Development

Pediatric development

At 15 months
Gross motor
Walks alone; crawls up stairs
Fine motor & vision
Inserts pellet in bottle, draw a line
tower of 3 cubes
Hearing & speech
Says 3-6 words.respond to his nameFollows commands
Social
Attempts to use spoon. Hug parents.








At 18 months
Gross motor
Runs stiffly; sits on small chair; walks up stairs with one hand held
Fine motor & vision
Makes tower of 4 cubes, imitates scribbling, dumps raisin from bottle.
Hearing & speech
10 words (average); names pictures
Social
Feeds self; seeks help when in trouble; may complain when wet or soiled ;kisses parent with pucker

At 2 years

Gross motor
Runs well,walks up and down stairs, one step at a time, opens doors, climbs on furniture
Fine motor & vision
tower of 7 cubes, Circular scribbling & can copy lines.
Hearing & speech
Puts 3 words together (subject, verb, object)
Social
Handles spoon well; helps to undress.

2 1/2

motor
Goes up stairs alternating feet
Fine motor & vision
Makes tower of 9 cubes; makes vertical and horizontal line

Hearing & speech

Refers to self by “I”; knows full name
Social
Helps put things away; pretends in play
At 3 years
Gross motor
Rides tricycle and stands momentarily on one foot.
Fine motor & vision
tower of 10 cubes ,Imitates construction of “bridge” of 3 cubes and copies a circle.
Hearing & speech
Knows age and sex; counts 3 objects correctly
Social
Helps in dressing (unbuttons clothing and puts on shoes) and washes hands

At 4 years

Gross motor
Hops on one foot;uses scissors, throws ball overhand;
Fine motor & vision
copies cross and square
Hearing & speech
Counts 4 pennies,Tells a story.
Social
Goes to toilet alone.

At 5 years

Gross motor
Skips, walks on narrow line
Fine motor & vision
Copies triangle
Hearing & speech
counts 10 correctly, names 4 colors
Social
Dresses and undresses; asks questions about meaning of words, like to help in household tasks


Evaluating School Readiness:-
A-PHYSICIAN OBSERVATIONS
Ease of separation of the child from the parent
Speech development and articulation
Understanding of and ability to follow complex directions
Knowledge of colors
Counts to 10
Knows age, first and last names, address, and phone number
Ability to copy shapes
Stand on one foot, skip, and catch a bounced ball
Dresses and undresses without assistance
B-PARENT OBSERVATION
Does the child play well with other children
Does the child separate well
Does the child show interest in books, letters, and numbers
Can the child sustain attention to quiet activities
How frequent are toilet-training accidents?
General Principles Of Assessment

1) Milestones’ variations & disorders of development

Children’s developmental milestones are convenient guidelines to look at the rate or the extent of their progress.
Even though the sequences of developmental milestones are similar in most children there is a wide individual variation in the rate of achievement.
Developmental disorders generally present with:
Qualitative abnormality: e. g.,
poor awareness of task and context,
slowness in completing a task,
poor social interest
Regression of development: e.g.,
losing previously acquired skill
Disordered developmental sequence: e.g.,
Hand dominance ( hand preference) prior to 18 months(May indicate contralateral weakness with Hemiparesis) (average age of hand dominance is at 3 years) ,
pulling directly to a stand at 4 months (instead of to a sit) ,
rolling prior to 3 months
Severely delayed rate of development [Red Flags ] :
Persistent fisting at 3 months.
Poor head control by 4-6 months (Evaluate for hypotonia).
Failure to reach for objects by 5 months(Evaluate for motor, visual or cognitive deficits)
Persistence of primitive reflexes after 6 months.
Not walking by 18 months
Not sitting by 10 months
No single words by 18 months


2) History Taking :
Information regarding family history,family and social environment and the pre-, peri- and post-natal history should be obtained. Children’s current general health and a history of illness or medication may be relevant to their current presentation.
3) Observation & Assessment :
Observations made during free-play situations are a rich source of information about children’s developmental progress. A suitable selection of toys and an interactive style is essential.
Toys should be both age appropriate and relevant to the developmental domains.
4)Physical Examination:
Look for any dysmorphic features and congenital malformation that may suggest a particular syndrome or etiology such as trisomy 21.
Examination of the skin for hypo or hyper pigmented marks as Café au lait macules in neurofibromatosis.
Growth measurements:OFC, height and weight.
Vision and hearing assessment.
Neurological examination :for tone ,power, reflexes, coordination,any abnormal movements and compare both sides of the body
Adolescence and Puberty

Adolescence: It is the passage from childhood to adulthood.

Puberty: It refers to those changes that lead to reproductive capacity.The events of Puberty occur in predictable sequence but the time of initiation and the velocity of these changes are highly variable.
Puberty in Girls
The age of onset of puberty in girls is between 8-13 years and the average is 11 years.
Puberty is delayed in girls, when there is no any sign of pubertal development by age 13 years.
1st sign -----------Breast bud (thelarche).
2nd sign -----------Pubic and axillary hair (Pubarche or adrenarche) .
3rd sign -----------Menstruation (Menarche).
Puberty in Boys
The age of onset of puberty in boys is 9.5-13.5 years and the average is 11.5 years
Puberty is delayed in boys, when there is no any sign of pubertal development by age 14 years
1st sign -----------Testicular enlargement.
2nd sign ----------- Penile enlargement.
3rd sign ----------- Pubic and axillary hair.