Pediatric Rehabilitation: Milestones and Classification
Milestones and classification carry the marks
Pediatric questions test whether you know normal development well enough to recognize delay, then can classify and prognosticate. Key milestones: social smile at 6 weeks, sits without support at 6–8 months, pincer grasp at 9–10 months, walks independently at 12–15 months, two-word phrases at 18–24 months. Red flags: no sitting by 9 months, no walking by 18 months, no words by 16 months, and loss of skills at any age.
Cerebral palsy is a nonprogressive disorder of movement and posture. The GMFCS has five levels (I walks without limitations, II walks with limitations, III walks with a handheld mobility device, IV self-mobility with powered mobility, V transported in a manual wheelchair). Spastic diplegia often follows prematurity and periventricular leukomalacia; hemiplegia often follows perinatal stroke. Associated problems - strabismus, hearing loss, seizures, feeding difficulty, hip subluxation - often matter more than the motor label. Spina bifida: functional level predicts ambulation (sacral best, thoracic worst), latex allergy is common, and shunt malfunction or tethered cord presents as declining function, headache, or new scoliosis. Brachial plexus birth injury: Erb (C5–C6) gives the waiter's-tip posture; Klumpke (C8–T1) gives a claw hand with Horner syndrome. Developmental dysplasia of the hip is screened with Ortolani and Barlow maneuvers.
Worked example
A 2-year-old with spastic diplegia walks with a walker indoors and crawls outdoors: GMFCS level III.
Rule of thumb
Motor milestones proceed head-to-toe and central-to-peripheral; when unsure, ask what the child cannot yet do compared with the 12-month walker.