Physical examination

When assessing developmental disability, physical examination aims to identify:

• signs that might suggest the underlying cause of the disability (eg microcephaly)
• conditions that may contribute to a poorer outcome (eg iron deficiency, hearing impairment)
• conditions that might arise from the disability (eg periodontal disease due to difficulty with teeth brushing)
• developmental skills and difficulties (eg communication, mobility).

When performing a general physical examination to assess developmental disability, check the person’s:

• height, weight and body mass index (BMI) (or percentile for children)
  • for adults, see Body mass index to assess body weight for classification of weight according to BMI
  • for children, see growth percentile charts
• head circumference (record on a head circumference for age chart)
• physical features of the face, hands, etc—multiple atypical features are more likely to represent an underlying syndrome
• ears and eyes—including visual acuity, hearing
• heart, lungs, blood pressure
• abdomen—including pubertal development
• skin—look for pale or pigmented patches, neurocutaneous stigmata
• neurological function—including abnormalities of gait and cranial nerves.

Comorbidity is common in people with developmental disability; practitioners should allow extra time to identify and diagnose comorbid health conditions, particularly in people with intellectual disability or communication impairment. Consider using a disability health assessment template to prompt information gathering and identify health problems that are often missed. See also Commonly missed health problems in people with developmental disability.