DEVELOPMENTAL DELAY presentation pediatrics.pptx

Presentation on developmental delay

1. DEVELOPMENTAL DELAY SGD PROF.REETA BORA, HOD,DEPARTMENT OF PEDIASTRICS,AMCH

2. DEFINITION Failure to attain age appropriate developmental milestones as per age. Can be present in one or multiple domains If present in 2 or more domains of developmental Global developmental delay Domains- -Gross and fine motor -Cognitive -Language and speach /hearing -Social-emotional/ Aaptive

3. CAUSES OF DEVELOMENTAL DELAY 1.PRE-NATAL Genetic-Chromosomal anomalies eg - Trisomy 21, prader-Willi -Fragile X syndrome(single gene) -Metabolic- PKU,Galactocemia Acquired-Maternal substance abuse- Fetal alcohol syndrome -Infection- (TORCH) -Nutritional – maternal Iodine deficiency 2.PERINATAL Birth asphyxia , sepsis(meningitis), IVH (pre-term) Metabolic ( hypoglycemia , Hyperbilirubinemia )

4. 3.POST-NATAL- I nfections- Toxins eg - lead Trauma Malnutrition Untreated hypothyroidism 4.OTHERS- Structural brain anomalies Diseases- SMA, Autism, hearing/visual problems,metabolic disorders,neuro -degenerative diseases CAUSES OF DEVELOMENTAL DELAY

5. APPROACH TO DEVELOPMENTAL DELAY History G eneral physical examination Neurological examination Developmental assessment and screening Laboratory evaluation Treatment and Rehabilitation

6. History- Details history of events of birth including timing of delivery (term/preterm) , mode of delivery, h/o birth asphyxia(APGAR SCORE), h/o neonatal ICU admission, h/o jaundice/ hypoglycemia ,h/o feeding difficulities Antenatal history- maternal disease eg - GHTN,GDM, ante natal infection, h/o substance abuse etc H/o of onset of symptoms, pattern of delay APPROACH TO DEVELOPMENTAL DELAY

7. E xamination – Detailed physical examination – to look for syndromic features, congenital anomally Anthropometry... Micro/macro- cephaly , FTT/SAM Developmental /IQ assessment SCREENING TOOLS IN INDIA- 1.Trivandrum developmental screening test( 0-6 years) Gross&fine motor,language development,personal -social skills and cognitive abilities 2.Baroda developmental screening test( 0-3 years) gross motor,fine motor, language development and social interaction APPROACH TO DEVELOPMENTAL DELAY

8. Developmental scales/IQ tests- Bayles scales of infant development (BSID) Standford binet Weschler’s inteligence scales Indian scale for assessment of autism etc APPROACH TO DEVELOPMENTAL DELAY

9. Investigations- Investigations are directed based on detailed history and physical evaluation. 1.karyotyping/genetic analysis ( syndromic morphology) 2.Only Gross motor delay- CK levels-- normal- EMG, NCS high - gene study (DMD,SMA),muscle biopsy 3.Fine motor delay – complete ophthalmological examination neuroimaging (MRI /CT brain ) APPROACH TO DEVELOPMENTAL DELAY

10. 4.speech delay Hearing assessment-BERA,OAE,MRI BRAIN 5.Social/adaptive delay Autism screening, IQ assessment, psychological assessment APPROACH TO DEVELOPMENTAL DELAY

11. 6.Global develomental delay (GDD)- Starts with history and examination CBC,LFT,Ophthalmolical examination,hearing assessment, neuroimaging , EEG(h/o seizure), thyroid profile,hormonal analysis, rule out chronic infections, blood gas analysis,blood suger APPROACH TO DEVELOPMENTAL DELAY

12. ROLE OF CHILD DEVELOPMENTAL UNIT Management of developmental delay is a multidiciplinary approach Nowadays every district/sub-district and tertiary care hospitals have a child developmental/early intervention unit (DEIC) /NRC(nutritional rehabilitaion center ) Screening and early identification of disabilities (physical, audio-visual), physiotherapy and rehabilitation are done by these units Family counselling and family participation , specialised therapies,monitoring of progress.

13. REFERRAL A medical officer / pediatrician plays the most vital role in managing DDM by early detection of disability and timely referral/treatment. Treatable/transient causes which can be treated locally are to be managed by themselves and referral needs to be done to the specified area at appropriate time Eg - referring for ophtalmological Evaluation, hearing assessment, neuroimaging , to child psychologist to diagnose treat psycho-social disorders, to physiotherpist /DEIC center

14. THANK YOU