Developmental Milestones-An overview

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 MilestonesChildren develop from being totally dependent newborns to independent individuals by the acquisition of skillsRange of normality in the acquisition of skillsDevelopment follows an orderly process in a cephalic to caudal direction

PrinciplesListen to parents-partnershipMay need to see a child a second timeOpportunistic pick upThe state of the child-take into accountDistinguish between developmental items reported and those observed

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

Developmental Milestones4 fields with a sequence of developmentGross Motor - the development of locomotionVision and fine manipulation - the development of eye-hand controlHearing & speech - the devt. of languagePersonal & social - integration of acquired abilities to reflect understanding of env.

Developmental MilestonesBirthprone: pelvis high, knees under abdo6-8 weekssmiles to maternal overtures fixes & follows prone: pelvis flat, hips extended ventral: briefly holds head up3 monthsholds head up, good eye contact holds rattle in hand turns to sound ear level

Developmental Milestones4-5 monthsable to reach out for object6 monthstransfers hand to hand Chews, babbles sits with hands forward lifts head spont from supine10 monthsindex finger approach finger thumb appositionwaves bye-bye,

Developmental Milestones13 monthscasting objects walks without support single words15 monthsfeeds self from cup domestic mimicry 18 monthscasting stops ,tower of 3 Walking well, scribbles

Developmental Milestones2 yearsjoins 2/3 words, 50 wordsRuns well,climbs, stairscubes tower 6 or 73 yearsmainly dry by day+/- night dresses & undresses fullystairs - alternate feetrides tricycle

Developmental Warning Signs - at any ageFHx of note eg deafness, cataractsMaternal concernPersistent primitive reflexesPersistent squintDiscordance in developmental abilities in different areasRegression of previously acquired skills

Causes of Delayed Development(Correct for Prematurity)Idiopathic: constitutional, familial (affecting one field & catching up later)DeprivationIntellectual disabilitySpecific abnormality eg Blind, deaf, cerebral palsy

Causes of arrested/deteriorating developmentCommonEmotional deprivationIntercurrent illness eg malabsorptionAcute cerebral injury eg encephalitis, traumaSeizures: uncontrolled, prolongedDrugs eg phenytoin excess

Causes of arrested/deteriorating developmentUncommon/rareHydrocephalusMetabolic eg hypothyroidism, lead poisoningDegenerations- Infections: AIDS, SSPE - Genetic: Wilsons Dx Huntingtons Chorea, Lysosomal storage dx

Developmental Milestones - Delayed Motor DevelopmentFamilial featureEnvironmental - deprivation, practiceMental subnormalityHypotonia (Downs Syn)Hypertonia (Cerebral Palsy)Neuromuscular problems (DMD)Bottom shufflingVisual impairment

Developmental Milestones - Summaryordered process of developmentrange of normality in acquisition of skills - bands of normality - delayedrelevance of delay variesearly detection of delayed development desirable for maximum intervention and for parental acceptance

Video

Developmental examination of a child from birth to 18 months