Anda di halaman 1dari 16

STEP 7 1. Jelaskan mengenai pertumbuhan dan perkembangan?

Definisi tumbuh kembang pada anak 1) Pertumbuhan (Growth) Berkembangan dengan perubahan dalam besar, jumlah, ukuran atau dimensi tingkat sel, organ maupun individu yang bisa diukur dengan ukuran berat (kg/gr) atau ukuran panjang (meter/centimeter) (Soetjiningsih : 1998). Menurut Whaley dan Wong, pertumbuhan sebagai suatu peningkatan jumlah atau ukuran sel tubuh yang ditunjukkan dengan adanya peningkatan ukuran dan berat seluruh bagian tubuh (Supartini, Yupi : 2004). 2) Perkembangan (Development) Menurut Whaley dan Wong, perkembangan manitik beratkan pada perubahan yang terjadi secara bertahap dari tingkat yang paling rendah ke tingkat yang paling tinggi dan kompleks melalui proses maturasi dan pembelajaran ( Supartini, Yupi: 2004). Perkembangan adalah pertambahan kemampuan struktur dan fungsi tubuh yang lebih komleks dalam pola yang teratur dan dapat diramalkan sebagai hasil dari proses pematangan ( Soetjiningsih : 1998). Proses tumbuh kembang anak mempunyai beberapa ciri yang saling berkaitan, yaitu: 1. Perkembangan menimbulkan perubahan Perkembangan terjadi bersamaan dengan pertumbuhan. Setiap pertumbuhan disertai dengan perubahan fungsi, misalnya perkembangan intelegensia pada seorang anak akan menyertai pertumbuhan otak dan serabut saraf.2 2. Pertumbuhan dan perkembangan pada tahap awal menentukan perkembangan selanjutnya Setiap anak tidak akan bisa melewati satu tahap perkembangan sebelum ia melewati tahap sebelumnya. Sebagai contoh, seorang anak tidak akan bisa berjalan sebelum ia bisa berdiri. Seorang anak tidak akan bisa berdiri jika pertumbuhan kaki dan bagian tubuh lain yang terkait dengan fungsi berdiri anak terhambat. Karena itu perkembangan awal ini merupakan masa kritis karena akan menentukan perkembangan selanjutnya.2,4,7 3. Pertumbuhan dan perkembangan mempunyai kecepatan yang berbeda Sebagaimana pertumbuhan, perkembangan mempunyai kecepatan yang berbeda-beda, baik dalam pertumbuhan fisik maupun perkembangan fungsi organ dan perkembangan pada masing-masing anak.1,2 4. Perkembangan berkorelasi dengan pertumbuhan Pada saat pertumbuhan berlangsung cepat, perkembangan pun demikian, terjadi peningkatan mental, memori, daya nalar, asosiasi dan lain-lain. Anak sehat bertambah umur, bertambah berat dan tinggi badannya serta bertambah kepandaiannya.2 5. Perkembangan mempunyai pola yang tetap Perkembangan terjadi lebih dahulu menurut dua hukum yang tetap, yaitu: a. Perkembangan terjadi lebih dahulu di daerah kepala, kemudian menuju kearah kaudal/anggota tubuh (pola sefalokaudal).1,2 b. Perkembangan terjadi lebih dahulu di daerah proksimal (gerak kasar) lalu berkembang ke bagian distal seperti jari-jari yang mempunyai kemampuan gerak halus (pola proksimodistal).2

6. Perkembangan memiliki tahap yang berurutan Tahap perkembangan seorang anak mengikuti pola yang teratur dan berurutan. Tahaptahap tersebut tidak bisa terjadi terbalik, misalnya anak terlebih dahulu mampu membuat lingkaran sebelum mampu membuat gambar kotak, anak mampu berdiri sebelum berjalan, dan sebagainya.2 2. Sebutkan tahap2 tumbang? Walaupun terdapat variasi yang besar, akan tetapi setiap anak akan melalui suatu milestone yang merupakan tahapan dari tumbuh kembangnya dan tiap-tiap tahap mempunyai ciri tersendiri. Dari kepustakaan terdapat berbagai pendapat mengenai pembagian tahap-tahap tumbuh kembang ini, pembagian berdasarkan Hasil Rapat Kerja UKK Pediatri Sosial Kerja di Jakarta, Oktober 1986, seperti tampak pada tabel di bawah ini. Tabel 1. Tahap-tahap tumbuh kembang anak 1. Masa prenatal a. Masa mudigah/embrio : konsepsi 8 minggu b. Masa janin/fetus : 9 minggu lahir 2. Masa bayi : usia 0 1 tahun a. Masa neonatal : usia 0 28 hari - Masa neonatal dini : 0 7 hari - Masa neonatal lanjut : 8 28 hari b. Masa pasca neonatal : 29 hari 1 tahun 3. Masa pra sekolah : usia 1 6 tahun 4. Masa sekolah : 6 18/20 tahun a. Masa pra-remaja : usia 6 10 tahun b. Masa remaja: 1. Masa remaja dini - Wanita, usia 8 13 tahun - Pria, usia 10 15 tahun 2. Masa remaja lanjut - Wanita, usia 13 18 tahun - Pria, usia 15 20 tahun Sesungguhnya tiap-tiap tahap tumbuh kembang tersebut tidak terdapat batas yang jelas, karena proses tumbuh kembang berjalan secara berkesinambungan. 1 Fase tumbuh kembang anak usia 1-3 tahun : A. Tahap perkembangan anak usia 12 sampai 18 bulan Selama masa tahun ke-2 kehidupan masih tampak perlambatan fisis seperti kenaikan BB berkisar antara 1,5-2,5 kg atau 3x berat badan lahir. Panjang badan bertambah 6 - 10 cm/ tahun atau kali panjang badan lahir. Demikian pula halnya dengan pertumbuhan otak yang akan mengalami perlambatan selama tahun ke-2 kehidupan. Penambahan lingkar kepala pada tahun pertama sebanyak 12 cm, pada tahun ke-2 hanya 2 cm. Selama tahun ke-2 timbul sebanyak 8 gigi susu, termasuk gigi geraham dan gigi taring, sehingga seluruhnya ada 14-16 buah gigi susu.

Perkembangan mental yang terjadi pada anak usia 12-18 bulan : o Dapat berdiri sendiri tanpa bantuan o Dapat berjalan dengan dituntun o Menirukan suara o Mengulang bunyi yang didengarnya o Belajar menyatakan satu- dua kata o Mengerti perintah sederhana atau larangan o Ingin melihat semuanya,ingin menyentuh semuanya , memasukkan benda- benda kemulutnya o Berpartisipasi dalam permainan B. Tahap perkembangan anak usia 18 sampai 24 bulan Perkembangan fisisnya cenderung menetap, dapat diukur dengan rumus 5 (panjang bahadan lahir) + 80 untuk pengukuran panjang badan. Dan 2 ( berat badan lahir) + 8, untuk pengukuran berat badan. Lingkar kepal bisanya 47-50 cm. Perkembangan mental anak usia 18-24 bulan : Naik turun tangga Menyusun 6 kotak Menunjuk mata dan hidungnya. Menyusun dua kata. Belajar makan sendiri. Menggambar garis di kertas atau pasir. Mulai belajar mengontrol buang air besar dan buang air kecil. Menaruh minat pada apa yang dikerjakan oleh orang- orang yang lebih besar. Memperlihatkan minat kepada anak lain dan ikut bermain bersama mereka. C. Tahap perkembangan anak usia 2 sampai 3 tahun Pada tahap ini anak biasanya memiliki 20 gigi susu. Lingkar kepala sudah lebih dari 50 cm. Perkembangan mental anak usia 2 - 3 tahun : Belajar melompat dengan satu kaki, meloncat, dan memanjat. Membuat jembatan dengan 3 kotak. Mampu menyusun kalimat. Mempergunakan kata- kata saya, bertanya, mengerti kata- kata yang ditunjuk kepadanya Menggambar lingkaran Bermain dengan anak lain dan menyadari adanya lingkungan lain di luar keluarganya. 3. Jelaskan mengenai milestone serta tabel perkembangan? What is a developmental milestone? A developmental milestone is a skill that a child acquires within a specific time frame. For instance, one developmental milestone is learning to walk. Most children learn this skill or developmental milestone between the ages of 9 and 15 months. Milestones develop in a sequential fashion. This means that a child will need to develop some skills before he or she can develop new skills. For example, children must first learn to crawl and to pull up

to a standing position before they are able to walk. Each milestone that a child acquires builds on the last milestone developed. Developmental milestones are a set of functional skills or age-specific tasks that most children can do at a certain age range Gross motor: using large groups of muscles to sit, stand, walk, run, etc., keeping balance, and changing positions. Fine motor: using hands to be able to eat, draw, dress, play, write, and do many other things. Language: speaking, using body language and gestures, communicating, and understanding what others say. Cognitive: Thinking skills: including learning, understanding, problem-solving, reasoning, and remembering. Social: Interacting with others, having relationships with family, friends, and teachers, cooperating, and responding to the feelings of others. http://www.med.umich.edu/yourchild/topics/devmile.htm Children develop skills in five main areas of development: a. Cognitive Development This is the child's ability to learn and solve problems. For example, this includes a two-monthold baby learning to explore the environment with hands or eyes or a five-year-old learning how to do simple math problems. b. Social and Emotional Development This is the child's ability to interact with others, including helping themselves and self-control. Examples of this type of development would include: a six-week-old baby smiling, a ten-monthold baby waving bye-bye, or a five-year-old boy knowing how to take turns in games at school. c. Speech and Language Development This is the child's ability to both understand and use language. For example, this includes a 12month-old baby saying his first words, a two-year-old naming parts of her body, or a five-yearold learning to say "feet" instead of "foots". d. Fine Motor Skill Development This is the child's ability to use small muscles, specifically their hands and fingers, to pick up small objects, hold a spoon, turn pages in a book, or use a crayon to draw. e. Gross Motor Skill Development This is the child's ability to use large muscles. For example, a six-month-old baby learns how to sit up with some support, a 12-month-old baby learns to pull up to a stand holding onto furniture, and a five-year-old learns to skip. http://www.howkidsdevelop.com/developSkills.html#dev

Fine Motor/Adaptive Unfisted Bats at objects

Mean 3 months 3 months

Normal Range 0 to 4 months 2 to 5 months

Objects to midline Transfers objects Raking grasp Finger feeds Primitive pincer Neat pincer Voluntary release Helps with dressing Spoon feeds Uses cup open/sippy Imitates housework Handedness Helps with undressing Undresses self Toilet training

4 months 5 months 7 months 7 months 8 months 9 months 12 months 12 months 15 months 15 months 18 months 24 months 24 months 36 months

3 to 6 months 4 to 7 months 5 to 10 months 5 to 10 months 6 to 10 months 7 to 10 months 10 to 15 months 10 to 16 months 12 to 18 months 10 to 18 months 14 to 24 months 18 to 30 months 22 to 30 months 30 to 40 months 24 to 36 months

Language Cooing Laugh Turns to voice Razzing Babbling Dada/mama non-specifically Gesture games

Mean 3 months 4 months 4 months 5 months 6 months 8 months 9 months

Normal Range 1 to 4 months 3 to 6 months 3 to 6 months 4 to 8 months 5 to 9 months 6 to 10 months 7 to 12 months

Understands no, Mama/dada specifically One step command with a gesture Immature jargoning One step command w/out a gesture Points to body parts Mature jargoning Puts two words together Pronouns inappropriately Two step command States first name Pronouns appropriately Social/Emotional Social smile Object permanence Stranger anxiety Affective sharing Uses mother as secure base Separation distress Independence Parallel play Associative play Cooperative play

10 months 10 months 12 months 13 months 15 months 18 months 18 months 24 months 24 months 24 months 34 months 36 months Mean 5-6 weeks 9 months 9 months 10 months 12 months 12 months 18 months 24 months 30 months 36 months

9 to 18 months 9 to 14 month 10 to 16 months 10 to 18 months 12 to 20 months 12 to 24 months 16 to 24 months 20 to 30 months 22 to 30 months 22 to 30 months 30 to 40 months 30 to 42 months Normal Range 1 to 3 months 6 to 12 months 6 to 12 months 9 to 18 months 9 to 18 months 9 to 24 months 12 to 36 months 12 to 30 months 24 to 48 months

4. Apa sajakah gangguan2 tumbang pada anak?

a. Gangguan bicara dan bahasa a. Kamampuan berbahasa merupakan indikator seluruh perkembangan anak, karena kemampuan berbahasa sensitif terhadap keterlambatan atau kerusakan pada sistem lainnya, sebab melibatkan kemampuan kognitif, motor, psiklogis, emosi, dan lingkungan sekitar anak. Kurangnya stimulasi akan dapat menyebabkan gangguan bicara dan berbahasa bahkan gangguan ini dapat menetap.2 b. Cerebral palsy a. Merupakan suatu kelainan gerakan dan postur tubuh yang tidak progresif, yang disebabkan oleh karena suatu kerusakan/gangguan pada sel-sel motorik pada susunan saraf pusat yang belum selesai pertumbuhannya.2 c. Sindrom Down a. Anak dengan sindrom Down adalah individu yang dapat dikenal dari fenotipnya dan anak mempunyai kecerdasan yang terbatas, yang terjadi akibat adanya jumlah kromosom 21 yang berlebih. Perkembangannya lebih lambat dari anak yang normal. Beberapa faktor seperti kelainan jantung kongenital, hipotonia yang berat, masalah biologis atau lingkungan lainnya dapat menyebabkan keterlambatan perkembangan motorik dan keterampilan untuk menolong diri sendiri.2 d. Gangguan autis a. Merupakan gangguan perkembangan pervasif pada anak yang gejalanya muncul sebelum anak berumur 3 tahun. Pervasif berarti meliputi seluruh aspek perkembangan sehingga gangguan tersebut sangat luas dan berat, yang mempengaruhi anak secara mendalam. Gangguan perkembangan yang ditemukan pada autis mencakup bidang interaksi sosial, komunikasi dan perilaku.2 e. Retardasi mental a. Merupakan suatu kondisi yang ditandai oleh intelegensia yang rendah (IQ < 70) yang menyebabkan ketidakmampuan individu untuk belajar dan beradaptasi terhadap tuntutan masyarakat atas kemampuan yang dianggap normal.2 f. Gangguan pemusatan perhatian dan hiperaktivitas (GPPH) a. Merupakan gangguan di mana anak mengalami kesulitan untuk memusatkan perhatian yang seringkali disertai dengan hiperaktivitas.2 5. Mengapa pada pemeriksaan didapatkan LK mikrosefali, tonus ke empat ekstremitas hipertoni dan head lag + ? Microcephaly

The growth of the skull is determined by the expansion of the brain. Microcephaly occurs most often because the brain fails to grow at a normal rate. This can be caused by a variety of conditions or exposure to harmful substances during fetal development. Some of these causes include: Chromosomal disorders such as Downs syndrome, Cri du chat syndrome, Trisomy 13, and Trisomy 18 Maternal viral infections such as rubella (German measles), toxoplasmosis, and cytomegalovirus Maternal alcoholism or drug abuse Maternal diabetes Mercury poisoning Uncontrolled maternal PKU Maternal malnutrition Acquired microcephaly might occur after birth due to various brain injuries such as lack of oxygen or infection Etiologi Mikrosefali Cacat perkembangan otak Mikrosefali herediter (resesif)

Infeksi intrauterine Rubella kongenital

Mongolisme dan sindrom Inveksi CMV trisomi lainnya Paparan radiasi ionisasi pada Toksoplasma kongenital janin PKU maternal Sifilis kongenital

Penyakit postnatal dan perinatal Anoksia intrauterine atau neonatal Malnutrisi berat pada awal masa bayi Infeksi herpes neonatal

Ada yang membedakan etiologi mikro-sefali sebagai berikut : 1. Genetik 2. Didapat, yaitu disebabkan : Antenatal pada morbili, penyinaran, sifilis, toksoplasmosis, kelainan sirkulasi darah janin atau tidak diketahui penyebabnya. Intranatal akibat perdarahan atau anoksia. Pascanatal dan setelah ensefalitis, trauma kepala dan sebagainya. 5 Sign and Simptoms Small head circumference Large face High-pitched cry Poor feeding Convulsions Increased movement of the arms and legs (spasticity) Hyperactivity Developmental delays Mental retardation Hipotonia

6. Mengapa pada usia 2 tahun 6 bulan tidak bisa berjalan dan belum bisa bicara? Child development refers to the process in which children go through changes in skill development during predictable time periods, called developmental milestones. Developmental delay occurs when children have not reached these milestones by the expected time period. For example, if the normal range for learning to walk is between 9 and 15 months, and a 20-month-old child has still not begun walking, this would be considered a developmental delay. Childhood Development: 2 to 3 Years Your child is now a toddler. Toddlers have high energy levels. They want to do things for themselves. Keep in mind that your child is experiencing all sorts of impulses, but does not yet have control over them. Tantrums are common. Patience is important. How your child eats: Make eating fun to avoid "food jags" and pickiness by preparing food in fun shapes or with different dipping sauces (e.g. cheese spreads, yogurt, etc.) Your child should be eating "child-friendly" portions that are 1/3 to 1/2 of a regular adult portion. Your child should start the habit of washing his hands before meals. Your child is capable of helping with some meal preparation: scrubbing vegetables, snapping peas, tearing salad greens, and peeling bananas. Watch your child when he eats and avoid giving him foods that he might choke on. Examples include "hard to chew" food like steak, "small and round" food like hot dogs, grapes, peanuts, popcorn (hot dogs and grapes can be cut into strips), and "sticky" food like peanut butter (peanut butter can be mixed with plain yogurt to decrease stickiness). How to care for your child's mouth: Your child may be ready to use a small (pea-sized) amount of fluoridated toothpaste when brushing, but will need your help to floss and clean teeth completely. Talk to your pediatric dentist before starting toothpaste. Most children have all 20 "baby" (primary) teeth by age 2. Most children stop sucking their thumbs by age 2.

Your child should be seeing a pediatric dentist every 6 months. How your child uses his hands (your child's fine motor skill development): Your child is more interested in scribbling with crayons. He will begin to copy lines first, and then circles. Towards his third birthday, your child may enjoy learning to cut with safety scissors. Your child will enjoy simple stringing activities with large beads. Make sure the beads are large enough so that your child will not choke if he puts them in his mouth. How your child moves (your child's gross motor skill development): Your child will learn to run without tripping too often. Your child will also learn to jump on both feet. Your child will learn to walk up and down stairs independently. Your child will be able to balance her weight on one foot for a few seconds. How your child communicates (your child's speech and language development): You will be surprised at how many words your child will learn this year! Try writing down the words that he knows every three months. Your child will learn to talk in short sentences. Your child will be able to talk about events that he remembers happening in the near past, but will confuse words like yesterday and tomorrow. Though he may not always follow your directions, your child does understand you better. He will be able to follow directions using the words "on" "in" and "under." By age 3, 75% of his speech should be clear. Most strangers will understand at least 50% of what your child says. How your child explores (your child's cognitive development): Your child will understand simple stories. Your child's imagination will become more vivid. She may even have imaginary friends and will play pretend with dolls and stuffed animals. Your child also will learn to match familiar items to pictures of those items. Your child may enjoy simple puzzles (3-4 piece puzzles are great for 2 year-olds). Your child may begin to "play house." You will see that she knows what familiar objects are used for. Your child will be able to name pictures of objects and point to pictures of people doing familiar activities in books. Your child will learn to count "1-2-3" and understand what those numbers mean. How your child is growing emotionally (your child's social and emotional development):

Your child is showing more interest in other children. He will be more cooperative in simple games with other children. He will like playing with other children. Your child begins to understand rules that are consistently reinforced. Use praise or a favorite activity to reward her for following rules.

During this year, the more you help your child with transitions from one activity to the next, the easier it will be for your child. For example, tell him about an upcoming visit to the doctor, or a stay with a babysitter. Your child will like having a daily routine. Help him adjust to new experiences or persons by introducing him to the new person or situation slowly. "Mine" is a word often used by your child in this period. By the end of this year, your child will know that he is a boy, or that she is a girl and she can identify herself in the mirror.

7. Apakah infeksi 1 tahun berkaitan dengan gejala sekarang? pada post natal kemungkian infeksi yang menyebabkan developmental delayed? BATASAN Terlambatnya perkembangan pada anak dibawah usia 6 tahun seringkali merupakan gejala awal dari retardasi mental. Perkembangan anak dinyatakan terlambat apabila pada skrining terdapat keterlambatan pada salah satu atau beberapa dari aspek perkembangan (motorik kasar, motorik halus, berbicara, perilaku sosial). Adanya perbedaan standard edukasi 20% antara usia khronologis (C.A.) dan usia mental (M.A). PATOFISIOLOGI Perkembangan terlambat terjadi karena faktor-faktor yang mempengaruhi dan menghambat proses tumbuh kembang terjadi pada : o Masa sebelum lahir (antenatal) : Adanya kelainan genetik (Sindroma Down, Turner), gizi ibu hamil yang tidak adekuat kekurangan makronutrien dan atau mikronutrien, dan infeksi TORCH (Toxoplasmosis, Rubella, Cytomegalovirus, Herpes) o Masa persalinan (natal) : Asfiksia yang terjadi karena gangguan pada plasenta dan tali pusat, kesukaran persalinan, infeksi, trauma lahir, dan tindakan pada persalinan patologik. o Masa pasca persalinan (post natal) : Pola asuh yang salah dan infeksi, gangguan syaraf dan perilaku karena pengaruh lingkungan yang tidak optimal. http://old.pediatrik.com/isi03.php?page=html&hkategori=ePDT&direktori=pdt&filepdf=0&pdf=&ht ml=07110-jwoh274.htm 8. Apa factor resiko bayi yang bisa mengalami developmental delayed? The major risk factors for developmental delay or adverse neurodevelopmental outcome include maternal and child factors. The following are some of the most common: Maternal Factors Any of the following characteristics of a mother raise the possibility that she may have a child with developmental delay. These factors are associated with an increased risk but not necessarily causative. No all mothers with these characteristics will have a child with developmental delay and some mothers who have children with developmental delay have none of these characteristics: age of the mother under 18 at delivery mother having 12 or fewer years of education unwed marital status

prenatal care beginning after the third month of pregnancy tobacco use during pregnancy alcohol use during pregnancy medical history factors (anemia, poor nutrition, infections, diabetes, hypertension) complications of labor and/or delivery Child Factors Some child characteristics raise the risk the child with have developmental delay but not all children with these characteristics will a have delays and not all children with developmental delay will have one of these factors: gestational age less than 37 weeks birth weight under 2,500 grams (5 pounds) Apgar score (at 5 minutes) of less than 7; this is an assessment of the physical condition of a newborn infant, with scores ranging from 0 to 10. multiple births (e.g., twins, triplets, quadruplets) presence of newborn medical condition (such as anemia) congenital abnormality http://www.mychildwithoutlimits.org/understand/developmental-delay/who-does-developmentaldelay-affect/ Pola pertumbuhan dan perkembangan secara normal antara anak yang satu dengan yang lainnya pada akhirnya tidak selalu sama, karena dipengaruhi oleh interaksi banyak faktor. Menurut Soetjiningsih (2002), faktor yang mempengaruhi tumbuh kembang, yaitu: a) Genetika 1) Perbedaan ras, etnis, atau bangsa 2) Keluarga, Ada keluarga yang cenderung mempunyai tubuh gemuk atau perawakan pendek 3) Umur Masa prenatal, masa bayi, dan masa remaja merupakan tahap yang mengalami pertumbuhan cepat dibandingkan dengan masa lainnya. 4) Jenis kelamin Wanita akan mengalami pubertas lebih dahulu dibandingkan laki-laki. 5) Kelainan kromosom Dapat menyebabkan kegagalan pertumbuhan, misalnya sindrom down. b) Pengaruh hormone Pengaruh hormon sudah terjadi sejak masa prenatal, yaitu saat janin berumur empat bulan. Pada saat itu terjadi pertumbuhan yang cepat. Hormon yang berpengaruh terutama adalah hormon pertumbuhan somatotropin yang dikeluarkan oleh kelenjar pituitari. Selain itu kelenjar tiroid juga menghasilkan kelenjar tiroksin yang berguna untuk metabolisme serta maturasi tulang, gigi, dan otak. c) Faktor lingkungan Faktor kelompok yang dapat berpengaruh dikelompokkan menjadi tiga, yaitu pranatal, kelahiran, dan pascanatal. d) Faktor prenatal

1) Gizi, nutrisi ibu hamil akan mempengaruhi pertumbuhan janin, terutama selama trimester akhir kehamilan 2) Mekanis, posisi janin yang abnormal dalam kandungan dapat menyebabkan kelainan conginetal, misalnya club foot 3) Toksin, zat kimia, radiasi 4) Kelainan endokrin 5) Infeksi TORCH atau penyakit menular seks 6) Kelainan imunologi, 7) Psikologis ibu e) Faktor kelahiran Riwayat kelahiran dengan vakum ekstraksi atau forcep dapat menyebabkan trauma kepala pada bayi sehingga beresiko terjadinya kerusakan jaringan otak. f) Faktor pascanatal Seperti lainnya pada masa prenatal, faktor yang berpengaruh terhadap TUMBANG anak adalah gizi, penyakit kronis/ kelainan konginetal, lingkungan fisik dan kimia, psikologis, endokrin, sosioekonomi, lingkungan pengasuhan, stimulasi, dan obat-obatan 9. Mengapa disarankan dilakukan pemeriksaan penunjang SSP, fungsi pendengaran, penglihatan? What are the warning signs of a developmental delay? There are several general "warning signs" of possible delay. These include: Behavioral Warning Signs o Does not pay attention or stay focused on an activity for as long a time as other children of the same age o Focuses on unusual objects for long periods of time; enjoys this more than interacting with others o Avoids or rarely makes eye contact with others o Gets unusually frustrated when trying to do simple tasks that most children of the same age can do o Shows aggressive behaviors and acting out and appears to be very stubborn compared with other children o Displays violent behaviors on a daily basis o Stares into space, rocks body, or talks to self more often than other children of the same age o Does not seek love and approval from a caregiver or parent Gross Motor Warning Signs o Has stiff arms and/or legs o Has a floppy or limp body posture compared to other children of the same age o Uses one side of body more than the other o Has a very clumsy manner compared with other children of the same age Vision Warning Signs o Seems to have difficulty following objects or people with her eyes o Rubs eyes frequently o Turns, tilts or holds head in a strained or unusual position when trying to look at an object

Seems to have difficulty finding or picking up small objects dropped on the floor (after the age of 12 months) o Has difficulty focusing or making eye contact o Closes one eye when trying to look at distant objects o Eyes appear to be crossed or turned o Brings objects too close to eyes to see o One or both eyes appear abnormal in size or coloring Hearing Warning Signs o Talks in a very loud or very soft voice o Seems to have difficulty responding when called from across the room, even when it is for something interesting o Turns body so that the same ear is always turned toward sound o Has difficulty understanding what has been said or following directions after once she has turned 3 years of age o Doesn't startle to loud noises o Ears appear small or deformed o Fails to develop sounds or words that would be appropriate at her age In addition, because children usually acquire developmental milestones or skills during a specific time frame or "window", we can predict when most children will learn different skills. If a child is not learning a skill that other children are learning at the same age, that may be a "warning sign" that the child may be at risk for developmental delay. 10. Pemeriksaan penunjang lain? Developmental delay is identified through two types of play-based assessments: Developmental Screening Developmental Evaluation A developmental screening test is a quick and general measurement of skills. Its purpose is to identify children who are in need of further evaluation. A screening test can be in one of two formats, either a questionnaire that is handed to a parent or childcare provider that asks about developmental milestones or a test that is given to your child by a health or educational professional. A screening test is only meant to identify children who might have a problem. The screening test may either over-identify or under-identify children with delay. As a result, a diagnosis cannot be made simply by using a screening test. If the results of a screening test suggest a child may have a developmental delay, the child should be referred for a developmental evaluation. A developmental evaluation is a long, in-depth assessment of a child's skills and should be administered by a highly trained professional, such as a psychologist. Evaluation tests are used to create a profile of a child's strengths and weaknesses in all developmental areas. The results of a developmental evaluation are used to determine if the child is in need of early intervention services and/or a treatment plan. 11. Pengelolaan yang harus dilakukan ? fisioterapi What if my child does not meet a developmental milestone?

Each child is an individual and may meet developmental milestones a little earlier or later than his peers. You may have heard people say things like, "he was walking before he turned 10 months, much earlier than his older brother" or "she didn't say much until she was about 2 years old and then she talked a blue streak!" This is because each child is unique and will develop at his or her own pace. However, there are definitely blocks of time when most children will meet a milestone. For example, children learn to walk anytime between 9 and 15 months of age. So, if your child is 13 months of age and not yet walking, there is no need to worry if he is crawling and pulling to a stand. He has acquired the skills he needs to learn to walk and may begin walking soon. However, if you have a child 15 months of age who is not yet walking, it would be a good idea to talk with your child's pediatrician to make sure there aren't any medical or developmental problems since age 15 months is outside of the normal "window" or time frame in which children learn to walk. In this website, we will provide you with some information about these "windows" or blocks of time when children usually develop a skill. We also will share with you some warning signs or "red flags" to watch for that may mean your child is not meeting developmental milestones. We will also give you the names of some books and websites about child development that you may find helpful. However, whenever you have questions, do not hesitate to ask a professional like your child's doctor, nurse practitioner, or a trained child development or behavioral specialist. There are also several clinical specialists who are specifically trained in various areas of development who can be consulted. These include speech pathologists, occupational and physical therapists, developmental psychologists and audiologists. What are early intervention services? Early intervention services include a variety of different resources and programs that provide support to families to enhance a child's development. These services are specifically tailored to meet a child's individual needs. Services include: Assistive technology (devices a child might need) Audiology or hearing services Counseling and training for a family Educational programs Medical services Nursing services Nutrition services Occupational therapy Physical therapy Psychological services Respite services Speech/Language How can I help my child meet these developmental milestones? As parents, we all want our children to succeed and be the best they can be. We know from research that two factors influence how your child succeeds and grows: genes and environment. One of the factors that influence our child's development is their genetic makeup or "genes." Some

people refer to this as "nature." Genes are the genetic material we pass onto our children. Children are born with their "genes" in place. These genes act like a blueprint for what characteristics a child may have. For example, genes determine if a child will have blue eyes or brown eyes; they also determine if he will be left- or right-handed. The other factor that influences child development is the environment. This includes experiences children have in their home, school and community environments. Some people refer to this as "nurture." The environment can either improve or harm a child's genetic blueprint. For example, malnourished children who live in third world countries may not reach their IQ potential because of the impact of their environment on their brain development. We often think we need to run out and buy special toys, music and games to stimulate our child's development, but we have to remind ourselves that it is more important to provide the following, every-day activities you can do with your child to encourage brain development. Give your child lots of love and attention. No matter what a child's age, holding, hugging, and listening are important ways to show your child they matter. Interact with your child by talking, singing, playing, eating, and reading with your child. Your child will grow up feeling special and important to you. You will also learn a lot about your child's interests and skills. Read, read, read. Research has shown that children who are read to by their parents have a larger vocabulary than other children. Reading also provides children with new perspectives about the world we live in. Learn some simple parenting skills for helping your child to learn how to behave. The most important parenting skills are having consistent rules, rewarding behaviors you want to see your child do more of, and having consequences for behaviors you do not want your child to continue to do. Limit TV time and video time to no more than 1-2 hours of educational viewing per day. Daftar Pustaka : 1. Supartini yupi. 2004. Konsep dasar keperawatan anak : buku kedokteran, EGC, jakarta 2. Soetjiningsih. Tumbuh kembang anak. Jakarta : EGC;1995.h.1-32. 3. Departmen Kesehatan Republik Indonesia. Pedoman pelaksanaan stimulasi, deteksi dan intervensi dini tumbuh kembang anak di tingkat pelayanan kesehatan dasar. Jakarta : Departemen kesehatan republik Indonesia;2005.h.1-14. 4. Sinto R, Oktaria S, Astuti S, Mirdhatillah S, Sekartini R, Wawolumaya C. Penapisan perkembangan anak usia 6 bulan 3 tahun dengan uji tapis perkembangan Denver II. Sari Pediatri, vol.9,No.5,Februari 2008.h.348-353. 5. http://www.howkidsdevelop.com/developDevDelay.html 6. http://www.howkidsdevelop.com/developSkills.html#dev