Experience in Cambodia With the Use of a Culturally Relevant Developmental Milestone Chart for Children in Low‐ and Middle‐Income Countries

Abstract

The awareness and knowledge of developmental milestones among health practitioners need to be enhanced to better enable early identification and intervention with children who have delays in development, intellectual deficit, and developmental disabilities and are residents in low‐and middle‐income countries. To meet this end, a simple one‐page check‐off developmental milestone chart for age groups birth to eight years was developed as an outgrowth of a training program for pediatricians in Cambodia. Expected milestones for gross motor, fine motor, language, and social development were charted for each age group, and then validation trials were performed in an outpatient clinic over two years. It was observed that 25% and 31.5% of children failed to achieve one or more age‐appropriate developmental milestones in trials held in 2007 and 2008, respectively. The author observes that referral for further evaluation, parental education/support, early child care, and early intervention would need to be based on subsequent trials of more culturally accurate local milestones, and further studies to determine an acceptable number of milestone failures that would yield the least false positives. Similar processes for developing instruments, utilizing local culturally appropriate developmental milestones, are recommended for training purposes and regular clinic use in other low‐ and middle‐income countries.

Global perspective on early diagnosis and intervention for children with developmental delays and disabilities

“…A surveillance instrument of this type was used in a trial in Cambodia to alert, remind, and sensitize health workers of relevant developmental milestones using a simple check‐off sheet grouped by age intervals 69 . Possible future refinement of the Cambodia milestones selected would be based on recent doctoral work 70 .…”

Distortions and Dichotomies in Inclusive Education for Children with Disabilities in Cambodia in the Context of Globalisation and International Development

“…in the initial screening had proved problematic in other countries (Durkin et al, 1994;Zaman et al, 1990), while the next stage assumed the existence of an extensive corpus of trained professionals, such as psychologists, developmental paediatricians, audiologists, optometrists, and so forth, who could conduct sophisticated assessments, using culturally appropriate tools. In his study of the reliability of an easy-to-use developmental milestone chart to identify children with development delays in Cambodia modified from screening tools used in the West, Scherzer (2009) noted that what constitutes "delay" in one culture may not in another and recommended the need for more accurate, locally identified milestones. With services for children with disabilities being mainly in Phnom Penh and in some provincial capitals, assessments as the survey envisioned would either involve huge numbers of children coming to these centres or "mobile crews" of trained professionals following the survey enumerators.…”

Using indigenous knowledge to provide educational services for children with disabilities

“…So all milestones do not occur at the same time for all children. A second assumption is that developmental milestones are the same universally (Scherzer, 2009). However, research has shown that mothers may identify other events in their child's life as a developmental milestone: In Cambodia, mothers spoke about "bat phneak", literally translated to "opening of the eyes" of their one-month-old babies.…”