Growth and Developmental Tasks by Age - Developmental Assessment

Knowledge of human growth parameters and normal developmental landmarks is critical to the assessment of each age group. Growth is defined as changes in the values given certain measurements of maturity; where as development may encompass other aspects of differentiation of form or function, including those emotional or social changes preeminently shaped by interaction with the environment.

Serial measurements can indicate the normal or abnormal dynamics of the child’s growth. One key growth measurement important to the neurological assessment of the child is the head circumference. The measurement is taken around the most prominent frontal and occipital bones which offer the maximal circumference. How rapidly the head circumference accelerates or decelerates away from the percentile curve can determine whether the underlying cause of the growth change is more benign or serious. An example of a benign finding is the presence of extra-axial fluid collections of infancy, which often present with an accelerating head circumference. Generally, the infant with this finding is observed over time, but no intervention is warranted. On the other hand, an accelerating head circumference can also be a sign of increasing intracranial pressure in uncompensated hydrocephalus, which would require immediate evaluation and treatment.

Development is the essential distinguishing feature of pediatric nursing. Normal development is a function of the integrity and maturation of the nervous system. Only with a working knowledge of agerelated developmental standards can the examiner be sensitive to the deviations that indicate slight or early impairment of development and an abnormal neurological assessment. An abnormality in development from birth suggests an intrauterine or perinatal cause. Slowing of the rate of acquisition of skills later in infancy or childhood may imply an acquired abnormality of the nervous system. A loss of skills (regression) over time strongly suggests an underlying degenerative disease of the central nervous system.

Voluntary motor skills generally develop in a cephalocaudal and proximodistal progression, as it parallels the process of myelination. First the head, then the trunk, arms, hands, pelvis, legs, bowel, and bladder are brought under voluntary control. Early in life, motor activity is largely reflexive, and generalized movements predominate. Patterns emerge from the general to the specific; for example, a newborn’s totalbody response to a stimulus is contrasted with the older child, who responds through simply a smile or words. So, as the neuromuscular system matures, movement gradually becomes more purposeful and coordinated. The sequence of development is the same for all children, but the rate of development varies from child to child.

Finally, also important to a complete neurological exam is an assessment of the child’s cognitive and emotional development. These abilities impact directly on expectations of the child’s behavioral, social, and functional capabilities. The younger the child, the more developmental history is needed from the parents. Accurate identification of the child’s mastery of cognitive and emotional developmental milestones, as it relates to chronological age, is necessary for a comprehensive neurological assessment.