Pediatric Developmental Milestones and Screening Lecture

Speaker: Dr. Bergen, General Pediatrician at UCLA

Introduction

• Dr. Bergen, general pediatrician, not a developmental behavioral pediatrician
• Disclaimer about the lecture content being a repeat from previous trainings
• Condensed 3-hour sessions into 45 minutes
• Apology about impromptu changes in the session due to a colleague's emergency

Developmental Milestones Overview

• Domains of Development
  • Social
  • Language: Expressive and Receptive
  • Motor: Gross and Fine

Gross Motor Milestones

• Newborn: Limited movement, basic reflexes (sucking, rooting)
• 1 Month: Lifting head briefly
• 2 Months: Greater head control, lifts head higher
• 3 Months: Head and shoulders up, up on elbows
• 4 Months: Up on wrists, can roll over from front to back
• 6 Months: Sitting unsupported, some tripodding
• 12 Months: Walking begins
• 15-18 Months: Climbing
• 24 Months: Up and down stairs (one step at a time)
• 3 Years: Mature stair climbing and riding a tricycle
• 4 Years: Hopping on one foot
• 5 Years: Skipping to school

Fine Motor Milestones

• Newborn: Hands mostly in fists
• 1 Month: Fix and track with eyes
• 3 Months: Hands open
• 4 Months: Bringing hands to midline, batting at objects
• 6 Months: Raking grasp, transferring objects between hands
• 9 Months: Immature pincer grasp
• 12 Months: Mature pincer grasp, feeding self with small foods
• 9 Months: Pointing (fine motor, social, and language milestone)
• Encouraged activities: Play-Doh, safety scissors, crayons

Language Milestones

• Newborn: Crying, alert to sound
• 2 Months: Cooing
• 4 Months: Adding consonant sounds (agooing)
• 6 Months: Babbling consonant sounds (mamama, dadada)
• 9 Months: Mama and Dada, non-specific
• 12 Months: Mama and Dada specific, plus one other word
• 24 Months: Two-word combinations, 50 words, 50% intelligible
• 3 Years: Small sentences, plural, 75% intelligible
• 4 Years: Use of past tense, 100% intelligible

Social Milestones

• Newborn: Crying, looking at faces
• 6 Weeks: Social smiles
• 3 Months: Recognizes and prefers parents
• 9-10 Months: Stranger anxiety, pointing, object permanence
• 12-15 Months: Joint attention, social referencing
• Toddler Years: Exploratory behavior, temper tantrums, push-pull dynamics

Developmental Screening and Diagnosis

• Surveillance vs. Screening
  • Surveillance: General questions at each visit
  • Screening: Formal tools at specific ages (9, 18, 24/30 months)
• Screening Tools: Use structured, validated tools
  • Developmental Screening (e.g., MCHAT)
  • Autism-specific screening
• Assessment: Referrals as needed, detailed evaluation for at-risk children

Developmental Delays and Concerns

• Prevalence: 10-15% for developmental and behavioral issues
• IDEA services: Part C (Early Intervention, birth to 3) and Part B (Special Education, 3 and up)
• Language and Speech Delays: Check for hearing issues, exposure, autism, environmental factors
• Intellectual Disability: Caused by various genetic, environmental, or traumatic factors
  • Criteria: Intellectual function and adaptive behavior
  • Common causes: Genetic (Down syndrome, Fragile X), environmental (lead, alcohol), in utero infections, trauma

Autism Spectrum Disorder (ASD)

• Diagnosis (DSM-5): Social communication impairment + repetitive behaviors
• Prevalence: 1 in 68 children, more common in boys
• Screening Tools: MCHAT, ADOS for diagnosis
• Treatment: Behavioral therapies (ABA, floor time)

Attention-Deficit/Hyperactivity Disorder (ADHD)

• Symptoms: Hyperactivity, Impulsivity, Inattention
• Subtypes: Hyperactive, Inattentive, Combined
• Diagnosis Criteria: Symptoms present in more than one setting, evident before age 12, impairing function
• Screening Tool: Vanderbilt
• Treatment: Medication, structured environment, behavioral therapy

Postpartum Depression

• Distinction: Baby blues improve within 2 weeks; postpartum depression can last within the first year
• Risk Factors: Personal history, low social support, stressful socio-economic conditions
• Screening Tools: Edinburgh Postnatal Depression Scale, PHQ-2, PHQ-9

Conclusion

• Always be vigilant for signs of developmental and behavioral issues and intervene early
• Use screening tools consistently
• Educate parents and provide resources for support