Chapter 9: Child Development: Implications for Inpatient Medicine

UNDERSTANDING DEVELOPMENT

Understanding child development and its associated constructs sets the care of children apart from the care of adults.¹ There is consensus on the need to provide developmentally appropriate health care to children and adolescents, especially in the context of disability and chronic illness.² When provided with an appropriate venue children across developmental ages can develop mastery in skills necessary to adapt and cope with illness, hospitalization, and treatment. They begin to understand many aspects of illness and treatment. Over time they are adept participants in care and treatment planning, able to communicate their needs as active partners in physician-patient-parent communication triads.³

DEVELOPMENTAL STREAMS AND MILESTONES

Human development is a highly dynamic process that involves an interaction between the genetic and neurologic makeup of a child with the environment in which he or she lives.⁴ Children are typically monitored in health supervision visits across dimensions or streams of development including physical, social and emotional, language, and cognitive growth.¹ Milestones are the myriad of developmental achievements that occur in typical patterns over predictable sequences in time.⁴ Knowledge of these sequences aids the inpatient medicine physician in being able to explain diagnosis, care, and treatment to patients and families, aid parents in helping their children adapt to hospitalization, and promote health and well-being in a developmentally appropriate manner. Table 9-1 outlines the specific milestones for various developmental streams, with special attention paid to when the absence of a skill becomes a red flag for problems.