Skills such as taking a first step, smiling for the first time, and waving “bye bye” are called developmental milestones. Children reach milestones in how they play, learn, speak, act, and move (crawling, walking, etc.)

1. Developmental assessment of
child 1-5 year

2. Begin by introducing yourself to the parent and patient.
Inspect for the following:
1. Growth parameters; for example, failure to thrive,
associated with syndromic or chromosomal anomalies.
Undernutrition or chronic illnesses can be associated with
developmental delay, as may be small or large head size.
2. Evidence of any dysmorphic features (various syndromic
diagnoses).
3. Obvious neurological abnormalities (including ‘floppy
infant’ posturing, hemiplegic posturing, and involuntary
movements).

3. The next step depends on the age of the child.
•A child small enough to be comfortably sat on his or her
mother’s knee should be positioned there for assessment of
vision, hearing, language, personal–social interaction and fine
motor control. It is unwise to remove a child from his or her
mother to perform a gross motor assessment first.
•If a child is older, then he or she may prefer to be examined
sitting on a chair.

4. 4.
Always test vision before hearing. Fixing and following, and an
approximation of visual acuity (e.g. the ability to pick up a toy or the
ability to read in older children), are important. Testing of visual fields is
not required. Testing each eye separately is desirable but can be
difficult to achieve without upsetting an infant.

5. 5.
Testing hearing, requires initial distraction with a non-noisemaking (i.e.
purely visual) stimulus, directly in front of the child. This is then hidden,
at the same time the noisemaker (e.g. bell) is brought towards the ear
from behind (out of range of visual fields) by an assistant (e.g. the chief
examiner). On a signal given by yourself, the assistant makes a sound
(e.g. rings the bell) at a certain distance from the ear (this varies for
different ages), testing each ear in turn and noting whether the child’s
facial expression, changes, and if the head turns towards the stimulus,
localizing the sound (in older children). If the conditions are not
optimal for testing hearing (e.g. fractious toddler), say so. If there is an
equivocal result, it is reasonable to suggest a formal audiological
assessment.

6. Throughout the testing described above, assessment of personal–social
interaction and language can be performed. Do not forget to comment
on any vocalizing the child does, or on interactions with you (e.g.,
smiling, waving, laughing), as these may give very valuable information,
which can be overlooked if it is not actively considered as part of a
developmental assessment.

7. Speech and hearing
• Name
• What is this? (any object)
• How Old are you
• Where do you live
• Do you know how to count?
• Rhymes

8. age words
12months 2-6 words
Turn to Own name
18 months Up to 20 words
Recognize objects
2yr Up to 50 words
Refers to self by name
3yr Knows name, age, sex
Counts to ten.
4yr Full name+ address
Counts to 20
5yr Name, age, birthday

9. 6.
The fine motor assessment can then be performed.
Ensure that you have appropriate objects in your case to test fine
motor functions such as pencils, colors, books, a plastic knife, fork, and
spoon set.

10. FINE MOTOR DEVELOPMEN
• Cubes
• Pencil/crayons/paper
• Book with animals (Turn pages)
• Name pictures, Body parts.

11. Age Fine motor
12 months 2 cubes click together
try to build a tower
Turn pages of book (several)
Pincer Grasp
18 months 3cuber (Tripod grasp)
Hold pencil and scribbles
Turn several pages.
Name pictures (animals and body parts)
2yr 6 cubes. + train
Draw straight line
Turn pages singly
3yr 9 cubes+ bridge
Draw circle
Nursery Rhymes
4yr Stairs of 6 cubes
Draw Cross (+) and stick man
Use scissors to cut Pictures
5yr Draw Square + triangle.

12. SOCIAL BEHAVIOUR.
• cup and spoon.
• Toilet training
• self-cleaning and clothing
• play with toys and friends

13. age
12 months Uses cup with assistance
Not toilet trained / cannot verbalize need.
Find Toy hidden before eyes.
18 M feeds self with spoon.
Still wets pants but verbalize when wet
Take off shoes & socks.
Plays alone on floor with toys
2yr lifts + Replace cup safely (cup + spoon)
Handles spoon well,
Dry by Day + verbalized toilet needs
Pull down pants & Knicker
3yr Fully toilet trained (Dry by night)
Pulls up + down knicker
cannot button up.
wash & dries hand under supervision.
4yr Dress + undress except shoelaces
Washes hand & face +brush teeth
Needs Companion Ship & other people.
5yr Complex pretend play (see cartoons and become part of it)
can play with others to achieve a common goal
might also be able to work things out if another child doesn’t want to play a particular game.
becoming more social and prefers to play with friends
can share, although they might find it hard to share favorite toys and other things.
Games with rules sometimes challenging, and child might even accuse others of cheating sometimes.

14. 7.
now perform gross motor assessment.
Observe and ask about 5 things
• Can walk.
• Can Run
• Can stand on one foot
• can climb Stairs
• Can Hop/ skips”

15. Age Gross motor
12 months walks with one handheld.
18 months Walks independent
Stairs & one handheld (upstairs)
Throws ball.
2yr Runs +walks well.
Stairs Up+ down handheld.
Kicks bail on Requests
Climb up furniture.
3yr stair up – alternate feet
Stair down 2 feet/step.
Can stand momentary on one foot.
4yr Walks down + up – independent alternate feet.
Stand on foot 3-5 sec.
5yr Hops + Skips
Walks on straight line.
Can catch a ball.

16. As the examination is proceeding, it is useful to comment on each
finding as it is elicited, making sure that the examiners see that you
know the significance of each sign found. Terms such as ‘age
appropriate’ may be useful when normal findings occur.

17. A succinct summary at the completion of the examination should
attempt to give a developmental age to each of the areas assessed, and
state whether any delay detected is global, or whether there is a
scatter of abilities (e.g. gross and fine motor delay only in Werdnig–
Hoffmann disease, visual and gross motor impairment in an ex-
premature baby, global delay in a child with congenital rubella or
severe Cerebral palsy)