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Developmental Milestones Project for Neurophysiology

Dan Lane

on 11 March 2013

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Transcript of Milestones

0-6 months newborn
undifferentiated crying
3 months
cooing (vowel sounds)
4 months
babbling (string of vowel and consonant sounds)
6 months
repeats own sounds Communication newborn – becomes quiet in response to a voice
1-2 months – begins to explore environment by putting objects in mouth
3-5 months – object permanence begins, searches for dropped and partially hidden objects, puts hand on bottle/breast during feeding, finds mouth
6 months – calls out to get attention, begins to understand cause-and-effect
7-9 months – puts objects in containers, copies movements, bangs objects together, begins to search for objects in containers, responds to “no”, explores spatial concepts pays attention to his/her own name

recognizes different tones of voice and responds

able to interpret the emotional expression of familiar adults

copies simple actions of others

recognizes himself as an individual apart from mother

learning to cooperate; shows guilt at wrongdoing

actively seeks to maintain interactions with adult landau
develops at 3-4 months
integrates at 12-24 months Reflexes action that is performed without conscious thought as a response to a stimulus a series of activities in a child's physical and/or mental development
that may be used to assess maturation and detect developmental delays models of development Theories present at birth, persist throughout life: Survival non-integrating present at birth Survival integrating present at birth Positional infant reflexes develops after birth must be suppressed before the child can learn to roll, crawl, and creep effectively Tonic neck reflexes persistence can indicate CNS damage. ATNR movements that require a high degree of control and precision Fine motor plays peek-a-boo Social coordinated movements of all body parts for performance Gross motor pertaining to the mental processes of perception, memory, judgment, and reasoning Cognitive process of imparting or exchanging information survival

positional eye blink



gag rooting
to 3 months

to 2-5 months traction
2-5 months
3-6 months
4 months
4-6 months
8-12 months
tonic neck reflex (TNR)
4-6 months Traction when pulling to sitting from supine shoulders and arms elevate stabilizes head prior to development of head control integrates
2-5 months Galant frequently fails to integrate in children with CP integrates
3-6 months in prone, when stroked on one side of the trunk, lateral flexion toward that side Stepping integrates
4 months toe-heel vs. heel-toe pattern when the infant is supported with feet on the floor, she will “step” with one foot at a time, as if walking “startle” reflex asymmetry can indicate brain lesion or UE peripheral nerve lesion Moro integrates
4-6 months palmar grasping
4-6 months
plantar grasping
4-9 months decreased in prone Babinski when seen in older children or adults, indicates damage to corticospinal tract integrates
8-12 months gently stroking the sole or side of the foot  causes toes to fan apart in abduction Palmar grasp thumb does not participate integrates
4-6 months scooping up an object Plantar grasp integration allows voluntary toe motion to aid in balance integrates
4-9 months gently stroking the sole of the foot causes toes to curl into flexion retention of reflex may cause children to lack rhythmical interaction and movement efficiency (poor equilibrium / balance / posture / visual motor control) asymmetrical Tonic Neck Reflex (ATNR)

symmetrical Tonic Neck Reflex (STNR)

tonic Labyrinthine Reflex (TLR) STNR initial total UE movement patterns. related to development of crawling neck extension =  LE flexion and UE extension

neck flexion = LE extension and UE flexion integrates
4-6 months integrates
4-6 months integrates
4-6 months TLR Supine – Extension

Prone – Flexion persistence can interfere with movements requiring co- activation of flexors and extensors Milestones gross motor

fine motor

self-care social


cognitive head control
4 months
segmental rolling
6-8 months
sitting w/ trunk
8 months hand regard facilitated by ATNR
2 months
palmar grasp
6 months
radial palmar
7 months
radial digital AKA Thumb finger opp
9 months
inferior pincer
9-12 months
superior pincer (tip to tip)
1 year
three jaw chuck (3 point)
1 year transfer object from hand to hand
5- 6months
true voluntary release - can drop
7-9 months
mature release without external support
12-15 months Righting reactions complex postural responses that continue to be present even in adulthood in the infant
head righting reactions

trunk righting reactions

protective reactions of the extremities righting


equilibrium tonic reflexes inhibit spinal cord reflexes righting reactions inhibit tonic reflexes Neck on body righting related to rolling/transitions between supine, sidelying, and prone when head is turned, body turns in the same direction Body on body righting when one segment of the body is turned, the rest of the body turns the same direction assists with rolling supine  prone when body is tilted to one side, the head tilts the opposite direction to keep the head upright Optical head righting maintains head upright in relation to the
horizontal; maintains stable visual image birth to 4-6 months, then voluntary rolling birth to 4-5 months, then volntary rolling birth to 2 months, through life Protective reactions downward lower extremity
4 months
forward upper extremity
6-7 months
sideways upper extremity
7-8 months
backward upper extremity
9 months
stepping lower extremity
15-17 months equilibrium reactions develop in all postures beginning with prone reactions to rapid displacement of the body; have a predictable developmental sequence protect from falls and injury most advanced postural reactions; the last to develop Equilibrium reactions allow the body as a whole to adapt to slow changes in the relationship of the center of gravity with the base of support prone
6 months
7-8 months
7-8 months
9-12 months
12-21 months creeping
9 months
10 months
12-18 months Social 0-2 months
2-3 months
visually fixates a face; smiles at a face; may be soothed by rocking
3-4 months
smiles spontaneously to mother's face, voice, smile
responds to person-to-person contact with adults and children
enjoys being cuddled of or relating to society or its organization 4-9 months
enjoys being near people and played with
no longer smiles indiscriminately
responds to play interactions with others
cries, smiles, kicks, coos, laughs to attract attention
cries if other child cries
responds differently to strangers
8 months
shouts for attention; rejects confinement 0-9 months 10-12 months early childhood Social tries to alter parental plans through persuasion or protest

displays separation anxiety when apart from parent(s)

developing a sense of humor

teases and tests parental limits

can demonstrate affection

discriminates positive and negative attention

begins to self feed 10-12 months Social 1-2 years toddler Social refines toilet training

differential facial expression reflect emotional range

defends own possessions but is beginning to share

asks for wants

knows gender identity

participates in simple group activity - singing, dancing

little interaction with other children

mother continues to be very important to child

sometimes makes special friend by age 3 2 -3 years pre-school Social friends becoming more interesting than adults

shares toys, takes turns with assistance

uses "I, me, you"

beginning to learn to take responsibility

shows affection for younger siblings

associative group play begins 3-4 years pre-school Social plays and interacts with other children

improving in turn-taking and cooperating

spurred on by rivalry in activity

understands social problem solving

shows interest in exploring sex differences

developing self-responsibility; enjoys doing things for self

plays outside with little supervision; likes
to be trusted

sense of property is developing

still home and mother-oriented 4-5 years wants to do what is expected

respects reasonable authority

willing to play with most other children in the class

engages with other children in cooperative play; fair play

engages with other children in role assignments

chooses own friends; friendships change rapidly

one or two best friends of same sex

awareness of sex roles begins school age Social 5 years toddler now able carry object while walking
ascends & descends stairs one at a time with help
creeps up the stairs without help, and may creep or scoot down
walks sideways and backwards
supine to stand by rolling to prone, pushing up on hands and knees/feet, assuming a squat, and rising to standing demonstrates a run-like walk
decline in falls, improved balance reactions in standing
may occasionally fall or trip over objects, as eye-foot coordination is not fully developed
first attempts at jumping head lifting in prone
unilateral - lift to one side
bilateral – lift and turn
lift and hold the head in midline typical motor development physiologic flexion / flexor tone dominant prone
0-3 months random arm and leg movements
legs remain flexed
head is held to one side or the other
asymmetric tonic neck reflex present – assists development of hand regard
by 2 to 3 months eyes and hand are sufficiently linked to allow for reaching, grasping, and shaking a rattle
primitive rolling (log rolling) – result of neck righting reflex
head lags when infant is pulled to sit (until 4 mo.) typical motor development supine
0-3 months physiologic flexion / flexor tone dominant – result of neck righting reflex typical motor development supine 0-3 months posture and movement become more symmetric
head control and midline orientation develop
lift head in midline past 90° in prone
midline orientation of the head in supine
bring hands together in midline and watch them
bring objects to mouth with both hands
infant attempts to assist with trunk control in supported sitting typical motor development 4 months lower extremity movements begin to produce
pelvic mobility, starting in the supine position
anterior pelvic tilt is produced by bridging into hip extension
active hip flexion in supine produces posterior pelvic tilt
random LE pushing against support surface provides practice of pelvic mobility that will be used later for gait anti-gravity neck flexion in supine chin tuck when pulled to sit, with hip flexion to counterbalance typical motor development 5 months bilateral arm and leg movements are present, with proximal joints directing reaching and kicking
lower extremity pedaling
infant lifts bottom from support surface and grabs feet - this provides lengthening of the hamstrings and abdominal strengthening to prepare baby for sitting prone extension develops, extensor control against gravity; dissociation of head and limbs infant becomes mobile in prone by pivoting in a circle typical motor development 6 months landau reflex - represents total body righting against gravity
maximum extension of head and trunk is possible in prone, along with extension and abduction of the limbs away from the body
may push self backward along floor
can sit up if placed in sitting and supported at the low back or pelvis
can sit in the corner of the couch or on the floor if propped on extended arms pull-to-sit maneuver causes the infant to pull all the way up to standing will bear weight on the feet and bounce in this position typical motor development 6 months typical motor development 6 months repetition of rhythmic upper extremity activities – banging and shaking toys
reaching becomes less dependent on visual cues
neutral pronation-supination reaching pattern
supinated reaching is more mature than pronated reaching patterns originate from the shoulder typical motor development 7 months sitting postures: sits with narrower base of support due to increased trunk balance and LE adduction
lateral (sideways) protective reactions emerge
unilateral reach and ability to transfer objects hand-to-hand lateral (sideways) protective reactions emerge ring sitting
wide abducted sitting / half-long sitting
long sitting typical motor development 8 months sitting is the most functional position pulling develops as strength increases in the upper back and shoulders
back is straight and UEs are free to play with objects or to extend and abduct to catch if loss of balance occurs
upper trunk rotation - infant can prop on one arm and reach across the body
increased control of trunk rotation–body moves more segmentally transitional movement from sidelying to sitting
may attempt to walk
belly crawling
creeping on hands and knees
sitting and hitching (scooting on bottom with or without hand support)
pushing for locomotion – backward propulsion typical motor development 9 months experimenting with quadruped position–rocking back and forth side sitting
trunk stability increases – reciprocal UE/LE movement is possible while maintaining weight on the remaining two extremities
may pull up from quadruped to kneeling
balance is maintained by holding on with arm
does not have the control necessary to balance in a kneeling or half-kneeling position - this is a transition to standing
pulling to stand is a rapid movement transition with little time spent in kneeling or half-kneeling
early standing by leaning against a support surface to free the hands for play
legs abducted for wider base of support
alternate between knee flexion and extension
toe flexion (“clawing”) and abduction/extension (“fanning”) assist balance and are considered equilibrium reactions of the feet typical motor development 12 months toddler stage may attempt forward locomotion without hands held
first attempts at walking are lateral weight shifts
legs widely abducted
arms held in “high guard” position
strong extension of the upper back compensates for lack of hip extension
as upper trunk is maintained against gravity arms are lowered to mid-guard, then to low guard, then no guard typical motor development 16-18
months reciprocal arm swing and heel strike during gait typical motor development 2 years
can go up and down stairs one step at a time
jump off a step with a 2-foot takeoff
kick a large ball
throw a small ball
stepping over low objects
true running characterized by a “flight” phase – quick starts and stops are difficult
becomes faster
reciprocal arm swing
steps are bigger
time spent in single limb stance increases gait able to stand on 1 foot for 1 to 3 seconds fundamental movement patterns 3-6 years fundamental movement patterns are learned in early childhood three years gait
jumping four years jumping
striking five years gait
kicking six years gait
stricking fundamental movement patterns 3 years fundamental movement patterns 4 years both arms and legs move reciprocally in synchrony with each other
out-toeing has been reduced
pelvic rotation and a double knee-lock pattern is present
at heel strike, the knee is flexed to absorb the impact of the body’s weight gait fundamental movement patterns 3 years gait & running reciprocal actions mastered
pedaling a tricycle or climbing a jungle gym
locomotion can be started and stopped
can make sharp turns while running
can balance on toes and heels in standing
tandem standing–one foot in front of the other
reciprocal gait is used to ascend stairs in an alternating fashion–may descend stairs one step at a time fundamental movement patterns 3 years step down jump with 1 foot and land on 1 foot–18 months
jumping off the floor and land on the floor with both feet–age 2
26–28 months–jump down from 1 foot, land on 2 feet
26- 28 months – jump down from 2 feet, land on 2 feet
29–31 months - run and jump forward from 1 foot, land on the other foot jumping 29–31 months - jump forward from 2 feet land on 2 feet
29 to 31 months - run and jump forward from 1 foot, land on 2 feet
38–42 months - jump over object from 2 feet, land on 2 feet
age 3 - jump over an obstacle on the floor by leading with 1 foot
42 months–jump from 1 foot to same foot rhythmically may perform a running broad jump from 1 foot landing on two feet
vertical jumps are possible-increases with age
repeated vertical jumps from both feet can be done before true hopping
hopping on dominant foot can be performed by 3 ½ years hopping on 1 foot
girls perform better than boys
rhythmic relaxed galloping - consists of a walk on the leading leg followed by a running step on the rear leg, also called unilateral skipping jumping, galloping, skipping throwing–begins with accidental letting go of an object at about 18 months of age
from ages 2 to 4–throwing is variable with underhand and overhand throwing observed
gender differences are noted
distance a child is able to propel object is related to height
development of mature throwing is related to combining leg and shoulder movements
throwing is learned more quickly than catching fundamental movement patterns 4 years throwing throwing and catching have a close functional relationship
pre-catching requires the child to interact with rolling a ball
learning time and spatial relationships of moving objects proceeds from sitting to standing and chasing
tries to stop, intercept, and control movements, and anticipate movement of the object in space
next tries to catch the moving object fundamental movement patterns 4 years catching ball size
arm position
skill of the thrower visual cues
depth perception
eye-hand coronation
experience age-related sensory-perceptual factors catching depends on: fundamental movement patterns 4 years earliest form–child uses extension of their arm to hit something with their hand
when child is holding an object such as a stick or bat, the reach is increased, but the form results in striking down on the object striking fundamental movement patterns 5 years gait, jumping, galloping, skipping stands on either foot for 8-10 seconds
walks forward on balance beam
hops 8-10 times on 1 foot
makes a 2-3 foot standing broad jump
skips on alternating feet
hops 50 feet in 11 seconds fundamental movement patterns 5 years hit a 2 foot target from 5 feet away
underhand first, progressing to overhand
bouncing the ball to the target
5 ½ years - able to catch a ball when their hands start at their sides throwing, catching fundamental movement patterns 5 years kicking requires good static balance on the stance foot and counterbalancing the force of the kick with arm positioning
2 years- able to kick a ball on the ground
5-years- kick a ball rolled toward him 12 feet. into the air
kick a soccer ball 8 to 11½ feet fundamental movement patterns 6 years gait, throwing, catching, kicking stand on either foot for 10 seconds or more with eyes open or closed
walk on balance beam forward, backward, and sideways
throw and catch a small ball from 10 feet away
kick the ball 10-18 feet fundamental movement patterns 6 years common striking patterns
underhand running, throwing, catching master mature patterns for running, throwing, catching mature striking pattern
take a step
turn away
swing 2 years – label items, ask simple questions
3 years – 1500 words, express thoughts and feelings in simple sentences
4 years – narrate long stories (sometimes exaggerated) 5-6 years – able to enunciate clearly and use their advanced language skills as a tool for learning
7-12 years – vocabulary expands, reading increases, socialized communication develops, jokes, puns, slang, curse words, secret languages
Adolescence – manipulation of language (codes, slang, sarcasm), debate/discussion skills, abstract use of language Communication 2-4 years early childhood Communication 5 years to
adolescence middle childhood 10-12 months – follows simple directions, uses objects to reach goal and solve problems, begins to be capable of decentralized thought (objects exist apart from self)
13-18 months – solves problems by trial and error, begins tool use, uses objects conventionally, begins to group objects
19-24 months – follows 2-step directions, fully understands object permanence (uses systematic searching), begins to show insight, purposeful tool use, mental representation (symbols) Cognitive 0-9 months 10-24 months 24-48 months toddler 2 to 4 years – beginning of symbolic thought
egocentrism – inability to realize that others have thoughts/feelings that may not be the same as their own
animism – mentally giving inanimate objects lifelike qualities (~age 3)
draws somewhat recognizable picture that is meaningful to child if not to adult; names and briefly explains picture
recognizes and matches six colors retells story from picture book with reasonable accuracy
names some letters and numerals
rote counts to ten
sorts objects by single characteristics
is beginning to use accurately time concepts of tomorrow and yesterday
uses classroom tools meaningfully and purposefully
begins to relate clock time to daily schedule Cognitive plays with words: creates own rhyming words, says or makes up words having similar sounds
points and names four to six colors
matches pictures of familiar objects
draws a person with two to six recognizable parts, such as head, arms, and legs; can name or match drawn parts to own body
draws, names, and describes recognizable pictures
rote counts to five, imitating adult
knows own street and town
time concepts are expanding; can talk about yesterday or last week, about today, and about what will happen tomorrow Cognitive 4-5 years 5-6 years pre-school kindergarten- 1st grade Cognitive toddler hierarchic

systems model maslow


piaget motor control: psychosocial: cerebral cortex is the highest level of control, with all subcortical structures taking orders from it
the ultimate level of motor control, voluntary movement, is achieved by maturation of the cortex
reflex is the basic unit of movement
movement is acquired from chaining together reflexes and reactions Hierarchic theory top-down perspective nervous system maturation is seen as the ultimate determinant of the acquisition of postural control.
as the infant develops motor control, brain structures above the spinal cord begin to control posture and movement until the ultimate balance reactions are achieved
ultimate balance reactions are the righting, protective, and equilibrium reactions Hierarchic theory top-down perspective musculoskeletal system, Cardiopulmonary system and Nervous system are involved in motor control
posture and movement are thought to be self organizing
feedback is the third fundamental characteristic of the systems of motor control Systems model feedback: a fundamental characteristic Systems model feedback: closed loop vs. open loop Maslow – hierarchy of needs

Erikson – eight stages (over the life span) related to development of personality

Piaget – four stages (infancy through adolescence) related to development of intelligence – not a “life span” approach Psychosocial development three theories Erikson eight stages of psychosocial development Maslow hierarchy of needs survival needs must be met before higher self-needs or the needs of others can be addressed
moving to a higher level depends upon mastering the level before
highest level – self-actualization – person is self-assured, autonomous, independent, oriented to solving problems, not self-absorbed Piaget four stages in the development of intelligence Radial palmar grasp Radial digital grasp Inferior Pincer Grasp Superior pincer grasp Three-jaw chuck grasp 7 months 9 months 9 to 12 months 1 year 1 year recognizes self in mirror or picture and refers to self by name

beginning to become independent

cooperates by helping to put things away

may become angry if activities are interrupted

responds to simple commands by adult

begins to realize they can't have everything their way

social relationships with other children are awkward

may hit, bite or fight over a toy

engages in social laughter

shows anger through aggressive behavior may begin toilet training at 2 primitive rolling (log rolling) dan lane washburn university al-265 applied neurophysiology november
1, 2010 Self care activities performed independently using a fork and spoon:
13-18 months - begins
4 years- refined
12-24 months
brushing teeth:
16 months - needs adult help until school-age
washing hands
2 years (should learn while toilet training)
2 years (may need help with buttons/zippers.) Fine motor development 0-3 months • hands are fisted
• grasping reflex when placing a finger or
object in hand
• brings hands to mouth
• watches the movements of his/her hands arm movement is mostly random and asymmetrical Fine motor development 3-6 months • reaches for toys with both hands
• hands are primarily open with thumbs out
• holds toys with palm and fingers but not
• brings hands to midline
• no longer stares at his/her hands
• looks at objects a few feet away movements are mainly purposeful and more symmetrical Fine motor development 6-9 months • straightens elbows when reaching
• rakes pellet-sized items with fingers
• holds items with fingers and thumb
• claps hands transfers objects hand to hand Fine motor development 9-12 months • uses a neat, tip to tip pincer grasp on small pellet-sized items
• places items into an open container or into adult’s hand points with index finger • holds crayon in closed fist (power grasp)
• scribbles with a crayon using whole arm movements
• turns pages in a cardboard book (more than one at a time)
• holds object with one hand and manipulates it with the other
• places small items in a closed-neck bottle
• places one to two shapes in a three-shape geometric puzzle
• places large pegs in a pegboard Fine motor development 12 - 18 months stacks two to three small blocks • snips paper with scissors
• strings two to three beads
• imitates vertical and circular scribbles
• turns pages of a book one at a time
• places three shapes in a three shape
geometric puzzle stacks three to five blocks Fine motor development 18-24 months imitates simple horizontal and vertical block designs Fine motor development 2-3 years • Imitates a circle and vertical and horizontal lines
• Unscrews screw-top lid
• Begins manipulating small items within the hand
• Cuts paper into two pieces
• Holds crayon with fingers, not fist (pronated grasp)
• May use one hand consistently in most activities copies a square and cross
cuts on a straight line
begins to use thumb and index finger to hold pencil/crayon (tripod grasp)
touches each finger to thumb
buttons and unbuttons one button stacks 10 plus small blocks Fine motor development 4-5 years imitates circle and cross
manipulates clay and dough (pinches, rolls balls, snakes) stacks five to seven small blocks Fine motor development 3-4 years cuts out simple shapes
copies triangle
writes first name
handedness well established
mature, adult grasp of pencil well established (dynamic tripod) colors inside the lines Fine motor development 5-6 years 8 months
recognizing and imitating others – lallation (accidental repetition) and echolalia (conscious repetition)
12 months
2-8 spoken words, babble short sentences
24 months
50 to 200 spoken words in vocabulary Communication 8-24 months vocabulary explosion typical motor development 9 months experimenting with quadruped position–rocking back and forth creeping
require counter rotation of trunk segments - shoulder rotates in one direction while the pelvis rotates in the opposite direction
extension of the head, neck, back, and arms, dissociation of arm and leg movements from the trunk
foundation for walking (reciprocal movement) thanks for looking!
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