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EDUCATION CORNER
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    Developmental Screening and Assessment of Child

    The process of development of a single embryo to a mature adult is a very complex and complicated one. The brain of a baby triples in weight and trillions of nerve connections are established in the first three years of life. Development is a process which starts when baby is born and progresses in an orderly manner till adulthood. It is the natural progression in physical, mental and psychological maturity attain by the growing child. 


    The development milestones of a baby occur mainly in 5 domains 


    


    • Gross motor milestone: neck holding, rolling over, sitting, standing walking, etc. 
    • Fine motor skill: grasping, transferring objects, scribbling, holding a spoon, etc.
    • Personal-social development and general understanding: social smile, recognizing mother, stranger anxiety, follows commands, knows name and gender, plays in a group
    • Speech and language: cooing, babbling, laughing when talked to, saying mama dada, words, sentences, etc. 
    • Vision and hearing


    Regular assessment of the baby’s development should be done at the routine baby check-ups and immunization visits by the pediatrician to look for any faltering or delay.

    The development of every child is different. It follows the same sequence but the time and manner of attainment of a milestone may vary. For e.g. Some babies start walking at 9 months of age while some babies don’t walk till 15 months. Both are in the normal range of development. Temporary delays or lags are not a matter of concern.


    If your baby is not attaining the milestones at the expected time, it does not necessarily mean he/she has developmental delay. But if there is ongoing delay or delay in achieving more than one milestone, it is a cause of concern.


    It is always advisable to consult the pediatrician and get developmental screening and assessment because it would help to identify the problem and accordingly suggest the early intervention.


    An Informal assessment by a pediatrician is a very essential preliminary step. There are various methods of developmental screening:- 


    Trivandrum developmental screening charts can be used for screening and early detection of children with developmental delay. 


    The common red flags sign in development are:


    1) If there is no fixing of gaze or following an object by 2 months

    2) If the baby produces no sounds by 6 months

    3) Not sitting without support by 9-10 months

    4) Not standing alone by 16 months

    5) Not walking alone by 18 months

    6) No single word with meaning by 18 months

    7) Lack of imaginative play by 3 years


    The causes of developmental delay: 


    Approximately 10% of the children have developmental delay. Most of the time the cause of developmental delay is not known, as many factors contribute to it.  


    • Genetic disorders - down syndrome, Angelman syndrome, Rett syndrome, metabolic diseases, etc.


    • Pregnancy and birth related: prematurity, low birth weight, maternal infections, birth trauma, birth asphyxia, infections resulting in brain injury, etc.


    • Environmental issues: poor nutrition, fetal alcohol syndrome, exposure to toxins like lead, etc, poverty, social and emotional deprivation, etc


    • Medical issues: brain infections, brain trauma, iodine deficiency, hypothyroidism, ear infections causing hearing impairment.


    Ideally, periodic developmental screening should be done in every child but at least children with the above risk factors should be screened for early diagnosis.


    A developmental delay can occur in one domain like motor delay. If a kid has a developmental delay in at least two domains of development, it is called a global developmental delay.


    Motor skill delay: gross motor and fine motor delays are the first to picked up in a child during routine baby checkups. Parents can also be alert and seek immediate pediatric consultation if the baby has:


    • Floppy and lose limbs and trunk
    • Abnormal stiffness of limbs and trunk
    • Limited movement of arms and legs 
    • Can’t sit without support by 9 months 
    • Can’t stand alone by 16 months
    • Can’t walk alone by 18 months
    • Involuntary reflexes have dominance over voluntary movements


    Detailed developmental assessment by a pediatrician can identify the delay and detailed evaluation should be done. 


    Language and speech delay: Language and speech develop during the first three years of life. Speech delay is when a child is unable to produce the sound correctly but understands the language and uses nonverbal gestures and signs. 

    Language delay is when a child is unable to understand and follow other people words and has difficulty in expressing his /her own thoughts. 

    He does not use nonverbal gestures to communicate. Hearing loss and autistic spectral disorder are common causes of language delay


    Cognitive delay: there is an intellectual disability, which hampers the general awareness and causes learning difficulties in the child. It is commonly associated with Down syndrome, seizure disorders, and brain injury. It can also co-exist with other conditions like autism etc. 


    Social, emotional and behavioral delay: these children have a delay in developing social and emotional skills due to the difference in brain development. This has an impact on their ability to communicate, interact and learn e.g. children with the autistic spectral disorder and attention deficit.


    Parents are the experts for their child. If they feel their child is lagging behind compared to other children or the school teacher points out an area of concern, a prompt developmental screening followed by detailed evaluation should be done.

    Early diagnosis and early intervention have a positive impact on the outcome of such children.


    Reference


    Textbook: Ghai Essential Pediatrics (OP Ghai, Vinod K Paul and Arvind Bagga) (Normal and Abnormal Development)

    Frequently Asked Questions

    A developmental delay means a child fails to attain the developmental milestones expected by a certain age. Parents are the ones who can easily notice this lag in achieving milestones in stipulated timeline. The right intervention at early stages can help the child to catch up on his developmental track. 

    The child development assessment is important in evaluation of a child’s current developmental status and identifying problems or delays in his development. It can be easily used by the parents and it is suggested that they assess their child’s development on regular intervals.

    To track developmental milestone of the child, it is important to pay attention on child activities. Simple steps to track developmental milestone of the child: 

    • Insert the age of your child in the tracker  
    • Fill the assessment form focused on development and language milestone 
    • If the result shows delay in the development of the baby, we suggest you connect with health expert.  

    Developmental delay may be caused by a variety of factors comprising genetics, heredity, environmental, complications with pregnancy, nutrition and premature birth. if your child is not achieving milestones as per his/her age, we suggest you consult your health expert for better understanding. 

    If your child is not achieving any of the milestone as per the age, it is matter of concern. We suggest you connect with your health expert to roll out the course of actions required for your child.  

    With any developmental delay early treatment is the key. Flexibility and adaptability are highest in the early years. Exercising Intervention during the early years of 0-3 helps the child quickly pick up skills needed to lead a quality life in future.