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"A physicist is just an atom's way of looking at itself." - Niels Bohr

Developmental assessment

Developmental milestones:

 

AGE

GROSS MOTOR

FINE MOTOR

SPEECH AND LANGUAGE

PERSONAL AND SOCIAL

Newborn

Primitive reflexes

Head lag

Symmetrical posture

Responds to bright lights

Startles to loud sounds

 

6-8 weeks

Symmetrical movements

Normal tone

Follows side to side

Opens hands

Normal cry

Responds to sounds

Smiles responsively

3 months

Head control

Lifts head when prone

Visually alert

Follows vertically

Hand regard

Reaches for objects

Vowel sounds

Laugh

 

6 months

Rolls over

Lifts head and chest when prone

Sits with support

Reaches and grasps for objects

Consonant babble

 

8 months

Sits without support

Attempts to crawl

Palmar grip

Transfers

 

Turns to voice

Two syllable babble

Friendly to all

Finger feeds

12 months

Crawls

Stands

Walks holding furniture (cruising)

Points

Two finger grip

Casts

Recognises name

“No”

Imitates speech sounds

Stranger anxiety

Drinks from a cup

Waves

Peek-a-boo

18 months

Walks unsupported

Pincer grip

Tower of 2 bricks

6 words with meaning

Understands simple instructions

Spoon feeding

Nursery rhymes

2 years

Runs

Climbs stairs

Jumps off floor

Kicks ball

Scribbles

Tower of 6 bricks

Points to body parts

Combines words

Undresses

Symbolic play

3 years

Pedals tricycle

One foot to step

Copies circle/cross

Builds bridge

Sentences

Recognise colours

Gives first and last name

Puts on clothes

Toilet trained by day

Names friend

4 years

Stands on one foot

Hops

Ball skills

Good pencil grip

Builds stairs

Draws Square

Draws 3 part man

Asks questions

Enjoys jokes

Tells stories

Uses fork

Washes hands and face

Brushes teeth

 

Bold items indicate that further investigation is needed if skills not acquired.

 

Developmental delay may be in one specific area (e.g. speech only) or may be general. Delay includes arrest of development and deterioration of development. Some conditions may present as unusual patterns of development such as sudden development of complex speech in autism.

 

History

The history of any child with possible developmental delay should include:

  • Definition of developmental problem
  • Developmental history (onset, progress, behaviour, concentration)
  • Pregnancy and birth (alcohol, congenital infection, prematurity, IUGR)
  • General health (fits, hearing, vision, neurology, other systems)
  • Family history
  • Social history (neglect, impact on family, schooling)
  • Specific parental concerns

 

Examination

Examination should include assessment of:

  • Four areas (listed above): gross motor, fine motor, speech and language and social behaviour
  • Dysmorphic features
  • Growth (including head circumference)
  • Skin (hyper/hypopigmentation, port wine stains)
  • Hearing and vision
  • Neurological system (gait, tone, power, reflexes, asymmetry)
  • Other systems (murmurs, organomegaly)

 

Risk Factors

Major risk factors for developmental delay include:

  • Prematurity
  • Birth asphyxia
  • Dysmorphic conditions
  • Psychosocial deprivation
  • Maternal drug use
  • Injury/ill health
  • Hearing and visual problems

 

 

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