developmental assessment of a child even from birth is important in identifying many developmental disorders. these slides highlights the importance of development during this critical period

1. DEVELOPMENT
0-6 MONTHS
PRESENTOR- DR SUGANYA R
MODERATOR- DR PAWAN GHANGHORIYA SIR

2. DEVELOPMENT
 MATURATION OF FUNCTION AND ACQUIRING OF NEW SKILLS
RULES OF DEVELOEPMENT
 CEPHALOCAUDAL AND PROXIMAL TO DISTAL.
 INITIAL MASS ACTIVITY IS REPLACED BY MATURE ACTIVITIES
 DEPENDS ON MATURATION OF NERVOUS SYSTEM
 PRIMITIVE REFLEXES TO BE LOST BEFORE MATURE REFLEXES APPEAR

3. TYPES OF DEVELOPEMENT
 SOMATIC DEVELOPMENT
 NEUROLOGICAL DEVELOPMENT- SYNAPTIC CONNECTIONS INCREASES
 BEHAVIORAL DEVELOPMENT

4. NEONATAL PERIOD
 ALERT AWAKE PERIOD- 1ST ALERT AWAKE PERIOD- IMMEDIATELY AFTER BIRTH USUALLY LASTS FOR 40
MINUTES FOLLOWED BY SHORT ALERT AWAKE PERIODS.
MOTOR- GENERALLY FLEXED, HEAD LAG ON VENTRAL SUSPENSION
REFLEXES- ACTIVE MORO’S REFLEX, DOLL’S EYE MOVEMENT, FIXATE FACE ON LIGHT, STEPPING AND
PLACING
LANGUAGE-
SOCIAL- VISUAL PREFERENCE FOR HUMAN FACE
BEHAVIORAL- 6 BEHAVIORAL STATES

5.  BEHAVIORAL STATES- ALERT STATE- TRY TO VIRTUALLY FIXES OBJECT
TURNS TOWARDS A NOVEL SOUND
DROWSY STATE- ANY STIMULUS CAN FORCE THE CHILD TO
CRYING
FUSING/CRYING-
QUITE SLEEP-
ACTIVE SLEEP- LESS REACTION TO ANY STIMULUS
 FORMAL BEHAVIORAL ASSESSMENT- New Born Behavioral Assessment Scale [NBAS]
(3 days- 4 weeks)

6. DEVELOPMENT OF LOCOMOTION
WEEKS PRONE CHIN LIFT VENTRAL SUSPENSION PULL TO SIT
0-2 WEEKS PELVIS HIGH, KNEE
FLEXED
HEAD LAG HEAD LAG
2-4 WEEKS HEAD LAG HEAD LAG WITH ROUND BACK
4-6 WEEKS PELVIS HIGH,
INTERMITTENT
EXTENSION
MOMENTARY
CHIN LIFT
6-8 WEEKS CHN LIFT TO 45 MOMENTARTY HEAD AT LINE OF BODY PARTIAL HEAD LAG
8-10WEEKS PERSISTENT HEAD AT THE LINE OF BODY
10-12
WEEKS
LEGS EXTENDED CHIN AND
SHOULDER LIFT
TO 90 DEGREE
HEAD ABOVE LINE OF BODY NO HEAD LAG

7. DEVELOPMENT OF LOCOMOTION
WEEKS SITTING AND STANDING
16- 20 WEEKS WEIGHT ON FLEXED FOREARM WITH FACE 90 DEGREE
20 WEEKS ROLLS OVER
20- 24 WEEKS WEIGHT ON HANDS WITH EXTENDED ARMS, BEARS HIS OWN WEIGHT, SITTING WITH
HANDS FORWARD FOR SUPPORT

8. DEVELOPMENT OF FINE MOTOR
 3 MONTHS – HAND REGARD
 4 MONTHS- BIDEXTROUS GRASP
 6 MONTHS- UNIDEXTROUS GRASP
TRANSFERS OBJECTS FROM ONE HAND TO ANOTHER
MOUTHING

9. DEVELOPMENT OF SOCIAL SKILLS
 1 MONTH- STARTS TO SMILE
 2 MONTH- SMILE WHEN SOCIALISED
 3 MONTHS- RECOGNISES MOTHER
 4 MONTHS- ANTICIAPATES FEED
 5 MONTHS- SMILES AT HIS MIRROR IMAGE
 6 MONTHS- STRANGER ANXIETY, ENJOYS PEE BOO GAMES, IMITATES

10. DEVELOPMENT OF LANGUAGE
 1MONTH- ALERTS TO SOUND
 3 MONTHS- COOS
 4 MONTHS- LAUGH LOUD
 6 MONTHS- MONOSYLLABLES

11. DEVELOPMENT OF VISION AND HEARING
 AT BIRTH- FOLLOW MOVING PERSON WITH EYES
 2 WEEKS- FOLLOWS DANGLING RING WITH RANGE OF 45DEGREE
 4 WEEKS- FOLLOWS RING WITH RANGE OF 90 DEGREE
 12WEEKS- FOLLOWS RING WITH RANGE OF 120 DEGREE
 4 MONTHS- BINOCULAR VISION DEVELOPS
 5 MONTHS- EXCITES WHEN FOOD IS BEING PREPARED
 6 MONTHS- ADJUSTS POSITION TO SEE OBJECTS

12. RED FLAG SIGNS OF DEVELOPMENT
 POSITIVE INDICATORS-
PERSISTENT LOW MUSCLE TONE/ FLOPINESS
NOT RESPONDING TO SOUND AT ANY AGE
ASSYMETRY OF MOVEMENTS
PARENTAL / PROFESSIONAL CONCERN ABOUT VISION/ FIXING/ FOLLOWING OBJECTS
 NEGATIVE INDICATORS-
LACK OF LOOKING AT FACES/ LACK OF FIXATION AT 2 MONTHS
LACK OF SMILING AT 4 MONTHS
LACK OF LAUGHING OUT LOUD AND LACK OF EXPRESSION BY 6 MONTHS

13. Case- 1
 A 3 ½ months old female baby on well baby clinic is found to have increased tone on lower limbs. The child
had normal perinatal period with APGAR of 8 and 9. the child have developed social smile, on prone chin lift
to 90 degree is present with head above the line of body on ventral suspension, she alerts to sound and
coos.
 So is this a case of developmental delay ??
no. there is no obvious developmental delay
 Is there a red flag sign??
Yes there is red flag sign
 Further management
low risk case, could be a normal variation. Requires Amiel Tyson method for assessment of adductor and
popliteal angles. Rquires follow up.

14. Case-2
 7 month old female child referred for not smiling. No perinatal history. Motor development was found to
be normal. The child had started to vocalize and she alerts to sound. She transfers objects from one
hand to another. On general physical examination she has no expression of emotions and the range of
movements of to dangling ring is 45 degree. However feeding difficulties were present. No possible
emotional deprivation found.
 So, is this a developmental delay.?
yes. Not global. But isolated social delay.
Isolated delays look for isolated causes.
This child was found to have congenital facial diplegia