Review – Kaplan Pediatrics: Development

Dec 4, 2019 admin NHI KHOA 0

Review – Kaplan Pediatrics: Development

  • Five main skill areas
    • Visual-motor
    • Language
    • Motor
    • Social
    • Adaptive
  • Assessment based on acquisition of milestones occurring sequentially and at a specific rate
    • Careful assessment of ALL skills because abnormal development in one area increases likelihood of abnormality in another
  • Developmental delay—performance significantly below average, e., developmental quotient (developmental age/chronologic age x 100) of <75
  • Major developmental disorders
    • Mental retardation—IQ <70–75 plus related limitation in at least 2 adaptive skills, e.g., self-care, home living, work, communication
    • Communication disorders (deficits of comprehension, interpretation, production, or use of language)
    • Learning disabilities, one or more of (defined by federal government; based on standardized tests): reading, listening, speaking, writing, math
    • Cerebral palsy
    • Attention deficit/hyperactivity disorder
    • Autism spectrum disorders
  • Denver II Developmental Assessment
    • To screen the apparently normal child between ages 0–6
    • At every well-child care visit
    • Screens in gross motor, fine motor, language, personal-social
    • For infants born <38 weeks’ gestation, correct age for prematurity up to age 2 years
    • Failure is at least 2 delays

PRIMITIVE REFLEXES AND DEVELOPMENTAL MILESTONES

Scenario: An infant can sit up with its back straight, has started crawling, has a pincer grasp, and plays peek-a-boo. What age is most appropriate for this baby?

Newborn Reflexes
(appear and disappear in sequence during specific periods of development)

Reflex Description Appears Disappears CNS Origin
Moro Extend head → extension, flexion of arms, legs Birth 4–6 mo Brain stem vestibular nuclei
Grasp Finger in palm → hand, elbow, shoulder flexion Birth 4–6 mo Brain stem vestibular nuclei
Rooting Cheek stimulus → turns mouth to that side Birth 4–6 mo Brain stem trigeminal system
Trunk incurvation Withdrawal from stroking along ventral surface Birth 6–9 mo Spinal cord
Placing Steps up when dorsum of foot stimulated Birth 4–6 mo Cerebral cortex
Asymmetric tonic neck (ATNR) Fencing posture when supine Birth to 1 month 4–6 mo Brain stem vestibular nuclei
Parachute Simulate fall → extends arms 6–8 mo Never Brain stem vestibular

Developmental Milestones

  Gross Motor Visual Motor Language Social Adaptive
Birth •    Symmetric movements in supine

•    Head flat in prone

 •    Visually fixes on an object •    Alerts to sound •    Regards face
2 months •    Head in midline while held sitting

•    Raises head in prone

•    Begins to lift chest

 •    Follows past midline •    Smiles in response to touch and voice •    Recognizes parent
4 months •    Holds head steadily

•    Supports on forearms in prone

•    Rolls from prone to supine

 •    Reaches with both arms together

•    Hands to midline

 •    Laughs

•    Orients to voice

•    Coos

 •    Likes to look around
6 months •    Sits with support (tripod)

•    Feet in mouth in supine

 •    Unilateral reach

•    Raking grasp

•    Transfers object

 •    Babbles •    Recognizes that someone is a stranger
7 months •    Rolls from supine to prone

•    May crawl

•    Starts to sit without support

      
9 months •    Crawls well

•    Pulls to stand

•    Starting to cruise

 •    Immature pincer grasp

•    Holds bottle

•    Throws object (not overhand)

 •    “Mama,” “dada,” indiscriminately

•    Understands “no”

•    Understands gestures

 •    Plays gesture games

•    Explores environment (crawling and cruising)
12 months •    May walk alone (must by 18 months) •    Mature pincer grasp

•    Crayon marks

•    Object permanence (from 10 months)

 •    1-2 words other than “mama” and “dada” (used appropriately)

•    Follows one step command with gesture

 •    Imitates actions

•    Comes when called

•    Cooperates with dressing
15 months •    Creeps up stairs

•    Walks backward

 •    Scribbles and builds towers of 2 blocks in imitation •    4-6 words

•    Follows 1-step command without gesture

 •    Uses cup and spoon (variable until 18 months)
18 months •    Runs

•    Throws objects overhand while standing

 •    Scribbles spontaneously

•    Builds tower of 3 blocks

 •    15-25 words

•    Knows 5 body parts

 •    Imitates parents in tasks

•    Plays in company of other children

(continued)

  Gross Motor Visual Motor Language Social Adaptive
24 months •    Walks up and down stairs one foot at a time •    Imitates stroke (up or down) with pencil

•    Builds tower of 7 blocks

•    Removes clothing

 •    50 words

•    2-word sentences

•    Follows 2-step commands

•    Uses pronouns inappropriately

 •    Parallel play
3 years •    Alternates feet going up the stairs

•    Pedals tricycle

 •    Copies a circle

•    Undresses completely

•    Dresses partially

•    Unbuttons

•    Dries hands

 •    ≥250 words

•    3-word sentences

•    Plurals

•    All pronouns

 •    Group play

•    Shares

•    Takes turns

•    Knows full name, age and gender
4 years •    Alternates feet going downstairs

•    Hops and skips

 •    Copies a square

•    Buttons clothing

•    Dresses completely

•    Catches ball

 •    Knows colors

•    Recites songs from memory

•    Asks questions

 •    Plays cooperatively

•    Tells “tall tales”
5 years •    Skips alternating feet

•    Jumps over lower obstacles

 •    Copies triangle

•    Ties shoes

•    Spreads with knife

 •    Prints first name

•    Asks what a word means

•    Answers all “wh-” questions

•    Tells a story

•    Plays pretend

•    Knows alphabet

 •    Plays cooperative games

•    Abides by rules

•    Likes to help in household tasks

Possible Abnormalities

  • You must take into account the number of weeks of prematurity to assess development appropriately, e., per the preterm age, NOT chronological.
Age Corrected
 A 6-month-old baby born at 32 weeks (i.e., 2 months preterm) must be assessed at 6 – 2 = 4 months CORRECTED Do this until chronological age 2 years, then consider delays to be true
  • If there appears to be a language delay, first consider conductive hearing While all babies receive hearing testing within the first month of life, that is for congenital sensorineural hearing loss. Over the first year of life, conductive hearing loss may occur from repeated ear infections.
  • If there is a lack of development or regression of language skills with impaired social interaction, restricted activities and interests and stereotypic behaviors, consider autistic spectrum.Onset of abnormal findings must occur age <3 years.
    • After a complete H and P with neurologic exam and development testing, the first step is to perform an autism screening. Refer to a specialist suspected cases.
  • Delay is defined as ≥1 skills significantly below average, e., developmental quotient (developmental age/chronological age x 100) is <75. Next look for a possible reason.

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