UNIVERSITY OF ZAMBIA

SCHOOL OF NURSING SCIENCES

RIDGEWAY CAMPUS

INDIVIDUAL ASSIGNMENT
====================================================================
NAME: LUNGU GABRIEL

COMPUTER NO: 2018242806

PROGRA: MASTER OF SCIENCE IN MENTAL

HEALTH AND PSYCHIATRIC NURSING

YEAR: 2019

COURS: HEALTH ASSESSMENT AND DIAGNOSTIC

REASONING

COURSE CODE: NRS 6010

LECTURER: DR. P.K. MUKWATO

TASK: DEVELOPMENTAL ASSESSMENT IN

CHILDREN

DUE DATE: 25th MARCH, 2019

Table of Contents
Task……………………………………………………………………………………………......ii

Abstract ............................................................................................................................................1
Introduction ......................................................................................................................................1
Definitions........................................................................................................................................2
Indications of developmental assessment ........................................................................................2
Goal of developmental assessment ..................................................................................................3
Principles of developmental assessment ..........................................................................................3
Benefits of developmental assessment…………………………………………………………….3

Normal developmental assessment……………………………………………………………..…5

Conducting assessment………………………………………………………………………..…..7

Implications………………………………………………………………..……………………....7

Conclusion………………………………………………………………………………………...8

References…………………………………………………………………………………………9

Annex 1……………………………………………………………………………………….........

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TASK
Individual Assignment
Having completed you MSc Nursing, you have been appointed as Area Nursing Officer for
Children’s Hospital of the University Teaching Hospitals, Lusaka. In your first week of work
you realize that most nurses are unable to conduct Developmental Assessment of Children.
They totally depend on the Drs to assess and are therefore unable to give appropriate IEC to
Parents. You decide to conduct a half day seminar on Developmental Assessment. Outline
the information you would include in your seminar which is being attended by nurses of
different qualifications from your department.

Due date 25th March, 2019

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Abstract
Developmental assessments are useful to assess a young child’s current skills relative to where
they should be compared to typical child development. Assessment involves procedures to
identify children who are at risk for a particular problem and for whom there are available
effective interventions. According to as study on Implications of Newborn Screening for Nurses,
results showed that, adequate developmental assessment had dramatically decreased the
morbidity and mortality associated with a wide range of developmental conditions (Deluca, J., et
al., 2013). In this assignment, a close look is taken on developmental assessment and information
necessary for nurses and nursing faculty and its impact and benefits. The information aims to
equip nurses with skills and knowledge needed when handling children and their parents and also
helps nurses to conduct developmental assessment with confidence and purpose.

Introduction
Developmental assessment is a public health approach to the identification of rare but treatable
conditions in early childhood. Nurses, nurse educators, and nurse researchers are positioned to
contribute to the field of newborn screening by assuring programs are implemented safely and
effectively, by facilitating education of the nursing work force, and by developing and
contributing to research programs in newborn screening. Developmental assessment is the
process of observing and recording the work children do and how they do it, as a basis for a
variety of decisions about their care, suitable programs and program goals and service needs. It is
done on every contact with a child and parents by attentive caregivers. It includes early
identification of problems through screening and surveillance, and more definitive assessment
including both standardized and non-standardized measures, as well as integration of information
from the developmental, social, and family history and the medical history and examination.

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Definitions
1. Developmental assessment is the process of mapping a child’s performance compared
with children of similar age (Bellma, M., 2013).
2. Developmental assessment is the process of observing and recording the work children
do and how they do it, as a basis for a variety of decisions about their care, suitable
programs and program goals, and service needs done every day by attentive caregivers
(Bower, R., 2010).
3. Developmental assessment is the detailed analysis of particular areas of development and
follows concern after screening that a child’s developmental progress may be abnormal in
some way. It is part of the diagnostic process and includes investigation, therapy and
advice on how to optimize the child’s progress (Lissauer, T., & Clayden, G., 2012).
Developmental assessment is by referral to a specialist service and this may be the
developmental pediatrician, therapy disciplines, or the local multidisciplinary child
development service, which will include a pediatrician (Lissauer, T., & Clayden, G.,
2012).
4. Development is the process by which each child evolves from helpless infancy to
independent adulthood (Bellma, M., 2013).
5. Growth and development of the brain and central nervous system is often termed
psychomotor development and is usually divided into four main domains namely gross
and fine motor skills, speech and language, social and personal and activities of daily
living and performance and cognition.

Indications for developmental assessment

1. Screening might be needed for follow up of high risk neonates for early detection of
cerebral palsy and or mental retardation and if a child is at high risk for developmental
problems due to preterm birth, low birth weight, or other reasons.
2. For identification of children at increased risk of having developmental difficulties that
uses relatively brief and simple techniques, according to well recognized criteria.
3. Complete evaluation of children with developmental, chromosomal and neurological
disorders.

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 4. To differentiate children with retardation in specific fields of development as opposed to
those with global retardation.
Goal of Developmental Assessment
 The goal of developmental assessment is not only to generate a diagnosis, but equally
important to analyze the pattern of strengths and weaknesses in the child, family, and
available developmental, educational, and social support systems, in order to direct
treatment.

Principles of developmental assessment

 Utilization of play as a fundamental assessment tool.
 Promotion of optimal performance of the child.
 Gearing the assessment towards remediation rather than merely producing a profile.
 Involvement of the parents in the assessment process. Child health surveillance or
assessment should not generate significant parental anxiety. There is no "pass" or "fail" in
child health surveillance. Therefore, when speaking with parents or discussing Concerns
with Parents of a child where there is concern about an aspect of development, it is
essential to emphasize the positive features of the child's development.
 Close linking of the assessment with services offering help and support.

Benefits of developmental assessment

 Early diagnosis and intervention: it helps in the coming up of the diagnosis and identify
special need(s) that may establish eligibility for funding or services.
 Provides an opportunity to interact with children’s carers. Therefore parents need to be
informed about the content, purpose and outcome of developmental assessments of their
child and attend to questions and concerns they may have.
 Early diagnosis of conditions with a genetic basis, such as Duchene muscular dystrophy
and fragile X syndrome, facilitates genetic counseling for families
 Provides carers with reliable information before a developmental problem becomes
obvious and gives them more time to adjust to the child’s difficulty and make appropriate
management plans for their family

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 Carers are reassured and relieved of anxiety if assessment shows that the child is within
the normal range During infancy, assessment serves to reassure parents and to identify
sensory, motor, cognitive, and emotional problems early, when they are most amenable to
treatment as well as helping in addressing academic and social problems.
 Early assessments can be compared with later ones, allowing the practitioner to follow a
child’s individual developmental trajectory.
 Provides an opportunity to encourage good parenting and developmental stimulation
 Milestones are useful indicators of mental and physical development and possible
deviations from normal.
 Offers an opportunity for institutions of early intervention which includes prevention and
early detection of disabilities, as well as health, educational and community services that
assist the child, family and community in adapting to the child’s developmental needs
and disability.
 In a case of serious concern, provides a mechanism for rapid referral for further
exploration of the issue and dealt with it without incurring a lengthy period of parental
anxiety when parents feel powerless and fear of the worst possible outcome.
 Creates provision for advice and guidance to families, parents, schools and other agencies
as they may cause concern for parents, difficulties in the pre-school period and constitute
a risk factor for subsequent poor school performance and lead to further delays causing a
wide range of personal and social difficulties for the individuals concerned (Law, et al.,
1998, Hall & Elliman, 2004).
 Provides the parents and family with an understanding of the child’s development and
outlines developmental goals and strategies to reduce any handicapping effects of the
disability through the input of physiotherapists, speech pathologists, teachers,
occupational therapists, psychologists and social workers (Thomson, et al., 2014)

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 Normal developmental milestones

Skills
Age Gross motor Fine motor and Hearing, speech, and Social, emotional, and Red flags
vision language behavioral
6 weeks Head level with body in Fixes and follows Becomes still in Smiles Unresponsive to
ventral suspension response to sound sound or visual stimuli
3 months Holds head at 90° in ventral Holds an object Turns to sound Hand regard, laughs, and Lack of social
suspension placed in the hand squeals response or
vocalization
6 months No head lag on pull to sit; sits Palmar grasp of Vocalizations May finger feed self Poor head control,
with support; in prone objects; transfers floppiness, not
position lifts up on forearms objects hand to hand reaching
9 months Crawls; sits steadily when Pincer grasp; index 2 syllable babble, Waves bye bye, plays pat-a- Can’t sit unsupported;
unsupported and pivots finger approach; non-specific consonant cake; indicates wants; stranger no babble
around bangs two cubes vowel, such as “mama” anxiety emerging
together
12 Pulls to stand; cruises; may Puts block in cup; One or two words; Imitates activities; object Not communicating
months stand alone briefly; may walk casts about imitates adults’ sounds permanence (the understanding by gestures, such as
alone that objects still exist when pointing; not weight
they cannot be seen) bearing through legs
established; stranger anxiety

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 established; points to indicate
wants
18 Walks well; runs Builds tower of 2-4 6-12 words Uses spoon; symbolic Play Not walking; no
months cubes hand “talking” on telephone; symbolic play; no
preference emerges domestic mimicry “helps” in words
household chores like
sweeping, wiping surfaces
2 years Kicks ball; climbs stairs two Builds tower of 6-7 Joins 2-3 words; knows Can remove some clothes Not joining two
feet per step cubes; does circular some Can remove some words; cannot run
scribbles clothes body parts;
identifies objects in
pictures
3 years Stands briefly on one foot; Builds tower of 9 Talks in short sentences Eats with fork and spoon; puts Not communicating
climbs stairs one foot per step cubes; copies a circle that a stranger can on clothing; may be toilet with words; cannot
understand trained climb stairs

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Conducting an assessment
Developmental screening or assessment involves the use of standardized screening tests to
identify children who require diagnostic assessment. The American academy of pediatrics
recommends the use of validated standardized screening tools at three of the health maintenance
visits: 9 months, 18 months and 30 months (Marcdante, K. J., & Kliegman, R. M., 2015). Clinics
that serve a higher risk patient population (children living in poverty) often perform a screening
test at every health visit. A child who fails to pass a developmental screening test requires more
comprehensive evaluation but does not necessarily have a delay; definitive testing must confirm.
Prior to assessment, a health care provider should have knowledge on the developmental
milestones in order to detect diversion from the normal.
A good starting point is to believe parents and carers who are worried about their child. It is
important that these are elicited through appropriate history and examination. Observe the child
entering and moving around the clinic while playing with a few age appropriate toys, such as
blocks, toy cars, pull-along toys, paper, and crayons.
A range of tests have been developed to screen or to assess development in a formal reproducible
manner. The common used assessment tool is the Denver developmental screening test II, which
is completed by an observer and gives “pass or fail”, results in the four major developmental
fields, and the schedule of growing skills. It was a classic test used by general pediatricians. The
Denver II assesses the development of children from birth to 6 years of age in the following
domains Personal-social, fine motor-adaptive, Language and Gross motor (Marcdante, K. J., &
Kliegman, R. M., 2015). The advantage of this test teaches developmental milestones when
administered (See Annex I).

Implications
Nurses are uniquely well suited to address the educational needs and future research in newborn
screening because of the role that nurses play in the provision of direct clinical care and in
population-based healthcare delivery. Nurses, nurse educators, and nurse researchers are
positioned to contribute to the field of newborn screening by assuring programs are implemented
safely and effectively, by facilitating education of the nursing work force, and by developing and
contributing to research programs in newborn screening (Deluca, et al., 2013).

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CONCLUSION
Child development can seem baffling to those not used to thinking about it. However, like most
things in medicine it is straightforward if you familiarize yourself with what is normal and
develop a system for trying to identify what is abnormal. Health maintenance or supervision of
visits should consist of comprehensive assessment of the child’s health and of the
parents’/guardian role in providing an environment for optimal growth, development and health.
Elements of each visit should include evaluation and management of parental concerns, inquiry
about any interval illness, growth development and nutrition, anticipatory guidance, physical
examination and screening tests.

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REFERENCES
Bellma, M., Byrne, O., Sege, R., (2013). Developmental assessment of children. Departmental
of paediatrics. Royal free Hospital, London.
Deluca, et al., (2013). Implications of Newborn screening for nurses. Journal of nursing
scholarship, Sigma Theta Tau international vol 45:1
Dosman, C. F., Andrews, D., & Goulden, K. J., (2012). Evidence-based milestone ages as a
framework for developmental surveillance. Pediatrics & child health, 17(10).
Frankenburg, William K., (2002). Developmental Surveillance and Screening of Infants and
Young Children, Pediatrics 109 (109).
Lissauer, T., & Clayden, G., (2012). Illustrated textbook of pediatrics. 4th edition, Mosby
Elsevier, Philadelphia. ISBN: 978-0-7234-3565-5
Marcdante, K. J., & Kliegman, R. M., (2015). Nelson Essentials of Pediatrics, 7th edition,
Elsevier Saunders, 1600, John F. Kennedy Ste 1800, Philadelphia. ISBN: 978-14557-5980-4.
McEniery, J,. (2012). Assessment of infant / child nutrition, growth and development, within
the primary health care setting. Statewide Child and Youth Clinical Network (SCYCN).
Standard 12. Queensland government.
Thomson K., et, al. (2012). Pediatrics handbook. 8th edition, Blackwell Publishing, A John
wiley and Sons Ltd. Melbourne. ISBN: 978-1-405-17400-8.

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