Developmental assessment
Developmental milestones:
|
AGE |
GROSS MOTOR |
FINE MOTOR |
SPEECH AND LANGUAGE |
PERSONAL AND SOCIAL |
|
Newborn |
Primitive reflexes Head lag Symmetrical posture |
Responds to bright lights |
Startles to loud sounds |
|
|
6-8 weeks |
Symmetrical movements Normal tone |
Follows side to side Opens hands |
Normal cry Responds to sounds |
Smiles responsively |
|
3 months |
Head control Lifts head when prone |
Visually alert Follows vertically Hand regard Reaches for objects |
Vowel sounds Laugh |
|
|
6 months |
Rolls over Lifts head and chest when prone Sits with support |
Reaches and grasps for objects |
Consonant babble |
|
|
8 months |
Sits without support Attempts to crawl |
Palmar grip Transfers
|
Turns to voice Two syllable babble |
Friendly to all Finger feeds |
|
12 months |
Crawls Stands Walks holding furniture (cruising) |
Points Two finger grip Casts |
Recognises name “No” Imitates speech sounds |
Stranger anxiety Drinks from a cup Waves Peek-a-boo |
|
18 months |
Walks unsupported |
Pincer grip Tower of 2 bricks |
6 words with meaning Understands simple instructions |
Spoon feeding Nursery rhymes |
|
2 years |
Runs Climbs stairs Jumps off floor Kicks ball |
Scribbles Tower of 6 bricks |
Points to body parts Combines words |
Undresses Symbolic play |
|
3 years |
Pedals tricycle One foot to step |
Copies circle/cross Builds bridge |
Sentences Recognise colours Gives first and last name |
Puts on clothes Toilet trained by day Names friend |
|
4 years |
Stands on one foot Hops Ball skills |
Good pencil grip Builds stairs Draws Square Draws 3 part man |
Asks questions Enjoys jokes Tells stories |
Uses fork Washes hands and face Brushes teeth |
Bold items indicate that further investigation is needed if skills not acquired.
Developmental delay may be in one specific area (e.g. speech only) or may be general. Delay includes arrest of development and deterioration of development. Some conditions may present as unusual patterns of development such as sudden development of complex speech in autism.
History
The history of any child with possible developmental delay should include:
- Definition of developmental problem
- Developmental history (onset, progress, behaviour, concentration)
- Pregnancy and birth (alcohol, congenital infection, prematurity, IUGR)
- General health (fits, hearing, vision, neurology, other systems)
- Family history
- Social history (neglect, impact on family, schooling)
- Specific parental concerns
Examination
Examination should include assessment of:
- Four areas (listed above): gross motor, fine motor, speech and language and social behaviour
- Dysmorphic features
- Growth (including head circumference)
- Skin (hyper/hypopigmentation, port wine stains)
- Hearing and vision
- Neurological system (gait, tone, power, reflexes, asymmetry)
- Other systems (murmurs, organomegaly)
Risk Factors
Major risk factors for developmental delay include:
- Prematurity
- Birth asphyxia
- Dysmorphic conditions
- Psychosocial deprivation
- Maternal drug use
- Injury/ill health
- Hearing and visual problems
