DEVELOPMENTAL ASSESSMENT
? Developmental assessment is integral part of pediatric examination and therefore it is essential that normal developmental and normal variation are clearly understood. In general , assessment is ongoing through to adolescent but is of more importance during the preschool children-0-5 years
. Thorough physical examination is essential , particularly looking for minor abnormalities and noting the size and shape of the head , height and weight.
Examination of assessment is then based on
1-gross motor status
2-vision and fine motor
3-hearing and speech
4-sotial skills
(Neonatal Period (1st 4 Wk
? )
? Grosse motor: Lies in flexed attitude; turns head from
? suspension side to side; head sags on ventral
? Generally flexed and a little stiff
?
Visual,and fine motor: May fixate face or light in line of vision; “doll s-eye&” movement of eyes on
? turning of the body
? Reflex: Moro response active; stepping and placing reflexes; grasp reflex active
? Social: Visual preference for human face
4-8 week
? Grosse motor: Legs more extended; holds chin up; turns head; head lifted momentarily to
? plane of body on ventral suspension
? head lags on pull to sitting position
?
Visual, fine motor: Watches person; follows moving in 180 degree object
? Social: Body movements in cadence with voice of listens to voice and coos other in social contact;
? beginning to smile
3months
?
Gross motor =hold head erect and steadily to 30 and in ventral suspension head is held up for prolonged period ,can hold shoulders off table when in prone posiation
?
Vision and fine motor =appears alert and open the hands spontiously and grasp reflex is gone
?
Hearing and speech = more respnosive to noise and may turn to sound ,coos and laughs
?
Social skills = smiles appropraitely
6-8months
Gross motor =sits momentarily,good head control,rolls over,back striaght
Fine motor and vision =transfers objects,alert,eyees move in all directions, fixates on smaal objects-20 cm
Hearing and speech =babbling, turns to sounds 0.5cm,vocalize-Ka,dah
Social skills =shows like and dislikes, mouthing ,tries to hold bottle, response to tickling
Warnings
? Poor head control
? Brisk reflexes and clonus
?
Not alert
? Not turing to sounds
? Persistent primitive reflexes
9-10months
? Gross motors =pull to stand, sits alone and can turn to look,rolling,crawling,does not like being moved from sitting to lying supine
?
Fine motor and vision =pincer grasp,can see small objects at 3cm
?
Hearing and speech =imitate sounds,test hearing at 1 m
? Social skills =hold,bites,chews biscuit, beginning of suspicion of strangers
?
Warnings
? Not sitting
? Asymmetry of tone
? Poor respons to sounds
12 months
? Gross motors =walk with one hand held
?
Fine motor =release an object on comand
?
Hearing and speech =1-2 meaningful words
?
Social skills =come when called
15 month
? Gross motor =walk alone, crawel upstair
?
Vision and fine motor = 3cubs, make line
?
Hearing and speech= jargon, flow simple command
? Social skills = indicate names of some familiar object (ball) desire on need by pointing, hug parent
=
18 months
? Gross motors =walks upstairs with assistance, run stiffly , sit on small chair.
?
Fine motor =feeds from spoon,build 2-4 blocks, point to distant objects, imitate scribbling .
?
Hearing and speech =at least 10 words,voclize freely, responds quickly to simple comands, name picture, idetify one or more parts of body .
?
Social skills =mimic the actions of others, stopped putting toys into mouth, kiss parent, complain when wet, seek help in trouble.
?
Warning
? Not standing
? Not walking
? Poor attention span
24 months
? Gross motors =runs well, climb on furniture , jump
?
Fine motor =builds tower of 7blocks, imitate horizontal line,
?
Hearing and speech =2-3 word sentences, put 3 words together (subject, verb, object)
?
Social skills =plays with others, help to undress, hold spoon well.
3YEARS
Gross motors= Can walk upstairs, one foot per step, able to jump, stands on one foot momentarily ,may able to ride tricycle
Fine motor = Builds tower of10 blocks, draw a circle,
Hearing and speech = may know one to two colors, count to 10,know age ,sex, and full name
Social skills =play simple games in parallel with others children, wash hand
4years
? Gross motors= Hop on one foot, can walk downstairs in adult fashion, climb well.
?
Fine motor = draw square and Crosse, draw man with 2-4 part of body beside the head, with left or right hand dominant.
? Hearing and speech = know 3-4 colors
? Talks a lot , asks question-tell stories
?
Social skills =toilet training well established , play with several children with interaction.
?
Note: The rate of development may vary between children, the sequence of development does not differ significantly
5year
? Gross motors= skipping,
?
Fine motor =draw triangle, name heaver of 2 weight.
?
Hearing and speech =5 colors, repeat sentence of 10 syllables
?
Social skills = dress and undress
Developmental decision
? Normal
?
Probably normal-see again
?
Doubtful-see soon
?
Abnormal-refer for diagnosis and treatment
Locomotion variants:
?
some infant never crawl ,they stand and walk
? Some do normal crawl with flexed knees
?
Some do bear walk knees extended)
?
Some commando crawl-on elbows rather than hands