)

What is Child Development?

 Development is the process that
 Turns babies into adults
 Has stages
 Begins at conception
 Ends at death
 Child Development is
 The scientific study of children from
conception to adolescence
What Are the Factors that Influence the
Growth and Development of Children?

 Heredity
 Genes
○ Hair color and
other body
features
What Are the Factors that Influence the
Growth and Development of Children?
 Environment
 Conditions
 Experiences

 In the early years

this is primarily
the family.
 What is Environment?

1. List ten examples of important

environment factors that can affect
children.
Effects of Poverty
 What does a child need in his
or her environment to
develop well? What does it
cost?
What Are the Factors that Influence the
Growth and Development of Children?
 Heredity and
Environment
COMBINED!
 Your height is
influenced by your
diet (environment)
and your genes
(heredity)
Fulanah and Fulan
 Fulanah, age four, and Fulan, age two, are brother and
sister. Fulanah has black hair, dark skin, and deep brown
eyes. She is quiet and dependable, talking only when
necessary. When her parents leave her at the child care
center, she is content to play quietly. She prefers to play
alone, with dolls or puzzles, but often watches the other
children. Fulan has brown hair, fair skin, and light brown
eyes. He prefers playing with tractors, trucks, and blocks
with other children. He is talkative and becomes bored
when he plays alone. List some reasons for the
differences in these children.

List several heredity reasons and several environment

reasons for their differences.
Our Responsibility – To provide
the best environment we can.
Contents :
 Definition
 Prevalence
 Classification
 Causes
 Clinical Evaluation
 Investigation
 Management
Definition
Mental Retardation is defined statistically
as tested cognitive performance that is
two standard deviation below the mean
of the general population ( roughly
below the 3rd percentile )
The Classical definition comprises 3
components :
1- subaverage intellectual function .
2- that result from an injury , disease or
abnormality before the age of 18 years .
3- resulting in impaired ability to adapt to
the environment .
Prevalence :
Mental retardation is present in about 2 to
3% of the population.
AAMR Classification Scheme
IQ classification:
I.Q.(intelligence quotient) is 100; normal ranges from 90 to 110

1-Border line { IQ 70-80 }

2-mild MR { IQ 55-70 }
3-moderate MR{ IQ 40-55 }
4-sever MR { IQ 25-40 }
5-profound MR { IQ below 25 }
Etiology
 Unknown “ 30-40 % “
 Genetic “ 5% “
 Early embryonic ( prenatal ) “ 30% “
 Prematurity , IUGR (perinatal) “ 10 % “
 Acquired medical condition (trauma ,
infection ..) “ 5% “
 Environment “ 5-20% “
Etiology classification :
 Prenatal
 Perinatal
 Postnatal
Prenatal causes :

»Genetic Disorders :
Fragile X syndrome FXS :most common cause .
Klinefelter syndrome :male with extra x chromosome 47,XXY
Down syndrome :
Meabolic disorders: PKU, Tay-sachs, Galactosemia
Skin disorders : neurofibromatosis and Tubererous sclerosis .
Prader-Willi Syndrom :
Endocrine : hypothyroidism
Fragile X syndrome (FXS)
 Is the commonest cause of MR.
 The incidence has been estimated at
approximately 1 in 1,500 males and 1 in
2,500 females.
 Mutation of a gene on the long arm of the X
chromosome is responsible for FXS and
involves instability of trinucleotide repeat
sequence .
 DNA-analysis of the FMR-I gene is the best
way to diagnose which is usually done on
lymphocytes.
Fragile X syndrome (FXS)cont..

 C/P: { phenotype }
 Large ears , Large testes (testicular
volume>30 ml in adults) , Plantar crease ,
Hyperextensible joints , Simian crease,
 Broad forehead, Increased hand width,
Increased hand length , Elongated face, High
arched palate ,
 Mitral valve prolapse , Hypotonia , Hernia,
Double jointed thumbs , Scoliosis and Flat
feet
Fragile X syndrome (FXS)cont..
 C/P: {NEUROCOGNITIVE }
 Mental retardation , Hyperactivity ,
Attentional problems , Language delays
, Hand flapping , Hand biting , Irritability ,
Perseveration , Excessive temper
tantrums Gaze avoidance , Sensory
aversion , Self-stimulatory behavior and
Autism
»Congenital Factors :
Maternal : Rubella , congent. Syphilis & Rh incompitability
Toxins : drugs , fetal alcohol syndrom ..
Perinatal Causes :
 Low Bwt : premature , teen pregnancy , poor nutrition ..
21 % with MR

Birth Anoxia : breech presentation , knotted umbilical cord.

Postnatal Causes :
Child abuse and neglect :
Traumatic brain injury :
Infection : meningitis and encephalitis
Nutritional deficiencies :
Cultural and familial :
Clinical Evaluation
 Complete History
 Examination
History
»complete and detailed history«
complete systemic review
surgical history : trauma , accidents
medical illnesses : hospitalization , general heath
pregnancy history : maternal age , parity , infections..
birth : type , wt . GA ,complications , apgar score
Postnatal : incubator , ventilator , disease ..
History (cont.)
drugs: mother and child
developmental Hx : mile stones , loss it , speech ..
educational Hx : schooling , IQ tests
behavioral Hx : skills , attention , activity
family Hx : inherited ds ..
social Hx :
Examination
»complete and detailed examination«
• Growth parameters :
• Dysmorphic features :
• Other system and skin exam :
• IQ tests :
• Developmental testing :
Investigations
»» there is no specific investigation for MR but
good hx and physical examination guide us
toward the proper one ««
 DNA analysis: chromosomes
 FISH probes: Prader-willi,wiliams,cri du chat syndrom
 Metabolic labs:plasma a.a. , urine organic a. ,TFT , ck
 Imaging : brain MRI , CT , skeleton films
 Psychological Assesment:
 Electrophysiology : EEG , auditory & visual evoked potentials
When to do the investigations?
 Cytogenetic studies if:
Microcephaly
Multiple (even minor) somatic anomalies
Family history of mental retardation
Family history of fetal loss
IQ <50
Skin pigment anomalies (mosaicism)
Suspected contiguous gene syndromes
(e.g., Prader-Willi, Angelman, Smith-
Magenis )
 Metabolic studies if :
Episodic vomiting or lethargy
Poor growth
Seizures
Unusual body odors
Somatic evidence of storage disease
Loss or plateau of developmental skills
Movement disorder (choreoathetosis, dystonia, ataxia)
Sensory loss (especially retinal abnormality)
Acquired cutaneous disorders

 MRI of the brain if :

Cerebral palsy or motor asymmetry
Abnormal head size or shape
Craniofacial malformation
Loss or plateau of developmental skills
Multiple somatic anomalies
Neurocutaneous findings
Seizures
IQ <50
Management of MR

»» there is no specific Rx for MR ««

»General rules :
-Identify the cause then initiate a
comprehensive plan
-Special educator , Language , behavioral and
occupational therapists
-Special school programs
-Community services