Lesson 1Early intervention principles and evidence-based therapies: parent-mediated interventions, physical therapy goals, speech-language interventionsThis section reviews core principles of early intervention, emphasising neuroplasticity, goal setting, and family-centred care. It details parent-mediated strategies, physical therapy aims, and speech-language approaches tailored to infants and toddlers in local settings.
Neuroplasticity and timing of interventionFamily-centred and strengths-based careDesigning functional, measurable therapy goalsParent-mediated interaction and play coachingEarly motor therapy aims and methodsEarly communication and language strategiesLesson 2Differential diagnosis and common causes of developmental delay: prematurity, genetic conditions, hearing loss, cerebral palsy, autism spectrum disorder, environmental factorsThis section reviews major etiologies of developmental delay in early childhood, including prematurity, genetic syndromes, cerebral palsy, autism, sensory impairments, and environmental factors, and outlines a practical approach to differential diagnosis in Botswana.
Impact of prematurity and perinatal eventsRecognising patterns of genetic syndromesCerebral palsy: early signs and subtypesAutism spectrum features under age threeHearing and vision loss as contributorsEnvironmental and psychosocial risk factorsLesson 3Initial evaluation and targeted investigations: hearing and vision screening, growth/nutrition assessment, basic labs, neuroimaging indications, genetic testing triggersThis section covers the initial evaluation of a child with suspected delay, including detailed history, examination, hearing and vision screening, growth and nutrition review, and indications for labs, neuroimaging, and genetic testing in primary care settings.
Key elements of developmental historyFocused neurologic and physical examinationHearing and vision screening in young childrenGrowth, nutrition, and feeding assessmentIndications for basic laboratory testingWhen to order imaging or genetic studiesLesson 4Clinic workflows for developmental surveillance: documentation templates, screening schedules, referral tracking, and community resourcesThis section describes how to design efficient clinic workflows for developmental surveillance, including standardised documentation, screening schedules, referral tracking, and linkage to early intervention and community-based family supports in Botswana.
Standardised developmental documentationAge-based screening and surveillance schedulesEmbedding tools into electronic recordsReferral tracking and feedback loopsLinking families to community resourcesQuality improvement for surveillance processesLesson 5Referral pathways: when to refer to early intervention, developmental pediatrician, pediatric neurology, physiotherapy, speech therapy, audiology, and occupational therapyThis section outlines clear referral thresholds and pathways from primary care to early intervention, developmental paediatrics, neurology, and therapy services, emphasising timely access, documentation, and follow-up on recommendations in local health systems.
Criteria for early intervention referralWhen to refer to developmental paediatricsIndications for paediatric neurology referralReferral to PT, OT, and speech therapyAudiology and vision specialist pathwaysTracking outcomes of specialist referralsLesson 6Monitoring, milestone tracking, scheduling follow-ups, and coordinating multidisciplinary careThis section focuses on longitudinal follow-up of at-risk children, including milestone tracking, use of standardised tools, scheduling visit intervals, coordinating multidisciplinary input, and ensuring continuity between medical and community services.
Using milestone checklists and tracking toolsDetermining follow-up intervals by risk levelCoordinating multidisciplinary care plansSharing information across care settingsAdjusting goals as the child developsSupporting family engagement over timeLesson 7Screening tools and structured developmental surveillance: Ages and Stages Questionnaires (ASQ), M-CHAT, Denver II — administration and interpretationThis section explains how to select, administer, score, and interpret common developmental screening tools under age three, including ASQ, M-CHAT, and Denver II, and how to integrate structured surveillance into routine paediatric visits in Botswana.
Choosing age-appropriate screening instrumentsAdministering and scoring the ASQUsing and interpreting the M-CHATApplying the Denver II in busy clinicsCommunicating screening results to familiesIntegrating surveillance into well-child visitsLesson 8Communicating developmental concerns to families: plain-language explanations, culturally sensitive counselling, setting expectationsThis section provides strategies for discussing developmental concerns with families using clear, non-alarmist language, cultural humility, and shared decision-making, while addressing emotions, stigma, and realistic expectations for progress in Botswana contexts.
Preparing for difficult developmental conversationsUsing plain, non-stigmatising languageCulturally responsive counselling approachesAddressing parental emotions and guiltDiscussing prognosis and goal settingProviding written summaries and resourcesLesson 9Normal neuropsychomotor milestone timeline to 36 months: motor, language, social, cognitive benchmarksThis section reviews normal motor, language, social, and cognitive milestones from birth to 36 months, highlighting expected age ranges, variability, and how to distinguish normal variation from patterns that warrant closer monitoring in local populations.
Motor milestones from birth to three yearsLanguage and communication progressionSocial-emotional development trajectoryEarly cognitive and play skill milestonesRecognising normal variation in timingUsing milestone charts during visitsLesson 10Red flags for referral: absent babbling/words, lack of social smile, poor eye contact, motor delays, loss of skills — what they mean clinicallyThis section outlines key developmental red flags in infants and toddlers, including social, language, and motor concerns. It clarifies their clinical significance, urgency, and how to distinguish variation from signs of underlying neurodevelopmental disorders.
Early social and communication red flagsLanguage delay and absent babbling or wordsMotor delay, asymmetry, and abnormal toneRegression and loss of previously gained skillsWhen red flags require urgent referralDocumenting and tracking concerning signs
