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Indian Pediatr 2011;48: 679-680

Growth Monitoring, Developmental Assessment and Autism Modules

T U Sukumaran

National IAP President, 2011 and Professor of Pediatrics, PIMS, Thiruvalla, Kerala.

Correspondence to: Sreeshylam, Ettumanoor P.O., Kottayam 686631, Kerala.

Email: tusukumaran@gmail.com


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.


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