Developmental Milestones-An overview Dr Judith Meehan

Illingworth 1987 • Development is continuous from conception to maturity and its sequence is the same in all children,though its rate varies from one child to another

Developmental Milestones • Children develop from being totally dependent newborns to independent individuals by the acquisition of skills • Range of normality in the acquisition of skills • Development follows an orderly process in a cephalic to caudal direction

Principles • Listen to parents-partnership • May need to see a child a second time • Opportunistic pick up • The state of the child-take into account • Distinguish between developmental items reported and those observed

Routine Child Surveillance • Newborn • Supine (6-8wks) • Sitting (6-9 mths) • Mobile toddler (18-24mths) • Communicating child (3-4yrs)

Developmental Milestones • 4 fields with a sequence of development • Gross Motor locomotion - the development of • Vision and fine manipulation - the development of eye-hand control • Hearing & speech - the devt. of language • Personal & social - integration of acquired abilities to reflect understanding of env.

Pattern of abnormal development

Severity of abnormal development • • • • Mild Moderate Severe Profound Gap between normal and abnormal increase with advancing age, becoming more apparent with time.

(Usually within the 2 first years of life)

Developmental Milestones • Birth prone: pelvis high, knees under abdo • 6-8 weeks smiles to maternal overtures fixes & follows prone: pelvis flat, hips extended ventral: briefly holds head up • 3 months holds head up, good eye contact holds rattle in hand turns to sound ear level

Developmental Milestones • 4-5 months • 6 months able to reach out for object transfers hand to hand Chews, babbles sits with hands forward lifts head spont from supine • 10 months index finger approach finger thumb apposition waves bye-bye,

Developmental Milestones • 13 months • 15 months • 18 months casting objects walks without support single words feeds self from cup domestic mimicry casting stops ,tower of 3 Walking well, scribbles

Developmental Milestones • 2 years • 3 years joins 2/3 words, 50 words Runs well,climbs, stairs cubes tower 6 or 7 mainly dry by day+/- night dresses & undresses fully stairs - alternate feet rides tricycle

Developmental Warning Signs at any age • FHx of note eg deafness, cataracts • Maternal concern • Persistent primitive reflexes • Persistent squint • Discordance in developmental abilities in different areas • Regression of previously acquired skills

Causes of developmental delay

Causes of Delayed Development • (Correct for Prematurity) • Idiopathic: constitutional, familial (affecting one field & catching up later) • Deprivation • Intellectual disability • Specific abnormality eg Blind, deaf, cerebral palsy

Causes of arrested/deteriorating development •

Common

• Emotional deprivation • Intercurrent illness eg malabsorption • Acute cerebral injury eg encephalitis, trauma • Seizures: uncontrolled, prolonged • Drugs eg phenytoin excess

Causes of arrested/deteriorating development •

Uncommon/rare

• Hydrocephalus • Metabolic eg hypothyroidism, lead poisoning • Degenerations - Infections: AIDS, SSPE - Genetic: Wilson’s Dx Huntington’s Chorea, Lysosomal storage dx

Developmental Milestones Delayed Motor Development • Familial feature • Environmental - deprivation, practice • Mental subnormality • Hypotonia (Down’s Syn) • Hypertonia (Cerebral Palsy) • Neuromuscular problems (DMD) • Bottom shuffling • Visual impairment

Investigations

Developmental Milestones Summary • ordered process of development • range of normality in acquisition of skills bands of normality - delayed • relevance of delay varies • early detection of delayed development desirable for maximum intervention and for parental acceptance

Video Developmental examination of a child from birth to 18 months