NORMAL DEVELOPMENTAL MILESTONES TILL 1 YEAR

NORMAL NORMAL DEVELOPMENTDEVELOPMENT

OF CHILDOF CHILD0-1 yr0-1 yr

BY:BY:Sharmin SusiwalaFinal YearBPT

NORMAL DEVELOPMENT

"Maturation of function with Age"• Continuous Process.• Dependent on interaction between

innate genetic factors and environmental factors.

Nature v/s Nurture• Intimately related to the maturation

of CNS

PRINCIPLES OF DEVELOPMENT:Distinctive attribute of childhoodCephalocaudal orderMass activity specific and subtle

individual responses.Primitive Reflex pattern

MILESTONES• Set of functional skills or age-specific tasks that

most children can do at a certain age range.• Assessing developmental milestones or

attainment of those milestones is the central part of any pediatric neuro examination.

• Development is assessed by sequential attainment of milestones under following domains:

1.Gross Motor Development2.Fine Motor Development3.Social and Cognitive Development4.Language5.Vision and Hearing

NEWBORN

GROSS MOTOR DEVELOPMENT:POSTURES:

1.Prone 2.Supine 3.Sitting 4.Standing

1.Prone Position:

Head is turned to one side.Pelvis is raised off the surface by excessive hip flexion.Knees flexed and drawn up under abdomen.

2. Ventral Suspension:

Head flops down completely.

Back is rounded.

3. Supine Position:

Less flexed as gravity tends to favor extension.

Shoulders are less protracted.

Arms are more abducted.

Hips are less flexed and more ER.

4. Supine and Pull to Sit:

Head completely lags behind shoulder

Back is rounded.

5. Sitting:

When the newborn infants are placed in sitting, physiological flexion, joint immobility and decreased flexibilty of soft tissue allow them to maintain position briefly.

"Flopping like a rag doll"

6. Vertical Suspension:

Automatic stepping reaction observed.

Legs flex and extend reciprocally.

POSTURAL CONTROL:

Neck Righting Reflex. Primary Standing reaction.

Physiological flexion/ Flexor recoil of limbs.

REFLEXES:Primitive reflexes elicited by a specific stimulus:1.ATNR2.Moro3.Sucking/Rooting4.Galant

Sucking/ Rooting Reflex

Galants Trunk Incurvatum Reflex

FINE MOTOR DEVELOPMENT:

• Hand is fisted.• Grasp Reflex.

1. Prone:- Lifts and turns the head to one side.- Child lifts the chin up momentarily in midline.- Hips and knees are partially extended.

GROSS MOTOR DEVELOPMENT:POSTURES:

2. Ventral Suspension:- Head momentarily lifts up.- Elbow Flexed.

3. Supine:- Generally more extended.

4. Supine and Pull to Sit:- Greater Head lag than in newborn but attempts to lift head.

5. Sitting:- Attempts to lift head.- If unsupported at trunk, results in bobbing movement of neck.- Infant fatigues easily and falls forward into flexion.

6. Vertical Suspension:- Automatic Stepping diminishes.- Usually cannot be elicited after 1st month.

POSTURAL CONTROL:• Physiological flexion Diminishes.• Head righting continues to develop.

REFLEXES:• ATNR can be observed and

serves as a pattern of postural control.

• Others same as newborn


• Infant continues to exhibit Grasp Reflex

• Hands mostly closed.

1. Prone Position: Infant can lift the

head about 45 deg. off the couch momentarily.

GROSS MOTOR DEVELOPMENT:POSTURE:

2. Ventral suspension: Head is maintained momentarily in the same plane as the rest of the body. Can maintain this position well.

3. Supine Position:Arms and Legs more

extended.Kicking.

4. Pull to Sit: Head control starts to develop when the child is put to sitting position. Chin is lifted up momentarily. Back is rounded.

5. Sitting:When placed in

sitting, 2 months old baby, attempts to lift head

Bobs forward.Back is rounded.

6. Vertical Suspension:Can hold head up more than momentarily.

POSTURAL CONTROL:

• Physiological flexion further diminishes.

• Active control starts to develop.

• Head Righting continues to develop.

• Maintains his position when held upright on adult's shoulder.


• Awareness of object placed in hand.• Scratch and Clutch tactile input such as a

crib blanket.

1. Prone Position: Pelvis is kept flat on the

ground. Infant can symmetrically

lift the head and shoulder about 45 deg. off the couch.

2. Ventral Suspension: Lifts head beyond the

plane of the rest of the body.

Able to hold for sometime.


3. Supine:Hold the head in

midline for sometime.

Tucks chin inGazes towards the

chestBilateral activity of

UE and LE dominate during this period.

4. Pull to Sit: No head lag. But head tends to

bob.

5. Sitting: Infant can hold head upright in sitting for sometime but there may still be some wobbling of the head. Learns to control head and trunk.The back is still rounded, so the baby slumps forward.

6. Vertical Suspension:

Head erectTake weight only

briefly.No slipping from

shoulders.

POSTURAL CONTROL:

• Active Head and Trunk Righting reactions.

• Infant now begins to establish postural synergies, or a state of readiness in preparation for volitional movement.


• Hand Regard.• Hand to Hand

Coordination.• Sustained

Voluntary Grasp.• Tactile Awareness.

1. Prone Position:Prop on foreams Lifts the head and

chest higher.


2. Ventral Suspension:

Head is maintained well beyond the plane of the rest of the body.

Back is flat

3. Supine:Hold the head in

midline for long periods of time.

Initiation of rolling.

4. Pull to sit:When pulled up, there

is slight head lag during beginning and then head is flexed beyond the plane of the body.

Spine Curvature decreases.

5. Sitting:Sits upright for 10-15

min at a time.Attempts to lean

forward to reach or touch an object and return to erect position.

Learns to control head and trunk

6. Vertical Suspension:Stands erect with

better head and trunk control.

POSTURAL CONTROL:

• Functional Head Control starts to develop.• LANDAU REACTION:

Symmetrical Tonic Neck Reflex

ANATOMICAL CHARACTERISTICS:

Primary spinal curves that exhibit posterior convexity are present in the newborn infant in the thoracic and sacral-coccygeal region.Secondary curves with an anterior convexity starts to develop in cervical and lumbar areas in order to accommodate to a vertical position.The cervical curve is seen by 4 months as the infant can hold the head erect and steady.


• Hands come together in midline.

• Bidextrous Reach.• Tries to reach

object, but overshoots.


1. Prone Position:Chest is

maintained off the couch

Arms in extension.Turns head from

side to side.

2. Ventral Suspension:Head is maintained beyond plane of rest of

body with trunk extension.

3. Supine: Independent movement of head.Can also lift the head in supine and might lift

the shoulders off the surface.Symmetrically lifts the legs in air with knees

extended and forcefully lowers them to the surface with a bang.

"Bridging Activity"

4. Pull to Sit:Baby flexes and lifts

the head.Tucking the chin.

5. Sitting:Head is stable without

wobblingBack is straightTakes support on

handsTries to play by

carefully lifting one hand to reach object.

6. Vertical Suspension:Continue with wide BOSControls knee in weightbearing position.

POSTURAL CONTROL: Head Righting is complete Functional Head control is present in all positions. Landau reaction matures.Beginning of lateral postural control. Primitive Reflexes no longer dominate.


• Able to grasp an object with asymmetrical palmar grasp.

• Brings objects to the mouth.

• Begins to transfer an object from one hand to another.


1. Prone Position: Sufficient Postural

Stability. Arms and legs

outstretched. Experiments with

more movement of trunk in prone.

Begins to assume Quadruped position.

Tries to move self on floor.

Rolling:• Most babies can

transition between supine, prone and sidelying by the end of six months.

• Each baby develops an individual pattern for rolling that becomes more efficient with repetition and motor learning.

3. Pull to Sit: When about to be pulled up,

lifts head off the couch in anticipation.

Tucking the chin. Baby pulls with arms and

extends the kness while bringing the body weight forward.

Also the legs are flexed at the hips and are off the mat as the baby pulls himself to sitting.

2. Supine: Greater Anti-Gravity Control. Raises one or both arms freely in space and reaches to be picked up. Able to hold their legs vertical with knees extended.

4. Sitting:Able to sit well in a

high chair and begin to control the limited surrounding space.

Sit independently on the floor with arm support and may easily play in this position for upto half an hour.

"Tripod Sitting"May reach with one

arm while suporting with other.

5. Vertical Suspension: Stands with less

suport. Feet closer together. Bears almost all his

weight when made to stand.

Hold on by grasping an adults finger rather than being held by the hands or arms.

POSTURAL CONTROL:

• By 6 months of age, baby has sufficient postural tone to maintain many postures against gravity.

• More mature Landau reaction.• Labyrinthe and Optical righting have fully

developed.• Body on Body righting response can also be

elicited.• Equilibrium reactions are present in prone and

are beginning to be seen in supine.• Forward Protective Extension of arms begins to

emerge at 6 months.


• Unidextrous reach.• Consistent palmar grasp.• Tranfers hand to hand.• Attempts to help with spoonfeeding

and cupdrinking.• Shakes and bangs toys to create

auditory and visual object.• Child cannot yet voluntarily release

an object in space.


1. Prone Position: Baby is busy

reaching, weight shifting and trying to move along the floor.

Maintains Quadruped position well.

2. Supine: Rarely stays in

supine.

3. Rolling:Rolling to the side,

baby pushes up on one arm to a position in which a larger area can be visually and manually explored.

4. Sitting:Sit with their arms free for play.But supports with one hand while

reaching any object.

5. Transitions in and out of sitting:Baby is able to get into sitting position

independently but only from quadruped position.

7 month old infant also begins to transition from sitting to prone.

6. Quadruped:7 month old baby

symmetrically pushes the arms straight to assume a quadruped position.

Begins to rock forward and back

Loses balance and falling to prone.

7. Locomotion:Begins to move on

the abdomen by pivoting sideways.

Alternatively weight shifts from one side to other.

Baby learns to pull the body forward but his action is not propulsive.

8. Pulling to stand:Babies begin to pull

themselves to a standing position.

While in a crib, from prone or quadruped, baby pulls up to standing, using the arms to climb the rails.

When seated on the floor, an adult's lap is another optimal support for first pulling to standing.

9. Standing: Unstable. Legs are wobbly and appear disoriented. Stands at adducted hips. Often baby stands on toes. Baby widens BOS by taking step side-ways.

POSTURAL CONTROL:• Pelvic/Hip stability increases.• Equilibrium reactions present in

prone and supine.


•Learns to hold object with radial palmar grasp.•Tranfers objects.•Learns to release object as voluntary grasping has developed.


1. Sitting:Sits independently without any

support.Learns to maintain a more erect trunk

for longer periods.Moves arm in greater range up and

away from body.Lower portion of leg closer to the

body.

2. Rolling: As the balance

and coordination improves, child raises the trunk higher off the surface until close to sitting.

Now the child can move easily from here to quadruped.

3. Transition in and out of sitting: Baby develops sufficient UE, trunk and pelvis control to

rotate from sitting to Quadruped.

4. Quadruped: Baby becomes confident in assuming quadruped from

different positions using variety of patterns. In quadruped, baby develops the ability to reach

laterally as well as forward.

5. Locomotion: In 8 month, baby begins to pivot or belly crawl

in larger ranges and locomotes from one point to another.

Learns to crawl on all fours. Initially baby creeps on hands and knees slowly Pattern may not be well tolerated.Often baby collapses. Lateral flexion/elongation of trunk as weight is

shifted during early crawling.

6. Pulling to Stand: Pulls to standing from sitting, baby tries to pull up on

various objects of an optimal size and height. Baby learns which objects are stable and which are not

adequate. When first standing up, baby may be unable to get back

down and start to cry, which he soon learns to let it go and falls on buttocks.

7. Standing: Standing at 8 months becomes more controlled. Baby can free one arm and reach in a wider BOS Motivated to obtain objects which are out of reach, baby

uses this side-stepping pattern to cruise around furniture. With two hands held, 8 months old child begins to walk,

although this may be a continuation of early automatic stepping pattern of newborn, the coordination is now disrupted.

POSTURAL CONTROL:

• Increased postural activity to– maintain upright positions– accompany functional movts in sitting,

quadruped and standing at support– transition between sitting, quadruped

and supported standing.

• Equilibrium reactions are present in sitting and beginning in quadruped.• Protective extension of arms sideways in sitting.


• Mature palmar grasp.• Palmar arches are active as they

contribute in grasping any object.


1. Sitting:Becomes more dynamic A baby sits and plays with an object only

briefly, then drops it and throws it and reaches again.

Rotates the body to reach any object.(90 deg or more)Bouncing.May also begin to Side-sit, one hip ER and

other IR.

2. Transitions in and out of sitting:

By 9 months of age, babies have increased hip mobility as well as postural control and may use a variety of patterns to move from sitting to quadruped.

Also movement is performed more easily and quickly.

3. Quadruped: Learns to control

position.Able to reach in wider

ranges.Once mastered in

quadruped, he learns to locomote.

Uses this position for play and locomotion.

Sometimes, baby pushes up on his hands to come on toes.

4. Locomotion:With continued practice, crawling

becomes efficient.By 9 months, there is less lateral

excursion of trunk and improved hip control.

5. Pull to Stand: The same basic motor

pattern is used to pull to standing regardless of the support.

From quadruped, baby reaches up with one arm, then the other arm, and walks knees forward.

In 9 month, baby doesnt fall on buttock as in 8 month, but now baby drops the pelvis back while reaching, keeping weight more to one side.

6. Standing: Balance in standing

develops, baby begins to turn head and shoulders sideways to visually explore the environment.

Turns diagonal to the supporting surface.

Child learns to stand, reach and play.

Distal Stability is improved by leaning against a surface.

Has sufficient balance to stand with one hand-held, using hip flexion and a wide base.

POSTURAL CONTROL:

• Uses many functional motor skills and movement to interact with the environment.

• In addition to modulating postural activity during performance of a motor skill, baby learns to adapt posture prior to movement for more efficient execution.


• Child has a strong grip and maintains an object against resistance.

• Immature Pincer grasp.

• Learns to release an object first against a surface, in midair followed by into a large container.

Transitions in and out of sitting:

• Atempts to sit up from sidelying.

Pull to Stand: Baby develops hip control so

now he kneels upright while pulling to stand with pelvis and hips aligned.

Able to shift body weight in this position.

When pulling up, baby may stop in kneeling position and reach for a toy.

With no sufficient hand control in this position, baby lowers the buttocks and sits on the heels to play.

VISION:

HEARING:

SOCIAL/ COMMUNICATION:

PHYSICAL CHARACTERISTICS OF GROWTH:

• WEIGHT:The average birth weight of a full-term newborn

is approximately 3.4 kg.Range-2.7–4.6 kg.Usually infant loses 10% of body weight by the

age of 10 days in the form of ecf.Subsequently, they gain weight at a rate of

approx. 25 to 30 g per day for the first 3 months of life.

Thereafter they gain about 400g weight every month for the remaining one year.

• LENGTH / HEIGHT:The infant measures 50 cm at birth.60 cm at 3 months.70 cm at 9 months.75 cm at 1 year.

HEAD:A newborn's head is very large in proportion to

the bodyThe newborn's head is about 1/4 of total body

length.

• HEAD CIRCUMFERENCE:Normal head circumference for a full-

term infant is 33–36 cm at birth.Gains 2 cm per month for the first 3

months.Gains 1 cm per month between 3-6

months.Gains half cm per month for the rest of

first year of life.

•At birth, many regions of the newborn's skull have not yet been converted to bone, leaving "soft spots" known as fontanels.

•Anterior•Posterior

•The posterior fontanelle generally closes 1-3 months after birth.

•The anterior fontanelle is generally the last to close between 7-19 months.

REFERENCE:

• Rona Alexander, Normal Development of Functional motor skills.

• O P Ghai,7 ed, Essential Pediatrics. • Suraj Gupte, The Short Textbook Of

Pediatrics.• Meherban Singh, 2 ed, Pediatric Clinical

Methods.• Glady Samuel Raj, Physiotherapy in Neuro-

Conditions.

Education

NORMAL DEVELOPMENTAL MILESTONES TILL 1 YEAR