Assessing Physical Development

Many preschoolers have developed a hand preference. They will be able to use the wrist, hand, and fingers to open doorknobs, screw and unscrew lids, and rotate large puzzle pieces. They should be able to hold a container in one hand without spilling, and zip and snap clothing. They are able to sort small items using a pincer grasp, and manipulate smaller toys such as wooden pegs and Legos.

Children of this age are able to color and draw using their fingers to hold writing utensils, and are developing the hand strength they will need to use scissors properly. They may also be able to put on their own shoes and tie the laces.

Partial hearing and deafness are the two types of hearing impairments. Partial hearing is any loss of the ability to detect sound that does not result in complete deafness. Deafness is a complete loss of the ability to perceive sound.

Children with possible hearing impairments may: Speak in an expressionless or monotone voice Watch others' mouths when they speak Have frequent ear infections Continuously turn the same ear toward sounds Constantly misunderstand what others say

Toddlers have better control of fine motor movements.

They are able to roll a ball across the floor and release objects upon request. They can hold crayons in their fists and make marks with them. Toddlers have enough manual dexterity to stack blocks, pull and push toy components, and eat with a spoon and fork. Toward the end stages of toddlerhood, most children will be able to turn the pages of a book, hold writing utensils with their fingers instead of the whole hand, and zip clothing. They should also be able to manipulate small objects, such as when stringing beads or unwrapping a piece of candy.

School-aged children's fine motor skills have progressed almost to the level of an adult's. They are able to correctly hold writing utensils and scissors, copy figures and shapes, and trace and cut on a line.

They can color inside the lines, write letters and numbers, and draw characters with limbs and a head. Children this age are able to tie their shoes and have developed the ability to button and unbutton clothing. They have also developed hand-eye coordination and a strong hand preference, allowing them to participate in sports activities and begin to play musical instruments and computer/video games.

Preschoolers have mastered many of the skills related to gross motor development.

They can walk forward, backward, and sideways with confidence, and walk a curved line while keeping their balance. They can navigate climbing structures such as jungle gyms relatively well, hop on one foot, and jump over objects. Children this age are also able to bounce balls as well as catch them, and can throw with some degree of accuracy. Most learn how to skip during this age as well, though usually only with one foot.

What do child care providers use head circumference measurements for?

To help health care professionals identify possible problems with brain growth

Child care providers must be able to document concerns if a child is not accomplishing skills within expected time frames.

Tools child care providers can use to screen for delayed or impaired development of gross and fine motor skills include informal assessments, such as observation, parent surveys, checklists, and fill-in-the-blank forms. Informal assessment is the best way for child care providers to screen for developmental problems for two reasons: most child care providers are not trained in formal assessment methods, and informal assessment is less time-consuming than other methods.

Growth charts are used to compare children's growth against age-appropriate and gender-specific averages.

True

Which tool for vision screening consists of the capital letter E in various positions?

Tumbling E Chart

Tools used to assess auditory functioning include visual reinforcement audiometry, pure-tone audiometry, and the Auditory Brain Stem Evoked Response Test.

Visual reinforcement audiometry involves presenting a series of sounds through headphones and providing visual reinforcements when correct responses are made. Pure-tone audiometry also involves presenting a series of sounds through headphones, but responses are made through selecting a button. The Auditory Brain Stem Evoked Response Test uses high frequencies to assess how sound is processed by the brain stem.

Which of the following may be indications of delays or impairments related to fine motor skill development?

*a. Difficulty eating with utensils *b. Failure to use a pincer grasp *c. Dropping small items regularly d. Needing support to walk after 16 months of age e. Frequent stumbling or falling *f. Inability to speak or pronounce words properly

Which of the following may be indications of delays or impairments related to gross motor skill development?

*a. Difficulty running, skipping, jumping, or climbing b. Inability to use building blocks or Legos c. Inability to blow bubbles or whistle *d. Clumsiness or lack of coordination *e. Excessively fast or slow movements *f. Inability to maintain erect posture

Which of the following tools are used to assess the motor development of children with known disabilities or impairments?

*a. TPBA *b. GMFM *c. Lighthouse Test d. Beery-Buktenica Test e. LOMDS f. BSID

Which of the following are components of physical health and growth?

*a. Weight b. Balance *c. Height *d. Head circumference e. Coordination *f. Bone and muscle structure

Which of the following areas are associated with children's physical development?

a. Speech and language development *b. Visual and auditory functioning *c. Physical health and growth *d. Gross and fine motor skills e. Social and emotional functioning f. Cognitive and thinking processes

Generally, the only responsibility child care providers may have relating to assessment of bone and muscle structure is conducting routine spinal screenings to identify possible bone abnormalities, such as scoliosis. Child care providers often use the Adam's Forward Bend Test to screen for scoliosis. During this test, children are asked to stand with their feet together and bend at the waist to a 90-degree angle. Child care providers then observe from the front, back, and sides to identify abnormalities that may need clinical assessment, such as:

Abnormal hip or shoulder symmetry Unintentional leaning of the body toward one side Uneven rib cage or waist Changes to the skin covering the spine, such as dimpling or discoloration Misalignment of the head, which should position directly over the pelvis

Hearing impairments can result from heredity, birth defects, infections and diseases, and damage to the outer or middle ear or the brain.

Additional indicators of possible problematic development include when children coo and gurgle but do not talk; are difficult or impossible to understand; startle at sudden, loud sounds; and speak very softly.

Fine motor skills in infants begin with oral development, including the ability to use the lips and tongue to taste and receive nutrition. Fine motor skills also include the ability to grasp objects.

At birth, grasping is a reflex, but will later become more deliberate as infants "discover" their hands. Between 4 and 5 months of age, infants will be able to reach toward objects, without being distracted by their hands. Once they are able to grasp them, they will immediately try to bring them to their mouths, which strengthens hand-eye coordination. Around 8 months of age, they develop a Palmar grasp. Toward the end of the first year, infants will be able to use their fingers to poke objects, and will develop a pincer grasp. This allows them to be able to release, stack, and nest objects effectively.

Interpreting observations is a health care professional's responsibility, not a child care provider's. Interpretations can only be made by reviewing all areas of assessment, not just a child care provider's observations.

Avoid the use of words like "happy" or "because." These and similar words express what a person is feeling or thinking, which cannot be observed. What can be observed are the person's physical actions, including facial expressions, spoken words, and behaviors.

Child care providers use a child's weight to screen for possible health problems, including being underweight or overweight. As with height measurement, children who cannot stand unassisted should be lying down during weight measurement, and other children should be standing. When measuring weight, scales should be digital, not spring-loaded, and placed on even, uncarpeted surfaces to ensure accuracy. Children should not wear diapers, shoes, or heavy clothing items, such as coats or sweaters, while being weighed. They should also be as still as possible until weighing is completed.

BMI calculations are used only for children over 2 years of age. BMI is derived from measuring children's height and weight, and is specific to age and sex. To calculate BMI, divide weight by length or height, then divide by length/height again. Multiply the resulting number by 703. It is important to convert fractions and ounces to a decimal value for accuracy.

Growth charts compare a child's growth to average child growth. Boys and girls grow at differing rates, so a different growth chart is used for each sex. Both sex-specific charts are split into two groupings:

Children aged newborn to 3 years Children aged 2 to 20 years

The most important tool a child care provider uses during vision screening is observation. Observing children while they work and play gives the best indication of problematic development.

Child care providers can also screen for vision problems with a Tumbling E Chart, which consists of the capital letter E in various positions. The Es increase in number and decrease in size at each level, similar to the Snellen E Charts health care professionals use. For younger children, child care providers can use picture charts, such as the Lea Chart. Picture charts contain simple pictures and shapes, such as umbrellas, circles, and apples, because young children often do not know letters well enough to use standard eye charts.

Vision and hearing should be assessed prior to motor development because visual and auditory impairments often result in impairments of motor development.

Child care providers can assist health care professionals in visual and auditory assessment by screening for possible delays or impairments. To do so, they must be aware of indicators of problematic development and tools they can use to assist in the screening.

Length/height, weight, BMI, and head circumference measurements are all compared against growth charts to assess physical health and growth. They provide health care professionals a basis for comparing children's growth against age-appropriate and gender-specific averages.

Child care providers can use growth charts to identify possible problems. Therefore, they must be aware of how the growth charts are used in order to interpret whether or not a problem may exist.

Measuring head circumference is only used with children under 3 years of age. Child care providers use head circumference to help health care professionals identify possible problems with brain growth. A child who has a head circumference that falls well below average may have a brain that is developing abnormally, such as with many forms of intellectual disability. A child who has a head circumference that is well above the average may have hydrocephaly.

Child care providers should use a flexible measuring tape to measure a child's head circumference. It should wrap snugly, not tightly, around the child's head at its widest point. The measurement should be taken at the point where the tip of the measuring tape rests.

General guidelines for conducting observations include:

Documenting only what you see, and nothing else Observing, but not interpreting, what you see Recording observations immediately and sequentially Notating the date and time of each observation

Tools used to assess physical health and growth include physical exams, BMI calculations, and growth charts.

During physical exams, health care professionals look for development of bone and muscle structure. Impairments related to bone and muscle structure include scoliosis, bone growth abnormalities, and muscular atrophy. BMI calculations are used to evaluate body fat percentages in order to identify weight problems. Growth charts enable comparison of children's growth against age-appropriate and gender-specific averages. Length or height, weight and BMI, and head circumference measurements are all compared against growth charts to assess adequate physical health and growth.

The use of which of the following body parts relates to fine motor skills?

Face

Children with hearing impairments may also:

Fail to respond to others unless looking directly at them Speak very little or not at all Speak very loudly Seem surprised to look up and see others in the room Appear to have a short attention span or be easily distracted Leave out certain letter sounds when speaking Respond to loud noises, but not to speech

Informal assessments of children are conducted under direct supervision of a health care professional.

False

Difficulty imitating facial expressions can be an indication of which type of delay or impairment?

Fine motor skill

Vision and hearing should be assessed prior to motor development because impairments in these areas often result in impairments in other areas.

For example, children with visual impairments may not crawl because they don't have visual stimulation needed to motivate them to move forward. Children with hearing impairments may not be able to stand without stumbling because damage to the inner ear upsets their balance.

Gross motor skills in infants begin with reflexes. Soon after birth, these involuntary reactions disappear and are replaced with more deliberate movements. The first voluntary movement infants make is to lift the head. Next, they begin to support the weight of the head and develop enough muscle tone to turn it from side to side. Once these skills are mastered, their strength grows, and they begin to lift the shoulders and chest using the arm and back muscles. These movements strengthen the torso, which eventually enables them to roll over onto the back.

From here, infants progress to sitting, creeping, and crawling. All of these movements strengthen the arm, leg, and back muscles that enable infants to support their body weight. When strong enough, they will pull up to a standing position, cruise around the room with support, and eventually begin taking their first steps.

Which area of a child's physical development is associated with jumping, skipping, and climbing?

Gross motor skills

Motor skills assessment includes evaluation of gross and fine motor skills development.

Gross motor skillsare related to the large muscle groups in the body, including the legs, back, arms, and torso. Fine motor skills are related to the small muscle groups in the body, including the mouth, hands, and fingers.

Children with possible vision impairments may:

Have unfocused eyes Rub the eyes excessively Stumble or trip frequently Tilt the head to one side or to the front Hold books or other objects close to the eyes Squint when looking at something Experience headaches, nausea, or dizziness while concentrating their vision, such as when watching a video Consistently red, swollen, or watery eyes Crossed eyes Rapid blinking Sensitivity to bright light Disorientation Recurring sties or excessive eye encrustation

Which of the following are characteristics of children with possible vision impairments?

Having unfocused eyes

Which component of physical health and growth is only relevant to children under 3 years of age?

Head circumference

Observation is by far the most viable and cost-effective means of screening for delays or impairments in physical development, because it can be conducted during any given day.

However, it must be done systematically to get meaningful results. Following general guidelines for screening will always yield information necessary for child care providers to tailor a child's activity to his/her level of development.

The plotted measurement, or the point where the horizontal and vertical lines intersect, will fall within the lines that represent the growth curve except in extreme cases. That measurement indicates how the child compares with other children of the same age and sex.

If a child's plotted measurement lies on the 80th percentile line, it means that his/her measurement is greater than approximately 80 percent, and less than approximately 20 percent, of children in the same age and sex group. If the measurement lies on the 5th percentile line, it means his/her measurement is greater than approximately 5 percent, and less than approximately 95 percent, of children in the same age and sex group. The 50th percentile line represents average growth. The closer a child's ranking is to this line, the lesser the chance for growth problems. The further away, the higher the possibility a problem could exist.

Fine motor skills relate to the use of the small muscle groups in the body, including facial, hand, and foot muscles. Children with fine motor impairments may have difficulty with any or all of the following:

Imitating facial expressions Speaking or pronouncing words properly Blowing bubbles or whistling Grasping with thumb and forefinger (pincer grasp) Coloring or drawing Holding small items without dropping them Cutting with scissors Tying, buttoning, or zipping Using building blocks or Legos Feeding themselves with utensils

Regardless of the length or content of the observation, notations should always include a date and time. This provides background information about when the behavior occurred, which may affect the reason the behavior occurred.

In situations where more than one staff member makes observations, each notation should also include the observer's initials or signature.

There are several factors to keep in mind when measuring children's length or height. Most importantly, children should not wear shoes, hats, bulky clothing, or any other item that may skew measurement. Child care providers should ensure children are standing erect on an even, uncarpeted floor and against a flat surface, such as a wall with no baseboards. Children should stand looking forward with their legs straight, shoulders level, and arms hanging at their sides. Child care providers then use a flat item, such as a ruler or folder, to mark the level of the child's crown or highest point of the head, then measure the distance from the floor to the mark for accurate height measurement.

Infants and children who cannot stand unassisted should be measured while lying down. To do this, child care providers place a flexible measuring tape in the area where the child will lie, ensuring the head and the tip of the measuring tape are aligned precisely. The child's legs will often need to be fully extended by the child care provider to ensure accurate measurement.

Informal settings include homes, child care facilities, and other locations where children are not under direct supervision of a health care professional. Informal assessment, also known as screening, is performed occasionally by health care professionals but mostly by parents, child care providers, and teachers. It utilizes preexisting formulas and guidelines, checklists, and simple tests to evaluate whether children may have problems with physical development.

Informal assessment is often conducted by observing children while they are playing. This is known as play-based assessment. Play-based assessment is important because it allows children to act naturally in a comfortable environment, without the direction of a physician or other health care professional. Such assessment increases the odds that children will act in their normal manner so observation results are accurate.

Which of the following tools is used by health care professionals to evaluate balance and posture; touch, pressure, temperature, and pain perception; and awareness of the body's position?

MAP

Which of the following measure a child's performance in relation to other children of the same age or grade?

Norm-referenced tests

Formal settings include clinics, hospitals, or other health care facilities. Formal assessment is performed by health care professionals who use norm- or criterion-referenced tests to evaluate a child's physical development.

Norm-referenced tests follow a set of standard procedures. They measure a child's performance in relation to other children of the same age or grade. These tests must be administered precisely to ensure reliability and validity. Criterion-referenced tests place emphasis on mastery of specific skills. They measure a child's performance in relation to his/her past performances rather than comparing it to average group performance.

What is the MOST important tool a child care provider can use during auditory screening?

Observation

First and foremost, observations should take place in natural settings and situations.

Observations resulting from created or artificial situations will have little relevance to how a child will normally behave. Observations should also be documented in some form or fashion, whether through use of well-prepared notes or checklists and forms.

Child care providers can use existing forms to assist in observation. These include parent surveys, checklists, and fill-in-the-blank forms (sample forms can be found in the Resources section of this lesson).

Parent surveys are question-and-answer forms that child care providers can send home for parents to complete. They help provide a more accurate picture of a child's development because parents often have more information than a child care provider can observe in a short period of time. Checklists provide an idea of general behaviors child care providers should be looking for during screenings. Fill-in-the-blank forms are designed to address specific behaviors that should be observed.

Gathering accurate facts about a child's performance is the immediate goal of observation.

Personal opinions should never come into play during observation. Assumptions made based on previous knowledge or personal viewpoints will skew results, making the observation process ineffective and a waste of time.

In order for health care professionals to properly diagnose physical development delays or impairments, children must undergo a developmental assessment. Physical developmental assessment identifies physical delays and impairments, and also the specific areas in which they occur.

Physical developmental assessment should include information gained from interviewing children's parents and child care providers and researching the children's medical histories. It should be performed in formal and informal settings to get the best picture of a child's overall physical development.

Both formal and informal assessments address several areas of children's physical development. Assessment areas include:

Physical health and growth Visual and auditory functioning Gross and fine motor skills

Physical health and growth relates directly to the growth of children's bodies, including bone and muscle structure, height, weight and body mass index (BMI), and head circumference.

Physical health and growth assessments are used to measure individual children's growth against average expected growth of children of all ages and ethnicities.

When should vision and hearing be assessed?

Prior to motor development assessment

Gross motor skills relate to the use of the large muscle groups in the body, including arm, leg, and back muscles. Children with gross motor impairments may have difficulty with any or all of the following:

Sitting without support after 12 months of age Standing without support after 14 months of age Walking without support after 16 months of age Standing on one foot Running, skipping, jumping, or climbing Reaching or throwing a ball Maintaining erect posture Children with gross motor impairments may appear clumsy and uncoordinated. Their movements may seem jerky or spastic, too fast or too slow, and they may stumble or fall often. Children with this type of impairment may also have difficulty planning their movements. For example, they might not realize they have to stand up before they can reach an object on a table.

Which of the following characteristics and actions might children with possible hearing impairments display?

a. Crying in response to loud noises *b. Speaking very loudly c. Talking incessantly *d. Leaving out certain letter sounds when speaking *e. Appearing to have a short attention span f. Responding to others immediately

Tools used to assess gross motor skill development include the Bayley Scales of Infant Development (BSID), Peabody Developmental Motor Scales (PDMS), and Bruininks-Oseretsky Test of Motor Proficiency (BOTMP).

The BSID evaluates children aged newborn to 3 ½ years through measuring body control proficiency, large muscle coordination, purposeful movement, and posture. The PDMS evaluates children less than 6 years of age, and measures reflexes; balance; locomotion, such as crawling, walking, and jumping; and object manipulation, such as catching and throwing. The BOTMP, which evaluates children aged 4 ½ to 14 ½ years, measures strength, speed and agility, and bilateral coordination.

Tools used to assess the motor development of children with known disabilities or impairments include the Gross Motor Function Measure (GMFM), Lighthouse Test, also called New York Flashcards, and Transdisciplinary Play-Based Assessment(TPBA).

The GMFM measures the continuing motor development of children with cerebral palsy. It evaluates children's functional abilities to sit, crawl, stand, walk, and jump (among other skills). The Lighthouse Test measures visual acuity in preschool children with disabilities. TPBA measures gross and fine motor development in children using observation of unstructured play.

Tools used to assess visual functioning include the Miller Assessment for Preschoolers (MAP), Test of Sensory Functioning in Infants (TSFI), Snellen E Charts, and Teller Acuity Cards.

The MAP evaluates balance and posture; touch, pressure, temperature, and pain perception; and awareness of the body's position. The TSFI evaluates how eyes see and how they process what they see. Snellen E Charts evaluate the degree or sharpness of vision using 11 rows of letters that increase in number and decrease in size at each level. Teller Acuity Cards also evaluate the degree or sharpness of vision, but are for nonverbal children. They use a series of cards containing stripes of different widths.

A few of the tools health care professionals use to assess children's development of fine motor skills include the PDMS, Lincoln-Oseretsky Motor Development Scale (LOMDS), and Beery-Buktenica Test (also called VMI or the Developmental Test of Visual-Motor Integration).

The PDMS evaluates children less than six years of age, and measures hand function (such as grasp), dexterity, and hand-eye coordination. The LOMDS evaluates children of all ages, and measures finger dexterity and speed and hand-eye coordination. The Beery-Buktenica Test evaluates children over two years of age, and measures hand control and hand-eye coordination.

Which of the following forms can child care providers use to assist in observation?

a. Professional intervention requests *b. Checklists *c. Fill-in-the-blank forms *d. Parent surveys

Young school-aged children have become experienced in gross motor movements, and do very well controlling their bodies.

Their legs are growing longer; therefore, their balance and coordination is improving. Children this age can usually skip with both feet, and they can maintain their balance for approximately 10 feet when walking a straight line, such as when walking on a balance beam. The majority of school-aged children are also able to use alternating feet on stairs, and are now able to jump rope and walk on their tiptoes. They also have all the skills necessary for more complicated movements, such as those required for tumbling, riding a bicycle, and negotiating obstacles.

There are many tools used by health care professionals to assess areas of physical development. Some are comprehensive, and others are specific to physical development areas.

These tools focus on target populations, usually grouped by age. Some are also grouped by ability level, particularly for children with known cognitive or developmental impairments such as ADD or ADHD, cerebral palsy, intellectual disability, and autism.

Toddlers' gross motor skills are developing more quickly because they are very active. Continuing to walk enhances balance, so they do not fall down as much, and begin to walk more smoothly without having to watch their feet.

They also begin to run with more confidence and can climb stairs by moving both feet to a step before moving to the next one. As they age, toddlers will be able to climb stairs by alternating their feet, but may still move both feet to a step while descending. They are also increasingly able to stand on one foot, walk backward, and hop, and may be able to throw and kick a ball.

Which of the following are characteristics of children with possible vision impairments?

a. Sitting close to others *b. Experiencing headaches, nausea, or dizziness when concentrating visually *c. Stumbling or tripping frequently *d. Having unfocused eyes e. Asking to be the book holder *f. Squinting when looking at something

On growth charts, length/height, weight, BMI, and head circumference are located on the vertical axes, or left and right sides, and age is located on the horizontal axis or bottom. In between the vertical axes is a growth curve, representative of average growth. Each line on the curve represents a percentile ranking between 5 and 95.

When plotting measurements, child care providers must first be sure they use the correct chart for the child's age and sex. Then, they will find the child's age on the horizontal axis and draw a vertical line straight up from that point. Lastly, they locate the desired measurement, length, height, weight, BMI, or head circumference, on the vertical axis and draw a horizontal line straight across from that point until it intersects with the other line.