ASSESMENT OF

DEVELOPMENT
DR KHANISA MD KHALID
GEN PEADIATRICS & CHILD HEALTH,
HRPZ2, KOTA BHARU
 CONTENT
• DEFINITION OF DEVELOPMENT
- Assesment of normal development
- Danger signs
- treatment
Assesment of development
 The Process of Child Development
Development

Heredity/ Environment
Genetic Personal identity

Physical Need Good health

Psychological Need
Functioning senses Activity
Affection/care
Role models
Food Clothing/shelter
security

play
 Normal Developmental milestones
• A set of functional skills or age specific task that most children can do at
certain age range

• Pediatrician use milestones to assess development of a child

• The actual age at which a child attain specific milestones can vary
according to age limits for each level
GROSS MOTOR FINE MOTOR

DEVELOPMENTAL
MILESTONES

SOCIAL AND SPEECH AND

ADAPTIVE LANGUAGE
Gross motor development
 Fine Motor Development
Reaching for object
Palmar grasp

Pincer grasp

Builds bricks

draws
 Speech and Language Use sentences

Link words

Use words

Mimmicks words

Understands commands

‘ma’ ‘ba’
Babbles

Coos
 Speech and language
 There are 2 aspects of speech :
- Receptive speech (what they understand)
- Expressive speech (what they can
 Behaviour/Social skills
smiles
Feeds self solid food

Drinks from cup

Helps with task eg dressing

Plays in parallel with other children

Plays with other children

1) UNOCCUPIED PLAY ( BIRTH-
3MONTHS)
- Baby making movements with their arms, legs,
hands, feet
2) SOLITARY PLAY ( BIRTH – 2 YEARS)
- Child playing alone. They are not interested in
playing with others yet
3) SPECTATOR/ONLOOKER BEHAVIOUR
( 2YEARS)
- Watch other children playing ,but doesn’t play
with them
4) PARALLEL PLAY (2++ YEARS)
- Child plays alongside or near others, but
doesn’t play with them
5) ASSOCIATE PLAY ( 3-4 YEARS)
- Child starts to interact with others during play
but not large amount of interaction at this stage
6) COOPERATIVE PLAY ( 4+ YEARS)
- A child plays together and has interest in both
the activity and other children involved in
playing.
Developmental Variation
5. APPROACH TO DIAGNOSIS
 A. HISTORY
• 1. PRENATAL HISTORY
- Antenatal complications
- Dx made in utero (Down Syndrome)
- Inutero infection (TORCHES)
- Substance exposure (Teratogenic drugs, Alcohol)
• 2. OBSTETRIC HISTORY
- intrapartum/peripartum complications
- Infection (Group B streptococcus)
- Asphyxia? Seizures?
- Newborn hearing screen
 A. HISTORY
• 3. PAST MEDICAL HISTORY AND MEDICATIONS
- Admission for meningitis/ seizure
- Ototoxic medications/ recurrent ear infection
4. FAMILY HISTORY
- Relatives with developmental delay, seizure, syndrome
- Consanguinity
- Plot three(3) generations family tree
5. SOCIAL HISTORY
- Evident of neglect or abuse
- Primary languages- >English as second language may have delay in acquisition of this language
 B. PHYSICAL EXAMINATION
• Important to thoroughly examine and correlate physical findings with
possible dx
1. GROWTH PARAMETERS
Microcephaly – Rett’s Syndrome, Intrauterine infection
Macrocephaly – hydrocephalus, Soto Syndrome
Short stature- Turner’s syndrome, William syndrome, Russel Silver
Obesity – Prader Willy syndrome, Beckwith- Wiedemann Syndrome
 B. PHYSICAL EXAMINATIONS
2. HEAD AND NECK
Flat occiput (brachycephaly)- Down Syndrome, Zellweger
Prominent occiput
Craniosynostosis- Crouzon, Apert sydrome
Midfacial hypoplasia- Down syndrome, Fetal Alcohol syndrome
Prominent nose and chin – Fragile X syndrome
Round facies- Pader willi syndrome
Triangular face- Turner’s, Edward Syndrome
 The syndromes
FRAGILE X SYNDROME vs PRADER WILLY AND
RUSSEL SILVER DWARFISM TURNER SYNDROME
 B.PHYSICAL EXAMINATIONS
2. HEAD AND NECK
Eyes: hypertelorism, Hypotelorism
Brush field spots
Lisch Nodules in neurofibromatosis

Nose: Flat nasal bridge-> Down syndrome

Ear: Malformed pinna-> Treacher Collin’s, CHARGE association

Large pinna: Fragile X syndromes
 B. PHYSICAL EXAMINATIONS
Mouth : Long philtrum: Fetal alcohol syndrome
Cleft lip and palate: Patau syndome
Micronaghtia: Robin sequence
Macroglossia: Beckwith-Wiedmann syndrome
Webbed neck: Turner syndrome

Genitourinary: Macroorchidism  Fragile X syndrome

Hypogonadism: Prader Willi syndrome
 B. PHYSICAL EXAMINATIONS
• Extremities: Clinodactyly  Trisomies including Patau,
Down syndrome
Transverse Palmar Crease  Down syndrome
• Skin “Neurocutaneous Syndrome”
- Port wine stain: Sturge Webber syndrome
- Café au lait spot: Neurofibromatosis
- Ashleaf spots, Adenoma sebaceum, Shagreen Patch: Tuberous sclerosis
 Neurocutaneous syndromes

Café au lait with axillary freckiling

Ashleaf hypopigmented macules

Port wine stain

Adenoma sebaceum
 INVESTIGATION
• A. GENETICS
- Karyotyping to assess for chromosomal abnormalities
- FISH analysis to assess for microdeletion
• B. ENDOCRINOLOGY
- THYROID FUNCTION TEST (t4/TSH)
• C. METABOLIC SCREENING
- Serum ammonia, lactate, plasma amino acid, urine organic acid, creatinine phosphokinase
• D. NEUROLOGY
- EEG, CT/ MRI brain , neurologist referral
 6. MANAGEMENT
Following identification of problems related to developmental delay, referrals to
multidisciplinary team:-
a. Physiotherapist
b. Occupational Therapist
c. Speech therapist
d. Special education teacher
e. Developmental pediatrician / Neurologist / metabolic specialist/endocrinologist/
pediatrician
f. Child psychiatrist/ pschologist
• Importance of Early Intervention Programme (EIP), ideally treatment
initiated before 3 years old to get the best outcome
• OKU registration
• Placement to either PDKs(Pusat Dalam Komuniti), Special Schools
(Sekolah Khas, Sekolah Pendidikan Khas Integrasi)
• Continuous follow up by multidisciplinary team and support from parents