B4 School Check Waikato Hospital 2019 222 Pembroke Street Private - - PowerPoint PPT Presentation

Child Development B4 School Check 2019

Child Development Centre Waikato Hospital 222 Pembroke Street Private Bag 3200 Hamilton 3240 07 839 8726 www.waikatodhb.govt.nz/cdc

What is child development?

• Predictable, pre-programmed pattern of

sequential skill acquisition in a cephalocaudal (top to bottom) progression.

• Reflects the growth and development of the brain

and central nervous system.

• Brain development starts in 4th week of gestation

and continues into the third decade of life.

• A milestone is the acquisition of a key

performance skill.

What is normal development?

• A predictable pattern of milestones acquired one

after the other.

• Commonly divided into 4 domains:
• Gross motor
• Fine motor (and vision)
• Language (and hearing)
• Social, emotional and behavioural

What is normal development?

• The normal age at which milestones are achieved

can vary widely.

• The median age is when 50% of children have

acquired the skill.

• The limit age is when 98% of children have acquired

the skill (2 standard deviations).

What is normal development?

– As milestones become more complex, multiple domains may be involved (eg. feeding self – fine motor, gross motor, behavioural) – There are a few normal variations of development

• Bottom-shuffling to walking without crawling (often

familial)

• Initial language delay in bilingual children

What is abnormal development?

– Developmental delay

• Milestones achieved slower than the standard

population (eg. intellectual disability).

– Disordered development

• Abnormal pattern of milestone acquisition (eg. Autism)

– Developmental regression

• Loss of developmental milestones (eg. Rett syndrome)

• Development can be affected by genetic and

environmental factors.

• Positive social experiences in early childhood

support brain development, particularly language and social skills.

Abnormal development

How common are developmental problems? – Global developmental delay affects 1-3% of children (up to 33,000 NZ children)

• Autism 1% (>11,000 NZ children)
• Mild learning disability 1-2% (up to 22,000 NZ children)
• Severe learning disability 0.3-0.5% (up to 3,300 NZ

children)

• Specific learning disability in a single domain 5-10%

(up to 112,000 NZ children)

Normal Development in 4 year

• lds
• Gross motor

– Can stand on one foot. – Can walk up and down stairs without holding a rail. – Can throw and kick a ball.

Normal Development in 4 year

• lds
• Fine motor (and vision)

– Can draw a circle. – Can build a tower of 10 blocks. – Can use scissors.

Normal Development in 4 year

• lds
• Language (and hearing)

– Can be understood by an unfamiliar adult. – Uses 5-6 word sentences. – Can describe something that has happened to them.

Normal Development in 4 year

• lds
• Social, emotional and behavioural

– Can dress and undress themselves with simple clothes (not buttons or zips). – Can say their first and last name. – Know if they are a boy or girl. – Can name some colours. – Can cooperate with other children in a simple game.

PEDS

• Parents Evaluation of Developmental Status

– 10 questions that draw out parent concerns. – Screening tool used to identify and address behavioural problems in 0-8 year olds.

• Screening tools are not diagnostic. They screen

populations to determine which individuals require further investigation.

– The language is important. Please don’t deviate from the language on the form unless using a translator.

• Advice to support child development

• Advice to support child development
• Ways to PLAY?

– Use your senses: touch, listen and look at objects (e.g. sand, leaves and toys) – Move about: help your child move, push and pull objects – Out and about: go to libraries, talk about books; visit parks – climb, throw and kick balls, ride a bike – Talk and problem solve, e.g. with puzzles – Use imagination: play out simple ideas and gradually introduce different scenarios or roles; play with dolls/teddies/figurines; creatively use boxes or containers as play objects (e.g. as a car) – Explore: use a variety of things for your child to explore and play with e.g. bubbles, pots and pans, play doh. Your cupboards are full of exciting things!

What to do next?

• Why refer?

– Early identification and intervention improve the

• utcomes for children with developmental

disability.

• Preschool interventions are highly cost-effective.

– Provides parents and caregivers with reliable information. – Early diagnosis of a genetic diagnosis may impact

• n family planning.

• When to refer

– Any concerns about loss of skills (regression) – Unusual pattern of skill acquisition (disordered development) – Concerns flagged on screening tool (PEDS)

• When to refer

– Red Flags for 4 year olds:

• Unwilling or unable to play cooperatively with other

children.

• Speech difficult to understand.
• Not able to follow two-step directions.
• Not able to draw a circle or line.
• Not toilet-trained by day

– Affected by current cultural norm of child-led toilet training and nappies that keep children very dry. At school teachers can help with toileting, but this is resource intensive. If parents have not started toilet training at 4 years old, please encourage them to do so for school readiness.

• Not able to run, jump or use stairs confidently
• Not able to catch or kick a ball.

Child Development Centre (CDC) is:

• Child centred and family focused

disability service for children and young people 0-15 years.

• Provides services for child and youth

population of Waikato DHB

• Works in outpatient clinics, home

and community settings

• Provides a variety of multidisciplinary

assessment services and interventions

• Provides ongoing service initiatives

to meet needs of the population

CDC Team includes:

• Paediatricians
• Psychologists
• Occupational Therapists
• Physiotherapists
• Speech Language Therapists
• Administration staff
• Social Workers
• Visiting Neurodevelopmental Therapists (OTs / PTs)
• ASD Co-ordinator

• What happens when you refer

– Referral is triaged – Initial assessment in preschool pathway with a child psychologist and an occupational therapist, speech language therapist or social worker. – May then be discharged if no concerns, or referred on for Autism Diagnostic Observation Scheduele (ADOS – diagnostic assessment for autism), Intellectual Disability Assessment or Individualised Developmental Assessment. – These assessments may include kindergarten observation visits.

Questions?

With thanks to:

• Dr Sadani
• Waikato DHB
• HealthLink British Colombia,
• Queensland Health Child and Youth Community Health

Service

• NZ Ministry of Health