Child Development: Difference between revisions
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Weight on hands, lower abdomen and thighs. Triangle base of support between nape elbow and thigh and face knee she use this base of support to liberate the face arm and wrap a toy with more stability. <br> | Weight on hands, lower abdomen and thighs. Triangle base of support between nape elbow and thigh and face knee she use this base of support to liberate the face arm and wrap a toy with more stability. <br> | ||
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=== 6 Months === | |||
{| width="100%" border="1" align="center" cellpadding="5" cellspacing="5" | |||
|- | |||
| align="center" | '''SUPINE''' | |||
| width="33%" align="center" | '''PRONE''' | |||
| width="33%" align="center" | '''PIVOTING''' | |||
|- | |||
| | |||
'''''Antigravity Movement:''''' | |||
Eyes-feet-hands coordination, rolls from supine to prone. Movement initiated by shoulder, pelvis or head.<br> | |||
'''''Posture during Rolling:'''''<br> | |||
''Head Position:'' | |||
*Lateral head righting when the baby reach lateral side. | |||
''Upper Limbs:'' | |||
*Base support arm is in 90° of FLEX, slight EXT ROT, elbow in flexion and pronation, hand open. Oscillate arm shoulder in ABD, elbow in semi-flexion and pronation, hand open. Scapulas dissociated one have weight bearing functions and the other a fasic movement to grasp a toy. | |||
''Trunk Position:'' | |||
*Elongated on weight bearing side. | |||
''Pelvic Girdle:'' | |||
*Dissociation of the hemipelvises start when the baby reaches the lateral side. | |||
*Transversal plane. | |||
Lower Limbs: | |||
*The rolling start with triple flexion and finish with legs in extension. | |||
'''''Weightbearing in Rolling:''''' | |||
*Shoulder, elbow, hemipelvis of the side that is rolling | |||
| valign="top" | | |||
'''''Antigravity Movement''''' | |||
Swimming posture. Active weight shift to one side and grasp with the other hand.<br> | |||
'''''Weightbearing:''''' | |||
Weight on one forearm or open hands, and distal thigh. <br> | |||
'''''Posture:''''' | |||
''Head Position:'' | |||
*Chin tuck and chest elevated,<br> | |||
''Upper Limbs: '' | |||
*Arms extended, shoulders coapted, hands open | |||
''Pelvic Girdle:'' | |||
*Extension | |||
''Lower Limbs:'' | |||
*Approaching neutral position<br> | |||
| valign="top" | | |||
'''''Weightbearing:''''' | |||
Weight on trunk, arms and hands<br> | |||
'''''Posture:''''' | |||
Head Position: | |||
*Head at 90° legs abducted and externally rotated | |||
'''''Antigravity Movement Pivots:''''' | |||
*Movements in arms and legs, lateral trunk flexion. Child use both arms and legs to pivot.<br> | |||
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<ref name="Bly">Bly L. Motor skills acquisition in the first year: An illustrated guide to normal development. ed. 1. Great Britain: Elsevier Science &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Technology books, 1998.</ref><ref name="Sheridan">Sheridan M. D. Sharma A. and Cockerill H. From birth to five years. ed. 3. London: Routledge, 2008.</ref> | <ref name="Bly">Bly L. Motor skills acquisition in the first year: An illustrated guide to normal development. ed. 1. Great Britain: Elsevier Science &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Technology books, 1998.</ref><ref name="Sheridan">Sheridan M. D. Sharma A. and Cockerill H. From birth to five years. ed. 3. London: Routledge, 2008.</ref> | ||
== Fine motor skills == | == Fine motor skills == |
Revision as of 20:19, 30 August 2016
Original Editor - The Open Physio project.
Top Contributors - Naomi O'Reilly, Siobhán Cullen, Admin, Chelsea Mclene, Oyemi Sillo, Kim Jackson, Lucinda hampton, Tony Lowe, WikiSysop, Simisola Ajeyalemi, 127.0.0.1, Lauren Kwant, Rachael Lowe, Jess Bell, Paule Morbois, Olajumoke Ogunleye, Matt Huey, Scott Buxton, Saeed Dokhnan, Claire Knott, Rucha Gadgil and Amrita Patro
Introduction[edit | edit source]
As a child grows they learn and acquire more refined gross and fine motor skills, as well as developing social skills. Reflexes that initially developed to aid survival, become integrated into more refined movements as the child matures. Children tend to acquire these skills in an orderly fashion and within certain age brackets. This patter of skill acquisition is often referred to as 'Normal or Typical Development', and is used to monitor a child's developmental progress. In some cases late acquisition of these 'milestones' can indicate developmental delay . However, it must be remembered that the time span within which acquistion of these skills is still considered 'normal' is wide (see WHO Study discussed later), and that some children may skip a milestone altogether eg crawling.
The average age at which gross motor, fine motor and social skills are acquired are outlined below.
Principles of Typical Development[edit | edit source]
- Craneal to Caudal
- Proximal to Distal
- Flexion to Extension
- Asymmetry - Symmetry - Asymmetry
- Gross to Fine; Simple to Complex
- Global Patterns in 3 Planes (Frontal, Sagital, Transverse)
Typical Development Global Patterns & Positions[edit | edit source]
0 - 2 Months
[edit | edit source]
| |
SUPINE | PRONE |
Functional Achievement: Slight movements in rotation of the head + lateral flexion of the trunk when trying to move the head, gesture, stared at the mother. Posture: Head Position:
Trunk Position:
Upper Limbs:
Pelvic Girdle:
Lower Limbs:
|
Functional Achievement: Raise head less than 45°, baby push the floor with the fists trying to lift head against gravity and against the resistance of spinal and hip that remain in flexion. Weightbearing: On cheek, hands, forearms and upper chest. Posture: Head Position:
Upper Limbs:
Trunk Position:
Pelvic Girdle: Pelvis in Anteversion Lower Limbs:
|
3 Months[edit | edit source]
| |
SUPINE | PRONE |
Functional or Antigravity Achievement: Stare and makes visual tracking. Head control and maintain in midline. Coordination between; hands-mouth, hand-hand and feet-feet these are up of the plane of support. Immature kicking. Posture: Head Position:
Upper Limbs:
Trunk Position:
Pelvic Girdle:
Lower Limbs:
|
Antigravity Movement: Pushes against surface to raise head at least 45° Chest elevated. Weightbearing: Symmetrically distributed on forearms (epitroclea and hands) and abdomen. Posture: Head Position:
Upper Limbs:
Trunk Position:
Pelvic Girdle:
Lower Limbs:
|
4 Months[edit | edit source]
| |
SUPINE | PRONE |
Antigravity Movement:
|
Weightbearing:
Antigravity Movement:
|
5 Months[edit | edit source]
Good lateral weight transfer, symmetry enables coordination between both sides. Increased Landau Reaction Swimming Position Important manipulative strategies in supine. | |
SUPINE | PRONE |
Antigravity Movement: Touches knees with hands, choosing to do it both hands at the same time or independence one from the other. Grasp and manipulate in the midline staring the toy. Gripping still, from the ulnar side of the hand, with palmar flexion and supination to explore the toy with mouth |
Antigravity Movement: Chin tucked and chest elevated. Flexion and extension of knees, may play with feet together, lateral weight shift to wrap with the opposite hand. The infant may also push backward in this position. Weightbearing: Weight on hands, lower abdomen and thighs. Triangle base of support between nape elbow and thigh and face knee she use this base of support to liberate the face arm and wrap a toy with more stability. |
6 Months[edit | edit source]
SUPINE | PRONE | PIVOTING |
Antigravity Movement: Eyes-feet-hands coordination, rolls from supine to prone. Movement initiated by shoulder, pelvis or head. Posture during Rolling: Head Position:
Upper Limbs:
Trunk Position:
Pelvic Girdle:
Lower Limbs:
Weightbearing in Rolling:
|
Antigravity Movement Swimming posture. Active weight shift to one side and grasp with the other hand. Weightbearing: Weight on one forearm or open hands, and distal thigh. Posture: Head Position:
Upper Limbs:
Pelvic Girdle:
Lower Limbs:
|
Weightbearing: Weight on trunk, arms and hands Posture: Head Position:
Antigravity Movement Pivots:
|
Gross Motor Activities[edit | edit source]
Activity |
Age |
Lifts head to 45° | 2/12 |
Props on forearms in prone | 3/12 |
Rolls over | 5/12 |
Prone on extended arms | 6/12 |
Balance reactions | 6/12 |
No Head lag | 5/12 |
Sitting without support | 6-8/12 |
Pulls to stand | 8-9/12 |
Cruises | 8-9/12 |
Crawls reciprocally | 9/12 |
Stands alone | 11/12 |
Walks alone | 12/12 |
Runs | 18-24/12 |
Walks up and down stairs with handrail | 2 yrs |
Pedals tricycle | 3 yrs |
Walks narrow line | 5 yrs |
Fine motor skills[edit | edit source]
Activity |
Age |
Follows objects with eyes | 1-2/12 |
Grasps objects | 4/12 |
Hand to hand transfers | 5/12 |
Finger feeds | 6/12 |
Objects into container | 12/12 |
Builds 2 block tower | 14/12 |
Helps with dressing | 15/12 |
Builds 6-7 cube tower | 2 yrs |
Uses fork and spoon skilfully | 2.5 yrs |
Holds pencil with adult grasp | 4 yrs |
Colours inside lines | 5 yrs |
Social Skills[edit | edit source]
Activity/Interaction | Age |
Smiles when stimulated | 1/12 |
Vocalises to self | 6/12 |
Plays peek-a-boo | 8/12 |
Stranger anxiety | 8/12 |
Drinks from cup | 12/12 |
Uses spoon | 13/12 |
2-6 words | 15/12 |
Feeds self fully | 2 yrs |
Bladder and bowel control | 2 yrs |
Has 50+ words, understands 1000+ | 2 yrs |
Undresses | 2.5 yrs |
Gramatically correct speech | 4 yrs |
Fluent | 5 yrs |
Age Ranges of Skill Aquisition[edit | edit source]
Windows of Milestone Achievement in Months [3]
While motor milestones are undoubtable a useful way of monitoring a childs' development, it must be remembered that each child is different and will achieve the various milestones at different rates. There is a wide window for achievement of these milestones, during which achievement of the milestone is still considered to be in line with normal development. A study published by the World Health Organisation in 2006 demonstrates just this. This study recorded the variations in milestone achievement in 816 children and generated windows during which achievements of these milestones is considered to be normal development, these are outlined in the table above. It should also be noted that this study found that 4.3% of participants never exhibited the hands and knees crawling milestone[3].
Primitive Reflexes[edit | edit source]
The primitive reflexes are movement patterns that can be involuntarily elicited in a newborn. They exist to enhance chances of survival. These reflexes should be integrated as the child's motor development matures. The persistence of these reflexes beyond the usual ages of integration is suggestive of ischemic brain injury. Below several of the primitive reflexes, their appearance and integration dates are discussed.
Rooting Reflex:
The rooting reflex can be elicited by gently stroking the child's cheek. The reflex is intact if the child's response is to attempt to bring the object to their mouth[4]. This is demonstrated in the video below.
Age of Integration: 3-4 months
Palmar Grasp:
This reflex can be elicited by stimulating the palmar surface of the child's hand. The reflex is intact if the child reflexively grasps the object stimulating the palm[4]. Both this and the plantar grasp reflex are seen in the next video clip.
Age of Integration: 4 months[6]
Plantar Grasp:
This reflex is elicited by stimulating the plantar aspect of the child's foot, just below the toes. The reflex is intact if this cuases toe flexion.
Age of Integration: 9 months[6]
[7]Moro:
The Moro reflex is typically elicited by rapid extension of the child's neck. However it can also occur in response to loud noises. The reflex is intact if the child symettrically and simultaneously abducts and extends the upper limbs, and extends the trunk. The upper limbs then immediately adduct[4]. This reflex is demonstrated in the clip below.
Age of Integration: 3-6 months[6]
[8]
Asymmetrical Tonic Neck Reflex (ATNR):
This reflex is elicited by turning the child's head to one side. A normal response is seen if the baby's extensor tone increases on the side the head is facing, and flexor tone increases on the opposite side[4]. This is demonstrated in the clip below.
Age of Integration: 6 months[6]
[9]Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ 1.0 1.1 Bly L. Motor skills acquisition in the first year: An illustrated guide to normal development. ed. 1. Great Britain: Elsevier Science &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Technology books, 1998.
- ↑ 2.0 2.1 2.2 Sheridan M. D. Sharma A. and Cockerill H. From birth to five years. ed. 3. London: Routledge, 2008.
- ↑ 3.0 3.1 WHO Multicentre Growth Reference Study Group. ‘WHO Motor Development Study: Windows of achievement for six gross motor milestones’. Acta Paediatrica. 2006: Suppl 450; 86-95.
- ↑ 4.0 4.1 4.2 4.3 Zitelli BJ, McIntire SC and Nowalk AJ. 2012. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. Ed. 6. Philadelphia: Elsevier
- ↑ onlinemedicalvideo. Physical exam-Newborn Normal: Primitive reflexes-suck, root. Available from: http://www.youtube.com/watch?v=_Vs7_aHfOy8 [last accessed: 17/06/13]
- ↑ 6.0 6.1 6.2 6.3 Votroubek W. 2009. Pediatric Home Care for Nurses: A Family-Centred Approach. Ed. 3. Sudbury: Jones and Bartlett Pblishers Inc.
- ↑ onlinemedicalvideo. Physical exam-Newborn normal: Primitive reflexes-grasp. Available from: http://www.youtube.com/watch?v=BF1j1PXRq-I [last accessed: 17/06/13]
- ↑ Onlnemedicalvideo. Physical exam-Newborn normal:primitive reflexes-moro. Available from: http://www.youtube.com/watch?v=7oD6set72lo [last accessed: 17/06/13]
- ↑ Dr. Prodigious. Primitive Reflexes, Asymettric Tonic Neck-3 months-Infant clinical exam (MRCP. Available from: http://www.youtube.com/watch?v=uXsb7bxTc5g)[last accessed: 17/06/13]