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

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

Common developmental OSCE stations

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