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You have probably noticed that your child's provider and/or nurse ask what your child has been able to do from a list of "developmental milestones." These are skills in your child's development that are "expected" at specific ages.

The classical tool used by many providers is the Denver Developmental Screening Test [DDST] or the Denver Scale¹ developed by Frankenburg and Dobbs in 1967 and revised in 1992. It screens children from newborn to 6 years and groups their developmental skills into 4 categories: social contact [e.g. smiling], fine motor skills [e.g. grasping, drawing], language [e.g. uttering sounds, combining words], and gross motor skills [e.g. sitting, walking].

The DDST shows in graphic form the ages at which 25%, 50%, 75% and 90% of children can perform each item – therefore, as compared to other children at a given age. It appears to be very useful in identifying normally developing children but may not pick up the child with milder delays or other specific problems. Nonetheless, it is still widely used as just that – a screening tool.

As baby grows and develops, he/she is now able to do more things and parents need to know how to keep the youngster safe in the home setting. Providers will commonly spend time advising parents how to keep the child safe and healthy at home, providing them with written patient educational materials and quality websites. Parents are always encouraged to promote a child's language and pre-academic/ academic development.

So what are "red flags" in a child's development that require more comprehensive evaluation?²

If any of the following are present:

• Loss of developmental skills at any age
• Parental or professional concerns about vision, fixing or following an object OR a confirmed visual impairment at any age [immediate referral to a pediatric ophthalmologist]
• Hearing loss at any age [immediate referral to an audiologist or ENT [ear-nose-throat] specialist
• Persistently low-tone or floppiness
• No speech by 18 months, especially if a child does not communicate by other means such as gestures [immediate referral for a hearing evaluation]
• Asymmetry of movement or other features suggestive of cerebral palsy, such as increased tone
• Persistent toe-walking
• Complex disabilities
• Head circumference greater than the 99th %-ile or below the 0.4th %-ile Or if the circumference has crossed 2 centiles up or down on the appropriate chart OR is disproportionate to parental head circumference
• A clinician is uncomfortable with some aspect of the developmental assessment

If a child cannot do any of the following skills:

• Sit unsupported by 12 mo
• Walk by 18 mo [boys] or 2 yr [girls] – check creatine kinase urgently
• Run by 2.5 years
• Hold object placed in hand by 5 mo [corrected for gestational age]
• Reach for objects by 6 mo [corrected for gestation]
• Point at objects to share interest with others by 2 yr

M-CHAT [Modified Checklist for Autism in Toddlers]³ is a tool commonly used by providers to screen for AUTISM, but easily accessed on the web if a parent is anxious.

Please contact your child's provider if you have any concerns about his/her development. But if there is any difficulty in locating a provider, free developmental screening is available in Converse County by calling 307.358.3901. Child Development Services of Wyoming can also be reached toll-free at 866.996.5437.

¹ https://en.wikipedia.org/wiki/Denver_Developmental_Screening_Test
² Kliegman, Robert M., et al., eds. Nelson Textbook of Pediatrics, Twentieth Edition. Philadelphia: Elsevier, 2016.
³ https://www.m-chat.org/mchat.php