Pediatrics
Development
Roll no :39. Roll no:03
De inition
Development
Development refers to m tur tion of functions nd cquisition of v rious skills for
optim l functioning of n individu l.
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Principals of development
1. Development is a continuous process, starting in utero
and progressing in an orderly manner until maturity. The child has to go
through many developmental stages before a milestone is achieved.
2. Development depends on the functional maturation of the nervous
system. Maturity of the central nervous system is essential for a child to
learn a particular milestone or skill; no amount of practice can make a
child learn new skills in its absence.
• The sequence of tt inment ofmilestones is the s me in ll children.
For ex mple, ll inf nts b bble before they spe k in words nd sit
before they st nd. V ri tions m y exist in the time nd m nner of
their tt inmentw
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The process of development progresses in a cephalocaudal direction.
Hence, head control precedes trunk control, which precedes ability to
use lower limbs. The control of limbs proceeds in a proximal to distal
manner, such that hand use is learnt before control over ingers.
Certain primitive re lexes have to be lost before relevant milestones are
attained. For example, palmar grasp is lost before voluntary grasp is
attained and the asymmetric tonic neck re lex has to disappear to allow
the child to turnover.
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The initial disorganized mass activity is gradually replaced by speci ic and
wilful actions. Hence, when shown a bright toy, a 3-4 month old squeals loudly
and excitedly moves all limbs, whereas a 3-4 yr old may just smile and ask for it.
Factors Affecting Development
Development depends on a variety of mutually interactive factors such as
hereditary potential, biological integrity, physical and psychosocial
environment and emotional stimulation.
Prenatal Factors
Genetic factors Intelligence of parents has direct correlation on the nal
IQ of the child. Moreover, certain developmental patterns are observed
to follow parental patterns like speech. There are numerous genetic
causes for developmental delay and subsequent mental reta dation
(MR). Prominent genetic factors include chromos mal abnormalities
Maternal factors :A host of factors which impair growth in utero
also can potentially affect brain growth,
Maternal nutrition. There is suggestion that maternal malnutrition (of
macronutrient as well as micr nutrients) has adverse effect on birth weight and
child development. Studies from developing countries suggest that nutrition
supplements including multiple micronutrient supplements have positive
impact on birth weight as well as child development.
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Exposure to drugs and toxins.Various drugs and toxins such as maternal
drug or alcohol abuse, antiepileptic drugs and environmental toxins can
have adverse effect on child development.
Maternal diseases and infections. Pregnancy induced hypertension,
hypothyroidism, malnutrition and fet placental insuf iciency due to any
cause. Acquired infections (e.g. syphilis, toxoplasmosis, AIDS, rubella, CMV,
herpes) can have a severe impact on fetal physical and brain growth. E
Neonatal Risk Factors
Intrauterine growth restriction Intrauterine growth restriction (IUGR)
indicates constraints in fetal nutrition during a crucial period for
brain development. In developing countries, intrauterine growth
restriction is mainly due to poor maternal nutrition and infections.
Prematurity Babies born before 37 weeks of gestation are
more likely to have developmental impairment
compared to term counterparts with babies born before
32 weeks gestation being at the highest risk.
Postneonatal Factors
1. Infant and child nutrition
2.Iron de ciency
3.Iodine de ciency
4.Infectious diseases
5Environmental toxins
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Psychosocial Factors
Parenting Cognitive stimulation, caregiver's sensitivity and a ection
(emotional warmth or rejection of child) and responsiveness to the
child in the setting of other factors such as poverty, cultural values
and practices have an important bearing on child development.
Apart from these, parental attitudes, involvement, education and
desire for the child also have an impact on the develo ment of the
child.
Poverty: This is possibly the most common underlyingfactor
for impaired child development worldwide. It acts throughout
the lifetime of the individual and also affects the next
generation.
A variety of risk factors such as biological, enviro mental,
nutritional and psychosocial that are associated with poverty
lead to cumulative adverse effect on early child development,
Lack of stimulation : Socialandemotionaldeprivationand
lack of adequate interaction and stimulation is an impo -
tant cause of developmental impairment, particularly
evident in the setting of poverty
Violence and abuse: Domestic and community violence
are emerging threats to child development. Child abuse,
physical and sexual, can have a profound psychological
effect on the child. Problems of attention and cognition are
more common in children exposed to violence or abuse.
Maternal depression :Low to middle income countries have a
high incidence of maternal depressive symptoms, which is
negatively associated with early child development
Institutionalization: Institutional care (e.g. orphanages) during early
life increases the risk of poor growth, il health, attachment
disorders, attention disorders,
Protective Factors
Breastfeeding Breastfeeding has a protective and
promotive effect on childhood development.
Maternal education :Maternal education is a protective
factor reducing child mortality and promoting early child
development. Infant and young children of educated
mothers have higher levels of cognitive development.
