MegNotes CCE Pediatrics: Developmental history

Focused history:
If parent/child is presenting with a concern, start with that, go through OLDCARTS, etc.

Otherwise:

Developmental hx:
● Birth Hx:
o Term vs preterm vs post date
o Complications with pregnancy
o Smoking during pregnancy? (RF for ADHD)
o EtOH during pregnancy? (FASD)
o Complications with delivery
o How long did you need to stay in the hospital?
o Any concerns at time of birth

● Milestones:
o See below for details on 2months-5yrs
o 6months: sits independently, transfers objects hand to hand, babbles, stranger anxiety
o 9months: stands, orients to name, separation anxiety
o 12months: walks, talks (1-2 words), pincer grasp
o 24months: does stairs, 50+ words, 50% intelligible, parallel play
o 3 yrs: tricycle, 3 word sentences, imaginative play
o 4yrs: writes letter, tells stories, 100% intelligible, group play
o 5yrs: skipping, writes name, 6-8 word sentences, apologizes for mistakes
o For older kids:
▪ How are they doing in school both academically and socially?
o NOTE: global developmental delay (GDD) must be dx prior to 5yrs old and have ≥2 areas
of delay (motor, language, cognition, social, ADLs)

● Screen for developmental concerns (if relevant):

o ASD
▪ Difficulty with social communication and interactions:

● Does not show joint attention (shared interest in an object/event)-this

should develop between 6-18months
● Do not focus on another person’s eyes when speaking to them

● Lack of body language

 ● Difficulty developing, maintaining, and understanding relationships

● No or little interest in peers, no group or imaginative play

▪ Restrictive, repetitive behaviors/interests/activities

● At least 2 stereotyped/repetitive movements, use of objects, or speech

o Ex. Hand flapping, lining up toys, echolalia
● Insistence on sameness

● Fixated interests (like fixated on an event in history, or a TV show, etc)

● Sensory issues-either hyper or hypo sensitive to touch, pain, sound, etc.

o ADHD
▪ Inattention symptoms:

● Do they have difficulty maintaining attention to play, school, home

activities?
● Careless mistakes?

● Fails to follow through on homework, chores, etc?

● Difficulty organizing tasks/activities/belongings

● Easily distracted by irrelevant stimuli

▪ Hyperactivity symptoms:

● Excessive fidgetiness

● Difficulty remaining seated

● Feels restless, inappropriate running/climbing

● Difficulty playing quietly

● Excessive talking

● Blurts out answers

● Interrupts others

● Seemingly always “on the go”

o FASD
▪ Difficulty with emotional management?
 ▪ Delayed in comparison to peers socially/academically

▪ Poor language/attention skills?

Medical Hx
● Any previous medical conditions?

● Any surgeries?

Any allergies?
Any medications?
● When did the meds start? How long? Any med changes?

Any family hx?

● Medical conditions

● Genetic conditions?

● Any siblings? Same concerns with them at this age?

Social Hx
● Who do you live with?

● House/apartment/etc.?

● Any financial concerns?

● Any smoking in the household?

● Any drug use/EtOH?

Physical exam:
Observe the child:

● Note if they interact with you

● Note speech/emotions

● Are they moving all over the room?

Wt./length/height

FASD

● Short palpebral fissure, thin upper lip, flat philtrum, mid face hypoplasia, micrognathia, ear
abnormalities, high arched palate, epicanthic folds
Investigations:
● Microarray/fragile X testing may be applicable for developmental delay

● IQ testing potentially

Management:
ADHD🡪mood/behavior modification, education, stimulants (concerta, Adderall, Vyvanse),
nonstimulants (atomoxetine, bupropion, guanfacine)

ASD🡪neuroimaging, EEG (if suspect seizures), multimodal treatment with speech therapy, OT, PT, psych

FASD🡪Adapt environment, speech therapy, OT, PT, psych

GDD🡪schedule regular checkups, speech therapy, PT, OT as needed