Dev Basics - Foundation First!
- Developmental Surveillance: A continuous, flexible, and longitudinal process of observing a child's development during routine health visits. It involves eliciting parental concerns and skilled observation.
- Developmental Screening: An intermittent, formal process using standardized, validated tools at specific ages (e.g., 9, 18, 24-30 months) to identify children at high risk for developmental delays.
- Importance: Both are crucial for early identification of developmental problems, enabling timely intervention and improved outcomes.
- Periodicity: Surveillance at every health encounter (IAP/WHO).
⭐ Surveillance is a continuous process, while screening is done at specific ages using standardized tools to identify at-risk children not picked up by surveillance alone.
Milestone March - Tiny Steps, Big Wins
Development follows a predictable pattern. 📌 Motor sequence: Cephalo-caudal (head to toe), Proximo-distal (center to periphery).
| Age | Gross Motor | Fine Motor | Language | Social/Cognitive |
|---|---|---|---|---|
| 2m | Lifts head 45° (prone) | Tracks past midline | Coos, gurgles | Social smile |
| 6m | Sits with support, rolls | Transfers objects | Monosyllabic babble | Recognizes mother |
| 9m | Sits alone, crawls | Immature pincer grasp | Bi-syllabic babble | Stranger anxiety |
| 12m | Walks with help, stands alone | Mature pincer grasp | 1-2 words (meaning) | Waves bye-bye |
| 2y | Runs, kicks ball | Tower of 6-7 cubes | 2-3 word sentences | Parallel play |
| 3y | Tricycle, hops | Copies circle, tower of 9 cubes | 3-4 word sentences, knows name/age/sex | Group play, shares |
| 5y | Skips well | Copies triangle, person 6 parts | Fluent speech, counts 10 | Follows rules, friends |
Screening Toolkit - Detective Kit
- Denver II (DDST-II):
- Age: Birth - 6 yrs. Direct observation.
- Domains: Gross motor, fine motor-adaptive, language, personal-social.
- ASQ-3 (Ages & Stages Questionnaire):
- Age: 1 mo - 5.5 yrs. Parent-completed, cost-effective.
- Domains: Communication, gross motor, fine motor, problem-solving, personal-social.
- M-CHAT-R/F (Autism Screen):
- Age: 16-30 mos (key: 18 & 24 mos). Good sensitivity; high specificity with Follow-Up.
- Scores: Low risk (0-2); Medium (3-7, needs FU); High (8-20, refer).
- TDSC (Trivandrum Development Screening Chart):
- Age: Birth - 2 yrs (Indian context specific).
- Domains: Key milestones, vision, hearing.
⭐ M-CHAT-R/F is a crucial parent-reported screening tool for Autism Spectrum Disorder, typically administered at 18 and 24 month well-child visits.
Red Flags & Response - Sound the Alarm!
- Critical Red Flags:
- Social/Language: No social smile (3 mo); no babbling/gesturing (12 mo); no single words (16 mo); no 2-word spontaneous phrases (24 mo); poor eye contact.
- Motor: Not sitting (9 mo); not walking (18 mo); persistent primitive reflexes.
- General: Any skill loss. ⚠️ Parental concerns are key; always investigate.
- Response Protocol:
⭐ Loss of previously acquired milestones (developmental regression) is a major red flag, warranting urgent, comprehensive evaluation.
High‑Yield Points - ⚡ Biggest Takeaways
- Developmental surveillance is an ongoing process; screening employs standardized tools at set ages.
- IAP recommended screening: 9, 18, 30 months (general development); 18, 24 months (autism).
- DDST-II evaluates four domains: Personal-Social, Fine Motor-Adaptive, Language, Gross Motor.
- Use M-CHAT-R/F for autism screening specifically between 16-30 months.
- Early detection and prompt intervention are key to better developmental outcomes.
- Global Developmental Delay (GDD): significant delay (≥2 SD) in ≥2 domains for children <5 years.
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