Developmental milestones (childhood): Clinical sciences

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Introduction0:00–1:13

Developmental milestones are behaviors and functional skills that Children are expected to acquire by a specific age. These milestones are typically achieved in a predictable sequence and are divided into five major categories.
Gross motor development, which relates to the movement of large muscles, fine motor development, which relates to the movement of small muscles, cognitive development, which includes reasoning, memory and problem solving, social emotional development, which describes attachment to and interactions with others.
And finally, language development, which consists of receptive and expressive communication. Your overall goal is to assess the child's developmental milestones according to their age.
Using the caregivers report as well as direct observation, understanding, normal developmental milestones will help you recognize when a child is at risk for a developmental delay that would benefit from a more detailed evaluation and early intervention services.
Now, when a pediatric patient presents for assessment of their developmental milestones first obtain a focused history and physical exam during the history.

H&P1:13–2:43

Be sure to review birth history including gestational age and birth weight as both prematurity and low birth weight are associated with developmental delays.
Also ask about family history of developmental delays as some developmental disorders such as autism spectrum disorder have a genetic component.
You should also take an interval history to determine what new skills the child has learned. Since the last clinic visit.
Additionally, observe the interactions between the child and their caregiver and ask the caregiver if they have any concerns about their child's development.
Now, here's a clinical pro to keep in mind, caregivers spend the most time with their child and are often the first to notice when something isn't quite right.
Whenever a caregiver is concerned about their child's development, be sure to investigate further. When it comes to the physical exam, check reflexes, assess muscle tone and test their balance.
Additionally, use this time to observe how the child interacts with the world with their caregiver and with you as this can help you gauge the child's development.
Once you are done with history and physical exam findings, it's time to assess developmental milestones based on the child's age.

3 Years2:43–4:57

Let's start by discussing expected milestones for a three year old. By this age, the child has achieved new gross motor skills including the ability to walk upstairs with alternating feet and without using a handrail.
A three year old can also balance on one leg, walk, heel to toe. When asked pedal, a tricycle and catch a ball.
Fine motor skills are more advanced. And now they are able to draw circles and crosses and cons string small items together like beads or macaroni cognitive skills have become more advanced and the child now can eat independently and are toilet trained.
They can also put on their own shoes, match letters and numbers and understand comparisons like long versus short or hot versus cold from a social emotional standpoint.
They now know their gender and their age and they can point to themselves in pictures, take turns with others and enjoy imaginative play.
Language. Milestones include the ability to use a vocabulary of over 200 words, make three word sentences and use plurals.
The three year old child is also known for asking all the w questions like who, what, when, where and why to strangers. About 75% of their speech is now intelligible.
While you assess your patient for their developmental milestones, keep an eye out for age specific red flags that may signal a developmental delay.
Some red flags to look for in a three year old include difficulty using stairs, inability to form three word sentences and lack of pretend play.
All right. Now let's move on to the milestones of a four year old.

4 Years4:57–7:17

By this age, the child has achieved several more gross motor milestones which include hopping on 1 ft and galloping. Fine motor skills are more advanced.
And now the child can hold a pencil properly. Draw squares and X shapes, write letters and tie a knot.
A four year old has the cognitive skills required to brush their teeth, wash their hands independently and use a fork. They now know their colors and can count to four.
They can also understand analogies such as banana is to fruit as broccoli is to vegetable. Social emotional development.
Now means that the four year old has a favorite friend and enjoys group play. Additionally, they are now able to label emotions and are aware of the concept of deception.
So they might lie to avoid getting into trouble. Newly acquired language skills include the ability to follow three step directions and tell stories.
A four year old uses a vocabulary of 300 to 1000 words and to a stranger. Their speech should be 100% intelligible.
Agespecific red flags to look for at this age include the inability to jump or to answer simple questions. Other red flags include unclear speech, lack of pronoun use and ignoring other Children during play time.
Here's a clinical pearl in the United States. Most Children start kindergarten around the age of five years because early childhood development is important to school readiness and success.
A child is likely ready for school when they can regulate their emotions and impulses, maintain attention and focus and show excitement for learning.
Additionally, receptive language is highly correlated with school success. So encourage caregivers to talk, read and play with their child.
Finally, let's talk about the milestones for a five year old at this age. Newly acquired gross motor skills include walking downstairs with alternating feet while using a handrail, skipping and broad jumping which is when a child takes a running start and makes a big jump forward.

5 Years7:17–9:49

Fine motor skills are becoming more refined. And now the child can draw triangles and cut with scissors.
As far as cognitive development goes, a five year old is able to get dressed and bathe independently and now they can count to 10 by now.
The child also knows right from left and understands the concept of time. Further social emotional development allows the five year old to have a group of friends follow rules when playing games and apologize when they make mistakes with respect to language skills.
They now are able to write their first name, use letters to sound out words and read at least 25 words. A five year old's vocabulary contains around 2000 words and they can answer simple why questions, agespecific red flags that indicate developmental delay in a five year old include poor balance, the inability to draw a square and resistance to daily tasks like dressing, sleeping or toileting.
Also considered developmental delay. Whenever a five year old does not know their shapes, letters or colors can't distinguish between real and imaginary or is unusually fearful, sad, shy or angry.
Here's a clinical pearl. As Children get older and progress through school, the focus of a developmental assessment shifts from discrete milestones to in school behavior and performance during well child visits, you can ask the caregiver about academic progress and teacher feedback.
A child who is succeeding in school is likely on track with their development. While child who is struggling may have a developmental delay, a child who has difficulty focusing during class due to attention deficit hyperactivity disorder or AD HD may benefit from additional support.
Ok. Once you've assessed the child's developmental milestones, assess for age specific red flags.

Assess for red flags9:49–10:34

If red flags are present, then the child may have a developmental delay. So your next step is to administer an age appropriate developmental screening tool to assess and document development.
You should also consider referring the child to a specialist for developmental and behavioral evaluation or hearing and vision screens.
On the other hand, if red flags are absent, then it's likely that development is progressing appropriately. In this case, you can provide reassurance and anticipatory guidance to the family and continue routinely scheduled developmental assessments.
All right, as a quick recap, developmental milestones represent behaviors and skills that Children acquire by a certain age.

Review10:34–11:27

The developmental assessment of a child starts with obtaining a focused history and physical exam. Milestones are assessed by age and divided into five main categories which include gross motor, fine motor, cognitive, social, emotional and language milestones.
Once you've reviewed the developmental milestones, assess the child for red flags. When a developmental red flag is identified during your assessment, proceed with an age appropriate developmental screening tool and consider referral for a diagnostic evaluation of their development.
On the flip side. If you identify no red flags continue routine developmental assessments.