Developmental assessment
Developmental assessments at the 6-month visit include social language, verbal language, gross motor, and fine motor. For social language we expect to see the child pat or smile at own reflection and to look when their name is called(Hagen, Shaw, et al., 2017). For verbal language we expect babbling and making sounds like “ga, ma, ba” (Hagen, Shaw, et al., 2017). Gross motor we expect to see the child roll over from back to stomach and sit briefly without support(Hagen, Shaw, et al., 2017). Fine motor we expect to see passing a toy from one hand to another, rakes small object with 4 fingers, and bangs small objects on surface (Hagen, Shaw, et al., 2017).
At 6 months we do not expect to see the child walking, but we do expect to see the child sit briefly unassisted. Although this is a concern it isn’t something that should raise all alarm bells at this time. If the patient is still not sitting up by 9 months then my concern would grow. What we would want to do is closely monitor this child. We would give the parents some exercises to preform every day and reassess in a month. If the child has not made any improvements then we would want to refer to physical therapist to further assist the parents in helping the child to grow this developmental milestone. I think education at this point is key. Maybe the parents aren’t doing enough tummy time or sitting the child up in a bumpo seat or other assistive seating devices that can help the child learn the skill. That is why I feel starting with education and exercises would be the top of my plan of care. This could also change if the child has other delays that we noted that would point to something neurologically going on at which point we would need to refer the child to a neurologist or other specialist (Khan, Leventhal, et al., 2023).
Surveillance would include the developmental milestones that I previously discussed while screenings include things such as depression (maternal), and oral health (Hagan, Shaw, et al., 2017). At a 6 month visit the screenings we would complete are depression (maternal), oral health (Fluoride varnish), blood pressure, hearing, lead, TB, and vision. Screenings are more educational pieces that every child will need while surveillance is more assessing that the child is where they should be developmentally compared to others their age.
Top 3 differential diagnosis include muscle weakness (M62.81), developmental delay (F82), and scoliosis (M41.00). All of these can lead to a child having difficulty with sitting up right at the proper time.
My CPT code would be 99214 for this visit.
Khan I, Leventhal BL. Developmental Delay. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562231/
Hagan, J. F., Shaw, J. S., & Duncan, P. M. (2017). Bright futures: Guidelines for health supervision of infants, children, and adolescents: Pocket guide. American Academy of Pediatrics/Bright Futures.
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