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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
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