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devp delay ppt

Developmental delay refers to significant delays in acquiring skills in one or more developmental domains, with Global Developmental Delay affecting 1-3% of children under five. The etiology is multifactorial, including prenatal, neonatal, post-neonatal, and psychosocial factors, and common concerns include delays in walking, speech, and social interactions. Management focuses on maximizing developmental potential through a multidisciplinary team approach, with early detection and intervention being crucial for better outcomes.

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Hunar Yadav
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23 views

devp delay ppt

Developmental delay refers to significant delays in acquiring skills in one or more developmental domains, with Global Developmental Delay affecting 1-3% of children under five. The etiology is multifactorial, including prenatal, neonatal, post-neonatal, and psychosocial factors, and common concerns include delays in walking, speech, and social interactions. Management focuses on maximizing developmental potential through a multidisciplinary team approach, with early detection and intervention being crucial for better outcomes.

Uploaded by

Hunar Yadav
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Developmental Delay

Part 2
What is Developmental
delay?
• It is a term for the child who has significant
delay in the acquisition of milestones or skills ,
in one or more domains of development.
• Global Developmental Delay (GDD) is defined
as a delay in two or more developmental
domains.
• GDD affects 1-3% under 5 children.
• Better term Early Developmental
Impairment(EDI).
delays…deviations…dissociations…regression

• Deviance…when a child develops skills outside


of the typical sequence.
• Dissociation…term used for a child who has
widely differing rates of development in
different developmental domains.
• Developmental Regression is the term used
for a child who loses previously acquired skills
or milestones, often linked with serious
neurological and inherited metabolic disorders
Etiology -The etiology of developmental delay is multifactorial.

• Prenatal factors –
– Genetic
– Maternal factors – nutrition, exposure to drugs
and toxins, smoking.
– Maternal diseases and infections
• Neonatal risk factors –
– SGA
– Prematurity
– Perinatal asphyxia
– Hyperbilirubinemia
Contd..
• Post neonatal factors
– Infant and child nutrition
– Infectious diseases
– Environmental toxins
– Acquired insults to the brain
– Associated impairments
• Psychosocial factors
– Parenting
– Lack of nurturing conditions
– Violence and abuse
– Maternal depression
– Institutionalization
• Common concerns which are often raised are
children who are -
– not walking independently by 18 months of age,
– those who have not developed speech by 2 years of age
and
– those who have abnormal social interactions.

• Intellectual disability (ID) tends to be reserved for


children over the age of 5 where more reliable
learning assessments can be carried out.
Clinical Approach

• History of presenting concerns –


– Detailed development history, please remember
chronological age requires to be corrected for prematurity till
2 years of age.
– History and observation about social interaction and play skills
– Feeding and sleep patterns
– Behavioural history
– History of seizures
– Family history with 3 generation pedigree and h/o
consanguinity, miscarriages or neonatal deaths.
– Antenatal and Birth history.
General examination

• Height , weight and Head circumference


should be plotted in a growth chart
• Pallor, knuckle hyperpigmentation
• Neurocutaneous markers
• Dysmorphic features
• Stigmata of congenital infections
• Spine
Systemic examination

• Organo-megaly
• Detailed neurological examination with fundus
examination.
• Diagnosis is largely based on
– presenting concerns and features,
– detailed history,
– thorough clinical examination, and
– targeted individualized investigations for the
etiological workup
Development Screening Tests -
procedure designed to identify children requiring detailed assessment

• Phatak’s Baroda screening test – upto 30


months….child psychologist is involved.
• Ages and stages Questinnaire (ASQ-3) – parents are
asked questions .. 1 m – 5 yr.
• Denver II – (Denver development screening test)
• TDSC ( Trivandrum development screening chart)
• Clinical adaptive test and clinical linguistic and auditory
milestone scale (CAT/CLAMS) – cognitive and language
skills – birth to 3 years
• Goodenough- Harris drawing test
Definitive tests –
are required once screening tests is abnormal
• Bayley scale for infant development IV
• Wechsler intelligence scale for children IV
• Stanford – Binet Intelligence scale
• Vineland adaptive behavior scale IV
• Development assessment scale for indian
infants (DASII)
Developmental red flags
(any age)
• Loss of developmental skills (regression)
• Parental or professional concern about visual
impairment, fixing or following
• Hearing loss or not responding to sounds
• Head circumference >99th centile or <0.4th
centile or
• Rapid change in size (crossed 2 centiles)
• Abnormal muscle tone (hypo/hypertonia) or
asymmetry in movement
Developmental red flags - Age specific:

• No social smile by 8-12 weeks


• Persistence of primitive reflexes at 6-8 months
• Not reaching for objects by 6 months
• Not sitting unsupported by 12 months
• No single words by 18 months (especially if not using gestures)
• Casting/mouthing at 18 months
• Not walking independently by 18 months
• Persistent toe walking
• Hand preference before 2 years
• Not sharing interest by 2 years
• Not running by 2.5 years
How do you investigate developmental delay?
• History and examination remain the most crucial aspect
of assessing developmental delay.

– Up to one third of patients can be accurately diagnosed by


history and examination alone
– further third diagnosed following targeted investigations led by
clinical assessment.
– not all children presenting with developmental delay require
investigation.

• In children with abnormal neurology, dysmorphic


features, microcephaly and significant prenatal and
perinatal events, the yield of investigations is significantly
increased.
How do you manage developmental
delay?
• Management of children with developmental delay should focus on
maximizing the child’s developmental potential.
• In children where a diagnosis is found condition specific management
might be available.
• However, in most cases curative treatment will not be available.
• As such, a multidisciplinary team approachwill be required dependant on
the needs of the child with child and family at the centre of care.

• Pediatricians (both in acute and community) are only one


part of the team which should also include involvement from
– physiotherapy,
– occupational therapy and
– speech and language therapy.
Home Based Young Child (HBYC) Program

• Home visits by ASHA on -


3rd..6th..9th..12thand 15th month

– Promoting good child nutrition


– Ensuring age appropriate immunization
– Ensuring optimal early childhood development (ECD)
– Promoting swachh practices
– Ensuring health care seeking behavior
• Under this program , ASHA counsels the family to promote
child development using Mother –child protection card and
other tools.
Take work lessons
• Every health care encounter should provide an opportunity to enquire
about childhood development as part of a holistic assessment.

• History and examination remain the most crucial aspect of assessing


young children with delayed development.

• Be mindful of developmental red flags as these require urgent referral


and assessment.

• Early detection and intervention will improve the outcome of children


with developmental delay.

• More extensive genetic investigations are advancing our ability to


diagnose children with impaired development.
You can take a break before the next class

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