Milestones that most infants achieve
Not all infants reach the same milestones at the same age, but there are average milestones that most infants achieve. At 6 months of age, typical developmental milestones for language include reacting to “no,” recognizing emotions through tone of voice, making sounds in response to hearing sounds, using vocalizations to express happiness and displeasure, and responding to their own name (American Academy of Pediatrics, 2019, p. 203). In terms of motor development, a child may roll over in both directions, begin to sit with or without hand support, support their entire body weight on their legs, move objects from one hand to the other, rock back and forth, and crawl backward (American Academy of Pediatrics, 2019, pp. 197-199). For visual milestones, a child might recognize familiar faces by smiling, differentiate strangers by crying or showing resistance, have full color vision, and show improved ability to track moving objects. They may also demonstrate curiosity and attempt to reach objects that are out of reach, even struggling to get them (American Academy of Pediatrics, 2019, pp. 202-205).
Therefore, if a 6-month-old patient cannot sit up during their wellness exam, it suggests that the infant may be showing slower developmental milestones and may require further assessment and evaluation to start early interventions and prevent additional developmental delays. I would conduct a thorough head-to-toe physical examination and review the patient\’s history, including any adverse prenatal (such as maternal infections like rubella or toxoplasmosis, maternal drug or alcohol dependence, or genetic abnormalities like Down syndrome or cystic fibrosis) or perinatal events (such as preterm birth, low birth weight, meconium aspiration, birth defects, or trauma during birth). Additionally, I would assess whether the patient is meeting all other expected milestones for their age.
Surveillance refers to the ongoing assessment and observation by a pediatric provider of a child\’s developmental status. In contrast, screening involves using systematic tools, such as the “Parents\’ Evaluation of Developmental Status, Ages and Stages Questionnaires” (Developmental Screening & Surveillance, 2024), or the “Denver Developmental Screening Test 2 (DDST-2)” (Vagha et al., 2023), which are standardized and structured tools to assess the child\’s developmental status at a specific point in time. According to the American Academy of Pediatrics\’ Bright Futures guidelines, developmental screening should be performed at 9, 18, 24, and 30 months of age.
The ICD 10
Q75.3 Macrocephaly: Abnormal enlargement of the head can make it difficult for an infant to hold their head up and sit up (Macrocephaly in Children – Approach to the Patient, 2024).
Q38.1 Ankyloglossia: An infant born with tongue tie, if not detected earlier, may have difficulty latching onto the nipple or bottle, which can lead to slow weight gain and delayed growth (Neonatal Ankyloglossia, 2022).
Q65.89 Hip Dysplasia: An infant with hip dysplasia may experience challenges in sitting upright (Developmental Dysplasia of the Hip, 2024).
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CPT code
99391 – Established patient comprehensive preventive exam for infant less than 1 year old.
96110 – Developmental screening
76506 – Ultrasound of head
?References
American Academy Of Pediatrics. (2019). Caring for your baby and young child, 7th edition: Birth to age 5 (NO-VALUE ed.). Bantam.
CPT® 76506, Under diagnostic ultrasound procedures of the head and neck. (2024). Codify by AAPC. https://www.aapc.com/codes/cpt-codes/76506
Developmental dysplasia of the hip. (2024, May 13). Dynamed. https://www.dynamed.com/condition/developmental-dysplasia-of-the-hip#GUID-4196C096-0297-45B6-930B-4682C5605CCA
Developmental screening & surveillance. (2024, March 13). Dynamed. https://www.dynamed.com/condition/speech-and-language-disorders#GUID-88341D13-972B-482F-A89C-E43CDEAE62D7A
Macrocephaly in children – approach to the patient. (2024, May 1). Dynamed. https://www.dynamed.com/approach-to/macrocephaly-in-children-approach-to-the-patient#BACKGROUND
Neonatal ankyloglossia. (2022, December 5). Dynamed. https://www.dynamed.com/condition/neonatal-ankyloglossia-20
Vagha, K., Taksande, A., Kenjale, S., Vagha, J., & Varma, A. (2023). Neurodevelopmental assessment in children with congenital heart disease by applying the denver developmental screening test 2: A prospective cross-sectional study. Cureus. https://doi.org/10.7759/cureus.33373
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In reply to Justine Kim
Re: Week 2
by Stephanie Easton – Thursday, July 25, 2024, 6:40 PM
Hello Justine, I enjoyed your post! Whenever you have a child that isnt meeting a motor milestone such as sitting up then you must rule our developmental dysplasia of the hip. If the patient has a hip disorder. This can cause the patient to not sit on time and also not walk on time. This can be assessed by preforming barlows and ortalanis maneuver. As a pediatric practitioner it is our job to assess for developmental dysplasia of the hip. We should assess for this at every visit until the child is walking. Unless once the patient is walking we note any abnormalities in gait. Education is key for this parents so that we can provide information on exercises that can be helpful in assisting in sitting up. Physical therapy can also be an option to assist the child in meeting their milestones. Education and support are the best tools at this point.
DynaMed. Developmental Dysplasia of the Hip. EBSCO Information Services. Accessed July 25, 2024. https://www.dynamed.com/condition/developmental-dysplasia-of-the-hip
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