1. Developmental Screening
4/21/2017 9:54 AM
Developmental Screening
Robyn Smith
Department of Physiotherapy
UFS
2012
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2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. Only then can one discuss the implications with a parent
A good assessment is essential in determining the cause and extent of the problem !
Only then can one discuss the implications with a parent

9. What does screening include?
An in-depth interview with the parent other healthcare professionals and the patient file may help identify possible risks factors

10. Birth History Date of birth Age/corrected age at present Gestation
Birth weight
Apgar Scores
Type of delivery
Neonatal management

11. Identify potential risk factors The 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

12. 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

13. 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

14. 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

15. 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)

16. 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

17. Neurological assessment
Muscle tone- active and passive
Observe for the presence of pathological reflexes

18. 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

19. 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

20. 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!

21. References Images courtesy of GOOGLE Images (2010)
Mayhew, A & Price, F Motor control in developmental neurology. Poutney, T (Ed). In Physiotherapy for children. Elsevier: Edinburough pp 73-89
Henning, P.A. Die pasgebore baba
Veitch, H & Kriel,H The role of the physiotherapist in the neurodevelopment of the child. A refresher course

22. References E. Brown.2001. NDT course work (unpublished)
E. Brown Early intervention: The evalution and treatment of infants with CMD. (unpublished)
Harel, S. approach to a child with neurodevelopmental Disability. Available at:
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 pp

23. References
American Academy of Pediatrics Developmental surveillance and screening. Available online at:
Smith, R The prevalence of neurological sequelae in infants with moderate to severe neonatal asphyxia. MSc.dissertation (unpublished).
Mayhew, A & Price, F Neonatal Care in Poutney, T(ed.) Physiotherapy for Children. Elsivier.Philadelphia 73-79
Mosby’s medical dictionary