Downloaded 16 times
More Related Content
Similar to Developmental assessment for medical students
![[Mary sheridan] from_birth_to_five_years_children(bookos.org)[1]](https://cdn.slidesharecdn.com/ss_thumbnails/marysheridanfrombirthtofiveyearschildrenbookos-200719030205-thumbnail.jpg?width=640&height=640&fit=bounds)
Developmental assessment for medical students
- 1. Dr.Varsha Atul Shah SC,Neonatal and Developmental Medicine, Singapore General Hospital VC, Dept. of Child Development, KKH Developmental Assessment For medical students
- 2. Usual lead inis ‘Would you please perform a developmental assessment’? • You may or may not be told age of the child? • Once you know 18 months of development ‘backwards’, including time of appearance and incorporation of primary reflexes, then you can fairly interpret the findings
- 3. WIPE approach • Watch/Wash-Scrubhands/WIPE Hands/Wipe Stethoscope with alcohol rub • Introduce, Interact, Initiate, Inspect • Position yourself and baby and Play, • Examine, eyeball, engage, EEENT Eye- Eyeball whole Environment and baby from head to toe, Examine-Use hands Ear-Hear Nose-Smell, Throat-baby talk • Begin by introducing yourself to parents, hand rub etc. 1st only look see, play…and examine. • Inform examiner about your approach either: - I would like to give live commentary or - I would summarize after full examination - Can ask permission if need to ask parents few milestones which you could not perform
- 4. General Inspection, Observationis the key, Eyeball 180 degree 1. Inspect for growth parameters e.g. FTT, syndromes, under nutrition can have Developmental delay 2. Syndromic/Dysmorphic features e.g. Down’s, trisomy's 3. Appearance of Ex premature infants(prominent forehead, pig nose), correct the age. 4. Obvious neurological anomalies like floppy infants, posturing, hemiplegic posturing, and involuntary movements.
- 5. Scars of Exprematureinfants: -Pig nose due to CPAP -prominent forehead -dolichocephalic head due to CPAP -VP shunt due to Post IVH hydrocephalous -scars due to multiple pricks IV extravasations, OGT, -Wearing glasses due to astigmatism/ROP, -abdominal scar due to NEC, PDA ligation
- 6. Position child • Ifchild is on mum’s lap (most of the time) can do DA in following sequence particularly toddlers: -1st vision and hearing -2nd Fine Motor -3rd language and personal social -4th Gross Motor examination last end with bye bye. • Do not separate for GM assessment from start. • Bigger kids can examine on chair. • Infants lie in bed-180 degree flip exam, with NNR
- 7. TOOLS NEEDED: 1. Redyarn pom pom (4 cm diameter) with string and dangling, 2. Bright color 12 cubes 2.5 cm, 3. Rattle with narrow handle 4. Raisins or cheerio's or honey stars or m and ms 5. Cup, spoon 6. A 4 size paper 7. Big size colour pencils 7. Picture cards, multiple picture books (like bird, fish, dog, bus, fruits etc) on same page, 8.Tennis ball 9. Small doll 10. Bell 11. Stickers, sweets for rewards
- 9. Vision • Always dovision before hearing. • Fixing and following pom pom ball. Distance 21 cm away. • Conjugated eye gaze(not rowing)/socially modulated eye contact Check ability to pick up hundreds and thousands, cubes are important. • Approached to toys • No rowing eye movement, No squint, No nystagmus • Wearing glasses
- 10. Vision • Fix andfollow wool ball (4cm) horizontally and vertically 20 cm from eye level
- 11. Hearing: Distraction test •Use initial distraction with non noise making stimulus in front of child • Always ask examiner to ring the bell at 20 cm from both ears • Bell is brought towards ear from behind out of range from visual fields 20 cm away from ears. • Changes noted are facial expression, vocalizing sounds, head turns.
- 12. Fine Motor: • Holdsrattles (3 months), • hand regards (4 months), • palmer grasp objects/block (5 months), • transfer cubes (7 months), • Raisins for pincer grip (9 months), 2.5 cm blocks for stacking • 2 cubes 15 months, • 3 cubes(18 months) • 6 cubes(21 months). • 6 cubes, turn pages (2 years), • 8 cubes (2.5 years), • 9 cubes (3 years), beads, thread, putting on biro, plastic knife, and fork. Comment on personal social interaction, language. Smiling, waving
- 13. Tools Cubes PenDrawing Book / Pages Cutting Others 1 year ▪ mouthing cubes ▪ bangs cubes together ▪ picks cubes with 1 hand ▪ opens book ▪ throws and cast objects ▪ place 1 correct shapes in holes ▪ puts pellets in & out of cup/box when shown 15 months ▪ builds 2 cubes ▪ scribbles thru & fro 18 months ▪ builds 3 cubes ▪ hand preference at 18 - 24 months ▪ turns 2-3 pages at the same time ▪ no more casting objects ▪ place 2 correct shapes in holes 2 years ▪ builds 6 cubes ▪ pen held in fist - palmar grasp (1.5 - 2 yrs) ▪ copies a single line: I then --- ▪ turns pages singly ▪ makes a cut with the scissors ▪ place 3 correct shapes in hole 2.5 years ▪ aligns 3 cubes ▪ stack a train ▪ inferior pen grip (2 - 2.5 years) ▪ removes screwed lid from bottle 3 years ▪ builds 9 cubes ▪ 3 cube pyramid ▪ 3 block bridge ▪ steadies paper with other hand ▪ copies O ▪ copies + (3 ½ yo) ▪ cuts along a line ▪ strings 4 beads ▪ puts 10 pellets in a bottle (3 ½ yo) ▪ laces 3 holds (3 ½ yo) Fine Motor:
- 14.
- 15.
- 17. Sequence of toolsused for FM Raisin->build blocks → place shape in hole → hold pen + scribble → put pellets in bottle → lace holes → cut paper → buttons → colours in lines → fold paper
- 18. Immature crude palmargrasp to immature pincer grasp to mature pincer grasp
- 19. Personal social DevtChronologically 1. Focus on faces (4 weeks), 2. social smile (6 weeks), 3. excited with toys (4 months), 4. Castrate toys (5 months), 5. stranger anxiety (6 months), 6. responds to No, imitates (8 months), 7. clapping, bye bye, bang blocks (10 months), 8. peek boo (11 months), 9. picture books ( 12 months), 10. kiss mirror (13 months), 11. Points (15 months), 12. Body parts (21 months)
- 20. GROSS MOTOR: • HH(16 weeks), Roll over(flip) • Tripod (6 months) • Bear weight, bounces, lifts head(7 months) • sit well (8 months) • pull to sit and stand, crawl (10months) • Creep 11 months • walk with support (1 year) • Walk independently (14 months) • climb stairs with rail ,throw ball (18months) • walk upstairs (21 months) • up and down, jumps well (2 years)
- 21.
- 22. GROSS MOTOR: 180degree flip examination in infant < 8 months and gait for > 1 year • Supine: Note posture, abnormalATNR, involuntary movements with CP. paucity of movements for hemiplegia. • Pull to sit: head lag. Sitting: Head and trunk control. Back is straight or rounded. • Weight bearing: scissoring, hypotonia, advanced weight bearing (CP) • Ventral suspension: Describe posture, low tone, increase extensor tone. • Prone: Observe ability to raise head, trunk above horizontal.
- 23. Gross Motor Milestones-1 BallJumping Stairs Walking Sitting 1 year ▪ throws ball 3 feet ▪ creeps up stairs ▪ walks holding on ▪ kneels & balances 18 months ▪ throws ball without falling ▪ walks up stairs ▪ creeps back down stairs ▪ walks well by 18 months 2 years ▪ throws ball overhead ▪ kicks ball ▪ hops with 2 feet ▪ jumps forward 4 feet ▪ 2 steps up & down ▪ runs ▪ walks around carrying toy ▪ starts & stops at ease around obstacles ▪ Climb furniture and sits on their own 2.5 years ▪ catches ball into body ▪ stand on tip toes if shown
- 24. Primitive reflexes: 1 Sucking/Rooting:( 0-4,6mths) 2. Palmer grasp; (0-3 months) 3. Placing, stepping: (0-6weeks) 4. ATNR: 2-6 Months 5. Landau: on ventral suspension, normally extend head, trunk, and hip. Flex head and neck, response is flexion of hip, trunk.0-6 month) 6. Neck righting reflex: rotation of trunk 6mths-2 years 7. Moro: 0-4 months 8. Parachute: 6-12 months persist. Prone position, move rapidly, face down. Will extend both upper limbs
- 25. Speech and Language: •Cooing ( 2months) • responds to human voice (4 months) • Babbling (6months) • Mamma, dada (9months) • 2 words plus mama, dada(12 months) • Jargon, points (15months) • 10 words and says his name, points to 3 body parts, one picture (18mths) • 2-3 word phrase, name 3 objects, 4 body parts, says no • (2 years), know name, age sex • (2.5years), preposition, count 1-10, 2 colours • (3 years), name 3 colours, converses (4 years)
- 26. Language Milestones *1st askthe parent, what is the child’s dominant language and any history of hearing loss
- 27. Red flag signsof SLD-when to refer to specialists
- 28. Present the shortcase as: • On general observation/inspection of this cute little /Race/ New born/infant/toddler, who is well thrived, but would like to chart gender specific progressive percentiles for Occipitofrontal circumference, length, and weight, he is not syndromic, (no expremmie scars/look), not floppy has good muscle tone moving all limbs equally. No involuntary movements seen/no obvious nystagmus/squint. • On examination of vision he had eye gaze, socially aware, he fixed followed pompom ball, approached to toys, picked up raisins etc. On examination of distraction hearing test …, On personal social.., On language. On fine motor…On gross motor..NN reflexes • Do mention what child could do and could not do, so Devt age is= (withing 3 months range+, can not say 12-18 month) . If CP GM may be more delayed than other domain, do specify each domain age separately) • In summary: this infant has DA of….GM … FM…. SL PS etc with Developmental quotient at __% • I.Q= Mental age x 100 • Chronological age • - Do offer: I would like to perform neurological exam, motor exams etc • Scrub hands at the end of exam
- 29. MustWatchVideos • Visit: http://www.martindalecenter.com/MedicalClinical_Exams.html • http://library.med.utah.edu/pedineurologicexam/html/home_exam .html •Visit link Free book download http://www.scribd.com/doc/44390551/Fro m-Birth-to-Five-Years