Examinations: one to two

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.



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.

(Ilse Pauw, Health24)

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