1. Developmental Milestones-An overview

2. 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

3. 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

4. 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

5. Routine Child Surveillance Newborn Supine(6-8wks) Sitting(6-9 mths) Mobile toddler(18-24mths) Communicating child(3-4yrs)

6. 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.

7. Developmental Milestones Birthprone: pelvis high, knees under abdo 6-8 weekssmiles to maternal overtures fixes & follows prone: pelvis flat, hips extended ventral: briefly holds head up 3 monthsholds head up, good eye contact holds rattle in hand turns to sound ear level

9. Developmental Milestones 4-5 monthsable to reach out for object 6 monthstransfers hand to hand Chews, babbles sits with hands forward lifts head spont from supine 10 monthsindex finger approach finger thumb apposition waves bye-bye,

11. Developmental Milestones 13 monthscasting objects walks without support single words 15 monthsfeeds self from cup domestic mimicry 18 monthscasting stops,tower of 3 Walking well, scribbles

12. Developmental Milestones 2 yearsjoins 2/3 words, 50 words Runs well,climbs, stairs cubes tower 6 or 7 3 yearsmainly dry by day+/- night dresses & undresses fully stairs - alternate feet rides tricycle

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. Video Developmental examination of a child from birth to 18 months