RED FLAGS IN DEVELOPMENTAL DELAY. DR. Monika Bajaj Royal London Hospital

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1 RED FLAGS IN DEVELOPMENTAL DELAY DR. Monika Bajaj Royal London Hospital

2 WHAT I HOPE TO COVER Red Flags in developmental milestones when to refer Cases Red flags to suspect ASD

3 IT IS ABNORMAL IF A CHILD IS NOT WALKING BY 12 months 18 months 2 years

4 MOTOR DELAY.. Poor Head control-4 months NOT sitting 9 months bearing weight -12 months walking -18 months running by 2 ½ yr jumping by 3yr hopping by 5yr

5 He is bottom shuffling DAVID, 2 YEAR OLD, BOY WHO IS NOT YET WALKING can rise from a squat and climb on to a chair obeys simple commands has many words & produces 2-3 word phrases has low tone but normal reflexes in legs hips can be fully abducted Spine is normal

6 DIFFERENTIAL DIAGNOSIS OF LATE WALKING Physiological Bottom shuffling/creeper/roller Failure to correct for prematurity Ligamentous laxity Pathological Part of global developmental delay Cerebral palsy:hemiplegia or diplegia Spinal dysraphism Duchenne s muscular dystrophy Development Dysplasia of hip

7 LEARNING POINTS You need to consider all areas of development Bottom shufflers, rollers, creepers normal variant, walk late Check hips carefully in all late walkers for limited abduction Arrange pelvic radiograph if in any doubt Check tone, power, reflexes, Always check the spine For a late walking male child arrange serum creatinine kinase to rule out muscular dystrophy

8 FINE MOTOR SKILLS Tower of 8 bricks at 2 years Imitate a Vertical line 2 years Circle at 3 years Cross at 4 years Square at 4 ½ years Imitate a bridge made of 3 cubes 3 years Copy 3 Steps 4 years

9 Not reaching with hands at 6 months FINE MOTOR DELAY No index finger exploration by 12 months Lack of purposeful exploration of objects/toys by 12 months

10 PETER, AGED 5 YEARS, IS ASKED TO DRAW A MAN BUT PRODUCES ONLY MARKS THE PAGE

11 DIFFERENTIAL DIAGNOSIS Difficulty comprehending verbal instructions-? ASD Processing difficulties /generalised learning difficulties Severe hypermetropia impairing near vision Difficulty grasping and manipulating the pencil due to hemiplegia Lack of experience of the task due to neglect

12 IT IS ABNORMAL IF A CHILD DOESN T SPEAK BY 12 months 18 months 24 months

13 SPEECH AND COMMUNICATION No clear words by 18 months No word combinations by 30 months Not using 2-3 word phrases by 3 years Not asking what, why questions by 4 years

14 PLAY AND SOCIAL DEVELOPMENT No pointing or other gestures by months No joint attention by 18 months Absence of pretend play -24 months Lack of social interest, solitary play at 3-4 years

15 MOHAMMED, 2 YEAR OLD BOY, PARENTS ARE CONCERNED, HE IS NOT YET SPEAKING

16 OTHER FEATURES Doesn t play with other children Doesn t look at parents /eye contact Doesn t point,pulls his parents to what he wants Very interested in wheels, lights, lines up toys Prefers toys in a certain place or upset Oversensitive to noise /wet Flaps his hand, tip toe walking

17 WARNING SIGNS OF POSSIBLE ASD Not respond to name by 12 months Not point to show interest by 15 months Want to be alone, avoid eye contact Delay or absence of spoken language, echolalia Look through people; not aware of others feelings No interest in peers ; no pretend play by 18 months Lack of joint attention; unable to share pleasure Get upset by minor change; unusual routines Unusual or repetitive hand, finger, body mannerisms Over or under reaction to sensory stimuli

18 Any regression of milestones/loss of skills OTHER WARNING SIGNS AT ANY AGE Hearing or vision loss Tip toe walking

19 Head circumference >99.6 th centile <0.4 th centile Has crossed 2 percentile lines upwards/downwards

20 SUMMARY See the child as a whole Examine growth, head, birthmarks, dysmorphic features Red flags refer immediately Get their vision and hearing checked Encourage to start nursery, HV to monitor If losing skills- refer to Neurology Sleep issues, Bedwetting/daytime wetting,chronic constipation, soiling Genital problems Obesity

21 REFERRALS SEEN AND CONTACT DETAILS Developmental delay Autism, ADHD General paediatrics problems Genitourinary problems Day /night wetting, soiling Sleep issues Obesity BUPA providers online- for practice details Phone Secretary : Katie@medicaladministration.co.uk