Developmental Ax (short case)

Question 1

Developmental introduction

Answer 1

Hello, my name is Cassie, I am the paediatric registrar. I have been asked to perform a developmental assessment on x, an x year old x. Thank you for volunteering to help us today, this examination shouldn’t casue any distress or pain, however if it does let me know and I’ll alter my approach. Is it okay if we proceed? great, I’ll just wash my hands. I’m having a look around the room, looking for mobility, respiratory, or nutritional devices, of which I see none/describe.

x looks well/unwell with (pallor/jaundice/ appears dyspnoeic). xx has no distinctive facial features, and looks like his mum. He appears small for his ag, of a disporportionate weight to height/disproportionately tall, however I would like to check this on growth charts, ideally serial growth measurements. Are these available?

Question 2

1. Vision

Answer 2

red ball

Question 3

2. Hearing

Answer 3

hide red ball and shake rattle

Question 4

3. closer vision + fine motor

Answer 4

hundreds and thousands and picking up

Question 5

4. Fine motor

Answer 5

Block stacking

Question 6

5. Speech?

Answer 6

comment on any vocalisations or state there are no vocalisations

Question 7

6. Gross motor - 180 degree

Answer 7

First, with the child lying supine, note the posture (e.g. adopting abnormal asymmetric tonic neck reflex [ATNR] positioning) and movement (e.g. choreoathetoid movements with cerebral palsy [CP], paucity of movement with some neuromuscular diseases).

Next, draw the child into the sitting position, by traction on the arms, noting the degree of head control/lag (e.g. marked head lag with spinal muscular atrophy).

With the child in the sitting position, note the amount of head and trunk control, and ability to sit, supported and unsupported.

Next, hold the child up to check weight bearing. This helps detect lower limb scissoring (as in CP), lower limb hypotonia and weakness (e.g. neuromuscular disorders causing the ‘floppy infant’ syndrome), and inappropriately ‘advanced’ weight bearing (in CP).

Then, hold the child in ventral suspension and describe the posture of the head, trunk and limbs. This position can demonstrate hypotonia well: if very severe, the infant describes a ‘C’ shape over the examiner’s hand. The converse can occur with CP, where an exaggerated extensor posture may be adopted.

Finally, lay the child prone. Make sure that the hands are placed to either side of the infant’s shoulders, with the palms apposed to the bed and elbows flexed, to optimise the ability to extend the upper limbs. Note the ability of the child to raise the head and trunk when placed prone.

Question 8

7c. Gross motor

Answer 8

Sitting unassisted (6 months)
Standing (9 months)
walking (1 year)
Jumping with feet on ground (18 months)
standing on 1 foot (2 years)
climbing stairs like an adult (3 years)

Question 9

7b. primitive reflexes

Answer 9

1. sucking and rooting (birth to 4 months)
2. Palmar grasp (birth to 3 months)
3. Stepping (birth to 6 weeks)
4. Landau reflex (2 stages 4 months - 2 years)
5. ATNR - 2-6 months
6. moro (birth-4 months)
7. parachute reflex

Question 10

fine motor by 2 months

Answer 10

Follow to midline

Question 11

Fine motor by 4 months

Answer 11

follow past midline

Question 12

fine motor by 6 months

Answer 12

raking grasp

Question 13

fine motor by 9 months

Answer 13

bang cubes

Question 14

by motor by 9 - 12 months

Answer 14

block in cup

Question 15

fine motor by 18 months

Answer 15

2 cubws

Question 16

fine motor by 2 years

Answer 16

4 cubes + vertical line

Question 17

fine motor by 3 years

Answer 17

6 cubes - 8 cubes + circle copy

Question 18

fine motor by 4 years

Answer 18

draw person 3 parts

Question 19

fine motor by5 years

Answer 19

draw person 6 parts and copy square

Question 20

language by 1 month

Answer 20

responds to bell

Question 21

language by 2 months

Answer 21

laugh and vocalisations

Question 22

language by 4 months

Answer 22

imitates speech sounds

Question 23

language by 6 -9 months

Answer 23

mama dada

Question 24

language by 12 months

Answer 24

1 word (50 word vocab by 2)

Question 25

language by 2 years

Answer 25

joins two words together + knows name

Question 26

languge by 3 years

Answer 26

adjectives/colour, speech mostly understandable

Question 27

language by 4 years

Answer 27

speech understandable fully

Question 28

language by 5 years

Answer 28

cam count 5 blocks

Question 29

Gross motor by 1 month

Answer 29

head up 45 degrees

Question 30

Gross motor by 4 months

Answer 30

rolling, pull to sit no head lag

Question 31

gros motor by 6 months

Answer 31

sit without support

Question 32

gross motor by 9 months

Answer 32

pull to stand

Question 33

gross motor by 12 months

Answer 33

walking

Question 34

gross motor by 18 months

Answer 34

run

Question 35

gross motor by 2 years

Answer 35

jump and kick ball

Question 36

gross motor by 3 years

Answer 36

balance each foot 2 seconds, hop

Question 37

gross motor by 4-5 years

Answer 37

balance foot 5 seconds, heel-toe walk

Question 38

social by 6 weeks

Answer 38

smile

Question 39

social by 6 months

Answer 39

wave ‘bye bye’

Question 40

social by 12 months

Answer 40

use spoon

Question 41

social by 24 months

Answer 41

put on clothing, brush teeth