Developmental assessment is the process of evaluating a child’s growth and progress across key domains to ensure they are meeting age-appropriate milestones. It helps identify delays or disorders early, allowing for timely intervention and support.
Principles
- Systematic approach: Complete each area of development at a time.
- Simple language: Use simple and clear language that can be understandable by the child.
- A fun activity: Make assessment as a fun giving and motivating activity.
- Quality of skill: The assessment should focus on how best the child can perform the activity for a particular age, not just able to do or not.
- Assistance: Developmental skills can be observed directly or can take assistance from the caregivers.
Core Domains of Development
| Domain | What It Includes |
|---|---|
| Gross Motor | Crawling, walking, jumping, balance |
| Fine Motor | Grasping, drawing, manipulating small objects |
| Language | Babbling, speaking, understanding, following directions |
| Cognitive | Problem-solving, memory, attention, cause-effect understanding |
| Social/Emotional | Interaction with others, empathy, self-regulation, play behavior |
| Adaptive (Self-help) | Feeding, dressing, toileting, daily living skills |
General Guidelines for Developmental Assessment
- Easy to difficult: Start from the activity that the child can do with less effort.
- Progression: Workup gradually until the child can no longer perform the task.
- Gross motor at end: Always try to assess the gross motor milestones at the last; otherwise, child may not cooperate.
- Positioning: Keep the child in optimal position to enhance cooperation during assessment. Children <2 years can be kept on caregiver’s lap, for 2-3 years old we can use small chairs and table/cot/floor for older children.
Types of Developmental Assessment
- Formal assessment: It is carried out by trained personnel using age-specific standardized development assessment tools.
- Informal assessment: It is carried out by health-care personnel (doctors and nurses) and students by comparing book picture with patient picture.
When to Assess
- Routine well-child visits: At 9, 18, and 30 months (per AAP guidelines)
- Autism-specific screening: At 18 and 24 months
- Anytime concerns arise from caregivers, teachers, or clinicians
Developmental History
Accurate history of developmental milestones is often difficult to obtain due to poor observation and educational status of the mother.
The milestones should be asked in chronological order in a simple and lucid manner.
- Ask the mother how the development of the index child (sick child) when compared to his siblings.
- Ask whether the child interacts and plays with other children of his age or likes the company of younger children.
- The effort should be made to identify whether the child is fully retarded or backward (delayed) only in an individual or specific field, for example, delayed speech in deaf child and delayed walking in a child with congenital dislocation of hip.
- In older children, consider the school performance, proficiency in games, motor dexterity, and social behavior.
Developmental Milestones
The child is placed in different postures and positions depending upon his chronological age and assessed for developmental responses.
Note: In preterm babies, corrected age (conception age) should be used as the chronological age.
Ventral Suspension
Suspend the infant in a prone position by supporting the abdomen of the baby on his palm. The extension of neck and flexion of the extremities observed.
Prone Position
The infant is placed on the examination table in a prone position and watched for the position of head, arms, pelvis, and legs.
Supine Posture and Sitting
The infant is placed supine on the couch and pulled to sitting position by lifting at the forearms (traction response).
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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