Milestones In Development

Development Milestones in development 2 month head up when prone, fix & follow, startle @ sound, smile 6 month sit with support, objects to mouth, babble & coo, finger feed 1 year cruising, pincer grip, wave bye-bye, single words 2 years 2 word sentences, understands 2 step commands, stairs, dress self 3 years 3 word combos, repeats 3 digits, rides tricycle, tower of 8 cubes 4 years draws square, counts 4 objects Drawing 12-18m 2y 2-2 ½ 2½ 3y 4y 5y 5½ 7 = vertical scribble = vertical line = round scribble = horizontal line = circle = Cross = square = triangle = Diamond Drawing people (Goodenough-Harris test) Based on number of body parts drawn Age 3 4 5 6 7 8 Boys 4 7 11 13 16 18 Building with Bricks 15/12 18/12 2y 3y 3¼y Sight 6 weeks 3 yrs 5 yrs 7 yrs Girls 4 7 12 14 17 20 = tower of 2 = tower of 3 = tower of 8 = tower of 10 3½y 4y 5y Fix & follow Striped cards Letter charts Adult Snellen chart Squints – common in early childhood. Fixed at any age, or variable > 6m need assessment. Exclude corneal opacities, cataracts and refractive errors Blind: require education not involving sight (e.g. Braille) Partial Sight: can use sight, but needs assistance (e.g. large print) Incidence: 1/2500 children, 50% have additional handicaps Causes – cataracts (rubella), retinoblastoma, ROP, drugs, injury, corneal ulceration, iridocyclitis (RA) Suspect if – pendular nystagmus or roving purposeless movements Hearing Neonatal 7 months 3 yrs 5 yrs hearing screen turn head to sound out of sight toy in box on hearing sounds pure tone audiogram Hearing = reception of sounds to brain Listening = attention to sounds & interpretation Sensorineural = damage to cochlear / nerve (usually from birth) Conductive = middle ear dysfunction (eg glue ear) Incidence = 4% (most due to glue ear) 2/1000 moderate deafness (require hearing aid) 1/1000 severely deaf (require special education) Rx = Grommets to relieve glue ear & follow up for otitis media cases Removal of hypertrophied adenoids (can block Eustachian tubes) Cochlear implants can help in some cases of sensorineural deafness Education – lip reading, sign language, SALT input Speaking Vocalisation = exploratory sounds Verbalisation = meaningful sounds Causes of delay = deafness, lip/palate probs, dysphasia, deprivation, developmental Developmental speech & language disorder syndrome 6% of 3-4 yrs have significant delay (usually have other syndromes) b>g + FH Usually catch up but can still have reading/spelling problems 1/1000 continue to have problems Dysrhythmia (stammer) 3-4yrs = common to have physiological stammer, will correct, NOT focus on Learning Mild learning disability = difficulty acquiring life skills to care for self/earn a living = IQ 50-70, link to lower social background Severe learning disability= cant feed, dress, walk, communicate, IQ<50 Described as mental age / chronological age Causes Genetic – chromosomal (downs), metabolic (PKU), cerebral degeneration, structural Intrauterine – nutritional (I2 etc), infection (CMV), drugs (alcohol, phenytoin), malformation (holoprosencephaly) Perinatal – pre-eclampsia, prolonged labour, IVH, meningitis, hyperbilirubinaemia Postnatal – trauma, infection, anoxia, metabolic & endocrine, poisoning, psychological Diagnosis = usually picked up on routine checks (80% have underlying cause, 25% CP) Management = multidisciplinary, special education, support for family