In the largest group of children with developmental delay, the causes are unknown. The following are some known causes: Abnormality in Embryonic Development Prenatal insult (e.g., intrauterine, drug) Chromosomal (e.g., Down syndrome) Hereditary and Genetic Disorders Inborn errors of metabolism Preconceptual genetic abnormalities Environmental and Social Problems Parental psychological/social problems with insufficient stimulation of child Childhood mental health disease Other Pregnancy or Perinatal Problems Fetal (e.g., placental insufficiency) Perinatal (e.g., prematurity) Childhood Diseases Infection (e.g., meningitis) Trauma
Severe chronic disease *Many disorders cause delays in more than one milestone.
The DDST is a highly specific screening test, so most normal children score as normal, but it is not very sensitive. Many children with mild developmental delay also score as normal. In particular, the language section of the DDST is sparse; it will miss children with mild language delay. While the DDST is a useful screening test, other more sophisticated tests are available for specialists to use to assess motor, language, and social development. You should use the DDST as an adjunct to a comprehensive de-
velopmental examination. When delays are suspected from the general examination or DDST, further evaluation is warranted.
For babies born prematurely, adjust the expected developmental milestones for the gestational age up to about 12 months of age.
All kids are gifted; some just open their packages earlier than others.
H Assessing Early Childhood_
One of the most difficult challenges facing the clinician examining children in this age group is avoiding a physical struggle, a crying child, or a distraught parent. Accomplishing this successfully is satisfying to all and is one aspect of the "art of medicine" in the practice of pediatrics.
Gaining the child's confidence and allaying the child's fears begin at the start of the encounter. The approach varies with the circumstances of the visit. A health supervision visit for a well child allows greater rapport than a visit when the child is acutely ill.
Letting the child remain dressed during the interview makes her less apprehensive. It also allows you to interact more naturally and observe the child playing, interacting with her parents, and undressing and dressing.
Toddlers who are 9 to 15 months may have stranger anxiety, a fear of strangers that is developmentally normal. It signals the infant's growing awareness that the stranger is "new." You should not approach these infants
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