Developmental milestones and prolonged hospitalisation

By March 13, 2018 No Comments

The aim of a developmental assessment is to evaluate a child’s developmental status against a representative population and introduce interventions if these are necessary. Childhood development describes the progression from dependent infancy to independent adulthood with sequential acquisition of skills over time. Key skills are referred to as milestones, like speaking in 2-3 word phrases at age 2.

Certain milestones are consistently achieved within a specified time period (e.g. social smiling by 8 weeks), while the attainment of others varies widely. Milestones are not always a necessary part of normal development (e.g. some infants may never crawl as they have an alternative means of locomotion: bottom shuffling).

The impact of prolonged hospitalisation on development

Long hospital stays at a preschool age have been shown to negatively impact long-term educational performance. Comparison of reading and mathematical proficiency at 10 years of age following preschool (less than age 5) hospitalisation for either less than a week or more than 3 weeks revealed the latter cohort of children performed approximately one-fifth of a standard deviation below their peers.

Previous studies have investigated the value of attempts to detect developmental delay within paediatric hospitals. To begin, Feldman et al. studied a group of 135 children who were less than 3-years-old and admitted to hospital for more than 1 month [1]. 30% of the hospitalisations exceeded 2 months, which totalled to 10,106 patient days.

A developmental evaluation was undertaken for 61% of the children, which revealed that 78% had evidence of developmental delay. Pennsylvania, where the study was undertaken, has specific criteria that when fulfilled necessitate early intervention services to support the care of children with biologic handicaps or developmental delay. The proportion of children that met these eligibility criteria increased with length of hospital stay; 74% of those hospitalised for 60-90 days were eligible, while 100% of those with a hospital stay of more than 120 days met these criteria [1].

Hospital admission has been therefore recommended as a point at which opportunistic developmental assessment is appropriate. Petersen et al. used this strategy to demonstrate that 10% of hospitalised children within their sample were identified for the first time as having a developmental disability [2].



  1. Feldman HM, Ploof DL, Hofkosh D, Goehring EL Jr. Developmental needs of infants and toddlers who require lengthy hospitalization. Am J Dis Child. 1993; 147(2):211-215
  2. Petersen MC, Kube DA, Whitaker TM, Graff JC, Palmer FB. Prevalence of developmental and behavioral disorders in a pediatric hospital. Pediatrics. 2009; 123(3):e490-495