Clinical examination of children. Laboratory methods include clinical, immunological and biochemical blood tests, studies of urine, feces, cerebrospinal and pleural fluids

The presented methodology involves examining the child along the main lines of development: social, physical, cognitive.

The purpose of conducting a psychological and pedagogical examination is to identify the individual level of formation of the main lines of development of a child in the third year of life. The examination is aimed at identifying the child’s current level of development (independent completion of tasks) and his zone of proximal development (the child’s ability to complete tasks with the help of an adult).

The main method of study during an individual examination is observation of children in the process of their activities.

Social development. The study of social development includes establishing the nature of the child’s interaction and communication with adults; determining the level of development of self-service skills; characteristics of behavior and emotional-volitional sphere. Social development is determined during a conversation with the child’s parents.

Child's means of communication: expressive facial expressions (smile, gaze, gestures, etc.); objective-active (handing various objects to an adult, expressing protest, etc.); verbal means of communication (statements, questions).

Characteristics of child-adult contacts: establishes contact easily and quickly; selective contact; contact is formal; does not make contact.

Features of behavior and emotional-volitional sphere: active (passive); active (inert); not aggressive (aggressive) towards other children; prevailing mood (cheerful, calm, irritable, unstable, sudden mood swings).

Characteristics of the child: calm, passive, cheerful, smiling, irritable, angry, stubborn, lethargic, often (rarely) cries, conflicted, etc.

Everyday skills (to be clarified in conversation with parents): eats independently with a spoon; eats with someone's help; fed by an adult; sucks a bottle; drinks independently from a cup; drinks with someone's help; an adult gives water; dresses independently; requires a little help from an adult; dressed by an adult; the skill of neatness has been developed (uses the toilet independently); The skill of neatness has not been developed (does not ask to go to the toilet in a timely manner).

To understand whether the baby can establish contact with a new adult and cooperate with him, he is offered the task “Catch a ball” (you will need a groove and a ball).

Conducting a survey: The teacher puts the ball on the groove and asks the child: “Catch the ball!” Then the adult turns the groove and asks the child to roll the ball along the groove: “Roll the ball!” You need to roll the ball four times.

Teaching a child to take action: if the child does not catch the ball, the adult shows him two or three times how to do it.

Assessment of the child's actions: ready to complete the task; understands verbal instructions; wishes to cooperate (play) with an adult; how he feels about the game; result.

If the child cannot cope with the “Catch the ball” task, he is offered an easier task, intended for children of the second year of life, “Fetch the ball”.

Conducting a survey: An adult rolls a ball on the carpet past a child and asks: “Bring the ball.” The game is repeated two or three times.

Education: if the child does not go for the ball, the adult takes the ball himself and gives it to the child. After the child has held the ball in his hands, the adult asks him to roll the ball: “Roll the ball.”

Assessment of the child's actions: ready to complete the task; understands verbal instructions; how he feels about cooperation (accepts the game or refuses to play).

Physical development. In order to study the level of formation of basic movements, sets of exercises are offered for children 2-3 years old, as well as special series of tasks for younger children (1.5 - 2 years old). Each series consists of 5 exercises of varying degrees of difficulty.

In the process of examining physical development, the level of formation of such basic child movements as walking, running, jumping, etc. is determined.

Due to the fact that many children entering the short-term stay group do not speak speech or speak it insufficiently, all tasks are given to the child in verbal and non-verbal form: during the examination, the teacher should use natural gestures.

When starting the examination, it is important to remember that the child may be stubborn, negativistic, and refuse proposed tasks. Therefore, the methodology provides for the use of various ways to encourage the child to perform them. If a child begins to interact with an adult, but refuses to complete any specific task, you should not force him.

If the child is unwilling to act, another pedagogical technique should be used: you need to complete the task together with a peer from the group. The teacher invites a peer and asks the children to complete the task one by one. In such a situation, as a rule, they attract an active child who knows how to quickly establish contact with others.

It should be emphasized that the specialist begins the examination only when a friendly, trusting relationship is established between him and the baby.

If the child easily comes into contact with an adult and willingly focuses his attention on a task, but cannot complete it independently or performs it incorrectly, training is carried out. The methodology provides for the use of fixed types of assistance - demonstration, imitation, joint actions. After assistance is provided, the child is always given the opportunity to complete the task independently.

In the process of examining physical development, attention is paid to the child’s contact (desire to cooperate with an adult) and his activity. There is an emotional response to encouragement or comments, the ability to detect the error of one’s own actions, and interest in the result of the activity.

For the examination you need: a log, three pins, two ropes, a cord, a hoop, a box 10 cm high; long stick; a board raised at one end above the floor by 15-20 cm.

Exercises for children 2 -2.5 years:

• 1. Walking in a given direction.
• 2. Run after an adult in a given direction.
• 3. Climbing over a log.
• 4. Jumping in place on two legs.
• 5. Walking on a cord laid straight.

Exercises for children 2.5-3 years old:

• 1. Walking with obstacles.
• 2. Crawling on all fours.
• 3. Jumping over a rope placed on the floor.
• 4. Running between two lines (you cannot step on the lines).
• 5. Walking on a cord laid in a zigzag.

Additional exercises

Exercises for children 1.5 -2 years and also

for children 2 -2.5 years old who failed to complete tasks appropriate to their age:

• 1. Walking in a straight direction.
• 2. Crawling through a hoop.
• 3. Lifting with the help of an adult onto a box 10 cm high that is turned upside down.
• 4. Stepping over a stick or rope placed on the floor.
• 5. Walking on a board, one end raised 15-20 cm above the floor, and stepping off it.

Assessment of the child’s actions: ready to complete a task, completes tasks with the help of an adult (demonstration, imitation, joint actions), ability to complete a task after training, result.

Cognitive development. A psychological and pedagogical examination of cognitive development involves identifying the level of sensory development: practical orientation to shape, size, color; perception of an object image, holistic perception of an object picture; development of visual thinking. An important direction in examining a child is the study of the child’s level of development of objective actions - correlative and instrumental, as well as the prerequisites for design and drawing.

Children are offered tasks taking into account their age: one series of tasks is designed for children from two years to two years and six months, the other - for children from two years and six months to three years (Table 1).

Let us consider in detail the methodology for examining the cognitive development of children.

Insert figures into slots (Seguin board).

The task is aimed at identifying the level of development of the child’s form orientation. Normally, a child acts by trial and error.

Equipment: a wooden (or plastic) board with three slots - round, triangular, square or with six slots - round, square, rectangular, semicircular, triangular and hexagonal, with six flat geometric shapes, the bases of each of which correspond to the shape of one of the slots.

Conducting a survey: The teacher shows the child the board, draws his attention to the figures and takes them out one by one. Then he invites the child to insert these figures into the slots: “Insert all the figures into your slots.”

Education: carried out if the child does not understand what needs to be done, tries to insert the figure using force, i.e. does not take into account the shape of the slot. The teacher slowly shows how to insert the figures into the slots, using the trial method: “Here is the figure. We'll try to insert it into this slot. She doesn't fit here. Let's try another one. This is where it fits.” After the explanation, the child is given the opportunity to act independently. If he doesn’t succeed, you need to act with him. Then he is again given the opportunity to complete the task independently.

Table 1

Tasks aimed at cognitive development

Name	Ages two to two years and six months	Ages from two years and six months up to three years
Insert figures into slots	Three figures	Six figures
Hide the ball in a box	Two boxes	Four boxes
Disassemble and assemble the pyramid	Of three rings	Of four rings
Select paired pictures
Match the colored cubes	Two colors	Four colors
Putting together a whole picture from parts	Two parts	Three parts
Get the cart	sliding	Sliding and false
Build from sticks
Draw

Assessment of the child’s actions: ready to complete a task, understands verbal instructions, acts purposefully, completes tasks independently or after training; method of completing the task - trial method, chaotic actions, joint actions with an adult; what is the learning ability during the diagnostic examination; result.

Hide the ball in a box. The task is aimed at identifying the child’s orientation towards magnitude and the presence of correlative actions. Normally, a child acts by trial and error.

Equipment: 2 (3) quadrangular boxes of different sizes of the same color with matching lids; 2 (3) balls, different in size, but identical in color.

Carrying out the examination: 2 (3) boxes, different in size, and lids for them, located at some distance from the boxes, are placed in front of the child. The teacher puts a large ball in a large box, and a small ball in a small box and asks the child to cover the boxes with lids and hide the balls. At the same time, the child is not explained which lid to take. The task is for the child to guess for himself which lid should be used to close the corresponding box.

Education: If the child selects the lids incorrectly, the adult shows and explains: with a large lid we close a large box, and with a small lid we close a small box. After training, the child is asked to complete the task independently.

Assessment of the child’s actions: ready to complete the task, understands verbal instructions; methods of implementation - trial method, the presence of correlating actions, chaotic actions, joint actions with an adult; what is the learning ability during the diagnostic examination; result.

Disassemble and assemble the pyramid. The task is aimed at identifying the child’s level of development of practical orientation to magnitude, the presence of correlating actions, determining the leading hand, the coordination of actions of both hands, and the purposefulness of actions.

Equipment: pyramid of 3 (4) rings.

Conducting a survey: The teacher invites the child to disassemble the pyramid. If the child does not begin the task, the adult disassembles the pyramid himself and invites the child to assemble it.

Education: if the child does not start the task, the adult begins to give him the rings one at a time, each time indicating with a gesture that the rings need to be put on the rod, then offers to complete the task independently.

Assessment of the child's actions: ready to complete the task, takes into account the size of the rings; learning ability, attitude to activity, result.

Select paired pictures. The task is aimed at identifying the child’s level of development of visual perception of object pictures and understanding of gesture instructions.

Equipment: two (four) pairs of subject pictures.

Conducting a survey: two object pictures are placed in front of the child. The exact same pair of pictures is in the hands of an adult. The psychologist shows with a pointing gesture that he and the child have the same pictures. Then the adult closes his pictures, takes out one of them and, showing it to the child, asks to see the same one.

Education: if the child does not complete the task, then he is shown how to correlate paired pictures: “Mine is the same as yours,” while the teacher uses a pointing gesture.

Assessment of the child’s actions: ready to complete the task, makes choices, understands the teacher’s gestures; learning ability, attitude towards one’s activities.

Match the colored cubes. The task is aimed at identifying color as a feature, distinguishing and naming color.

Equipment: colored cubes - 2 red, 2 yellow (2 white), 2 green, 2 blue (four colors).

Carrying out the examination: 2 (4) colored cubes are placed in front of the child and asked to show the same one as in the adult’s hand: “Take the same cube as mine.” Then the teacher asks to show: “Show me where

Education: if a child does not distinguish colors, then the teacher teaches him. In cases where a child distinguishes colors, but does not distinguish them by name, he is taught to distinguish two colors by name, repeating the name of the color two or three times. After training, independent completion of the task is checked again.

Assessment of the child's actions: ready to complete the task, does the child compare colors, recognizes them by name, knows the name of the color; the teacher records the speech accompaniment of the actions; attitude towards your activities; result.

Fold a cut picture. The task is aimed at identifying the level of development of holistic perception of an object image.

Equipment: subject pictures (2 identical), one of which is cut into two (three) parts.

Conducting a survey: The teacher shows the child two (three) parts of the cut picture and asks him to put the whole picture together: “Make a whole picture.”

Education: in cases where the child cannot correctly connect the parts of the picture, the adult shows the whole picture and asks to make the same one from the parts. If after this the child cannot cope with the task, the adult himself superimposes one part of the cut picture onto the whole one and asks the child to add another. Then he invites the child to complete the task independently.

Assessment of the child’s actions: ready to complete the task, in which way he performs it - independently, after training; attitude towards the result; result.

Remove the trolley (sliding strap). The task is aimed at identifying the level of development of visual-effective thinking and the ability to use an aid (ribbon).

Equipment: for a child aged 2 years to 2 years 6 months. - a trolley with a ring, a ribbon through the ring; for a child aged 2 years 6 months. up to 3 years - next to the sliding ribbon - false.

Carrying out the examination: There is a cart in front of the child at the other end of the table, which he cannot reach with his hand. Within the reach of his hand are two ends of the ribbon, which are separated by 50 cm. The child is asked to get the cart. If the child only pulls on one end of the strap, the cart stays in place. The task is for the child to figure out how to pull the cart by both ends of the ribbon (connect both ends, or pull both ends of the ribbon with both hands).

Education: The child completes the task himself by trial and error.

Assessment of the child’s actions: if the child pulls on both ends, then a high level of performance is noted. If the child first pulls on one end of the ribbon, then he should be given the opportunity to try again, but this is a lower level of performance. The adult behind the screen threads the ribbon through the ring and, removing the screen, invites the child to get the cart. If the child does not know how to use the ribbon, then this is assessed as failure to complete the task; The child’s attitude towards the result is also recorded, and the result itself is evaluated.

Build from sticks(“hammer” or “house”). The task is aimed at identifying the level of development of holistic perception, the child’s ability to act by imitation and demonstration.

Equipment: four or six flat sticks of the same color.

Carrying out the examination: In front of the child, they build a “hammer” or “house” figure out of sticks and ask him to do the same: “Build the same hammer.”

Education: If the child cannot complete the showing task, he is asked to complete the imitation task: “Look and do as I do.” After training, the child is again asked to build a “hammer.”

Assessment of the child’s actions: ready to complete the task, the nature of the action is noted - by imitation, demonstration; learning ability and attitude to the result are assessed; result.

Draw(path or house). The task is aimed at understanding verbal instructions, identifying the child’s readiness to create an object drawing, as well as determining the leading hand, coordination of hand actions, attitude to the result, result.

Equipment: pencil, paper.

Conducting a survey: the child is given a piece of paper, a pencil and asked to draw: “Draw a path (house).”

No training is provided.

Assessment of the child’s actions: whether the child understands verbal instructions; performs specific actions with a pencil; analysis of the drawing - scribbling, deliberate scribbling, object drawing; attitude towards drawing; result.

Speech development. A speech examination includes studying the child’s understanding of spoken language addressed to him and determining the state of his active speech. For these purposes, first of all, children are monitored during the entire examination. Special assignments are also offered.

During an individual examination, it is determined how many words denoting objects and actions the child knows, that is, vocabulary, the level of developed phonemic hearing, and the ability to follow verbal instructions of varying complexity.

Show picture. The task is aimed at studying the child’s vocabulary (nouns, verbs).

Equipment: pictures depicting objects familiar to the child: a doll, a ball, a bear, a spinning top; plate, teapot, cup, spoon; car, train, bus, plane; apple, orange, tomato, cucumber. Pictures depicting the action: a girl gets dressed, a boy washes his face; the boy is skating, the mother is bathing the baby; children are building a garage, children are playing ball; the girl drinks, the doctor gives the boy medicine.

Carrying out the examination: 2-4 pictures are laid out in front of the child and offered to show one of them. For example: “Show me where the spinning top (doll, bear) is.” If the child chooses the picture correctly, the teacher

asks to tell what is depicted on it. If the baby cannot choose the correct picture, the adult does it himself, names the object and asks the baby to repeat.

Another example. The teacher asks the child: “Show me where the girl gets dressed. What is the girl doing? If the child does not answer, the teacher himself says: “The girl is getting dressed,” and asks the child to repeat the phrase.

At the same time, the teacher records the child’s ability to name objects (actions) with a sound, syllable, onomatopoeia, word, or show with a gesture; the presence of phrasal speech (understandable or obscure to others) is noted.

Complete the task. The task is aimed at identifying the child’s ability to follow verbal instructions of varying complexity, as well as understanding simple prepositions (on, in, under), level of formation of phrasal speech.

Equipment: box; toys - matryoshka, dog, car, doll, red and yellow cubes, ball.

Carrying out the examination: The child is asked to perform the following actions: clap your hands; raise a hand; put a matryoshka doll on box; hide the ball under table; Take yourself a doll and give the teacher a red cube.

After each action performed, the teacher asks the child to say what he did: “Tell me, where did you hide the nesting doll?”, “What did you give me? What did you take for yourself?” etc.

If the child does not follow the instructions, the adult should repeat them. The tasks should not be repeated more than three times.

Fixed performing actions in accordance with verbal instructions.

During the examination, the state of the child’s speech is determined, and it is noted whether he uses sentences consisting of three words, whether he uses adjectives and pronouns, whether he uses sentences consisting of one or two words; does he use lightweight words? (beep) or complete, pronounces some words correctly (for example, car), names objects and actions at the moment of strong interest; Does he use light words at the moment of physical activity, surprise, joy?

Assessment of a child’s speech development: ready to complete the task, how he relates to the task - does he understand verbal instructions, is there independent speech, can he repeat after an adult a phrase, words, babbling words, sounds, lack of active speech.

Results of a psychological and pedagogical examination of children with organic lesions of the central nervous system

Many years of experience in conducting psychological and pedagogical examinations of young children using the presented methods allows us to determine the main parameters (indicators) of the main lines of development: the child’s readiness to interact and cooperate with adults; formation of basic movements; acceptance of the task, methods of completion (independently or with the help of an adult), learning ability in the process of psychological and pedagogical examination, presence of imitative ability, interest in the result. In accordance with these parameters, children in the third year of life with organic damage to the central nervous system can be divided into three groups.

To the first group include children who have a lag behind the age norm in some basic lines of development. A child in this group is interested in cooperation with an adult; he is ready to establish contact with a new adult, he takes initiative in communication; eats independently, dresses with the help of an adult, and has developed the skill of neatness. In most cases, physical exercises are performed by imitation in accordance with the age norm. Completes tasks related to cognitive development after training. At the same time, he is a good learner, interested in cooperation with adults, and shows interest in the results of his activities; There is an interest in deliberate scribbling, and there is an imitative ability. Understands elementary instructions addressed to him, uses a pointing gesture, and uses individual words in active speech.

To the second group include children who lag behind the age norm along all main lines of development. The child is inactive and shows little initiative in communicating with the new adult; When performing household procedures, he needs the help of an adult; the skill of neatness has not been developed. Physical development is below the age norm: performs only that part of the tasks that are designed for young children, does not imitate the actions of an adult. He cannot cope with tasks related to cognitive development on his own, and after training he completes only some of them, as a rule, together with an adult. When trying to complete tasks on his own, he exhibits chaotic movements and lacks the ability to imitate. The child has no interest in drawing on paper, he does not use a pencil for its intended purpose, and cannot independently build a figure out of sticks even after training. Understanding of speech addressed to him is limited, he acts only on instructions made by a gesture, in active speech babbling words or individual sounds are noted.

To the third group These include children who show a significant lag behind the age norm along all main lines of development. The child does not show interest in the adult, does not take the initiative in communicating with the new adult; When performing household procedures, he always needs the help of an adult; the skill of neatness has not been developed. He does not complete tasks aimed at physical development, because most often he does not understand the task assigned to him; His general movements are awkward, tense, he has difficulty switching to new movements, and his balance is poorly maintained. Does not complete tasks aimed at cognitive abilities independently. When trying to do them independently, he acts with objects chaotically and inappropriately: he takes toys in his mouth, knocks, throws them, i.e. the child does not understand what needs to be done. He has no orientation towards the conditions of the task and lacks purposeful actions. The child acts adequately only together with an adult (the adult’s hand holds the baby’s hand); he lacks the ability to imitate. Shows no interest in productive activities (scribbling on paper, building with sticks). Speech understanding is very limited; active speech contains only individual sounds.

Early diagnosis and correction of developmental problems. The first year of a child’s life Arkhipova Elena Filippovna

Examination of children in the first year of life

When working with children in their first year of life, special attention should be paid to preventing deviations in their development. For this purpose, when examining children from the first weeks of life, the following methods and techniques are used: observations of babies during the waking period, conversations with medical personnel, study of medical documentation, psychological and pedagogical observation of children in the pre-speech period, comparative analysis of their psychomotor and speech development.

Such an examination, which is comprehensive in nature, allows us to identify pathological features in the pre-speech development of children, including children with consequences of perinatal damage to the central nervous system (PPC CNS), identify the structure of the disorder and determine ways of correction.

Similar work with children is carried out starting from an early age, since pathological features in their development appear from birth and interfere with the further correct formation of speech and mental activity.

In the process of examining children in the first year of life, special attention is paid to the following areas of work.

Study of anamnestic data. When analyzing anamnestic data, the following are taken into account: the course of pregnancy, the condition of the child at birth, the characteristics of the cry, the presence and nature of asphyxia (Apgar score). Particular attention is paid to the innate unconditioned oral reflexes that provide the possibility of sucking and swallowing. The time of appearance of indicative reactions to visual and sound stimuli, the moment of appearance and the nature of the smile are taken into account.

Study of child motor development. Together with a neurologist, the child’s motor abilities are examined: the presence of pathological tonic reflexes and their spread to the muscles of the tongue and eyes; the ability to hold one’s head, which is necessary for the development of orientation-cognitive activity; the ability to turn and sit, which also expands the ability to understand the surrounding world, contributes to the development of objective activity and contact.

Particular attention is paid to the development of the muscles of the hand, the position of the first finger, the possibility of hand-eye coordination, manipulative and object-based activities (which affects the development of speech). Together with the doctor, the child’s general muscle tone, the nature of hyperkinesis (pathological, suddenly occurring involuntary movements in various muscle groups), convulsions are determined, and the child’s ability to stand on his feet and walk is also determined.

Study of the state of the speech apparatus. The presence of pathology in the structure of the articulatory apparatus is noted. Together with the doctor, the condition of the muscle tone of the articulatory apparatus, the distribution of tension during emotional stress, and the peculiarities of the movement of the lips and tongue are examined. The state of oral reflexes, oral synkinesis (involuntary accompanying movements that occur only with voluntary movements), and the nature of hyperkinesis are determined. Observing the child during feeding, the peculiarities of food intake are noted: sucking and swallowing. The nature of the voice, scream and breathing are taken into account.

Study of a child’s vocal and pre-speech activity. When examining the pre-speech level of development, the speech therapist notes the nature of the child’s cry, its intonation-expressive coloring and communicative function. Establishes the presence, nature and time of appearance of an intoned voice used by the child as a means of communication. While observing the child, it is necessary to note the time of appearance revelry, features of its development from spontaneous vocalization to self-imitation and reciprocal humming.

Let us give examples of methods for identifying possible vocal reactions of a child.

Identification technique

The situation is provocative or natural. The child lies on his back, calm.

1) An adult bends over the child, maintaining a distance of 25–30 cm from his eyes. Focuses the child's attention on his face, gently pronounces words and sounds for 2-3 minutes.

2) Only observation is carried out, without the use of means of influence.

3) Observations alternate with repeated pronunciation of vowel sounds for 8-10 minutes.

If the child has babble it is necessary to determine the stage of its development (stages I, II, III according to V.I. Beltyukov - see p. 65).

Identification technique

The situation is natural. The child is awake. An adult observes him for 30 minutes.

1) Roll call with the child.

2) The adult repeatedly pronounces the syllables that are in the child’s babble.

3) The situation is provoking. An adult, sitting in front of a child, emotionally addresses him and clearly, with short pauses, pronounces the syllables that the child had previously pronounced himself. The exercise is carried out for 30 seconds.

4) The adult clearly, with short pauses, pronounces syllables that are not in the child’s babble.

If the child has first words determine the time of their appearance and the nature of amorphous words-sentences.

Identification technique

The situation is natural or provoking.

1) An adult offers the child toys that he has played with many times and watches him play.

2) An adult can invite the child to name the toy: “What (who) is this?”

3) An adult sits in front of the child and pronounces syllables (in a variety of combinations) with different intonations that the baby has not previously uttered.

4) An adult tries to interest the child in a toy and asks: “What (who) is this?”

Psychological and pedagogical examination aimed at studying the state of orienting reactions in children in the first weeks of life and orienting-cognitive activity in children in the first months of life. During the examination, sensory functions are studied: visual and auditory perception, attention to adult speech and the level of development of initial understanding of speech.

Let us give an example of a technique for identifying visual indicative reactions.

Identification technique

The situation is provocative. The child lies on his back.

1) An adult holds a toy (a rattle with a ball with a diameter of 5-10 cm) at a distance of 40–50 cm from the child’s face and moves it to the right and then to the left by 20–30 cm (2–3 times).

2) An adult, attracting the child’s attention, swings the toy, talks to him, now leaning toward the baby, now moving away from him. Having caused concentration, the adult remains motionless or holds the toy at a height of 40–50 cm from the child’s eyes.

3) An adult causes the child to concentrate on an object (a bright toy), moving it to the side 20 cm, and then stops the object at a height of 50–70 cm from the baby’s eyes.

4) Familiar and unfamiliar adults take turns talking to the child. The exercise is carried out for 1.5–2 minutes.

There are many diagnostic methods designed for studying young children, for example, the methods of N. M. Aksarina, K. L. Pechora, G.V. Pantyukhina, E.L. Frucht, L. T. Zhurby, O. V. Timonina, E. M. Mastyukova, E.A. Strebeleva.

As basic methods for diagnosing the psychomotor development of infants suffering from PPP of the central nervous system, we can recommend the methods of G.V. Pantyukhina, G.L. Pechory, E.L. Frucht (1983), O. V. Bazhenova (1986), Yu.A. Lisichkina (2004), M. Griffiths (2000), M.L. Dunaykina (2001). To assess the nature and extent of disorders, prognosis of development, and determine the corrective focus of measures, a high-quality clinical analysis of deviations in psychomotor development is required. For this purpose, the methods of L. T. Zhurba, E. N. Mastyukova and E. D. Aingorn (1981) are used.

As an example, let us take the Griffiths test of psychomotor development (translation by E. S. Keshishyan, 2000), which is used for screening examinations of children (see Table 2).

table 2

Griffiths Psychomotor Development Test

The assessment of the child’s psychomotor development is made in points, which are then compared with the points determined by the standards (see Table 3).

Table 3

Summary table of points

Let us give an example of a quantitative analysis of the results of an examination of a child aged one year.

According to the results of the screening examination, a child aged one year scored: motor skills - 17 points; social adaptation – 16 points; hearing and speech – 13 points; eyes and hands – 19 points; ability to play – 20 points. The total score is 85 points out of 150–155 possible (see Table 3). Thus, a one-year-old child corresponds to a seven-month-old child in terms of motor development; according to the level of social adaptation - a six-month-old child; for the development of hearing and speech – for a five-month-old child; eyes and hands - for a seven-month-old child; ability to play - an eight-month-old child.

As a result, the graph of the level of psychomotor development of a child at the age of one year will look like this.

Examination parameters: 1. Motor skills. 2. Social adaptation. 3. Hearing and speech. 4. Eyes and hands. 5. Ability to play.

Analyzing the results obtained during the examination of a child at the age of one year, and comparing them with the conventional norm, we can note a lag in psychomotor development in all functions by 6 months. In fact, a one-year-old child corresponds to a six-month-old child. The identified features in the psychomotor development of the child are indications for a more in-depth study of it in medical, psychological and pedagogical terms.

During such an examination, it is possible to identify children at risk and plan a corrective regime aimed at stimulating certain functions, as well as include psychological and pedagogical support. If the lag increases with age, for example, at 8 months a child gains only 60 points instead of 100 points, which corresponds to the development level of a six-month-old child, then a more in-depth examination and, possibly, corrective and developmental measures are necessary. It is also necessary to study the conditions for raising the baby, his physical condition, etc.

For a more in-depth examination of children, the methods of O. V. Bazhenova (1986), M. L. Dunaykin (2001) and others should be used.

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Features of examination in pediatrics

The body of a child, especially the first months and years of life, differs in many ways from the body of an adult. Knowledge of the anatomical and physiological characteristics of the child’s body is the basis for proper examination, diagnosis, organization of therapeutic measures and care throughout the entire period of childhood.

It is always more difficult to examine a child than an adult. Before starting the examination, it is necessary to establish contact with the child and his parents, reassure the patient, and create an atmosphere of mutual trust. Harsh, rude and thoughtless words and actions should be avoided. A calm voice and light touch calm a stiff child, help reduce pain, and reduce anxiety in upset parents.

Usually, during the conversation, young children remain in the arms of their parents. A school-age child behaves calmly during a conversation; during a survey, he can be involved in the conversation by asking questions. The room where the child is examined should help create a positive emotional mood (bright colors, pictures, comfortable furniture, warmth).

The diagnostic process begins with collecting an anamnesis, which helps to clarify the causes and clinical picture of the disease.

Features of medical history collection in pediatrics are as follows:

It is impossible to collect an anamnesis in young children, so you have to rely on parental complaints based only on observations of the child;

Older children (who can already speak) can express complaints, but cannot correctly analyze various painful sensations, give them due significance, and associate them with certain factors;

The importance of a thorough and detailed clarification (in young children) of the characteristics of the course of pregnancy and childbirth in the mother, the condition of the child in the neonatal period, feeding, child care, physical and neuropsychic development;

When collecting an anamnesis of life and illness, it is necessary to be critical of the information received from the mother or child, highlight the most important symptoms of the disease, determine the sequence of their appearance;

Child research methodology

The clinical symptoms of the disease depend on the age and immunological state of the child’s body.

In order for the child’s examination to be complete, it must be carried out according to a certain scheme. The research methodology for a child differs from the research methodology for an adult. When starting an objective study, it is necessary to remember that it is very important to approach the child correctly, to be able to calm him down, distract him, occupy him with a toy or conversation, since anxiety and excitement make the study much more difficult, and sometimes simply impossible. Those. procedures that are unpleasant for the child (for example: examination of the pharynx) or may cause pain should be carried out at the end.

The study of a child consists of questioning and objective research.

Upon questioning, the following is revealed: 1) passport data;

2) life history;

3) history of the development of the disease.

Passport details

In the registration part, you should indicate the child’s age, exact date of birth, home address, number of the child care institution that the child attends, last name, first name, patronymic of the parents and place of work.

Anamnesis of life

Life history is extremely important for identifying the individual characteristics of the child and for recognizing the present disease, assessing the severity and predicting the course of the disease. The procedure for collecting anamnesis in children:

1.The age of the parents, their state of health, the presence of hereditary diseases, chronic intoxications, sexually transmitted diseases, tuberculosis, alcoholism and other diseases in the family and in close relatives.

2.How many pregnancies the mother had and how they ended. How many births were there? How many living children are currently alive, their age and state of health, age of deceased children, cause of death.

3. What kind of pregnancy and birth is this child from? State

maternal health during pregnancy and childbirth. Date of birth, duration, obstetric intervention.

4.Characteristics of the child during the newborn period; full term or not, if possible, find out the cause of prematurity. Cry at birth (weak, loud). Body weight and length at birth. When they put it to the breast, how they took the breast, how long after they fed the baby. On what day did the remainder of the umbilical cord fall off, and how did the healing of the wound with the umbilical cord proceed?

5. Weight of the child upon discharge from the maternity hospital (if possible, clarify the physiological decline). Physiological jaundice, time of its manifestation, degree of its manifestation, duration. On what day was he discharged from the hospital?

6. At what age did he begin to hold his head up, turn on his side, sit, crawl, walk? Weight gain in the first year of life and in subsequent years. Time and timing of teething, order of teething.

7. Neuropsychic development. When he began to smile, walk, recognize his mother, pronounce individual syllables, words, phrases. At what age does one attend a child care facility? Peculiarities of behavior in a children's team, what individual habits are. School performance. Additional loads (music, foreign languages, etc.) Sleep, duration of sleep (daytime, nighttime).

8.Feeding. What kind of feeding was the child in the first year of life? Time to transfer to mixed and artificial feeding. Timing of introduction of complementary foods. Supplementary and complementary feeding foods that the child received. Weaning time. Was the feeding regime followed? Nutrition now.

Appetite. Do you get enough protein foods (meat, fish, cottage cheese, milk, eggs), vegetables, fruits, juices? Diet: Gets hot food how many times a day.

9. Material and living conditions. Housing conditions (apartment, private house). Characteristics of the apartment (light, dark, cold, warm, sunny, dry, damp). How often is wet cleaning and ventilation carried out? Does the child have a separate bed, is there enough linen and clothing for the season? Bathing (regular, no, how often). Daily regime. Walk in the air, how many times a day, how many hours a day, systematically, no. Sleeping in the air.

10. Previous diseases. What kind, at what age, course, severity, presence of complications, treatment in hospital, at home.

11.Preventive vaccinations. What diseases is the child vaccinated against? Were the vaccination dates observed, was there a reaction to the vaccine, how did it manifest itself?

12. Tuberculin tests (Mantoux test), date and results.

13. Allergological history. Allergic reactions and diseases in parents, relatives, and a sick child. Were there any manifestations of allergic diathesis and what were they? Food allergies (to which foods). Drug tolerance.

14. Hematological history. Blood, plasma, gamma globulin transfusions and reactions to them.

15.Epidemiological history. Contact with patients with infectious diseases: where (at home, in a child care facility), when, preventive measures in connection with contact.

Related information.

According to prof. G. A. Zakharyina, a correctly collected anamnesis is half the diagnosis.

Usually the child's medical history is collected from the parents, preferably from the mother. An observant mother, with skillful questioning of the doctor, can provide a lot of valuable information about the development of the disease in the child. However, often the mother imposes on the doctor her subjective opinion about the cause and even diagnosis of the disease. Therefore, a lot of patience and tact is required from the doctor in order to, after calmly listening to the mother’s story, force her to answer specific questions accurately and briefly.

It is also necessary to talk with a sick child, especially an older one, but you should remember that he cannot always clearly define his feelings; he is very suggestible. In addition, children can deliberately mislead the doctor.

The age of the child determines some of the specifics of collecting anamnesis. Thus, for children of the first years, especially the first year of life, detailed data on the age and health of the parents, their habits and occupational hazards, as well as the mother’s obstetric history: information about the course of pregnancy, nutrition during pregnancy, duration of labor, complications, are of utmost importance. during childbirth. The course of the neonatal period, the nature of feeding (when complementary feeding is introduced, when the child is weaned), indicators of physical and mental development, behavioral characteristics, previous diseases, living conditions, contacts with infectious patients are clarified in detail.

For older children, data on all previously suffered diseases, including acute infectious diseases, indicating the age at which the disease was suffered, the severity of the disease and complications that occurred, is of particular importance. Attention is drawn to previously administered preventive vaccinations and the presence of pathological reactions to them.

Considering the increasing role of allergies in the development of diseases, it is necessary to identify the child’s tendency to allergic reactions to various factors of the external and internal environment, food, medications, the frequency of acute respiratory diseases and their connection with allergies.

The history of the present disease must reflect the onset of the disease, its first and subsequent symptoms, and the development of the disease to the present moment. The assessment of these data has its own characteristics, determined by the age of the child. Thus, the diagnostic value of the same symptom changes sharply at different age periods (for example, rash, convulsions, jaundice may have different diagnostic significance at an early and older age).

If the child’s condition is serious and urgent measures are necessary, it is advisable to first ask the mother about the cause and development of the present disease, examine the child and provide the necessary assistance, and then collect a general history and all additional information. If the child is at an outpatient clinic or is admitted to the hospital in satisfactory condition, then the medical history can be collected in the usual sequence.

A detailed anamnesis occupies an important place in the examination and allows us to make a conclusion about the suspected disease, the nature of the pathological process, as well as negative factors in the child’s life and family conditions that could contribute to the development of the present disease.

During a conversation with the mother and child, it is necessary to observe the patient’s behavior, coordination of his movements, characteristics of thinking and speech, i.e. begin an objective examination. In pediatrics, the same assessments of the patient’s condition (“satisfactory”, “moderate”, “severe”, “very severe”, “agonal”) and the same research methods are used as in adults, but in order for the results to be correct, you need to be able to approach the child and know some special examination rules.

Examination plays an important role in examining a child. If the child is sleeping, it is not recommended to wake him up. On the contrary, in this state the most accurate data will be counting the pulse rate and respiration. Gradually, with careful movements and always warm hands, it is necessary to completely undress the child. Only in patients of puberty, while sparing the psyche, can this be done partially.

If the child has a negative attitude towards the examination, then you should overcome his fear and resistance by turning his attention to toys, cuddle him, and tell him a fairy tale. Many children quickly get used to seeing a doctor; the examination process, if it does not cause pain, attracts their attention, the child willingly allows himself to be examined and even imitates the doctor’s techniques. But there are children who are spoiled, overly excitable, and for whom ordinary techniques do not work. In these cases, a strict doctor's order sometimes helps, and only in exceptional cases can a forced examination be used.

It is advisable to carry out the examination in daylight and, as an exception, in bright electric lighting, in which it is difficult to correctly assess the color of the skin and mucous membranes, especially to identify jaundice. Young children are placed on a table; older children can be examined in their mother's arms or in a crib.

There is a certain sequence of inspection. First of all, it is necessary to assess the child’s position (active, passive, forced), his posture, gait, facial expression, eyes, skin color, the presence and nature of the rash, and the severity of catarrhal syndrome. The child should be examined completely, even if the diagnosis is clear, as there may be unexpected findings of either concomitant illness or developmental abnormalities. Nutritional status and physical development are assessed, pulse and respiratory rate are determined, and then organs and systems are examined according to the generally accepted scheme.

Examination of the oropharynx and painful areas of the body (for example, joints with polyarthritis) should be carried out last, since this examination will certainly cause discomfort and cause resistance in the child, after which further examination may be impossible. When examining the oropharynx, the child must be fixed so that the doctor can carefully examine the mucous membrane of the oral cavity, pharynx, and tonsils in bright light. Inspection is carried out only with a spatula or spoon.

Calm, friendly, confident behavior of the doctor and medical

Personnel, humane attitude towards the patient and his relatives are the key to successful treatment and subsequent prevention of diseases in childhood. The doctor must always maintain close contact with the child’s mother, be a constant adviser in raising the child and a conductor of the necessary medical knowledge among the people around him.

The method of clinical examination of a child involves a sequential interview of parents and examination of the child, and the priority of interviewing parents or examining the child changes with age.

The clinical examination begins with a survey of parents and includes:

I. Genealogical history:

Letter designations for dental diseases of mother, father, and other relatives: K - caries; P - periodontal disease; ARF - anomalies of the face and jaws; ATT - anomalies of hard dental tissues; AP - malocclusion; AM - anomalies of soft tissue attachment; BUT - presence of tumors. Conclusion: there is a hereditary predisposition:
- to caries
- to periodontal diseases
- to malocclusions
- to tumors
- to hereditary defects

II. Chronic diseases of the mother:

A) endocrinopathies: diabetes mellitus, thyroid diseases, adrenal gland diseases,

B) cardiovascular: heart defects, hypertension, hypotension, etc.,

C) kidney diseases: nephritis, etc.,

D) gastrointestinal diseases: gastritis, peptic ulcer of the stomach and duodenum, colitis, etc.,

D) diseases of the liver and gall bladder: hepatitis, cholecystitis, etc.,

E) blood diseases: anemia, etc.

III. Acute infectious diseases of the mother suffered during pregnancy.

IV. Medicines that the mother received during pregnancy (antibiotics, hormones, sulfonamides, barbiturates, salicylic acid, etc.).

V. Occupational hazards in the mother during pregnancy (chemical production, etc.).

VI. Bad habits of parents (smoking, alcohol, etc.).

VII. Obstetric and gynecological history:

1, 2, 3 pregnancy; 1st, 2nd, 3rd births in a row; pregnancy full-term, premature, post-term; outcome of previous pregnancies.

VIII. Pathology of pregnancy and childbirth:

A) toxicosis of the first half of pregnancy (vomiting, salivation, dermatoses, chorea of ​​pregnancy, acute yellow liver atrophy, bronchial asthma, osteomalacia, etc.);

B) toxicosis of the second half of pregnancy (dropsy, nephropathy, preeclampsia, eclampsia, hypertension and hypotension in pregnant women, etc.);

B) bleeding, anemia;

E) complications during childbirth (abnormalities of labor, placenta previa, facial presentation of the fetus, fetal hypoxia, obstetric assistance using obstetric forceps, vacuum extraction, cesarean section).

IX. Child development (Apgar score):

A) length, birth weight, started holding head at... months, sitting at... months, walking at... months,

B) the nature of feeding (breastfeeding until... months, artificial feeding from... months, spoon feeding from... months, drinking from a cup from... months, transition to solid food from... months);

C) diseases suffered by the child in the first year of life (intracranial birth injury, hemolytic disease, staphylococcal infection, pneumonia, ARVI, exudative diathesis, dyspepsia, rickets);

D) health group: I, II, III, IV, V.

X. Dental status:

A) external examination: the face is proportional, symmetrical, asymmetrical, has developmental defects (cleft lip, palate, structural anomaly of individual parts of the face, fistulas, neoplasms (hemangioma, unspecified);

B) vestibule of the oral cavity (small, medium, of sufficient depth), frenulum of the upper lip (normal, anomaly in size, attachment), frenulum of the lower lip (normal, anomaly in size, attachment), frenulum of the tongue (normal, anomaly in size, attachment);

B) oral mucosa: color, moisture;

D) tongue (pink, moist, smooth, folded, coated, presence of foci of desquamation);

E) the shape of the alveolar processes (semicircular, elliptical, trapezoidal);

E) relationship of the jaws: sagittally (neutral, the lower jaw is located in front, behind or at the same level with the upper jaw), vertically (the presence of a gap between the gingival ridges is more than 3 mm, tight contact between the gingival ridges), according
transversals (correct, reduction or increase in the size and width of the jaws);

G) teething (normal, premature, delayed, paired, unpaired, sequence of teething;

H) the condition of the hard tissues of the tooth: color - white, yellow, gray, shape of the teeth - regular, changed; hypoplasia, hypoplasia complicated by caries, hypoplasia combined with caries; aplasia and other dental malformations;

I) functions: breathing (nasal, oral, mixed), swallowing (infantile, somatic), chewing (active, lazy);

K) bad habits (sucking fingers, tongue, cheeks, objects, biting lips, cheeks, placing a fist under the cheek during sleep);

K) use of a pacifier (not used, used constantly, limited) up to what age...

Stage epicrisis (drawn up every six months)

1. Age at the time of compilation of the epicrisis

2. The number of diseases suffered by the child over the past period.

3. Facial malformations (yes, no)

4. Deviations in the formation of occlusion (yes, no, no changes, self-regulation, correction, worsening)

5. Anomaly of soft tissue attachment (yes, no, eliminated, elimination not indicated)

6. Neoplasms (yes, no). Hypoplasia (yes, no, no changes, stabilization,
deterioration)

10. Preventive measures to prevent: caries, malocclusions

11. Treatment by a dentist, surgeon, orthodontist, therapist

12. Treatment by a pediatrician of a different profile

This plan for the history and examination of the child is quite extensive. However, many parts of it can be filled out by the nurse or the mother herself before, after, or during the doctor's examination of the child.

During a conversation between a doctor or nurse and the mother, it is very important to carefully monitor the child, because from this moment the examination of the child begins and in a relaxed atmosphere it is easy to identify his bad habits (thumb sucking, pacifiers, etc.), breathing problems, swallowing disorders etc.

Examination of a child under the age of 6 months should be carried out in a lying position, and after 6 months - in a sitting position on the mother’s lap, sitting on a chair or in a dental chair.

The results of a clinical examination of a child allow us to distinguish 3 dispensary groups:

Group I - healthy children,

Group II - healthy children with risk factors for dental diseases,

Group III - children with diseases, developmental defects, deviations in formation.