Developmental

Disorders: Part I
Surg Cdr RW Thergaonkar

Introduction
What is the difference between growth

and development?
Growth: a net increase in the size or
mass of tissues, related to
multiplication and cells and increase in
size
Development: maturation of functions,
related to myelination of nervous
system

Developmental
Milestones
Age

Gross Motor

Fine Motor

1 mth
3
mths

Head control

4
mths

Language

Social

Turns head
to sound

Social Smile

Keeps hands Cooing

open

Recognizes
mother

Voluntary
grasp

5
mths

Sitting with support

6
mths

Supine to prone

7
mths

Intentional
reach
Monosyllabl
es

Smiles at
image

Bisyllabes

Waves bye-

Palmar
grasp

8
mths

Sitting without
support

Standing with support

Pincer grasp

Developmental
Milestones
Age

Gross Motor

Fine Motor

Language

Social

10
mths

Walking with support

11
mths

Crawling / Creeping

12
mths

Standing without
support

Two words
with
meaning

Plays a
simple ball
game

13
mths

Walking without
support

18
mths

Running

Ten words
with
meaning

24
mths

Walking upstairs

Simple
sentence

Developmental
Milestones
Age

Gross Motor

Fine Motor

Language

Social

Alerts to
sound

Social Smile

Keeps hands
open

Cooing

Recognizes
mother

Voluntary grasp
Bidextrous reach

Laughs loud

Unidextrous
reach

Monosyllable
s

1 mth
3
mths

Head control

4
mths
5
mths

Rolls over
Sitting with
support

6
mths

Supine to prone

Recognizes
strangers,
Smiles at
image

Developmental
Milestones

Age

Gross Motor

Fine Motor

Language

Social

6
mths

Supine to prone

Unidextrous
reach

Monosyllable
s

Recognizes
strangers,
Smiles at
image

Bisyllabes
(babbling)

Waves byebye

7
mths

Palmar grasp

8
mths

Sitting without
support

9
mths

Standing with
support

Immature Pincer
grasp

Developmental
Milestones

Age

Gross Motor

10
mths

Walking with
support

11
mths

Crawling /
Creeping

12
mths

Standing
without support

13
mths

Walking without
support

15
mths

Walks alone,
creeps upstairs

Fine Motor

Language

Social

Mature Pincer
Grasp

Two words
with
meaning

Comes
When Called
Plays a
simple ball
game

Imitates Scribble,
Tower of 2 Blocks

Jargon

Developmental
Milestones

Age

Gross Motor

Fine Motor

Language

Social

18
mths

Running

Scribbles,
Tower of 3 Blocks

8-10 words
with meaning

Copies
parents

24
mths

Walking
upstairs

Vertical and
Circular Strokes,
Tower of 6 Blocks

Simple
sentence
with 2-3
words

Asks for
food, drink,
toilet

36
mths

Alternate Feet
Upstairs
Riding tricycle

Copies Circle,
Tower of 9 Blocks

Asks
questions

Shares toy,
Knows full
name and
gender

Caveats in Assessing
Development
Milestones: different for different children;

sequence is the same

Attempt is very important
Delay in one particular sphere is significant
Scales can be more objective, e.g. Denver II,
Trivandrum scale
One should know minor variations
Sequential examination is important
DO NOT PREDICT!!!!

Developmental Disorders
Evening colic
Stranger anxiety
Temper tantrums
Feeding problems
Repetitive behaviors
Masturbation
Stuttering
Pica

Evening Colic
Intermittent episodes of abdominal pain and
severcrying
Cause: Unknown ?? Overactive baby, anxious
parents, hunger, aerophagy, immaturity of
intestine, TRANSIENT HYPERRESPONSIVENESS
Clinical Features
Age: 3 weeks to 3 months
Sudden onset, evening/night
Red face, legs drawn up, tense abdomen
Diagnosis: Infant crying >3 hrs / day; > 3 wks

Evening Colic
Management
Counseling

Normal occurrence, no underlying disease, self limited

Parents: take rest when you can!

Manouvers (5 S)
Swaddle
Side position
Sound
Swing
Suck
Drugs

Simethicone: little benefit

Dicylcomine: effective but dangerous

Stranger Anxiety
Not to be confused with stranger reaction
Clinical Features
Intense discomfort on approach by stranger
Continuous crying, vomiting, refusal to socialize
Management
Reassurance to parents
Gradual exposure of infant to strangers

Repetitive Behaviors
Occur in normally developing children
Biological and environmental factors
Occur in low and high arousal state
Behaviours include:
Body rocking
Head Banging
Thumb Sucking & Nail Biting
Breath Holding Spells

Repetitive Behaviors
Body Rocking
Infancy
Rhythmic forward and backward swaying
Sitting position

Head Banging
Infancy/toddlerhood
Rhythmic hitting of head on a solid surface
Risks: callus formation, abrasions, contusions
Management: Counselling, padding the surface

Breath Holding Spells

Not really a repetitive behavior but

management is similar
Reflexive event following a provoking event
Clinical Features
Provoking event
Cry
Breath Holding
Loss of tone/ consciousness

Pallor/Cyanosis

Breath Holding Spells

Differential Diagnosis
Seizure
Cardiac Arrhythmia
Treatment
Parental reassurance: Will not harm child
Correct iron deficiency

Repetitive Behaviors
Thumb Sucking / Nail Biting
Second year of life
Used for bedtime and other stressful situations
(self-calming behavior)
Usually seen in children aged 1-4 years and
disappears spontaneously
Sequelae: if continued beyond 4-6 years
Dental problems: anterior open bite, decreased

alveolar bone growth, mucosal trauma, altered

growth of facial bones
Paronychia, digital deformity

Repetitive Behaviors
Thumb Sucking / Nail Biting
Management:
Evaluate events around thumb-sucking
Correction is required after 4 years
Cooperation of child is a must
Positive and negative reinforcement
Physical barriers/aversive taste substance

Temper Tantrums
18 to 3 years
Quest for autonomy
Negativism/Oppositionalism: child wants to do

exactly the opposite of what is asked

Manifestatiuon: physical aggression or
resistance e.g biting, kicking, crying, throwing
objects
Resolution at age 3-6 years

Temper Tantrums
Management
Prevent injury
Parents need to be calm, loving, firm nd

consistent
Allow task mastery
Minimize restrictions
Ignore the tantrum
Use time-out

Masturbation
Preschool child
Rubbing of thighs, genital stimulation,

swaying
Allay maternal anxiety

Stuttering
Age 2 to 5 years
Defect in speech characterized by hesitation,

stumbling and spasmodic repetition

Difficulty in pronouncing initial consonants
Increases when playmates ridicule or parents
pressurize
Management
Reassurance
Singing / recitation
Speech therapy for older children

Pica
Mouthing of non-edible objects
Normal upto age 2 years
Persistence > 2 yrs is abnormal
More common in lower socio-economic strata

Risks
Helminthiasis
Foreign body inhalation / ingestion
Lead poisoning
Management
Supervision
Behaviour management

Not Covered
Enuresis
Maladjustment
Television and children
Poor School Performance
Learning Disability
Autistic Spectrum Disorders
Attention Deficit Hyperactivity Disorders

Thank you!