Development milestone in pediatrics .pptx

Very important

1. Developmental milestones from newborn to children

2. INTRODUCTION Development specify maturation of functions . It is related to the maturation and myelination of the nervous system and indicates acquisition of a variety of skills for optimal functioning of the individual. Developmental assessment is the process of mapping a child’s performance compared with children of similar age. DOMAINS OF DEVELOPMENT Gross motor: Movements using the large muscles Fine motor: Movements using the hands and smaller muscles Social: Attachment , self-regulation, and interaction with others Language: Receptive and expressive communication, speech, and non-verbal communication Vision and Hearing

3. GROSS MOTOR: Ranges from development of head control to stage of mature walking and running FINE MOTOR : Disappearance of primitive grasp reflex at 2-3months , Hand regard, maturation of grasp from ulnar side  radial side  finger-thumb grasp and feeding or dressing

4. LANGUAGE: vocalize with ah, uh in 2-3 months , then adds consonant m, p,b expressing displeasure and j, k on pleasure, squeals with laughter at 4 months then monosyllable followed by bi-syllable, words with meaning, sentences SOCIAL: Smile, Recognizes mother, interest in surrounding, watching movements around, anticipation to be carried, anxiety, refusal, mimickery , understanding, questioning VISION : place a bright object about 8-10 inches from face at midline Light response, visual fixation and following light from 45-180 degree, normal vision HEARING : crumple paper about 18 inches from ear Turns head to sound along same plane ( 3 mo) , downward ( 5 mo), upward ( 7 mo) OTHERS : Sphincter control

5. 4 WEEKS (1 MONTH) Gross Motor: Ventral suspension: Head held up momentarily, elbows flexed, hips partly extended and knees flexed Prone : pelvis high, knees drawn up largely under abdomen . Momentarily lifts chin off couch. Head predominantly to one side Pulled to sit : almost complete head lag Held in sitting position : back uniformly rounded. H ead held up momentarily Supine : asymmetrical tonic neck reflex seen when at rest Held standing : Flops at knees and hips. Walking reflex when sole of foot is pressed on flat surface. Fine motor : Hands predominantly closed . Grasp reflex Social: watches mother’s face when she talks to him Vision: Supine- regards dangling object ( eg ring on string) when brought into line of vision (3 feet from the eyes) but not otherwise when in midline. Follows it less than 90’C Hearing : Quiets when bell is rung

6. 6 WEEKS (1 AND ½ MONTH) Gross Motor: Ventral suspension : Head held up momentarily in same plane as rest of body. Some extension of hips and flexion of knees. Flexion of elbows Prone : Pelvis high, but knees no longer under abdomen .. Chin raised intermittently off couch. Head turned to one side. Pulled to sit : Head lag considerable but not complete Held in sitting position : Intermittently holds head up. Held standing- head sags forward. May hold head up momentarily. Supine : asymmetrical tonic neck reflex at rest intermittently seen . Fine motor : H and often open. Grasp reflex may be lost Social: Smiles at mother in response to overtures Vision : Eyes fixate on objects , and follow moving persons. S upine: looks at object held in midline, following it as it moves from the side mildline ( 90’C)

7. 8 WEEKS (2 MONTHS) Gross Motor: Ventral suspension: Can maintain head in same plane as rest of body Prone : Head mostly in midline. Intermittently lifts chin off couch so that plane of face is at angle of 45’c to couch Pulled to sit : less head lag Held in sitting position : Less rounding of back. Head is held up but recurrently bobs forward. Supine : head chiefly to side. Asymmetrical tonic neck reflex seen intermittently at rest. Held standing : able to hold head up more than momentarily. Hands : Frequently open. Only slight grasp reflex Vocalisation : Smiles and vocalizes when talked to . Social: Social Smile Vision: Fixation, convergence and focusing. Follows moving person. In supine- followa dangling toy from side to point beyond midline, follows objects 180’C

8. 12 WEEKS (3 MONTHS) Gross Motor: Ventral suspension: Head held up for prolonged period beyond plane of rest of body Prone : . Pelvis flat on couch . Holds chin and shoulders off couch for prolonged period so that plane of face is at angle of 45-90 from couch weight born on forearms. Pulled to sit : .Only slight head lag. Held in sitting position head mostly held up but still bobs forward. Supine : no more asymmetrical tonic neck reflex. Fine motor : No grasp reflex . Hands loosely open. When rattle is placed in hand, holds it for a minute or more. Looks as if he would like to grasp object, but cannot without it being placed in hand, pull at his dress. Language : Squeals of pleasure “talks” a great deal when spoken to says “ aah ” or “ naah ” Social: . Sustained social contact Vision : Supine: characteristically watches movements of his own hands (“hand regard ”) Follow dangling toy from side to side ( 180’C ) . Promptly looks at object in midline. Hearing: Turns head to sound at the same level

9. 16 WEEKS ( 4 MONTHS) Gross Motor: Prone : Head and chest off couch so that plane of face is at angle of 90 to couch . Swimming : limbs stretched out in full extension. Pulled to sit : Only slight head lag in beginning of movement Held in sitting position : Head held up constantly. Child looks actively around. Head wobble on swaying. Back curved on lumbar region only Supine : Head in midline Fine motor: Hands come together as he plays. Hand regard still present . Pulls dress over face in play . Tries to reach object with hands but overshoots it. Plays with rattle in hand for long period and shakes it but can’t pick it up if he drops it Social : Excites when food prepared, toys seen, showing massive reaction involving all four limbs and respirations. Pleasure when pulled to sit. Language: L aughs Aloud Vision: Immediate regard of dangling object

10. 20 WEEKS (5 MONTHS) Gross Motor: Prone : Weight on forearms Pulled to sit : no head lag Held in sitting position: no head wobble when body swayed by examiner-full head control. Back Straight Supine : Feet to mouth Held in sitting position: Bears most of weight Fine motor : Able to grasp objects voluntarily. Plays with toes. Crumples paper. Splashes in bath. Objects taken to mouth. Cube- grasps, bidextrous approach takes it to mouth . Social: Smiles at mirror image , pats bottle . No more hand regard Language: Razzing “Ah-Goo” Hearing : Turns head towards a sound below the level (5-6 months)

11. 24 WEEKS (6 MONTHS) Gross motor: Prone : Weight on hands, not forearms , chest and upper part of abdomen off couch. When about to be pulled to sit, lifts head off couch. Sits supported in high chair Held in standing position : almost full weight on legs. Rolls prone to supine Fine motor : Holds bottle. Grasps his feet Cube: Palmar grasp of cube . Drops one cube when another is given Feeding: Drinks from cup when it is held to lips Social : When he drops a toy he looks to see where it has gone to and tries to recover it. May excite on hearing steps. Stretches arms out to be taken. Shows like and dislikes. May show fear of strangers and are (coy) Displeasure at removal of toy. Play: laughs when head is hidden in towel. Imitates cough or protrusion of tongue. Language : Smiles and vocalizes at mirror image, monosyllabic babble

12. 28 WEEKS (7 MONTHS) Gross motor: Prone : Bears weight on one hand. Sits with hand on couch for support. Rolls from supine to prone Supine : Spontaneously lifts head off couch. Held Standing : Bounces with pleasure Fine motor : Feeds self with biscuit . Likes to play with paper. Takes all objects to mouth. Unidextrous approach . Radial palm, rakes at pellet Cube : Bangs cube on table. Transfers it from hand to hand. Feeding: Chews. Keeps lips closed when he is offered more food than he wants. Speech : Polysyllabic sounds formed- ba , da,ka Hearing : Turns head towards a sound above the level (7 to 9 month) Social : Immitates simple acts. Pats image of self in mirror. Responds to name . Tries to establish contact with person by cough or others method. Expectation in response to repetition of stimulus. Prefers mother , enjoys mother, resist if toy is pulled from hand .

13. 32 WEEKS (8 MONTHS) Gross motor: Sits momentarily on floor without support Adjusts posture to reach object eg leans forward to reach Readily bears whole weight on legs when supported. May stand on holding on Social: Reaches persistently for toys out of reach. Responds to ‘NO’. Looks for dropped toy Imitation: Imitates sounds Speech : Combines syllables- da-da, ba-ba 36 WEEKS (9 MONTHS) Gross motor: Prone: In trying to crawl progresses backwards . May progress by rolling. Sits steadily on floor for 10 minutes. Lean forward and recovers balance but cannot lean over sideways. Stands holding in to furniture . Pulls self to stand Fine motor: Can pick up object of size of currant between tip of finger and thumb. Cubes: Compares two cubes by bringing them together. Social : Puts arms in front of face to prevent mother washing his face

14. 40 WEEKS (10 MONTHS) Gross motor: Prone: Crawl position , on abdomen. Crawls by pulling self forward with hands Sitting: Can go over into prone, or change from prone to sitting. Can pull self to sitting position. Sits steadily with little risk of overbalancing Standing: Can stand holding on to furniture. Collapses with a bump Fine motor : Goes for objects with index finger Cubes: Beginning to let go of objects (release) Social: Looks around corner for object. Responds to words. Pulls others clothes for attention. Repeats performance when laughed at Imitation: Waves bye-bye. Plays patacake

15. 44 WEEKS (11 MONTHS) Gross motor: Prone: creeps , abdomen off couch Standing: lifts foot Fine motor : Holds arm out for sleeve or foot out for shoe. Cubes: Beginning to put objects in and out of containers Social : Will not object to examiner: holds it but will not release it. Drops objects deliberately so that they will be picked up. 48 WEEKS (12 MONTHS) Gross motor: Prone : when creeping, sole of foot may be flat on couch Sitting: Pivots, twisting round to pick up object, Walks holding in to furniture. Walks two hands held Social : Rolls ball to examiner. Will now give toy to examiner, releasing it. Anticipates body movements when nursery rhyme being said. Shows interest in picture book. Shakes head for ‘No’ Plays : Plays peep- bo , covering face. Speech: One word with meaning .

16. 1 YEAR Gross motor: Prone : walks on hands and feet like a bear. Walks one hand held. May shuffle on buttock and hand Fine motor: Mouthing virtually stopped . Beginning to throw objects to floor Social : May understand meaning of phrases. “where is your shoe” May kiss on request. Language: two or three words with meaning. Hearing : Locates sound in all directions

17. 15 MONTHS Gross motor: Creeps up stairs. Kneels without support Walks without help with broad base and high stepping gait (from 13 months) Can get into standing position without support Falls by collapse Cannot go round corners or stop suddenly Several steps sideward Fine motor Builds tower of two. Holds two cubes in one hand. Cannot throw ball without falling Likes to take shoes off Feeding self, picking up cup, drinking, putting it down. Manages spoon but rotates it near mouth, self feeding Imitates scribbling Language: Jargoning, several intelligible words Social: Asks for objects by pointing . Mouthing stopped Kiss pictures of animal. Imitates mother in domestic duties Sphincter control: Begins to tell mother that he wants to use pot. Indicates wet pants Simple formboard : insert round block without being told

18. 18 MONTHS Gross motor : Gets up and down stairs holding rail, without help. Walks up stairs with one hand held. Walks pulling toy, carrying doll, seats self on chair, runs stiffly, sits on small chair Fine motor Tower of 3 or 4 Thows ball without falling. Dressing: takes off gloves, socks, unzips Feeding well with spoon without rotation Spontaneous scribbles Turns pages 2 or 3 at a time Language : Jargon average 10 words Social: Domestic mimicry . Copies mother in dusting, washing, cleaning. Uses stick to reach toy Points to two or three body parts Points to picture of dog or cat Sphincter control: Dry by day, occasional accident Simple formboard : block of three

19. 2 YEARS Gross motor : Goes up and down stairs alone two feet per step Walks backward without imitation(from 21 months) Picks up objects without falling Climbs on furniture Fine motor Kicks ball Turns door knobs, unscrew lids, washes and dries hands Cubes: tower of 6 or 7 cubes Puts on shoes, socks and pants. Takes off shoes and socks Immitates vertical and circular stroke Turns pages singly Social : Pulls people to show them toys. Listens to stories with pictures Language : Asks for drink, toilet and food Repeats things said Joins 2 or 3 words in sentences other than imitation Sphincter control: Dry at night if lifted out at evening Play : Wraps dolls. Parallel play

20. 2 1/2 YEARS Gross motor : Jumps with both feet . Walks on tiptoes when asked. Fine motor Cubes Tower of eight. Imitates train, adding chimney. Pencil Holds pencil in hand instead of fist. Imitates vertical and horizontal stroke. Two or more strokes for cross. Social : Helps to put things away. Begins to notice sex differences. Knows full name. Knows sex. Language : Names five common objects Digits Repeats two in one of three trials (e.g. say ‘Eight five’). Sphincter control: Attends to toilet need without help, except for wiping. Climbs on to lavatory seat Colour sense Names one colour.

21. 3 YEARS Gross motor : Jumps off bottom step . Goes up stairs, one foot per step , and down stairs, two feet per step. Stands on one foot for seconds. Rides tricycle Fine motor Can help to set table, not dropping china. Cubes-Tower of nine. Imitates building of bridge Copies circle (from a card). Imitates cross. Draws a man on request . Social : Dresses and undresses doll; speaks to it. Now joins in play. Language : Constantly asking questions . Uses pronoun. Knows some nursery rhymes, vocabulary 250 words Colour Names two .

22. 4 YEARS Gross motor : Goes down stairs, one foot per step. Skips on one foot. Fine motor Can button clothes fully. Cubes- Imitates gate . Copies cross Social : Questioning at its height. Says which is the larger of two lines. Language : Tells tall stories. Right — left discrimination Sphincter control: Attends to own toilet needs Play : Imaginative play with doll (e.g. being a nurse)

23. 5 YEARS Gross motor : Skips on both feet. Fine motor Cubes-Cannot make steps. Can tie shoelaces. Copies triangle. Social : Gives age. Distinguishes morning from afternoon. Compares two weights Language : Digits Repeats four (two of three trials). Colours Names four Preposition (triple order) - Put this on the chair, open the door, then give me that book.

24. ESSENTIAL MILESTONES Birth Prone: Pelvis high, knees under abdomen Ventral suspension: elbows flex, hips partly extended 4-6 weeks: Smiles at mother. Vocalizes 1-2 weeks later 6 weeks: Prone: Pelvis flat . Ventral suspension: head up to plane of trunk 12-16 weeks : turns head to sound 12-20 weeks: hand regard 20 weeks: Goes for objects and gets them, without being placed in the hand 26 weeks: Transfer objects , one hand to other, chews, sits hand forward for support 9-10 months : index finger approach, finger thumb opposition, creeps 13 months: walks 15-18 months: domestic mimickery 21-24 months: joins two or three words 2 years : dry by day

25. Developmental Milestones and its implication

26. Developmental Milestones and its implication

27. Developmental Milestones and its implication

28. Developmental Milestones and its implication

29. RED FLAG SIGNS TIME PERIOD LANGUAGE / VISION/ HEARING MOTOR SOCIAL Neonatal Period Infant does not respond to loud sounds Muscle tone too low to feed Caregiver shows indifference or disinterest in infant 2 months does not alert to voice Cannot raise head when prone rolls at younger than 3 months Lack of looking at faces/lack of fixation 4 months No cooing or gurgling sounds Unable to bring hands to midline lacks head control and who demonstrates scissoring Lack of smiling 6 months Lack of turning toward voices Does not pass object from one hand to another. No smiling, laughing, or expression. 9 months Lack of babbling with consonants. Inability to sit. Lack of rolling. Absence of back-and-forth smiles and vocalizations in “conversation Developmental Milestones,Rebecca J. Scharf , Graham J. Scharf and Annemarie Stroustrup , Pediatrics in Review 2016;37;25

30. TIME PERIOD LANGUAGE/ VISION/ HEARING MOTOR SOCIAL 12 months Child does not respond to name. Does not understand “no”. Does not stand or bear weight on legs when supported Indifferent or resistant attachment to caregiver. Does not look where caregiver points 15 months Does not use words such as mama and papa/dada. No pincer grasp. Absence of proto-imperative pointing (point to desired object 18 months Not using at least 6 words. Inability to walk independently. Absence of proto-declarative pointing (point to show interest) or showing gestures. 24 months Lack of words and two-word meaningful sentences. Inability to follow simple commands Inability to walk well. Does not imitate actions or words of caregivers. Poor eye contact. Developmental Milestones,Rebecca J. Scharf, Graham J. Scharf and Annemarie Stroustrup, Pediatrics in Review 2016;37;25

31. SCREENING TOOLS Denver Developmental Screening Test Bayley scale Baroda Trivandrum Ages & Stages Questionnaires Modified Checklist for Autism in Toddlers Developmental Quotient=average age of attainment/observed age at attainment * 100 Development delay: Delay in attainment of developmental milestones at the expected ages, in any - Gross / fine motor, vision, hearing, speech, language, behavioral, social and emotional . Global developmental delay: Significant delay in 2 or more developmental domains, including gross or fine motor, speech/language, cognitive, social and personal . Specific developmental delay: delay in single domain of development

32. Language Delays: Significant delay in receptive and/or expressive language skills Autism usually manifests as language delay Hearing difficulty to be ruled out All newborns should be screened for hearing loss by 1 month of age and have any hearing loss diagnosed by at least 3 months of age Motor Delays: Significant delay in fine or gross motor skills with no impairment in other developmental areas Alerting for signs of cerebral palsy, hypotonia or muscular dystrophy Visual Fine-Motor Skills Late smiling might suggest blindness, autism , or conditions such as Mobius syndrome or myotonic dystrophy Cognitive Delays A child is learning-disabled if achievement is two or more grades behind the grade level expected for IQ and age Behavior Problems A rule of thumb for social and behavior problems is that a child’s social and emotional development correlates with language development

33. WHO Motor Development Milestones The World Health Organisation (WHO) in a recent publication documented early postnatal motor skill development in terms of “milestones”.

34. RECENT ADVANCE Development and validation of an early childhood development scale for use in low-resourced settings . Dana Charles McCoy et all; Bio-med central; Population Health Metrics (2017) 15:3 Low-cost , cross-culturally comparable measures of the motor, cognitive, and socio-emotional skills of children under 3 years remain scarce. A new caregiver-reported early childhood development (ECD) scale designed to be implemented as part of household surveys in low-resourced settings. A sample of 2481 18- to 36-month-old children from peri -urban and rural Tanzania were taken. The total and subscale scores were compared with performance on the Bayley Scales of Infant Development (BSID-III ) in a subsample of 1036 children Correlations between the new scale and the BSID-III were high (r > .50) for the motor and cognitive subscales, but low (r < .20) for the socioemotional subscale Results of this study provide empirical support from a low-income country setting for the acceptability, reliability , and validity of a new caregiver-reported ECD scale. Additional research is needed to test these and other caregiver reported items in children in the full 0 to 3 year range across multiple cultural and linguistic settings

35. Reference: Illingworths the development of infant and young child 10 th edition Nelsons 20 th edition American academy of pediatrics: Developmental assessment Red Flags and Rules of Thumb: Sorting Out Developmental Delay Thank you!!!