Child Development

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Introduction

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 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.

Gross motor activities

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

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

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

                                                                  Windows of milestone achievement in months

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.

Primitive Reflexes

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. 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. Both this and the plantar grasp reflex are seen in the next video clip.

Age of integration: 4 months

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

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. This reflex is demonstrated in the clip below.

Age of integration: 3-6 months

 

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. This is demonstrated in the clip below.

Age of integration: 6 months 

Recent Related Research (from Pubmed)

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References

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