What if my child has blood in urine?

What if my child has blood in urine?

[mme_highlight] 3 to 4% of all children with ages 6 to 15 experience hematuria at least once, but commonly it is not associated with a severe condition. The main causes of hematuria are: infections, kidney stones, trauma and inherited diseases. [/mme_highlight]

The finding of even microscopic amounts of blood in a child’s urine alarms family. Although common, hematuria, which means “urine with blood”, is a sign or symptom but generally it is not related with a severe condition.  3 to 4% of all children with ages 6 to 15 experience hematuria at least once.
To understand hematuria, it is important to distinguish the origin of hematuria – from kidney or from urinary tract – and the types of hematuria – microscopic or macroscopic. Hematuria is macroscopic if blood is visible to the naked eye; otherwise, it is called microscopic.  It is also very useful to have a general knowledge of urinary system’s anatomy: we have two kidneys (that filter urine), two ureters (that move urine from the kidneys to the bladder), a bladder (a “bag” that holds urine), and the urethra (that carries urine out of the bladder).

What are the causes of hematuria?

  • Urinary Tract Infection;
  • Kidney stones;
  • Trauma;
  • Vigorous exercise;
  • Inherited diseases;
  • Drugs;
  • Urinary Tract Cancer (extremely rare in children).

It is also important to know if there is a history of hematuria in the family or test family to investigate it, as Familial hematuria is the most common cause of persistent hematuria in children.

What are the symptoms of hematuria?

Hematuria can occur without any associated symptom. Symptoms depend on the subjacent cause for the hematuria. In a urinary tract infection, children can feel ill, with chills and flank pain; fever, irritability and loss of appetite are frequent in young children, while burning while urinating, urinating many times and lower belly pain can be present in older children.
Flank pain can appear with kidney stones. Other kidney diseases can present with symptoms such as fatigue, abdominal pain, pale skin and high blood pressure.

What tests are used to study hematuria?

The dipstick test is an easy way to test hematuria; it uses a reagent strip embedded in hydrogen peroxide, which catalyses a chemical reaction in which hemoglobin is involved. It is not the most trustable test, but it is used due to its easiness, availability and low cost. It can detect hematuria when there are 5 to 10 red blood cells per microlitre of blood.

Urynalisis is the gold standard to test for microscopic hematuria, considered for values above 2 to 5 red blood cells per high power field (ampliation of 40 times in the microscopy).

A CT (computerized tomography) scan may be needed in selected cases.

What situations can mistake hematuria tests?

There are a number of situations that can cause a “false positive” hematuria result. It is the case of aliments like beet, mushrooms and berries and some medicines, as ibuprofen, rifampin, nitrofurantoin. Let your doctor know about these.

Why Urinary Tract Infections can be a cause of Hematuria?

Normally, there are no bacteria in the urinary tract. However, if bacteria enter the bladder they can cause an infection, which then leads to hematuria. These infections are called urinary tract infections (UTI). If bacteria go up in the urinary tract, they can reach the kidneys, causing one of the most serious type of UTI which, if not treated quickly, can lead to a permanent damage to the kidneys.

[mme_databox]

Probability of Urinary Tract Infection (UTI) among girls presenting with fever

Risk Factors in Girls:

–        Caucasian

–        Age < 12 months

–        Temperature ≥ 39ºC

–        Fever ≥ 2 days

–        Absence of another source of infection

 

If no risk factor or 1 risk factor is present: ≤ 1% probability of UTI

If no more than 2 risk factors are present : ≤ 2% probability of UTI

 

[/mme_databox]

[mme_databox]

Probability of Urinary Tract Infection (UTI) among boys presenting with fever

Risk Factors in Boys:

–        Non African

–        Temperature ≥ 39ºC

–        Fever ≥ 24 hours

–        Absence of another source of infection

 

If no more than 2 risk factors are present (circumcised): ≤ 1% probability of UTI

If no more than 3 risk factors are present (circumcised): ≤ 2% probability of UTI

If uncircumcised probability of UTI is > 1% even if no risk factor is present.

 

[/mme_databox]

What is the treatment for hematuria?

There is no specific treatment, as the treatment is not aimed at hematuria, but rather at its underlying cause. In addition, a symptomatic treatment may be necessary to relieve pain or to lower fever. In the case of a urinary tract infection, antibiotics are prescribed. If the cause of your child’s hematuria is a bruise to the kidney, she/he might not need any treatment.

Gross Hematuria

Gross hematuria in children is not a common situation, accounting for approximately 1 in 1000 visits to a pediatrician. There are multiple causes, as seen in the table below, but the implications of gross hematuria tend to be less serious in children when compared to adults, especially because urologic malignancies are much less common in children.

[mme_databox]

Gross Hematuria in Children

Study Design: 342 children, 1994-2003

–        Benign Urethrorrhagia: 19% of male patients

–        Urinary Tract Infection: 14% of male patients

–        Trauma: 14% of male patients

–        Congenital urologic abnormalities: 13% o all patients

–        Kidney stones: 5% of all children.

[/mme_databox]

Summary and Recommendations

  • Hematuria can occur in children, but commonly it is not associated with a severe condition.
  • Hematuria can be classified as microscopic or macroscopic (gross hematuria).
  • The main causes of hematuria are: infections, kidney stones, trauma and inherited diseases.
  • Urinary tract infections can present with hematuria, fever, chills and flank pain.
  • A dipstick test or urinalysis are generally sufficient to investigate hematuria.
  • Treatment is aimed at the underlying cause.
  • If you see blood in your child’s urine or if the urine has a different appearance (like tea stained or pink) take her/him to a doctor.

[mme_references]
References

  1. Subcommittee onUrinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children2 to 24 months. Pediatrics. 2011 Sep;128(3):595-610.
  2. Greenfield SP, Williot P, Kaplan D. Grosshematuria in children: a ten-year review. Urology. 2007 Jan;69(1):166-9.
  3. Meyers Evaluation of hematuria in children. Urol Clin North Am. 2004 Aug;31(3):559-73, x.
  4. Vehaskari VM, Rapola J, Koskimies O, et al. Microscopic hematuria in school children: epidemiology and clinicopathologic evaluation. J Pediatr 1979; 95:676.

[/mme_references]

What if my child has seizures?

What if my child has seizures?

[mme_highlight] Febrile seizures represent the most common form of seizures in childhood, with a prevalence of 2 to 5 % of all children; generally these seizures are self-limited.  A seizure refers to a single event; if it becomes recurrent it is called epilepsy.  Any insult to the cerebral cortex can cause a seizure. [/mme_highlight]

Seizures account for 1 to 5% of all emergency department visits. Seizures can be classified as febrile and afebrile, being the former the most frequent. When a seizure becomes recurrent it is called epilepsy. Transient epileptic discharges may appear in an electroencephalogram in 3 to 5% of healthy children, particularly in those with a positive history of seizure activity in the family.

How common are seizures in childhood?

[mme_databox]

Statistics of Seizures

·        Age adjusted prevalence in general population (developed countries): 4-8/1000 people

·        3.6% risk of experiencing at least one seizure during a life of 80 years.

·        Febrile seizures: 2 to 5% of all children (U.S. and Europe)/ 8% (Japan)

·        Afebrile seizures: 1% of all children will have at least one till the age of 14.

 

Prevalence – The total number of cases of a disease in a given population at a specific time.
[/mme_databox]

What are febrile seizures?

Febrile seizures represent the most common form of seizures in childhood, with a prevalence of 2 to 5 % of all children living in United States and Europe, a number that turns to 8% in Japan.

Febrile Seizures can be defined as a seizure accompanied by fever in a child from 6 months to 6 years of age, without evidence of central nervous system lesion or infection. Febrile seizures can cause your child to pass out and have jerking movements of limbs and face. They generally do not last more than 1 to 2 minutes. After the seizure, your child may feel confused or sleepy; this is normal.

There is an association between seizure and bacterial meningitis has been established by studies. There is a confounding element in this case – fever – and that is why it is imperative to rule out bacterial meningitis before making a diagnosis of febrile seizure.

Why do febrile seizures occur?

The exact process that leads to febrile seizures to occur remains unknown.  However, several factors such as vitamin B6 deficiency, electrolyte disturbances (sodium, potassium, and chloride), reduction in serum and cerebrospinal fluid (CSF) zinc levels, as well as low gamma-aminobutyric acid (GABA) levels are thought to play a role.
The study shown below found that zinc levels in children with febrile seizures were significantly lower than those in children with afebrile seizures.
[mme_databox]

Zinc Levels and febrile seizures: evidence

(Study design: 288 pre-school children, mean age, diagnosed with febrile seizures (n=248) and afebrile seizures (n=40))

Mean serum zinc levels:

Febrile seizures group: 60.5±12.7 μg/dL

Afebrile seizures group:  68.9 ±14.5 μg/dL

 

[/mme_databox]

How can I help my child if she/he is having a febrile seizure?

Keep calm, do not try to stop the movements and put your child on side. If the seizure lasts more than 5 minutes, call the emergency. Even if it recovers spontaneously and your child is with fever, take her/him to the doctor as soon as possible, to make sure it was a febrile seizure. Generally, these seizures are self-limited; doctor can prescribe medicines to lower fever or to treat a possible infection.
Keep also in mind that children with a first episode of febrile seizure have higher odds to have another one. It is important to emphasize that febrile seizures do not cause brain damage.

What is epilepsy?

A seizure refers to a single event; if it becomes recurrent it is called epilepsy. Epilepsy is not itself a disease, but rather a manifestation of a pathology involving the cerebral cortex, like in the case of a brain tumor. The epileptic crisis are classified as partial or generalized. The complex crisis occurs when a limited group of neurons from one of the hemispheres in the brain is activated. Partial crisis are subdivided in simple and complex, without or with loss of consciousness, respectively.
The generalized crisis involves the two hemispheres of brain and loss of consciousness may be the first manifestation.  Seizures tend to be stereotyped (similar to previous seizures), random (in anytime of the day) and without being related to any precipitator like environment or psychological events.
Bear in mind that any insult to the cerebral cortex can cause a seizure, even if it is transient: trauma, infection, bleeding (subarachnoid hemorrhage) and low levels of calcium or sodium.

What is the medical approach to childhood epilepsy?

Your doctor will order some tests to investigate the cause of epilepsy in your child, like a blood sample, an electroencephalogram (EEG), computerized tomography (CT) or a magnetic resonance (MRI). Treatment usually involves medicines to prevent seizures. These can have interaction with other medicines and vice versa, thus it is important you tell your doctor about any medicine your child is taking. A special diet or a brain surgery may be necessary in a few cases.

Summary

  • Seizures are common in children. Any insult to the cerebral cortex can cause a seizure.
  • Seizures can be classified as febrile and afebrile, depending on the presence of fever. Febrile seizures are the most common, occurring in 2 to 5 % of all children.
  • Epilepsy is diagnosed when seizures are recurrent. Your doctor will ask exam tests to try to find the cause of the epilepsy and possibly will prescribe a medicine to prevent seizures in your child.
  • If your doctor has prescribed a therapeutic regimen to prevent seizures, follow it strictly.
  • Call the emergency if a seizure lasts more than 5 minutes or if you notice repeated seizures overtime.
  • Take your child to a doctor after a seizure. Alarm signs are an increase in the number or in the duration of seizures.

[mme_references]
References

  1. American Academy of Pediatrics. Provisional Committee on Quality Improvement, Subcommittee on Febrile Seizures (1996) Practice parameter: the neurodiagnostic evaluation of the child with a first simple febrile seizure. Pediatrics 97: 769–772; discussion 773–765.
  2. Najaf-Zadeh A, Dubos F, Hue V, Pruvost I, Bennour A, Martinot A. Risk of bacterial meningitis in young children with a first seizure in the context of fever: a systematic review and meta-analysis. PLoS One. 2013;8(1):e55270.
  3. Lee JH, Kim JH. Comparison of serum zinc levels measured by inductively coupled plasma mass spectrometry in preschool children with febrile and afebrile seizures. Ann Lab Med. 2012 May;32(3):190-3.
  4. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia 1981; 22:489.
  5. Hauser WA, Annegers JF, Kurland LT. Prevalence of epilepsy in Rochester, Minnesota: 1940-1980. Epilepsia 1991; 32:429.
  6. Oka E, Ohtsuka Y, Yoshinaga H, et al. Prevalence of childhood epilepsy and distribution of epileptic syndromes: a population-based survey in Okayama, Japan. Epilepsia 2006; 47:626.
  7. Murphy CC, Trevathan E, Yeargin-Allsopp M. Prevalence of epilepsy and epileptic seizures in 10-year-old children: results from the Metropolitan Atlanta Developmental Disabilities Study. Epilepsia 1995; 36:866.

[/mme_references]

What if my child enrolls school too late?

What if my child enrolls school too late?

[mme_highlight] For children with adequate development, neither delayed nor early entrance into kindergarten has been shown to yield substantial differences regarding academic success after the first few years of school. Nevertheless, some results show that children who enroll kindergarten later may perform slightly better on some tests over time. [/mme_highlight]

Many parents pose a difficult question when the time of school entry comes: should they enroll their children in kindergarten as soon as they become age-eligible or may it be beneficial to academic success to wait an additional year? In fact, chronological age at entrance of kindergarten is many times considered by parents and teachers as a major determinant of future academic success achievement.
However, if a child entries kindergarten later because of poor readiness due to risk factors such as poverty, low maternal education, single parent status or minority status. Age of entry to school is also in the centre of some government policies.
The exact age of enrollment in kindergarten varies around the world. In most European countries, like Switzerland and German, as well as in Australia, Japan and Russia, children enter kindergarten at 6. In Sweden, children enter school at the age of 7 and in England between 4 and 5 years of age. Differently, in New Zealand children begin school on their fifth birthday, rather than on a specific uniform date in September or October.

What is redshirting?

Redshirting refers to a voluntary delay in kindergarten entrance. The term has its roots on a practice used by athletes to prolong their eligibility for another season. About 10% of American parents defer their children’s kindergarten entry.
This occurs more frequently Children whose birthdays are closest to the cutoff, Caucasian children, boys and children from high-income families are most likely to be held back from kindergarten by parents (redshirting).

According to the National Centre for Education Statistics, approximately 9% of kids have a delayed school entrance. In addition, a report from 2007 in the US has shown that this delayed entrance occurs with about 14% of children between 5 and 6 years of age.

What is the balance between benefits and possible harms in a delayed enrollment?

For children with adequate development, neither delayed nor early entrance into kindergarten has been shown to yield substantial differences regarding academic success after the first few years of school.

Nevertheless, data from a study conducted by Rand Corporation in 2005 suggested that children who entered kindergarten one year later scored better in reading tests. However, this conclusion can be biased, because those children had one more year of life experience and may be better prepared because they had an extra year in preschool. In addition, it should be noted that this difference is likely to disappear overtime.

An interesting study conducted by NICHD (Early Child Care Research Network) analyzed data from more than 900 children with the goal of understanding the effect of age of entry to kindergarten on children’s functioning in early elementary school. Children’s academic achievement and socioemotional development were evaluated repeatedly from 54 months of age through 3rd grade.
Results show that age of entry proved to be significantly related to three measures of children’s estimated functioning in the fall of their kindergarten year: Letter-word recognition test, Language and Literacy and Mathematical Thinking scales.

[mme_databox]

Effect of age of entry on the performance on cognitive tests

(only statistically significant results shown)

Effect size for estimated functioning in the fall of their kindergarten year:

–        Letter-word recognition test: 0.09

–        Language and Literacy scale: 0.12

–        Mathematical Thinking scale: 0.14

 

 

[/mme_databox]

Although the effect size is little, age of entry proved also to be significantly related over time to four measures: Letter-word recognition test, applied problems test, Memory for sentences and Picture vocabulary test.

[mme_databox]

Effect of age of entry on the performance on cognitive tests

(children who began school at an older age evinced greater increases over time; only statistically significant results shown)

Effect size for estimated functioning overtime (slope):

–        Letter-word recognition test: 0.09

–        Applied problems test:0.13

–        Memory for sentences: 0.07

–        Picture vocabulary test: 0.10

 

 

[/mme_databox]

Summary

  • Age of school entry should not be regarded as a major determinant of children’s later academic success.
  • Most research findings demonstrated that, in itself, entrance age was not a good predictor of learning or academic risk. Nevertheless, some results show that children who enroll kindergarten later may perform slightly better on some tests over time.
  • Empiric evidence supports the enrollment of children in kindergarten at the age-appropriate time (which varies from country to country).
  • If there is concern about a child’s school readiness, parents should discuss it with teachers and health care providers.
  • The decision of age of enrollment of children in kindergarten must be centered on each child and should balance costs of one more year of childcare and a marginal benefit for those children who have one more year of preschool preparation.
  • Keep in mind that a child whose entrance is delayed for one year may eventually be ahead in the class, but probably knows less than children of the same age who are in the next grade.

[mme_references]
References

  1. Stephanie Pappas, “More Parents ‘Redshirting’ Kindergartners”,Live Science, 5 September 2010.
  2.   Winsler A, Hutchison LA, De Feyter JJ et al. Child, family, and childcare predictors of delayed school entry and kindergarten retention among linguistically and ethnically diverse children. Dev Psychol. 2012 Sep;48(5):1299-314.
  3. NICHD Early Child Care Research Network. Age of Entry to Kindergarten and Children’s Academic Achievement and Socioemotional Development. Early Educ Dev 2007; 18:337.
  4. Morrison FJ, Griffith EM, Alberts DM. Nature-nurture in the classroom: entrance age, school readiness, and learning in children. Dev Psychol 1997; 33:254.

[/mme_references]

What if my child enrolls school too early?

What if my child enrolls school too early?

[mme_highlight] For children with adequate development, neither delayed nor early entrance into kindergarten has been shown to yield substantial differences regarding academic success after the first few years of school. When parents believe their child is ahead of peers regarding intellectual, social or creative skills, early entrance may be an option.  [/mme_highlight]

Many parents pose a difficult question when the time of school entry comes: should they enroll their children in kindergarten as soon as they become age-eligible or may it be beneficial to academic success to wait an additional year? Some parents may want to decide for early kindergarten enrollment (at age four years) if their children seem to be ahead of their same-age peers regarding cognitive development and skills.

Should my gifted child enroll school earlier?

Some gifted children may benefit from enrolling earlier in school, as in most cases pre-school does not have nothing new  left to offer to enhance their capabilities. The definition of giftedness used by a govern entity in Australia: “Students who are gifted have the capacity for advanced development relative to their age peers in at least one ability domain (intellectual, physical, creative or social), to a degree that places them at least among the top 10% of their age peers”.
In fact this benefit is more likely among exceptionally gifted children, i.e., the top 2% of the population. For these children, enrolling earlier is an educational intervention that boosts their academic achievement.

What is the balance between benefits and possible harms in an early enrollment?

Although the effect size is very little, according to a study conducted by NICHD (Early Child Care Research Network) which analyzed data from more than 900 children, teacher ratings of academic mastery in second or third grade were slightly higher in children who were older at kindergarten entry. According to this study, there were no differences regarding social functioning.

In addition, a study which collected data from a large community sample revealed that the youngest children in the school year were at an increased risk of being incorrectly identified by teachers as having learning difficulties.

Some adverse effects of early enrollment may become evident as the children progresses to middle and junior high and when physical maturation differences become more obvious. These early enrollees may be more likely to develop socioemotional difficulties. A study revealed that the younger children in a school year are at slightly greater psychiatric risk than older children.

[mme_databox]

Correlation between relative age and mean symptom score on strengths and difficulties questionnaire 

Adjusted regression coefficients:

–        According to teacher report: 0.51 (CI 0.36 to 0.65, P < 0.0001 ): moderate and statistically significant correlation.

–        According to parental report: 0.35 (CI 0.23 to 0.47, P < 0.0001 ): ): weak but statistically significant correlation.

Odds Ratio:

–        adjusted OR for psychiatric diagnoses for decreasing relative age: OR 1.14 (1.03 to 1.25, P = 0.009) – younger children in a school year have a risk 1.14 times higher to present a psychiatric problem.

 

CI – confidence interval; OR – odds ratio
[/mme_databox]

A study from 2011 addressed the impact of the age of starting education on obesity among adolescent girls and showed that early school entry may reduce girls’ likelihood of becoming obese in their adolescence.

[mme_databox]

Association between body weight status and early school status among adolescents aged 12–19 years in the National Longitudinal Survey of Youth 1997 (NLSY97)

1)      Within one month of cut-off date

–        One additional school year for girls decreased the risk of overweight (OR 0.78) and obesity (OR 0.73) in adolescence by approximately 30%.

2)      Within 6 months of cut-off date

–        One additional school year for girls decreased the risk of obesity (OR 0.84) in adolescence by approximately 16%.

 

[/mme_databox]

How should I decide concerning early enrollment?

As stated above, for children with adequate development, neither delayed nor early entrance into kindergarten has been shown to yield substantial differences regarding academic success after the first few years of school. Note also that children with normal development who miss the birth date cut off probably would not benefit from early enrollment, because being one of the oldest in their class may actually boost their success.

When parents believe their child is ahead of peers regarding intellectual, social or creative skills, early entrance may be an option. However, to enroll a child early in school should thus be a joint decision, resulting of the views of parents, educators and doctors. There may be an indication to consult a Psychologist of Psychiatrist so that the child is evaluated and can do IQ tests.

Summary

  • Age of school entry should not be regarded as a major determinant of children’s later academic success.
  • Most research findings demonstrated that, in itself, entrance age was not a good predictor of learning or academic risk.
  • Empiric evidence supports the enrollment of children in kindergarten at the age-appropriate time (which varies from country to country).
  • For gifted children, early enrollment may not only an option but an educational intervention to boost their academic success.
  • Some adverse effects of early enrollment may become evident later, namely some socioemotional disturbances.
  • If there is concern about a child’s school readiness, parents should discuss it with teachers and health care providers.

[mme_references]
References

  1. NICHD Early Child Care Research Network. Age of Entry to Kindergarten and Children’s Academic Achievement and Socioemotional Development. Early Educ Dev 2007; 18:337.
  2. Zhang N, Zhang Q. Does early school entry prevent obesity among adolescent girls? J Adolesc Health. 2011 Jun;48(6):644-6.
    1. http://www.education.vic.gov.au/school/teachers/teachingresources/diversity/pages/giftedentry.aspx (accessed 07.12.2013).
    2. Frequently Asked Questions about Early Entry to Kindergarten – Cross Sectoral Information for Parents. Department of Education. Tasmania, Australia.
    3. Gledhill J, Ford T, Goodman R. Does season of birth matter? The relationship between age within the school year (season of birth) and educational difficulties amongst a representative general population sample of children and adolescents (aged 5-15) in Great Britain.Research in Education 2002;68: 41-7.

    [/mme_references]

What if my baby has infantile spasms?

What if my baby has infantile spasms?

[mme_highlight] Infantile spasms are a rare form of epilepsy of the early infancy, occurring predominantly in the first year of life. The triad of West syndrome comprises infantile spasms, hypsarrhythmia (EEG pattern) and mental retardation. The prognosis is better if the neurologic history and examination were normal prior to the onset of febrile seizures. [/mme_highlight]

Infantile spasms are a severe form of epilepsy of early infancy. This epileptic disorder was first described by Dr. William James West in his own son in 1841. Named after Dr. West, the triad of West syndrome comprises infantile spasms, hypsarrhythmia (EEG (electroencephalogram) pattern) and mental retardation. An early diagnosis and a good response to treatment increase the chances for a normal development.

How common are infantile spasms?

Infantile spasms are a rare form of epilepsy of the early infancy, occurring predominantly in the first year of life. The table below shows incidence and proportion of infantile spasms by time of onset. Spasms usually cease by 5 years of age, but then other forms of seizures appear in as many as 60% of children with infantile spasms.

[mme_databox]

Epidemiologic (statistical) data for Infantile Spasms

·        Incidence: 2 to 3.5 cases per 10.000 live births

·        Time of  Onset:

–        Range: 1 day to 4.5 years of life

–        90% during the first year

–        50 to 77% between 3 and 7 months of life (peak incidence)

–        Very rarely in children older than 18 months of life.

·        Ratio boys:girls – 60:40.

Incidence – number of new cases within a specified time period in a population.
[/mme_databox]

How does an infantile spasm look like?

Infantile spasms are muscular contractions lasting 1 to 2 seconds.  3 main types of spasms have been identified:

  • Flexor spasms: sudden flexion of the neck, trunk and limbs associated with contraction of the abdominal muscles.
  • Extensor spasms: sudden extension of the neck and trunk, with inward or outward movement of limbs.
  • Combination of flexor and extensor spasms: generally, with flexion of the neck, trunk, and arms with extension of legs.

[mme_databox]

Types of Infantile Spasms

(Study: 5042 spasms were obseved in 24 infants)

–        Flexor spasms: 33.9% of spasms

–        Extensor spasms: 22.5% of spasms

–        Combination flexor+extensor spasms: 42%.

Note: Most of infants had more than one type of spasm

 

[/mme_databox]

What are the causes for infantile spasms?

The classification of infantile spasms by cause includes the categories of cryptogenic and symptomatic.

[mme_databox]

Classification of Infantile Spasms

·        Cryptogenic

–        10 to 40% of cases;

–        No underlying cause identified;

–        Normal development prior to onset of infantile spasms.

·        Symptomatic:

–        remaining cases;

–        when a cause can be demonstrated.

 

[/mme_databox]

Although much remains unclear, the following conditions may cause infantile spasms:

  • Metabolic disorders (eg., phenilketonuria, vitamine B12 deficit);
  • Malformations (eg., microcephaly, tetralogy of Fallot);
  • Tuberous sclerosis complex;
  • Infections (cytomegalovirus has been implicated);
  • Immune pathogenesis;
  • Neoplasms (eg., basal ganglia glioma);
  • Genetic syndromes (eg., Down’s syndrome, cri du chat syndrome);

How are infantile spasms diagnosed?

In the majority of cases, the first alert for further clinical evaluation is set by parents. Parents usually bring their child to a doctor because of episodes that can be mistaken with a colic or gastro esophageal reflux. Parental videos of the infant spasms may help the clinical evaluation. Generally, an EEG is done and further testing may be needed according to the clinical set.

Is there any association between infantile spasms and vaccination?

Studies have ruled out this association. This was a debated issue for more than 50 years, but a recent consensus stated that the risk of vaccine induced encephalopathy or epilepsy, if it exists at all, is extremely rare, very different from the higher risk of not vaccinating.

What is the treatment for infantile spasms?

Your doctor will guide you and certainly answer all your questions. Give the medicines to your baby exactly as prescribed as this increases the likelihood for recovery. Generally, antiepileptic drugs and ACTH (adrenocorticotropic hormone) are the therapeutic regimens offered.

What is the prognosis for infantile spasms?

It is consensual that the prognosis is better if the neurologic history and examination were normal prior to the onset of infantile spasms. Rapid cessation of infantile spasms and normalization of EEG also add for a good prognosis. Factors accounting for poor prognosis are mental retardation and abnormal mental status prior to the onset of infantile spasms.

Summary and Recommendations

  • Infantile Spasms are a severe and rare form of epilepsy of early infancy, generally appearing in the first year of life.
  • Infantile spasms can be flexor, extensor or a combination of both.
  • Parents and caregivers are generally the first to notice the spasms. If this is the case, take your child to a doctor. A video recording of the spasms may be helpful. An EEG is generally part of the investigation.
  • The prognosis is better if there was no prior history of neurologic impairment. Rapid cessation of spasms and normalization of EEG are also good signs.

[mme_references]
References

  1. Fois A. Infantile spasms: review of the literature and personal experience. Ital J Pediatr. 2010 Feb 8;36:15.
  2. James W Wheless, Patricia A Gibson, Kari Luther Rosbeck et al. Infantile spasms(West syndrome): update and resources for pediatricians and providers to share with parents. BMC Pediatr. 2012; 12: 108.
  3. Kellaway P, Hrachovy RA, Frost JD Jr, Zion T. Precise characterization and quantification of infantile spasms. Ann Neurol 1979; 6:214.
  4. Shields WD: West’s syndrome. J Child Neurol 2002, 17(suppl 1):S76–

[/mme_references]

What factors influence my child’s ability to learn?

What factors influence my child’s ability to learn?

[mme_highlight] The way a child experiences learning, particularly in early years, can influence the child’s global health and ability for further learning, as well as confidence, motivation and self-esteem. Factors such as a low socio-economical status, male gender, low maternal education, speech defects and low birth weight were found to raise the likelihood for grade retention.  [/mme_highlight]

Children are constantly learning, however they may have different ways and rhythms to incorporate knowledge and there are many factors which may affect a child’s ability to learn in the complex interplay between child, family, environment, educators and community. Entering kindergarten is an important developmental milestone not only for the child, but for the family as a whole.
The way a child experiences learning, particularly in early years, can influence the child’s global health and ability for further learning, as well as confidence, motivation and self-esteem. It is estimated that about 32 to 50% of children entering kindergarten have at least one risk factor to further experience difficulty in learning and approximately 15% have more than one risk factor.

What are the risk factors that can impair the ability to learn?

School readiness is a common worry among parents. However, little is known about what are the associations between children health and environment with school success and failure.  An interesting study tried to investigate health and social factors associated with early grade retention in a nationally representative sample of children in the United States, revealing that approximately 8 percent of children repeat kindergarten or first grade.
Results obtained after logistic regression analysis are shown in the table below. In this study, factors such as a low socioeconomical status, male gender, low maternal education, speech defects, low birth weight, enuresis and exposure to smoking were found to raise the likelihood for grade retention.

[mme_databox]

Factors independently associated with increased risk of grade retention (logistic regression analysis)

(Study design: study conducted to investigate health and social factors associated with early grade retention in a nationally representative sample of 10000 children in the United States.)

·        Poverty: 1.7 times more risk for grade retention (OR 1.7 – 95% CI 1.4-2.1)

·        Male gender: 1.5 times more risk for grade retention (OR 1.5 – 95% CI 1.3-1.9)

·        Low maternal education: 1.4 times more risk for grade retention

(OR 1.4 – 95% CI 1.1-1.8)

·        Speech defects: 1.7 times more risk for grade retention (OR 1.7 – 95% CI 1.1-2.6)

·        Low birth weight: 1.6 times more risk for grade retention (OR 1.6 – 95% CI 1.2-2.2)

·        Enuresis: 1.6 times more risk for grade retention (OR 1.6 – 95% – CI 1.1-2.2)

·        Exposure to household smoking: 1.4 times more risk for grade retention

(OR 1.4 – 95% CI 1.1-1.7)

 

OR – Odds Ratio; CI – Confidence Interval
[/mme_databox]

What are the factors that enhance the ability to learn?

It is consensual that a good learning environment as well as positive early learning experiences enhance a child’s ability to learn. In fact, such learning opportunities at an early age establish a solid basis for future academic success and general well-being. School readiness is thus a result of interactions between health and social, language, emotional, cognitive and social development. The study described above found that factors such as a high maternal education and living with both biological parents decrease the likelihood for grade retention.

[mme_databox]

Factors independently associated with decreased risk of grade retention (logistic regression analysis)

(Study design: study conducted to investigate health and social factors associated with early grade retention in a nationally representative sample of 10000 children in the United States.)

·        High maternal education: decreases the risk for grade retention by 40%

(OR 0.6 – CI 0.4, 0.9)

·        Residence with both biological parents at age 6 years: 1 decreases the risk for grade retention by 30% (OR 0.7, CI 0.6, 0.9)

OR – Odds Ratio; CI – Confidence Interval
[/mme_databox]

Getting the whole picture…

Child development is a major determinant of health throughout life. Risk and protective factors play an important role influencing the ability of a child to learn, however the cumulative experience of buffers or burdens is a more powerful determinant than any of these factors alone.

Summary and Recommendations

  • A child’s ability to learn can be influenced by different factors in the interplay between child, family, environment, educators and community.
  • Approximately 8 percent of children repeat kindergarten or first grade.
  • A good learning environment as well as learning experiences at an early age enhance a child’s ability to learn; studies have shown that factors such as a high maternal education and living with both biological parents decrease the likelihood for grade retention.
  • Poverty, male gender, low maternal education, speech defects, low birth weight, enuresis and exposure to smoking were found to be independently linked to a higher likelihood for grade retention.
  • The cumulative experience is a more powerful determinant for learning than any risk or protective factor alone.

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References

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What should a 1-year-old child be able to do?

What should a 1-year-old child be able to do?

[mme_highlight] When you celebrate your baby’s first birthday, you realize that your child has grown very fast and is becoming an independent walker. A child of this age likes to play “peek-a-boo”, waves for good-bye and understands that objects continue to exist even if he/she does not see them. [/mme_highlight]

When you celebrate your baby’s first birthday, you realize that your child has grown very fast and is becoming an independent walker. Also, she/he can independently feed her/himself and loves to explore the world around him/her.

Cognitive development

The child becomes more and more curious and interested in the world around him/her. He/she begins to associate names and objects and can point at objects when parents ask him/her to identify the objects that are part of her/his daily routine. The baby becomes capable of adapting the position of the body when a parent puts on the clothes.
In addition, children begin to imitate adults; in fact, 78% of children aged 12 months had at least one imitative act and besides that, children like to imitate the sounds of animals.

A child of this age likes to play “peek-a-boo”, waves for good-bye and understands that objects continue to exist even if he/she does not see them. Kids gain this important new skill- they can find a hidden object. Now, the child also can make a tower that consists of 2 blocks.

Motor development

One year old children rapidly develop the ability to move independently, as the data below demonstrates.

[mme_databox]

  • 97% of children have ability to crawl;
  • 95% of children can walk with assistance;
  • 75% of children can stand alone;
  • 50% of children have ability to walk without support;
  • 50% of children walk with heel strike;
  • 95% of children can squat without support.

[/mme_databox]

Also, one year old toddler improves his/her fine motor skills. Now, he/she can turn several pages of the book at once and can use pincer grasp to grab or hold small objects (the use of tip of the thumb and index finger). Many kids can grasp a pencil and start to scribble.

Children at this stage also acquire new eating habits, as shown below.

[mme_databox]

  • 30 % of children can drink from a cup;
  • 84 % of children eat with the spoon;
  • 90 % of children can eat biscuit or bread.

[/mme_databox]

Social/Emotional

In this period, children learn to recognize their feelings and learn to cope with them. Temper tantrums are a common occurrence. In addition, separation anxiety and fear of strangers become more apparent. According to the parents’ statements, the frequency of temper tantrums is eight times per week for one-year-olds and the duration of temper tantrums is two minutes on average.

Children still don’t have the ability to play with others or to share the toys at this age.

Language / communication

One year-old child understands about 80 words and can understand simple commands (e.g. “no”, “drink”, “eat” etc.). Also, babbling starts to resemble adult speech (by intonation, manner and duration). Besides words “mama” and “dada”, she/he can clearly say at least 2 words.

The toddler understands the meaning of the word “no”, but she/ he often does not obey the command.

What are the alarm signs I should be worried about?

  • If the child does not say a word or babbling does not become more complex;
  • if the child cannot stand with support;
  • If the child does not crawl;
  • If the child does not point to objects when parents ask to identify objects of everyday use;
  • If there is no nodding or waving “good-bye”, or if he/she does not play “peek-a-boo”;
  • If he/she does not respond to his/her name;
  • if he/she prefers to play alone.

What are the risk factors that can impair development?

As the baby is moving more and more, parents should provide the safety of the place where the baby stays and plays. Parents should prevent the possibility of crashes, therefore harsh and fragile items must be removed. Keep away poisons and small items that can cause choking.

Parents should remove water tanks, pools, sink and bathtub, because the baby can drown in a small amount of water. Take into account that the child may come in contact with hot liquids and hot surfaces. Thus, parents must protect child from possible contact with power sources.

In addition, pay attention to the possible existence of signs of autism. If the baby does not babble or shows repeated gestures and he/she avoids communication and eye contact with others, you should contact a doctor.

Also, pay attention to the possibility of anemia, especially in children who are not fed with iron fortified infant formula or if the intake of vegetables is not sufficient.

What should parents do to encourage the development of baby at this age?

During this period, baby is dealing with temper tantrums. You should stay calm and support your baby, with love and tenderness. Do not punish your baby, but rather reward her / his for the good behavior.

The good way to have some pleasant time with your toddler is listening to music. Baby is curious and he / she likes new things, like new sounds and rhythms.

You should often repeat things through communication in order to give your baby confidence and security. For example, you may ask several times a day: “What does a cat say?” or “Where is the dog on the picture?”.

Remember that your baby certainly likes to play “peek-a-boo”,“patty-cake” or building a tower over and over again.

Summary and Recommendations

  • Your one-year-old will show developmental progresses every day. Knowing what to expect makes it easier for you to recognize the progresses and help the child to achieve them.
  • Cognitive Development: one-year olds are curious about the world around them, identify and point at objects; they can wake goodbye and play peek-a-boo and also look for a hidden object.
  • Motor Development: one-year-olds can stand up and walk with support and progressively with more independence. They can use pincer grasp to hold objects and turn pages of a book.
  • Social/Emotional Development: separation anxiety and fear of strangers are typical of this stage. Temper tantrums are frequent.
  • Language Development: the child can understand about 80 words and can say a few words other than “mama” and “dada”.
  • Each child has her/his own pace, but if you think your child is not developing adequately, seek for medical advice.

[mme_references]
References

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Development milestones 21 to 24 months

What should a baby be able to do between 21 and 24 months?

[mme_highlight] Toddlers at this age also perceive differences between the colors, shapes and sizes of objects. They begin to express their likes and dislikes. Between the 21st and 24th months, the child becomes a confident walker and a reliable runner. Children can also ride the tricycle. Toddler can say a sentence consisting of 2 to 4 words. [mme_highlight]

Each child develops at his/her own pace. During this period, children become increasingly aware of their capabilities. The toddler is still dependent on parental care and he/she believes that he/she is the center of the world. Nevertheless, children gradually begin to become more independent and improve their motor, cognitive, communicative and social skills every day.

Cognitive development

Children are now able to find the hidden object under several layers of blankets. Also, they like to hide the objects and then to ask parents to find them. They know to identify about 10 parts of body. Although they cannot name the colors, they definitely understand the difference between them. Toddlers at this age also perceive differences between the shapes and sizes of objects.

93% of children recognize the image in the mirror as their own body. In addition, they begin to express their likes and dislikes.

Motor development

Between the 21st and 24th months, the child becomes a confident walker and a reliable runner.

[mme_databox]

  • 97 % of children between 21 and 24 months can run;
  • 50% of children between 21 and 24 months can stand on one leg longer than 6 seconds (for instance, children can stand on one leg while the other is used to kick the ball) ;
  • 90% of children between 21 and 24 months can stand on their tiptoes.

[/mme_databox]

Children can also ride the tricycle. During the previous months, he/she has mastered in climbing up the stairs and now the child overpowers climbing down the stairs.

A toddler of this age likes to play with a ball: she/he can throw the ball and catch it in a sitting position. Fine motor control is improved, so your child can grab small objects. You should expect your child to begin opening doors and closets, because she/he may now reach for door handle. In addition, children learn to undress themselves.

Children can walk backwards and they can pull the toy at the same time.

Regarding feeding at this age, researchers have found the data below:

[mme_databox]

  • 80% of the children were self-feeding until the end of 24 months;
  • 54% of children were using adult spoons by 24 months.

[/mme_databox]

Social / Emotional

He/she loves to play with older children and adults. On the other hand, toddlers still behave as they are the center of world, so they do not want to share toys with others and begin to show shyness in contact with strangers.  During this period, approximately 25 to 50% of children still suck their thumbs.

Now, child knows to show a wide variety of emotions (e.g. sympathy, joy, anger, modesty, guilt, fear etc.). According to a study from the University of Minnesota, 91 % of two year old children have temper tantrums once a week.

Language / communication

[mme_databox]
Average lexicon length by age

– 270  words by 22 months;

– 320 words by 23 months;

– 300 words by 24 months.

25 to 50% of speech is intelligible to unfamiliar adults. Children begin to use pronouns like “my” and “me”.

Toddler can say a sentence consisting of 2 to 4 words. The average age when child begins to say the sentence is 22.1 months and at the age of 24 months 60% of children have ability to combine the words.
[/mme_databox]

Representation of words in toddler’s vocabulary

[mme_databox]

  • about 50% of words are nouns
  • 50% of words are verbs or action words.

[/mme_databox]

What are the alarm signs parents should be aware of?

  • If the child does not point to objects when parents ask to identify an object;
  • If the child is silent during the play and there is no babbling;
  • If the child does not respond when his/her parents ask a question;
  • If the child does not use 2 word sentences (e.g. “no more”)
  • If the child does not imitate the behavior of adults;
  • If the child does not identify objects of daily routine (e.g. phone, hair brush etc.).

What are the risk factors that can impair development?

The child becomes more independent, which is directly related to the increased freedom to move. Therefore, you should protect the child from injury and keep the windows closed.

Make sure that the child does not play with toys that are not appropriate for the child’s age (e.g. too small toys). Parents should pay attention to what children put in the mouth, because choking is a common occurrence.

[mme_databox]
Choking in children

  • 60% of choking incidents were food-related;
  • 13% of choking incidents were caused by swallowing coins;
  • 19% of choking incidents were caused by swallowing gum or candy.

[/mme_databox]

Keep away from children medicines, cleaning products and chemicals. All of these can cause fatal poisoning.

What should parents do to encourage the development of baby at this age?

Encourage your child to play with a ball. You can kick the ball and encourage him/her to kick the ball back. You can also take the child to the park and watch him/her climbing on the equipment.

You should support all children’s attempts to communicate with you. Ask your child questions such as “What is this?”, “How can I use this?” Give your child a bunch of small toys to play in order to practice fine motor skills. When child completes simple tasks you entrusted to him/her, you should reward him/her.

Summary and Recommendations

  • Almost completing the second year of life, your child will continue showing developmental progresses every day. Knowing what to expect makes it easier for you to recognize the progresses and help the child to achieve them.
  • Cognitive Development: The child identifies about 10 parts of the body, distinguishes different shapes, colors and sizes and expresses likes and dislikes.
  • Motor Development: Most children at this period are confident walkers and reliable runners. They can stand on only one leg and they can ride a tricycle.
  • Social/Emotional Development: Children like to play with older children but still do not like to share toys. They express emotions and sometimes have temper tantrums.
  • Language Development: The lexicon incredibly enlarges and a good part of what a child says can be understood by an adult. They can build 4 words sentences.
  • Each child has her/his own pace, but if you think your child is not developing adequately, seek for medical advice.

[mme_references]
References

  • American Academy of Pediatrics. (1999) Steven P. Shelov, S.P. & Hannemann, R.E. (eds.)Caring for Baby and Young Child: Birth to Age 5. New York: Bantam.
  • Rossetti, L.M. (2005) The Rossetti Infant-Toddler Language Scale: A Measure of Communication and Interaction. East Moline:  LinguiSystems, Inc.
  • http://www.cdc.gov/ncbddd/actearly/milestones/milestones-2yr.html
  • Bates et al. Individual differences and their implications for theories of language development. Chapter 4 for Paul Fletcher & Brian MacWhinney (Eds.), Handbook of Child Language. Oxford: Basil Blackwell, 1995.

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Development milestones 18 to 21 months

Development milestones 18 to 21 months

[mme_highlight] Toddlers in this age group can identify about 6 parts of body. The child also begins to turn one page at a time.  Over 90% of children in this period can independently walk and 80 % of kids can run. [/mme_highlight]

In this period, children improve complex fine motor activities. The toddler continues the cognitive and social development, enjoys socializing with other children and begins to understand the importance of language for social interaction. Most children in this age group are ready to start toilet training.

Cognitive development

Toddlers in this age group can identify about 6 parts of body (e.g. child touches her/his nose when parents ask “Where is the nose?”). Also, they love to dance to the rhythm of music. Parents should expect the development of self-regulation (children begin to voluntarily control their behavior and attention). According to research, 33% of children between 18 to 20 months are able to voluntarily control their behavior.

In addition, children become aware of themselves (self-awareness). 68% of children recognize the image in the mirror as their own body.

Children love to imitate their parents (e.g. during the game, toddlers choose similar toys that parents take and use them the same way). 84% of children perform synchronic imitation and the duration of imitation lasts from 10 to 20 seconds in 18 months old children; the duration increases by 21 months old toddlers (26 to 39 seconds).

At this age, a toddler can identify objects that are used in the daily routine (spoon, phone, hairbrush etc.). The child also begins to turn one page at a time and knows to identify (e.g. pointing to picture when parents ask “Where is the dog?”):

  • At least 2 pictures with animals;
  • On average 4 pictures with animals.

Motor development

Over 90% of children in this period can independently walk and 80 % of kids can run. 98 % of children at the age of 18 months walk with heel strike. He/she begins to climb the stairs, but also to climb the furniture. The child is now also able to walk back a few steps, can climb up and down on chairs and perform other actions while walking (pushing or pulling a toy while walking).

At the age of 20 months, the child is able to squat without holding on, grab a toy, get up and keep on going, but she/he is still insecure in overcoming the obstacles and often falls down.

The toddler continues to improve coordination and to develop fine motor skills, so do not be surprised if your child begins to use a crayon and starts to scribble on a paper. In addition, children are able to independently drink from a cup and eat using a spoon. They love to play with blocks and they should know to build a tower with at least 4 blocks.

Social/Emotional skills

In this period child enjoys the company of adults, and especially loves to play with older children. The toddler can act aggressively (hitting or pulling hair) and this is normal because she/he wants to try out new patterns of behavior.

Children often imitate everyday situations and conversations through play. At the age of 18 months, 85% of children begin to pretend play (e.g. brush doll’s hair, use vacuum cleaner etc.).

Language/communication development

At the age of 18 months toddler has about 10 words in the vocabulary. At the age of 21 months, a child knows to say about 20 words. He/she understands two-steps commands (e.g. “go, get a toy!”) and begins to link two words in phrases, such as “no more”. About 30% of children have the ability of combining words.

[mme_databox]
Representation of words in toddler’s vocabulary

  • 60 % of toddler’s first 50 words are nouns;
  • Less than 20% of words are verbs or action words.

[mme_databox]

It was noticed that children whose parents read stories at 6 months of age have 40% increase in receptive vocabulary at the age of 18 months. On the other hand, toddlers whose parents did not use to read have only a 16 % increase in receptive vocabulary.

What are the alarm signs parents should be aware of?

  • If the child does not walk independently until 21 months;
  • If the child does not imitate adults;
  • If the child cannot identify objects present in everyday use;
  • If the toddler cannot say at least 6 words;
  • If the child does not babble trying to imitate the adults’ conversation;
  • If the child does not show interest in peers;
  • If the toddler cannot understand simple instructions.

What are the risk factors that can impair development?

During this period, the child likes to climb all over the furniture. Therefore, you should pay attention and protect the child from falling. Tipping over the furniture is the cause for 12% of baby walker injuries. In addition, parents should install stair gates because falling down the stairs is the cause of 76% of baby walker injuries.

Parents should remove dangerous objects (knives, glassware etc.) and ensure that child cannot reach them when he/she climbs on a piece of furniture. Parents should also remove items that can easily fall hurting the child.

The child is curious and he/she likes to touch and see everything. So, you should keep her/him away from sources of fire and make sure that toddler has no access to hot irons or oven.

What should parents do to encourage the development of the baby at this age?

At this age, parents should talk to the child as much as possible (e.g. explain the function of the object) as this helps to enrich the child’s vocabulary. It is recommended to arrange puzzles with large pieces.

Parents should involve children in their daily routine and encourage them to imitate everyday situations (e.g. Give your child toys in the form of cooking set and encourage her/him to imitate adults). In addition, ask your child to identify the parts of body and familiar objects.

Parents should be supportive and patient during toilet training and should reward child for a well-done task.

Summary and Recommendations

  • Between 18 and 21 months of age, your child will show developmental progresses every day. Knowing what to expect makes it easier for you to recognize the progresses and help the child to achieve them.
  • Cognitive Development: The child identifies parts of the body, loves to dance and listen to new rhythms. Children develop a sense of self-awareness and can turn one page at a time while reading a book.
  • Motor Development: Most children walk by 18 months, use crayons and build a tower of 4 blocks.
  • Social/Emotional Development: Children love to play with older children.
  • Language Development: By 18 months the lexicon is composed of 10 words and of 20 words by 21 months.
  • Each child has her/his own pace, but if you think your child is not developing adequately, seek for medical advice.

[mme_references]
References

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Development milestones 15 to 18 months

Development milestones 15 to 18 months

[mme_highlight] Your toddler can now hold the cup and drink from it without spilling the contents, as well as chewing the food well. . Now he/ she can also walk without support and carry objects while walking.       A 15-18 month old child can make choices. He/ she can choose what to wear, eat or play.  [mme_highlight]

The home of a “15 to 18 months old child” is easily recognizable. Moms have a hard time keeping things organized. Open shelves and toy boxes are always a mess. It is sometimes difficult for parents to understand what their child needs. Indeed, your child is now recognizing you and expressing his/her love through words. You may be surprised to see how your child can now play balls and balance that glass of milk. If you have these experiences to share, your child is on the right track as far as developmental cycle is concerned.

For the better understanding of the developmental milestones, we will divide the skill-set into four sections: motor, cognitive, social and language skills.

Motor skills

Now your child has become physically more independent. Your toddler can now hold the cup and drink from it without spilling the contents, as well as chewing the food well. Some data related to food intake manners are described below.

[mme_databox]

  • 55 % of 15 months old children can drink from a cup;
  • 90 % of 15 months old children can eat bread or biscuit without help;
  • 64 % of 15 to 18 months old children can eat with a spoon.

[/mme_databox]

Your child can recognize the objects and get pick them if asked to. Now he/ she can also walk without support and carry objects while walking.

[mme_databox]

  • 97 % of 15 months old children can stand alone;
  • 95 % of 15 months old children can walk without support.

[/mme_databox]

Balancing is one skill they seem to have mastered in, so do not be surprised if you see your toddler building a wall with cubes. Children love balls and by now they can throw and pick them. You should be extra cautious as the toddlers can now open the closed doors.

Cognitive skills

A 15-18 month old child can make choices. He/ she can choose what to wear, eat or play. You can be surprised as to how much recognition capacity your child has developed. He /She can identify family members in the photographs and remember more things. They have developed a little insight about the life around them and understand the cause and effect relationship. So they know that when you turn off lights, it is dark. Do not be confused when your toddler does things over and over again. This is a skill that helps them to understand how something works polishing their problem-solving skill.

[mme_databox]
Children at this age love imitating their parents and siblings:

  • 40 % of 15 months old children imitate parents’ activities and daily household routines.
  • 75 % of 18 months old children imitate parents’ activities and daily household routines.

[/mme_databox]

Language skills

Reading to your child everyday is a very healthy practice. Frequent use of words helps them to build vocabulary. Toddlers at this stage understand and respond to your simple directions such as standing up or sitting down. Children are very expressive with words and they figure out how to express better. Though their lexicon contains only 10-20 words, those faces express what is in their hearts.

Social Skills

Socializing, like the other skills, is updated on a daily basis. Children at 15-18 months can understand “you” and “me”. They are now interested in strangers and play with other children, though claim things that are not theirs. So words like “me” and “mine” are an important part of their vocabulary.

What should parents do to encourage their children development at this age?

In order to improve using of fingers, parents could encourage children to play a toy like a piano. Also, parents should teach children to make choices through simple games and ask children to make choices, for instance, choosing a toy among others. In addition, include your child in household routines and teach him/her to recognize objects and understand their function.

Identifying of body parts is a useful and interesting game. Also, imitation of familiar people and situations can be beneficial for your child’s development.

Risk factors: can autism be identified at 18 months?

Autism has gained significance in recent times. Children with autism do not need sympathy but they need opportunity to flourish. Years of research have brought in a tool that can help to assess the risk of autism in children at a very early age.  A brief evidence based understanding is presented below.

In 2000, Baird et al screened 16,235 children aged 18 months for childhood autism (CA) and studied them for 6 years, with further screening at 3 and 5 years. They used Checklist for Autism in Toddlers (CHAT) for the screening and identification of autism in children. At 18 months, nineteen cases of CA were identified using CHAT.
Children with other developmental disorders such as language disorders were also identified. VanDenHeuvel et al (2007) came to a conclusion that the use of CHAT can be a valuable tool to assess autism at an early stage in the life of the child.

Summary and Recommendations

  • Between 15 to 18 months, your child will show developmental progresses every day. Knowing what to expect makes it easier for you to recognize the progresses and help the child to achieve them.
  • Cognitive Development: your child begins making choices: between toys, food, clothes… Imitating behavior is frequent and should be encouraged at this stage.
  • Motor Development: child are able to drink from a cup, chews food well and is capable of using a spoon. Children become able of independently walking and even walking while carrying objects.
  • Social/Emotional Development: Your child plays with others, but frequently claims things that do not belong to her/him.
  • Language Development: the lexicon comprises about 10 to 20 words, but the child also expresses a lot with her/his face.
  • Each child has her/his own pace, but if you think your child is not developing adequately, seek for medical advice.

[mme_references]
References

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