Developmental Milestones-An overview

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Developmental Milestones-An overview
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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

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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

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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

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Routine Child Surveillance

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

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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.

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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

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Developmental Milestones

• 4-5 months able to reach out for object
• 6 months 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,

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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

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Developmental Milestones

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

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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

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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

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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

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Causes of arrested/deteriorating development

• Uncommon/rare
• Hydrocephalus
• Metabolic eg hypothyroidism, lead poisoning
• Degenerations - Infections AIDS, SSPE
  - Genetic Wilsons Dx Huntingtons
  Chorea, Lysosomal storage dx

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Developmental Milestones - Delayed Motor
Development

• Familial feature
• Environmental - deprivation, practice
• Mental subnormality
• Hypotonia (Downs Syn)
• Hypertonia (Cerebral Palsy)
• Neuromuscular problems (DMD)
• Bottom shuffling
• Visual impairment

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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

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Video

• Developmental examination of a child from birth
  to 18 months