Early Child Development and Risks

EARLY CHILD DEVELOPMENT
Neurology 5th Year 2022

Mrs M. Simpamba
INTRODUCTION
• Over 200 million children globally are not meeting their

developmental potential.
• In developing countries, majority of children younger than 5 years

are exposed to multiple risks.
• Examples of multiple risks include poverty, malnutrition, poor

health, and unstimulating home environments.
• These have adverse effects on the cognitive, motor, and social

emotional development.
• The early years of life are a period of maximal growth and
development of the human brain.
• The early years of life forms the foundation for the rest of the life
• It is therefore the best time for the prevention and amelioration of

problems that could cause developmental difficulties due to brain
damage.
• This period is extremely important in determining whether the

person will reach his or her full potential.
Early child development
• According to WHO (2020), Early childhood development refers
to:
- Cognitive, physical, language, motor, social and emotional
development between 0 - 8 years of age.
• Motor development consists of gross motor and fine motor.
• Child growth refers to child increasing in size

Areas of child development
• Gross motor: using large groups of muscles to sit, stand, walk, run, keeping balance,
and changing positions, etc.
• Fine motor: Fine motor skill include small muscles of the hand and tongue that are
used for writing or talking respectively.
• Language/communication: Speaking, using body language and gestures,

communicating, and understanding what others say.
• Cognitive/Thinking skills: including learning, understanding, problem-solving,

reasoning, and remembering.
• Social/emotional: Interacting with others, having relationships with family, friends,

and teachers, cooperating, and responding to the feelings of others.
Normal/Typical development
• As the child grows, he/she learns and acquires more refined skills in different
areas of development
• Children tend to acquire these skills in an orderly and predictable sequence

within certain age brackets known as “Trimesters”.
• This pattern of skill acquisition is often referred to as 'Normal or Typical

Development’.
• A set of functional skills or age-specific tasks that most children can do

within a certain age range are known as Developmental milestones.
Importance of knowledge of child development
• It is essential to compare the typical with the atypical
development
• To understand the children with developmental delay at all stages

of their development.
• To gain understanding of the prerequisites and components for

skill performance which are necessary for planning of treatment.
Principles of child development
1. Cephalic-caudal: From head downwards- Child first gains control
of the head, trunk, then arms and legs
2. Proximal distal: Development proceeds from center going

outwards
3. Maturation: Sequences of biological and behavioral changes in

children depends mainly on brain and spinal cord maturation.
4.Development occurs in predictable and orderly
sequences known as milestones
5. The sequence of development is the same, but the

rate of development is different for each child.
• Development in one area is influenced by other areas of
development
• E.g. Motor behaviour contributes to perceptual, visual,

language, emotional and social development.
• Development in all these areas in turn impacts on motor

development.
• While the sequence of development is the same for all

children, the rate of development is different for each child.
Factors influencing child development
• Development, usually occurs according to a typical
sequence, pattern, and timing.
• However, intrinsic (biological) and extrinsic (environmental)

factors modify the sequence, pattern and timing for
attainment of skills.
• This results in individual variations, making each child’s

developmental path unique
Examples of biological factors (Intrinsic factors)
 Inherited characteristics, e.g., cognitive potential and temperament
 Prenatal and perinatal history
 General health of the child including:
- Vision and hearing
- Central nervous system
- Nutrition
- Cognition, motivation, etc.

Examples of environmental factors
 Opportunities such as sensitive and supportive parenting and
education
 Cultural and child rearing practices
 Threats such as social and economic deprivation
 Experience and encouragement

What are the Unique features of human Development?
• Upright locomotion
• Communication via speech
• Precise manipulation
Motor development
• Motor development is a progression of increasingly complex stages
(milestones) through which infants achieve control over use of their
muscles.
• Important for control of upright posture, balance and mobility and

manipulation of objects for interaction with the environment.
• Motor development consists of acquisition of gross motor and fine

motor skills.
• Critical for a child to move independently and to interact with his or her
environment meaningfully and usefully.
• Reflexes are the first forms of human movement and they form the basis for
motor development.
• A newborn infant responds to his or her environment in an involuntary or

reflexive way through primitive or postural reflexes.
• The reflexes are generated in response to specific sensory stimuli
• Through reflex activity the infant learns about his body and the outside
world
Progression of Motor skills development
• From generalized stimulus based reflexes to specific, goal-
oriented, reactions.
• Purposeful movements become incorporated into activities of

daily life.
• From cephalic to caudal (from head to toe) and from proximal to

distal (from inside out).
NORMAL MOVEMENT
What are the qualities of normal movement?
• Effortless
• Fluent/ smooth and coordinated
• Efficient/ accurate
• Purposeful / functional
• Variety / choice
WHY IS MOVEMENT IMPORTANT
• It gives comfort
• Gives security and it enables self-exploration, reaching into

spaces.
• This contributes to development of perceptual skills.
• Perception is the integration of sensory impressions into

psychologically meaningful information
What enables us to have normal movement?
• Normal balanced tone- perfect balance between

stability and movement
• Normal range of motion
• Intact CNS
SENSORY-MOTOR EXPERIENCE
• We first learn the sensation of movement before
learning the actual movement.
• Many children with Cerebral Palsy have limited

movement experience
• They also lack sensory experience and/ or have

sensory deficits.
Relevance of sensory-Motor Experience to
treatment
• Children with CP needs to experience the sensation of
more normal movement to promote learning.
• E.g. Normalise tone and then facilitate more normal

movement, gradually reducing our assistance as the child
takes over.
• Treatment needs to be adjusted according to the ability of the

child to integrate sensory stimuli.
Motor development from 0 - 12 months
Why is this period of development important?
• It is a period of rapid motor development
• It is relevant to the child with developmental disabilities

(e.g. cerebral palsy).
Neonate (New-born)
Refers to first 4 weeks after birth
Characterized by :
• Physiological flexion,
• Random movements,
• Automatic standing and walking,
• Head and neck extension as the first component of anti-gravity control.

1st Trimester 0-3 months
By end of 3rd month, child:
• Will establish midline, head in midline
• Can move head away from midline and bring it back to midline. E.g,
independent head movement
• Brings hands to midline and to mouth
• In prone, head up in mid-line and takes weight on arms
• Has independent movements of knees, ankles and toes
• Has a firm grip
2nd Trimester. 4-6 months
By the end of this trimester, child will be;
• Getting hands to feet in supine

• Pushing on extended arms in prone
• Rolling
• Sitting alone when placed
3rd Trimester. 7-9months
• Sits independently
• Starts to crawl
• Begins to sequence movement and moves in and out of sitting
• Pulls to standing with support
• Increase fine motor abilities
4th Trimester. 10-12 months
By the end of this trimester, child;
• Cruises around furniture

• Develops balance in standing
• Problem solves new situation
• Learn a lot about his environment, what it can offer, how he can
manipulate it and what he can perceive from it
WHO windows of achievement of gross motor milestones
• Standards are based on six motor milestones being
achieved during the first two years of life among healthy
children growing up in different cultural settings.
• These standards consists of normal age ranges for the

attainment of gross motor milestones in health children.
WHO six gross motor milestones
1. Sitting without support: 3.8 – 9.2 months
2. Standing with assistance: 4.8 – 11.4 months
3. Hands-and-knees crawling: 5.2 – 13.5 months
4. Walking with assistance: 5.9 – 13.7 months
5. Standing alone: 6.9 – 16.9 months
6. Walking alone: 8.2 – 17.6 months
Average (mean) age for achieving each milestone
1. Sitting without support: 6 months (with 1.1 month standard deviation, SD)
2. Standing with assistance: 7.6 months (with 1.4 month SD)
3. Hands-and-knees crawling: 8.5 months (with 1.7 month SD)
4. Walking with assistance: 9.2 months (with 1.5 month SD)
5. Standing alone: 11 months (with 1.9 month SD)
6. Walking alone: 12.1 months (with 1.8 month SD)

Delayed motor development
• Developmental delay is a term used to describe a child who does not reach
developmental milestones at the expected age.
• Significant delays in early child development are a warning sign that something
may be wrong.
• Examples of such signs include inability to hold up the head securely by 3 months
• Inability to roll front to back and back to front by 6-8 months
• Inability to sit independently when placed in a sitting position by 8-10 months

Early abnormal signs and patterns of movement
• When only grasp hands if arm is pronated and head and trunk flexed.
• When only opens hand if head is thrown backwards and no isolated

movements of the fingers seen.
• Forearm always pronated and never supinated.
• Obligatory asymmetrical tonic neck reaction when the head is turned to one
side.
• Unable to get hands to mouth or midline
• Head always to one side

Specific signs of delayed motor development
By 3 months
• Difficulty lifting head in prone
• Stiff hand with little or no movement
• Keeps hands fisted
• In supine, pushes head backwards

By 6 months
• When placed in sitting, sits with round back
• Unable to lift head up due to poor head control
• Difficulties with bringing arms forward to reach out
• Stiffens legs or can’t take weight through legs when placed

in supported standing
By 9 months
• Uses one hand predominantly
• Sits with round back
• Poor use of arms in sitting
• Uses only one side of body to move

Development of Movement in a child with abnormal
postural tone
• Insufficient inhibition in the CNS
• Leading to difficult refraining from one response easily in favour of

another. E.g., a child in extensor pattern will have difficult taking hands
to mouth.
• Involuntary movements are attempted on a background of abnormal

postural tone.
• Therefore the child goes further in abnormal pattern

Movement patterns in children with Cerebral Palsy
• Mass response in total patterns of flexion or extension
• Movement initiated from one or two abnormal postural

sets.
• Movement patterns may lack variety, or be atypical
• Sensory-motor experience of normal movement is

missing
References
• https://www.cdc.gov/ncbddd/childdevelopment/facts.html
• Raine, S., Meadows, L. and Lynch-Ellerington, M. eds., 2013. Bobath

concept: theory and clinical practice in neurological rehabilitation.
John Wiley & Sons.
• World Health Organization, 2020. Improving early childhood

development: WHO guideline. World Health Organization.

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EARLY CHILD DEVELOPMENT

Neurology 5th Year 2022

• Over 200 million children globally are not meeting their

• In developing countries, majority of children younger than 5 years

• Examples of multiple risks include poverty, malnutrition, poor

• These have adverse effects on the cognitive, motor, and social

• It is therefore the best time for the prevention and amelioration of

• This period is extremely important in determining whether the

• Motor development consists of gross motor and fine motor.

• Child growth refers to child increasing in size

• Language/communication: Speaking, using body language and gestures,

• Cognitive/Thinking skills: including learning, understanding, problem-solving,

• Social/emotional: Interacting with others, having relationships with family, friends,

• Children tend to acquire these skills in an orderly and predictable sequence

• This pattern of skill acquisition is often referred to as 'Normal or Typical

• A set of functional skills or age-specific tasks that most children can do

• To understand the children with developmental delay at all stages

• To gain understanding of the prerequisites and components for

2. Proximal distal: Development proceeds from center going

3. Maturation: Sequences of biological and behavioral changes in

5. The sequence of development is the same, but the

• E.g. Motor behaviour contributes to perceptual, visual,

• Development in all these areas in turn impacts on motor

• While the sequence of development is the same for all

• However, intrinsic (biological) and extrinsic (environmental)

• This results in individual variations, making each child’s

 Inherited characteristics, e.g., cognitive potential and temperament

 Prenatal and perinatal history

 General health of the child including:

- Vision and hearing

- Central nervous system

- Cognition, motivation, etc.

 Cultural and child rearing practices

 Threats such as social and economic deprivation

 Experience and encouragement

• Communication via speech

• Important for control of upright posture, balance and mobility and

• Motor development consists of acquisition of gross motor and fine

• A newborn infant responds to his or her environment in an involuntary or

• The reflexes are generated in response to specific sensory stimuli

• Purposeful movements become incorporated into activities of

• From cephalic to caudal (from head to toe) and from proximal to

• Gives security and it enables self-exploration, reaching into

• This contributes to development of perceptual skills.

• Perception is the integration of sensory impressions into

• Normal balanced tone- perfect balance between

• Normal range of motion

• Many children with Cerebral Palsy have limited

• They also lack sensory experience and/ or have

• E.g. Normalise tone and then facilitate more normal

• Treatment needs to be adjusted according to the ability of the

Why is this period of development important?

• It is a period of rapid motor development

• It is relevant to the child with developmental disabilities

• Automatic standing and walking,

• Head and neck extension as the first component of anti-gravity control.

• Getting hands to feet in supine

• Cruises around furniture

• These standards consists of normal age ranges for the