Tools to assess developmental milestones and scope of Homoeopathy

Dr Ayfoona Rahiman P.S

ABSTRACT
Developmental milestones are markers of infant and child skill attainment occurring in predictable sequences over time.

They can be used by parents and clinicians to promote healthy development by identifying problems as well as to provide opportunities for early intervention

Milestones represent skill development; attainment based on interaction of neurological and physical development, and can be influenced by social or cultural expectations.

There are various tools to assess, includes:

1. Developmental screening
2. The definitive test to define impairment in sphere and degree

INTRODUCTION

A study conducted in cultural diverse group that is particular interest in Canada an aboriginal   population.

These children are in risk living in poor socio economic conditions and are also in risk for poor neonatal outcomes & language problems.

There is lack of monitoring or screening tools validated for these children.

While studies reporting an early developmental milestones attainment for aboriginal children are notably sparse, some research suggest that certain developmental skills including gross motor and fine motor skills may be attained earlier than in general population.

This study concludes that, Milestones achievement may differ for those cultural specific subgroups of children high lightening the importance of establishing culturally specific age range not relying solely on those derived from general populations. ¹

PRINCIPLES OF DEVELOPMENT²

• continous process.
• cephalocaudal progression.
• set sequence.
• functional maturity of nervous system gateway to skill development.
• loss of primitive reflexes and milestones.
• change over from mass activity to organized activity.

METHODS
A literature search was performed using PUBMED, world of science and SCOPUS. The SCOPUS,

The scope of search included English language articles published within last 5 years, including Paediatric subjects ranging from 0 to 18 yrs.

RESULTS
Child development refers to biological, psychological and emotional changes that occurs in human in the period between childhood and adolescence. 

Developmental milestones can be studied under the headings

• First year
• Second year
• Preschool period
• Mid and late childhood

1^st year: ²

• Motor development
• Cognitive development
• Language development
• Emotional development

2^nd year

• Key points: sense of self Esteem and Increased independence
• Motor development
• Cognitive
• Emotional
• Language

PRE SCHOOL PERIOD ( 2 TO 5 YEARS )

3 YEARS	4 YEARS	5 YEARS
RUNS FORWARD	COPIES A CROSS	SWINGS
TURNS SINGLE PAGE OF BOOK	WALKS DOWN STAIRS	SAYS NAME AND ADDRESS
STRING BEADS	USES PLEURAL	DRAWS SQUARE

MID AND LATE CHILDHOOD

• Physical development
• Cognitive development
• Social development
• Emotional

FOUR MAJOR DOMAINS OF DEVELOPMENT²

1. Gross Motor
2. Fine Motor
3. Social
4. Language
5. Vision

GROSS MOTOR	FINE MOTOR
Head/Neck holding:3 months	Grasping a rattle : 4 months
Sitting with support : 5 months	Reaching out for a bright object : 4 to 5 months
Sitting without support : 7 to 8 months	Transferring object from one hand : 6 months
Walking without  support  : 12 -14 months	Transferring object from one hand to other : 6 to 7 months
Running  : 18 months	Hiding an object with crude palmar grasp : 7 months
Running comfortably : 24 months	Holding an object between index finger and thumb : 9 to 12 months
Climbing stairs  : 24 months
Riding tricycle : 3 years

SOCIAL /ADAPTIVE	LANGUAGE
Social smile : 6 to 8 months	Turning head to sound : 1 month
Recognition of mother : 3 months	cooing : 3 months
Stranger anxiety : 6 months	Laughing : 4 months
Smiling at mirror image : 6 months	Monosyllabic : 6 months
Wave Bye Bye : 9 months	Bisyllabic:9 months
Playing a simple ball game : 1 year	2 words with meaning :1 year
Copying parents /care taken :18 months	Simple sentence : 2 years
Asking for food , toys ,toilet :2 years	Telling a story and a rhyme : 3 to 4 years
Knowing gender and name : 3 years	Account of recent events : 4 years
Going to toilet alone : 4 years	Enquires of meaning of word : 5 years

TOOLS TO ASSESS

Assessment of development : 2 phases

1. Developmental screening

2. Definitive tests to define impairment in sphere and degree

1) Developmental screening

• Brief testing procedure.
• To identify children who should receive more intensive diagnosis or assessment.
• Essential for detecting abnormal developmental delay.
• Developmental issues expected in 10% of children.

VARIOUS TESTS EMPLOYED

The most widely used screening test detecting developmental delays in infancy and preschool years are DDST.

DENVER DEVELOPMENTAL SCREENING TEST

• Developed in 1967.
• DDST assesses development of infants and preschool children.
• Usually up to 3 yrs.
• Gross motor, fine motor adaptive , language and personal and social behaviour

OTHER SCREENING TESTS

• Baroda developmental screening test.
• Trivandrum developmental screening test.
• Goodenough-Harris Draw-A-Man Test.

DEFINITIVE DEVELOPMENTAL ASSESSMENT TEST

• Beyley scale for infant development II
• Wechler intelligence scale for children
• Stanford binet intelligence scale
• Vineland social maturity scale
• Gassels DST
• Woodside DST

HOMOEPATHIC RUBRICS FOR DEVELOPMENTAL ISSUES :Children – DELICATE, puny, sickly brom. Calc-p. Caust. irid-met. Lyc. mag-c. phos. psor. SIL.

Children – DEVELOPMENT, delayed or arrested : aeth. Agar. bac. BAR-C. borx. Calc. CALC-P. CARC.

Children – BULIMIA : Carc. ign. iod. nat-m. puls. staph.

Children – CAPRICIOUS, children : calc-p. carc. Cham. Cina ign. merc. puls. sacch.

Children – CLINGING, child, awakens terrified, knows no one, screams, clings to those near: Acon. Ars. BORX. cham. cina stram

CONCLUSION
Developmental milestones and growth chart are important tools of Paediatric screening. Growth chart are used to assess height and weight for age, while developmental milestones helps to define physical, intellectual, and behavioral skills. Child growth and development are assessed during routine well-child visits at regular intervals. Children whose growth and weight are far below or above average and those who do not meet their developmental milestones for their age group should be evaluated for underlying diseases and receive treatment accordingly.

REFERENCES

1. Findlay L, Kohen D, Miller A. Developmental milestones among Aboriginal children in Canada. Paediatrics & child health. 2014 May 1;19(5):241-6.
2. Sinha IP. Nelson textbook of pediatrics. InSeminars in Fetal and Neonatal Medicine 2012 Dec 1 (Vol. 17, No. 6, p. 380). Elsevier.

Dr Ayfoona Rahiman P.S
Department of Paediatrics
GHMC Bangalore