Child Development: Difference between revisions
No edit summary |
No edit summary |
||
Line 20: | Line 20: | ||
== Typical Development Global Patterns & Positions == | == Typical Development Global Patterns & Positions == | ||
{| width="100%" border="1" align="center" cellpadding="3" cellspacing="3" | {| width="100%" border="1" align="center" cellpadding="3" cellspacing="3" | ||
Line 73: | Line 75: | ||
|} | |} | ||
<br> | |||
{| width="100%" border="1" align="center" cellpadding="1" cellspacing="1" | {| width="100%" border="1" align="center" cellpadding="1" cellspacing="1" | ||
Line 80: | Line 82: | ||
|- | |- | ||
| colspan="2" | | | colspan="2" | | ||
*SYMMETRY (control of bilateral neck muscles) begins<br> | *SYMMETRY (control of bilateral neck muscles) begins<br> | ||
*Begins orientation to the midline of head<br> | *Begins orientation to the midline of head<br> | ||
*The Tonic Grasp Reflex is gone so can play with hands; hand-hand coordination and hand-eye coordination begins<br> | *The Tonic Grasp Reflex is gone so can play with hands; hand-hand coordination and hand-eye coordination begins<br> | ||
*Increase of Extension <br> | *Increase of Extension <br> | ||
*TACR and MORO decreased or disappear.<br> | *TACR and MORO decreased or disappear.<br> | ||
*Increased visual control independent from the head also can do visual tracking of 180 degrees of rotation of head to follow an object | *Increased visual control independent from the head also can do visual tracking of 180 degrees of rotation of head to follow an object | ||
|- | |- | ||
| width="50%" align="center" | '''SUPINE''' | | width="50%" align="center" | '''SUPINE''' | ||
| align="center" | '''PRONE''' | | align="center" | '''PRONE''' | ||
|- | |- | ||
| | | | ||
'''Functional or Antigravity Achievement:''' | '''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.<br> | ||
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.<br> | |||
'''Posture:''' | '''Posture:''' | ||
*Head Position: chin tuck, selective movement of rotation, not deviations in trunk or shoulders. Cervical vertebras elongate and dissociate. | *Head Position: chin tuck, selective movement of rotation, not deviations in trunk or shoulders. Cervical vertebras elongate and dissociate. | ||
*Upper Limbs: Scapulas in ADD, shoulders in 120 of FLEX, elbows 90º, hands open (not ulnar deviation). | *Upper Limbs: Scapulas in ADD, shoulders in 120 of FLEX, elbows 90º, hands open (not ulnar deviation). | ||
*Trunk: Symmetric | *Trunk: Symmetric | ||
*Pelvis: Slightly to retroversion. | *Pelvis: Slightly to retroversion. | ||
*Lower Limbs: Triple flexion 90º of hips, knees and ankle. Ext ROT and ABD, feet in middle line. Good synergy between ventral and dorsal muscles.<br> | *Lower Limbs: Triple flexion 90º of hips, knees and ankle. Ext ROT and ABD, feet in middle line. Good synergy between ventral and dorsal muscles.<br> | ||
Line 106: | Line 107: | ||
'''Antigravity Movement:''' | '''Antigravity Movement:''' | ||
Pushes against surface to raise head at least 45°, chest elevated.<br> | Pushes against surface to raise head at least 45°, chest elevated.<br> | ||
'''Weightbearing:''' | '''Weightbearing:''' | ||
Symmetrically distributed on forearms (epitroclea and hands) and abdomen. | Symmetrically distributed on forearms (epitroclea and hands) and abdomen. | ||
'''Posture: ''' | '''Posture: ''' | ||
*Head Position: To 90º | *Head Position: To 90º | ||
*Upper limbs: Shoulders abducted, elbows in line with shoulders, forearm support on immature extended arm support the end of 3 months elbows in 90º of FLEX and in front of shoulders. | *Upper limbs: Shoulders abducted, elbows in line with shoulders, forearm support on immature extended arm support the end of 3 months elbows in 90º of FLEX and in front of shoulders. | ||
*Trunk: Beginning to gain range of lumbar extension because of the activity and alignment of the upper limb. | *Trunk: Beginning to gain range of lumbar extension because of the activity and alignment of the upper limb. | ||
*Pelvic girdle and lower extremities: Beginning of pelvic extension, hips abducted and externally rotated, knees semi- Flex. <br> | *Pelvic girdle and lower extremities: Beginning of pelvic extension, hips abducted and externally rotated, knees semi- Flex. <br> | ||
|} | |||
{| width="100%" border="1" align="center" cellpadding="3" cellspacing="3" | |||
|- | |||
! scope="col" | 4 MONTHS | |||
! scope="col" | | |||
|- | |||
| o Development of Sagital plane<br>o Strong symmetry, flexion and extension increased<br>o Beginning of Landau reaction in EXT. <br>o Strong synergy between flexor and extensor muscles of the neck, chin in more retraction.<br>o Begins gripping feature, can hold an object but loose it by chance.<br>o Lateral rocking<br>o Able to remove a blanket from the face with both hands.<br> | |||
| | |||
|- | |||
| SUPINE | |||
| PRONE | |||
|} | |} | ||
Revision as of 18:59, 30 August 2016
Original Editor - The Open Physio project.
Top Contributors - Naomi O'Reilly, Siobhán Cullen, Admin, Chelsea Mclene, Kim Jackson, Oyemi Sillo, Lucinda hampton, Tony Lowe, Simisola Ajeyalemi, 127.0.0.1, Lauren Kwant, WikiSysop, Claire Knott, Rucha Gadgil, Amrita Patro, Rachael Lowe, Jess Bell, Paule Morbois, Olajumoke Ogunleye, Matt Huey, Scott Buxton and Saeed Dokhnan
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 | |
---|---|
| |
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:
|
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:
|
3 MONTHS | |
---|---|
| |
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:
|
Antigravity Movement: Pushes against surface to raise head at least 45°, chest elevated. Weightbearing: Symmetrically distributed on forearms (epitroclea and hands) and abdomen. Posture:
|
4 MONTHS | |
---|---|
o Development of Sagital plane o Strong symmetry, flexion and extension increased o Beginning of Landau reaction in EXT. o Strong synergy between flexor and extensor muscles of the neck, chin in more retraction. o Begins gripping feature, can hold an object but loose it by chance. o Lateral rocking o Able to remove a blanket from the face with both hands. |
|
SUPINE | PRONE |
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]
Failed to load RSS feed from http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1pq-4TZ0w1pMimA6HFKwRAJNY5tJplV6wNxPBF51WFfE1hwQtQ|charset=UTF-8|short|max=10: Error parsing XML for RSS
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; 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]