Specific perinatal Increased risk of CNS damage adverse events
Illness—seizures, Increased risk of CNS damage respiratory distress, hyperbilirubinemia, metabolic disorder mutation associated with developmental
Illnesses (e.g., Hereditary illness associated with metabolic diseases) developmental delay
Family member died May suggest inborn error of metabolism young or unexpectedly or storage disease
Family member requires Hereditary causes of developmental special education delay
Resources available Necessary to maximize child’s potential (e.g., financial, social support)
Educational level of Family may need help to provide parents stimulation.
High-risk behaviors Increased risk for HIV infection; index of (e.g., illicit drugs, sex) caregiving risk
Other stressors (e.g., May exacerbate child’s conditions or marital discord) compromise care
Gender of child Important for X-linked conditions
Developmental Index of developmental delay; milestones regression may indicate progressive condition.
associated with developmental delay or learning disabilities.
Serious infections (e.g., May be associated with developmental meningitis) delay
Toxic exposure (e.g., May be associated with developmental lead) delay
Physical growth May indicate malnutrition; obesity, short stature, genetic syndrome
Recurrent otitis media Associated with hearing loss and abnormal speech development
Visual and auditory Sensitive index of impaired vision and functioning hearing
Nutrition Malnutrition during infancy may lead to delayed development.
Chronic conditions such May be associated with delayed as renal disease development or anemia
Adapted and updated from Liptak G: Mental retardation and developmental disability. In Kliegman RM, editor: Practical Strategies in Pediatric Diagnosis and Therapy, Philadelphia, 1996, WB Saunders. CNS, Central nervous system; HIV, human immunodeficiency virus.
Psychological Assessment Although a child should not be labeled as having a problem Psychological assessment includes the testing of cognitive abil-solely on the basis of a standardized test, these tests provide ity (Table 10-3) and the evaluation of personality and emotional important and reasonably objective data for evaluating a child’s well-being. The IQ and mental age scores, taken in isolation, progress within a particular educational program. are only partially descriptive of a person’s functional abilities,which are a combination of cognitive, adaptive, and socialskills. Tests of achievement are subject to variability based on Educational Assessment culture, educational exposures, and experience and must be Educational assessment involves the evaluation of areas of standardized for social factors. Projective and non-projective specific strengths and weaknesses in reading, spelling, written tests are useful in understanding the child’s emotional status. expression, and mathematical skills. Schools routinely screen
Information to Be Sought during the Physical Examination of a Child with Suspected
Short stature Williams syndrome, malnutrition, Turner syndrome; many children with severe retardation have associated short stature.
Macrocephaly Alexander syndrome, Sotos syndrome, gangliosidosis, hydrocephalus, mucopolysaccharidosis, subdural effusion
Microcephaly Virtually any condition that can retard brain growth (e.g., malnutrition, Angelman syndrome, de Lange syndrome, fetal alcohol effects)
Coarse, triangular, round, or flat face; hypotelorism or hypertelorism, slanted or short palpebral fissure; unusual nose, maxilla, and mandible Specific measurements may provide clues to inherited, metabolic, or other diseases such as fetal alcohol syndrome, cri du chat syndrome (5psyndrome), or Williams syndrome.
Prominent Crouzon syndrome, Seckel syndrome, fragile X syndrome
Cataract Galactosemia, Lowe syndrome, prenatal rubella, hypothyroidism