In developmental screening time has to be spent in gaining friendship of the child and time can be profitably utilized by offering, for example, a 10 month old baby- a small toy to see how the child grasps it and reacts to it. Much more is learnt by simply watching a child play and his or her reactions to the surroundings. Developmental screening is usually carried out by questionnaire by a health worker at 8, 18, and 24 months.
The four fields of development are as follows:
i. Gross motor: Control of the child over his body.
ii. Vision and fine movements: (Adaptive) e.g. of eye-hand control.
iii. Hearing and speech: The development of language.
iv. Social behavior and play.
Assessment of development:
This can not be done by developmental history alone. Unless the assessment is done systematically, mild developmental problems might be overlooked. Assessment requires information on the range of normality, the time of appearance of specialized skills, while taking into account the practical problems and constrains. Three screening tests that deserve special mention are the Denver Developmental Screening Test (DDST), the Early Language Milestone (ELM) scale, and the clinical (Capute) Linquistic and Auditory Milestone Scale (CLAMS). Developmental history may help in defining the time of onset of a disease at which arrested or delayed development occurred.
Developmental Milestones in Normal Child :
Milestone of development means stages of both physical and functional development.
Neonate:
Prone: Lies in flexion attitude, head sags on ventral suspension.
Supine: Generally flexed. Pulled to sitting-marked head lag.
Visual: Doll's eye reflex. Pupil reacts to light. Turning towards diffuse light.
Reflex: Moro, rooting, sucking, grasp, startle, freezing reflexes.
Social: preference for human face.
A. Gross motor:
Age and Milestone:
3 months : Neck holding, lifts head and chest.
6 months : sitting with support
9 months : sitting without support, standing with support, crawls
12 months : Walks with one hand held; rises independently; takes several steps.
15 months : Walks alone; crawls up stairs
18 months : Runs stiffly; sits on small chair; walks upstairs with one hand held; explores drawers and waste baskets.
24 months : Runs well; walks up and down stairs; one step at a time;
3 years : Riding bicycle.
4 years : Hops on one foot; climbs well.
5 years : Skips.
B. Fine motor (adaptive):
3 months : Reaches toward and misses objects; waves at toys when placed in hands.
6 months : Reaches out for and grasp large object (palmer grasp); transfer object from hand to hand.
9 months : Holding small object like a pillet, between index finger and thumb (Pincer grasp)
12 months : Release object to other person on request or gesture.
15 months : Makes tower of three cubes.
18 months : Makes a tower of four cubes; imitates vertical stroke.
2 years : Tower of seven cubes; circular cribbling, horizontal stroke.
3 years : Tower of ten cubes; copies a circle.
4 years : Copies cross and square; draws a man with 2 to 4 parts besides head.
5 years : Draws triangle from copy.
C. Language:
3 months : Cooing
6 months : Monosyllables ("mam" 'da")
9 months : Bisyllables ('mama' 'dada')
12 months : Two words with meaning
15 months : Follows simple commands; may name a familiar object (ball).
18 months : Ten words with meaning
24 months : A simple sentence of three wards (subject, verb, object).
3 years : Knows age and sex; counts three object correctly; repeats 3 numbers or a sentence of 6 syllables.
4 years : Telling a story
5 years : Names 4 colors; repeats sentence of 10 syllables.
D. Social behavior & Play:
1 month : Social smile
3 months : Recognize mother
6 months : Smiles at mirror image
9 months : Waves 'bye-bye'.
12 months : Plays a simple ball game.
15 months : Indicates some desire or needs by pointing.
18 months : Feeds self; may complain when wet or soil.
24 months : Handles spoon; helps to undress; listens to stories with pictures.
3 years : Plays simple games, washes hands.
4 years : Plays with several children with social interaction and role playing; goes to toilet alone.
5 years : Dresses and undresses, asks questions about meaning of words; domestic role playing.
E. Testing vision :
Notice whether the child is looking around the room and at particular toys or staring at nothing or nystagmoid eye movements, the later suggests that the child is unable to see. and the tests are as follows:
4 weeks : The infant should fix on his mother's face.
6 weeks : Follow an object 90cm away through an angle of 90°A 4cm red ball or pen torches are suitable objects.
3 months : Follow an object 90cm away for 180° while lying supine.
10 months : Can go for an object the size of a raisin lying on the palm of the examiner's hand and pick it up between finger and thumbs (pincer grasp). Test with each eye covered.
2-3 years : Test with miniature toys such as doll, car, plane, spoon. The majority of children over two years of age can identify all toys from a distance of 3m.
3 years : After the age of 3 years, the Stycar matching letters can be used. The first letters to be learnt by a child are V, O, X, H and T, and later A, U, I and C. Normal vision between 3 and 5 years approximates R: 6/8, L: 6/8.
From 5 yrs : Most children are able to read the Snellen charts sitting in front of a mirror at 3m.
F. Testing hearing :
Hearing is normally checked for the first time between 6 and 8 months of age. To carry out the distraction test, the baby sits on his or her mother's lap, facing outwards. It helps if an assistant can sit facing them to distract the child with toys etc. The examiner then makes a series of soft noises to one side or the other but behind mother and child and out of the child's line of vision. The sounds used are a special high frequency rattle, a bell, a spoon in a cup, and the rustle of tissue paper or a whisper.
At 6 months of age a baby should turn to the source of the sound when it is about 45cm from their ear.
By 9 months a baby reacts more quickly, and localizes the sounds at a distance of 90cm.
If the child fails to the test on the first occasion, the test should be repeated after a further month. If the child still fails, s/he should be referred for audiological testing.
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