Developmental Red Flags: Uw Lend
Developmental Red Flags: Uw Lend
Developmental Red Flags: Uw Lend
Gross motor
Fine motor
Language
– Expressive
– Receptive
Problem solving
Social
Patterns in Development
MOTOR PS RL/EL SOCIAL
ID V D D D
CP D V-N V-N D
VI D D N D
HI N N D V-N
AUTISM N V-N D D
Prevalence of DD
Dx per 1000 age (mo) MD 1st
GDD 50 24 30%
ID (mild MR) 25 39 60%
ID (mod/severe MR) 5 12 90%
Learning disability 100 69 12%
ADHD 90 59 45%
CP 3 12-14 99%
AUTISM 8 40 30%
Visual impairment .5 55 60%
Hearing Impairment 1-3 39 40%
What’s the problem?
16% of preschool children
have developmental or
behavioral problems.
The Federal Law mandates
early identification.
30-50% of MDs screen.
There is a $10 return on $1
invested in early child
programs.
Reynolds AJ CHILD DEV 2011
Use the parent!
CP CP CP mild
Autism Autism/LD LD
CHILD WITH DEVELOPMENTAL DELAY
NBN , VISION,
HEARING,
DEVELOPMENTAL
HISTORY
SCREEN
PHYSICAL EXAM
DQ <70 Delay
DQ 70-85 Monitor
DQ >85 Typical range
3/10,000 boys
30% have no Fam Hx
Absent dystrophin
Xp21.2
CPK is >20x normal!
DNA analysis of blood
can make dx in 2/3’s.
Motor delay
TONE REGRESSION
Decreased Increased
STRENGTH
CEREBRAL
PALSY
Normal Decreased
REFLEXES
NEUROMUSCULAR
Normal or increased
Receptive Receptive
– Infant – Toddler
Alerts to voice 1 mo 1 step command without
Regards speaker 3 mo gesture 14 mo
Listen then vocalizes 5 mo 1 body part 15 mo
Enjoys gesture games 9 mo Fetches on command 16 mo
Orients to name 10 mo Points to picture 18 mo
Understands “no” 11 mo 6 body parts 20 mo
Command, with gesture 12mo 2 step command 24 mo
Language delay
ID 3%
Autism .6-1%
RED FLAG
Pencil
5
– Imitates scribble 15 mo
– Scribbles spontaneously 18 mo
– Imitates vertical line 24 mo
– Imitates horizontal line 28 mo
– Circle 3 yr
– Square 4 yr
– Triangle 5 yr
– Goodenough-Harris DAP see HLH
RED FLAG
Early Handedness
NOT a diagnosis
12 cm in first 12 months!
Head Circumference
Rule of 3’s and 9’s
– Birth: 35 cm
– 3 mo: 40 cm
– 9 mo: 45 cm
– 3 yrs: 50 cm
– 9 yrs: 55 cm
Pits and tags
1/100 –common!
ALL need Hearing
Renal US if:
– Other malformation
– FHx of deafness,
ear or kidney issue
– Gestational DM
Single umbilical artery
6/1000
More common in twins
If exam normal, and
mother did not have
oligo/polyhydramnios,
no further work up.
Exam should r/o GI, AJ Schuman, Contemporary Peds, Dec, 1991