Child Development

Definition

Just as every child will have its own unique personality, every child will develop differently, influenced by a variety of individual and environmental factors. Mostly, these differences are minor.

Assessing a child's development is important not only to provide reassurance where the child is found to be normal, but also to enable early intervention and improve the outcome where development is abnormal.

Description

Parents naturally have a interest in their child's development. Witnessing a child reach standard developmental milestones, such as walking and talking, in the expected timeframe, brings both satisfaction and reassurance. On the other hand, concerns about delayed or abnormal development can be very worrying. An estimated 3-5% of children will at some stage exhibit significant developmental delay.

The assessment of a child's development takes several forms. Parents make informal assessments of their child's development everyday. These are largely based on comparisons with older siblings or other people's children. Maternal and Child Health Care Nurses, GPs and Paediatricians make more formal assessments of development.

Medical professionals tend to assess development across a number of areas, including gross motor skills (e.g. crawling, walking, jumping), fine motor skills (e.g. holding and picking up objects, drawing), vision, hearing, language, and social skills (e.g. smiling, feeding, dressing). As an example of developmental milestones, 90% of children will by:

• 1 month: watch a face, lift their head momentarily when lying on their belly.
• 3 months: follow objects with their eyes, laugh.
• 6 months: roll over, reach for an object with their hands, turn to a voice.
• 9 months: sit without support, feed themselves a biscuit, repeat syllables (e.g. Dada).
• 1 year: walk holding on to furniture, understand several words.
• 1.5 years: walk steadily, drink from a cup, use 5 words.
• 2 years: scribble, point to one named body part, feed themselves with a spoon.
• 3 years: pedal a tricycle, use 3 word sentences, put on clothes.
• 4 years: copy a square, give their first and last name.
• 5 years: hop on one foot, know some colours and their age, draw a person.

It is worth remembering several facts - most children will not be average in all respects, slow development is not necessarily abnormal and fast development does not necessarily indicate that a child is gifted. Also, it is important to remember that while medical professionals can perform developmental screening tests based upon expected milestones, evaluations tend to be one-off snapshots of a child's performance and may therefore not accurately reflect a child's true status.

Parents are therefore better-placed to monitor their child's development. They are usually the first to suspect that there may be a problem with their child's development. Where parental concerns exist, they tend to be highly sensitive predictors of an underlying developmental problem, a fact that holds true regardless of a parent's background and of whether or not he or she is caring for their first child.

The Parents' Evaluations of Developmental Status (PEDS) questionnaire is a validated way of determining parental concerns, designed as a screening tool to detect children with possible developmental problems. It asks you to list any specific issues you may have regarding your child's development and if you have any concerns about how your child:

• Understands what you say?
• Talks and makes speech sounds?
• Uses his or her hands and fingers to do things?
• Uses his or her arms and legs?
• Behaves?
• Gets along with others?
• Is learning to do things for himself or herself?
• Is learning preschool and school skills?

In some cases parental concerns will be significant and in other cases your child will be developing normally. If you have any concerns about your child's development - especially concerns about vision and hearing, or if there has been a loss of previously attained skills - then you should consult your Doctor or Maternal and Child Health Care Nurse for further advice.

Treatment Options

Where there are significant concerns about a child's development, formal developmental testing and management can be carried out. This will usually be conducted in a specialist clinic setting and may involve a multidisciplinary team of professionals including Paediatricians, Speech Pathologists, Physiotherapists, Psychologists, Audiologists, Ophthalmologists and Occupational Therapists.

Unlike screening assessments which simply determine whether or not a developmental problem is likely or not, formal developmental testing not only determines if there is a problem, but also characterises the nature of the problem. It not only provides parents with an understanding of their child's strengths and weaknesses, but also allows for the planning of strategies to best manage a child's problem in the clinic, at home and at school. In the end, it gives a child the best chance of optimising his or her future development.

Notes

This article was written by Dr Ken Pang, Paediatric Registrar at Royal Children's Hospital in Melbourne, Victoria.