Developmental milestones an overview
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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 Milestones.

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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: Wilson’s Dx Huntington’s Chorea, Lysosomal storage dx


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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


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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


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