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Child developmental assessment

Introduction

  • Wash hands
  • Introduce self
  • Ask Patient’s name and what they like to be called
  • Explain examination and obtain consent from parents
  • Ask parents if they have any developmental concerns
  • Observe child for 30 seconds
  • Tips
    • The modalities below can be assessed in any order, so if the child is comfortable on the parent’s lap, for example, it may be better to assess the other modalities before gross motor 
    • Ask the parents questions about anything you cannot get the child to demonstrate (e.g. if they are not rolling, ask if the parents have seen them roll)
    • You should know the ages for a few milestones in each category 

Gross motor

  • Check parent is happy for you to put the child on a play-mat on the floor
  • Lie child on back – see if they can roll
  • Put child in a sitting position – look for head control (3 months)
  • See if they can sit aided/unaided (6-9 months)
    • Look at curvature of spine and sitting reflexes
  • Pull to a standing position – see how much support is needed (9-12 months)
  • Get them to walk if able (15-18 months) or run (2 years)
  • Lastly, place prone – see if child lifts head/chest or crawls (10 months)

Fine motor and vision

  • Get child to take a toy and observe
    • Transfers (6 months)
    • Type of grip (palmar grasp at 6 months; pincer grip at 9-10 months)
  • Offer bricks
    • 3-cube tower (18 months)
    • Builds bridge (3 years)
  • Give paper and pen if old enough
    • Scribbles (18 months)
    • Circular scribbles and lines (2 years)
    • Copies circle (3 years)
    • Copies cross (4 years)
  • Vision – wave toy
    • Fixes and follows (3 months)

Hearing and language

  • Click fingers or use rattles (see if they turn to sounds)
    • Startles to noise (neonate)
    • Turns to sounds (6 months)
    • Turns to name (12 months)
  • Talk to child and ask parents what words/noises the child can say/make
    • Babble (6 months)
    • ‘Mamma’ and ‘Dadda’ (12 months)
    • 2-word phrases (2 years)
    • Knows own name and colours (3 years)
  • Commands
    • One-step command, e.g. ‘take the brick’ (18 months)
    • Two-step command, e.g. ‘take the brick and place it in the cup’ (2 years)

Social

  • Observe interaction with people/environment 
    • Smiles (6 weeks)
    • Laughs (3 months)
    • Stranger anxiety (9 months)
    • Plays ‘peek-a-boo’ (9 months)
    • Waves goodbye (12 months)
  • Ask parents about the child’s diet
    • Solids (6 months)
    • Fork and spoon (2 years)

To complete

  • Thank child and parents
  • ‘To complete my examination, I would review growth charts and measure weight, height and head circumference.’
  • ‘I would also like to take a full history.’
  • Summarise
    • If age unknown: estimate developmental age 
    • If age known: comment if the development is appropriate for age, globally delayed, or asymmetrically delayed

Normal developmental milestones

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Common developmental OSCE stations

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Fragile X syndrome

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Klinefelter’s syndrome

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Turner syndrome

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Trisomy X

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Down’s syndrome

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Edwards syndrome

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Patau syndrome

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