Developmental History Research of a Child on a Specific Example

Introduction

Filling and analyzing the developmental history of a child, the main critical purpose of such analysis is the identification of any disorders and deviations of the development, at the earliest stage possible. Such identification can be seen as a function of primary and pediatric care. The significance of analyzing the developmental history can be seen through the fact that the identification of developmental disorders might be used to indicate the medical conditions or the complications causing the disorder, as well as to indicate the risks of behavior disorders. In that regard, the early diagnosis will allow the possibility of early interventions. Serving the purpose of establishing the developmental history, many questionnaires were developed, in order to assess the child’s early development in different areas.

Purpose of the paper

This paper provides an investigation of the developmental history, based on the case history of Billy, a four-year-old boy, whose development was traced through the answers to a developmental history questionnaire. The investigation will be addressed towards indicating possible areas of deficit, and the potential diseases associated with disorders and diseases. The questionnaire and the answers can be reviewed in Appendix A.

Developmental History

Billy Smith is a four-year-old boy who was brought by his parents to address the concerns over his development and problems with anger and aggression. An important factor in the development history was the fact that Billy was a premature baby, born on 36^th week of pregnancy. The fact of preterm pregnancy initially put the baby to a number of challenges such as underdevelopment of organs, risking for learning and developmental disabilities, including mental retardation (National Institutes of Health, 2009). Accordingly, the further analysis of the development stage characteristics showed concern in several other areas.

Disorders of motor functions

Spitting the food, specifically solid or semi-solid, might be an indication of Billy choking the food out, where the possible causes of such symptoms can be related to the disco-ordination of the muscles of swallowing-chewing. The inclination toward the disco-ordination of muscles can be seen through an indication in the developmental history of difficulties in riding a bike, and the clumsiness when catching and throwing a ball. In that regard, the disco-ordination of movements implies “mal-directed, mal-timed movement complicated by accessory, superadded movement” (Gesell, 2007). The latter can be related to disorders of motor functions, where the specific indications in the developmental history, matching the disorder, include poor performance in ball games, and activities requiring coordination such as riding a bicycle. Although such disorder has several known variations such as developmental coordination disorder, the clumsy child syndrome, and developmental dyspraxia, all of them share a common feature, which is the impairment of the development of motor coordination (Barker, 2004). The risk of ignoring such identification can be seen in the perception of the children to be intellectually dull, due to their inability to express their knowledge in written form. Other tests are required for confirmation of the disorder, which in addition to the development history include writing and drawing comparison tests, and psychological testing of the child’s verbal and non-verbal skills (Barker, 2004, p. 107).

Late Weaning

An important risk factor that can be extracted from Billy’s developmental history is the apparent indication of late weaning. The questionnaire reveals that Billy’s mother started weaning at the age of two. The consequences of late weaning are mostly related to the development of iron deficiency anemia, where a study of anemia among 4- to 17-month children revealed the importance of targeting anemia in the first year of life (Siegel, et al., 2006). Additionally, a study conducted in Ali and Zuberi (2003), examined the association of late weaning in 1-2 years old children with iron deficiency anemia, and found out that “late weaning was the most important predictor of iron deficiency anemia in 1–2 years of age” (N.S. & R.W., 2003). Assessing the consequences of anemia on the long term can be seen through the complications and the side effects, which might go unnoticed if the treatment was ignored. Several studies reported the association between anemia, poor mental performance, and abnormalities of behavior, all of which are complications that can be treated in earlier detection, while a severe iron deficiency can cause an irreversible neurological impairment (Chantry, Howard, & Auinger, 2007). Additionally, another factor that should be considered is the total disregard of breastfeeding, the benefits of which can be evident in the recommendations made in 2003 by the World Health Organization (WHO) to feed infants exclusively on breast milk until six months of age (Britton, McCormick, Renfrew, Wade, & King, 2007). The outcomes of breastfeeding can be seen in the reduction of a number of risk factors, where a systematic review of the literature on the effects of breastfeeding on short- and long-term infant health outcomes, found an association between breastfeeding and reducing the risk of “acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis” (Ip, et al., 2007).

Amentia

Another set of symptoms indicated in the developmental history can be indicative of abnormal neuro-motor signs. The symptoms are the excessiveness of crying and temper tantrums, whenever Billy is frustrated or there is much noise around him. The tantrums were mostly occurring through anger biting. Taking in consideration that such factors can be considered normal only during the period from 15 to 18 months, it can be seen that these symptoms have particular causes (Gesell, 2007). The possible causes include auditory defects, emotional factors, and retardation. Assuming that at the age of four auditory defects would have been detected by the parents, the combination of other factors included in the developmental history such as sleeping and feeding problems might be used to indicate retardation in development. Additionally, taking into consideration such elements in the developmental history as the delays in sitting and turning over, it can be stated that Billy might have the possibility of some forms of Amentia (Gesell, 2007). In that regard, the temper tantrums expressed by Billy should be analyzed in order to examine the reasons for the development of such behavior. Accordingly, Billy should be directed to a behavior analyst for further examination. The possibility of a medical condition causing pain should not be eliminated and thus, the conditions with no apparent physical manifestations should be considered.

Conclusion

It can be concluded that the evaluation of Billy’s developmental history indicates several areas of concern. The initial examination request was based on manifestations of anger and aggression. In addition to such factor, other areas of concern were indicated. These areas are related to developmental concerns which might have resulted from preterm birth. Additional factors, such as 2^nd hand smoking, to which exposure can be just as detrimental to a developing fetus as primary exposure (Baum, 2005), and late weaning, which was discussed in the paper, might have contributed to such developments. In that regard, a further individual examination might be required in order to assess the full picture of Billy’s functioning. At the present time, it would be recommended to examine Billy for iron deficit anemia as well as a physiological examination of Billy’s motor functions.

References

Barker, P. (2004). Basic child psychiatry (7th ed.). Oxford; Malden, Mass.: Blackwell Pub.

Baum, M. D. (2005). Second-hand smoke during pregnancy is risky. Medical News Today. 2009. Web.

Britton, C., McCormick, F., Renfrew, M., Wade, A., & King, S. (2007). Support for breastfeeding mothers. 2009. Web.

Chantry, C. J., Howard, C. R., & Auinger, P. (2007). Full Breastfeeding Duration and Risk for Iron Deficiency in U.S. Infants. Breastfeeding Medicine, 2(2).

Gesell, A. (2007). Developmental Diagnosis – Normal and Abnormal Child Development – Clinical Methods and Pediatric Applications (2nd ed.): READ BOOKS.

Ip, S., Chung, M., Raman, G., Chew, P., Magula, N., DeVine, D., et al. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Web.

National Institutes of Health (2009). Preterm Labor and Birth. National Institute of Child Health and Human Development. Web.

N.S., A., & R.W., Z. (2003). Late weaning: the most significant risk factor in the development of iron deficiency anemia at 1-2 years of age. Journal of Ayub Medical College, 15(2).

Siegel, E. H., Stoltzfus, R. J., Khatry, S. K., LeClerq, S., Katz, J., & Tielsch, J. M. (2006). EPIDEMIOLOGY OF ANEMIA AMONG 4- TO 17-MONTH CHILDREN LIVING IN SOUTH-CENTRAL NEPAL. European Journal of Clinical Nutrition(60), 228–235.

Appendix A

Case History Form

Demographic Information:

• Child’s Name: Billy Smith
• Date of Interview___8/30/09____ Date of Birth__8/15/05___________ Age of child___4______________

Referral Information

• Why are you seeking help for this child?

I am concerned that Billy is not developing normally. I want to know if he has a psychological problem, and I need help in managing his behavior—especially his tantrums & aggressive behavior. ____________________________________________________________________________

• Who referred you to our services? I am self-referred.

• What kind of services are you seeking? (psychological or psychiatric testing, medical or physical exam, therapy) Whatever will help.

Primary Caregiver/Parent Information

• Father Name: Jose __________________________________________________________________
• Address (if different from mother) __________________________________________________
• Phone________________________________________________________________________
• Employment___________________________________________________________________
• Length of Employment __6 years_________________________________________________________
• Occupation: Construction Worker_________________________ Highest Grade Level: high school
• Stepfather_____________________________________________________________________
• Primary Language: Spanish________________________ Secondary Language: English________________
• Mother Name: Carla________________________________________________________________
• Address (if different from father) __same_________________________________________________
• Phone________________________________________________________________________
• Employment___________________________________________________________________
• Length of Employment ___________________________________________________________
• Occupation: homemaker_________________________________ Highest Grade Level: high school
• Primary Language: English _________________________ Secondary Language___________________

Primary Caregiver

• With what adults does this child live?_Both parents_____________________________________________
• How long in the current living situation? since birth. We have tried 3 daycares, but Billy keeps getting kicked out because of anger and aggression.

Family History

Please list all brothers and sisters, and any other children living with the family:

• June—age 6—sister
• Robert—age 3—brother

Pregnancy_________________________________________________________________

• Full Term Pregnancy? No=born at 36 weeks
• Pregnancy under doctor’s care: Yes
• Number of previous miscarriages:_0___________________
• Check any of the following complications that occurred during the pregnancy
• XDifficulty in conception XToxemia Abnormal weight gain
• Measles XExcessive vomiting German measles
• Excessive swelling XEmotional problems Vaginal bleeding
• X–Maybe-Flu
• XAnemia
• XHigh blood pressure
• XRh-incompatibility
• Hospitalization during pregnancy:_for one week before birth__________________________________________________
• Reason:__premature labor, toxemia____________________________________________________________________
• X-rays during pregnancy:__No_______________________________________________________
• Medications used during pregnancy:_Prozac_______________________________________________
• Alcohol used during pregnancy:_Yes-1 glass of wine per night __________________________________________________
• Cigarettes during pregnancy:No, but father smoked—2^nd hand smoke______________________________________________________
• Other drugs used during pregnancy:
• Type__marijuana occasionally before I knew I was pregnant______________
• Birth____________________________________________________________________________________
• At this child’s birth, what was the mother’s age?__18__________ Fathers Age?_19_______________
• Mother’s age at birth of FIRST child?__16___________________
• Was this child born in the hospital? Yes
• Length of pregnancy ___36 weeks__________Birth Weight ___4 lbs. 10 oz.______________________
• Length of Labor___C-section__________Apgar Score_Don’t know________________________
• Child’s condition at birth__Weak________________________________________________________
• Mother’s condition at birth___OK______________________________________________________
• Check any of the following complications that occurred during birth:
• Forceps used Breech Birth Labor Induced XYes-Caesarean Delivery
• Other Delivery Complications: _____________________________________________________
• Incubator: Yes How long? __2 weeks_______________________________________________
• Jaundiced: Yes Bilirubin Lights? Yes If Yes, How Long? __1 week________________
• Breathing Problems right after birth: _Yes_______________________________________________
• Supplemental Oxygen Yes If yes, how long? 1 week__________________________________
• Was anesthesia used during delivery? Yes If yes, what kind? _Don’t know____________________

Development

• At what age did this child first do the following? Please indicate year/month of age.
• Turn Over___4 months__________Walk down Stairs_24 months_____________________________
• Sit Alone____9 months_________ Show interest in or attraction to sound___2 weeks___________
• Crawl____11 months___________ Understand first words_Not sure-does not always appear to be listening_________________
• Sand Alone___14 months_______ Speak first words 18 months____________________________
• Walk Alone_16 months_________ Speak in sentences__3 years__________________________
• Walk up Stairs_2 years___________________
• Was this child breast-fed? No
• Was this child bottle-fed? Yes When weaned? _2 years________________________________
• When was this child toilet trained? Days_2 years_______ Nights 3 years____________
• Did bed wetting occur after toilet training Yes If yes, until what age? ___3 years_____________
• Did bed-soling occur after toilet training? No If yes, until what age? ________________
• Has this child experienced any of the following problems? If yes, please describe.
• Walking difficulty: Yes was slow to start—is awkward____________________________________________________
• Unclear Speech: No _____________________________________________________
• Sleep Problem: Yes Takes an hour to get to sleep & wakes up every 2-3 hours_________________________________
• Feeding Problem: Yes Did not like solid foods. Spits food out if doesn’t like it. Eats very few foods._____________________________
• Underweight Problem: Yes Slightly
• Eating Problem: Yes Won’t try new foods. Doesn’t like some textures/________________________________________
• Overweight Problem No _________________________________________________
• Colic: Yes For 1^st six months—had reflux & projectile vomitting_______________________________________________
• Difficulty learning to Ride a Bike: Yes No __hasn’t tried______________________________________
• Difficulty Learning to Skip: Yes No _Does not do____________________________________________
• Difficulty Learning to Throw and Catch: Yes Is clumsy & not very coordinated___________________________________
• During this child’s first four (4) years, were any special problems noted in the following areas? If yes, please describe.
• Eating: Yes I already said this_____________________________________________________________
• Motor skills: Yes I already said this. _________________________________________________________
• Sleeping too much: No Not enough___________________________________________________
• Temper tantrums: Yes Anytime there is much noise or when frustrated. Bites when angry.
• Excessive crying: Yes Cries easily if frustrated.____________________________________________________
• Sleeping too little: Yes I already said this.___________________________________________________
• Failure to thrive: No _____________________________________________________
• Separating from parents: Yes Is clingy ______________________________________________
• Which hand does this child used for writing or drawing?___R_______ Eating?_R____
• Has this child been forced to change writing hand?

Medical History

Childhood Illnesses/Injuries

• Please check the illnesses this child has had and indicate age, year and month
• Measles: No__________ Rheumatic fever: No__________
• German measles: No__________ Diphtheria: No__________
• Mumps: No ______ Meningitis: No__________
• Chicken pox: Yes 3 years__________ Encephalitis: No__________
• Tuberculosis: No__________ Anemia: Yes won’t eat healthy food __________
• Whooping Cough: No__________ Fever above 104⁰: Yes Age 2
• Scarlet Fever: No__________ Broken bone: No__________
• Head injury: No__________ Sustained high fever: Yes Age 2_________
• Coma or any loss of consciousness: No__________

Illness/Operations

• Has this child ever been on any medication for six months or more? No
• Describe:___Takes asthma medicine when needed_____________________________________________________

Please indicate whether this child currently has any of the following problems.

Respiratory

• Cardiovascular
• Gastrointestinal
• X-Frequent colds
• Shortness of breath
• Excessive vomiting – only as infant
• Chronic cough
• Dizziness with physical exertion Frequent diarrhea
• X_Asthma
• Activity limited due to heart X-Constipation
• Hay fever
• Heart murmur

Genitourinary Musculosketetal

• Neurological
• Urination in pants/bed Muscle pain
• X-Clumsy walk
• Speech defects
• Excessive urination Poor posture
• Bites nails
• Strong odor to urine Other muscle problems X–Sucksthumb
• Pain while urinatingTics/twitches
• X-Bangs head

Hearingproblems

• X-Earinfections
• Date of most recent hearing exam: Last month—hearing was normal even though he sometimes acts like he doesn’t hear us_______

Medical Care

• Child’s Physician_Dr. Jones_______________________________________________
• How often does child see doctor? __When sick ________________________________________________
• Is this child currently on medication? No______________________________________
• Has this child ever been physically or sexually abused or neglected? ____No__________________
• Has this child ever had psychological counseling or therapy? __No__________________________