Keywords
Developmental screening, Autism, Milestones
Developmental Surveillance and Screening
Developmental and behavioral problems are more common than any category of problems in pediatrics, except acute infections and trauma. In 2008, 15% of children ages 3-7 had a developmental disability and others had behavioral disabilities. As many as 25% of children have serious psychosocial problems. Parents often neglect to mention these problems because they think the physician is uninterested or cannot help. It is necessary to monitor development and screen for the presence of these problems at health supervision visits, particularly in the years before preschool or early childhood learning center enrollment.
Development surveillance, done at every office visit, is an informal process comparing skill levels to lists of milestones. If suspicion of developmental or behavioral issues recurs, further evaluation is warranted ( Table 8.1 ). Surveillance does not have a standard, and screening tests are necessary.
| AGE | GROSS MOTOR | FINE MOTOR–ADAPTIVE | PERSONAL-SOCIAL | LANGUAGE | OTHER COGNITIVE |
|---|---|---|---|---|---|
| 2 wk | Moves head side to side | — | Regards face | Alerts to bell | — |
| 2 mo | Lifts shoulder while prone | Tracks past midline | Smiles responsively | Cooing Searches for sound with eyes | — |
| 4 mo | Lifts up on hands Rolls front to back If pulled to sit from supine, no head lag | Reaches for object Raking grasp | Looks at hand Begins to work toward toy | Laughs and squeals | — |
| 6 mo | Sits alone | Transfers object hand to hand | Feeds self Holds bottle | Babbles | — |
| 9 mo | Pulls to stand Gets into sitting position | Starting to pincer grasp Bangs two blocks together | Waves bye-bye Plays pat-a-cake | Says Dada and Mama , but nonspecific Two-syllable sounds | |
| 12 mo | Walks Stoops and stands | Puts block in cup | Drinks from a cup Imitates others | Says Mama and Dada , specific Says one to two other words | — |
| 15 mo | Walks backward | Scribbles Stacks two blocks | Uses spoon and fork Helps in housework | Says three to six words Follows commands | — |
| 18 mo | Runs | Stacks four blocks Kicks a ball | Removes garment “Feeds” doll | Says at least six words | — |
| 2 yr | Walks up and down stairs Throws overhand | Stacks six blocks Copies line | Washes and dries hands Brushes teeth Puts on clothes | Puts two words together Points to pictures Knows body parts | Understands concept of today |
| 3 yr | Walks steps alternating feet Broad jump | Stacks eight blocks Wiggles thumb | Uses spoon well, spilling little Puts on T-shirt | Names pictures Speech understandable to stranger 75% Says three-word sentences | Understands concepts of tomorrow and yesterday |
| 4 yr | Balances well on each foot Hops on one foot | Copies O , maybe + Draws person with three parts | Brushes teeth without help Dresses without help | Names colors Understands adjectives | — |
| 5 yr | Skips Heel-to-toe walks | Copies □ | — | Counts Understands opposites | — |
| 6 yr | Balances on each foot 6 sec | Copies Δ Draws person with six parts | — | Defines words | Begins to understand right and left |
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