What happens at a developmental assessment: a developmental paediatrician explains

A developmental paediatrician at Cadabam's CDC explains what she watches in the first ten minutes, what she asks parents, and the questions to ask if therapy has had no clear goals.

A developmental assessment looks at the whole child, not only whether they are talking. Dr. Keerti Kilas Chaurasia, Consultant Developmental Paediatrician at Cadabam's CDC, watches how a child responds to their name, makes eye contact, plays and communicates, takes a full history from the parents, and uses standard tools chosen for the child. Her advice to parents: do not wait for a child to fall significantly behind, and ask for clear goals if your child is already in therapy.

The first ten minutes: what a developmental paediatrician watches

Dr. Keerti Kilas Chaurasia starts with the parents. She notices whether they are calm or braced to be judged, because many arrive already carrying a lot of guilt, so she tries to be calm first. She then says hello to the child, asks their name, and only after that turns to the parents' concerns, while she watches the child play.

She is looking at a pattern, not at one thing:

Does the child respond when she says their name?
Do they make eye contact?
Are they drawn to the toys on her desk, and how do they play with them?
How do they communicate: words, gestures, or neither?

The overall pattern she observes matters more than whether the child is speaking. One observation is never enough to name a condition. She puts what she sees together with the child's developmental history and any earlier reports.

What she asks parents

She asks parents to describe the child's whole day, from waking to sleeping: meals, play, screens, who talks to the child and when. She wants to be, as she puts it, part of the child's life when families talk to her. That daily picture tells her more than a single number. For a child with late speech, it shows how many chances the child has for real conversation, and how screens fit in.

The five areas an assessment looks at

A developmental assessment helps understand a child's strengths and difficulties across:

Social communication
Language
Play
Thinking (cognition)
Daily living skills

Dr. Keerti combines the parents' history, her clinical observation and standard tools suited to the child. The tools differ from child to child; a developmental paediatrician chooses them case by case.

What parents often hear before they arrive

Many families say they were told the child is fine, that boys talk late, that a father or an uncle spoke late too, or to wait seven or eight months and the child will grow out of it. Dr. Keerti's answer is that children do develop at different paces, but every milestone has a bracket. If the bracket is crossed, the child should be assessed whether they are a boy or a girl. Her example: if a child cannot put two words together by 24 months, the bracket has been crossed.

In her view, an early assessment is not overreacting; it is what a responsible parent does.

For the milestones themselves, see communication milestones from birth to three years.

If your child has been in therapy for months without an explanation

Dr. Keerti meets many families who are drained emotionally, financially and mentally after months of therapy without a diagnosis. She tells them not to feel guilty, and that any improvement they have seen is real. She also says a comprehensive assessment is just as important, because therapy without a clear picture is like a person without a name trying to work out what to do.

Three questions she encourages parents to ask the therapist:

What is this therapy targeting?
How is progress being measured?
In how many weeks or months do you expect this goal to be reached, and is it a short-term or long-term goal?

After a month, go back and ask what was achieved and what comes next. In her words, you deserve clarity. She also believes therapy should be reviewed regularly, not only by the therapist but by the person looking at the child's development as a whole, the developmental paediatrician.

After the assessment: the plan

Dr. Keerti sets short-term and long-term goals, reviews them, and changes the plan when needed. She does not promise outcomes. Her responsibility, she says, is to give an honest assessment, not to reassure. In her practice, follow-up is often monthly at first and later about every three months when parents are carrying the plan out at home. She watches the parents' effort too, because therapy is a few hours and home is the rest of the child's life.

Which therapies a child needs depends on the child, not on the label. Some children need speech therapy, some behaviour therapy, some occupational therapy, some educational support, and some mainly need rich stimulation at home. More therapy does not automatically mean better progress.

Developmental care is a team effort. The developmental paediatrician diagnoses and coordinates; the therapists work towards shared goals; progress is reviewed together. Parents are at the centre, and she asks them to keep a short diary, weekly if not daily.

What a diagnosis means

Dr. Keerti describes a diagnosis as a gate. Before it, the gate is closed and you cannot see beyond it. A diagnosis does not decide a child's whole future. It helps parents see their child's strengths and challenges and guides the support, and it does not limit expectations.

You can love your child exactly as they are, and still seek help.

When to book a developmental assessment

Book an assessment if your child:

has missed a milestone for their age, or has lost a skill they already had
has few or no meaningful words by about 18 months, or no two-word phrases by about 24 months
rarely responds to their name, or makes very little eye contact
has strong needs for sameness in food, objects or routine that upset the whole day when they change
has been in therapy for months without a clear explanation or goals

Children aged 0 to 6 with any developmental concern are best served at Cadabam's CDC. For teenagers with attention or behaviour concerns, our neighbouring centre MindTalk is often a better fit, and a child and adolescent psychiatrist is the right door for diagnosis and medication questions.

Frequently Asked Questions

Who does a developmental assessment at Cadabam's CDC?

Dr. Keerti Kilas Chaurasia, Consultant Developmental Paediatrician at Cadabam's Child Development Centre, describes her approach in this article. Book an appointment through the Book Appointment button or call 95355 85588 to ask which professional will see your child.

What does a developmental paediatrician watch for in the first visit?

How the child responds to their name, whether they make eye contact, how they play with the toys in the room, and how they communicate with words and gestures. She also watches how the parents are feeling, because many arrive carrying guilt.

Is one visit enough to give a diagnosis?

Dr. Keerti says one observation is never enough. She combines what she sees in the room with the child's developmental history and any earlier reports before she names a condition.

My boy is a late talker. Should I wait?

Dr. Keerti says being a boy is not a reason to dismiss a speech delay. Every milestone has a bracket, and if the bracket is crossed the child should be assessed. Early assessment is not overreacting.

My child has had months of therapy but no diagnosis. What should I ask?

Ask what the therapy is targeting, how progress is measured, and in how many weeks or months each goal is expected, and whether it is a short-term or long-term goal. Go back after a month and ask what was achieved and what comes next.

Does every child need every therapy?

No. Which therapies a child needs depends on the child, not only the label. Some need speech therapy, behaviour therapy, occupational therapy or educational support, and some mainly need home stimulation. More therapy does not automatically mean better progress.

Does a diagnosis limit my child's future?

Dr. Keerti says a diagnosis does not define a child's whole future. It helps you understand your child's strengths and challenges and guides the support.

Support at Cadabam's CDC

Developmental paediatricians and therapists at our three centres, JP Nagar, Kalyan Nagar and Kanakapura Road, work with children and their parents as a multidisciplinary team. Book an appointment or call 95355 85588, Monday to Saturday, 9 am to 7 pm.

This article shares the perspective of Cadabam's CDC professionals. It is general information and does not replace an assessment.

What happens at a developmental assessment: a developmental paediatrician explains | Cadabam's CDC