Developmental Milestones Flashcards
Gross motor milestones
3 months
- lies on abdomen with good head control
- held sitting with lumbar curve
6 months
- lying on abdomen with arms extended
- lies on back and grasps feet
- pulls self to sitting
- rolls front to back
7 - 8 months
- sits without support
9 months
- pulls to standing
- crawls
12 months
- cruises
- walks with one hand held
13 - 15 months
- walks unsupported
18 months
- squats
2 yo:
- runs
- walks upstairs and downstairs holding on to a rail
3 yo:
- rides tricycle
- can walk upstair independently
- walks on tiptoes
4yo:
- can hop and skip
Fine motor milestones
6 weeks - fixated on objects
6 months - reaches for objects and transfers from one hand to another
1 year - pincer grip
18 months - scribbles
2.5 yo - draw lines
3 yo - circle
4 yo - cross
4.5 yo - square
5 yo - triangle
Social behaviour and play milestones
6 weeks - smiles
3 months - laughs, enjoys friendly handling
6 months - not shy but stranger anxiety
9 months - shy and takes everything to mouth, object permanence
10 months - waves bye
15 months - requires help with dressing, uses spoon
18 months - indicates toilet needs
2 years - dry during the day
3 years - dry at night
4 - 5 years - dresses alone
Feeding milestones
12 - 15 months - drinks from cups, uses spoons
2 years - competent with spoon and doesn’t spill with a cup
3 years - uses spoon and fork
5 years - uses knife and fork
Dressing milestones
12 - 15 months - helps getting dressed
18 months - takes off shoes
2 years - puts on hat and shoes
4 years - can dress and undress independently except laces and buttons
Play milestones
9 months - peek a boo
10 - 12 months - waves bye
18 months - plays alone
2 years - plays near others but not with them
4 years - plays with other children
When to investigate delayed walking
Refer at 18 months
When to investigate sitting
Refer at 12 months
When to investigate delayed social behaviour
Refer is not smiling at 10 weeks
Grasp milestones
6 - 8 weeks - fixes their eyes on an object and follows it
6 months - palmar grasp of objects
9 months - scissor grasp of objects
12 months - pincer grasp
Red flags for development
Not smiling at 10 weeks Not being able to hold an object at 5 months Not sitting unsupported at 12 months Not walking at 18 months Bot running at 2.5 yo No words at 18 months No interest in others at 18 months
How is a learning disability assessed?
The severity of the learning disability is based on the IQ (intelligence quotient):
55 – 70: Mild
40 – 55: Moderate
25 – 40: Severe
Under 25: Profound
Puberty age in males and females
Males: 9 - 15yo
Females: 8 - 14 yo
First and last signs of puberty in females
First: Breast bud development and pubic hair
Last: Menstruation
First and last signs of puberty in boys
Start: testicular enlargement
Last: deepening of voice
What can be used to determine the pubertal stage of a patient
Tanner staging
Causes of hypogonadism
Hypogonadotrophic hypogonadism: a deficiency of LH and FSH
Hypergonadotrophic hypogonadism: a lack of response to LH and FSH by the gonads (the testes and ovaries)
Hypogonadsim meaning
Lack of the sex hormones - oestrogen and testosterone
Causes of Hypogonadotropic Hypogonadism
damage to the pituitary or hypothalamus - radiotherapy, surgery, cancer
- Hyperprolactinaemia
- Excessive dieting or exercising
- Constitutional delay in growth and development
- Kallman syndrome
Causes of Hypergonadotropic Hypogonadism
Previous damage to the gonads (e.g. testicular torsion, cancer or infections, such as mumps)
Congenital absence of the testes or ovaries
Kleinfelter’s Syndrome (XXY)
Turner’s Syndrome (XO)
Investigations for delayed puberty
Bloods - FBC and ferritin for anaemia
U&E - CKD
Anti-TTG / anti-EMA antibodies - coeliac disease
Hormonal blood tests:
- Early morning serum FSH and LH - low in hypogonadotrophic hypogonadism and high in hypergonadotrophic hypogonadism.
- TFTs
- GH and ILGF Insulin-like growth factor I - GH deficiency.
- Serum prolactin
Genetic testing:
- Kleinfelter’s syndrome (XXY)
- Turner’s syndrome (XO)
Imaging:
- Xray of the wrist - bone age for constitutional delay
- Pelvic USS in girls - ovaries and other pelvic organs
- MRI of the brain - pituitary pathology and assess the olfactory bulbs in possible Kallman syndrome
Tools to monitor development
Primary care - ASQ, Denver development screeing
Secondary care - SOGS II, Griffiths
Investigations for developmental delay
Bloods
- FBC
- U+E
- Bone profile
- LFT
- CK - muscular dystrophy
- TFTs
- Ferritin
- Metabolic screen if indicated
Urine tests - urine amino acids and organic acids
Genetic testing - if dysmorphic
EEG/MRI - seizures
