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May 2013, Volume 63, Issue 5

Letter to the Editor

Developmental milestones: Even the Physicians don’t know enough and what we need to do?

Ahmad Zaheer Qureshi  ( Department of Physical Medicine and Rehabilitation, King Fahad Medical City Riyadh, Kingdom of Saudi Arabia. )

Madam, in a correspondence to a previously published article titled "Developmental milestones: Do the parents know enough?", Rathore and Mansoor have attempted to reflect physician`s awareness over the subject.1,2 Conventionally, in scientific journals, comments to a published article are usually quoted under the same title as that of the original article, but a similarly derived title in their letter was an innovative thought. A first view of the title stating "Even the Physicians don\\\'t know enough" may deliver the readers a message that probably this is a conclusion based upon some survey. Inversely, such declaration was based upon mere "observations" by the authors. This is not common to scientific publications. Such statements may be misquoted in future articles and reflect poorly on the journal as well, as there is no sufficient evidence to support this. Whereas, in the appraised article titled "Developmental milestones: Do the parents know enough?" Mushtaq and Rehman have based their review in context of references from international and local studies.1
Similarly, stating that "many of the Pakistani physicians are not well aware of important motor and mental developmental milestones and more often they fail to detect and ignore them" could have been true if supported by evidence or research. Considering the international impact of scientific publications, any citation of such dubious statements may not be appropriate. Likewise, the statement that "Considering the fact that most of the children with delayed developmental milestones in Pakistan usually report to the local GP or paediatrician"; is not supported by any reference as well.
Authors also propose that recognition of delayed milestones should be included in the medical curriculum before medical students qualify. In Pakistan, the subject of paediatrics is already a part of medical curriculum which includes these basic topics at undergraduate level. A strong question may arise to the statement "There is no rationale for prescribing prolonged and high doses of multi vitamins, Calcium and Vitamin D to children with delayed milestones. This practice should be discouraged". Contrarily, a clear rationale exists. Developmental delay is a spectrum of diseases which also includes metabolic and nutritional ailments requiring vitamin or nutritional supplementation.3-5
Opinion based articles and observations may be narrated with great caution. Where applicable, generalization may be avoided to maintain scientific value of research.


1. Mushtaq A, Rehman A. Developmental milestones: Do the parents know enough? J Pak Med Assoc 2012; 62: 991.
2. Rathore FA, Mansoor SN. Developmental milestones: Even the Physicians don\\\'t know enough and what we need to do? J Pak Med Assoc 2013; 63: 132-3.
3. Banka S, Roberts R, Plews D, Newman WG. Early diagnosis and treatment of cobalamin deficiency of infancy owing to occult maternal pernicious anemia. J Pediatr Hematol Oncol 2010; 32: 319-22.
4. Halicioglu O, et al. Nutritional B12 deficiency in infants of vitamin B12-deficient mothers. Int J Vitam Nutr Res 2011; 81: 328-34.
5. Oladipo O, et al. Cobalamin F disease detected by newborn screening and follow-up on a 14-year-old patient. Pediatrics 2011; 128: 1636-40.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: