Early Diagnosis & Intervention for
Developmental Delay (0 - 3yrs)
Child development is a basic science of child health care. Here is the key to best outcome the development delays to attain better future.
Child development is a basic science of child health care. Here is the key to best outcome the development delays to attain better future.
| Age | Ventral suspension | Prone | Pull to sit / sitting position | Supine | Held in standing |
|---|---|---|---|---|---|
| 4 weeks | Held in prone position with hand under abdomen Head held up momentarily. Elbows flexed, hips partly extended, knees flexed | Pelvis high, knees drawn up largely under abdomen. Intermittent partial extension of hip and knee. Momentarily lifts chin off couch. Head predominantly to one side. | @Almost complete head lag, back uniformly rounded. May hold up momentarily | ATNR seen when at rest | Flops at knee and hips. May be residual walking reflex when sole of foot is pressed on flat surface. |
| 6 weeks | Head held up momentarily in same plane as rest of body. Some extension of hips and flexion of knees. Flexion of elbows | Pelvis high, but knees no longer under abdomen. Chin raised intermittently off couch. Head turned to one side | head lag considerable nut not complete | tonic neck reflex at rest intermittently seen | No walking reflex, head sags forward. May hold head up momentarily |
| 12 weeks | Head held up for prolonged period beyond plane of rest of body | Pelvis flat. Chin and shoulder off couch for prolonged periods. Plane of face at angle of 45 to 95 degrees from couch, weight borne on forearms | Only slight head lag. Head mostly held up, but still bobs forward | No more ATNR | |
| 6 weeks | Head and chest off couch so that plane of face is at angle of 90 degrees to couch | Only slight head lag at the beginning of movement. Head held up constantly. Head wobbles when child is gently swayed | Head in midline | ||
| 20 weeks | Weight on forearms | No head lag, no head wobble when swayed, back straight | Feet to mouth, | Bears most of weight | |
| 24 weeks | Weight on hands, not forearms chest and upper part of abdomen off couch, Rolls prone to supine | When about to be pulled to sit, lifts head off couch. Sits supported in high chair | Bears full weight on legs | ||
| 28 weeks | Weight bears on one hand, rolls from supine to prone | Sits with hands on couch for support, | Spontaneously lifts head off couch | Bounces with pleasure | |
| 36 weeks | In trying to crawl progresses backwards, may progress by rolling | Sits steadily on floor for 10 minutes | Leans forward and recovers balance but cannot lean over sideways | Stands holding on to furniture, pulls self to stand | |
| 40 weeks | Crawl position on abdomen, crawls by pulling self forward with hands | Can go over into prone, or change from prone to sitting, sits steadily | can pull self to sitting position | Can stand holding onto furniture. Collapses with a bump. | |
| 44 weeks | Creeps abdomen off couch | Lifts foot | |||
| 48 weeks | Sitting, pivots, twisting round to pick up object | Walks holding on to furniture. Walks two hands held | |||
| 1 year | Walks on hands and feet like a bear | Walks one hand held | |||
| 15 months | Creeps up stairs | Walks without help, can get into standing position without support, cannot go round corners or stop suddenly |
| 18 months | 2 years | 30 months | 3 years | 4 years |
|---|---|---|---|---|
| Goes up and down stairs, holding rail, walks up stairs, one hand held,carrying doll, seats self on chair, beginning to jump both feet | Goes up and down stairs alone, 2 feet per step. Walks backward in imitation. Picks up object without falling. Runs, kicks ball without overbalancing | Jumps with both feet, walks on tiptoes when asked | Jumps with both feet, walks on tiptoes when asked | Goes down stairs, one foot per step. Skips on one foot |
| Reflex reaction | Normal until | Stimulus | Response |
|---|---|---|---|
| Sucking | 3 months | Introduce a finger into the mouth | Sucking action of lips and jaw |
| Rooting | 3 months | Touch baby’s cheeks | Head turns towards stimulus |
| Grasp | 3 months | Press finger into palm from ulnar side | Fingers flex and grip object |
| Foot grasp | 9 months | press the sole of the foot behind the toes | Grasping response of feet |
| Placing | remains | Bring the anterior aspect of foot against the edge of table | Lifts limb up to step onto table |
| Reflex stepping | 2 months | Hold baby upright and tip forward, sole of foot presses against table | Initiates reciprocal flexion and extension of legs, simulating walking |
| Galant’s trunk incurvation | 2 months | Stroke back lateral to the spine | Stroke back lateral to the spineFlexion of trunk towards side of stimulus |
| Moro | 0-6 months | Baby supine and back of head is supported above table. Drop head backwards, associated with loud noise | Abduction and extension of arms. Hands open. This phase is followed by adduction of the arms as if in an embrace |
| Startle | remains | Obtained by sudden loud noise or tapping the sternum | Elbow flexed( not extended as in the moro reflex) and hand remains closed |
| Landau | From 3 months to 2 and a half years, strong 10 months | Child held in ventral suspension, lift head Depress head: | Head, spine and legs extend. Extend arms at shoulders The hip, knees and elbows flex |
| Crossed extension | 2 months | Supine head in mid position legs extended – stimulate medial surface of one leg by tapping | Opposite leg adducts, extends, internally rotates and foot plantar flexes (typical scissor position) |
| ATNR | 6 months usually pathological | Patient supine: head in mid position, arms and legs extended – turn head to one side | Extension of arm and leg on face side, or increase in extensor tone; flexion of arm and leg on skull side or increase in flexor tone |
| STNR | Rare and usually pathological | Patient in quadruped position or over tester’s knees – ventroflex the head b) dorsiflex the head | Arms flex or flexor tone dominates, legs extended or extensor tone dominates Arms extend or extensor tone dominates: legs flex or flexor tone dominates |
| Positive support | 3 months | Hold baby in standing position – press down on soles of feet | Increase of extension in legs. Plantar flexion, genu recurvatum may occur |
| Negative support | 3 – 5 months | Hold in weight bearing position | Child ‘sinks’ astasia |
| Body righting derotative | 4 – 6 months | Supine – rotate head or one knee one side passively | Active derotation at waist, segmental rotation of trunk between shoulders and pelvis |
| Rotative | 6 – 10 months | Rotate hip and knee or arm or head actively | Active segmented rotation (hyperactive at 10 months, cannot lie supine) |
| Parachute | Appears 6- 9 months and persists throughout life | Hold the child in ventral suspension and suddenly lower him towards the couch | The arms extend as if to protect from falling |
| Propping reaction | 5 -7 months | Child in sitting position, tilted to one side or backwards. | Arms extend to the appropriate position as if to protect from falling |
| Age | Hands | Vocalisation | General understanding | Social behavior |
|---|---|---|---|---|
| 4 weeks | Predominantly closed, grasp reflex | Crying. Variation in crying for hunger, pain and fatigue | Watches mother’s face when she talks to him and he is not crying. Opens and closes mouth | While suckling, baby’s face towards mother, regards mother’s face intermittently |
| 6 weeks | Often open. Grasp reflex may be lost | Smiles at mother in response to overtures | Is pacified by being carried social smile | |
| 8 weeks | Frequently open. Only slight grasp reflex | Smiles and vocalizes when talked to | ||
| 12 weeks | No grasp reflex, hands loosely open, hold rattle placed in hand for a minute or two | Squeals of pleasure, ‘talks’ a great deal when spoken to, gutteral noises | Smile is integral part of infant behavior. Responds with smile | |
| 16 weeks | Hands come together in play, try to reach for object but overshoots. plays with rattle, shakes it | gurgling | Excites when food prepared, toys seen, showing mass reaction involving all 4 limbs and respirations | Laughs aloud |
| 20 weeks | Able to grasp objects voluntarily, plays with toes, splashes in bath, objects taken to mouth. | Razzing; ‘ah- goo’ | Smiles at mirror image, pats bottle | Differentiates between stern and affectionate tones of voice |
| 24 weeks | Holds bottle, grasps feet, palmar grasp of cube, drops one cube when another is given | Rhythmic syllable chains | When he drops a toy he looks to see where it has gone to and tries to recover it, smiles and vocalizes at mirror image, shows likes and dislikes, displeasure at removal of toy | Differentiated social smile. Child smiles more readily when it sees familiar faces. |
| 28 weeks | Feeds self with biscuit, | Babbles. likes to play with paper, bangs cube on table, transfers it from hand to hand, if he has one cube in hand, he retains it when second is offered | Imitates simple acts, pats image of self in mirror, responds to name, tries to establish contact with person by cough or other method | Can clearly differentiate between familiar people and strangers |
| 36 weeks | Can pick up object of size of currant between tip of finger and thumb, compares two cubes by bringing them together | Combines syllables da-da, ba-ba, ma-ma | Puts arms in front of face to prevent mother washing his face | Is interested in its own reflection, observes adults at work |
| 40 weeks | Goes for objects with index finger, beginning to let go of objects(release) | Has a dialogue with the mother. When she voices baby’s single or double syllables, the child repeats the syllables. If asked where is papa/ light, it turns the head to look for the person / light | Looks round corner for objects, responds to words, where is daddy, pulls clothes of another to attract attention | repeats performance laughed at |
| 1 year | Mouthing virtually stopped, beginning to throw objects to floor | 2 or 3 words with meaning, knows meaning of more words, understands simple instructions | May understand meaning of phrases where is your shoe, may kiss on request, apt to be shy | Can play games. Ex., when mother crawls behind on all fours and tries to catch the Child |
| 15 months | Constantly throwing objects on floor, builds tower of 2, holds 2 cubes in one hand | Jargoning, several intelligible words | Asks for objects by pointing, beginning to imitate mother in domestic duties – sweeping, cleaning, inserts round block without being shown | |
| 18 months | Tower of 3 or 4, Spontaneous scribble, makes stroke imitatively | Tower of 3 or 4, Spontaneous scribble, makes stroke imitativelyPoints to 2or 3 body parts, follows simple orders like bring it to me, speech is jargon, many intelligible words, points to pictures of car or dog, knows one common object | Domestic mimickry, copies mother in dusting, washing, cleaning | Uses mother as secure base, checking back with her frequently |
| 2 years | Turns door knob, unscrews lid, washes and dries hands, tower of 6 or 7, imitates train of cubes, without adding chimney, imitates vertical and circular stroke | Points to 4 body parts, asks for drink, food, obeys 4 simple orders, names 3 – 5 common objects, points to 5 pictures, asks for drink, toilet, food, uses I, you, me, joins 2 or 3 words in sentences | Pulls people to show them toys, wraps up doll. Puts it to bed | parallel play, watches others play and plays near them, but not with them |
| 2 and a half years | Tower of 8, imitates train, adding chimney. Imitates horizontal and vertical stroke | Names 5 common objects, points to 7 picture cards, repeats 2 digits in 1 of 3 trials | Knows full name, knows sex, names one color | |
| 3 years | Tower of 9, imitates building of bridge, copies circles, imitates cross | Names 8 picture cards, repeats 3 digits in 1 of 3 trials prepositions obeys 2 | Knows some nursery rhymes, may count upto 10 | Separates from mother easily in strange environment, identifies own gender, Begins to understand taking turns |