It is my pleasure and privilege to present a new module on Growth
monitoring in children, Developmental delay in children and Autism
in children, developed by Growth, Development and Behavioral
Pediatrics Chapter of IAP. The purpose of the modules is to set some
nationally acceptable guidelines for the general pediatrician. A
consensus was reached after several meetings at the national level
by a group of specialist, which was further reviewed by an advisory
committee and finally endorsed by central IAP. Each module is
divided in to different sessions.
Growth Monitoring
Growth is an optional nutritional indicator in
children. Growth monitoring is a cheap effective way to identify
children who require extra care. Growth monitoring is a screening
tool to diagnose nutritional, chronic systemic and endocrine
diseases at an early stage. This ensures early management and
optimal outcome.
Growth monitoring module has 3 sessions.
Session 1: Growth assessment, Anthropometric
measures, Assessment of puberty and practical session. By the end of
this session a participant should know definition of growth
monitoring, anthropometric measures taken to assess growth of a
child, the equipment required to take these measurements, the
correct technique of recording measurements, and pitfalls in
measurements recording frequency.
Session 2: Includes interpretation of
anthropometric data, reference standards, concept of centiles,
score, SD, BMI and practical exercise on interpretation. By the end
of this session a participant should be familiar with reference
standards and their presentation: tables and charts, concept of
centiles, Z score, SD, various types of charts used for growth
assessment, plotting data on charts. He should be able to interpret
anthropometric measures recorded to understand growth and
nutritional status of the child.
Session 3: Interpretation of growth charts
that includes prediction of adult height, calculation of genetic
potential, understanding the significance of bone age, understanding
growth failure at various ages, and practical session on
interpretation of growth charts. By the end of this session the
participants would be able to predict adult height based on current
growth, calculate genetic potential and compare whether a child’s
growth is commensurate with it, understand the significance of bone
age, interpret growth patterns of individual cases and differentiate
between various normal and pathological growth patterns.
Developmental Delay
A developmental delay is any significant lag in a
child’s physical, cognitive, behavioral, emotional or social
development, in comparison with norms for the age and sex. Global
delay means where two or more areas of development are delayed as
per the specified norms for the child’s age and sex. Where a
particular area of development shows significant lag, it is termed
as isolated delay. Early intervention means finding the specific
ways to help a child become as functional as possible in some
situations, the therapy a child receives at an early age enables
that child to reach developmental milestones on target or close to
target. Developmental delay in children module has 5 sessions:
Session 1: Introduction, definition,
incidence, principles of development, factors causing developmental
delay. The objectives of the first session are: to identify presence
and pattern of developmental delay and to understand the
co-morbidities associated with developmental delay.
Session 2: Approach to developmental delay:
Objectives of this session are to describe an approach to
developmental delay, to identify the delay by history and
neurological examination and to identify the red flags signs in
delay in various domains.
Session 3: Developmental assessment and
tools: Objectives of this session are : to define who should undergo
developmental screening, to determine the appropriate schedule for
screening, to identify tools for developmental screening, to
sensitize the pediatrician for appropriate referrals and
intervention.
Session 4: Early Intervention: Objectives of
this session are to understand the principles and rationale for
early intervention, to understand the concept of developmental
surveillance, to appreciate the role of multidisciplinary team in
early intervention program, and to empower parents for home-based
program.
Session 5: Group Study: Case Discussions are
planned in this session where the application of the above screening
tools can be practiced.
Autism in children
Autism is a complex lifelong developmental
disorder that occurs in the first three years of life. There is
disturbance in development in three main areas: communication (both
verbal and nonverbal), social understanding, and learning style and
thinking process (strong visual learners but difficulties in
imagination and abstract thinking). All individuals with autism have
difficulties in three main areas mentioned above (described as triad
of impairment) but these areas of impairment affects each individual
in different ways, therefore each individual with autism is
different from each other. There are no specific investigations for
autism. Investigations should be directed towards associated medical
disorder based on clinical suspicion only. The module on Autism is
also divided in to 3 Sessions.
Session 1: It consists of a pretest
questionnaire, background information on autism, screening and early
identification of autism and diagnosing autism. By the end of this
session a participant should know the following: What are the aims
and objectives? Why a separate module for autism? What is autism?
What is the prevalence of autism? How do the children present? And,
understanding the term - Autism Spectrum Disorder. The objective of
this session is to sensitize as to when to suspect?
Session 2: This is an interactive session
consisting of case discussions. The participants may be divided in
to 4 groups, one case for each group. The groups will then present
the answers to the questions provided at the end of each case. The
discussion will be conducted by the presenter and facilitators. The
case discussions will be followed by a presentation of medical
management of autism in children. The objective of this session is
to help participants in identification of cases in the community and
provide guidelines for doctors regarding medical management of
autism.
Session 3: This is again an interactive
session consisting of case discussions. This can be done in the form
of role play. The objective of this session is to develop counseling
skills. The national launch of the modules was held at Peerless
Hospital, Kolkata. The National launching will be followed by 5
similar workshops in 5 zones of IAP.
I profoundly thank Dr Parida, Chairperson, Dr
Jaydeb Ray, the Secretary and all EBM of Growth, Development and
Behavioral Pediatrics Chapter of IAP for preparing this module. I
also acknowledge the help of Dr Jaydeb Ray for preparation of this
write up.