Lecture 11: Developmental Assessments & Growth Abnormalities Flashcards
When should developmental assessments occur?
EVERY WCC
How common are developmental delays?
About 1 in 5 children have delays/conditions placing them at risk.
What is the birth to 3 program?
Federally funded home visits for developmental therapies
After 3, therapy is via school.
What is the M-CHAT?
Modified CHecklist for Autism in Toddlers
0-2: low, 3-7: mod, 8-20: severe
M-chat 2 just expands on questions
What is the Denver Developmental Screening Tool?
- 125 Question test for 2 weeks to 6 years
- Parent + direct obs
- Subjectively allows clinican to observe and assess overall behavior
- Normal = 0 delays and 1 caution max
What are the main issues with the Denver developmental screen?
- Only identified about 50% of children that needed help
- Long time to do
- High sens but low spec (AKA it mainly rules out)
- Low sample size
Prob best used for making sure theres no development delays
What is the Ages and Stages Questionnaires?
- 19 surveys
- 1 month to 5.5y
- Language, personal-social, fine/gross motor, problem solving
- Determines if a child is on schedule
What are the 5 areas of the ASQ and the cutoff?
- Communication
- Gross Motor
- Fine Motor
- Problem Solving
- Personal/Social
Cutoff is 2 SD below the mean: at least 1 cutoff = diagnostic referral indicated.
Close to cutoff = rescreen after practicing 4-6 months.
Developmental Milestones for 1-2 months
- Hold head up and lift
- Turns from side to back
- Regards faces and follows objects through visual field
- Drops toys
- Becomes alert in response to voices(turning head to sound)
- Recognizes parents
- Engages in vocalizations
- Smiles spontaneously
- Melodic vowel called cooing
- Reciprocal vocal play between parent and child
A mnemonic for developmental milestones at 1-2 months can be created using the acronym “BABY”:
- Blinking: Babies at 1-2 months of age start to exhibit the reflex of blinking in response to light or sudden movements.
- Alertness: They become more alert and attentive to their surroundings, showing interest in faces, sounds, and objects.
- Babbling: While not yet producing distinct sounds, babies may start to make cooing and gurgling noises, demonstrating the early stages of vocalization.
- Yawning: Yawning is a common reflex in babies at this age, often occurring in response to fatigue or changes in stimulation.
Using the acronym “BABY” can help parents and caregivers remember key developmental areas to observe and support in infants at 1-2 months of age.
Developmental Milestones for 3-5 months
- Ulnar grasps & thumb opposition
- Reaches for and bring objects to mouth (needed prior to complementary feeding)
- Raspberry sound (altho the WCC lect says its at 9 months…)
- Sits with support
- Laughs
- Look toward voice
- Turns front to back around 4 months
- Follows an object while in visual field
- Puppy prop, prone and rest on forearms.
Developmental Milestones for 6-8 months
- Babbling
- Sits alone for short period
- Can scoop a pellet and grasp it with thumbs
- Imitates byebye
- Passes objects between headlines
- Rolls from back to stomach
- Inhibited by the word no
- Can feed themselves with puffs or cheerios (Complementary feeding)
- Commando crawl at 7 months
A mnemonic for developmental milestones at 6-8 months can be created using the acronym “GROWTH”:
- Grasping: Infants begin to develop the ability to grasp objects with their hands, using a palmar grasp initially and progressing to a more refined pincer grasp between 8-10 months.
- Rolling: Babies typically start to master the skill of rolling over from their back to their stomach and vice versa, demonstrating improved control of their body movements.
- Observation: Infants become more observant of their surroundings, showing increased interest in exploring objects, people, and their environment.
- Weaning: At around 6 months, many babies begin the transition from exclusive breastfeeding or formula feeding to introducing solid foods into their diet, as recommended by healthcare providers.
- Teething: Teething usually begins around this age, with the emergence of the first teeth (usually the lower central incisors), leading to increased drooling, chewing, and potential discomfort.
- Hand-Eye Coordination: Babies develop better hand-eye coordination, demonstrating the ability to reach for and manipulate objects with increasing precision.
Using the acronym “GROWTH” can help parents and caregivers remember key developmental areas to focus on and observe in infants at 6-8 months of age.
Developmental Milestones for 9-11 months
- Crawls
- Can pull self up
- Can stand alone for a short period
- Recognizes name
- Neat pincer grasp with thumb and index finger
- 1 stp command following
- Babbling with repetition of sounds: da da da
- Self feeding
- Word comprehension beginning
- Object permanence (even if it leaves their visual field it still exists)
By 9 months: A baby should be able to sit up without support and may start to crawl or pull themselves up to stand.
By 9 months: A baby should respond to their name, understand simple gestures (like waving goodbye), and may start to say simple words like “mama” or “dada.”
By 9 months: A baby should start to imitate actions and expressions of others and may show signs of separation anxiety when separated from caregivers.
Developmental Milestones at 1 year
- Walk independently
- Mama/dada specific
- Perfect neat pincer grasp
- Gives toys on request
- Can build a tower of up to 2 CUBES
- Points to desired things
- Can say 1-2 words
- Babbling reaches peak
1 point, 2 words (12)
years x 2 = cubes
A mnemonic for developmental milestones at age 1 can be created using the acronym “FIRST STEPS”:
- Fine Motor Skills: Babies start to develop fine motor skills, such as grasping objects with their fingers, picking up small items, and exploring textures.
- Improving Coordination: They begin to improve their coordination and balance, sitting without support, pulling themselves up to stand, and possibly taking their first steps.
- Recognizing Faces: Babies become more adept at recognizing familiar faces, including family members and caregivers, and may start to respond to their names.
- Social Interaction: They show an increased interest in social interaction, smiling, babbling, and engaging in simple games with others.
- Teething and Tasting: Teething typically begins around this age, with babies experiencing discomfort as their first teeth emerge. They also start to explore a variety of tastes and textures through solid foods.
- Sleep Patterns: Babies may start to establish more predictable sleep patterns, with longer periods of sleep at night and shorter naps during the day.
- Touching and Exploring: They become more curious about their environment, touching and exploring objects, and using their senses to learn about the world around them.
- Expressive Language: While they may not yet be speaking words, babies begin to express themselves through gestures, babbling, and nonverbal communication.
- Physical Growth: Babies experience rapid physical growth during their first year, with significant gains in height, weight, and head circumference.
- Stimulation and Stimulation: Providing a stimulating environment with plenty of opportunities for play, exploration, and interaction is crucial for supporting their development.
Using the acronym “FIRST STEPS” can help parents and caregivers remember key developmental areas to focus on and observe in babies at age 1.
Developmental Milestones at 18 months
- Tower of 3-4 cubes
- Throw ball
- Seats self in chair
- Dumps things out
- Walk up and down stairs with help
- 4-20 words
- 2 step command
- Carries stuffed animal around
- Can feed self with fork/spoon
- Recognizes 3 body parts
- Protodeclarative pointing
- Protoimperative pointing
year x 2 = cubes approximately
Developmental Milestones at 2 years
- 50 word vocab
- Kick ball on request
- Tower of 6-7 cubes
- Points to named objects
- Turns pages of book individually
- Plays with mimicry
- Imitative behavior and parallel play
At 2, years x3 for cubes
TODDLER
A mnemonic for developmental milestones at 24 months of age can be created using the acronym “TODDLER”:
- Talking: By 24 months, toddlers are expanding their vocabulary and starting to use two-word phrases or short sentences. They may be able to say around 50 words or more and understand simple instructions.
- Observation: Toddlers are becoming more observant of their surroundings and may show interest in exploring objects and activities in their environment. They may imitate adult behaviors and engage in pretend play.
- Drinking: Toddlers are transitioning from breastfeeding or bottle feeding to drinking from a cup. They may be able to hold and drink from a cup with assistance and may start to feed themselves with utensils.
- Dancing: Toddlers are becoming more physically active and may enjoy activities like dancing, jumping, and climbing. They are refining their gross motor skills and may be able to walk, run, and climb stairs with assistance.
- Learning: Toddlers are curious and eager learners. They may start to recognize and name familiar objects, animals, and people in their environment. They may also begin to sort objects by shape, color, or size.
- Eating: Toddlers are developing independence in feeding themselves and may start to feed themselves with fingers or utensils. They may be exploring a variety of foods and textures as they expand their diet.
- Reactions: Toddlers may show a range of emotional reactions and may have tantrums or meltdowns when frustrated or upset. They are learning to express their emotions verbally and may start to understand simple emotions like happy, sad, or mad.
Using the acronym “TODDLER” can help parents and caregivers remember key developmental areas to focus on and observe in children at 24 months of age.
Developmental Milestones at 30 months
- Walks backwards
- Hops on 1 foot
- Prepositions
- Copies crude circle
- Points to objects described by use
- refers to self as I (or at 30m)
- Holds crayon in fist
- Can carry on a conversation
GROWTH
Gross Motor Skills: At 30 months, children continue to refine their gross motor skills. They may be able to walk, run, climb stairs with assistance, jump in place, and pedal a tricycle.
Receptive Language: Children at this age understand more complex instructions and can follow simple two-step commands. They may also comprehend basic concepts such as "big" and "little." Observational Skills: Children are becoming more observant and curious about their surroundings. They may enjoy exploring objects in their environment, imitating adult behaviors, and engaging in pretend play. Words: By 30 months, children typically have an expanding vocabulary and may be able to say around 200 words or more. They may also begin to combine words into short phrases or simple sentences. Tantrums: Tantrums and emotional outbursts are common at this age as children assert their independence and struggle with frustration. They may have difficulty regulating their emotions and may express themselves through crying, screaming, or other challenging behaviors. Hand-Eye Coordination: Children are developing better hand-eye coordination and fine motor skills. They may be able to stack blocks, use crayons or markers to make marks, and feed themselves with utensils.
Developmental Milestones at 3 years
- Holds crayon with fingers
- Tower of 9-10 cubes
- Copies circle
- Gives first and last name
- Rides tricycle with pedals
- Can dress with supervision
Rule of 3s: 3 numbers, 3 letters, 3 colors, 3 shapes, 3 wheels
Developmental Milestones at 3-4 years
- Climbs stairs with alternating feet
- Button and unbutton
- What do you like to do for fun? answers
- Knows own sex (genitalia diff at 4y)
- Gives full name
- Feeds self at mealtime
- Takes off shoes and jacket
Developmental Milestones at 4-5 years
- Runs and turns without losing balance
- Stands on 1 leg for 10s
- Draws a person without a torso
- Copy a square
- Knows days of the week
- What do you do if you’re cold/hungry? answers
- Self-care at toilet (might need help with wiping)
- Dresses self (need help with tying shoes)
A mnemonic for developmental milestones at ages 4-5 can be created using the acronym “KINDER”:
- Kinesthetic Skills: Children develop improved coordination and motor skills, such as running, jumping, skipping, hopping, and throwing or catching a ball.
- Imaginative Play: Their imagination blossoms, and they engage in elaborate pretend play scenarios, storytelling, and role-playing activities.
- New Friendships: Children begin to form more meaningful friendships and enjoy social interactions with peers, demonstrating sharing, cooperation, and empathy.
- Development of Language: Language skills continue to advance, with expanded vocabulary, sentence structure, and comprehension. They may also start to ask more complex questions and engage in conversations.
- Expanding Knowledge: Children show a growing interest in learning about the world around them, asking questions, exploring new topics, and showing curiosity about various subjects.
- Readiness for School: They demonstrate readiness for formal education, showing interest in letters, numbers, and basic literacy and numeracy concepts. They may also start to develop pre-reading and pre-writing skills.
Using the acronym “KINDER” can help parents and educators remember key developmental areas to focus on and support in children at ages 4-5.
Developmental Milestones at 5-6 years
- Can catch a ball
- Skips smoothly
- Tells age
- Knows right from left hand
- Can describe favorite TV show with detail
- Does simple chores at home
- Good motor ability but little sense of danger
A mnemonic for developmental milestones at ages 5-6 can be created using the acronym “SCHOOL”:
- Social Skills: Children develop more sophisticated social skills, including cooperation, sharing, taking turns, and empathy towards others.
- Cognitive Growth: Their cognitive abilities continue to expand, with improved memory, attention, problem-solving, and reasoning skills. They may also begin to show an interest in more complex topics and activities.
- Handwriting: Many children start to refine their handwriting skills, learning to write letters and numbers more legibly and accurately. They may also begin to copy words and sentences.
- Outdoor Play: Physical activity and outdoor play remain important for children’s development, promoting gross motor skills, coordination, strength, and cardiovascular health.
- Organized Activities: Children may participate in more organized activities, such as sports, clubs, or classes, which provide opportunities for learning new skills, teamwork, and leadership.
- Language Development: Language skills continue to progress, with improved vocabulary, grammar, sentence structure, and comprehension. They may also start to express themselves more clearly and fluently.
Using the acronym “SCHOOL” can help parents and educators remember key developmental areas to focus on and support in children at ages 5-6.
Developmental Milestones at 6-7 years
- Knows morning from afternoon
- reads several one syllable words
6 am to 7 pm
Developmental Milestones at 7-8 years
- Ties shoes
- Knows current day of the week
- Adds and subtracts 1 digit numbers
Year 7 = knows the 7 days of the week specifically!
4-5 is knowing the days of the week
A mnemonic for developmental milestones at ages 7-8 can be created using the acronym “EIGHT”:
- Expanding Vocabulary: Children’s vocabulary continues to expand, with a growing ability to understand and use more complex words and expressions.
- Interest in Reading: Many children develop a stronger interest in reading, enjoying a wider variety of books and showing improved reading comprehension skills.
- Growing Independence: Children become more independent in various aspects of their lives, including self-care tasks, homework completion, and decision-making.
- Honing Math Skills: They continue to build upon their numeracy skills, mastering concepts such as addition, subtraction, multiplication, and division, and applying them to solve more complex math problems.
- Teamwork and Cooperation: Children learn to work collaboratively with peers, demonstrating improved social skills, empathy, and conflict resolution abilities.
- Self-Expression: They become more adept at expressing themselves verbally and creatively, through writing, storytelling, art, and other forms of self-expression.
- Taking on Challenges: Children embrace new challenges and opportunities for learning, demonstrating resilience, persistence, and a willingness to try new things.
Using the acronym “EIGHT” can help parents and educators remember key developmental areas to focus on and support in children at ages 7-8.
Developmental red flags
- Persistence of Moro after 6 months
- No joyful expressions by 6 months
- Not sitting by 9 months
- No babbling/pointing/gesturing by 12 months
- No single words by 16 months
- Not walking independently by 18 months
- Hand dominance prior to 18 months
- Failure of 2 word sentences by 24 months
- Failure of 3 word sentences by 36 months
- Regression at any point
What is the best predictor of cognition and school achievement?
Language development
2y: 50%
3y: 75%
4y: 100%
Weight gain changes in a baby
- 6 months: 2x BWt
- 12 months: 3x BWt
When is head circumference measured?
Birth to 24 months
What is the red flag when it comes to growth charts?
Major percentile drops
MC growth abnormality
Type 1: Head circumference same, but weight drops faster than height
Wt is king, #1
MCC of type 1 growth abnormality (3)
Wt drop only
- Inadequate caloric intake
- Excess loss of calories
- Inability to use calories peripherally
Not eating, losing calories, can’t use calories
Describe a type 2 growth abnormality
- Normal head circumference
- Depressed ht and wt
- D/t genetically short, endocrinopathies, growth delay, heart/renal dz, skeletal dysplasias
Type 2 = 2 things (wt & ht)
Once ht is involved, more genetics
Describe a type 3 growth abnormality
- Decrease in Ht, Wt, and Head circumference
- D/t CNS issues, chromsomal defects, or in utero/perinatal insults
AKA all 3 measurements affected.
Average weight for a baby in america
7 lbs 7 oz
Lucky 7s
How does constitutional growth delay present?
- Similar growth pattern to FSS
- Key difference: Delayed puberty and growth spurt
- late bloomers
FSS has no effect on puberty or bone age.
What characterizes Prader-Willi syndrome?
- Chromosome 15
- Almond-shaped eyes, short, obese, hypogenitals, small hands, deficient GH
- Obsessed with late night snacking
- Obsessive hyperphagia is hallmark, seen at 3-4y
Prader Willi is will raid kitchen at night
What can cause GH excess resulting in tall stature?
Pituitary adenomas
Gigantism
