Study guide growth and development 2007 2008

Study Guide Block Growth and Development
CURRICULUM
Aims:
• To assess growth and development in children and adolescents.
• To diagnose, manage, and refer if required, common disorders of growth and
development.
• Awareness of the general means to assess fetal growth (intrauterine growth).
• Awareness of the common health implications of normal and abnormal aging.
Learning outcomes:
• Assess physical growth of children and adolescents.
• Diagnose and manage common nutritional problems in children and adolescents.
• Investigate infant or child with suspect failure to thrive.
• Identify common congenital anomalies in infants and children.
• Assess fetal growth (intrauterine growth).
• Assess development of children in specific domains.
• Awareness of common developmental disorders in children.
• Awareness of the normal sexual developmental sequence in children and
adolescents.
• Capability to evaluate critically the use of medicine in pregnancy, children, and
elderly.
• Detection of developmental deviation in children (Screening & Stimulation).
• Awareness of the impacts of aging on the common health parameters of the elderly.
• Awareness of the common clinical manifestations and disorders in the elderly.
• Diagnose and manage common health problems and disorders in the elderly.
Curriculum contents:
• Normal growth patterns in children and adolescents.
• Nutritional impacts on growth (and development) in infant, children and adolescents.
• Clinical manifestations and diagnosis of failure to thrive.
• Common congenital anomalies in infants and young children.
• Clinical assessment of intrauterine growth (fetal growth).
• Drug recommendation and toxicity on pregnancy and Children.
• Assess development of children and adolescents in specific domains.
• Methods of developmental deviation detection and stimulation.
• Common developmental disorders in children and adolescents.
• Diagnose common sexual developmental problems in children and adolescents.
• Aging and physiologic changes in health parameters.
• Common clinical manifestations and problems and management in the elderly.
Udayana University Faculty of Medicine, MEU 1

PLANNERS TEAM
NO NAME DEPARTMENT
1. dr. I G A Trisna Windiani, SpA (Head) Child Health
2. dr. I NG Wardana, S.Ked (Secretary) Anatomy
3. Prof. dr. Soetjiningsih, SpAK, IBCLC Child Health
4. dr. I N Mangku K, M.Repro Anatomy
5. dr. Eka Putra S, Sp.THT ENT
6. dr. I Komang Kari, SpA (K) Child Health
7. dr. I Made Kardana, SpA Child Health
8. dr. I KG Suandi, SpA Child Health
9. dr. AAN Prayoga, SpA Child Health
10. dr. W Bikin Suryawan, SpAK Child Health
11. dr. N. Sunerti, SpM Ophthalmology
12. dr. IGA Endah Ardjana, SpKJ Child Health
13. dr. R A Tuty Kuswardhani, SpPD Geriatri
14. dr. Nyoman Astika, SpPD Geriatri
15. dr. Tjok Gd Suardewa, SpOG Obstetri & Gynaecoogy
~ LECTURERS ~
NO NAME DEPARTMENT
1. dr. I G A Trisna Windiani, SpA (Head) Child Health
2. Prof. dr. Soetjiningsih, SpAK, IBCLC Child Health
3. dr. I N Mangku K, M.Repro Anatomy
4. dr. Eka Putra S, Sp.THT ENT
5. dr. I Komang Kari, SpA (K) Child Health
6. dr. I Made Kardana, SpA Child Health
7. dr. I KG Suandi, SpA Child Health
8. dr. AAN Prayoga, SpA Child Health
9. dr. W Bikin Suryawan, SpAK Child Health
10. dr. N. Sunerti, SpM Ophthalmology
11. dr. IGA Endah Ardjana, SpKJ Child Health
12. dr. R A Tuty Kuswardhani, SpPD Geriatri
13. dr. Nyoman Astika, SpPD Geriatri
14. dr. Tjok G A Suwardewa, SpOG Obstetri &Gynaecoogy
15. dr. Wayan Suwitra, Sp.HK Histology
FACILITATORS
Regular Class:
No Name Department Phone Group Venue
1 dr. Nyoman Astika, Sp.PD Geriatri 08123974128 1
2nd
floor:
R.2.01
2 dr. Muliani, S.Ked Anatomy 08123900767 2
2nd
floor:
R.2.02
3 Ni Wyn Tianing, S.Si.,M.Kes Biochemistry 08123982504 3
2nd
floor:
R.2.03
4 dr. Ketut Ngurah Parasitology - 4
2nd
floor:
R.2.04

5 dr. Susi Purnawati Physiology 08123989891 5
2nd
floor:
R.2.05
6 dr. Wayan Suwitra Histology 08123803996 6
2nd
floor:
R.2.06
7 dr. Ratna Sundari Physiology 08123963634 7
2nd
floor:
R.2.07
8 dr. Wayan Sugiritama, M.Kes Histology 08164732743 8
2nd
floor:
R.2.08
9 dr. I G K Arijana Histology 08124665966 9
2nd
floor:
R.2.09
10 dr. I Nyoman Wartana Parasitology 081558119779 10
2nd
floor:
R.2.10
11 dr. I GA Sri Mahendra D, SpPA
Phatologi
Anatomy
- 11
3rd
floor:
R.3.26
12 Drs. Made Rustika, Msi Physichology 08123958663 12
3rd
floor:
R.3.27
English Class:
No Name Department Phone Group Room
1 dr. Hengky Forensic 08123988486 1
2nd
floor:
R.2.01
2 dr. I N Mangku K, M.Repro Anatomy 0811387105 2
2nd
floor:
R.2.02
3 dr. Ni Wayan Winarti
Pathology
Anatomy
08123997328 3
2nd
floor:
R.2.03
4 dr. A A Wiradewi Lestari, SpPA
Phatologi
Anatomy
08555237937 4
2nd
floor:
R.2.04
5 dr. I N G Wardana, S.Ked Anatomy 0361-7864957 5
2nd
floor:
R.2.05
6 dr. I B Putu Alit, SpF Forensic 081916361398 6
2nd
floor:
R.2.06
7 dr. Matinus Noerwidjaja Anatomy 08123803718 7
2nd
floor:
R.2.07
8 dr. Siany Herawati, SpPK
Clinical
Pathology
0818566411 8
2nd
floor:
R.2.08
9 dr. Dsk Md Wihandani, M.Kes Biochemistry 081338776244 9
2nd
floor:
R.2.09
10 dr. Yuliana, S.Ked Anatomy 0816555671 10
2nd
floor:
R.2.10
Reserve
No Name Department Phone
1 dr. I GA Widianti Anatomy 08123921765
2 dr. Dwi Fatmawati Microbiology 0818557082
3 dr. Sri Widnyani
Pathology
Anatomy
081337115012
4 dr. I GN Swarba, SpA Child Health 08123994911
5 dr. Made Arimbawa, SpA Child Health 085237052159

~ TIME TABLE ~
Regular Class
DAY/
DATE
TIME ACTIVITY VENUE CONVEYER
LEARNING OUTCOMES 1: ASSESS PHYSICAL GROWTH OF CHILDREN AND ADOLESCENTS
1
Friday
14 Dec 07
08.00 - 08.30
08.30 - 09.00
09.00 - 11.00
11.00 - 12.00
12.00 - 12.30
Intro: General Concepts of
Growth and Development
Lecture 1: Assessment
Physical Growth of
Children And
Adolescents
Individual learning
Group discussion
Plenary
Class room
Class room
-
Discussion room
Class room
Prof. Soetji
Prof. Soetji
Facilitator
Prof. Soetji
LEARNING OUTCOMES 2: ASSESS FETAL GROWTH (INTRAUTERINE GROWTH)
2
Monday
17 Dec 07
08.00 - 09.00
09.00 - 11.00
11.00 - 12.00
12.00 - 12.30
Lecture 2: The Stages of
Prenatal Development
Individual learning
Group discussion
Plenary
Class room
-
Discussion room
Class room
Mangku K
Facilitator
Mangku K
3
Tuesday
18 Dec 07
08.00 - 08.30
08.30 - 09.00
09.00 - 11.00
11.00 - 12.00
12.00 - 12.30
Lecture 3: USG to
Assess Fetal Anatomy
in Neonatus
Individual learning
Group discussion
Plenary
Class room
Class room
-
Discussion room
Class room
Tjok Suardewa
Kardana
Facilitator
Tjok S & Kardana
LEARNING OUTCOMES 3: IDENTIFY COMMON CONGENITAL ANOMALIES IN INFANTS AND
CHILDREN
4
Wednesday
19 Dec 07
08.00 - 09.00
09.00 - 11.00
11.00 - 12.00
12.00 - 12.30
Lecture 5: Prenatal
Genetic Evaluation and
Counseling
Individual learning
Group discussion
Plenary
Class room
-
Discussion room
Class room
Suwitra
Facilitator
Suwitra
LEARNING OUTCOMES 4: CAPABILITY TO EVALUATE CRITICALLY THE USE OF MEDICINE IN
PREGNANCY, CHILDREN, AND ELDERLY
5
Thursday
27 Dec 07
08.00 - 09.00
09.00 - 11.00
11.00 - 12.00
12.00 - 12.30
Lecture 6: Drugs in
Pregnancy, Children, and
Elderly
Individual learning
Group discussion
Plenary
Class room
-
Discussion room
Class room
Jawi
Facilitator
Jawi
LEARNING OUTCOMES 5: DIAGNOSE AND MANAGE COMMON NUTRITIONAL PROBLEMS IN
CHILDREN AND ADOLESCENTS
6
Friday
28 Dec 07
08.00 - 08.30 Lecture 7: Principles
Breastfeeding for Infants
With Normal Delivery
Class room Prof. Soetji

08.30 - 09.00
09.00 - 11.00
11.00 - 12.00
12.00 - 12.30
Lecture 8: Principles
Feeding for Infants With
Complicated Delivery
Individual learning
Group discussion
Plenary
-
Discussion room
Class room
Kardana
Facilitator
Soetji & Kardana
7
Wednesday
2 Jan 08
08.00 - 08.30
08.30 - 09.00
09.00 - 11.00
11.00 - 12.00
12.00 - 12.30
Lecture 9: Vitamin A, Fe &
Iodine Deficiencies
Lecture 10: Protein Energy
Malnutrition (PEM) &
Obesity
Individual learning
Group discussion
Plenary
Class room
-
Discussion room
Class room
Prayoga
Suandi
Facilitator
Prayoga&Suandi
LEARNING OUTCOMES 6: INVESTIGATE INFANT OR CHILD WITH SUSPECT FAILURE TO THRIVE
8
Thursday
3 Jan 08
08.00 - 09.00
09.00 - 10.00
10.00 - 12.00
12.00 - 12.30
Lecture 11: Failure to
Thrive
Individual learning
Group discussion
Plenary
Class room
-
Discussion room
Class room
Suandi
Facilitator
Suandi
LEARNING OUTCOMES 7: ASSESS DEVELOPMENT OF CHILDREN IN SPECIFIC DOMAINS
9
Friday
4 Jan 08
08.00 - 08.30
08.30 - 09.00
09.00 - 11.00
11.00 - 12.00
12.00 - 12.30
Lecture 12: Assess
Development in Motoric
Domains
Lecture 13: Assess
Development in
Language Domains
Individual learning
Group discussion
Plenary
Class room
Class room
Discussion room
Class room
Trisna
Prof. Soetji
-
Facilitator
Trisna & Soetji
10
Tuesday
8 Jan 08
08.00 - 08.30
08.30 - 09.00
09.00 - 11.00
11.00 - 12.00
12.00 - 12.30
Lecture 14: Cognitive
Development
Lecture 15: Psychosocial
Development
Individual learning
Group discussion
Plenary
Class room
Class room
-
Discussion room
Class room
Rustika
Marheni
-
Facilitator
Rustika&Marheni
LEARNING OUTCOMES 8: DETECTION OF DEVELOPMENT DEVIATION IN CHILDREN (SCREENING AND
STIMULATION)
11
Wednesday
09 Jan 08
08.00 - 09.00
09.00 - 11.00
11.00 - 12.00
12.00 - 12.30
Lecture 16: Detection of
Developmental Deviation
In Children (Screening &
Stimulation)
Individual learning
Group discussion
Plenary
Class room
-
Discussion room
Class room
Prof. Soetji
& Trisna
-
Facilitator
Soetji & Trisna
LEARNING OUTCOMES 9: AWARENESS OF THE NORMAL SEXUAL DEVELOPMENT SEQUENCE IN
CHILDREN AND ADOLESCENT
12
Friday
11 Jan 08
08.00 - 09.00
09.00 - 11.00
11.00 - 12.00
Lecture 17: Sexual
Developmental Sequence
in Children and
Adolescent
Individual learning
Class room
-
Discussion room
Bikin S
Facilitator

12.00 - 12.30 Group discussion
Plenary
Class room Bikin S
LEARNING OUTCOMES 10: AWARENESS OF COMMON DEVELOPMENTAL DISORDERS IN CHILDREN
13
Saturday
12 Jan 08
08.00 - 08.30
08.30 - 09.00
09.00 - 11.00
11.00 - 12.00
12.00 - 12.30
Lecture 18: Visual
Impairment
Lecture 19: Hearing
Impairment
Individual learning
Group discussion
Plenary
Class room
Class room
-
Discussion room
Class room
Sunerti
Eka Putra
-
Facilitator
Sunerti & Eka
Putra
14
Monday
14 Jan 08
08.00 – 08.30
08.30 - 09.00
09.00 - 11.00
11.00 - 12.00
12.00 - 12.30
Lecturer 20: Learning
Disorders
Lecture 21: Down
Syndrome and Mental
Retardation
Individual learning
Group Discussion
Plenary
Class room
-
Discussion room
Class room
Endah
Endah
Facilitator
Endah
15
Tuesday
15 Jan 08
08.00 - 09.00
09.00 - 11.00
11.00 - 12.00
12.00 - 12.30
Lecture 22: Attention
Deficit/Hyperactivity
Disorders
Individual learning
Group discussion
Plenary
Class room
-
Discussion room
Class room
Trisna/Endah
Facilitator
Trisna/Endah
16
Wednesday
16 Jan 08
08.30 - 08.30
08.30 - 09.00
09.00 - 11.00
11.00 - 12.00
12.00 - 12.30
Lecture 23: Autism
Spectrum Disorders
Lecture 24: Cerebral Palsy
Individual learning
Group discussion
Plenary
Class room
Class room
-
Discussion room
Class room
Prof. Soetji
K Kari
-
Facilitator
Prof. Soetji &
K Kari
LEARNING OUTCOMES 11: AGING AND ITS CLINICAL IMPLICATIONS
17
Thursday
17 Jan 08
08.00 - 08.30
08.30 - 09.00
09.00 - 11.00
11.00 - 12.00
12.00 - 12.30
Lecture 25: Aging Process
Lecture 26: Clinical
Implication of Aging
Process
Individual learning
Group Discussion
Plenary
Class room
-
Discussion room
Class room
R A Tuty K
Astika
Facilitator
Tuty & Astika
18
Friday
18 Jan 08
Case Field
Visit to day care centre (TPA), Playgroup, Kindergarten, Primary Health Care,
Special Need School
19
Monday
21 Jan 08
08.00 - 10.20 Case Presentation Class room Team
20
Tuesday
22 Jan 08
Preparation for Examination
22
Friday
25 Jan 08
EXAMINATION
~ TIME TABLE ~

English Class
DAY/
DATE
TIME ACTIVITY VENUE CONVEYER
LEARNING OUTCOMES 1: ASSESS PHYSICAL GROWTH OF CHILDREN AND ADOLESCENTS
1
Friday
14 Dec 07
09.00 - 09.30
09.30 - 10.00
10.00 - 12.00
12.00 - 13.00
13.00 - 13.30
Intro: General Concepts of
Physical Growth of
Children And Adolescents
Individual learning
Group discussion
Plenary
Class room
Class room
-
Discussion room
Class room
Prof. Soetji
Prof. Soetji
Facilitator
Prof. Soetji
LEARNING OUTCOMES 2: ASSESS FETAL GROWTH (INTRAUTERINE GROWTH)
2
Monday
17 Dec 07
09.00 - 10.00
10.00 - 12.00
12.00 - 13.00
13.00 - 13.30
Lecture 2: The Stages of
Prenatal Development
Individual learning
Group discussion
Plenary
Class room
-
Discussion room
Class room
Mangku K
Facilitator
Mangku K
3
Tuesday
18 Dec 07
09.00 - 09.30
09.30 - 10.00
10.00 - 12.00
12.00 - 13.00
13.00 - 13.30
Lecture 3: USG to
Assess Fetal Anatomy
Growth and Development in
Neonatus
Individual learning
Group discussion
Plenary
Class room
Class room
-
Discussion room
Class room
Tjok Suardewa
Kardana
Facilitator
Tjok S & Kardana
LEARNING OUTCOMES 3: IDENTIFY COMMON CONGENITAL ANOMALIES IN INFANTS AND
CHILDREN
4
Wednesday
19 Dec 07
09.00 - 10.00
10.00 - 12.00
12.00 - 13.00
13.00 - 13.30
Lecture 5: Prenatal Genetic
Evaluation and Counseling
Individual learning
Group discussion
Plenary
Class room
-
Discussion room
Class room
Suwitra
Facilitator
Suwitra
LEARNING OUTCOMES 4: CAPABILITY TO EVALUATE CRITICALLY THE USE OF MEDICINE IN
PREGNANCY, CHILDREN, AND ELDERLY
5
Thursday
27 Dec 07
09.00 - 10.00
10.00 - 12.00
12.00 - 13.00
13.00 - 13.30
Lecture 6: Drugs in
Pregnancy, Children, and
Elderly
Individual learning
Group discussion
Plenary
Class room
-
Discussion room
Class room
Jawi
Facilitator
Jawi
LEARNING OUTCOMES 5: DIAGNOSE AND MANAGE COMMON NUTRITIONAL PROBLEMS IN
CHILDREN AND ADOLESCENTS
6
Friday
28 Dec 07
09.00 - 09.30
09.30 - 10.00
Breastfeeding for Infants
With Normal Delivery
Class room Prof. Soetji
Kardana

10.00 - 12.00
12.00 - 13.00
13.00 - 13.30
Feeding for Infants With
Complicated Delivery
Individual learning
Group discussion
Plenary
-
Discussion room
Class room Facilitator
Soetji & Kardana
7
Wednesday
2 Jan 08
09.00 - 09.30
09.30 - 10.00
10.00 - 12.00
12.00 - 13.00
13.00 - 13.30
Lecture 9: Vitamin A, Fe &
Iodine Deficiencies
Lecture 10: Protein Energy
Malnutrition (PEM) &
Obesity
Individual learning
Group discussion
Plenary
Class room
-
Discussion room
Class room
Prayoga
Suandi
Facilitator
Prayoga&Suandi
LEARNING OUTCOMES 6: INVESTIGATE INFANT OR CHILD WITH SUSPECT FAILURE TO THRIVE
8
Thursday
3 Jan 08
09.00 - 10.00
10.00 - 12.00
12.00 - 13.00
13.00 - 13.30
Lecture 11: Failure to Thrive
Individual learning
Group discussion
Plenary
Class room
-
Discussion room
Class room
Suandi
Facilitator
Suandi
LEARNING OUTCOMES 7: ASSESS DEVELOPMENT OF CHILDREN IN SPECIFIC DOMAINS
9
Friday
4 Jan 08
09.0 - 09.30
09.30 – 10.00
10.00 - 12.00
12.00 - 13.00
13.00 - 13.30
Lecture 12: Assess
Development in Motoric
Domains
Lecture 13: Assess
Development in Language
Domains
Individual learning
Group discussion
Plenary
Class room
Class room
-
Discussion room
Class room
Trisna
Prof. Soetji
-
Facilitator
Trisna & Soetji
10
Wednesday
9 Jan 08
09.00 - 09.30
09.30 - 10.00
10.00 - 12.00
12.00 - 13.00
13.00 - 13.30
Lecture 14: Cognitive
Development
Lecture 15: Psychosocial
Development
Individual learning
Group discussion
Plenary
Class room
Class room
-
Discussion room
Class room
Rustika
Marheni
-
Facilitator
Rustika&Marheni
LEARNING OUTCOMES 8: DETECTION OF DEVELOPMENT DEVIATION IN CHILDREN (SCREENING
AND STIMULATION)
11
Thursday
10 Jan 08
09.00 - 10.00
10.00 - 12.00
12.00 - 13.00
13.00 - 13.30
Lecture 16: Detection of
Developmental Deviation In
Children (Screening &
Stimulation)
Individual learning
Group discussion
Plenary
Class room
-
Discussion room
Class room
Prof. Soetji
& Trisna
-
Facilitator
Soetji & Trisna
LEARNING OUTCOMES 9: AWARENESS OF THE NORMAL SEXUAL DEVELOPMENT SEQUENCE IN
CHILDREN AND ADOLESCENT
12
Friday
11 Jan 08
09.00 - 10.00
10.00 - 12.00
12.00 - 13.00
13.00 - 13.30
Lecture 17: Sexual
Developmental Sequence in
Children and Adolescent
Individual learning
Group discussion
Plenary
Class room
-
Discussion room
Class room
Bikin S
Facilitator
Bikin S

LEARNING OUTCOMES 10: AWARENESS OF COMMON DEVELOPMENTAL DISORDERS IN CHILDREN
13
Saturday
12 Jan 08
09.00 - 09.30
09.30 - 10.00
10.00 - 12.00
12.00 - 13.00
13.00 - 13.30
Lecture 18: Visual
Impairment
Lecture 19: Hearing
Impairment
Individual learning
Group discussion
Plenary
Class room
Class room
-
Discussion room
Class room
Sunerti
Eka Putra
-
Facilitator
Sunerti & Eka
Putra
14
Monday
14 Jan 08
09.00 - 09.30
09.30 - 10.00
10.00 - 12.00
12.00 - 13.00
13.00 - 13.30
Lecturer 20: Learning
Disorders
Lecture 21: Down Syndrome
and Mental Retardation
Individual learning
Group Discussion
Plenary
Class room
-
Discussion room
Class room
Endah
Endah
Facilitator
Endah
15
Tuesday
15 Jan 08
09.00 - 10.00
10.00 - 12.00
12.00 - 13.00
13.00 - 13.30
Lecture 22: Attention
Deficit/Hyperactivity
Disorders
Individual learning
Group discussion
Plenary
Class room
-
Discussion room
Class room
Trisna/Endah
Facilitator
Trisna/Endah
16
Wednesday
16 Jan 08
09.00 - 09.30
09.30 - 10.00
10.00 - 12.00
12.00 - 13.00
13.00 - 13.30
Lecture 23: Autism
Spectrum Disorders
Lecture 24: Cerebral Palsy
Individual learning
Group discussion
Plenary
Class room
Class room
-
Discussion room
Class room
Prof. Soetji
K Kari
-
Facilitator
Prof. Soetji &
K Kari
LEARNING OUTCOMES 11: AGING AND ITS CLINICAL IMPLICATIONS
17
Thursday
17 Jan 08
09.00 - 09.30
09.30 - 10.00
10.00 - 12.00
12.00 - 13.00
13.00 - 13.30
Lecture 25: Aging Process
Lecture 26: Clinical
Implication of Aging
Process
Individual learning
Group Discussion
Plenary
Class room
-
Discussion room
Class room
R A Tuty K
Astika
Facilitator
Tuty & Astika
18
Friday
18 Jan 08
Case Field
Visit to day care centre (TPA), Playgroup, Kindergarten, Primary Health Care, Special
Need School
19
Monday
21 Jan 08
10.20 – 12.40 Case Presentation Class room Team
20
Tuesday
22 Jan 08
Preparation for Examination
22
Friday
25 Jan 08
EXAMINATION

~ MEETING ~
Meeting with the student representatives
The meeting between block planners and student group representatives will be held on
Saturday, 5 January 2008, at 09.00 until 11.00 at Class Room. In this meeting, all of the
student group representatives are expected to give suggestions and inputs or complaints
to the team planners for improvement. For this purpose, every student group should
choose one student as their representative to attend the meeting.
Meeting with the facilitators
The meeting between block planners and facilitators will take place on Saturday, 5
January 2008, at 11.00 until 13.00 at Class Room. In this meeting the facilitators are
expected to give suggestions and inputs to improve the study guide and the educational
process. Because of its importances, all facilitators are expected to attend and participate
in the meeting.
~ ASSESSMENT METHOD ~
Assessment will be carried out on Friday 25 January 2008. There will be 100 questions
consisting mostly of Multiple Choice Questions (MCQ). The minimal passing score for the
assessment is 70. Other than the examination score, your performance and attitude
during group discussions will also be considered in the calculation of your final score.

~ LEARNING PROGRAMS ~
LECTURE
Prof. dr. Soetjiningsih, SpAK, IBCLC
Learning outcomes
- To describe the general concept of growth and development
- To describe the stages in lifespan development
- To understand the conceptual differences between growth and development
- To describe the factors that may affect growth and development
Abstract
Lifespan development is a field of study that examines patterns of growth, change, and
stability in behavior that occur throughout the entire life span. The life span is usually divided into
broad age ranges: the prenatal period (the period from conception to birth); infancy and toddler
hood (birth to age 3); the preschool period (ages 3 to 6); middle childhood (ages 6 to 12);
adolescence (ages 12 to 20); young adulthood (ages 20 to 40); middle age (ages 40 to 60); and
late adulthood (age 60 to death).
Lifespan development specialists discuss development in several topics: physical
development (development involving the body’s physical make up, including the brain, nervous
system, muscles, senses, and the need for food, drink and sleep); cognitive development
(development involving the ways that growth and change in intellectual capabilities influence a
person’s behavior); personality development (development involving the ways that enduring
characteristics that differentiate one person from another change over the life span); and social
development ( the way in which individuals’ interactions with others and their social relationships
grow, change, and remain stable over the course of life).
Growth and development are an integral process. Growth refer to the metabolic change by
which an organism increases in size and changes shape. Growth refers to quantitative changes.
Changes in physical size and appearance are visible manifestations of the complex morphologic,
biochemical and physiologic changes taking place during childhood.
Child development is a process, a continuous series of purposeful changes, consisting of
many aspects, moving together at differing paces. Development refers to qualitative and
quantitative changes. There are 10 fundamental principles of development:
1. Development involves change
2. Early development is more critical than later development
3. Development is the product of maturation and learning
4. The developmental pattern is predictable
5. The developmental pattern has predictable characteristics
6. There are individual differences in development
7. There are periods in the developmental pattern
8. There are social expectations for every developmental period
9. Every area of development has potential hazards
10. Happiness varies at different periods in development
Udayana University Faculty of Medicine, MEU
Introductory lecture: General Concepts of
11

Lecture 1:
~ Assessment Physical Growth of
Children and Adolescents ~
Environmental and genetic factors influence growth and development. In Bronfenbrenner’s
ecological system theory, development is influenced at four levels: the microsystem, mesosystem,
exosystem and macrosystem.
Learning outcomes
- Describe the clinical importance of study physical growth
- Describe the normal patterns of the physical growth
- Understand factors that affecting physical growth
- Use of common growth parameter
Abstract
Physical growth usually refers to changes in size or mass. The most people usually think of
growth at the level of the whole child, the cells and internal structures that make up the child,
primarily by increasing in number or size.
Growth assessment is essential because almost any problems within the physiologic,
interpersonal and social domains can adversely affect growth. Anthropometry is an effective and
frequently performed child health screening procedure. The value of physical growth data
depends on their accuracy and reliability, how they are recorded and interpreted, and what follow-
up efforts are made after identification of growth abnormality.
The most powerful tool in growth assessment is the growth chart. Whenever possible, growth
should be assessed by plotting accurate measurements on growth charts and comparing each set
of measurements with previous measurements. The CDC Growth Charts 2000 are used to
measure growth, consist of 16 charts including “Body mass index (BMI) for-age percentile” for
boys and girls aged 2-20 years.
Normal growth patterns have spurts and plateaus, but some shifting on the percentile graphs
can be expected; however, large shifts warrant attention. Large discrepancies among height,
weight, and head circumference percentiles also diserve attention. Deviation in growth patterns
are nonspecific but important indicators of serious medical disorders. Deviations often provide the
first clue that something is wrong, occasionally even when the parents do not suspect a problem.
An accurate measurement of height, weight, and head circumference should be obtained at every
health supervision visit. Serial measurements are much more useful than single measurements
because they can help detect deviations from a particular child’s growth pattern even if the value
remains within statistically defined normal limits.
Factors affecting physical growth and health in infancy and toddlerhood continue to be
influential in early childhood. Heredity affects physical growth by regulating the production of
hormones. Extreme emotional deprivation can interfere with the production of growth hormone,
thereby stunting children's growth. Sleep difficulties, in the form of night waking and nightmares,
are common during the preschool years. Appetite decline is associated with a slower rate of
physical growth. Disease can lead to malnutrition, seriously undermining children's growth, an
effect that is especially common in developing countries.

Lecture 2:
~ The Stages of Prenatal
Development ~
Lecture 3:
~ USG to Assess Fetal
Anatomy ~
I Nym Mangku Karmaya
Learning outcomes
Describe the main stages of embryonic development for use to estimate the gestational age of
embryo.
Abstract
Early embryonic development is describe in stages because of the variable period it takes for
embryos to develop certain morphological characteristics. Stage 1 of development begins at
fertilization and embryonic development ends at stages 23, which occur on day 57 and ends when
he fetus is completely outside the mother. The stages of embryonic development can be
assessed by ultrasonography. In general the period of prenatal development is as follows:
 1st
week : zygote-blastomeres-morula-blastocyst.
 2nd
week : bilaminar germ disc
 3rd
week : trilaminar germ disc
 3rd
- 8th
week : embryonic period/organogenesis
 8th
week-BIRTH : fetal period
Tjokorda Gde Agung Suwardewa
Learning outcomes
Apply of USG to assess fetal anatomy:
- Comprehend ultrasound waves generally
- Comprehend compartments of ultrasonography unit (USG)
- Comprehend how USG used for pregnant woman
- Safety ultrasound waves to the fetus
- Comprehend length, frequency, media of ultrasound waves
Abstract
Ultrasound is a sound waves with frequency more than 20,000 HZ. Normally we can
hearing of sound waves by frequency between 16,000-20,000 cycle per second (Hertz) (1
Megahertz=1000,000 Hz). The sound waves length in ultrasound compartment (USG unit) role
play to determine of resolution capacity that unit.
The pictures displayed on the screen is produced by sound waves reflected back from the
imaged structure. Alternating current is applied to a transducer containing piezoelectric crystals,
which converts electric energy to high-frequency sound waves. A water soluble gel applied to the
skin acts as coupling agent. Sound waves pass through layers of tissue, encounter an interface
between tissues of deferent densities, and are reflected back to the transducer. Converted back
into electrical energy, they are displayed on the screen. Dense tissue such as white on the
screen. Fluid is anechoic and appearing black on the screen.
Higher-frequency transducers yield better images resolution, whereas lower frequencies
penetrate tissue more effectively. For examples, abdominal scanning is most commonly

performed with a 3-5 mHz transducer, but in early pregnancy, 7-10 mHz vaginal transducer may
provide excellent resolution because the fetus is close to the transducer.
Since the first obstetrical application of ultrasound imaging by Donald and co-worker
(1958), this technique has become indispensable for evaluation of the fetus. Some indications for
ultrasound examination are: confirm gestation location, fetal number, estimating gestational age,
fetal morphology/anatomy, fetal abnormality, placenta, amniotic fluid volume.
Kardana
Learning outcomes
- Apply the New Ballard Score to assess the gestational age of infant: the small for
gestational age (SGA), appropriate for gestational age (AGA), or large for gestational age
(LGA).
Abstract
Since the late 1960s, a variety of methods for assessing the gestational age of the newborn
infant have been developed. Currently, the most widely use system for the postnatal assessment
of gestational age is the New Ballard Score (NBS). This system includes both physical and
neurologic characteristics. The score spans from 10 (correlating with 20 weeks’ gestation) to 50
(correlating with 44 weeks gestation). The examination consists of six neuromuscular criteria and
six physical criteria. The neuromuscular criteria are based on the understanding that passive tone
is more useful than active tone in indicating gestational age. The neuromuscular maturity includes:
posture, square window, arm recoll, popliteal angel, scarf sign, and heal to ear. The physical
maturity includes: skin, lanugo hair, plantar surface, breast, ear and ear, and genitalia. The
examination of NBS is administered twice by two different examiners to ensure objective, and the
data entered on the chart.
Suwitra
Abstract
When Steele and Breg in 1966 demonstrated that amniotic fluid cells could be cultured to reveal
fetal karyotype, prenatal diagnosis has become a mayor medical genetic service, in the context of
prevention of specific genetic disorder
The demand for genetic testing is sure to rise if a screening procedure is developed to identify
pregnancies at risk of a chromosomal abnormality.
In some minds prenatal diagnosis is equated with the issue of abortion. For families at risk having
a child with condition that can be diagnosed prenatal, the option of monitoring pregnancies allow
the parents to undertake pregnancies that they would otherwise forego. Only about 2% of all
pregnancies in which there is prenatal diagnosis are terminated because of the fetus has genetic
defect. Much more often, the fetus is found to be unaffected and the pregnancy continues.
Indication of prenatal diagnosis:
Udayana University Faculty of Medicine, MEU
Lecture 4:
~ Assessment of Growth and Development
in Neonatus
14
Lecture 5:
~ Prenatal Genetic Evaluation and
Counseling ~

1. Mother age of 35 years or more
2. Previous child with chromosomal abnormality
3. Present of structural chromosomal abnormality
4. Family history of neural rube defect.
5. X-linked disorder in family
Techniques:
amniocentesis, chorionic villous sampling, ultrasonography, fetoscopy, prenatal
chromosome analysis, alpha-fetoprotein analysis,
Prenatal diagnose require the combined skill of obstetricians, laboratory scientist, geneticists. The
mayor concern in any prenatal diagnosis program is time or week of gestation for prenatal
diagnosis and it should be provided as early in pregnancy as possible.
Learning outcomes: after the lecture, the medical students have a knowledge obout:
a. The history of prenatal diagnosis
b. The aim of prenatal diagnose
c. The indications and techniques of prenatal diagnosis
d. The advantages and disadvantages of technique chosen

Lecture 6:
~ Drugs in Pregnancy, Children,
and Elderly ~
Made Jawi
Learning outcomes
After completing this lecture, the students should be able to:
- Describe the effect of drugs use in pregnancy.
- To Choose the safe drugs for pregnant women, children, and elderly
Abstract
When a woman becomes pregnant, it is very important for her to lead a healthy life: to eat plenty
of nourishing food, get plenty of rest, and exercise regularly. It is also vital that she avoid anything
that might harm her or her baby-to-be. It is especially important to give up alcohol, cigarettes, and
drugs. For a pregnant woman, drug abuse is doubly dangerous. First, drugs may harm her own
health, interfering with her ability to support the pregnancy. Second, some drugs can directly
impair prenatal development. Both prescription and over-the-counter drugs can be harmful, for her
own health and the health of her baby-to-be. So a woman should avoid all of them as much as
possible, from the time she first plans to become pregnant or learns that she is pregnant. Some
drugs can be harmful when used at any time during pregnancy; others, however, are particularly
damaging at specific stages. Most of the body organs and systems of the baby-to-be are formed
within the first ten weeks or so of pregnancy (calculated from the date of the last menstrual
period). During this stage, some drugs and alcohol in particular can cause malformations of such
parts of the developing fetus as the heart, the limbs, and the facial features. After about the tenth
week, the fetus should grow rapidly in weight and size. At this stage, certain drugs may damage
organs that are still developing, such as the eyes, as well as the nervous system. Continuing drug
use also increases the risk of miscarriage and premature delivery. But the greatest danger drugs
pose at this stage is their potential to interfere with normal growth. Intrauterine growth retardation
(IUGR) is likely to result in a low-birth weight baby a baby born too early, too small, or both. Low-
birth weight babies require special care and run a much higher risk of severe health problems or
even death.
Current Categories for Drug Use in Pregnancy
Category Description
A Adequate, well-controlled studies in pregnant women have not shown an
increased risk of fetal abnormalities.
B Animal studies have revealed no evidence of harm to the fetus; however,
there are no adequate and well-controlled studies in pregnant women.
Or
Animal studies have shown an adverse effect, but adequate and well-
controlled studies in pregnant women have failed to demonstrate a risk to
the fetus.
C Animal studies have shown an adverse effect and there are no adequate
and well-controlled studies in pregnant women.
Or
No animal studies have been conducted and there are no adequate and
well-controlled studies in pregnant women.
D Studies, adequate well-controlled or observational, in pregnant women have
demonstrated a risk to the fetus. However, the benefits of therapy may
outweigh the potential risk.
X Studies, adequate well-controlled or observational, in animals or pregnant
women have demonstrated positive evidence of fetal abnormalities. The use
of the product is contraindicated in women who are or may become
pregnant.

Lecture 7:
Apply the Principles of Breastfeeding for
Infants with Normal Deliveries
Both prescription and over-the-counter drugs can be harmful, for children and elderly.
There are a number of pharmacokinetic and pharmacodynamic differences between children or
pediatric, elderly and adult patients. Neonates ( 0 to 1 month), infants (1 to 12 month) and children
of increasing age are not simply small adult.
The drugs used by the elderly are the same as those that a younger person might take--
yet they can have a far different effect. It doesn’t matter whether a person has heart disease or
arthritis, osteoporosis, or high blood pressure, the story is the same: Because the organ systems
tend to function less efficiently as we age, medications are handled differently by our bodies. Here
are some of the most common changes affecting our health and our response to medicines:
The stomachs may not absorb food and medication as well as they did before. The
kidneys and livers don’t eliminate fluids and toxins in the same efficient manner.
All of the above contribute to the potential harm that medications can cause in the aging body. If a
kidney can’t eliminate a drug after it has done its work, it remains in the body longer, perhaps
causing an overdose or an adverse effect. If someone forgets to take a medication that regulates
the heart or blood pressure, a stroke or heart attack could be the result.
Any person over the age of 65 who is taking medications in the following categories should be
aware of the potential for increased side effects, overdose, and diminished efficacy: Antibiotics,
Anti histamines, Anti hypertensives, Antiulcer medicines, Blood thinners, Bronchodilators, Calcium
or potassium supplements, Cardiac medications, Corticosteroids, Estrogens, Over-the-counter
drugs containing alcohol (cough and cold medications) or caffeine, Pain relievers, Psychiatric
medications, Skin medications and creams
In the lecture will be discuss the effects of drugs to the embryo and how to choose drugs
for pregnant women, Children and Elderly
Abstract
Breast-feeding exclusively the recommended method for feeding normal infants during the
first 6 months of life. Breastfeeding should continue with the addition of appropriate foods, for two
years or more.
Breastfeeding has advantages for infants, mothers, families, and society. These advantages
include health, nutritional, immunologic, developmental, psychologic, social, economic, and
environmental benefits. Breast milk contains the right balance of nutrients to help the infant grow
into a strong and healthy toddler. Some of the nutrients in breast milk also help protect the infant
against some common childhood illnesses and infections. While nutrients and antibodies pass to
the baby, beneficial hormones are released from the mother's body. Colostrums, a high protein
and low fat lactose product, are produced in small amounts during the first few postpartum days. It
has some nutritional value but primarily has important immunologic and maturational properties.
The bond between baby and mother can also be strengthened during breastfeeding.
Breastfeeding doesn't always happen easily. Some new mums find it hard to get started, while
others hit problems later on. Breast tenderness, engorgement, and cracked nipples are the most
common problems encountered by mothers who are breast-feeding.

Lecture 8:
~ The Principles of Feeding for Infants with
Complicated Deliveries ~
Lecture 9:
~ Vitamin A and Fe Deficiency ~
~ Iodine Deficiency ~
Kardana
Learning outcomes
- To know indication of enteral and parenteral nutrition
- To know the type nutrition’s for enteral feeding
- To know the routes of enteral feeding and feeding technique
- To know the administration for parenteral nutrition
- To know the contents of total parenteral nutrition
Abstract
Providing adequate nutrition support to newborns is an important to know and understanding
the maturation, functional and physical disturbances to the baby. Optimal nutrition after birth
enhances future neurodevelopmental outcome. For term healthy infants should be breast-fed as
soon as possible within the first hour. Human milk is preferred for feeding term, preterm and sick
infants. The following criteria should usually be met before initiating infant’s feedings: no history of
excessive oral secretions, vomiting, or bilous-stained gastric aspirate, non-distended, soft
abdomen with normal bowel sound, and no respiration distress. If the baby is small or complicated
baby such as baby with the following associated conditions: perinatal asphyxia, hemodynamic
instability, sepsis, frequent episodic apnea and bradycardia etc, initiation of enteral feeding is
often precluded and parenteral nutrition can be initiation. Nutritional requirements in neonate
includes: calories to maintain weight and to induce weight gain, carbohydrates, proteins, fats,
vitamins and minerals and fluids.
A A Ngr Prayoga
~ Vitamin A and Fe Deficiency ~
Learning outcomes
- To understand the sign and symptom of patient with vitamin A and Fe deficiency
- To built diagnosis of patient with vitamin A and Fe deficiency
- To understand the treatment and prevention of patient with vitamin A and Fe deficiency
Abstract
Vitamin A is the generic term used to describe all retinoid having the biologic activity of all-
trans retinol. Vitamin A, a light yellow crystalline alcohol, has been named retinol in reference to
its specific function in the retina of the eye. The yellow-orange-red provitamin carotinoids, are
describe in the term of beta-carotene
A deficiency of Vitamin A is accompanied by keratinization of the mucous membranes that line the
respiratory tract, the alimentary canal, and the urinary tract, and by keratinization of the body skin
and epithelium of the eye, which lowers the barrier role played by these membranes in protection
of the body against infections. Prolonged deficiency may produce skin changes, night blindness,
and corneal ulceration.
Primary deficiencies of vitamin A are the result of dietary inadequacies. Secondary can result from
liver disease, protein-energy malnutrition, abetalipoproteinemia, or malabsorption due to bile acid

Lecture 10:
~ Protein Energy Malnutrition (PEM) ~
~ Obesity ~
insufficiency. Acute deficiency is treated with large oral doses of vitamin A and correction of the
usually concomitant protein-energy malnutrition. Massive intermittent dosing with 200,000 IU of
vitamin A can reduced mortality by 35 to 70 %.
Iron deficiency anemia is characterized by the production of small erythrocytes and
diminished level of circulating hemoglobin.
The three primary causes of iron deficiency anemia are chronic blood lose, faulty iron intake or
absorption and increased iron requirement.
The clinical findings are fatigue, anorexia, pica (pagophagia). Growth abnormalities, epithelial
disorders, and reduction in gastric acidity are common. Defect in structure and function of
epithelial tissue of tongue, nails, mouth, and stomach as deficiency becomes more severe.
The chief treatment for iron deficiency consists of oral administration of inorganic iron in the
ferrous form and nutritional care.
~ Iodine Deficiency ~
Learning outcomes
- To understand the sign and symptom of patient with iodine deficiency.
- To built diagnosis of patient with iodine deficiency.
- To understand the treatment and prevention of patient with iodine deficiency.
Abstract
Iodine is absorbed easily in the form of iodide, in circulation it occurs both as free and
protein-bound iodine. Iodine is stored in the thyroid, where it is used for synthesis of T3 and T4
when needed.
Lack of iodine intake is associated with the development of endemic or simple goiter, which is an
enlargement of thyroid gland. The deficiency may be absolute, especially in areas of subnormal
iodine intake, or relative subsequent to increased need for thyroid hormones, such as in the
female during adolescence, pregnancy, and lactation.
Severe iodine deficiency during gestation and early postnatal growth results in cretinism, a
syndrome characterized by mental deficiency, spastic diplegia, or quadriplegia, deaf mutism,
dysarthria, a characteristic shuffling gait, shortened stature, and hypothyroidism. Early diagnosis
and treatment are needed to prevent more severe of clinical sign and symptom.
IKG Suandi
~ Protein Energy Malnutrition (PEM) ~
Learning outcomes
- To understand the sign & symptom of patient with protein energy malnutrition (PEM)
- To built diagnosis of patient with protein energy malnutrition (PEM)
- To understand the treatment and prevention of the patient with protein energy malnutrition
(PEM)

Lecture 11:
~ Failure to Thrive ~
Abstract
Definition
PEM is a spectrum of conditions caused by varying levels of protein and calorie deficiencies. The
common form of primary PEM is marasmus and caused by severe caloric depletion. Kwashiorkor,
presenting with pitting edema caused by inadequate protein intake in the presence of fair to good
caloric intake. Secondary form of PEM is associated with other diseases.
Clinical manifestation
The clinical manifestation of marasmus: The body weight below 60% of expected for age or below
70% of the ideal weight for height and depleted body fat stores. Edema usually is absent. The
head may appear large but generally proportional to the body length. The clinical manifestation of
kwashiorkor: presenting pitting edema that starts in lower extremities and ascends with increasing
severity, may be a complication of critical illness (acute and chronic infections, multiorgan system
failure, anorexia nervosa, etc)
Treatment and prevention
Calories account of nutritional rehabilitation can be safety started at 20% above the child’s recent
intake. The calorie intake can be increased 10-20% per day until appropriate re-growth is initiated.
This may require 150% or more of the recommended calories for an age-matched, well nourished
child.
~ Obesity ~
Learning outcomes
- To understand the sign & symptom of patient with obesity
- To built diagnosis of patient with obesity
- To understand the treatment and prevention of the obesity
Epidemiology
The prevalence of obesity in children has increased in the last 2-3 decades, mainly in children as
young as 4-5 years.
Clinical manifestation
In children BMI (body mass index) age and gender specific percentile curves allow an assessment
of BMI percentile. In adolescent and adult BMI has been used in weight/height2
(kg/m2
).
The effects of obesity complication; such as psychosocial effect, growth (advanced bone age,
increased height, early menarche), CNS (pseudo tumor cerebri, respiratory (sleep apnea,
pickwickian syndrome), cardiovascular (hypertension, cardiac hypertrophy, ischemic heart
disease, sudden death), orthopedic (slipped capital femoral epiphysis, Blount disease), metabolic
(insulin resistance, type II diabetes mellitus, hypertriglyceridemia, hypercholesterolemia, gout,
hepatic steatosis, ovary disease, cholelithiasis).
The treatment and prevention of obesity includes a combination of education, behavior
modification, exercise and diet.
I KG Suandi
Learning outcomes
1. To apply the diagnostic criteria of patient with failure to thrive (FTT).
2. To discuss the cause or path physiology of patient with FTT.
3. To evaluate and manage a child with FTT.

Lecture 12 &13:
~ Assess Development in the Motoric and
Language Domains ~
Definition
The term ‘failure to thrive’ first was used to describe the malnutrition and depressed condition of
many institutionalized infants in early 1900s. It remains a descriptive rather than a diagnostic label
applied to children whose attained weight or rate of weight gain is significantly below that of other
children of similar age and same sex.
Table Definition of failure to thrive
Attained growth
1. Weight < 3rd
percentile on NCHS growth chart
2. Weight for height < 5th
percentile on NCHS growth chart
3. Weight 20% or more below ideal weight for height
4. Triceps skin fold thickness < 5 mm
Rate of growth
1. Depressed rate of weight gain
< 20 g/d from 0-3 months of age
< 15 g/d from 3-6 months of age
2. Fall-off from previously established growth curve
Downward crossing of > 2 major percentiles on NCHS growth chart
3. Documented weight loss
Patho physiology and clinical manifestation
FTT can result from wide range of factors, including serious medical disease, dysfunctional child-
caregiver interactions, poverty, parental misinformation, and child abuse. The physical
examination of a child who is growing poorly should focus on identifying sign of underlying organic
disease, severity of malnutrition, and important concomitant finding such as evident of physical
abuse/neglect or the presence of deprivational behaviors.
Management of the child with psychosocial failure to thrive must be individualized to the specific
needs of the child and family. Nutritional rehabilitation, efforts are focused on correcting the
dysfunctional child-parent interaction by addressing areas of parental misinformation, providing
and helping to implement specific feeding guidelines, and addressing the larger psychosocial
needs of the family. A multidisciplinary team approach involving the primary-care provider,
nutritionist, social worker, child behavior specialist, and community-based outreach services is
often most beneficial.
I GA Trisna W
~ Assess Development in The Motoric Domain ~
Learning outcomes:
- Describe gross and motor development
- Determine factors affecting motor development
Abstract
Child developmental consist of several skills like: 1) Gross motor: using large groups of
muscles to sit, stand, walk, run, etc., keeping balance, and changing positions; 2) Fine motor:
using hands to be able to eat, draw, dress, play, write, and do many other things; 3) Language:
speaking, using body language and gestures, communicating, and understanding what others

say; 4) Cognitive: Thinking skills: including learning, understanding, problem-solving, reasoning,
and remembering; 5) Social: Interacting with others, having relationships with family, friends, and
teachers, cooperating, and responding to the feelings of others.
Developmental milestones are a set of functional skills or age-specific tasks that most children
can do at a certain age range. Milestone can be described as what a child accomplishes
throughout the different stages in their life. We can use milestones to help check how our child is
developing. Although each milestone has an age level, the actual age when a normally
developing child reaches that milestone can very quite a bit. Every child is unique. To determine
whether a child has developmental delay, the physician must understand normal milestones
The red flag age is the age at which you would expect almost every child to have already
mastered a particular skill. For example walking, most children walk on their own, without holding
on, around their first birthday. By 15 months--the red flag age for walking--a child who has not
taken his first independent steps is certainly slower to walk than 90 percent of other children. Red
flag milestones are helpful because they put a limit on when you, as a good, concerned parent,
should worry.
Motor development means the development of control over bodily movements through the
coordinated activity of the nerve centers, the nerves and the muscles. This control comes from the
development of the reflexes and mass activity present at birth. Until this development occurs, the
child will remain helpless.
From longitudinal studies of babies and young children, five general principles of motor
development have emerged: 1) motor development depends on neural and muscular
development; 2) learning skills cannot occur until the child is maturationally ready; 3) motor
development follows a predictable pattern; 4) it is possible to establish norms for motor
development; and 5) there are individual differences in rate of motor development.
Motor development is divided into gross motor and fine motor development. Gross motor skills
refer to the ability of children to carry out activities that require large muscles or groups of
muscles. Muscles or groups of muscles should act in a coordinated fashion to accomplish a
movement or a series of movements. Examples of gross motor tasks are walking, running,
throwing something, jumping, standing on 1 leg, playing hopscotch, and swimming. Posture is an
important element to consider in the assessment of gross motor skills. Adequate posture may
make all the difference between being able or not able to execute a movement.
Fine motor skills consist of movements of small muscles that act in an organized and subtle
fashion, for instance, the hands, feet, and muscles of the head (as the tongue, lips, facial
muscles), to accomplish more difficult and delicate tasks. Fine motor skills are the basis of
coordination, which begins with transferring from hand to hand crossing the midline when aged 6
months. Examples of fine motor activities are writing, sewing, drawing, putting a puzzle together,
imitating subtle facial gestures, pronouncing words (which involve coordination of the soft palate,
tongue, and lips), blowing bubbles, and whistling. Many children who have difficulties in their fine
motor skills also have difficulties in articulating sounds or words.
The static and motor development of newborn into adult depends on the maturation process
of the central nervous system. The process of this development is determined by genetically
established patterns of behavior and stimulation from the environment. Some conditions that
influence the rate of motor development. These factors include genetic constitution, prenatal
condition, prematurity, nutrition, physical defects, stimulation, etc. They may contribute to poor
abilities in motor functioning and coordination difficulties
A decrease in movement during the process of motor development in the early stage of
development and abnormal reactions on examination of primary reflexes may reflect early signs
of motor handicaps.

~ Assess Development in The Language Domain ~
Learning outcomes
- Describe language development
- Determine factors affecting language development
Abstract
Speech and language are tools that humans use to communicate or share thoughts, ideas,
and emotions. Language is different from speech. Language is an elaborate system of
communication that uses arbitrary and socially agreed on symbols to transmit and to receive
messages from one human to another. Language is made up of socially shared rules that include
the following: what words mean; how to make new words; how to put words together; and what
word combinations are best in what situations. Speech is the verbal means of communicating.
Speech consists of the following: articulation (how speech sounds are made); voice (use of the
vocal folds and breathing to produce sound); and fluency (the rhythm of speech).
There are many languages in the world, each includes its own set of rules for phonology
(phonemes or speech sounds or, in the case of signed language, hand shapes), morphology
(word formation), syntax (sentence formation), semantics (word and sentence meaning), prosody
(intonation and rhythm of speech), and pragmatics (effective use of language).
The most intensive period of speech and language development for humans is during the first
three years of life, a period when the brain is developing and maturing. These skills appear to
develop best in a world that is rich with sounds, sights, and consistent exposure to the speech and
language of others. Children vary in their development of speech and language. There is,
however, a natural progression or "timetable" for mastery of these skills for each language. The
milestones are identifiable skills that can serve as a guide to normal development. Typically,
simple skills need to be reached before the more complex skills can be learned. There is a
general age and time when most children pass through these periods. These milestones help
doctors and other health professionals determine when a child may need extra help to learn to
speak or to use language.
When a person has trouble understanding others (receptive language), or sharing thoughts,
ideas, and feelings completely (expressive language), then he or she has a language disorder.
Receptive language refers to the ability to understand, encompasses visual (reading, sign
language comprehension) and auditory (listening comprehension) skills. Expressive language
refers to the ability to produce symbolic communication, this output may be either visual (writing,
signing) or auditory (speech)
Delay in speech and language development in children can be defined as a “delay in speech
and / or language development compared with controls matched for age, sex, cultural
background, and intelligence”, or a discrepancy between a child’s potential ability to speak and
the performance that is actually observed. Three common causes of speech delay are mental
retardation, hearing loss and maturation delay.
There are some conditions that contributing to variations in learning to speak i.e. health;
intelligence; socioeconomic status; sex; desire communicate; stimulation; size of family; ordinal
position; child-training methods; multiple birth; contact with peers; personality, etc.

Lecture 14:
~ Cognitive Development ~
Lecture 15:
~Psychosocial and Emotional Development~
Rustika
Learning outcomes:
a. To understand the basic principles of cognitive process.
b. To understand four stages of cognitive development
Abstract:
Most progressive change of human behavior related to cognitive development, so if someone
wants to understand growth and development of human being comprehensively, they should learn
about cognitive development.
Piaget specifies four stages of cognitive development. The major cognitive achievement in the
sensorimotor stage (which lasts from birth to about two years) is the development of the schema
of object permanency. Thus, the attainment of this knowledge is indicative of representational
ability. Such ability is involved in the major cognitive achievements in the preoperational stage
(which lasts from about two through six years). Here, true systems of representation develop (e.g.,
as indexed by language, symbolic play, and delayed imitation). With the emergence of the
concrete operational stage, however (which lasts from about six through twelve years),
conservations are typically seen; thus, operational structures – internalized actions that are
reversible – are evidence. The child cannot think counterfactually or hypothetically. Such ability
characterizes the last stage of cognitive development, the formal operational stage (which lasts
from about year twelve onward).
Marheni
Absract:
Psychosocial development as propounded by Erik Erikson describes eight developmental
stages through which a healthily developing human should pass from infancy to late adulthood. In
each stage the person confronts, and hopefully masters, new challenges. Each stage builds on
the successful completion of earlier stages. The challenges of stages not successfully completed
may be expected to reappear as problems in the future.
Erik Erikson developed the theory in the 1950s as an improvement on Sigmund Freud's
psychosexual stages. Erikson accepted many of Freud's theories (including the id, ego, and
superego, and Freud's infantile sexuality represented in psychosexual development), but rejected
Freud's attempt to describe personality solely on the basis of sexuality. Also, Erikson criticized
Freud for his concept of originology. This states that all mental illness can be traced to early
experiences in childhood. According to Erikson, experience in early childhood is important, but the
individual also develops within a social context. Erikson believed that childhood is very important
in personality development and, unlike Freud, felt that personality continued to develop beyond
five years of age. In his most influential work, Childhood and Society 1950, he divided the human
life cycle into eight psychosocial stages of development.
“ Human personality, in principle, develops according to steps predetermined in the growing person's
readiness to be driven toward, to be aware of, and to interact with a widening social radius. ”
—Erik Erikson

Lecture 16:
~ Detection of Developmental Deviation in
Children (Screening & Stimulation) ~
dr. I GA Trisna Windiani, SpA
Learning outcomes
- Describe the aims of detection developmental deviation
- Recognize the methods of detection developmental deviation
- Apply methods of detection developmental deviation (Denver test, Pediatric Symptom
Checklist / PSC test)
- Describe the aims of stimulation developmental deviation
- Understand the principles of early stimulation
- Recognize the methods of stimulation developmental deviation
Abstract
Developmental screening is a brief evaluation of developmental skills that is applied to a total
population of children to identify children with suspected delays who require further diagnostic
assessment. Developmental screening involves the use of standardized screening tests.
Screening tests can be categorized as general screening tests that cover all behavioral domains
or as targeted screens that focus on one area of developmental. They can administer in the office
setting by professionals or completed at home by parents.
The Pediatric Symptom Checklist is a psychosocial screen designed to facilitate the
recognition of cognitive, emotional, and behavioral problems so that appropriate interventions can
be initiated as early as possible. Included here are two versions, the parent-completed version
(PSC) and the youth self-report (Y-PSC). PSC can be administered to 4-18 years old while Y-
PSC can be administered to adolescents ages 11 and up.
The Denver II is design to be used with apparently well children between birth and six years of
age and is administered by assessing a child’s performance on various age appropriate tasks.
The test is valuable in screening asymptomatic children for possible problem, in continuing
intuitive suspicious with an objective measure, and in monitoring children at risk for developmental
problems, such as those who have experienced perinatal difficulties. The Denver II consist of 125
tasks, or items which arranged on the test form in four sectors to screen areas of function: 1)
personal social; 2) Fine motor adaptive; 3) Language; and 4) gross motor
Early intervention or stimulation is necessary and effective because development is
malleable and readily affected by the environment. In large part, early intervention works by
systematically removing external risk factors. Early intervention programs place children in
developmentally enriching settings; train parents in responsiveness and effectiveness, and
provide continuous positive redirection and focused building of skills. The benefits of early
intervention clearly depend on early detection, which requires that clinicians know how to identify
accurately patients who have disabilities. Because time and reimbursement are limited, clinicians
also should know how to identify patients quickly. Appropriate stimulation in childhood ranks as
one of the most important factors that influence childhood development.

Lecture 17:
~ Sexual Developmental Sequence in Children
and Adolescents ~
W Bikin Suryawan
Learning outcomes
- To interpret maturation of the hypothalamic-pituitary-gonadal axis and connecting with the
onset of puberty starts.
- To explain positive feedback and negative feedback in puberty regulation.
- To interpret kind of the factors affecting for sexual developmental.
- To explain the pubertal staging in boys and girls.
- To interpret the ovarian development and testicular development.
- To explain the process of adrenarche and gonarche in puberty starts.
Introduction
Puberty can be defined as maturation of the hypothalamic-pituitary-gonadal axis that results in
growth and development of the genital organs, and leads to the capacity to reproduce. Puberty is
characterized by a number of physical and psychological changes. The onset of puberty starts
with slow, frequent releases of gonadotropin releasing hormone (GnRH). GnRH is transported via
the portal system to gonadotropic cells at the pituitary level, where it stimulates the production and
release of the gonadotropins luteinizing hormone (LH) and follicle stimulating hormone (FSH). LH
and FSH then stimulate growth and production of hormones and other factors in the ovaries and
the testes, respectively. These secreted products are inhibitory (via negative feedback) at the
pituitary and hypothalamic levels. During maturation in females, positive feedback occurs, leading
to the mid-cycle LH surge.
Hormonal regulation
The release of the hypothalamic neurotransmitter GnRH is regulated by many factors, and is
subject to negative and positive feedback at the pituitary and hypothalamic levels. During
gestation, GnRH plasma levels increase; maximum levels are attained at 22-25 weeks of
gestation in female fetuses and at 34-38 weeks of gestation in male fetuses. In primate studies,
gamma-amino butyric acid (GABA) and other substances have been associated with decreased
GnRH release, although stimulating effects of GABA have been observed as well. In primates,
disinhibition of GnRH neurons by GABA is critical for the onset of puberty. In humans, low
gonadotropin levels during childhood may in fact be due to tonic inhibition of GnRH by GABA.
GnRH stimulates the production and release of both LH and FSH. GnRH levels are difficult to
measure directly, since GnRH is secreted into the portal circulation and transported directly to the
pituitary. GnRH is secreted in a pulsatile pattern. Simultaneous episodic fluctuations of GnRH in
the portal blood and LH in the peripheral blood have been observed in sheep. A pulsatile pattern
of LH release has been observed in humans as well, and it can be assumed that this pattern
reflects pulsatile GnRH release. Fluctuations in FSH levels are not as marked as those in LH
levels in humans, and are not always synchronized with LH pulses. As puberty progresses, LH
secretion gradually increases, and occurs both during the day and during the night. This increase
in LH secretion can be attributed to both enhanced LH pulse frequency and enhanced LH pulse
amplitude. During puberty, the day-night rhythm is maintained; however, this with the progression
of puberty in girls, the response to a challenge of exogenous GnRH increases as well. During
prepuberty (pubertal stage B1), when endogenous GnRH stimulation is low, there is little or no
increase in gonadotropins following such a challenge. From pubertal stages B2 to B5, a GnRH

challenge leads to increases in LH and FSH in girls (see also the subchapter entitled ‘Pubertal
staging’).
In girls, there is a remarkable exception for FSH in stage B2. High GnRH-stimulated levels of FSH
alone characterize this stage. The FSH response is much lower in stage B3. In their study, they
observed that the mean weight of 48 kg at menarche remained constant with increasing
menarcheal age, while mean height increased significantly with increasing menarcheal age. Later
studies in both female rats and humans showed that a particular ratio of fat to lean body mass is
necessary for puberty to begin and for maintainance of reproductive capacity.
Pubertal staging
In girls, puberty, which begins following increased release of GnRH, can best be defined as the
estrogen-dependent onset of breast development (thelarche), as increased estrogen levels are
the result of an active hypothalamic-pituitary-gonadal axis. Growth of pubic hair (pubarche) begins
following secretion of adrenal and ovarian androgens. In general, pubic hair appears a few
months after the onset of breast development. However, pubic hair development can occur in the
absence of breast development, as the result of an early adrenarche. Below are the 5 stages of
breast development described by Marshall and Tanner.
B1: In this pre-pubertal stage, which persists until puberty begins, only the nipple is raised above
the level of the skin.
B2: In this budding stage, a bud-shaped elevation of the areola and papilla becomes noticeable.
On palpation, a fairly hard “button” can be felt, and may be painful to the touch. The areola
increases in diameter and the surrounding area can be elevated. These changes may occur
earlier in one breast than in the other.
B3: Further elevation of the breasts occurs. The diameter of the areola increases further. The
shape of small adult mammary glands, with continuous contours, is apparent.
B4: Fat deposits increase. The areola and papilla enlarge further. The areola forms a secondary
elevation above that of the breast. This secondary mound is apparent in roughly half of girls and
may persist into adulthood.
B5: In this adult stage, the areola is usually recessed to the general contour of the breast. Pubic
hair grows as a result of exposure to androgens. In girls, these androgens, including DHEA-S, are
of adrenal origin. The ovaries also produce androgens such as 4-androstenedione.
Below are the 6 stages of pubic hair development in girls.
P1: In this pre-pubertal stage, there is no growth of pubic hair.
P2: A few lightly pigmented hairs, usually straight or only slightly curled, appear, chiefly along the
labia.
P3: Pubic hair is still sparse, yet there is definite pigmented, curly hair on the labia that also
spreads onto pubic mons.
P4: Pubic hair is “adult” in type, but the area covered is still considerably smaller than in adults.
There has been no spread of pubic hair up to inguinal fold.
P5: Pubic hair has an adult distribution in an inverse triangle, with horizontal lining on the pubic
mons and lateral spreading up to the inguinal fold.
P6: This stage is reached after adolescence in only in a minority of women. There is a further
extension of pubic hair laterally onto the thighs or upward onto the abdominal wall. In boys, the
first sign of pubertal development is testicular growth. A testicular volume greater than or equal to
4 mL indicates that the gonadal axis is active. Marshall and Tanner have described different

stages of testicular and penile growth. Below are the 5 stages of genital development described
by Marshall and Tanner.
G1: In this pre-pubertal state, the testes, scrotum, and penis are the same size and shape as in a
young child.
G2: The testes and scrotum become larger, with testicular volume greater than or equal to 4 mL.
The skin of the scrotum becomes redder, thinner, and wrinkled. The size of the penis is similar to
that in G1.
G3: The penis becomes larger, particularly in length. The testes and scrotum become even larger,
and the scrotum descends.
G4: The testes and scrotum become even larger, and the scrotal skin shows increased
pigmentation. This stage is “not quite adult”.
G5: In this stage, the external genitalia are adult in size and shape. The scrotum is ample, and
the penis and bottom of the scrotum reach to about the same level. Below are the 6 stages of
pubic hair development in boys.
P1: In this pre-pubertal stage, there has been no growth of pubic hair. There may be fine hair over
the pubes, but this growth is not different from that on the rest of the abdomen.
P2: A few lightly pigmented, longer, straight hairs, often still downy, appear at base of the penis
and sometimes on the scrotum.
P3: Hair that is still sparse, yet definitely pigmented, coarser, and curlier appears around the base
of the penis.
P4: Hair is “adult” in type, but the area covered by hair is still considerably smaller than in adults,
not going further than in the inguinal fold.
P5: Hair is adult in quantity and type and spreads up to the medial surface of the thighs, but not
up the linea alba.
P6: Further extension occurs laterally and up the linea alba after adolescence. The majority of
adult men reach this stage.
Ovarian development
Menarche, which usually occurs about 2.4 years after the start of breast development, does not
necessarily indicate that there is full interaction among the hypothalamus, the pituitary, and the
ovaries. In fact, during the first years after menarche, anovulatory cycles occur. Following this
stage, ovulation occurs after an LH surge as a result of positive feedback to estrogens. During
menstruation, gonadotropin levels (primarily levels of FSH) increase. FSH levels then decrease,
with gradual increases in estradiol.
Testicular development
In young, developing, 6- to 7-week-old embryos, gonadal tissue is undifferentiated. The presence
of the sex-determining region of the Y chromosome (SRY) triggers the tissue to differentiate to
become testes. In the absence of this SRY, the tissue would differentiate to become ovaries.
Undifferentiated gonadal tissue consists of 4 major cell lines:
1. Supporting cells develop into Sertoli cells, which have a paracrine function in
spermatogenesis. Their number is a limiting factor in spermatogenesis. Anti-Mullerian
hormone, a hormone secreted by Sertoli cells, is necessary for regression of the Mullerian
duct and influences gonadal differentiation.

Lecture 18:
~ Visual Impairment ~
2. Leydig cells, which are steroidogenic, produce androgens, which induce development of
secondary sex characteristics. In the human fetus, Leydig cells are present after 8 weeks
of gestation. During gestation and shortly after birth, these cells are functionally active,
secreting testosterone. Fetal Leydig cells eventually develop into adult-type Leydig cells,
which are responsible for pubertal development.
3. Connective cells give rise to peritubular myoid cells. These cells function along with
Sertoli cells to produce the basal lamina of testicular tissue. This basal lamina serves as a
base for testis cord formation.
4. Germ cells develop through several stages into spermatozoa. Testicular volume increases
3-fold between birth and 9 years of age, but remains at a prepubertal volume (i.e., <4 mL).
Gonadarche versus adrenarche
Androgens of adrenal origin, particularly dehydroepiandrosterone (DHEA) and its sulfate (DHEA-
S), are responsible for sexual hair development in girls. The point at which the adrenals increase
production of DHEA is known as adrenarche. In girls, pubic hair development occurs around the
same mean age as breast development (11 years).
Premature adrenarche is characterized by an early development of pubic hair, with little or no
increase in height velocity and without progressive bone maturation. Early pubic hair growth may
be an isolated event or may be accompanied by increased sweat and body odor, acne, axillary
hair, and/or fatty skin. In general, premature adrenarche does not require treatment.
In boys, pubic hair development is caused by adrenal and testicular androgens. Premature
adrenarche may occur in boys, but is diagnosed more often in girls. When early growth of pubic
hair occurs along with an increase in height velocity and progression of bone development, one
should be aware of diagnoses associated with an excess of sex steroids. In such cases, a late-
onset adrenal hyperplasia caused by a partial enzyme deficiency can often be diagnosed.
Maturation of the gonadal axis and the adrenal axis occur separately, which means that in cases
of adrenal insufficiency, gonadarche will occur appropriately. In cases of gonadal failure, the
adrenals will contribute to adrenarche. It is well known that delayed and early-onset puberty are
related, although specific genes contributing to these phenomena have not yet been recognized.
To date, several gene mutations and polymorphisms of GnRH and its receptor, and of the
gonadotropins LH and FSH and their receptors, have been identified.
Sunerti
Abstract
Many people have some type of visual problem at some point in their lives. Some can no
longer see objects far away. Others have problems reading small print. These types of conditions
are often easily treated with eyeglasses or contact lenses. But when one or more parts of the eye
or brain that are needed to process images become diseased or damaged, severe or total loss of
vision can occur. In these cases, vision can't be fully restored with medical treatment, surgery, or
corrective lenses like glasses or contacts.
Blindness. They haven't lost their sight completely but have lost enough vision that they'd have to
stand 20 feet from an object to see it as well as someone with perfect vision could from 200 feet
away.
What Causes Visual Impairment?

People rarely lose their eyesight during their teen years. When they do, it's usually caused by an
injury like getting hit in the eye or head with a baseball or having an automobile or motorcycle
accident.
Some babies have congenital blindness, which means they are visually impaired at birth.
Congenital blindness can be caused by a number of things — it can be inherited, for instance, or
caused by an infection (like German measles) that's transmitted from the mother to the developing
fetus during pregnancy.
Conditions that may cause vision loss after birth include: amblyopia, strabismus, cataracts,
diabetic retinopathy, glaucoma, macular degeneration, trachoma

Lecture 19:
~ Hearing Impairment ~
Lecture 20:
~ Learning Disorders ~
Eka Putra S
--------------
I GA Endah Ardjana
Learning outcomes
Learning disorders are diagnosed when standardized est. achievement in reading, math, or
written expression are substantially lower than expected for a particular age, school level, or
intelligence. These disorders involve academic deficits and impairments in specific areas of
reading, math, spelling, and writing. About 5 percent of students in public schools in the United
States are estimated to have a learning disorder, and up o 40 percent of these students drop out
of school.
Reading Disorders:
a. Reading achievement, as measured by individually administered standardized tests of
reading accuracy or comprehension, is substantially below that expected given the
person’s chronological age, measured intelligence, and age-appropriate education.
b. The disturbance in Criterion A significantly interferes with academic achievement or
activities of daily living ha require reading skills.
c. If a sensory deficit is present, the reading difficulties are in excess of those usually
associated with it.
Mathematic Disorders
a. Mathematical ability, as measured by individually administered standardized tests, is
substantially below that expected given the person’s chronological age, measured
intelligence, and age appropriated education.
activities of daily living that require mathematical ability.
c. If sensory deficit is present, the difficulties in mathematical ability are in excess of hose
usually associated with it.
Disorders of Written Expression
a. Writing skills, as measured by individually administered standardized tests (or functional
assessments writing skills), are substantially below those expected given the person’s
chronological age, measured intelligence, and age-appropriate education.
activities of daily living that require the composition of written text (e.g., writing
grammatically correct sentences and organized paragraphs).
c. If a sensory deficit is present, the difficulties in writing skills are in excess of those usually
associated with it.

Lecture 21:
~ Mental Retardation and Down Syndrome ~
I GA Endah Ardjana
~ Mental Retardation ~
Abstract:
For a definite diagnosis, there should be a reduced level of intellectual functioning resulting
in diminished ability to adapt to the daily demands of the normal social environment. Associated
mental or physical disorders have a major influence on the clinical picture and the use made of
any skills. The diagnostic category chosen should therefore be based on global assessments of
ability and not on any single area of specific impairment or skill. The IQ levels given are provided
as a guide and should not be applied rigidity in view of the problems of cross-cultural validity. The
categories are given below are arbitrary divisions of complex continuum, and cannot be defined
with absolute precision. The IQ should be determined from standardized, individual’s level of
functioning and additional spesific handicapping conditions, e.g. expressive language problem,
hearing impairment, physical involvement. Scales of social maturity and adaptation, again locally
standardized, should be completed if at all possible by interviewing a parent or care provider whi
is familiar with the individual’s skills in everyday life. Without the use of standardized procedures,
the diagnosis must be regarded as a provisional estimete only.
According to Diagnosis and Statistical Manual of Mental Disorders (DSM-IV-TR), mental
retardation is defined as,
a. Significantly subaverage general intellectual functioning: an IQ of approximately 70 or
below on an individually administered IQ test (for infants, a clinical judgment of
significantly subaverage intellectual functioning).
b. Concurrent deficits or impairments in present adaptive functioning (i.e., the person’s
effectiveness in meeting the standards expected for his or her age by his or her cultural
group) in at least two of the following areas: communication, self-care, home living,
social/interpersonal skills, use of community resources, self-direction, functional academic
skills, work, leisure, health and safety.
c. The onset before age 18 years.
Degree of Mental Retardation:
- Mild Mental Retardation : IQ level 50 to 69.
- Moderate Mental Retardation : IQ level 35 to 49.
- Severe Mental Retardation : IQ level 20 to 34.
- Profound Mental Retardation : IQ is under 20.
~ Down Syndrome ~
Learning outcomes:
- Understand the genetic aspect of Down Syndrome.
- Understand the screening test of Down Syndrome.
- Understand the clinical aspect of Down Syndrome.
- Understand the diagnosis and therapy of Dwon Syndrome.
- Understand the genetic counselling of Down Syndrome.
Abstract:
Dwon Syndrome, also known as trisomy 21, is a disorder caused by a chromosomal
abnormality, and the most common cause of birth defect including mental child is born. Women
over the age of 35 are in the most risk. The incidence of Down Syndrome is estimated 1 in every
800 to 1000 babies born. They don’t appear to be associated with paternal age.

Lecture 22:
~ Attention Deficit / Hyperactivity Disorder
(ADHD) ~
Down Syndrome is a chromosomal abnormalty characyerized by extra copy of genetic
maternal on the 21st
chromosome, either in whole (trisomy 21) or due to translocation
(Robertsonian translocation or familial Down Syndrome), mosaicism or duplication of portion of
chromosome 21.
Patient with Down Syndrome chare certain physical features such as a flat facial profile,
an upward slant to the eyes, small ear, a single crease across the centre of the palms, and an
enlarge tongue. Down Syndrome affect cognitive abilities in different ways, but most have mild to
moderete mental retardation.
Diagnostic test are about 99% accurate in detecting Down Syndrome. They are generally
recommended only for women age 35 or older, and those with a familial history of genetic defect.
Screening test include nuchal translucency testing, alpha fetoprotein, ultrasound, amniocentesis,
chorionic villus sampling, and percutaneus umbilical blood sampling, now widely available for
early detection.
Learning outcomes:
Awarness of common developmental disorders in children:
- Suspect children with ADHD
- Refer children with ADHD
Abstract:
Attention Deficit Hyperactivity Disorders (ADHD) is the most common neurobehavioral
disorders of childhood. ADHD is also among the most prevalent chronic health conditions
affecting school-aged children. Recorded prevalence rates for ADHD vary substantially, partly
because of changing diagnostic criteria over time, partly because of variations in ascertainment in
different settings and the frequent use of referred samples to estimate rate. Prevalence rates also
vary significantly depending on whether they reflect school samples 6.9% (5.5%-8.5%) versus
community samples 10.3% (8.2%-12.7%).
The core symptoms of ADHD include inattention, hyperactivity and impulsivity. Children with
ADHD may experience significant functional problems, such as school difficulties, academic
underachievement, troublesome interpersonal relationships with family members and peers, and
low self-esteem. Individuals with ADHD present in childhood and may continue to show symptoms
as they enter adolescence and adult life.
Early recognition, assessment and management of this condition can redirect the educational
and psychosocial development of most children with ADHD. The American Academy of Pediatrics
(AAP) recommended that the primary care physicians should initiate an evaluation for ADHD. The
clinician during routine health supervision may assist in early recognition of ADHD. So,
knowledge, skill for screening, diagnosis and manage children with ADHD is mandatory
understood by primary care physician

Lecture 23:
~ Autism Spectrum Disorders ~
Learning outcomes
Awareness of common developmental disorders in children:
- Suspect children with Autism
- Refer children with Autism
Abstract
Autism describes a spectrum of clinical conditions of neurobiological origin that are
characterized by: (1) qualitative dysfunctions of social interaction, (2) qualitative impairments in
communication abilities, and (3) unusual or restricted ranges of play and interests. The totality of
these impairments, though quite variable from person to person, is usually a lifelong condition that
results in some degree of social isolation and varying amounts of unusual behavior.
Despite extensive investigation, no consistent pattern of the cause of autism has emerged. In
fact, more than 60 different disease entities have been shown to be likely causes of autism,
including genetic, infectious, endocrine, toxic, and space-occupying etiologies. This suggests that
autism is a final common clinical presentation of a variety of underlying neurobiological and
genetic processes.
The prevalence of autism appears to have increased during the past decade, perhaps due to
(1) greater awareness about autism and its symptoms, (2) more-inclusive recent definitions, and
(3) possibly a true increase in incidence. Overall, the ratio of males to females is about 3:1 to 4:1.
Prevalence estimates range from 2 to 6 per 1,000 children. This wide range of prevalence points
to a need for earlier and more accurate screening for autism.
Many instruments can used to screen for autism. The brief instruments such as the Checklist
for Autism in Toddlers (CHAT), designed to screen for autism in 18-months old. Screening
instruments do not provide individual diagnosis but serve to assess the need for referral for
possible diagnosis of Autism. Criteria for the diagnosis of autism are included in the Diagnostic
and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). The
earlier the disorder is diagnosed, the sooner the child can be helped through treatment
interventions.
For most children who have a disorder within the autistic spectrum, results of the physical
and neurology examinations will entirely normal. No routine laboratory tests seem necessary.
When autistic disorders are associated with general medical condition, laboratory findings
consistent with general condition will be observed.
Although no definitive treatments are yet available, remarkable progress in the area of
intervention has occurred. Primary modalities include (1) educational programs, including early
intervention, school-based programs, and prevocational services; (2) behavioral techniques; (3)
speech and language therapy programs; (4) family support services; and (5) adjunctive
psychopharmacologic management of specific symptoms. Early intensive intervention may
dramatically improve outcome.

Lecture 25:
~ Aging Process ~
Lecture 24:
~ Cerebral Palsy Syndrome ~
K Kari
Abstract
Cerebral palsy (CP) is an umbrella term encompassing a group of non-progressive, non-
contagious diseases that cause physical disability in human development. The incidence in
developed countries is approximately 2.12–2.45 per 1000 live births. Incidence has not declined
over the last 60 years despite medical advances (such as electro-fetal monitoring) because these
advances allow extremely low birth weight and premature babies to survive. Cerebral refers to the
affected area of the brain, the cerebrum (however the centres have not been perfectly localised
and the disease most likely involves connections between the cortex and other parts of the brain
such as the cerebellum) and palsy refers to disorder of movement. CP is caused by damage to
the motor control centers of the young developing brain and can occur during pregnancy (about
75 percent), during childbirth (about 5 percent) or after birth (about 15 percent) up to about age
three. Eighty percent of causes are unknown; for the small number where cause is known this can
include infection, malnutrition, and/or head trauma in very early childhood.
R A Tuty Kuswardhani S
Abstract
Aging is a process of the loosing of ability the tissue slowly to develop itself and to maintain the
structure and the normal function; so it cannot stand towards the trauma to develop the damage.
The human being progressively will lose his defense against the infection it will pile the more
metabolic and structural distortion.
Aging process theory, according to this theory aging has been programmed genetically for some
certain species.
Different of aging process theories which support the process of aging i.e.:
1. Genetic clock theory
2. The damaged of body immune system.
3. Metabolic theory.
4. The shortening of telomere theory.
5. The damaged by free radical.

Lecture 26:
~ Clinical Implication of Aging Process ~
Nym Astika
Learning outcomes
- To describe the changes associated with aging
- To know common problem of Geriatrics (a series of I’s)
- To knows components of assessment of older patients
Abstract
The care of older patients differs from that of younger patients for number of
reasons. Some of these can be traced to the change that occur in the process of aging, some are
caused by the plethora of diseases and disruptions that accompany seniority, and still other
result from the way old people are treated
We have already noted the critical and difficult distinction a clinician must make to attribute
a finding to either the expected course of aging or the result of pathology changes.
Many of the changes associated with aging result from gradual loss, most organ systems
seem loss function at about 1 percent a year beginning around age 30 year. Other data suggest
that the changes in people followed longitudinally are much less dramatic and certainly begin well
after age 70 years
Comprehensive evaluation of an older individual’s health status is one of the most
challenging aspects of clinical geriatrics.

DAY
1
~LEARNING TASKS~
Case 1
A mother came to the physician to consult about her child development. Her child is a boy 10
months old. His mother complained that he cannot crawl and cannot stand up alone. When he
was 8 months old, he has sir alone. He was born at midwife, spontaneously; his birth weight was
2700 gram.
Assignment:
a. Please describe, is it a normal child development?
b. Please describe, was the child had sequential normal development?
c. As a physician, what kind information that you give to his mother?
Self Assessment
a. Describe the lifespan developing stages
b. What is the differentiate between growth and development
c. Describe factors that affecting growth and development
Case 2:
A 15 months old girl was brought by her mother to the Growth and Development Clinic to know
whether her child’s growth normal or not. On the physical examination revealed that her weight
was 9 kg; her length was 75 cm; her head circumference was 47 cm. Her father’s height was 176
cm; her mother’s height was 157 cm.
Assignment:
a. Please plot all of the data to the CDC 2000 curve, and interpret it
b. Please calculate the potential genetic height of the child
c. Please plot the head circumference measurement to the Nellhauss curve and interpret it
Case 3:
An infant, girl, was brought by her mother to the Growth and Development Clinic for immunization,
on September 22, 2007. She was born on December 9, 2006. The following are the data of her
weight based on measurement at Primary Health Care.
Birth weight 2900 grams
1 month 3800 gram
2 months 5600 grams
3 months 6000 grams
5 months 6500 grams
6 months 6700 grams
8 months 7000 grams
Assignment:
a. Please calculate the chronological age
b. Please plot the data into KMS (Road to Health Chart)
c. Please interpret the result of the measurement
Self Assessment
a. Please differentiate physical growth patterns between boy and girl
b. Describe the factors that affecting physical growth
c. Describe the normal pattern of the body system growth

DAY
2
DAY
3
DAY
4
Assigment:
1. Describe the embryonic development phases and its morphological characteristic.
2. Explain the main phenomena during human development on the 1st
week, 2nd
week, 3rd
week,
3rd
-8th
week and 8h
week to birth.
3. Explain the clinical correlation in each phase.
4. Predict the time of birth based on the LNMP.
Case
You are called to attend the delivery of baby boy G at uncertain gestational, who is to be delivered
by spontaneously labor. The delivery, there was no meconium, and the baby need only towel
drying, clearing of the airway. After the baby stable (about 10 hours) the New Ballard Score was
examination, with the score are: neuromuscular maturity score are 19, and the physical maturity
score are: 21. The baby weight is 3500 gram, length is 51 cm, and head circumference is 35 cm.
Assignment 1:
1. What is your assessment of his gestational age?
2. What is your assessment of his classification?
Self assessment:
1. Describe the methods of determining postnatal gestational age
2. Describe and explain the classification of the infants based on Lubchenco chart.
3. Describe the physical appearance the preterm, term and post term infant.
4. Describe and explain the risk factors the baby born preterm, or post term.
Assignment 2:
1. What does the definition of ultrasound waves?
2. Explains that ultrasound waves length and its associate with images resoluition.
3. What does the function of gel was applied on the skin?
4. What kinds of ultrasonic media/tissue in pregnant woman?
5. Indication of ultrasound scanning is?
6. When did the USG used firstly in Obstetrics?
7. Explains about RADIUS means!
1. ????

DAY
5
DAY
6
Assignment:
Many medications have side effects that are potentially harmful during pregnancy, but their
benefits may outweigh their risks. A woman should consult her doctor or midwife before taking
any drug, even one sold over the counter. If you to be a medical doctor can you explain to a
pregnant women if she want to take medicine like:
1. Anticonvulsants, such as phenytoin (Dilantin) and carbamazepine (Tegretol), to prevent
epileptic seizures?
2. Aspirin, ibuprofen, and other non-steroidal anti-inflammatory drugs (NSAIDs)?
3. Could you explain to her about the effect of drugs at different stages of pregnancy?
4. Paracetamol is a drugs that A category. Could you explain it? How about B category, C
category and X category?
Case 1
A mother came to the clinic with lactation problem. During the first week she found that her
breasts were very swollen, tender, throbbing, lumpy, and uncomfortably full. Sometimes the
swelling extends all the way to the armpit. She panicked, thinking that her milk ducts were
blocked, even though she had been through exactly the same experience with her first child.
Assignment
a. What kind of the mother lactation problem?
a. How can the mother treat it (What should the mother do?)
b. How long does it last?
c. Can the mother still breastfeed?
d. Will the conditions affect her baby?
Self Assessment
a. Describe the composition of human milk
b. Describe the benefits of breastfeeding
c. Describe the most common problems encountered by mothers who are breast-feeding
and management of the breastfeeding problems
Case 2
A male neonate was born at 40 weeks gestation with severe asphyxia. After resuscitation about
10 minutes, the baby was spontaneously breathing and crying loudly. The body weight was 3500
gram. You want to give nutrition on the first day of life.
Assignment
1. What type nutrition you will give? Why?
2. How many fluids will you give?
3. When will you start the oral feeding? What is the best oral feeding will you chose?
Self assessment
1. Describe the benefits of breastfeeding
2. Describe the general principles of feeds small babies
3. Describe feed and fluid volume for small babies
4. Explain about feeding intolerance and complications

Study guide growth and development 2007 2008

Study guide growth and development 2007 2008

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