18 Questions
What is the typical age range for a child to develop a mature pincer grasp?
9-12 months
At what age can a child typically make a tower of 5-6 cubes?
3 years
What is the typical age range for a child to start using monosyllables?
6-9 months
When does a child typically develop handedness?
2-3 years
What is the typical age range for a child to start playing simple ball games?
9-12 months
What should be done if a child does not attain a milestone by the upper age limit?
Evaluate for possible cause of delay in development
According to the developmental milestones, what is the typical age for attaining the milestone of walking without support?
12 months
Which of the following is NOT a domain of development in childhood?
Cognitive
At what age does a child typically attain the milestone of standing with support?
8 months
What is the typical sequence of attainment of gross motor milestones in childhood?
Cephalo-caudal direction
At what age does a child typically attain the milestone of climbing with 1 foot/step upstairs?
3 years
What is the typical age range for attaining the milestone of rolling over?
3-4 months
At what age is the milestone of sitting typically achieved?
10 months
What is the upper age limit for achieving the milestone of walking?
18 months
At what age is the milestone of single words typically achieved?
18 months
What is the formula for calculating the developmental quotient (DQ)?
DQ = (Developmental age / Chronological age) x 100
What is the definition of global developmental delay?
Delay in ≥ 2 domains
What is the cause of nocturnal enuresis?
Maturational delay of bladder
Study Notes
Fine Motor Milestones
- Bidextrous grasp is attained at 4 months
- Unidextrous grasp: Ulnar (Immature) palmar grasp is attained at 6 months
- Unidextrous grasp: Radial (Mature) palmar grasp is attained at 8 months
- Immature pincer grasp (Hold with sides of fingers) is attained at 9 months
- Mature pincer grasp (Holds with tip of fingers) is attained at 12 months
- Makes tower of 2 cubes at 12 months
- Makes tower of 3-4 cubes at 18 months
- Draws line, makes tower of 5-6 cubes at 2 years
- Draws circle, makes tower of 8-9 cubes at 3 years
- Draws cross at 4.5 years
- Draws square at 5 years
- Draws triangle at 6 years
- Handedness develops by 3 years
Language Milestones
- Cooing (Musical) sound is attained at 3 months
- Monosyllables are attained at 6 months
- Bisyllables are attained at 9 months
- 1-2 words (Meaningful) are attained at 1 year
- 8-10 words are attained at 18 months
- Sentences are attained at 2 years
- Recognises and tells name, age, and gender at 3 years
- Tells story and rhymes at 4 years
Social Milestones
- Social smile is attained at 2 months
- Mother regard is attained at 3 months
- Stranger anxiety, smiles at mirror image is attained at 6 months
- Waves bye-bye, plays “peek a boo” at 9 months
- Simple ball game is attained at 1 year
- Parallel play (Non-interactive) is attained at 2.5-3 years
- Group play (Interactive play) is attained at 4 years
Red Flag Signs in Development
- If milestones are not attained by the upper age limit, evaluated for possible cause of delay in development
Precocious Puberty
- Caused by Central or Peripheral CNS (Pituitary & hypothalamus related) functioning tumors of ovary or testis
- Eg: McCune-Albright syndrome (triad)
- Hypothalamic hamartoma
- Precocious puberty (ovarian cysts)
- Polyostotic fibrous dysplasia
- Cafe-au-lait macules
- Gliomas
Developmental Milestones
- 4 domains of development: Gross motor, Fine motor, Language, Social
Gross Motor Milestones
- Neck holding is attained at 3 months
- Roll over is attained at 4 months
- Sit with support, Tripod posture is attained at 6 months
- Sit without support, crawling is attained at 8 months
- Stand with support, creeping is attained at 10 months
- Stand without support, walk with support is attained at 12 months
- Walk without support is attained at 15 months
- Running is attained at 18 months
- Climbing with 2 feet/step is attained at 2 years
- Climbing with 1 foot/step: Upstairs, rides tricycle is attained at 3 years
- Climbing with 1 foot/step: Downstairs, hops is attained at 4 years
Developmental Quotient
- Developmental quotient = Developmental age (DA) x 100 / Chronological age (CA)
- Developmental delay: DQ < 70
- Global developmental delay: Delay in ≥ 2 domains → Significant brain problem (E.g: Cerebral palsy)
Nocturnal Enuresis
- Categories:
- a. 10: Never dry since birth (M/C)
- b. 20: Previously dry child
- Cause: Maturational delay of bladder
- Management:
- a. Ist line of Rx: Non-pharmacological → Motivation therapy + alarm therapy
- b. 2nd line: Desmopressin (Preferred, oral), anti-cholinergic (Oxybutynin)
Nutrition
- Breastfeeding: Breast milk: 67 kcal/100ml
- Properties of breastmilk:
- Nutrition: Lactose, Proteins, Fat
- Immunological (PLAB): Colostrum (1st formed milk): Rich in IgA
- Brain growth factors:
- Whey protein
- Taurine & cysteine
- PUFA: Docosa Hexaenoic Acid (DHA)
Test your knowledge of the fine motor skills milestones in infant development, from 4 months to 4.5 years. Covers grasping, pincer grasp, and tower building skills. Identify the age ranges for each milestone and assess your understanding of child development.
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