Developmental Milestones Flashcards
What are the 8 red flags for development?
ARSWSLV
- Asymmetry of movement
- Not reaching for objects (Autism?)
- Unable to sit unsupported at 12 months
- Not walking at 18 months- check CK for Duchenne’s
- Not speaking at 18 months
- Loss of skills
- Concerns re. hearing/vision
In terms of child development, what does median age mean?
The median age is the age at which 50% of kids have achieved the milestone.
In terms of child development, what is the limit age?
The limit age is the age at which the skill should’ve been acquired (97.5% of children)
Which is more useful to assess if a child is developmentally delayed and if investigations are required?
Median age or limit age?
Limit age
You’ve been asked by the GP to see a mother and her 6 week old newborn while he goes to make a cup of tea. He wants you to see if the baby has hit her four developmental milestones.
What are you hoping to find?
- Gross motor
- head control in vertical
- Fine Motor & Vision
- follows torch with eyes
- Language & Hearing
- stills to voice
- Social & Play
- social smile
You see baby Joe in clinic. He’s 3 months and maintain this posture when pulled from supine position to a sitting position.
What developmental milestone has he hit?
Gross Motor Skill
No head lag on pulling to sit
In clinic Joe you also notice that when left lying on his back Joe lies like this:
Is this to be expected in a 3 month old baby?
Yes
This is Joe achieving his fine motor and vision skills milestone of “regarding hands in midline”
The GP assess Joe’s Language & Hearing and Social & Play development?
What are you hoping he (at 3 months old) displays?
- Language & Hearing
- vocalises with familar person
- laughs and coos
- Social & Play
- reacts pleasuribly to familiar situations
You see Sophie in Baby Clinic whilst on GP placement. She’s 6 months old. She’s very cute and happily sits in her buggy happily making noises vaguley sounding like “mamama”
Whilst her mum chats to the GP you give Sophie a toy which she clusmily grabs from your palm using her full hand. She starts playing with the toy which she passes from one hand to another before putting it in her mouth. Her mum (a frightfully posh lady who’s disgusted that her little angel is playing with an NHS GP Surgery’s toy) takes the toy off her causing Sophie to scream.
What developmental milestones has Sophie displayed here?
- Language & Hearing
- babbles tunefully (mamama)
- screams when annoyed
- Fine motor vision
- palmar grasp
- transfers object hand to hand
- mouths object
After a minor meltdown Sophie decides she’d rather play with her feet anyway. You’re having a great wee time with Sophie who is very friendly with you while her mum moans and groans about immigrants coming into this country to steal people’s jobs.
The GP is clearly bored of the mum and decides it’s time to assess Sophie’s gross motor skills.
What has she already displayed whilst sitting in her buggy? And what do you hope to see in regards to her gross motor skills?
(In the buggy)
Social and Play
- still friendly with strangers
- plays with feet
Gross Motor Skills
- Pushes up on arms in prone
- Can roll from stomach to back
- Weight bears on legs
On placement and it’s baby clinic day. You’re absolutely knackered and just want to get this last consultation over and done with. You look at the list and the name of the next baby is Valentino *inner sigh* The GP spots this and reassures you Valentino’s parents are not the rude posh kind but the new-age hippie posh kind and he’s actually a very cute baby- even if they won’t vaccinate him because “they wouldn’t want to risk the health of their baby with unnatural products” (we’ll get to that later)
While the GP chats to Valentino’s parents about the importance of vaccination you play with him in an attempt to assess some developmental milestones.
At first, he’s anxious being left with you rather than his parents but after a quick game of peek-a-boo settles in. He crawls over to the nearest chair and uses it help him stand- for what purpose you’re not sure but hey that’s babies. You get Valentino to sit down and are impressed with how he can sit up and lean forward to reach for the toys you’ve cruelly left just out of reach.
You set him up on the examination table to see if he can pick up a cheerio (which he can’t). He quickly loses interest and points to the larger more manageable toy which he then drops off the table- out of sight. He looks at you as though you might have it rather than over the edge of the table.
What developmental milestones has Valentino displayed and what ones has he missed?
He’s hit all his gross motor targets:
- Sits well and leans forward to reach toys
- Stands holding on to furniture
- May crawl
He’s done 50/50 with fine motor & vision:
- using index finger to point
- picks up tiny objects between thumb and hand
In terms of social & play he hasn’t quite figured out object permanence (silly Valentino) but has shown:
- anxious around strangers
- plays peek-a-boo
The bit you’re more worried about is his language & hearing. He should:
- localise sound consistently
- make polysyllabic babble (aghah aghah)
- imitate sound
After a gruelling PLEASE VACCINATE YOUR CHILD chat the GP turns to you to see how you’re getting on and asks for a quick report
You explain what you’ve noticed about Valentino’s language & hearing milestones. Valentino’s parents admit they haven’t noticed anything unusual at home. The GP points out Valentino hit his 6 month Language & Hearing milestone a bit late and so maybe his 9 month will be a bit “late” too.
Are you still concerned about Valentino’s Language & Hearing development?
Not massively
9 months is the median age; not the limit age
Some kids take are a bit slower with certain aspects of the milestones thing.
What gross motor skills would you expect of a 12 month old?
“cruises” around furniture
may take first step
What fine motor and vision developmental milestones would you expect of a 12 month old kid?
- neat pincer grip
- bangs toys together
- casting toys
What language and hearing developmental milestones would you expect of a 12 month old baby?
- knows and responds to name
- jargons vowels and consonants
What social and play developmental milestones would you expect of a 12 month old?
- drinks from cup
- waves bye-bye
What would you expect of an 18 month old toddler in regards to Gross motor skills?
Runs
Clims onto adult chair
What would you expect of an 18 month old toddler in regard to fine motor and vision developmental milestones?
Builds tower of 3-4 bricks
Hand preferance
Enjoys picture books
What would you expect of an 18 month year old toddler in regards to social & play developmental milestones?
- feeds with spoon
- initiates adult activities e.g. sweeping
What would you expect of an 18 month old toddler in regards to language and hearing developmental milestones?
- 5-20 words
- points to body parts
In baby clinic again on GP placement. The next case is an intersting one, in that it’s two 2 year old twins. Mary-Jane (MJ for short) and John Junior (JJ for short). You go downstairs to get them from the waiting room.
You walk into a waiting room that has descended into chaos upon the arrival of these unruly twins. MJ has just built a tower of 6-7 bricks showing a clear preference for her right hand. Just as she steps back to admire her handiwork her brother JJ throws a ball (who the f*** thought giving him a ball would be a good idea?) overhead which consequently knocks down Anna’s tower.
Before she has a chance to get upset you call their names. Their mum brings them to the bottom of the stairs and tells them to go up. They both clamber upstairs 2 feet per tread.
What developmental milestones have they shown already?
Gross motor
- can throw ball overhead
- ascends and descends stairs 2 feet per tread
Fine Motor and Vision
- builds tower of 6-7 bricks
- hasn’t shown an ability to make a circular scribble yet
Language and Hearing
- able to understand simple instructions
- haven’t shown 50+ words; joining 2 words or talking to themselves
Social & play
- you haven’t had a chance to assess it yet but would hope to see
- puts on hat and shoes
- developing symbolic play e.g. feeding teddy
MJ and JJ (the two 2 year old twins) finally reach the GP’s room where they’re left to play under your supervision while GP chats to mum about the stress of having twins- oh and she mentions she’s now pregnant with another so that’s exciting/stressful!!
JJ grabs a pencil and paper and draws with his right hand a series of circular scribbles. Meanwhile MJ begins to “feed” a BabyBorn doll.
You have a chat with each of them and they each had 50+ words; even managing to join some of them together. You also notice when you were talking to MJ JJ chatted away to himself admiring his circles and vice versa.
What developmental milestones have the twins clearly hit?
Fine Motor and vision
- circular scribbles
- (having already shown an ability to build a tower of 6-7 blocks)
Language and Hearing
- 50+ words
- joins 2 words
- talks to self
- (having already shown they can understand simple instructions)
Social and Play
- developing symbolic play (e.g. feeding teddy)
- have yet to show an ability to put on hats and shoes
Whilst sitting drawing circular scribbles with JJ and MJ (who’s now lost interest with the doll and wants to show she too can draw circles) you look over to see their mother showing the GP a simply adorable video of her two precious little beings.
The video shows them getting ready to go out for a walk in the snow and putting on their own woolly hats and slipping on their shoes. Adorable!
What is medically relevant in this scenario?
You can now confirm MJ and JJ have also achieved a Social and Play developmental milestone by putting on hat and shoes.
Don’t ask me what’s sociable or playful about that.
Also I don’t know what the rules are on ticking off developmental milestones via video but it’s a modern world and I don’t see why not.
You’re walking your dogs in the park and notice a kid who looks to be about 3 y/o pedalling a trike. Is this a developmental milestone for his age group?
What are the gross motor skills expected of a 3y/o?
Yes!
Gross motor skills for a 3 y/o:
- pedals a trike
- stands on one foot momentarily
- up stairs with alternating feet
