Developmental evaluation from birth to two years

By: Dr.Priyanka Marwaha

The first three years are very crucial in terms of development of a child. The development that occurs from birth to 3 years provides the foundation for subsequent development across domains. Infant/toddler development proceeds in a predictable sequence: infants crawl before they walk, babble before they talk, and so on. But when each developmental milestone is achieved varies from child to child.

Child development is a process every child goes through. This process involves learning and mastering skills like sitting, walking, talking, skipping, and tying shoes. Children learn these skills, called developmental milestones, during predictable time periods.

Developmental Milestones- Developmental milestones is a list of developmental skills that believed to be mastered at roughly the same time for all children but that are far from exact act as a useful guideline of ideal development..

Developmental Evaluation- A brief test using a screening tool does not provide a diagnosis, but it indicates if a child is on the right development track or if a specialist should take a closer look. If the screening tool identifies an area of concern, a formal developmental evaluation may be needed.

This formal evaluation is a more in-depth look at a child’s development, usually done by a trained specialist, such as a developmental pediatrician, child psychologist, speech-language pathologist, occupational therapist, or other specialist.

The specialist may observe the child, give the child a structured test, ask the parents or caregivers questions, or ask them to fill out questionnaires. The results of this formal evaluation determine whether a child needs special treatments or early intervention services or both.

 But discussions of development typically include some combination of the following domains:

• Physical- o Growth and health status
• Motor- o Fine motor o Gross motor
• Speech and language
• Social and Emotional
• Cognitive

PHYSICAL:

0-4months

• moves wholebody
• squirms,armswave,legsmoveupanddown
• eating and sleeping patterns
• startle reflex when placed unwrapped on flat surface/ when hears loudnoise
• head turns to side when cheektouched
• sucking motions with mouth (seekingnipple)
• responds to gentle touching, cuddling,rocking
• shuts eyes tight in brightsunlight
• able to lift head and chest when laying onstomach
• begins to roll from side toside
• starts reaching to swipe at danglingobjects

able to grasp object put intohands

4-8months

• plays with feet andtoes
• makes effort to sit alone, but needs handsupport
• raises head and chest when lying onstomach
• makes crawling movements when lying onstomach
• rolls from back tostomach
• reach for and grasp objects, using one hand tograsp
• eyes smoothly follow object orperson
• crawling movements using both hands andfeet
• able to take weight on feet whenstanding
• watch activities across room – eyes move inunison

turns head to sound ofvoices

 8-12months

• pulls self to standing position when handsheld
• raises self to sitting position
• sits withoutsupport
• stands by pulling themself up usingfurniture
• stepping movements aroundfurniture
• successfully reach out and grasptoy
• transfers objects from hand tohand
• picks up and pokes small objects with thumband finger
• picks up and throws smallobjects
• holds biscuit or bottle
• crawls
• mature crawling (quick andfluent)
• may stand alonemomentarily
• may attempt to crawl up stairs
• grasps spoon in palm, but poor aim of foodto mouth
• uses hands to feedself
• alerts peripheralvision

rolls ball and crawls toretrieve

1-2yrs

• walks, climbs andruns
• takes two to three steps without support,legs wide and hands up forbalance
• crawls upsteps
• dances in place tomusic
• climbs onto chair
• kicks and throws aball
• feedsthemselves
• begins to run (hurriedwalk)
• scribbles with pencil or crayon held infist
• turns pages of book,two or three pages at a time
• rolls large ball, using both hands andarms
• finger feeds efficiently
• beginstowalkaloneina‘totteringway’,with frequentfalls
• squats to pick up an object
• reverts to crawling if in ahurry
• can drink from acup tries to usespoon/fork

Gross motor skills-Gross motor skills involve the larger muscles in the arms, legs and torso. Gross motor activities include walking, running, throwing, lifting, kicking, etc. These skills also relate to body awareness, reaction speed, balance and strength. Here are general guidelines for gross motor development for children ages 0 to 5 years.  

• months –Can raise head when pulled to sitting position 
• months -Rolls from back to side 
• months -Rolls from back to front 
• months -Can raise chest and upper part of abdomen (when on stomach) 
• months -Can bear weight on one hand while exploring with the other hand (when on stomach) 
  • months-Sits alone 
  • months -Crawls 
  • months -Cruises around furniture 
  • months -Reaches actively for toy (when in sitting position) 

11-12 months -Pulls to a standing position 

15 months -Walks alone well 

• Squats and stands back up 
• Walks up and down steps holding hand 

18 months -Can run, though falls easily 

2 years 

• Walks and runs fairly well 
• Can jump with both feet 
• Can climb stairs without support 
• Can kick a ball 

Fine motor skills

The movement and use of hands and upper extremities, fine motor skills include reaching, grasping and manipulating objects with your hands.

3 months  

• Holds small object in hand (without thumb tucked in hand) 

5 months  

• Reaches for toy 
• Briefly holds toy 

6 months 

• Follows objects with eyes in all directions 

7 months 

• Transfers objects from one hand to the other 

8 months 

• Keeps hands open and relaxed most of the time 
• Starting to have ability to pick up small foods, like Cheerios 

10 months  

• Able to release an object voluntarily 
• Gives toy to caregiver when asked 

14 months  

• Likes to explore, turn pages of cardboard books 

15 months 

• Puts objects/toys in a container 

16 months  

• Uses both hands to play 
• Points at objects with index finger 
• Can isolate index finger with other fingers closed 

17 months 

• Can build a block tower using 3-4 blocks 

SPEECH AND LANGUAGE SKILLS:

 Speech means making the sounds that make words. Speech issues include difficulties in the pronunciation of sounds (articulation), stuttering, or physical problems with a child’s mouth that interfere with talking and eating. Language means using words and sentences to express wants, needs or ideas. Language development relates to the understanding of spoken information (such as following directions or understanding concepts, like “big and little”) and expression/talking (such as using sentences, asking questions and telling stories). 

Newborn to 3 months 

• Listens and responds to voice and other sounds
• Tells feelings by cooing, gurgling, smiling and crying
• Vowels will predominate, but they will begin to vocalize with 2 syllables
• Cognitively, the child will begin exploratory play by mouthing and touching objects; will begin to watch speaker’s eyes and mouth

4-6 months 

• Turns to your voice and other sounds
• Begins to respond to own name
• Laughs or squeaks; babbles a series of syllables
• Varies volume, rate and pitch by playing with sounds
• Cognitively, the child begins to play; visually follows a vanishing object; inspects objects; reaches to grab a dropped object

7-12 months

• Recognizes family members, pays attention to music or singing, looks at named pictures with an adult
• Obeys some commands, especially if accompanied by visual cues (e.g., bye-bye), begins two syllable sentence-like jargon
• By 12 months, may speak one or more words
• Cognitively, the child will use trial and error approach to attain a goal; increases imitation; uses common objects appropriately

12-18 months

• By 18 months, produces/uses approximately 15 meaningful words
• Asks for “more,” points to pictures in a book
• Cognitively, gives a toy if asked; removes lid of a box to find a hidden toy; explores environment; imitates several new gestures

18-24 months 

• Likes rhyming games; pulls a person to show them something; uses “I” and “mine,” names most common objects
• Uses short incomplete sentences (e.g., “want juice”, “ car go.”)
• By 24 months, the child may understand (but not necessarily use) 200-300 words
• Cognitively, knows shapes; sits alone for short periods with books; matches familiar objects; comprehends one and many; points to body parts

SOCIAL SKILLS-This is the child’s ability to interact with others, including helping themselves and self-control. Examples of this type of development would include: a six-week-old baby smiling, a ten-month-old baby waving bye-bye, or a five-year-old boy knowing how to take turns in games at school.

0-4months

• smiles andlaughs
• makes eye contact when held with face about20cm from face of adult looking atthem
• may sleep most of thetime
• alert and preoccupied withfaces

moves head to sound ofvoices

4-8months

• reactswitharousal,attentionorapproachtopresence of another baby or youngchild
• responds to ownname
• smiles often and shows excitement when sees preparations being made for meals or forbath

recognises familiar people and stretches arms to be pickedup

8-12months

shows definite anxiety or wariness at appearance of strangers

1-2yrs

• begins to cooperate whenplaying
• may play alongside other toddlers, doingwhat they do but without seeming to interact (parallelplay)

curious and energetic, but depends on adult presence forreassurance

EMOTIONAL SKILLS:

0-4months

• bonding
• cries (peaks about six to eight weeks) and levelsoff about 12-14weeks
• cries when hungry or uncomfortable and usually stops whenheld

shows excitement as parent prepared tofeed

4-8months

• becoming more settled in eating and sleepingpatterns
• laughs, especially in socialinteractions
• may soothe self when tired or upset by suckingthumb ordummy
• begins to show wariness ofstrangers
• may fret when parent leaves theroom

happy to see faces theyknow

8-12months

• actively seeks to be next to parent orprincipal caregiver
• shows signs of anxiety or stress if parentgoes away
• offers toy to adult but does not releaseit
• shows signs of empathy to distress of another(but often soothes self)

actively explores and plays when parentpresent, returning now and then for assurance and interaction

1-2yrs

• may show anxiety when separatingfrom significant people in theirlives
• seeks comfort when upset orafraid
• takes cue from parent or principal carerregarding attitude to astranger
• may ‘lose control’ of self when tiredor frustrated

assists another in distress by patting, making sympathetic noises or offering materialobjects

COGNITIVE SKILLS: the learning and use of language; the ability to reason, problem-solve, and organize ideas; it is related to the physical growth of the brain.

0-4months

smiles andlaughs

• looks toward direction ofsound
• eyes track slow moving target for briefperiod
• looks at edges, patterns with light/dark contrastand faces
• imitates adult tongue movements when beingheld/ talkedto
• learns through sensoryexperiences

repeats actions but unaware of ability to cause actions

4-8months

• swipes at danglingobjects
• shakes and stares at toy placed inhand
• becomes bored if left alone for long periods oftime
• repeats accidently caused actions that areinteresting
• enjoys games such as peek-a-boo orpat-a-cake
• will search for partly hiddenobject
• able to coordinate looking, hearing andtouching
• enjoys toys, banging objects,scrunching paper
• explores objects by looking at and mouthingthem
• develops preferences forfoodsexplores objects withmouth

8-12months

• moves obstacle to get at desiredtoy
• bangs two objects held in handstogether
• responds to ownname
• makes gestures to communicate and tosymbolise objects, e.g.points to something they want
• seems to understand some things parent or familiar adults say tothem
• drops toys to be retrieved, handed back, then dropped again/looks in direction of droppedtoy
• smiles at image inmirror
• likes playing withwater
• shows interest in picturebooks
• understands gestures/responds to ‘byebye’
• listens with pleasure to sound-making toysand music notices difference and showssurprise

1-2yrs

• repeats actions that lead to interesting/ predictable results, e.g. bangs spoon on saucepan
• points to objects when named
• knows some body parts
• points to body parts in a game
• recognises self in photo or mirror
• mimics household activities, e.g. bathing baby, sweeping floor
• may signal when s/he has finished their toileting
• spends a lot of time exploring and manipulating objects, putting in mouth, shaking and banging them
• stacks and knocks over items
• selects games and puts them away
• calls self by name, uses ‘I’, ‘mine’, ‘I do it myself’
• will search for hidden toy

What if my child does not meet a developmental milestone?
Each child is an individual and may meet developmental milestones a little earlier or later than his peers. You may have heard people say things like, “he was walking before he turned 10 months, much earlier than his older brother etc. This is because each child is unique and will develop at his or her own pace.

However, observing and monitoring child development is an important tool to ensure that children meet their ‘developmental milestones’.The earliest possible detection (and early intervention treatment if appropriate) of developmental challenges can be helpful in minimizing the impact these developmental hiccups can have on a child’s skill development and subsequently their confidence, or serve as an indicator of a possible future diagnosis.

Whom to consult if the child does not meet a developmental milestone?

Problems in child development can arise due to: genetics, prenatal circumstances, the presence of a specific diagnosis or medical factors, and/or the lack of opportunity or exposure to helpful stimuli.As the process of child development involves multiple skills developing simultaneously, there may then be benefit in consulting multiple professionals.

 Specific assessment by the best fit professional (which may initially be the General Physician or Paediatrician, and then Occupational Therapist, Speech Therapist, Psychologist and/or Physiotherapist) can provide clarity about the developmental issues and extent of concern as well as can help to formulate a plan to overcome the challenge(s).

What happens during the evaluation?

The team will talk to you to get more information about your concerns and what your child is and isn’t yet able to do. They’ll also:

• Ask questions about your child’s medical history.
• Observe your child playing or interacting with family members. (They might ask you if what they’re seeing is typical.)
• Do play-based evaluations where the team asks your child to do certain developmental tasks.
• Use standardized tests or other methods to learn about your child’s skills
• After the evaluation, you’ll meet with a team of professionals to review the results. They’ll share how your child did in each area. Be sure to ask questions and be honest if you disagree with any of the findings. The results help determine if your child is eligible for early intervention services.

How can I help my child meet these developmental milestones?
As parents, we all want our children to succeed and be the best they can be. We know from research that two factors influence how your child succeeds and grows: genes and environment.We often think we need to run out and buy special toys, music and games to stimulate our child’s development, but we have to remind ourselves that it is more important to provide the following, every-day activities you can do with your child to encourage brain development.

• Give your child lots of love and attention. No matter what a child’s age, holding, hugging, and listening are important ways to show your child they matter.
• Interact with your child by talking, singing, playing, eating, and reading with your child. Your child will grow up feeling special and important to you. You will also learn a lot about your child’s interests and skills.
• Read, read, read. Research has shown that children who are read to by their parents have a larger vocabulary than other children. Reading also provides children with new perspectives about the world we live in.
• Learn some simple parenting skills for helping your child to learn how to behave. The most important parenting skills are having consistent rules, rewarding behaviors you want to see your child do more of, and having consequences for behaviors you do not want your child to continue to do.
• Limit TV time and video time to no more than 1-2 hours of educational viewing per day.

Need for EARLY INTERVENTION:

The purpose of early intervention is to lessen the effects of the disability or delay. Services are designed to identify and meet a child’s needs in five developmental areas, including: physical development, cognitive development, communication, social or emotional development, and adaptive development.

The main purpose behind early invention is that a child’s developmental delays can be addressed best when they are discovered early.

 The Early Intervention Program for Infants and Toddlers with Disabilities is a federal program that provides for services and supports to children birth through 2 years old at risk for developmental delays or disabilities. These services can include speech–language therapy, occupational therapy, physical therapy, assistive technology, and more.

Research shows that early intervention treatment services can greatly improve a child’s development.

• Early intervention services help children from birth through 3 years of age (36 months) learn important skills.
• For children age 3 and older with an identified developmental delay or disability, special education services may be needed
• If your child appears to be experiencing developmental challenges, getting support early and understanding exactly how services can help is essential.   Opportunities for play with a caregiver or Early Intervention specialist can facilitate the development of the skills needed for problem-solving, self-control, socialization and communication.

CONCLUSION:

As soon as you notice a development delays consult your Pediatrician and go for Developmental Evaluation.

There are lots of benefits of Early Intervention for children. And the sooner a child starts , the more effective it tends to be.

However, some children may have trouble mastering the skills .They might experience issues with physical(fine or gross motor skills), sensory processing, cognitive and academic skills etc . In those cases,  pediatric occupational therapy  can make a big difference.

An OT would look for your  your child’s strengths  and areas of weakness.

An OT can evaluate and identify the areas of concerns and provide you right intervention, tips, strategies and social activities to use in everyday situations