Developmental Ax (short case) Flashcards
Developmental introduction
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?
- Vision
red ball
- Hearing
hide red ball and shake rattle
- closer vision + fine motor
hundreds and thousands and picking up
- Fine motor
Block stacking
- Speech?
comment on any vocalisations or state there are no vocalisations
- Gross motor - 180 degree
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.
7c. Gross motor
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)
7b. primitive reflexes
- sucking and rooting (birth to 4 months)
- Palmar grasp (birth to 3 months)
- Stepping (birth to 6 weeks)
- Landau reflex (2 stages 4 months - 2 years)
- ATNR - 2-6 months
- moro (birth-4 months)
- parachute reflex
fine motor by 2 months
Follow to midline
Fine motor by 4 months
follow past midline
fine motor by 6 months
raking grasp
fine motor by 9 months
bang cubes
by motor by 9 - 12 months
block in cup
fine motor by 18 months
2 cubws
fine motor by 2 years
4 cubes + vertical line
fine motor by 3 years
6 cubes - 8 cubes + circle copy
fine motor by 4 years
draw person 3 parts
fine motor by5 years
draw person 6 parts and copy square
language by 1 month
responds to bell
language by 2 months
laugh and vocalisations
language by 4 months
imitates speech sounds
language by 6 -9 months
mama dada
language by 12 months
1 word (50 word vocab by 2)
