1. Pediatric Nutrition Child Development 2013 Nia Handout

7/24/2019 1. Pediatric Nutrition Child Development 2013 Nia Handout

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N I A N W I R AW AN

P ED I AT R I C N U T R I T I ON

CHILD DEVELOPMENTDefinition

Apsychophysicalchange resulting from theprocess of maturation of psychological and physicalfunctions, supported by the environment andlearning process (Satoto, 1990).

Involves the process that are biologically

programmed within the organism and theprocesses in which organism is changed ortransformed to the interaction with theenvironment(Chopra, et al.2004)

Three aspects of children development: mentaldevelopment, psychomotor and behaviordevelopment (Bayley, 1969).

MENTAL DEVELOPMENT

Mental development concerns the emergence of thinkingcapacity in the individual, how an infant perceives, thinkand gains an understandingof the world.

Mental/cognitive development refers to the process ofknowing or a process by which knowledge is gained fromperceptions or ideas.

It encompasses the phenomenon of sensation , perception,imagination, retention, recall, problem solving, reasoningand thinking.

It involves our reception of raw sensoryinformation, elaboration, storage, recovery and its usagein various field.

We can see how the child develops andchanges from one age to the next

Exploration of surroundingsand thequestions regarding thewhy and how ofthings result in an increasing store ofinformation

MENTAL DEVELOPMENT


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Piaget's theory is focused on theprocesses of cognitive development andstates that the child is born with aninnate curiosity to interact with

and understand his/herenvironment.It is through interaction with others

that the child actively constructshis/her development

MENTAL DEVELOPMENT

Motor/psychomotor development means thedevelopment of control overbodilymovementsthrough the coordinatedactivities of nerve centers, the nerves and

muscles Infants motor development is dependent

upon their physical growthlike walking,climbing, crawling, etc

During the first two years of life, infantsgrow and develop in many ways.

MOTOR DEVELOPMENT

Large motor development (Gross motor):

allows infants to have more control overactionsthat help them move around theirenvironment

Small motor development (Fine Motor):

gives them more control overmovementsthat allow them to reach,grasp, and handle objects.

The sequence is similar; however, the rate

are varies by individual.

MOTOR DEVELOPMENT

Temperament is the set ofgenetically determined traits thatorganize the child's approach tothe world.

They are instrumental in thedevelopment of the child'sdistinct personality and behavior.

This behavioral style appearsvery early in lifewithin thefirst two months after birthandundergoes development, centeredon features such as intensity,activity, persistence, or

emotionality.

BEHAVIORAL DEVELOPMENT


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F CTORS FFECTING CHILD DEVELOPMENT

Child development depend on many factors which encourage andinhibit the childs development

The development not only influenced by childshealth andnutritional statusbut also by the kind of interactions

beginning inutero

an infant/child develops with caregivers intheir environment

The type of environmentprovided to children at tender age isvery important for their total development

Studies in human subjects and animals have shown that poornutritionduring gestation may not only impair fetal g rowth, butmay also have an impact on development during this period

FACTORS AFFECTING CHILDDEVELOPMENT

Biological factorssuch as congenitalanomalies, extreme prematurity andperinatal hypoxia can be profound adverseeffect on child development but their

attributable risk is small compared withthe effect of more pervasiveenvironmental risk factors

In particular home environment is apowerful determinant to cognitivedevelopment(Duncan et al 1994 in )

In addition psychosocial stimulationintervention to prevent delayed childdevelopment in disadvantaged communitieshave been successful in both industrializedand developing countries at least in shortterm

Long lasting benefits have been reported insome studies (Grantham-McGregor et al.

1997 in)

FACTORS AFFECTING CHILDDEVELOPMENT

Cognitive development of the children relate tosome factors such as nutritional status andpsychosocial care

Psychosocial careearly in life is associatedwith later cognitive or emotional developmentof the child and also with more favorablenutritional and growth outcomes, even withinpopulations with nutritional and health risks(Engle et al., 1995).


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Psychosocial Care

Child survival, growth and developmentdepend not only on food intakebut also oncare behaviorsas shown by the extendedUNICEF model of care (Begin F., Frongillo and Delisle 1999).

Psychosocial care is a part of the carepracticesset that influence both growthand development of children consists ofsocial, emotional, and cognitive interactions

between caregivers and children.

Three major kinds of practices

Responsiveness to developmentalmilestone and cues.

Attention, affection and involvement.

Encouragement of autonomy, exploration,and learning.

Much research has illustrated theimportance of attachment between child andcaregiver, a unique and enduring bond, andof psychosocial care in general for allaspects of a childs development.

STEPS OF DEVELOPMENT

Critical time in brain development: Conception to schoolage

Steps: Fetusproduces brain cells.

Newbornneurons are not connected together. Human experienceis a crucial determinant of the manner and degree of connectedness.

Influencing factors:

Wide range of stimuli in the environment of the newborn:visual, verbal, emotional, physical, touch, smell and taste

Biological: pre-programmed critical period in braindevelopment during the specific areas of the brain turn on andbecome ready to receive environment stimuli

During the first month of life, breastfeedingplays an important role not only in providing

nutrients for healthier physical, brain, andprotective of several type of diarrhea disease

but also encourage important attachment

processes with the caregiver providing childrenwith feelings of security social development

Un-stimulating inearly yearsemotionally andphysicallyunsupportiveenvironmentaffect braindevelopmentinadverse way and leadto cognitive, socialand behavioraldelays

A key requisite foroptimal childdevelopment issecureattachment to atrusted caregiverwith consistent

caring, support andaffection early in life

A secure attachment


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Stunted children at birth, if given nutritionand stimulation at birth can approach theperformance of control children after24 months (Grantham-McGregor et.al)

Compatible with hypothesis that epigeneticeffects initiated during early developmentcan be prevented or reverse by goodnutrition and stimulation

HOW TO MEASURE

(Using HOME inventory Questionnaire)

Perkembangan anak secara umum

(Developmental scales)

Perkembangan Tingkat intelektual umum

Developmental scales

Brazelton Neonatal Behavioral scale-BNBS) Tests an infant's neurological development, interactive

behavior, and responsiveness to the examiner, and needfor stimulation.

Applicable for newborn babies

Reaction to 21 tasks

Score range 0-9

Score 5 is considered as Normal

Differentiate normal babies and babies with brainabnormality


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Gesell Developmental Schedules Test for fine and gross motor skills, language behavior,

adaptive behavior including eye-hand coordination,imitation, object recovery, personal-social behavior suchas reaction to persons, initiative, independence, and playresponse.

4 weeks 60 months Includes 3 aspects: spontaneously behavior observation,

interaction of child with objects, interview for childdevelopment history

Score classified into: normal, retarded (terhambat) andaccelerated (maju) based on age


Diagnostik perkembangan fungsi Munchen

0-1 tahun

Denver Developmental Screening Test: Used to identify problems or delays that should be more

carefully evaluated. Measures four types of development: personal/social,

fine-motor/adaptive, language, and gross motor skills.

Bayley Scales of Infant development

Perkembangan Tingkat intelektual umum

Uji Stanford-Binet

Skala Inteligens Wechsler

Skala Piaget

The BSID were first published by Nancy Bayley in TheBayley Scales of Infant Development(1969), secondedition in 1993, 3rdedition?

The scales have been used extensively worldwide toassess the development of infants

The BSID are known to have high reliability andvalidity. The mental and motor scales have highcorrelation coefficients (.83 and .77 respectively) fortest-retest reliability.

The BSID are used to describe the currentdevelopmental functioningof infants and to assistin diagnosis and treatment planningfor infantswith developmental delays or disabilities

The Bayley Scales of Infant Development (BSID) usedfor of infants from one to 42 months of age.


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The test is intended to measure a child's level ofdevelopment in three domains: cognitive, motor, andbehavioral.

BSID are also used in cases in which there aresignificant delays in acquiring certain skills orperforming key activities in order to qualify a child for

special interventions. Specifically, they are also used to dothe following: identify children who are developmentally delayed chart a child's progress after the initiation of an

intervention program teach parents about their infant's development conduct research in developmental psychology

Description of BSID

It is administered by examiners who are experiencedclinicians specifically trained in BSID test procedures.

The examiner presents a series of test materials to the childand observes the child's responses and behaviors.

The mental and motor scales indicate the childs currentlevel of cognitive, language, personal-social, and fine and

gross motor development. The BRS assessed the childs behavior during testing

situation, which facilitates interpretation of the mental andmotor scales.

Description of BSID

Items of BRS were developed to measuredimensions of a childs behavior that are relevantto an assessment setting.

BRS has a 5-point scoring system for each itemwith descriptors specific to the behavior being rate.Placing all items on a 5-point scale providingdescriptors should increase the reliability of thescale and facilitate scoring and interpretation.

The test is given on an individual basis and takes4560 minutes to complete.

Mental scale

This part of the evaluation, which yields a scorecalled the mental development index

Evaluates several types of abilities:sensory/perceptual acuities, discriminations, andresponse; acquisition of object constancy; memorylearning and problem solving; vocalization and

beginning of verbal communication; basis ofabstract thinking; habituation; mental mapping;complex language; and mathematical conceptformation.


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Motor Scale

Assesses the degree of body control, large musclecoordination, finer manipulatory skills of thehands and fingers, dynamic movement, posturalimitation, and the ability to recognize objects bysense of touch (stereognosis).

This assesses control of the gross and fine musclegroups. This includes movements associated with rolling,

crawling and creeping, sitting, standing, walking,running and jumping.

This scale also tests fine motor manipulationsinvolved in apprehension, adaptive use of writingimplements, and imitation of hand movements.

Behavior rating scale

This scale provides information that can be used tosupplement information gained from the mental and motorscales.

The BRS assesses qualitative aspects of the child test-takingbehavior. This scale allows the examiner to rate the childsattention, orientation/engagement towards the tasks,

examiner and caregiver, emotional regulation, and qualityof movement. This 30-item scale rates the child's relevant behaviors and

measures attention/arousal, orientation/engagement,emotional regulation, and motor quality.

Classification of developmentindex

Score range Classification

115 and above Accelerated performance

85-114 Within normal limits

70-84 Mildly delayed performance

69 and below Significantly delayed performance

Precautions

BSID data reflect the U.S. population in terms of race,ethnicity, infant gender, education level of parents, anddemographic location of the infant.

The BSID was standardized on 1,700 infants, toddlers, andpreschoolers between one and 42 months of age.

Norms were established using samples that did not includedisabled, premature, and other at-risk children.

Corrected scores are sometimes used to evaluate thesegroups, but their use remains controversial.

The BSID has poor predictive value, unless the scores arevery low. It is considered a good screening device foridentifying children in need of early intervention.


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Parental concerns

Parental involvement is IMPORTANT Because parents are more familiar with their child's

behavior, their assessment may indeed be more indicativeof the child's developmental status than an assessment thatis based on limited observation in an unfamiliar clinicalsetting.

Improves their knowledge of child development issues andtheir subsequent participation in required interventionprograms, if any.

In cases of developmental problems, parents should bear inmind that the scoring and interpretation of the test resultsis a highly technical matter that requires years of trainingand experience.

Preparation

Examiner explains to the parents what will happen duringthe test procedure.

Allow the examiner to establish a focused rapport with thechild once the procedure has started and avoid divertingattention from the child to the parents during the test.

The parents are also asked not to talk to the child duringthe BSID test to avoid skewing results.

Risks

There are no risks associated with the BSID test.

Assessed by doing observation and interview measures ofcare and the HOME scale, which has been widely usedboth in United States and in third world setting(withappropriate adaptation)

Based on interviewing the caregiver at home as well asobserving the child with caregiver.

The information necessary to score the inventory can beobtained with about three main probes dealingrespectively with trips out of the home and visit into the home, toys that are available to the child, the way family arranges the daily routine, discipline.

It provides an overall score and sub scores on sixscales:Emotional and verbal responsively of caregiver

(11 items);avoidance of restriction and punishment

(acceptance) (8 items);organization of the physical and temporal

environment (6 items);provision of appropriate play materials (9 items); caregivers involvement with child (6 items); andopportunities for variety in daily stimulation (5

items) (Engle et al. 1993).


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All item on this inventory receive binaryscores-yes or no- and no attempt is made torate finger gradations. Overall score as wellas subscale score will be classified into threecategories, are as follows: low, medium,high.

In conducting HOME inventory, mother ormain caretaker should present together onthe interviewing/observation time.

Classification of HOME score

NoSubscale Low Medium High

1 Emotional and verbal

responsively of the mother

0-6 7-9 10-11

2 Acceptance of childs behavior 0-4 5-6 7-8

3 Organization of environment 0-3 4-5 64 Provision of play material 0-4 5-7 8-9

5 Parental involvement with the

child

0-2 3-4 5-6

6 Opportunities for variety in daily

stimulation

0-1 2-3 4-5

Total score 0-25 26-36 37-45

Instruction

Do the interview and observation towards mothertogether with her child

Do the observation for items, which are marked with O

Do the interview for items, which are marked with I

Place a plus (+) or minus (-) in the box alongside eachitem if the behavior is observed during the visit or if theparents report that the condition or events arecharacteristic of the home environment.

Documents

1. Pediatric Nutrition Child Development 2013 Nia Handout