4 Child development
Introduction
Assessing an individual child’s development depends on:
• How that child is developing over time
• How that child’s development compares with other normally developing children of the same age.
Taking a history
The history can give a picture of a child that cannot always be obtained from observation so it is important to allocate sufficient time. It is a good idea to have a format so that you can make sure that important details are not missed. This is covered in Chapter 1. Particular areas of importance when considering a developmental disorder are detailed below.
1. What are the parents’ concerns?
2. The birth history; where, how, gestational age and birth weight are important details. Did the baby require neonatal intensive care? Has anyone expressed concern about the baby?
3. Social history and family tree; include a history of the parents’ educational attainment and developmental concerns about other family members.
4. Find out if the child attends a playgroup or nursery; they may be with a child minder or family member for much of the day. Do they go to special groups and activities?
The developmental milestones are best asked about in a systematic way:
• Gross motor skills. Most parents can provide accurate information about the age of their child when they sat and walked. The Personal Child Health Record (‘red book’) is also a useful source of information
• Fine motor skills. Many parents find it difficult to remember dates when these milestones were achieved but are able to describe what their child can do now
• Speech and hearing. The results of hearing tests should be in the Personal Child Health Record. Most parents will remember when their child said their first word. They may recall that a professional expressed concern or told them that their child’s language development was normal. Health visitors, nursery nurses and pre-school staff are very astute in detecting delay in communication skills
• Play and social skills. It is difficult to remember the fine detail of these rapidly evolving abilities and often an accurate picture of current skills is the most useful information. Ask about whether the children play with, or alongside, others. Are they very shy? Do they have difficulty in separating from a parent or carer? What do they like to play with? Is there imaginative play? Do they enjoy looking at books? Is there pointing, copying and anticipation?
The motor skills
Babies develop motor skills if:
• They have a normal central nervous system
• They have the motivation to practise new skills
• They have the opportunity to practise new skills.
• Children who are visually impaired may lack confidence to walk independently (as in Case 4.1). They cannot see a really interesting toy so they may be less motivated to go in search of it.
