HOW TO ASSESS DEVELOPMENT IN THE MRCPCH
CLINICAL EXAM
GROSS MOTOR DEVELOPMENTAL ASSESSMENT A) Ask him to walk: (8 things)
- Forward walking: 1 year - Backward Walking: 1 1/2 year - Side Walking: 3 years
- Forward Tandem Walking: 4 years - Backward Tandem Walking: 5 years - Tip toe standing: 2 years
- Tip toe walking: 3 years - Tip toe running: 4 years
- Stands on one foot for 1 sec: 3 years - Stands on one foot for 5 sec: 4 years - Jumps (in place): 2 years
- Runs stiffly: 2 years
- Runs smoothly (fast): 3 years - Hops: 4 years
- Skips: 5 years
B) Give him a Ball: (4 things)
- Kicks a ball (standing): 2 years - Kicks a ball (running): 4 years - Throws a ball: 2 years
- Catches a ball:
Front out stretched arm: 3 years Up out stretched arm: 4 years
Near to the body (front of the chest): 5 years - Bounces and catches a ball: 5 years
C) Ask him to climb stairs:
- Climbs stairs with assistance: 1 1/2 year - Climbs stairs in a child manner: 2 years - Down stairs in a child manner: 2 1/2 years
- Climbs stairs in a adult manner and down stairs in a child manner: 3 years - Climb and down stairs in adult manner: 4 years
D)Ask him to ride a tricycle:
FINE MOTOR DEVELOPMENTAL ASSESSMENT
Ask About the age if the examiner did not tell you. 1 YEAR A) Cubes: - Bangs together - Casting - Points by index - Object permanence
B) Hundreds and thousands, counter or make a small paper:
- Crude pincer grip
1 1/2 YEARS A) Cubes:
- Builds a tower of 3 cubes
- Puts cubes in a container and gets it out
B) Paper and Crayon:
-Draws a vertical line
-Draws To and fro scribbles
C) Book:
- Turns many pages together
D) Hundreds and thousands, counter or make a small paper:
- Fine pincer grip
2 YEARS A) Cubes:
- Builds a tower of 6 cubes (age in years × 3).
B) Paper and Crayon:
-Draws a horizontal line -Draws a circular scribbles
-Writes T and V letters (2 letters at 2 years)
C) Book:
- Turns 1 Page
D)Simple form board:
3 YEARS A) Cubes: (3 things):
- Builds a tower of 9 cubes (age in years × 3) - Builds a Bridge of 3 cubes.
- Train
B) Paper and Crayon: (3 things):
- Copies a circle
- Writes T, V and H letters (3 letters at 3 years). - Draws 3 parts in draw a man test:
C) Scissor:
- Can cut the paper
D) Large threads and beads:
- Can lace large threads in large beads
E) Simple Form Board:
4 YEARS A) Cubes:
- Builds a tower of 12 cubes (age in years × 3) - Builds a stair of 6 bricks
B) Paper and Crayon:
- Copies a square
- Writes X and O letters.
- Draws 4 parts in draw a man test:
C) Small threads and beads:
- Can lace small threads in small beads.
E) Complex Form Board:
5 YEARS A) Cubes:
- Builds a tower of 15 cubes (age in years × 3) - Builds a stair of 10 bricks
B) Paper and Crayon:
- Copies a triangle
- Writes C, U, Y, L and A letters (5 letters at 5 years). - Draws a man test:
L O X S T D
Vertical line: Circle: Cross: Square: Triangle: Diamond: 1 1/2 years 3 years 4 years 4 1/2 years 5 years 6 years
Horizontal line: 2 years
ASSESSMENT OF SOCIAL MILESTONES A) Feeding (by examination):
- Drinks from cup: 1 year.
- Uses cup and spoon: 1 1/2 year. - Uses spoon and fork : 2 years. - Uses spoon fork and knife: 3 years. B) Play (by examination):
- Waves bye bye, pat-a-cake and peek-a-boo: 1 year
- Symbolic play e.g. feed a doll and explores environment: 1 1/2 year - Solitary play and pretend (role) (imagination) play e.g. cooking tray or mobile talking: 2 years
- Parallel Play (interactive play evolving) and takes turn: 3 years. - Share toys: 4 years
- Make believe play (you are mum and I am dad): 5 years
C) Care (by history only):
- Indicates need (not by crying) : 1 year - Indicates toilet need: 1 1/2 year
- Dry by day: 2 years - Uses toilet alone: 3 years
- Brushes teeth, wash and dry hands: 4 years - Mostly dry by night: 5 years
D) Dressing ( by examination):
- Takes off shoes and socks: 1 1/2 years - Helps in dressing: 2 years
- Able to undress: 3 years
- Dress with supervision: 4 years
ASSESSMENT OF HEARING AND SPEECH
A) Ask the child about his name, age, sex, address and ask him to count from 1-10:
If he did not answer, tell that you want to ask the mother about any concerns regarding his hearing.
B) Assess concentration and attention:
Give him a colored object and ask him to point to an object with the same color.
C) Assess picture recognition and selection: e.g. Ask him about the picture of
the duck: what is this? If he did not answer, tell him can you show me the picture of the duck?.
D) Assess object recognition and selection: e.g. ask him about the horse: what
is this? If he did not answer, tell him can you show me the horse?
E) Assess imitation of sounds: e.g. show him a dog and ask him what is the
sound of this? If he did not answer I will ask him which animal has haw haw sound ?
F) Assess words together:
a) A single task: e.g. take the horse
b) Double task: e.g. take the horse and give it to your mother
c) Triple task: e.g. take the horse, put it behind your back and give it to your mother.
MILESTONES OF HEARING AND SPEECH 1YEAR
- Says Mama and Dada meaningfully. - Turns to name ( by examination) - Understands words
1 1/2 YEAR
- Says Mama, Dada and another word
- Points to 3 parts of the face (by examination). - Obeys simple commands (by examination).
2 YEARS - Says his name (by examination).
- Understands many words (by examination). - Uses plurals e.g. books (by examination).
- Says 2 words sentence (2 words sentence at 2 years) (by examination). 3 YEARS
- Says full name (by examination). - Says age and sex (by examination).
- Says 3 words sentence (3 words sentence at 3 years) (by examination). - Says prepositions e.g. up and down (by examination).
- Says nursery rhymes (songs) (by examination).
- Identify 3 colors (3 colors at 3 years) (by examination). 4 YEARS
- Counts 1-10 by 1 hand (by examination). - Says address (by examination).
- Says 4 words sentence (4 words sentence at 4 years) (by examination). - Identify 4 colors (4 colors at 4 years) (by examination).
5 YEARS - Counts 1-10 by 2 hands (by examination). - Says his birthday (by examination).
REFERENCES
1 - Dr. Abla Alalfy lecture
2 - MRCPCH Clinical: Short Cases, History taking and communication skills.
3 - The MRCPCH clinical exam made simple.
4 - Short Cases for the MRCPCH
