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 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 - the development of

locomotion• 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.

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 monthsholds head up, good eye contact holds rattle in hand turns to sound ear level

Developmental Milestones

• 4-5 months able to reach out for object• 6 monthstransfers 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 casting objects walks without support

single words

• 15 months feeds self from cup domestic mimicry

• 18 months casting stops ,tower of 3 Walking well, scribbles

Developmental Milestones

• 2 years joins 2/3 words, 50 wordsRuns well,climbs, stairscubes tower 6 or 7

• 3 years mainly dry by day+/- night dresses & undresses fully

stairs - alternate feetrides 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 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

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