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,Dr.Khalid Hama salih
Pediatrics specialist
M.B.Ch.; D. C.H


:Introduction    An estimated 12-16% of children have a developmental and/or behavior disorder Only 30% are identified before school entrance Those detected after school entrance miss out on early intervention services proven to have long term health benefits .

. particularly in relation to developmental problems in the 0-5 years age group.implies slow acquisition of all skills (global delay) or of one particular field or area of skill (specific delay). Delay .

Development delay  the condition where a child does not reach one of the stages of development at the expected For example. this would be considered a developmental delay. . and a 20month-old child has still not begun walking. if the normal range for learning to walk is between 9 and 15 months.

near drowning. seizures trauma Head injury . e. microcephaly. hydrocephalus. hyperbilirubinaemia  Postnatal l infection Meningitis. neurofibromatosis Perinatal   Extreme prematurity Intraventricular haemorrhage/periventricular leucomalacia Birth asphyxia Hypoxic-ischaemic encephalopathy metabolic Symptomatic hypoglycaemia.prenatal genetic Chromosome/DNA disorders. e. vascular occlusion metabolic Hypothyroidism. absent corpus callosum. Down's syndrome. encephalitis anoxia Suffocation. toxoplasmosis ncs Tuberous sclerosis.g. cytomegalovirus. phenylketonuria teratopgenic Alcohol and drug abuse Congenital infection Rubella. fragile X syndrome Cerebral dysgenesis.accidental or non-accidental . neuronal migration disorder.g.

     The severity can be categorised as: mild moderate severe profound .

Global developmental delay implies delay in acquisition of all skill fields (gross motor. social/emotional and behaviour). hearing and speech/language. . vision and fine motor. It usually becomes apparent in thefirst 2 years of life.Types of delay  1.

However. delay in speech and language but review of their developmental history may reveal delayed gross and fine motor Global developmental delay is likely to be associated with cognitive difficulties although these may only become apparent several years later. . some children present later with. for instance. .

Specific developmental delay is when one field of development or skill area is more delayed than others or is developing in a disordered way . 2.

g. e. standing. asymmetry of hand use. Concern about motor development usually presents between 6 months and 2 years of age when acquisition of motor skills is occurring most rapidly .Abnormal motor development  This may present as delay in acquisition of motor milestones. walking or as problems with balance. rolling. head control. sitting. an abnormal gait. involuntary movements or rarely loss of motor skills.



e. spina bifida global developmental delay as in many syndromes or of unidentified cause .Causes of abnormal motor :development include     cerebral palsy congenital myopathy/primary muscle disease spinal cord lesions.g.

which may be due to retinoblastoma. not smiling responsively by 6 weeks post-term lack of eye contact with parents visual inattention.squint photophobia .:Fine motore &vision        Visual impairment may present in infancy with: loss of red reflex from a cataract a white reflex in the pupil. cataract or retinopathy of prematurity (ROP). random eye movements nystagmus .


The deficit may be a delay or a disorder.Hearing speech and language  Abnormal speech and language development A child may have a deficit in either receptive or expressive speech and language. . or both.

e.g.:Speech and language delay may be due      global developmental delay to hearing loss difficulty in speech production from an anatomical deficit. cerebral palsy environmental deprivation/lack of opportunity for social interaction normal variant/familial patter .g. e. cleft palate. or oromotor incoordination.

Presentation is usually between 2 and 4 years of age when language and social skills normally rapidly expand. The children present with a triad of difficulties and associated co-morbidities . It is more common in boys. The prevalence of autistic spectrum disorder is 3-6/1000 live births.Abnormal development of social/communication skills  Children who fail to acquire normal social and communication skills may have an autistic spectrum disorder.


Developmental Quotient (DQ)  Divide child’s developmental or best milestone age (DA) by child’s chronological age (CA)  DQ = DA/CA x 100  DQ of 100 = mean or average rate  DQ < 70 is approx. 2 standard deviations below the mean .

Developmental Quotient    DQ > 80 may be considered normal DQ 70-80 borderline DQ < 70 is abnormal .

white cell (lysosomal) enzymes. ammonia.g. 1 consider for ent *Chromosome Metabolico Thyroid function tests. plasma Creatine kinase. urea and electrolytes. liver function tests. EMG. bon a chemistry. VLCFA (very lo chain fatty acids).Investigations or assessment to karyotypeCytogenetic abnormal developmTable 4-2. for chromosome 7. blood lactate. blood gases. some progressive neurological disorders) Nerve conduction studies. DNA FISH analysis. urine mucopolysaccharides (GAG) reduc  substanc Maternal amino acids for raised phenylala Infection Congenital infection screen Imaging CT and MRI brain scans Skeletal survey Cranial ultrasound in newborn Neurophysiology EEG (may be specific for seizures. Fragile X analysis* . e. VEP (visual . urine amino and org acids.

management Assistive technology (devices a child might need)  Audiology or hearing services  Counseling and training for a family  Educational programs  Medical services Nursing services Nutrition services  Occupational therapy Physical therapy  Psychological services Respite services  Speech/Language  .