Normal Developmental Milestones

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Normal Developmental Milestones

• An emphasis on anticipatory guidance
• Ana Malinow, MD

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Why we should teach parents about development

• Parents who understand their childs
  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.

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Objectives

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

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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

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Development Occurs in a Cephalocaudal Direction
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Development begins in utero

• Age Responses/Reflexes
• 8 ½ wks tactile stimuli (reflex arc laid down)
• 12 wks sucking
• 24 wks sound
• 26 wks rhythmic breathing movements/ controls
  body temperature
• 30 wks pupilary light reflex
• 35 wks grasp/spontaneous orientation to light

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

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

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Declining intensity of primitive reflexes and
increasing role of definitive motor actions
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Gross motor developmentLocomotion
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Locomotion begins with head control
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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

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Ventral suspension
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Head control
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2 month head control
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4 month head, arm control
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6 month head, arm, trunk control
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8 month head, arm, trunk, leg control
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9 month pulls up to stand
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12 month old locomotion
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2 year old Running Backward Walking
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3 year old Balance
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ManipulationFine Motor Development
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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

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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
• gt12m letting go, stacking

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Cognition

• Social Development
• Problem solving
• Play
• Causality
• Language Development

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Assessing cognitive developmentProblem 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

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Assessing cognitive developmentPlay

• Age Play stage Piagetian stage
• lt12m sensory-motor sensory-motor
• 12m-18m functional sensory-motor
• 18m-24m symbolic sensory-motor
• 2-5y imaginary/magical pre-operational
• 6y logical thinking concrete operation
• 11y hypothetical formal operational

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12-month 18-monthFunctional Play
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18-month 24-monthSymbolic Play
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2-5 yearImaginary/Magical Play
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6 year oldLogical Thinking
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11 years Hypothetical thinking
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Assessing cognitive developmentCausality

• Age Cause Effect
• Early cries mom comes
• Early smiles mom responds
• 4m kicks crib mobile moves
• 8m pulls string gets ring
• 10m funny response/repeats
• 24m winds key toy moves

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Conversational speech probably starts with smiling
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2 month old language
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Assessing cognitive development Language

• Age Milestone
• 4-6wks smiles
• 2m vocalizes with vowels
• 3m vocalizes with consonants
• 4m squeals
• 6m syllables
• 7m non-specific combinations
• 8m imitates sounds, understands no
• 12m 1-3 words

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Assessing language

• Age Expressive Receptive Jargon Sentence
  L. Intelligible
• 12m 1-3 100 Y none
• 18m 10-25 ID body Y giant words
• holophrases
• 2y 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

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Behavior

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

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Behavior-continued-

• Cognitive, gross and fine motor development
• Illness, separation, feeding issues
• Birth order, family size
• Secondary attachments
• Environment
• Gender identification

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Bonding
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Personality

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

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Newborn Personality
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4 month old Personality
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9-month oldPersonality
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Other PersonalityLandmarks

• 2-year old independence/dependence
• 3-year old master of impulse control, sharing,
  wants to please, guilt
• 7-year old ability to see anothers point of view
• Adolescence begins identity formation
  (idealistic)
• Adulthood completion of identity formation

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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