Developmental Milestones-An

overview

Illingworth 1987

Development is continuous from conception

to maturity and its sequence is the same in
all children,though its rate varies from one
child to another

Developmental Milestones
Children develop from being totally
dependent newborns to independent
individuals by the acquisition of skills
Range of normality in the acquisition of
skills
Development follows an orderly process in
a cephalic to caudal direction

Principles

Listen to parents-partnership
May need to see a child a second time
Opportunistic pick up
The state of the child-take into account
Distinguish between developmental items
reported and those observed

Routine Child Surveillance

Newborn
Supine (6-8wks)
Sitting (6-9 mths)
Mobile toddler (18-24mths)
Communicating child

(3-4yrs)

Developmental Milestones
4 fields with a sequence of development
Gross Motor - the development of
locomotion
Vision and fine manipulation - the
development of eye-hand control
Hearing & speech - the devt. of language
Personal & social - integration of acquired
abilities to reflect understanding of env.

Developmental Milestones
Birth prone: pelvis high, knees under abdo
6-8 weeks smiles to maternal overtures
fixes & follows
prone:
pelvis flat, hips extended
ventral: briefly
holds head up
3 months holds head up, good eye contact
holds rattle in hand
turns to sound ear level

Developmental Milestones
4-5 months able to reach out for object
6 months transfers hand to hand
Chews, babbles
sits with hands forward
lifts head
spont from supine
10 months index finger approach
finger thumb apposition waves bye-bye,

Developmental Milestones
13 months casting objects
walks without support
single
words
15 months feeds self from cup
domestic mimicry
18 months casting stops ,tower of 3
Walking well, scribbles

Developmental Milestones
2 years

3 years

joins 2/3 words, 50 words

Runs well,climbs, stairs
cubes tower 6 or 7
mainly dry by day+/- night
dresses & undresses fully
stairs - alternate feet
rides tricycle

Developmental Warning Signs at any age

FHx of note eg deafness, cataracts

Maternal concern
Persistent primitive reflexes
Persistent squint
Discordance in developmental abilities in
different areas
Regression of previously acquired skills

Causes of Delayed Development

(Correct for Prematurity)
Idiopathic: constitutional, familial (affecting
one field & catching up later)
Deprivation
Intellectual disability
Specific abnormality eg Blind, deaf,
cerebral palsy

Causes of arrested/deteriorating
development
Common
Emotional deprivation
Intercurrent illness eg malabsorption
Acute cerebral injury eg encephalitis,
trauma
Seizures: uncontrolled, prolonged
Drugs eg phenytoin excess

Causes of arrested/deteriorating
development
Uncommon/rare
Hydrocephalus
Metabolic eg hypothyroidism, lead poisoning
Degenerations - Infections: AIDS, SSPE
- Genetic: Wilsons Dx
Huntingtons
Chorea,
Lysosomal storage dx

Developmental Milestones Delayed Motor Development

Familial feature
Environmental - deprivation, practice
Mental subnormality
Hypotonia (Downs Syn)
Hypertonia (Cerebral Palsy)
Neuromuscular problems (DMD)
Bottom shuffling
Visual impairment

Developmental Milestones Summary

ordered process of development
range of normality in acquisition of skills bands of normality - delayed
relevance of delay varies
early detection of delayed development
desirable for maximum intervention and for
parental acceptance

Video
Developmental examination of a
child from birth to 18 months