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MOCA: 9-12 month development

Carol Wilkinson MD, PhD and Lisa Patel, MD
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23:00

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Lisa and Carol discuss normal milestones in this age group such as social behaviors like joint attention and early language and intentional movement for gross motor skills in addition to discussing red flag that would necessitate early referral to a specialist.

  • The AAP recommends developmental surveillance at all well child checks with  validated developmental screeners being administered at the 9, 18 and 24 or 30 month visit.  Surveillance can help track where as screeners help identify delays. The Ages and Stages Questionnaire (ASQ) is the most widely used screening tool.

    • Unfortunately, as of 2016, only 50% of children were being screened appropriately.

  • At 9 months, gross and fine motor skills often represent the biggest changes in that children are now moving with intention and have more dexterity.  Object permanence is now seen and therefore, sleep regression may also occur.

    • Domains, however, should not be thought of in silos.  For example, the motor domain is connected to the cognitive domain.  Language skills and social skills are also tightly linked.

      • This is exemplified in the concept of joint attention; the ability of the child to know what someone else is interested.  

      • In addition to specific screeners, families should be asked if they have specific developmental concerns.

  • Red flags at 9 months include: not sitting or rolling, not babbling, and not having a reciprocal smile.

  • If a child fails any section of a screener, a referral for early intervention should be placed.

    • If a child falls into the “grey” zone on the ASQ, home interventions and resources should be given.  The CDC is a good place to get this information.

      • Good anticipatory guidance should be given to all families regarding reducing screen time and when screens are used, families are encouraged to watch and interact with their children while watching,

  • Developmental delays may be because of an underlying syndrome, environmental exposures and more rarely secondary to the quality of parenting leading to a full-fledged delay (unless it is trauma or neglect).   

  • Autism diagnoses are being made at younger ages in certain parts of the  country. Delays in the social/communication domain may point to this diagnosis early on.  Siblings of children with autism have a 20-30 times higher odds of being diagnosed with autism as well and therefore, should have their development monitored closely.

 

Ed’s note: Lack of eye contact, orienting to name being called or pointing are specific symptoms that may appear in the first year of life.

 

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