Developmental screening
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Developmental Screening. Robyn Smith Department of Physiotherapy UFS 2012. Learning objectives. Following this theme the learner must be able to: Define developmental screening Describe the screening process Define a child at risk Identify risk factors in a patient history.

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Developmental Screening

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Developmental Screening

Robyn Smith

Department of Physiotherapy



Learning objectives

Following this theme the learner must be able to:

  • Define developmental screening

  • Describe the screening process

  • Define a child at risk

  • Identify risk factors in a patient history

Early childhood development

Physiotherapists involved in early intervention services need to be knowledgeable about:

  • Typical development patterns

  • Developmental sequencing

  • Current developmental theories

  • Factors which may impact on a child’s development

  • Tools that can be used to screen a child in order to determine their developmental status

Developmental Screening

  • Screening is a brief assessment procedure designed to see whether a child's development is similar to other children of the same age

  • screening helps identify children who should receive a more comprehensive neurodevelopmental assessment

What is the value of developmental screening

  • Identifies children need comprehensive interdisciplinary assessment

  • Identifies children who need regular monitoring

  • Identify, at the earliest possible time, the presence of any developmental delays and indications of possible future disability.

  • Ensures the earliest possible intervention and support to infants and their families with developmental difficulties

So how do these at risk children find their way to physiotherapy services?

  • Routine screening of infants in neonatal unit by physiotherapist

  • Routine follow up of at risk infants

  • Referral from paediatrician

  • Concerned parents who bring the child to our services

Assessment procedure

Parent who are concerned child is not reaching their milestones



Follow up

More formal

assessment at


Developmental surveillance


& identification risk


Term assessment

Hands off approach

A good assessment is essential in determining the cause and extent of the problem !

Only then can one discuss the implications with a parent

What does screening include?

  • An in-depth interview with the parent other healthcare professionals and the patient file may help identify possible risks factors

Birth History

  • Date of birth

  • Age/corrected age at present

  • Gestation

  • Birth weight

  • Apgar Scores

  • Type of delivery

  • Neonatal management

Identify potential risk factorsThe following medical conditions should be noted as red flag

  • Birth asphyxia

  • Very low birth weight

  • Premature infants

  • Metabolic disorders

  • Convulsions/seizures and epileptic syndromes

  • IVH & PVL

  • Meningitis

  • Congenital neurological abnormalities and genetic disorders e.g. Down Syndrome

  • Dimorphism

  • Congenital infections:

    • Congenital rubella

    • CMV

    • Toxoplasmosis

    • HIV

  • Arthrogryposis multiplex congenita

  • Maternal substance abuse

  • HIV-exposed

Try and identify possible intrinsic factors which may impact in development

  • Physiology

  • Anatomy

  • Genetics

  • Personality/motivation

  • Race/ethnicity

  • Medical conditions

    Often cannot avoid internal factors

Try and identify possible extrinsic factors which may impact in development

  • Inadequate bonding or nurturing with mother/caregiver

  • Opportunities to learn or practice

  • Culture

  • Environmental risks

  • Parental and child-rearing practices

  • Nutrition

  • Socio-economic factors

  • Trauma

    Often factors that can be avoided or altered

Developmental history to date

  • Milestones reached to date

  • Time frames on reaching key milestones

  • Any regression milestones

  • Immunisation status

  • Development in comparison to sibling

  • Any other developmental concerns

Objective evaluation

  • The second part of the screening procedure requires a more objective look at the child’s developmental abilities and lack of ability in some cases

  • Preferably use a valid reliable objective screening tool that covers all areas of development

    • Bayley Scales of Infant Development (BSID-III)

    • START (not quantifiable)

Physically examination

Functional abilities for age & growth for age need be examined for his corrected age

  • Assess milestones and functional abilities for age in all areas

    ICF : impairment, activity and participation limitations need to be indentified

  • Growth charts to be plotted or use the road to health chart of the child

  • Normal variance of 1-2 months on either side of the expected norms

Neurological assessment

  • Muscle tone- active and passive

  • Observe for the presence of pathological reflexes

High risk infant /child

Discharge once child not longer at risk of problems

Developmental screening

& assessment

Discharge once milestones have caught up

No current developmental


Surveillance programme


Intervention &

therapy and

family support


If delays are later identified intervene

How is screening programmes implemented?

  • Literature in favour of developmental surveillance and screening programs

  • Lack consensus in literature regarding implementation of such programmes.

    Suggested as a guideline to be followed:

  • 6 weeks

  • 3 months

  • 6 months

  • 9 months

  • 12 months

  • 18 months

  • 24 months annually then until school going age

What do I do with a child who I have surveyed and who by the 2 years does not show any signs of developmental delay or has caught up on his milestones?

  • Research has shown that these “at risk” children should be followed up annually until school going age

  • Perceptual, intellectual and scholastic problems will only be identified as the child gets older

  • Coordination and balance can also only be assesed beyond age of 2 years

  • If no problems are identified by school going age – DISCHARGE!


  • Images courtesy of GOOGLE Images (2010)

  • Mayhew, A & Price, F. 2007. Motor control in developmental neurology. Poutney, T (Ed). In Physiotherapy for children. Elsevier: Edinburough pp 73-89

  • Henning, P.A. Die pasgeborebaba

  • Veitch, H & Kriel,H. 2006. The role of the physiotherapist in the neurodevelopment of the child. A refresher course


  • E. Brown.2001. NDT course work (unpublished)

  • E. Brown. 2009. Early intervention: The evalution and treatment of infants with CMD. (unpublished)

  • Harel, S. approach to a child with neurodevelopmental Disability. Available at: Retrieved on 27 August 2009

  • Versaw-Barnes, D & A. Wood. The infant at risk of developmental delay in Pediatric Physical Therapy. Tecklin, J.S. (Eds) in Pediatric Physical Therapy. Lippincott, Williams & Wilkins. Baltimore pp101 -175


  • American Academy of Pediatrics. 2001. Developmental surveillance and screening. Available online at:;108/1/192.pdf

  • Smith, R. 2005. The prevalence of neurological sequelae in infants with moderate to severe neonatal asphyxia. MSc.dissertation (unpublished).

  • Mayhew, A & Price, F. 2007.Neonatal Care in Poutney, T(ed.) Physiotherapy for Children. Elsivier.Philadelphia 73-79

  • Mosby’s medical dictionary

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