Achieving Optimal Child Development

Are Your Children Developing Well?

The key to nurturing your children to become well-rounded adults is to understand that it’s not really about what you want your children to be, but about doing your best to develop your children to their full potential.

Consultant Paediatrician Datuk Dr Zulkifli Ismail, the Immediate Past President of Malaysian Paediatric Association and Chairman of the Positive Parenting Management Committee says: “Unfortunately, some parents are just too eager to ensure their children get a head start. You’ll be surprised to know that some 5-year olds nowadays are spending their weekends in tuition classes. And when these children do not turn out the way their parents want them to be, the parents get so upset that they begin to be less affectionate to the children. This in turn has such a negative impact on their development and self-esteem.”

So as to ensure children develop to their full potential, parents need to understand how all the aspects of child development (please see below) interrelate with one another from birth to maturity.

Datuk Dr Zulkifli remarks: “Knowledge about child development definitely helps. Ask your child’s doctor for recommendation and clarify what you don’t understand. You can see a paediatrician for consultation even when there is nothing wrong with your child. Also, talk to your child. Find out what he likes and dislikes so that you will not ‘torture’ him without noticing it. ”

Important Areas of Child Development
Involves major movements like crawling, standing, sitting, walking, etc.

Child’s ability to use hands to manipulate objects.

From smiling and laughing to feeding and dressing self.

From vocalisation and babbling to making full sentences and using language to communicate.

Understand to Prevent

Taking the right steps towards prevention

Child development is the process whereby a baby develops to become an independent functioning adult. According to Dr Hussain Imam Muhammad Ismail, development is about acquiring skills of increasing complexity leading to independence.

“Child development can be divided into four main areas: fine motor, gross motor, speech and language, and personal and social skills,” says Dr Hussain, the Head of the Paediatric Department, Hospital Kuala Lumpur. “These four functional areas make a person a wholesome individual.”

He defines the four areas as thus:

  • Gross motor – A process by which a baby acquires independent mobility. It is like the hatching behaviour of chicks; innately programmed, rather than learned.
  • Fine motor – This has to do with the ability to use handsto manipulate objects, which requires visual-spatial skills.
  • Speech and language – Revolves around the need to communicate, acquire new ideas and exchange them and mature intellectually. It makes human beings go forward.
  • Personal and social skills – Requires you to learn to interact with others and even yourself.

Range of Normality

Dr Hussain says that it’s important for parents to know that there is a range of normality. For instance, some parents may think their child is slow, but this child could actually be functioning within the normal range of development.

”One should not hurry to label a developmental delay because it is usually determined over a few examinations, unless it is an obvious case of global delay as with Down syndrome,” he says, adding that parents should follow the levels of progression and that any expectations should not exceed the normal pace.

“Children will only walk when they are ready to walk. Putting them in walkers at six months of age does not make them walk any earlier and may result in serious domestic accidents,” Dr Hussain emphasises.

Developmental problems are not uncommon, as 10% of children are affected by them. However, the vast majority of children are only mildly affected. Children with mild developmental problems do get better and have a high chance of becoming independent adults with proper intervention, help and added attention. However, about 10 to 15% of children with developmental delay are severely affected with impairments that will limit their independence as adults.

Developmental Warning Signs
Gross Motor Fine Motor Speech and Language Personal and Social Skills
  • Not rolling over by 6 months
  • Not sitting by 8 months
  • Not crawling by 10 months
  • Not standing by 15 months
  • Not walking by 18 months
  • Not fixing on objects by 2 months
  • Not reaching for objects by 6 months
  • Not transferring by 8 months
  • Not princer grasp by 16 months
  • Not sribbling by 2 years
  • Not drawing a circle by 3 years
  • Not cooing by 6 months
  • Not pointing (using gestures) by 1 year
  • Not single words by 18 months
  • No meaningful phrases by 2 years
  • Not understood by family at 3 and by strangers at 4 years
  • Does not understand what is said to him at 3 years
  • Not smiling by 10 weeks
  • No stranger anxiety by 8 months
  • Not spoon-feeding self at 18 months
  • Unable to dress self (except buttoning) at 3 years

Impairment, Disability and Handicap

These three terms are often misunderstood. Dr Hussain addresses this issue with an interesting point: “Impairment is a problem you have. For example, vision problems. But if you wear glasses, your vision is no longer impaired. If you don’t or cannot correct this, however, it becomes a disability, which then involves your interaction with social limitations. If you cannot do what society expects you to do, you then become handicapped.” He states, however, that if society is willing to become more accommodating, disabled people can function with the limits of their disability and become productive and independent adults. Fewer individuals then become handicapped.

Causes of Developmental Problems


Developmental problems that are congenital can be broken down into two groups: genetic endowment and specific genetic.

“If you come from a family with a history of learning disorders, there is an increased tendency for you to have certain intellectual problems,” says Dr Hussain. “This is what is meant by genetic tendency. The same applies for diabetes and hypertension.”

On the other hand, specific genetic disorders lead to recognisable syndromes. Individuals with Down syndrome, for example, have an extra chromosome 21 that causes a delay in all aspects of development, especially intellectual functions, language and social skills. Dr Hussain says that this is the most common specific chromosomal developmental problem in this country, and one that does not get better with time.


Sub-cultural factors cause about 10% of mental retardation. Dr Hussain explains, “Everything from poor housing, malnutrition and poverty to a lack of motivation, selfesteem and opportunities tend to compound matters, resulting in mild, intermediate or severe mental retardation.”

Preventing Developmental Problems

Not all developmental problems can be treated. Depending on the time of intervention and the degree of seriousness, Dr Hussain says there is no guarantee that a problem can be corrected. “As with other problems, prevention is better than cure.”

Some measures that can be taken to prevent developmental problems include:

  1. Screening pregnant mothers.
    Screening can help detect problems like AIDS and syphilis which can lead to mental retardation. In addition, all children should be immunised against rubella to prevent congenital rubella syndrome.
  2. Screening newborn babies.
    All newborn babies should be screened for congenital hypothyroidism. If these children are treated early, they will develop normally. They should also be monitored for high levels of jaundice as this is another highly preventable cause of brain damage.
  3. Assuring safe delivery.
    Delivery should be conducted in a safe environment to avoid birth injury and trauma.
  4. Planning pregnancy.
    Women who plan to get pregnant should take their age into consideration. If you are above 35 years of age, you face an increased risk of giving birth to a child with Down syndrome.
  5. Eliminating sub-cultural causes.
    There will be better opportunities for self-improvement with affirmative actions to improve nutrition, housing and education and providing support to those exposed to sub-cultural causes.
  6. Ensuring more means for early intervention.
    There is a great need for allied health professionals in Malaysia. A lack of therapists and multitasking by nurses cause early intervention to be simplistic and not tailored to the needs of individual children.

Dr Hussain concludes, “Both unrealistic expectations and denial will hinder optimal child development. Don’t delay intervention, seek help when concerned.”

Common Pitfalls of Parenting

Addressing the wrong to do the right

If you’ve ever felt that children nowadays are growing up on fast-forward mode, you’re not alone. Consultant Clinical Psychologist Dr Teoh Hsien-Jin, says: “We’ve noticed that there is a change in development within this country,” he says. “For instance, four-year-olds nowadays can easily operate DVD players or use hand phones to take photos. While parents can be proud of such accomplishments, they don’t seem worried whether their children are developing basic social skills just as well.”

He points out some common areas where parents often go wrong when it comes to equipping their children with the necessary social developmental skills, and what they can do to remedy the situation:

  1. Leaving it all to the maid
    Successful parents do not always bring up successful children. This is because their commitment to work often leaves them little time to spend with their young ones. These parents instead leave their children totally in the care of the maid, depriving them of the love and affection they need from parents. Spend some time with your children and let them know that they still have a secure relationship with you.
  2. Not allowing them to help out
    Your children are never too young for simple chores. Besides, you cannot always do things for them. Some parents give in so much that their children begin to boss them around. Letting children help with things around the house will help them develop. Folding blankets, making their own beds and allowing them to set the dining table will not only improve their motor skills, but will also give them a sense of responsibility that boosts their social development.
  3. Praising only the ‘As’
    Praising your children definitely makes them feel happy. But why only praise them when they do well in their exams? Do you praise them when they act in a school play? Or sing on Teacher’s Day? Address your children’s talents and encourage them even when you think they should be doing something else. Try to understand and see things from their point of view. Remember that you’re not always right. For all you know, it could be something that they would want to do for the rest of their lives, so recognise and appreciate all their abilities.
  4. Telling yourself that “they are just children”
    You notice your child spitting on his friend’s hamster, but all you do is laugh and ignore it, thinking that there is no need to scold him as he’s just a child. When parents do not correct such behaviour, or worse still, become role models by behaving badly in front of their kids, children will grow up thinking that it’s okay to misbehave. This often leads to anti-social behaviour that will be practised throughout their lives. Children need to learn the appropriate social behaviour. If you do not start now, when do you think you should?
  5. Letting them learn solely from TV
    Some parents think that placing their children in front of the television all day will improve their vocabulary and make them more intelligent. Little do these parents know that real interaction is essential. Children may understand words that they hear on TV, but will not know how to use that particular word until they practise it. The next time you let your children watch television, join in and talk to them. Discussing subjects that interest them will develop speech and language skills and also encourage creative thinking.
  6. Using threats and lies
    How often have you used phrases such as “Come inside or the ghosts will come after you” or “Behave yourself and I’ll take you to the mall?” “Many parents think that threatening, ‘blackmailing’ and lying to their children will gain them some compliance and respect. They don’t think, however, of the negative images, thoughts and false hopes they’re instilling in their children. Children are vulnerable, they get hurt and confused easily. Threats and lies will only add up and interfere with their personal and social.

Dr Teoh has these words of advice: “Think carefully about what you are doing to your children now. If you wish for the community to move forward, nurture your children’s abilities and mould them to become good individuals. Build a good foundation for the future because your children will be passing it on to the next generation.”

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