How to Assess Development in the Mrcpch Clinical Exam(1)

HOW TO ASSESS DEVELOPMENT IN THE MRCPCH CLINICAL EXAM GROSS MOTOR DEVELOPMENTAL ASSESSMENT A) Ask him to walk: (8 things) - Forward walking: 1 year - Backward Walking: 1 1/2 year - Side Walking: 3 years - Forward Tandem Walking: 4 years - Backward Tandem Walking: 5 years - Tip toe standing: 2 years - Tip toe walking: 3 years - Tip toe running: 4 years - Stands on one foot for 1 sec: 3 years - Stands on one foot for 5 sec: 4 years - Jumps (in place): 2 years - Runs stiffly: 2 years - Runs smoothly (fast): 3 years - Hops: 4 years - Skips: 5 years B) Give him a Ball: (4 things) - Kicks a ball (standing): 2 years - Kicks a ball (running): 4 years - Throws a ball: 2 years - Catches a ball: Front out stretched arm: 3 years Up out stretched arm: 4 years Near to the body (front of the chest): 5 years - Bounces and catches a ball: 5 years C) Ask him to climb stairs: - Climbs stairs with assistance: 1 1/2 year - Climbs stairs in a child manner: 2 years - Down stairs in a child manner: 2 1/2 years - Climbs stairs in a adult manner and down stairs in a child manner: 3 years - Climb and down stairs in adult manner: 4 years D)Ask him to ride a tricycle: - Rides Tricycle: 3 years

FINE MOTOR DEVELOPMENTAL ASSESSMENT Ask About the age if the examiner did not tell you. 1 YEAR A) Cubes: - Bangs together - Casting - Points by index - Object permanence B) Hundreds and thousands, counter or make a small paper: - Crude pincer grip 1 1/2 YEARS A) Cubes: - Builds a tower of 3 cubes - Puts cubes in a container and gets it out B) Paper and Crayon: -Draws a vertical line -Draws To and fro scribbles C) Book: - Turns many pages together D) Hundreds and thousands, counter or make a small paper: - Fine pincer grip 2 YEARS A) Cubes: - Builds a tower of 6 cubes (age in years × 3). B) Paper and Crayon: -Draws a horizontal line -Draws a circular scribbles -Writes T and V letters (2 letters at 2 years) C) Book: - Turns 1 Page D)Simple form board: Fits 2 shapes: circle and square (2 shapes at 2 years)

3 YEARS A) Cubes: (3 things): - Builds a tower of 9 cubes (age in years × 3) - Builds a Bridge of 3 cubes. - Train B) Paper and Crayon: (3 things): - Copies a circle - Writes T, V and H letters (3 letters at 3 years). - Draws 3 parts in draw a man test:

C) Scissor: - Can cut the paper D) Large threads and beads: - Can lace large threads in large beads E) Simple Form Board: - Fits 3 shapes: circle, square and triangle (3 shapes at 3 years).

4 YEARS A) Cubes: - Builds a tower of 12 cubes (age in years × 3) - Builds a stair of 6 bricks B) Paper and Crayon: - Copies a square - Writes X and O letters. - Draws 4 parts in draw a man test:

C) Small threads and beads: - Can lace small threads in small beads. E) Complex Form Board: - Fits six shapes

5 YEARS A) Cubes: - Builds a tower of 15 cubes (age in years × 3) - Builds a stair of 10 bricks B) Paper and Crayon: - Copies a triangle - Writes C, U, Y, L and A letters (5 letters at 5 years). - Draws a man test:

L Vertical line: 1 1/2 years Horizontal line: 2 years

O

X

Circle: 3 years

Cross: 4 years

S Square: 4 1/2 years

T

D

Triangle: Diamond: 5 years 6 years

ASSESSMENT OF SOCIAL MILESTONES A) Feeding (by examination): - Drinks from cup: 1 year. - Uses cup and spoon: 1 1/2 year. - Uses spoon and fork : 2 years. - Uses spoon fork and knife: 3 years. B) Play (by examination): - Waves bye bye, pat-a-cake and peek-a-boo: 1 year - Symbolic play e.g. feed a doll and explores environment: 1 1/2 year - Solitary play and pretend (role) (imagination) play e.g. cooking tray or mobile talking: 2 years - Parallel Play (interactive play evolving) and takes turn: 3 years. - Share toys: 4 years - Make believe play (you are mum and I am dad): 5 years C) Care (by history only): - Indicates need (not by crying) : 1 year - Indicates toilet need: 1 1/2 year - Dry by day: 2 years - Uses toilet alone: 3 years - Brushes teeth, wash and dry hands: 4 years - Mostly dry by night: 5 years

D) Dressing ( by examination): - Takes off shoes and socks: 1 1/2 years - Helps in dressing: 2 years - Able to undress: 3 years - Dress with supervision: 4 years - Completely dress without supervision: 5 years

ASSESSMENT OF HEARING AND SPEECH A) Ask the child about his name, age, sex, address and ask him to count from 1-10: If he did not answer, tell that you want to ask the mother about any concerns regarding his hearing. B) Assess concentration and attention: Give him a colored object and ask him to point to an object with the same color. C) Assess picture recognition and selection: e.g. Ask him about the picture of the duck: what is this? If he did not answer, tell him can you show me the picture of the duck?. D) Assess object recognition and selection: e.g. ask him about the horse: what is this? If he did not answer, tell him can you show me the horse? E) Assess imitation of sounds: e.g. show him a dog and ask him what is the sound of this? If he did not answer I will ask him which animal has haw haw sound ? F) Assess words together: a) A single task: e.g. take the horse b) Double task: e.g. take the horse and give it to your mother c) Triple task: e.g. take the horse, put it behind your back and give it to your mother.

MILESTONES OF HEARING AND SPEECH 1YEAR - Says Mama and Dada meaningfully. - Turns to name ( by examination) - Understands words 1 1/2 YEAR - Says Mama, Dada and another word - Points to 3 parts of the face (by examination). - Obeys simple commands (by examination). 2 YEARS - Says his name (by examination). - Understands many words (by examination). - Uses plurals e.g. books (by examination). - Says 2 words sentence (2 words sentence at 2 years) (by examination). 3 YEARS - Says full name (by examination). - Says age and sex (by examination). - Says 3 words sentence (3 words sentence at 3 years) (by examination). - Says prepositions e.g. up and down (by examination). - Says nursery rhymes (songs) (by examination). - Identify 3 colors (3 colors at 3 years) (by examination). 4 YEARS - Counts 1-10 by 1 hand (by examination). - Says address (by examination). - Says 4 words sentence (4 words sentence at 4 years) (by examination). - Identify 4 colors (4 colors at 4 years) (by examination).

5 YEARS - Counts 1-10 by 2 hands (by examination). - Says his birthday (by examination).

REFERENCES 1 - Dr. Abla Alalfy lecture 2 - MRCPCH Clinical: Short Cases, History taking and communication skills. 3 - The MRCPCH clinical exam made simple. 4 - Short Cases for the MRCPCH 5 - Illustrated textbook of pediatrics