Developmental Surveillance



Developmental Surveillance


Patty Huang



INTRODUCTION

Primary care physicians play a vital role in identifying children at risk for developmental disabilities and in referring them for appropriate early intervention services. Developmental surveillance involves using information obtained from the history, physical examination, and developmental screening tests to assess development on an ongoing basis. This ongoing monitoring of development is critical for two reasons. First, new circumstances (e.g., medical illness, family or environmental disruption, or injuries) may interfere with development. Second, as children develop, they gain new categories of skills that are difficult to assess at earlier stages (e.g., one cannot usually detect isolated language delays in children younger than 18 to 24 months, the point at which children begin to develop a good repertoire of language skills). In 2006, the American Academy of Pediatrics published guidelines recommending developmental surveillance at every well-child visit, as well as additional periodic developmental screening using a standardized test at the 9-, 18-, and 30-month-old visits.




HISTORY

The following information should be elicited:



  • Parental concerns regarding the child’s development. In most cases, parental concerns regarding the child’s language development, articulation, fine motor skills, or global development are likely to be associated with true developmental delays. Parental concerns about behavior or personal-social skills are associated with developmental delays in some cases.


  • Risk factors for developmental disabilities (Table 3-1).


  • Attainment of developmental milestones (Table 3-2).


PHYSICAL EXAMINATION


Head Circumference

Brain growth is the principal stimulus for increasing head circumference. Therefore, a small head circumference may indicate abnormalities in brain growth that place a child at risk for developmental disabilities. A large head circumference may be a sign of hydrocephalus, a genetic syndrome, or a metabolic storage disease (see Chapter 51, “Macrocephaly”). However, before assuming pathology in a child, one should measure the head sizes of parents as a small or large head circumference may be a family trait.









TABLE 3-1 Risk Factors for Developmental Disabilities







































Prenatal


Maternal illness, infection, or malnutrition


Maternal exposure to toxins, teratogens, alcohol, illicit drugs, anticonvulsants, antineoplastics, or anticoagulants


Decreased fetal movements


Intrauterine growth retardation


Family history of deafness, blindness, or mental retardation


Chromosomal abnormalities


Perinatal


Asphyxia: Apgar scores of 0-3 at 5 min


Prematurity, low birth weight


Abnormal presentation


Postnatal


Meningitis, encephalitis


Seizure disorder


Hyperbilirubinemia: bilirubin >25 mg/dL in full-term infant


Severe chronic illness


Central nervous system trauma


Child abuse and neglect










TABLE 3-2 Developmental Milestones from Birth to 5 Years of Age
































































































Age (Months)

Adaptive/Fine Motor

Language

Gross Motor

Personal-Social


1

Grasp reflex (hands fisted)

Facial response to sounds

Lifts head in prone position

Stares at face


2

Follows object with eyes past midline

Coos (vowel sounds)

Lifts head in prone position to 45°

Smiles in response to others


4

Hands open Brings objects to mouth

Laughs and squeals Turns toward voice

Sits: head steady Rolls to supine

Smiles spontaneously


6

Palmar grasp of objects

Babbles (consonant sounds)

Sits independently Stands, hands held

Reaches for toys Recognizes strangers


9

Pincer grasp

Says “mama,” “dada” nonspecifically; comprehends- “no”

Pulls to stand Feeds self

Waves bye-bye


12

Helps turn pages of book 2-4 words Follows command with gesture

Stands independently Walks, one hand held

Points to indicate wants


15

Scribbles

4-6 words Follows command without gesture

Walks independently

Drinks from cup Imitates activities


18

Turns pages of book

10-20 words Points to four body parts

Walks up steps Feeds self with spoon


24

Solves singlepiece puzzles Combines 2-3 words Uses “I” and “you”

Jumps Kicks ball

Removes coat Verbalizes wants


30

Imitates horizontal and vertical lines

Names all body parts

Rides tricycle using pedals

Pulls up pants Washes, dries hands


36

Copies circle Draws person with three parts

Gives full name, age, and sex Names two colors

Throws ball overhand Walks up stairs (alternating feet)

Toilet trained Puts on shirt, knows front from back


42

Copies cross

Understands “cold,” “tired,” and “hungry”

Stands on one foot for 2-3 sec

Engages in associative play


48

Counts four objects Identifies some numbers and letters

Understands prepositions (under, on, behind, in front of) Asks “how” and “why”

Hops on one foot Dresses with

little assistance Shoes on correct feet


54

Copies square Draws person with six parts

Understands opposites

Broad-jumps 24 in.

Bosses and criticizes Shows off


60

Prints first name Counts 10 objects

Asks meanings of words

Skips (alternating feet)

Ties shoes




image HINT: Microcephaly is defined as a head circumference <3rd percentile; macrocephaly is defined as a head circumference >97th percentile.

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Sep 14, 2016 | Posted by in PEDIATRICS | Comments Off on Developmental Surveillance

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