DEVELOPMEN

TAL
PEDIATRICS
MODERATOR:
Dr. Malijan

REPORTER:
Dr. Cauyao
 NAME: A.B.

GENERA AGE/SEX: 4/M

ADDRESS: Tandang Sora,
L DATA Quezon City

First time to seek consult at

our institution via
Telemedicine (March 2021)
 CHIEF
SPEECH DELAY
COMPLAI
NT
 Birth and Maternal History

• Live, baby boy born full-term to a 27-year-old G1P1 (1001)

mother via NSD at PNP-Camp Crame General Hospital

• 10 PNCU started at 5months AOG

• (+) Multivitamins, Calcium

• (+) Abortifacient drugs (unrecalled drug and tea) for 1 week at

1 month AOG
 Birth and Maternal History
• (-) Smoker (-) Alcohol beverage drinker

• CBC, OGTT, HIV, Hepatitis B, UA, Ultrasound

• (+) UTI at 6 months AOG

• No other maternal illnesses

• No feto-maternal complications
 Past Medical History
• Newborn screening: Normal

• (-) Bronchial asthma

• (-) Allergy to food/ medications

• (+) Previous Hospitalization at PNP-Camp Crame General

Hospital due to Pneumonia

• (-) Surgery/ blood transfusion

Immunization History
 Nutritional History
• Exclusive breastfeeding until 3 months

• Mixed feeding started at 4 months

• Complimentary feeding started at 5 months

• Fond of eating fruits and candies

 Social History
• Father is a 42 years old police officer, college graduate

• Mother is a 31 years old businesswoman, college

undergraduate

• Parents are separated for 4 months

• Patient is currently living with his mother and grandparents

(second family)
 Family Medical History

• (+) Hypertension – maternal

• (+) Pulmonary tuberculosis – maternal
• (+) Behavioral disorder - maternal
• (-) Diabetes Mellitus
• (-) Malignancy
• (-) Bronchial asthma
• (-) Liver or Kidney Disease
 n e s i s
Anam
 DEVELOPMENTAL
MILESTONES Age Seen Red Flag
Smiled socially 4 months 4 months
Able to hold head up from prone 3 months 5 months
Rolled over 4 months 6 months
Babbled 9 months 6 months
Sat without support 6 months 10 months
Walked alone 15 months 18 months
Pointed with index finger to get attention at 12 months 12 months
Able to wave bye, shook head no, “close-open” 12 months 12 months
Able to say “mama” 11 months 12 months
Combined 2 words to form phrases 24 months 24 months
Toilet trained Not yet 24 months
 -Tries to look at parent
Infancy
2 -Coos, make gurgling sounds
MONTHS
-Turns head towards sounds

-Pays attention to faces

 -Smiles spontaneously

-Likes to play with people

Infancy
4
-Copies some movements and facial
expressions
MONTHS
-Cries in different ways to show
hunger, pain, or being tired

-Reaches for toy with one hand

-Uses hands and eyes together

 -Follows moving things from side
to side
Infancy
4 -Holds head steady, unsupported
MONTHS
-Able to roll over from tummy to
back

-Brings hands to mouth

 -Likes to play with others

-Responds to sounds, by making

sounds

Infancy
6
-Makes sounds to show joy and
displeasure
MONTHS
-Looks around at things nearby

-Begins to pass things from one

hand to the other

-Begins to sit without support

-Rolls over in both directions

 -Has favorite toys

-Understands “no”

Infancy
9
-Copies sounds and gestures of
others
MONTHS
-Plays peek-a-boo

-Stands, holding on

-Can get into sitting position

-Crawls
 -Cries when mom or dad leaves

-Has favorite things and people

One year -Repeats sound or action to get

attention

-Puts out arm or leg to help with

dressing

-Responds to simple requests

-Uses simple gestures, (“no” or

”bye-bye”
 -Says ”mama” and “dada”

-Tries to say words you say

-Copies gestures

One year -Starts to use things correctly

-Follows simple directions

-Gets to a sitting position without

help

-Pulls up to stand

-Stand alone
 -Likes to hand things to others

-Temper tantrums

18 months -Plays simple pretend

-Points to show others something

new

-Says several single words

_Points to show someone what he

wants
 -Knows what ordinary things are for

-Can follow 1-step verbal commands

18 months -Scribbles on his own

-Walks alone

-Eats with a spoon

-Drinks from a cup

-Help undress himself

 -Plays beside other children

-Points to things or pictures when

Two years
named

-Follows simple instructions

-Repeats words

-Points to things in a book

-Says phrases with two to four

words
 -Sorts shapes and colors

-Plays simple make-believe games

Two years -Completes sentences and rhymes in

familiar books

-Names items in a picture book

such as a cat, bird, or dog

-Stands on tiptoe

-Begins to run
 -Copies adults and friends

-Cannot dress and undress

-Follow 2-3 step instructions

Three years -Say first name, age, and sex

-Names a friend

-Have conversation but stutters

-Understand what “two” means

Runs easily
 EARS
R Y
FOU
 NT I A L
FFE RE
DI SI S
A G NO
DI
Differential 1. Language Disorder

Diagnosis 2. Developmental Stuttering

 Salient Differential
Feature Diagnosis
-Difficulty in forming sentences 1. Language Disorder
- Difficulties in the acquisition and
use of language across modalities
(spoken and written)
-Limited sentence structure
-Language abilities below for age
-Onset is early in the development
-Not attributed to other cause
 Salient Differential
Features Diagnosis
-Difficulty in forming sentences 2. Developmental Stuttering
-Limitations in effective
communication
-Onset is in early development
-Not attributed to other causes
-Ruled out – disturbances in the
normal fluency and time patterning
of speech
Current Working
Impression

U AG E
LA N G
RD ER
DI SO
 Language Disorder
• Specific language impairment

• Discrepancy with the child’s cognitive level and functional language

level

• Deficits in understanding and use of word meaning and grammar

• Learn visually and demonstrate their ability on nonverbal tests of

intelligence

• Difficulties with social interaction

 ENING
SCR E
 Screening
• Normal language developmental milestones and observations of the
child’s behavior

• Clinical judgment – eliciting and responding to parent’s concerns

 O S T I C
DIAG N
AT I O N
EVA LU
 Diagnostic Evaluation
• A child’s language and communication skills must also be interpreted
within the context of the child’s overall cognitive and physical abilities

• Multidisciplinary evaluation is often warranted

• Psychologic evaluation, neurodevelopmental pediatric assessment, and

speech-language examination
 Psychologic Evaluation
• Nonverbal cognitive ability
• Determine if the child has an intellectual disability

• Social behaviors
• Determine whether ASD is present
 Cognitive Assessment
• Intellectual disability
• Deficits in cognitive abilities and adaptive behaviors

• Delayed communication does not necessarily signal intellectual

disability

• A broad-based cognitive assessment is an important component to the

evaluation of children with language delays, evaluation of both verbal
and nonverbal skills
 Evaluation of Social Behaviors

• Children with SLI have an interest in social interaction, but they may
have difficulty enacting their interest because of their limitations

• Autistic children show little social interest

 Speech and Language Evaluation

• Assessment of language, speech, and the physical mechanisms

associated with speech production

• Both expressive and receptive language

 Medical Evaluation

• Careful history and physical examination should focus on the

identification of potential contributors to the child’s language and
communication difficulties

• Family history of delay in talking, need for speech and language

therapy, or academic difficulty – genetic predisposition to language
disorders
 Medical Evaluation

• Pregnancy history – reveal risk factors for prenatal developmental

anomalies (e.g. polyhydramnios or decreased fetal movement patterns)

• Developmental history – age when various language skills were

mastered and the sequences and patterns of milestone acquisition
 Medical Evaluation

• Physical Examination

• Height, weight, and head circumference

• Skin examined for lesions consistent with phakomatosis and other
disruptions of pigment
• Anomalies of head and neck

• Neurologic Examination

• Muscular hypertonia or hypotonia

 Medical Evaluation

• No routine diagnostic studies are indicated for isolated language

disorders

• Further genetic evaluation is needed when it is part of a generalized

cognitive or physical disorder
 M ENT
TREAT
 Treatment
• Early intervention and special education services

• Speech-language therapy includes a variety of goals

• Speech: development of more intelligible speech

• Language: expanding vocabulary and understanding meaning of

words, learning to expand words to sentences, social use of
language
 Treatment
• Individual sessions – drill activities or play activities

• Group sessions – practice peer communication

• Classroom integration – therapist team-teaching or consulting with the

teacher to facilitate the child’s use of language in common academic
situations
 Treatment
• Severe language impairment
• Alternative methods of communications (sign language, pictures,
computerized devices)

• Achieve better spoken language

• Speech pathologist can guide parents on effective modeling and

eliciting communication from their child
 NOSIS
PR OG
 Prognosis
• Children with mild isolated expressive language disorder (“late
talkers”) – excellent prognosis

• Children respond overtime to therapeutic/ educational interventions and

improvement of communication skills

• 50-80% experience difficulty with language and social development up

to 20 yrs beyond the initial diagnosis
Thanks!
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