Child Development

Child Development

1. Domains of Development

   • Motor
     • Physical growth is important for normal motor development
       • Infant motor control can be limited by physical development
       • Requires CNS and musculo-skeletal maturation
     • Two areas to motor control
       • Large, gross motor control
       • Small, fine motor control
     • Relationship to vision
       • Visual Spatial Skills
         • Safe efficient movement through space
       • Visual Motor Skills (Hand-Eye Coordination)
         • Handwriting, Sports, Musical Instruments
   • Cognitive (Piaget's theory of cognitive development)
     • Sensorimotor (0-2years): If a child is not interacting with an object it does not exist "out of sight, out of mind"
     • Pre-operational (2-7 years): learn concepts of space, time and conservation
     • Concrete Operational (7-11 years): logical thinking, gain ability to see through perspective other than own
     • Formal operational (from 12years): abstract thought
     • Relationship to Vision
       • Vision provides sensory and perceptual input necessary for cognitive development
   • Language
     • Vision underlies second language code, reading and writing
   • Emotional
     • Relationship to vision
       • Tics can develop at 6-7 years, caused by anxiety. Common PC, will disappear if ignored

2. Visual Development

   • Eye Movements
     • Fixation
       • Faces: at birth objects: at 3 months
     • Conjugate eye movements
       • Saccades
         • Horizontal at birth Vertical at 3 months
       • Smooth Pursuits
         • Horizontal at birth Vertical at 3 months
       • OKN and VOR
         • present at birth
     • Near triad
       • Pupil: at birth
       • Accommodation: 3-4 months
       • Vergence: 3 months Fusional Vergence: 6 months
   • Refractive error development
     • Emmetropisation
       • Newborns: +2.00D 6-8years: +1.00D
     • Astigmatsim
       • Reduces in first 5 years even if corrected
   • Visual Function
     • Visual Acuity
       • at birth: 6/180 3 mon: 6/60 12 mon: 6/15 4-5 yrs: 6/6
       • Difference in acuities may be more important
     • Fusion
       • Develops at 3 months
     • Stereopsis
       • develops 4-7 months

3. What is development?

   • Physical, cognitive and psycho-social changes that occur from conception to adulthood
   • Normal Development: typical changes that are shared by almost all children over time
   • Development of most characteristics occur in a predictable sequence, but rate of development is unique to each child
   • Global and domain specific development
     • Allows for delay in general development or in specific skills

4. Hereditary vs Environmental

   • Hereditary: sets limits and determines developmental framework
   • Environmental:provides the setting which allows or does not allow development to reach full potential
   • Mixture of both

5. Overall

   • Understanding what is expected and what isn't can help appropriately manage young patients
   • Approach varies with age, also among same chronological age