Developmental Delay Flashcards
Sequence of events
Open question- what are your concerns (eg. specific developmental concern eg. delayed walking, speech etc.)
Timeline- how have they developed since birth, have they reached other milestones
Symptom analysis
Development- how have they developed otherwise, what can they manage now, do you have their red book with you
Concerns- concerned about developed in other areas
Family pattern- when did his parents/siblings start walking/talking etc.
NB- now ask questions below to check development (only ask those relevant to age)
Gross motor
Concerns with physical development?
Hand dominance- how long for
Early motor- what age did they hold their head up, sit up, crawl, how do they crawl (both knees, one leg dragging, bottom shuffling)
Walk- when did they walk unsupported
Vision and fine motor
Any concerns with eyesight or development of finer skills
Fix and follow- when did they start following things with their eyes
Objects- When did they start reaching for things, making pincer grip, transferring things from one hand to another
Drawings- what do they draw, can they scribble a line or circle, can they copy something you draw
Stacking toys- can they build towers, how many levels
Hearing speech and language
Hearing- any concerns, do they react to sounds out of sight, do they respond when you call them
Speech- what can they say, when did they first babble, when did they say their first word
Social emotional and behavioural
Describe social interactions with others
Actions- first smile, wave goodbye
Play- would they play with a teddy, do they share with others
Systems review
see previous entry
Patients perspective
feelings and effect of life
ICE
Background
PMH (any meningitis- can cause hearing loss)
DH
FH (DMD, anything in family, when did mum and dad walk, talk etc.)
SH- how are they are home/school/playgroup etc.
Delay in motor development
Normal
-often FH
-normal in other aspects
-when motor skills are achieved, they are of normal standard
Cerebral palsy
-abnormal tone and posture, abnormal achievement of developmental milestones
-often widespread dysfunction
DMD
-X linked recessive
-Gowers sign: hands to climb up legs to stand up
-waddling gait etc.
Other
-Down’s syndrome, tuberous sclerosis
-metabolic eg. hypoglycaemia, rickets
-environmental: if always kept in a cot
Delay in speech and language
Normal variation
-often FH
-otherwise normal and appropriately developing child
Hearing difficulties
-otitis media with effusion
Autism spectrum disorder
-impaired social interaction and communication
-repetitive stereotyped behaviours
-delayed or complete lack of speech with no form of communication in its place
-abnormal social emotional and behavioural development eg. playing in isolation
Other
-cleft palate
-learning difficulties
-environmental deprivation and neglect
Investigations
Observe child at play
Neuro exam
Ear exam, hearing assessment
Creatinine phosphokinase (DMD)
Chromosomal karyotyping
Management
MDT- physio, paediatrician, audiologist, psychologist, social works, speech and language, occupational therapists
Treat underlying condition where possible
Global delay
Syndrome eg. Down’s
Foetal alcohol syndrome
Maternal intrauterine infections
Cerebral palsy
