality) susceptible
Sum total of all the areas of development as seen in the gene DCDC2
persons activities in relation to situations

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ADHD 50-100 (Nelson) Multiple and
Q: And at night, when everyone is asleep, do they move?
heritable, A: Yes
candidate Q: But you tell me that they move when somebody walks.
genes D AT 1
& DRD4 A: They always move. The cats, when they walk, and then the
dogs, they make the clouds move along.
Autism 6 (Nelson) Multifactorial Egocentrism
spectrum and heritable,
disorders implicated
or PDD chromosome
s 7q, 2q &
15q11-13, no
association
with MMR
v accine

Disruptiv e 100-150 Genetic,

Behav ioral (http://www.merck.com/mmpe/sec19/ch3 socio-
disorders 00/ch300e .html) cultural,
( CD & temperament,
ODD) some
psychiatric
conditions or
cognitiv e
limitations

Theories of Development
**table 5

Cognitive Development Model

Children must construct knowledge, intelligence is a form of
equilibrium, and the process of achieving it is called
equilibration
Cognitive schemes make up the structure of intelligence:
Behavioral (or sensorimotor) schemes: Organized
patterns of behavior used to respond to an object or
experience
Symbolic schemes: Experiences represented
mentally
Operational schemes: Internal mental activity
performed to reach a logical conclusion

**table 6
Piagetian Stages of Development

Object Permanence

Realism and Animism

Realism: Thoughts are REAL, as real as the item being thought
about!
Animism: Giving thoughts, feelings and intentions to
inanimate objects (toys!)
Implications: perception thinking not abstraction; magical
thinking
Advantage: contributes to the faculty of imagination and
creative thinking
Disadvantage: can generate intense fears

Transductive Reasoning
Q: You have already seen the clouds moving along. What
makes them move?
A: When we move along, they move along too
Q: Can you make them move?
A: Everybody can, when they walk.
Q: When I walk and you are still, do they move?
A: Yes.

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**table 5

Theories of development

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**table 6

Piagetian Stages of development

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Conseravtion

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Socio-emotional/Affective Dimension ==>> lalabas daw to sa exam..heheh.. jowk lang;-)
(Freuds Psychosexual Development)

Failing doesn't mean I'm a failure

ORAL ANAL OEDIPAL LATENCY GENITAL It just means I haven't succeeded yet.
Failing doesn't mean I'm infereior
0-1 YR 1-3 YR 3-7 YR 7-11 YR 11-21 YR
I just means I'm not superior

Impuls Ensuring Defining the Defining Simmering Old battles Failing doesn't mean i haven't accomplished anything,
es & survival emerging relationship down, re-fought It just means I haven't started something.
drives self & how s between channeled to & needs Failing doesn't mean I must give up,
toward it relates to self, my school & resolution It just means I must try harder.
others loved one socialization Failing doesn't mean I'm nonsense,
& It just means you haven't heard me talking seriously.
somebody
else Failing doesn't mean that i must stop trying,
Because quitting the fight before it's over is the true failure,
Issues Food, Control, Boyness, Preparation True And I won't stop trying until I'm sixth feet under
love, power, limits girlness, for storm genitality 'Coz simply I want to prove that I'm not a failure..
care, , boundaries, femininity, of now a I'm just taking things at a time...
contact, territories, masculinity, adolescence psychologi
dependen etc. competition cal &
cynurtur biological
ance, etc. possibility

At each stage, the childs drive can potentially conflict with the rules of
society

Socio-emotional/Affective Dimension
(Eriksons Psychosocial Development)

Favorable ratio yields

Trust vs Mistrust 0-1 Yr Sense of Optimism

Autonomy vs Shame & Doubt 1-3 Yr Sense of Self-control & Will Power

Initiative vs Guilt 3-7 Yr Sense of Direction & Purpose

Industry vs Inferiority Sense of Method & Competence

7-11 Yr

Identity vs Role Confusion Sense of Devotion & Fidelity

11-21 Yr

Salient issues face children at different ages

Kohlbergs Moral/Ethical Development

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