devt1

Report
Normal Developmental
Milestones
An emphasis on anticipatory guidance
Ana Malinow, MD
Why we should teach
parents about development
Parents who understand their child’s
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.
Objectives
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Principles of development
Primitive Reflexes
“Locomotion”: Gross Motor
“Manipulation”: Fine Motor
“Cognitive”: Language and Social
Behavior and Personality
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
Development Occurs in a
Cephalocaudal
Direction
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
All primitive reflexes
develop during gestation
and disappear by the 3rd to
6th month after birth
Primitive reflexes
• Tonic labyrinthine reflex
• Asymmetric tonic neck reflex
• Positive support reflex
Declining intensity of
primitive reflexes and
increasing role of
definitive motor actions
Gross motor development
“Locomotion”
Locomotion begins with
head control
Assessing Locomotion
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Ventral suspension
Sitting position
Prone position
Standing/Forw. Walking
Running/Backw. Walking
Balancing
NB-3m
NB-8m
NB-9m
9m-18m
2 yrs
3 yrs +
Ventral suspension
Head control
2 month head control
4 month head, arm
control
6 month head, arm, trunk
control
8 month head, arm,
trunk, leg control
9 month pulls up to stand
12 month old locomotion
2 year old Running
Backward Walking
3 year old
Balance
“Manipulation”
Fine Motor Development
Manipulation: Assessing the
pincer grasp from 0-6m
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NB
1m
2m
3m
4m
5m
6m
primitive
primitive
starting to lose
voluntary on ulnar
hands together
palmar grasp
hand-mouth-hand;
hand-to-hand
Manipulation: Assessing
the pincer grasp 7-12 m
• 7m
• 8m
• 9m
• 10m
• 12m
• >12m
thenar side, raking
1 block in each hand
radial-digital grasp;
inferior pincer
index finger isolation
fine pincer
letting go, stacking
“Cognition”
Social Development
Problem solving
Play
Causality
Language Development
Assessing cognitive
development
Problem solving
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NB
4-6wks
2m
3m
5m
6m
7m
8m
9m
10m
visual exploration
smiles, fixes, follows
imitates mouth movements
anticipates feeds
object permanence
looks to floor when toy dropped
grabs 2nd cube, drops first
seeks object after fall (silent)
uncovers hidden object under cloth
isolates index finger
Assessing cognitive
development
Play
Age
<12m
12m-18m
18m-24m
2-5y
6y
11y +
Play stage
sensory-motor
functional
symbolic
imaginary/magical
logical thinking
hypothetical
Piagetian stage
sensory-motor
sensory-motor
sensory-motor
pre-operational
concrete operation
formal operational
12-month 18-month
Functional Play
18-month 24-month
Symbolic Play
2-5 year
Imaginary/Magical Play
6 year old
Logical Thinking
11 years +
Hypothetical thinking
Assessing cognitive development
Causality
Age
Cause
Effect
Early
Early
4m
8m
10m
24m
cries
smiles
kicks crib
pulls string
funny
winds key
mom comes
mom responds
mobile moves
gets ring
+response/repeats
toy moves
Conversational speech
probably starts with
smiling
2 month old language
Assessing cognitive
development: Language
Age
Milestone
4-6wks
2m
3m
4m
6m
7m
8m
12m
smiles
vocalizes with vowels
vocalizes with consonants
squeals
syllables
non-specific combinations
imitates sounds, understands “no”
1-3 words
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
Behavior
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One-way or two-way interactions
Prenatal factors
Bonding/attachment
CNS maturation
Match
Schedule
Language
Instincts
Behavior
-continued• Cognitive, gross and fine motor
development
• Illness, separation, feeding issues
• Birth order, family size
• Secondary attachments
• Environment
• Gender identification
Bonding
Personality
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Factors that influence behavior
Create behavior
Through adaptability and flexibility
Produce personality/social behavior
Newborn “Personality”
4 month old
“Personality”
9-month old
“Personality”
Other “Personality”
Landmarks
• 2-year old independence/dependence
• 3-year old master of impulse control,
sharing, wants to please, guilt
• 7-year old ability to see another’s point of
view
• Adolescence begins identity formation
(idealistic)
• Adulthood completion of identity
formation
Conclusion
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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

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