Child Development Evaluation

Introduction

This case study aims at evaluating the parameters of child development of a particular child, whether they are within the normal ranges and the possible influencing factors of child development. This involves critiquing a one-year developmental health review which is a part of the universal health service as described in the Healthy Child Program (HCP). The study utilizes a framework that is in use within the employing organization of the author; the 3rd edition Ages and Stages Questionnaire (ASQ-3) tool, which helps guide the assessment. The tool is analyzed to determine the effectiveness and limitations of the tool. Additionally, students seeking healthcare dissertation help can benefit from understanding how frameworks like the ASQ-3 contribute to assessing developmental health. The study has used pseudonyms to protect the confidentiality of the clients (NMC, 2018).

Assessment of The Parameters of Child Development and Other Influencing Factors

Laylah is the First daughter of Aisha and Mohammed; a couple married for ten years, and the sister to Zainab who is 8 years old. The family lives in a three-bedroom privately rented accommodation. Both parents are in full-time employment. Mohammed is a pharmacist working in a specialist hospital located in central London whereas Aisha is a Teaching Assistant in a Primary School located close to the family home. Aisha previously reported that she has great family support and a great network of friends. Laylah’s paternal grandparents live close to the family and help by taking Laylah for two days in a week to enable the parents to attend work. Mohammed has two sisters that live in neighboring boroughs, both have similar aged children as Laylah and Zainab and they all frequently play together. Laylah attends a private nursery thrice a week in which her parents stated that she enjoys.

As Laylah approached her first birthday; the developmental assessment was planned and was to be conducted using the ASQ3 developmental tool. Adhering to the author’s NHS trust local policy guidelines, the ASQ3 questionnaire was sent with an invitation letter to the family home two weeks prior. The advantage of sending the questionnaire prior to the assessment date enables parents to be active and involved in the child’s development hence, encouraging interaction between parent and child giving the best results (Steens et al., 2015).

Schonhaut et al., (2013), studied that the ASQ3 is widely accepted because it is convenient and has an approach that centers on the parent. The tool acts as a guideline to promote understanding so that the professional is able to understand how the baby is developing (Kvestad et al., 2013). This is also an opportunity for parents to become involved and attempt activities covered by the questionnaire with the child in the comfort of their home in familiar surroundings. As part of the government Healthy child programme mandated contacts, the one-year review assesses the physical, cognitive, and language development of a child as well as their socio-emotional development. Additionally, it allows for health professionals to provide health promotion to families on aspects of the health and wellbeing of their child/ren.

Kendall et al., (2019), observed that the review is an opportunity to discuss health and safety measures connected to the next stage of development. Developmental reviews are essential in monitoring growth and the development of a child and pointing out abnormalities. Nicholson & Greenwood (2018), demonstrated that the review is crucial in providing support, to give information, identifying abuse or neglect and guiding parents to support organizations. At the time of the assessment, Laylah was under the universal service as per the HCP doh 2009.

The ASQ-3 has been designed to be filled out by a parent or a primary care-giver. The Screening tool is composed of 21 questionnaires that can be used for children from the age of 1 month up until the age of 51/2 years. Each questionnaire has 30 developmental items that are written in simple, straight forward English with illustration for a better understanding and to be easily followed. The screening relies on parents to observe and complete the developmental questionnaire about the ability of their child. Schonhaut et al., (2013), explained that the completion of the tool by parents enhances the accuracy of the outcome as parents are aware of their Childs ability. Kendall et al., (2019), on the other hand, studied the importance of the psychometric properties of the test and states that the performance of a child may differ depending on the surroundings and various people. Although the assessment was designed to be completed by parents the tool still requires the input of health professionals in scoring, providing feedback and if needed, follow the approved referral pathway as per local protocol (Steens et al., 2015).

The ASQ3 is a valued monitoring system used to assess children in the main developmental areas distinguished as personal-social skills, gross motor skills, communication, fine motor skills and problem-solving (Kvestad et al., 2013). Whilst completing the ASQ3 questionnaire There are three answers that a parent could give their child, The answer ‘YES, ‘SOMETIMES’ and ‘NOT YET’. These answers are then converted into points where: YES, is given 10 points; SOMETIMES 5 points and NOT YET is 0 points. An answer of YES suggests that the child is completing the suggested behavior, an answer of Sometimes indicates the child is performing the behavior occasionally and Not yet indicating the child is not performing the behavior at all (Steens et al., 2015). It is important to remember that the ASQ is used simply as a guideline and that the developmental stages of children might differ individually.

(Armijo et al., 2015) argues that the reliability of the questionnaire is questionable as parents may not always discuss concerns they may have with their child. Schonhaut et al., (2013), on the contrary; discusses that the assessment tool can be used as an aid memoir for the less experienced health professionals with enhancing their knowledge in child development. Health care professionals need to keep in mind that the ASQ3 questionnaire could become more of a tick box exercise with parents not accurately assessing the child for their developmental behaviours requested and inadequately scoring. Under these conditions, a health professional with knowledge of child development is needed in combination to gain a more accurate assessment. Britto et al., (2017), explained that health care professions need to be aware that parents are the ones that know their child better. However, health professionals have knowledge and skills and working together as a team approach would be essential in the development of the child.

The ASQ3 does not take into consideration of children’s health and environmental factors (Snyder et al., 2008). The local policy guidelines suggest that the assessment framework should be utilized when performing an assessment on a child and their family. By looking at the three key areas of parenting capacity, child developmental needs and environmental and family factors, it is essential to focus on the child at all times (Armijo et al., 2015). Utilization of the framework enables professionals to collect, analyze, act upon and record data regarding the child within the context of the family, community and environment they live. The common assessment framework (doh,2009) is used together with the ASQ3 in order to obtain a more holistic assessment (Snyder et al., 2008).

The assessment took place within the clinic to enhance her full participation, as stated by Roshanfekr et al., (2017). Developmental reviews that have been conducted in clinics have had a positive impact on parenting and family functioning due to reduced distractions. As per the local policy guidelines (NHS, 2013), prior to the assessment, the room should be checked ensuring all equipment is in working order and cleaned. The environmental scenery needs to be favorable to achieve the best responses from the child’s assessment. There were appropriately aged toys available at the venue to entertain Laylah, the toys are beneficial for Laylah to be able to demonstrate developmental skills and also serves as a welcome distraction to Laylah incase further discussion is needed with the parents. Though everything was in order, it was recognized that the clinic could be an obstacle while conducting the assessment as children prefer familiar settings such as their home (Britto et al., 2017).

Laylah arrived on the day of the assessment with both parents and her elder sister and they were escorted into the clinic room. Laylah was happy to see the toys, once her mother placed her beside them, she started playing immediately although, at the same time, looking back at her mother. Laylah’s parents reported that she is usually very clingy but since she begun nursery, she became more sociable and independent. According to Roshanfekr et a., (2017), the attachment behaviour was expected and that between 7-18 months, children show selective attachment to their main care-giver, usually the mother; they tend to follow the mother, show joy with smiling and distress on separation. Laylah explored the clinic room freely but kept looking back at her parents for reassurance. She showed the appropriate attachment behaviour in accordance with her age.

Feinman (2013), explained that children seeking reassurance from care-givers in unfamiliar situations is known as ‘social referencing’. A study by Britto et al., (2017), suggested that children learn to trust others based on the consistency of the key people around them. Positive relationships and established attachments boost cognitive development. Positive relationships and established attachments improve cognitive development. Parental input that creates a secure base for the child, nurture and loving build resilience in children creating positive factors. Negative impacts on the child can result from parental separation. The relationship between the child and primary caregiver within the first 12 months of age is regarded as the template to future experience. The interaction observed during the assessment between Laylah and the parents seemed positive and a secure attachment. Roshanfekr et a., (2017), studied that the earliest bonds formed by children with their caregivers have a great influence that is constant throughout life as this child will develop other important attachment relationships.

Speech and language were the first topics to be discussed at the assessment, which falls under communication in the ASQ3. Whilst Laylah was playing with her elder sister and the toys, it was observed that she was babbling loudly and incessantly in conversational cadences. Laylah parents reported that she calls them mama and dada and is able to understand simple commands such as ‘bring your shoes here’. Laylah’s parents also indicated that she points to objects and also points to her facial features when instructed. She answers to her name, this is a piece of vital information as problems in hearing have a fundamental effect on speech and language and critical areas of growth. positive feedback reported from Laylah’s parents and the observations of her interaction demonstrates that the child is achieving communication milestones for her age (sharma 2014).

During the review Laylah’s mother asked her to bring a brick to her, Laylah immediately followed her the command and bought the brick to her mother. The development of speech and language is crucial to every child as these improves other areas of learning. They provide a good foundation for extra learning to occur, hence, have become important focus areas for early childhood development (Roshanfekr et al., 2013). children learn easily from people who utilize sound and words and they develop by aping others (Feinman, 2013). A book start pack was given (DOH HCP) to reinforce and encourage this.

Laylah was very active during the assessment she demonstrated the ability to push herself to a standing position and sitting down while holding on to furniture. Laylah’s parents were asked questions concerning her gross motor skill development that was unwitnessed during the assessment. They reported that she takes a few steps and walks with their assistance. According to Metgud et al., (2019), discussions with parents make use of their extensive knowledge of the child’s development. The gross motor skills involve the movement of the entire body of the child, such as running, jumping and sitting. Also, eye-hand coordination like throwing and kicking is part of the gross motor skills. These skills are essential in ensuring that the child performs daily important activities like playing, sporting, dressing up and walking. The gross motor skills also influence the ability to be involved in fine motor skills (Bedford et al., 2016)

Fine motor skill was assessed by observing Laylah play. She built blocks by stacking them on top of each other and then gave a block to her sister Zainab, directly into her hand. Laylah also picked up a piece of string that was attached to a toy indicating that she has a neat pincer grip. Using the ASQ3 as a guideline the author determined that Laylah was achieving her developmental milestones according to her age. Fine motor skills incorporate the utilization of smaller muscles of the hands to perform activities like use of spoons, pencils, building bricks and opening snack boxes. They are essential in impacting the quality and speed of the activity outcome being conducted by a child (Weiss, 2018). In case a kid has weak fine motor skills, then recommendation for occupational therapy (OT) is necessary (Toth, 2017).

For the problem-solving part, a brick that Laylah was playing with was hidden behind the back of the author and she immediately crawled behind the author’s back to see if the brick was there. Laylah’s father voiced that he usually tries this at home with her and she always looks for the hidden item. This discloses that Laylah is slightly ahead in this stage of development. As Landreth (2012) studied, children will attempt to look for a hidden toy at the age of 15 months. This demonstrates to the author that Laylah is able to illustrate the ‘Object permanence’ which is the ability to realize that an item still exists even when it can no longer be perceived as in Petersen (2017) theory of cognitive development.

Laylah’s parents commented that she enjoys playing with balls, she has a particular ball that she tends to throw and drops and always watches to see where it has fallen. The rest of the Problem-solving questions went unanswered by Laylah’s parents they had never witnessed Laylah attempt a certain activity and also due to the lack of apparatus. The author agreed the advantage of having appropriately aged toys available during the review was to assess an activity that could not be achieved due to a lack of understanding from parents or lack of equipment. The author was able to successfully assess the activity whilst watching Laylah play. Play is a way a child learns and is significant in a child’s development. Through the natural activity of play they learn and develop essential cognitive, social and language developmental skills. Play improves creativity, language development, thinking skills and social competence. Play is crucial in keeping children healthy (Landreth, 2012)

Personal –social skills were then analyzed. This section of the assessment depended on the response of the parent, combining with the knowledge obtained from observing Laylah play and the knowledge on child development. Laylah was observed pointing for a snack in her mother’s bag and talking on the toy phone demonstrating social referencing. These developmental milestones are aged appropriately for Laylah. The personal social skills enable a child to take care of themselves by performing actions such as cleaning their hands and also relate with others i.e. playing games and being aware of other people’s feelings (Valadi et al., 2020). As stated by the HCP (2009), and local policy guidelines health promotion should be part of the health assessment. The HCP strives to ensure that all children receive a basic package of health promotion which can increase according to individual needs.

Health promotion was discussed and the parents reported that Laylah generally eats well, together with plenty of fruit and vegetables. Her mother disclosed that Laylah caught a viral infection from nursery recently that affected her appetite but is now recuperating. There was a discussion about the introduction of cow’s milk into her diet followed by ensuring immunizations were up to date and informing her parents that she was due for other immunizations as she turned one. Laylah’s Height and weight was recorded to ensure adequate growth development. As stated by the local policy (NHs trust,2013) results were documented in the personal child’s health record also known as the red book to boost communication between parents and health care professionals in the United Kingdom (Wickham et al., 2016). The author discussed the interpretation after plotting the results on the growth chart with Laylah’s parents as directed by the Hcp 2009 to monitor signs of obesity and failure to thrive. The weight of Laylah had dropped probably due to the recent illness. The author advised her mother to return in a month to the Healthy child baby weighing clinic for a review.

At the end of the health review, the author asked Laylah’s parents if they had any concerns they would like to discuss regarding Laylah’s developments or any questions regarding health promotion. Laylah parents stated that they were satisfied with her development and had no concerns. Advice was given that the parents should implement the 4Ts: Talk to the child often; turn off cell phones and the television; take turns talking to the child and tuning in into what the child is saying. An activity sheet was also handed to the parents to utilize in order to promote healthy development and behaviour in their child.

A limitation of the tool is that there is parental anxiety, unrealistic expectation and lack of understanding regarding the results of the tool although it has been confirmed to be user friendly. Another limitation is that it does not incorporate immunization, safety and health promotion factors and topics like sleep, oral hygiene and nutrition (Otalvaro et al., 2018). Despite this, the tool is effective and health care professionals should be confident with interviewing and retrieving information from parents to enable them to discuss and analyze the child’s development (Metgud et al., 2019.)

Conclusion

Laylah scored well and met all her millstones accordingly. However, her parents were not so sure and had concerns that she did not reach the maximum score that could be achieved from the assessment. The review went well and took the shortest time possible. To improve on future practice, the venue of the assessment might need to change to a place that is more familiar to the child, like the home and done in the morning hours when the child is fully alert. There will be the incorporation of all necessary equipment to ensure part of the assessment is not skipped due to lack of equipment. The ASQ3 might also need to be adjusted a little bit to fit the cultural context of the party of interest.

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