Normal Developmental

MilestonesAn emphasis on anticipatory

guidanceAna Malinow, MD

Why we should teach parents about development

Parents who understand their child’s developmental state, are more likely to have appropriate expectations.

Having appropriate expectations makes for a healthier relationship between parent and child.

Healthier relationships facilitate development.

Objectives• Principles of development• Primitive Reflexes• “Locomotion”: Gross Motor• “Manipulation”: Fine Motor• “Cognitive”: Language and Social• Behavior and Personality

Principles of Development

• A continuous process• Sequence of development is the same, rate of

development varies• Not parallel• Related to CNS maturation• Involuntary movements give way to voluntary

responses• Occurs in cephalocaudal and proximal to distal• Progresses from dependence to independence

Development Occurs in a Cephalocaudal

Direction

Development begins in utero

Age Responses/Reflexes8 ½ wks tactile stimuli (reflex arc laid

down)12 wks sucking24 wks sound26 wks rhythmic breathing movements/

controls body temperature30 wks pupilary light reflex35 wks grasp/spontaneous orientation to light

All primitive reflexes develop during gestation and disappear by the 3rd to 6th month after birth

Primitive reflexes• Tonic labyrinthine reflex• Asymmetric tonic neck reflex• Positive support reflex

Declining intensity of primitive reflexes and

increasing role of definitive motor actions

Gross motor development“Locomotion”

Locomotion begins with head control

Assessing Locomotion• Ventral suspension NB-3m• Sitting position NB-8m• Prone position NB-9m• Standing/Forw. Walking 9m-

18m• Running/Backw. Walking 2 yrs• Balancing 3 yrs +

Ventral suspension

Head control

2 month head control

4 month head, arm control

6 month head, arm, trunk control

8 month head, arm, trunk, leg control

9 month pulls up to stand

12 month old locomotion

2 year old Running Backward Walking

3 year old Balance

“Manipulation”Fine Motor

Development

Manipulation: Assessing the pincer grasp from 0-

6m• NB primitive• 1m primitive• 2m starting to lose• 3m voluntary on

ulnar• 4m hands together• 5m palmar grasp• 6m hand-mouth-

hand; hand-to-hand

Manipulation: Assessing the pincer

grasp 7-12 m• 7m thenar side, raking• 8m 1 block in each hand• 9m radial-digital grasp;

inferior pincer• 10m index finger isolation• 12m fine pincer• >12m letting go, stacking

“Cognition”Social Development

Problem solvingPlayCausality

Language Development

Assessing cognitive development

Problem solving• NB visual exploration• 4-6wks smiles, fixes, follows• 2m imitates mouth movements• 3m anticipates feeds• 5m object permanence• 6m looks to floor when toy

dropped• 7m grabs 2nd cube, drops first• 8m seeks object after fall

(silent)• 9m uncovers hidden object under

cloth• 10m isolates index finger

Assessing cognitive development

PlayAge Play stage Piagetian stage<12m sensory-motor sensory-motor12m-18m functional sensory-motor18m-24m symbolic sensory-motor2-5y imaginary/magical pre-operational6y logical thinking concrete

operation11y + hypothetical formal

operational

12-month 18-monthFunctional Play

18-month 24-monthSymbolic Play

2-5 yearImaginary/Magical Play

6 year oldLogical Thinking

11 years +Hypothetical thinking

Assessing cognitive developmentCausality

Age Cause EffectEarly cries mom comesEarly smiles mom

responds4m kicks crib mobile moves8m pulls string gets ring10m funny +response/repeats 24m winds key toy moves

Conversational speech probably starts with

smiling

2 month old language

Assessing cognitive development:

LanguageAge Milestone4-6wks smiles2m vocalizes with vowels3m vocalizes with consonants4m squeals6m syllables7m non-specific combinations8m imitates sounds, understands “no”12m 1-3 words

Assessing languageAge Expressive Receptive Jargon Sentence L.

Intelligible12m 1-3 100 Y none18m 10-25 ID body Y giant words

holophrases2y 50 Pts. Body N 2 words 25-

50%3y 500 Prepositions N 3-4 words 75%4y 5 def. Comparisons N 4-5 words

100%5y 7 def. N 100%6y masters rules of grammar

Behavior• One-way or two-way interactions• Prenatal factors• Bonding/attachment• CNS maturation• Match• Schedule• Language• Instincts

Behavior-continued-

• Cognitive, gross and fine motor development

• Illness, separation, feeding issues• Birth order, family size• Secondary attachments• Environment• Gender identification

Bonding

Personality• Factors that influence behavior• Create behavior• Through adaptability and flexibility• Produce personality/social

behavior

Newborn “Personality”

4 month old “Personality”

9-month old“Personality”

Other “Personality”Landmarks

• 2-year old independence/dependence• 3-year old master of impulse control,

sharing, wants to please, guilt• 7-year old ability to see another’s point

of view• Adolescence begins identity formation

(idealistic)• Adulthood completion of identity

formation

Conclusion• Development is a continuous process• Sequence is always the same, rate

varies• Development does not run parallel• Intimate relationship with CNS• Generalized activity gives way to

voluntary activity• Cephalocaudal development• Dependence to independence