The nine month check-up

These tests are usually done when the child goes for the immunisations at nine months. They are done at a clinic, satellite or mobile clinic. The “Road-to-Health” card is examined to identify any high risk factors such as the antenatal history or birth history.

Note: In premature babies, for purposes of developmental assessment, the correct gestational age is calculated by subtracting the number of months born early from the actual age. For example, a child born at 32 weeks gestation is considered to be only seven months old and not nine months old.

Physical examination:

Weight	The weight is plotted on the growth chart.
Head	The head circumference is plotted on the growth chart. The weight should be on similar centiles.
General Appearance	The body shape, face, ears, hands and feet are checked for dysmorphic features. Dysmorphism means an abnormality of the physical structure of a single or multiple parts of the body. Characteristic patterns of malformations may be recognised as syndromes, for example Down Syndrome or Foetal Alcohol syndrome.

 

Gross and fine motor examination:

Sitting	The child should sit unaided for at least one minute and be able to use the hands for playing and eating. In order to sit unaided a child needs good trunk and neck control.
Limb movements	The child’s limbs are observed for any asymmetry of movements. Decreased movement on one side may indicate hemiplegia.
Limb tone	Any signs of an abnormal posture, floppiness or spasticity are checked.
Feeding	A child of nine months usually takes objects to the mouth if within its reach. He/she should be able to hold a bottle and drink from a cup.

 

Language, hearing and vision:

Speech sounds	An absence of speech sounds indicates a developmental problem, for example deafness, emotional problems or a mental handicap.
Hearing	The child should turn when called.
Vision	The child is observed whilst it makes eye contact or follows an object in front of him/her. The examiner will also check for signs of a squint.

 

Psycho-social:

Prefers familiar people	Infants interact differently with caregivers and strangers within their first few months, but begin to show a consistent preference for their primary caregivers at about eight – nine months of age. At this stage, the infant tends to look warily at unfamiliar people or strangers and resists being handed over to them by a caregiver.
Caregiver’s interaction	The examiner looks whether the caregiver responds appropriately to the child’s behaviour. For example, does she respond calmly and caringly when the infant signals his/her needs?