by Muruvet Elkay, MD YourChildsHealth@tadam.org Lastly, I would like to thank to TADAM for giving me the opportunity of communication with you&your child by offering me this beautiful project.     First of all, I would like to say "Hello" to everybody. I have really a good news for you&your child. Starting from today, I am going to try to give important information about medical problems of your child on this page.   Depending on my schedule, the topic will be changed once every few months, or may be more often, like once a month. Even though the topic will be mainly determined by me, your concerns that I am going to get through the questions will guide me a lot, which means that sometimes you will decide on what subject I need to write about.

Title: YOUR CHILD’S HEALTH BY DR ELKAY Editor: Muruvet Elkay, MD YOUR CHILD’S HEALTH BY DR ELKAY-2 DEVELOPMENTAL DELAY I saw a 1 year-old female patient in my clinic last week, brought by her parents. They were told by her primary physican that their daugther should be seen by a pediatric neurologist. She might be developmentally delayed. She was born as a full term baby, but she could´nt cry immediately after delivery. She was admitted to NICU (Neonatal Intensıve Care Unit) due to severe respiratory distress. During the hospital stay, she had a variety of medical complications and she was treated and managed accordingly. She was discharged from the hospital at around 8 months of age. She could´nt walk. But she was able to sit without support since 10 months of age. She started to stand with help at 11 months of age. She was able to say ´´mama and dada´´ since 10 months of age. After this brief presentation of my patient, I would like to ask you only one question: Do you really think that your child is developing normally? Some of you might say ´´ Yes, of course´´, some of you might say ´´ I have some concern about it´´, or ´´my child is a little bit behind his peers´´. Even though you don´t know exactly the normal developmental milestones, but I believe in that you are the only one who knows your child the most. If you think that your child is developmentally delayed, and if you realize that there is something going on wrong with him, you should take him to the primary physician as soon as possible. Developmental and behavioral disorders affect almost 20% of children and adolescent. Development can be divided into 5 domains of functions: visual-motor, language, motor, social, and adaptive. These domains are interdependent and, developmental change within each domain is generally orderly and predictable. The assessment of development is a vital component of health maintenance. Let´s review developmental milestones in the normal child (table). References: 1. Atlas of Pediatric Physical Diagnosis, Basil J. Zitelli, Holly W Davis. Fourth Edition 2. The Johns Hopkins Hospital The Harriet Lane Handbook, Veronica L. Gunn and Christian Nechyba, Sixteenth Edition. Age Gross Motor Visual-Motor/Problem Solving Language Social/Adaptive 1 mo Raises head from prone position Birth: Visually fixes 1mo: Has tight grasp, follows to midline Alerts to sound Regards face 2 mo Holds head in midline, lifts chest off table No longer clenches fists tightly, follows object past midline Smiles socially (after being stroked and talked to) Recognizes parent 3 mo Supports on forearms in prone position, holds head up steadily Holds hands open at rest, follows in circular fashion, responds to visual threat Coos (produces long vowel sounds in musical fashion) Reaches for familiar people or objects, anticipates feeding 4 mo Rolls over, supports on wrists, and shifts weight Reaches with arms in unison, brings hands to midline Laughs, orients to voice Enjoys looking around 6 mo Sits unsupported, puts feet in mouth in supine positon Unilateral reach, uses raking grasp, transfers objects Babbles, ah-goo, razz, lateral orientation to bell Recognizes that someone is a stranger 9 mo Pivots when sitting, crawls well, pulls to sand, cruises Uses immature pincer grasp, probes with forefinger, holds bottle, throws objects Says´´mama,dada´´indisciminately, gestures, waves bye-bye, under- stands ´´no´´ Starts exploring environment, plays gesture games (e.g., pat-a-cake) 12 mo Walks alone Uses immature pincer grasp, can make a crayon mark, releases voluntarily Uses two words other mama/dada or proper nouns, jargoning, one-step command with gesture Imitates actions, comes when called, cooperates with dressing 15 mo Creeps up stairs, walks backwards independently Scribbles in imitation, builds tower of 2 blocks in imitation Uses 4-6 words, followsone-step command without gesture 15-18 mo: Uses spoon and cup 18 mo Runs, throws objects from standing without falling Scribbles spontanously, builds tower of 3 blocks, turns 2-3 pages at a time Mature jargoning, 7-10 word vocabulary, knows 5 body parts Copies parent in task (sweeping, dusting), plays in company of other children 24 mo Walks up and down steps without help Imitates stroke with pencil, builds tower of 7 blocks, turns pages one at a time, removes shoes, pants, etc. Uses pronouns (I, you, me) inappropriately, folllows two-step commands, has a 50-word vocaulary, uses two-word sentences Paralel play 3 yr Can alternate feet when going up steps, pedals tricycle Copies a circle, undress completely, dresses partially, dries hands if reminded, unbuttons Uses of minimum of 250 words, 3-word sentences, uses plurals, knows all pronouns, repeat two digits Group play, shares toys, takes turns, plays well with others, knows full name, age, gender 4 yr Hops, skips, alternates feet going down steps Copies a square, buttons clothing, dresses self completely, catches ball Knows colors, says song or poem from memory, asks questions Tells ´´tall tales´´, plays cooperatively with a group of chidren 5 y Skips alternating feet, jumps over low obstacles Copies triangle, ties shoes, spreads with knife Prints first name, asks what a word means Plays competitive games, abides by rules, likes to hep in household tasks   Muruvet Elkay, MD  CV

Contact: MuruvetElkay, MD: YourChildsHealth@tadam.org