Infant Growth and Development

Hussam Al Halabi
Important Points
• Infancy is defined as the period from birth till 2 years of life: “infants” in Latin is unable to speak
• Infants undergo an orderly and predictable sequence of neurodevelopmental and physical growth
• Intrinsic and extrinsic influences exist
Important Points
• Developmental milestones provide a systematic approach by which to observe the progress of an infant and child over time
• Each skill is built on achievement of earlier skills, skills are rarely skipped
• Each domain must be assessed during the context of routine health supervision visits
Important Points
• Generalizations about development cannot be based on the assessment of skills in a single domain
• Delays in one domain may impair development in another domain
• A deficit in one domain may compromise assessment of skills in another domain
• Understanding normal development and acceptable variations is essential.
Nurture vs. Nature
• The sensitive period: a particular stage of development when learning a particular skill is easier than at other times
• Practice and development: an essential factor in development is maturation of the central nervous system
• Nutrition, love, security and opportunity to practice, ? affect IQ
Neurodevelopmental rules
• Responses to stimuli proceed from generalized reflexes to entire body responses
• Development proceeds from cephalic to caudal and proximal to distal
• Development progression is from dependent to independent
Physical Growth and Development
• Red flags in physical growth
– Large and small head size
– Below or above average size
– Dysmorphism
Tools
• History
• Physical examination
• Denver developmental chart
• Specialized developmental testing tools
History
• History
– Prenatal and perinatal hx…preterm delivery
– Environmental history
– Relevant illnesses-malnutrition
– Rate of development
– Past achievements

Developmental history
• Simple language
• Whether skill developed, when, how often
• Be precise: “smiling”, “talking”, “sitting”, etc
• Assess reliability of the history
Physical examination
• Primitive reflexes
• Righting reflexes
• Protective reflexes
• Neurological examination
• Developmental testing
Primitive Reflexes
• Moro reflex: gone by 3 months
• Asymmetrical tonic neck reflex, disappears by 3-4 months
• Symmetrical tonic neck reflex, gone with crawling
• Grasp reflexes
• Oral reflexes
Righting/Postural Reflexes
• Head righting
• Balancing reflex
• Parachute reflex


Gross Motor Development
• Consider quality of movement
• Red flags in motor development:
– Persistent fisting beyond 3 months of age
– Spontaneous postures: frog legs, scissoring
– Delays in postural reactions, persistent primitive reflexes
– Abnormal movement patterns
– Hand dominance prior to 18 months
Fine Motor Development
• Highlight is attainment of pincer grasp in first year
• In the second year infants move from learning to manipulate, to manipulating to learn
Language Development
• Prespeech period: 0-10 months
• Naming period: 10-18 months
• Word combination period: 18-24 months
• Language vs. speech: expressive speech is slower than receptive skills.

The End