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development
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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