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

Developmental Screening

Robyn Smith

Department of Physiotherapy

UFS

2012


Learning objectives

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

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 screening1

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

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

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

Assessment procedure

Parent who are concerned child is not reaching their milestones

Birth

Discharge

Follow up

More formal

assessment at

discharge

Developmental surveillance

Observation

& identification risk

factors

Term assessment

Hands off approach


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

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

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

Birth History

  • Date of birth

  • Age/corrected age at present

  • Gestation

  • Birth weight

  • Apgar Scores

  • Type of delivery

  • Neonatal management


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

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

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

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

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

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

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

Neurological assessment

  • Muscle tone- active and passive

  • Observe for the presence of pathological reflexes


Developmental screening

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

problems

Surveillance programme

only

Intervention &

therapy and

family support

programme

If delays are later identified intervene


How is screening programmes implemented

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


Developmental screening

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!


References

References

  • 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


References1

References

  • 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:

    http://www.scribd.com/doc/6701564/Approach-to-a-Child-With-a-Neurodevelopmental-Disablity. 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


References2

References

  • American Academy of Pediatrics. 2001. Developmental surveillance and screening. Available online at: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;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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