Focused Issue of This Month Well Baby Clinic: Developmental Guidance according to the Parent s Chief Complaints Seong Woo Kim, MD Department of Rehabilitation Medicine, National Health Insurance Corporation Ilsan Hospital E - mail : ksw42754@hanmail.net Young Key Kim, MD Department of Psychiatry, National Health Insurance Corporation Ilsan Hospital E - mail : psykay@hanmail.net Hee Jung Chung, MD Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital E - mail : agathac@nhimc.or.kr J Korean Med Assoc 2009; 52(3): 244-261 Abstract Despite the relatively high prevalence (5~10%) of developmental disability, the early identification for such problems remains difficult. Doctors who care children with developmental delay tried to find out these disorders as early as possible in order to apply an early intervention and reduce the long-term disabilities among them. Identification of a delayed young child by routine out-patient s clinic mandates a careful search for an underlying etiology. This article discusses the available approaches for the infants and young children with various kinds of developmental disabilities, according to the parent s chief complaints including unable to walk, unable to speak, unable to control temper, and unable to contact his or her eyes. Keywords: Developmental disability; Cerebral palsy; Developmental language disorder; Intellectual impairment; Autistic disorders; Behavior disorders 244
Developmental Guidance according to the Parent's Chief Complaints Table 1. Prevalence and mean age at identification of developmental disabilities Prevalence Mean age at identification (cases/1,000) (months) MR 25 39 Learning disability 75 69 ADHD 150 59 Cerebral palsy 2~3 10 Autistic disorder 0.4~0.5 - Visual impairment 0.3~0.6 55 Hearing impairment 0.8~2 39 MR: mental retardation, ADHD: attention deficit hyperactivity syndrome 245
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Developmental Guidance according to the Parent's Chief Complaints Table 2. Developmental motor milestones Age (months) Gross motor Fine motor 4 Head midline Hands mostly open Turns to supine Midline hand play 7 Sitting lean on arms Transfer cube from hand to hand Rolls to prone Bangs object 10 Creeps on all fours Pincer grasp, mature thumb to Cruises index grasp 14 Walks alone Scribbles Holds crayon full length in palm 18 Seats self in chair Holds crayon butt end in palm Walks backward 24 Begins running Aligns cube horizontally Walks up and down stair alone Imitates vertical line 36 Runs well Copies circle Pedals tricycle Imitates 3- cube bridge 48 Hops on one foot Copies cross 251
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Developmental Guidance according to the Parent's Chief Complaints Table 3. Korean language developmental milestones Age (years) Semantics Syntax 1 Noun, One word This What, Verb() 2 Verb( ) Two-words phrase Adverb( ) Who, Where 3 Big-small Three-words Why, How 4 Long -short, Extension of phrases When 5 Connective adverb Passiveness, ( ) Causativeness, Wide-narrow Compound sentence 253
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Developmental Guidance according to the Parent's Chief Complaints Peer Reviewers Commentary 261