DEVELOPMENTAL MILESTONES.pptx

Developmental Maturation

1. DEVELOPMENTAL MILESTONES

2. Development specifies maturation of functions. It is related to maturation and myelination of nervous system and indicates acquisition of a variety of skills for optimum functioning of the individual. Developme n t al ass e s s men t i n cl u des early identification of problems through screening and surveillance.

3. THE GOAL OF DEVELOPMENTAL ASSESSMENT IS NOT ONLY TO GENERATE A DIAGNOSIS BUT ALSO T O ANA L YS E THE P A TTE R N OF STRENGTHS AND WEAKNESS IN ORDER TO DIRECT TREATMENT.

4. PRINCIPLES OF DEVELOPMENT Development is a continuous process , starting in utero Sequence of attainment of milestone is same, rate of development varies from child to child based on their neurological status known as ‘ dissociation’ Development is cephalo-caudal and proximal to distal Certain primitive reflexes need to be lost before any milestone to develop. Ex walking reflex, palmar grasp, ATNR Generalized mass activity is replaced by specific individual responses

5. Gross Motor - the development of locomotion Vision and fine manipulation – the development of eye-hand control Hearing & speech - the development of language Personal & social - integration of acquired abilities to reflect understanding of env ironment 4 fields of development

6. GROSS MOTOR : Involves control of child over his body. Tested in : Prone Supine Sitting Standing Gross Motor Milestones

7. MOTOR DEVELOPMENT MILESTONES - Age:0-3 months Ventral suspension De velopmen t prone S u pi n e Sittin g in/of Age: 0-3 months 4 weeks – lifts head momentarily for a few moments 6 weeks – head lifted in line to the plane of body 8 weeks – head lifted beyond the plane of body 12 wks – brings head to plane of body and then above plane of body and maintains in that position. 1 st Month - Complete Head Lag 2 nd Month – Partial Head lag 3 rd Month - Moderate Head Control Head lag Newborn – can turn head to 1 side 1 mth – lifts chin momentarily 3 mths – lifts head and upper chest 1 st Month – Holds Head up momentarily 2 nd Month – Head Bobs 3 rd Month - Moderate Head Control

8. MOTOR DEVELOPMENT MILESTONES - Age:4-6 months prone supine sitting standing Age: 4 -6 months Stabilization W eight bearing M otion 4 th Month – Pushes with feet 4 th Month – Enjoys sitting with full truncal support 4 th Month - No Head Lag ATNR Gone 4 th Month – Head steady, holds head and chest off Couch 5 th Month – Full Head Control 6 th Month - Weight Bearing on extended arms Holds chest and abdomen above couch Rolls over from Prone to Supine

9. Development in/of prone supine sitting standing Age:6-9 months MOTOR DEVELOPMENT MILESTONES - Age:7-9 months 7 th Month – Weight Bearing Present, bounces actively 8 th Months- Pulls self to standing position 9 th Month - Stands holding on to furniture 10 th month- Cruises 6 th to 7 th Month – Grasps his feet and tries to bring it to his mouth 7 th Month – Sits briefly with support of pelvis, Weight bearing on one hand 8 th Months- Sits alone with back straight 9 th Month- Can Lean Forward 7 th Month Rolls over from Supine to Prone Position, Weight bearing on one hand 8 th Month- Weight bearing on hand and knees 9 th Month- Trying to crawl

10. Development in/of prone supine sitting standing Age: 10 -12 m onth s MOTOR DEVELOPMENT MILESTONES - Age:10-12 months 10 th Month – Pulls self to standing Position 11 th Month- Walks side ways holding on to furniture, walks with 2 hands held 12 th Month- walks with one hand held, rises independently,, bears walking 10 th Month – Pulls self to sitting Position 11 th Month- Can lean sideways, can turnaround to pick objects (Pivot) 10 th Month – Pulls self to sitting Position 9 th Month – Crawls with abdomen on the couch 11 th Month- Creeps- abdomen off ground, kneeling supported

11. Develo pment in/of prone supine sitting standing Age:12-18 mos MOTOR DEVELOPMENT MILESTONES - Age:13-18 months 13 th Month - Stands alone 15 th Month – Walks alone with broad base and high stepping gait, takes several steps sideward 18 th Month- Runs stiffly, walks upstairs with one hand held, pulls hand as he walks, walks normally throws ball without falling 15 th Month – Crawls upstairs 18 th Month – Sits on a small chair

12. 18 months Walk forward 10 feet with narrow base of support Walk backwards 5 steps Walk upstairs and downstairs with hand held Kick a ball forward 3 feet Throws ball while standing Seats self in small chair

13. 20 months – squats , carries large object 22 months- kicks ball with demonstration

14. 24 months / 2 Yrs - Runs without loss of balance climb on furniture Walk backward & sideways Walks upstairs and down stairs, two feet per step Kicks ball without demonstration Throws ball 3 feet away

15. MOTOR DEVELOPMENT MILESTONES - Age:21-60 months 36 Months/3 Yrs - Stands momentarily on single foot for 3 sec Goes upstairs with 1 foot per step and downstairs with 2 feet per step, Rides tricycle, catches ball with stiff arms Walks heel to toe Jumps In place

16. 48 Months/4 Yrs - Down stairs with 1 foot per step, hop on 1 feet, throw a ball overhand Catches bounced ball Standing jump

17. 5 years – skips jumps backward 6 years Tandem walking 7 years Bicycle

18. FINE MOTOR OR ADAPTIVE MILESTONES Includes eye coordination, hand eye coordination, hand mouth coordination and manipulation with hand (grasping, thumb-finger apposition, dressing) Eye coordination: 1 Month – follows moving objects less than 90 degree 2 Months – follows object from side to side – 180 Degree (Unsteady Movement) 2-3 Months – follows with steady movements of eyes 3-6 Months - Binocular vision develops

19. 2 Months- Hand predominantly closed 3 Months – Hands open, grasps reflex gone, Reaches towards objects and misses, Hand regard present 4 Mon ths – Approaches objects but overshoots, Hand in midline and plays with them 5 Mon ths – reaches out & grasps object with ulnar side , no more hand regard, bidexterous grasp 6 Months - transfers objects from hand to hand , unidextrous reach 8 month- radial grasp 9 Months – immature pincer grasp, attempts to pick fallen toys 10 mths – pincer grasp(between thumb and forefinger) – picks up pellet 12 Months - mature pincer grasp 12 months- casting – throwing deliberately on to floor one after another FINE MOTOR OR ADAPTIVE MILESTONES - Hand eye coordination

20. Hand-mouth coordination: 4 months- mouthing starts 11 months – mouthing stops 1 2 Months – tries to feed with spoon but may spill 15 Mon ths – feeds with spoon 18 Mon ths – feeds self from cup Hand skills : Book: 18 Months – turn 2-3 pages at a time 24 Months – turns 1 page at a time FINE MOTOR OR ADAPTIVE MILESTONES

21. Scribbling : 12- 1 8 Mon ths - scribbles 18 Months – copies vertical line 24 Months – copies horizontal line , HANDEDNESS is established 3 yrs – circle 4 yrs – cross, rectangle 5 yrs – triangle 6 yrs - hexagon 7yrs- kite 8yrs- doube cross 9 yrs - cylinder 11 yrs - cube FINE MOTOR OR ADAPTIVE MILESTONES

22. Tower of cubes 15 months – tower of 2 cubes 1.5 Years – tower of 3 cubes 2 Years – tower of 6 cubes , train of cubes 3 Years – tower of 9 cubes , bridge 4 Y ears – gates with cubes 5 Years – stairs from model with cubes 6 years- builds stairs from memory

23. beads 2 yrs - large beads 3 yrs - strings small beads well 3 yrs - cuts paper with scissors – side to side awkwardly 4 yrs - cuts circle 5 yrs - cuts properly

24. Socio Emotional Development

25. PERSONAL & SOCIAL DEVELOPMENT 1m Face regard-looks intently at mother 2 mth - social smile 3 mths - recognises mother/caretaker 4 mths – laughs loud 6 mths - enjoys mirror 6-9 months stranger anxiety (disappears by 1 year) 7 months – separation anxiety 8 months – object permanence - the understanding that objects continue to exist even when they cannot be sensed 9 mths - waves bye-bye , pulls mother to attract her 12m Comes when name is called, understands phrases, plays simple ball game 18 mths – complaints when wet or soiled 2yrs Asks for food, pulls people to show toys. 3 years – helps in dressing 5 years – dresses and undresses

26. BOWEL & BLADDER CONTROL 1.5-2yrs Start toilet training 1.5 yrs Bowel control is achieved 1.5-2 yrs Dry by day 2 yrs 50 % dry by night 3 yrs 75 % dry by night 5 yrs 90 % dry by night

27. language 1m Turns head to sound 2m Vocalizes 3m Cooing and babbling 4m Laughs aloud 6m Monosyllables 9m Bi syllables 12m Speaks 1st true word, repetition, knows 2 words with meaning 15-18m Jargon speech 18m Knows 10 words with meaning 2yrs Uses pronouns, points 1 part of body, speaks simple sentence with 3 words. 3yrs Knows name and sex, shares toys, asks questions 4yrs Tells a story, plays co-operatively in a group, goes to toilet alone 5yrs Names 5 colors, helps in household tasks

28. Play Milestones 10m Plays peek-a-boo 1yr Egocentric pretend play, solitary 2yr Parallel play 4yr cooperative Plays with others 5yr Domestic play 7-8 yrs - social play

29. directions

30. PARENTING POVERTY LACK OF STIMULAION V IOL E N C E A ND ABUSE MATERNAL DEP R E S S ION INSTITUTIONALIS INFANT AND CHILD NUTRITION IRON DEFICIENCY IODINE DEFICIENCY INECTIOUS DISEASE IUGR PREMATURITY PERIN AT AL AS P H YX I A M A TERNAL FACTORS GE N ET I C FACORS NEONATAL PSY C H O- SOCIAL POST NEONATAL PROTECTIVE B R E A ST FEEDING MATER NAL EDU

31. Indication for developmental assessment Follow up of high risk neonates for early detection of cerebral palsy or intellectual disability Complete evaluation of children with developmental, chromosomal or neurological disorders To differentiate children with delay in specific domain of development or global developmental delay

32. ⦿ DEVELOPMENTAL MILESTONES SERVE AS AN IMPORTANT BASIS OF MOST STANDARDIZED ASSESSMENT AND SCREENING TOOLS ⦿ TWO S E P AR A TE DE V E V EL O PME N T AL ASSESSMENT OVER TIME ARE MORE PRODUCTIVE THAN A SINGLE ONE

33. ⦿ WHETHER PARENTS ARE CONCERNED OR NOT ⦿ RIGH T Q U E S TIO N S ⦿ A G E S PECIFIC Q U E S TIO N S ⦿ CHEC K DOUBTFU L R E P L Y ⦿ C HECK THE ANSWE R S ABO U T ONE MILES T ONES BY ANOTHER AND BY EXAMINATION

34. ⦿ FAMILY HISTORY -FIRST, SECOND AND THIRD DEGREE RELATIVE ⦿ SOCIAL HI S T O R Y - CA P ACITY T O CO P E WIT H A CHILD WITH DISABILITY

35. ⦿ Obser v e v o c alizatio n an d gestures t o attract others attention, to indicate needs . in response to others vocalization and to share emotion ⦿ Note speech quality ,use of language to express and responding to conversation

36. ⦿ D Q =devel o pmenta l ag e \chr o nologi c a l age*1 ⦿ For The infa n t s wh o wer e bo r n prematurely should the chronological age should be corrected during the gestational age till 2yrs of life ⦿ Interp r etatio n - ⦿ >=85- normal ⦿ 71-84 - mil d t o mode r ate ⦿ <=70-sev e re delay

37. Prerequisites Should be done in a place free from distractions Child should not be hungry, tired, ill or irritated Playful mood with mother around Adequate time to make child and family comfortable A developmental kit

38. Equipment required: The following equipment is required for developmental testing in the fi rst 5 years: • Ten 1-inch cubes • Hand bell • Simple formboard • Goddard formboard • Coloured and uncoloured geometric forms • Picture cards • Scrap book • Cards with circle, cross, square, triangle, diamond drawn on them. • Patellar hammer • Paper • Pellets (8 mm)

39. Goodenough ‘draw-a man’ test The child is asked to draw a man carefully, in the best way he knows how and to take his time. The test is most suitable for children between 3 and 10 years of age. The child receives one point for each of the items which is present in his drawing. For each four points 1 year is added to the basal age which is 3 years. As a child draws circle at 3 years, the starting point for drawing a person, the basic score is considered 3 and the formula is: 3 + n/4, where n is the number of parts drawn. Interpretation- the score is low in children who suffered hypoxia in utero and high in children with certain emotional disorders

40. Gesell ‘incomplete man’ test 3 years One or two parts 4 years Three parts 4½ years Six parts 5 years Six or seven parts 6 years Eight parts

41. Goddard formboard. (Best of three trials) 3½ years -56 seconds. 4 years -46 seconds. 4½ years -40 seconds 5 years -35 seconds 6 years -27 seconds 7 years -23 seconds 8 years -20 second

42. Coloured geometric forms 2½ years- Places one 3 years -Places three 4 years- Places all Uncoloured geometric forms 3 years -Places four 3½ years- Places six 4 years -Places eight 4½ years- Places nine 5 years -Places all

43. Digits 2½ years - Repeats two, one of three trials 3 years - Repeats three, one of three trials 3½ years - Repeats three, two of three trials 4 years - Repeats three, three of three trials 4½ years - Repeats four, one of three trials 5 years - Repeats four, two of three trials 6 years - Repeats five 7 years - Repeats three backwards: (‘Say these figures backwards’) 8 years - Repeats six digits, one of three trials

44. Simple orders. (Put the ball under the chair, at the side of the chair, behind the chair, on the chair.) 3 years -Obeys two 3½ years -Obeys three 4 years- Obeys four Book 15 months- Interested 18 months- Turns pages two or three at a time Points to picture of cat or dog 2 years- Turns pages singly

45. Screening tests

46. Screening Tool for Motor Milestones Child Development Centre, Kerala Grading for Motor Milestones Developmental screening of all babies, particularly graduates of neonatal intensive care units (including vision and hearing domain), is important in identification of potentially handicapping conditions that may be prevented or ameliorated if addressed early. Motor Milestones Grading: (Assessed at completed 4 months) Grade 0 - No head holding at all. Grade I - Head erect and steady momentarily. Grade II - Dorsal suspension—lifts head along with body. Grade III - Prone position—elevates on arms, lifting chest. Grade IV- Holds head steady while mother moves around. Grade V - Head balanced at all times

47. . Sitting grading: (Assessed at completed 8 months) Grade 0 No sitting at all. Grade I Sits momentarily. Grade II Sits 30 seconds or more leaning forward. Grade III Sit with the child’s back straight. Grade IV While sitting, can turn around and manipulate a toy. Grade V Raises self to sitting position

48. . Standing grading: (Assessed at completed 12 months) Grade 0 Not standing well. Grade I Stands holding on to a furniture momentarily. Grade II Take few steps with both hands supported. Grade III Can stand alone with legs apart. Grade IV Come to standing position by throwing weight on arms. Grade V Without support takes few steps. (Interpretation of CDC grading: Grade III, IV, V—normal for that age

49. Trivandrum Developmental Screening Chart (TDSC) This is a simple developmental screening test for babies below 2 years; it is used in large scale community developmental screening programs by anganwadi workers (community health workers) and other health workers. The left end of each horizontal dark line represents the age at which 3% of children passed the item and the right end represents the age at which 97% of the children passed the item. A vertical line is drawn or a pencil is kept vertically, at the level of the chronological age of the child being tested. If the child fails to achieve any item that falls short on the left side of the vertical line, the child is considered to have a developmental delay.

50. Bayley developmental screening chart It measures the mental(cognitive) and motor development and test the behaviour of infants from one to 42 months of age It takes 45-60min to complete , administered by examiners who are experienced clinicians The examiners presents a series of test materials to the child and observes the child’s responses and behaviours Mental scale – it yields a score called mental development index , evaluates severe types of abilities, sensory/perceptual acuities, discriminations and response , acquisition of object constancy, memory learning and problem solving, vocalisation , basis of abstract thinking, habituation, mathematical concept formation

51. Behavior rating scale- Motor scale – it assesses the degree of body control , large muscle coordination, fine coordination, postural imitation, stereognosis It has 30 items which rates child’s relevant behaviors and measures attention/arousal , orientation, emotional regulation.

52. Baroda developmental screening test It is a simplified bayley scales having 22 motor items and 31 mental items It is grouped age wise , one monthly in the first 1 months and 3 monthly thereafter till 30 months The 50 percent and 97 percent age placement of each item has been plotted on a graph and joined to have two smooth curves. The total number of items passed by a child is plotted against his chronological age or corrected age if preterm When this point falls below 97 percentile curve , this child is considered to have developmental delay and is subjected to detailed assessment

53. Denver developmental screening test( ddst ) It is used to assess for examining the developmental progress of children from birth until the age of six The test consists of 125 items divided int 4 domains Social- aspects of socialisation inside and outside the home Fine motor – eye/hand coordination, manipulation of small objects eg. Grasping and drawing Language- production of sounds, ability to recognise , understand and use of language Gross motor – siting, walking, jumping and other movements

54. Performance rated as pass/ caution/delay Interpretation- Draw a vertical line at the child’s chronological age on the charts , if the infant was premature , substract the months premature from chronological age The more items a child fails to perform passed by 90% of his/her peers, the more likely the child manifests a significant developmental deviation

55. Definitive test

56. Stanford–Binet Intelligence Scales   it is an individually administered  intelligence test  that was revised from the original Binet–Simon Scale by  Lewis Terman , a psychologist at Stanford University. The Stanford–Binet Intelligence Scale is now in its fifth edition (SB5) and was released in 2003. The test measures five weighted factors and consists of both verbal and nonverbal subtests. The five factors being tested are knowledge, quantitative reasoning, visual-spatial processing,  working memory , and fluid reasoning It is for age group 2-23yrs Yields intelligent quotient

57. Fluid reasoning Knowledge Quantitative reasoning Visual-spatial processing Working memory Early reasoning Vocabulary Non-verbal quantitative reasoning (non-verbal) Form board and form patterns(non-verbal) Delayed response (non-verbal) Verbal absurdities Procedural knowledge (non-verbal) Verbal quantitative reasoning Position and direction Block span (non-verbal) Verbal analogies Picture absurdities (non-verbal) Memory for sentences Object series matrices (non-verbal) Last word

58. IQ Range ("deviation IQ") IQ Classification 145–160 Very gifted or highly advanced 130–144 Gifted or very advanced 120–129 Superior 110–119 High average 90–109 Average 80–89 Low average 70–79 Borderline impaired or delayed 55–69 Mildly impaired or delayed 40–54 Moderately impaired or delayed

59. Binet- Kamath intelligence scale It undertook a revision of the Stanford binet scale Age limit is of 3 yrs to 22 yrs For each item passed the child earns a credit of 2 months, 4 months or 6 months depending on the corresponding age