PCM: Child Development Exam

For the infant exam you need to focus on these main area

=Learning Objectives=

Describe the progression of gross motor development in a normal child.
In general, gross motor development occurs in a cephalo-caudal direction
 * Birth - 2 Mo: begin to lift their head
 * 4 Mo: Up on shoulders, roll front
 * 6 Mo: Sit, roll on back
 * 9 Mo: Crawl and pull up onto furniture
 * 12 Mo: Walk

Describe the progression of fine motor development in a normal child
In general, fine motor skills develop from proximal to distal
 * 2-3 Mo: begin grasp objects
 * 5 Mo: grasp objects with thumb.
 * Needs completion.....

Identify common developmental delay and potential red flags

 * Persistent fisting past 3 months.
 * Maintains primitive reflexes like palmar, plantar, Moro reflexes past 6 months.
 * Early milestones, ie rolling over at 2 months
 * Hand dominance before 18 months usually demonstrates weakness or injury in the contralateral side.
 * No words by age 2 (could mean a hearing or cognitive deficit)
 * Delay in reciprocal smile (should happen at 1-3 Mo).
 * Lack of social relationships (parallel playing beyond age 3 could be a sign of autism)
 * Normal delayed growth on a growth chart
 * Familiar macroencephaly
 * Delayed walking (raises serious concern at 18 months)
 * No rolling at 4 months
 * Delayed speech due to hearing impairment, gender, or sibling issues

=Components of an Exam=
 * 1) Physical: height (v. length), head circumference, weight, more than 3 dysmophic features
 * 2) Motor: age appropriate development, reflexes
 * 3) Cognitive: problem solving & language
 * 4) Psychosocial: interaction with parent and physician
 * 5) Solid History--see 'Directed Developmental History'

=Directed Developmental History=
 * Ask about "first", total number of words
 * Ask about sleeping, crawling, playing, eating/breast feeding, talking, hygiene, diapers
 * how do they communicate with parents?
 * what do they like to play?
 * how independent is the child with specified tasks like eating, dressing, etc.
 * Any problem and concerns
 * Engage the parents. How are the parents doing?
 * Immunizations
 * Use screening tools as objective assessments
 * chart for height, weight, head circumference, etc.
 * Ages & Stages questionnaire

=Motor Development=
 * Gross motor develops from head to foot
 * Fine motor develops from proximal to distal

=Signs= Special tests
 * Plantar grasp: touch bottom of the foot --> toes curl (less than 8 Mo)
 * Palmar grasp: touch ulnar side of palm --> strong grasp up to 2 Mo; disappears after more than 3 Mo.
 * Moro reflex: Birth - 6 Mo. [[Image:moro.jpg]]
 * Red Reflex: shine ophthalmoscope into the eye at a 15-degree angle. Lack is suggestive of a retinal lesion.
 * Placing: day 4 - variable disappearance. Touch dorsum of foot to table. Child will react as if steppping
 * Stepping: (birth/8 weeks) - Hold infant in standing position, touch bottom of feet to the ground and simulate walking. observe for flexion/extension of muscles.
 * Assymetric fencing: 2 Mo - 4 Mo., While supine. When head turns in one direction, the infant prevents itself from rolling over.  Observe ipsolateral leg & arm extension with contralateral leg & arm flexion.

=Physical Exam=
 * Adapted cranial nerve exam
 * Hip dysplasia exam for young infant