These tests are usually done when the child goes for the immunisations at eighteen 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 the eighteen-month screen, there is no correction done for the gestational age for children who are born prematurely.
Physical examination
| Weight |
The weight should be plotted on a growth chart. |
| Head |
The head circumference is plotted on the growth chart. The head
circumference and 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
| Walking |
The
child should be able to take at least ten steps unaided. |
| 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. |
| Pincer grip |
The child is observed demonstrating a pincer grip by grasping a
bean-sized object. |
| Drinking |
The child should be able to drink out of a cup unaided. This item
assesses the child's fine motor ability and psychosocial development. If
the child still only drinks from a bottle, encourage the caregiver to
introduce the use of a cup. |
| Feeding |
Handles spoon for feeding. |
Language, hearing and vision
| Simple commands |
A child should be able to show you his/her foot or nose or at least
respond by looking at the foot. |
| Three recognisable words |
The child should respond to words that have a particular meaning, but do not have to be phonetically correct. They must be used consistently to indicate the same person or object. The absence of words may indicate a developmental problem, for example deafness, emotional problems or a mental handicap. |
| Hearing |
The child should turn when called. |
| Vision |
The child should make eye contact or follow an object moved in front of
him/her. The examiner will observe the eye movements for any signs of
squint. |
Psychosocial
| Plays alone |
Toddlers vary individually in the closeness to and amount of attention
they need from their caregivers, particularly in the presence of new
places and people. If not hungry or ill, the average toddler shows
interest in exploring the assessment room in the presence of his/her
caregiver, rather than being disinterested in his/her environment or
clinging to the caregiver, being fearful. |
| Comes when needs assistance |
The child's exploration of his/her environment should be balanced by the
need for closeness to the caregiver. The examiner will look for signs of
bonding and response to the caregiver, for example, showing things to the
caregiver. The toddler should not show fear or aggression towards the
caregiver, or ignore her. |
| Caregiver's interaction |
The examiner will observe how the caregiver interacts with the child,
how the child is held, handled and spoken to. Some caregivers may respond
to the child inappropriately because of inadequate parenting skills or
psychiatric or psychological difficulties. |
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