Developmental examination

Introduction

These are the guides for checking a child is progressing in the right lines physiologically and physically. Just as you measure a baby's weight to check its growing okay, you check it is learning to walk at the right speed, etc.

Child health surveillance

This is a programme, part of child health promotion, which tried to pick up children with developmental delay early in order that something can be done about it.

Physical Development

Basically, as a child grows it will have a height, a weight, head circumference, etc. With each of these measurements, there is a normal range of growth, and then an abnormal deviance from this. If a child is under growing, it is referred to as failure to thrive. This is a common red flag that flags up problems in children.

It's not very exciting listing all the figures here. There will be graphs in every paediatric consulting room and you can put them on there. Try it - its fun!

File:Denverscreeningchart.png

Physiological development

You can do 80% of this without touching the child. The key is to check that the child has reached the appropriate milestones for its age. This can be assessed from just watching the child, and getting them to do stuff. The chart for gauging these advancements is the Denver II screening chart.

Gross Motor

• Newborn - Limbs flexed - Symmetrical posture - Head lag on pulling the child up to the sitting position
• 6-8 weeks - Whilst lying on stomach, raises head 45 degrees
• 6-8 months - Sits without support, with a round back at 6 months, and with a straight back at 8 months
• 8-9 months - Crawling
• 10 months - Walks around with support from furniture
• 12 months - Walks unsteadily; broad-base gait
• 15 months - Walks steadily

Fine Motor and Vision

• Newborn - Follows face in midline (but does not turn head)
• 6 weeks - "Fix and follow" - follows moving object by turning head
• 4 months - Reaches for objects e.g. toys
• 6 months - Transfers objects from one to the other - Palmar grasp - grips object in palm
• 10 months - Pincer grip - can grip objects between a single finger and thumb

Unless specified, the following building blocks and writing tasks should be done without demonstration. With a demonstration, the child should be able to perform the writing tasks 6 months earlier than specified below.

• 14 months - Scribbles with a pencil on a piece of paper
• 18 months - Tower of 3 cubic building blocks
• 2 years - 'Tower of 6 blocks
• 2½ years - Tower of eight building blocks OR - Train with four bricks - L-shape with the long side on the floor
• 3 years - Bridge - two bricks with a small gap and another brick across the top forming a bridge (after demonstration) - Able to draw a circle
• 4 years - Steps made from building blocks (after demonstration) - Able to draw a cross
• 4½ years - Able to draw a square
• 5 years - Able to draw a triangle

Speech, Language and Hearing

• Newborn - Startles at loud noises
• 3 months - Vocalises alone, when spoken too, laughs, coos ("aah-aah")
• 7 months - Turns to soft sounds out of sight
• 7-10 months - Sounds used indiscriminantly - Some sounds used discriminately to parents.
• 12 months - 2 to 3 words other than "dada"/"mama"/"Honorificabilitudinitatibus"
• 18 months - 10 words - Can point to four parts of the body
• 20-24 months - Uses two or more words to make a simple phrase.
• 2½-3 years - Talks constantly in 3-4 word sentences.

Social

• 6 weeks - Smiles responsively
• 8 months - Separation anxiety - puts food in mouth.
• 10 months - Waves bye-bye, plays peek-a-boo.
• 12 months - Drinks from a cup.
• 18 months - Holds a spoon, and gets food safely to mouth - Symbolic play.
• 2 years - Dry by day - Pulls off some clothing.
• 3 years - Interactive play - Takes turns.