Normal Child Development

Authors
Affiliations

Doctor of Physical Therapy

B.S. in Kinesiology

Doctor of Physical Therapy

B.A. in Neuroscience

Why should we care about normal development?

  • Need a baseline for “normal” to identify problems
  • Identifies atypical behavior

Developmental sequence

Darrah et al. (1998)

Darrah et al 1998, tested motor skills of 45 infants every month from 2 weeks to time of independent walking

  • Ton of variability is what he found
  • Created Alberta Infant Motor Scale (AIMS)
  • LARGE variation in motor skills in first year
  • All pts will present differently, Examination is a snapshot of what happens in that moment
    • Could differ (dependent on emotion, sleepiness, etc)
  • So may not be entirely accurate– must keep in mind

Variability in Development

Intrinsic and Extrinsic factors

  • Individual: physiology (ie height weight of baby), temperament, cognition
    (one with lower cognition will have less motivation to move)
  • Environment: immediate microsystem → womb, family, home, surroundings, peers
    • (could also be in utero environment, was there trauma w their pregnant person)
  • Exosystem: extended family, neighborhood, school
  • Macrosystem: community, economic system, culture

Theories in child development

Read more about theories in child development

Year 1 Development

Neonate (Sub-1 month)

  • Motor ability:
    • Gross motor- Flexion dominates posture, random movements with little control, reflexive movement
    • Fine motor- hands generally fisted (indwelling or outdwelling thumb → does not make a difference)
    • Their muscle tone is springy
  • Feeding: every 2-4 hours, breast or bottle feeding only
  • Cognitive ability:
    • Cognition- attends to sound, begins to track (used to being around background noise, quiet is odd)
  • WB surface:on face
  • Interests
    • Don’t care about toys (visual acuity is not high)
    • They just want to be held and talked to

Tests:

  • They will recoil back to flexion position if stretched out → if they don’t , can be a problem
  • NO vertebral discs
  • some ossification
  • lots of cartilage in babies

Month 1

  • Motor
    • Gross motor: increased extension and mobility, cont. Random mvmts, attempts head control
    • Fine motor: open and closes hands, reflexive grasp
    • Fidgety movement still
    • Start to move out of physiological flexion
  • Feeding: begins to anticipate feeding
  • Cognition:
    • Eye tracking is smoother
    • Eye is more accurate than hand
    • More visual tracking: They are checking things out
    • Can start to swipe at things
  • WB:
    • Weight bearing more at trunk (moves cephalocaudal)

Month 2

  • Motor
    • Gross motor: brief head control, more variable extremity mvmt
    • Fine motor: beginning to swipe at toys, hands more open
  • Feeding: cont. breast/bottle feeding
  • Phonation: begins cooing
  • Cognition:
    • May track 180
    • More attempts to explore world

Assessment

  • Hard to tell if there are true delays, bc there are lots of asymmetries as babies start to move across gravity
  • This age- start to see some asymmetries:
    • Can swat at one thing not other side
    • head turned more to one side
    • may or may not be indicative of an issue –> just watch it

Month 3

  • Motor
    • Gross motor: symmetry and midline orientation, head steadier
      • Movement happens from midline out (prox to distal)
      • Starting to also see hands coming together at midline
      • Lots of hands to the mouth
    • Fine motor:
      • Swipes at object
      • Gross grasp
    • Oral motor: strong hand to mouth
  • Functions
    • Phonation: more variety of sound
  • Cognition
    • Consistently tracking 180
    • Exploring world with their hands
  • WB:
    • Head comes off of surface
    • Head ext 45-90 in prone (more post chain activation)

Assessment

  • If there’s a chance of visual problems (ie result of prematurity → retinopathy) need to pay attention to that
    • if not developing as it should, will affect their development
  • Pseudoneglect: If always turning head to one side, could develop pseudo neglect
    • Introduce their other side to these types of children

Month 4

Motor

  • Gross motor
    • Controlled, purposeful movement
    • May not WB in standing
  • Fine motor: Symmetrical and accurate reaching

Functions

  • Feeding: May begin eating solids from spoon
    • Some babies eat solid foods → variable on parents

    • Can help Rolling up kitchen towels to provide positioning assistance w feeding

  • Phonation - may start babbling (when strong enough torso/core strength )

Cognition

Assessment:

Is the baby safe to eat solids?: Is your baby able to sit up, maintain head control, are they able to be in a safe position, can they get enough chin tuck to safely swallow foods

Month 5

Motor:

  • Gross motor: beginning to roll and prop sit briefly, head control should be presents in all positions
    • Nice palmar grasp - can reach for things
    • Good upright sitting position
  • Fine motor- refined reach with improved eye hand coordination , uses palmer grasp

Functions:

  • Feeding - may start to munch solids, bite soft foods
    • May or may not see feeding
  • Phonation - babbling, vowel consonants sounds

Cognition

  • Smiles at mirror image

Month 6

  • Gross motor - more functional and active , sits, rolls, bouncing on feet
  • Fine motor - transferring objects, radial or palmar grasp
  • Feeding - begin large finger foods and cup cont. breast/bottle
  • Phonation - babbles longer, more variety
  • Cognition - beginning cause and effect
    • Can be bouncing and dancing a lil
    • Transferring objects
  • Some babies are on hands and knees (in quadruped) rocking or pushing backward

Month 7

Motor

  • Gross motor - wider variety between babies , beginning mobility skills - push to sit , quad crawling, pull to stand, cruising
  • Fine motor - UE free in sitting, radial palmar grasp (grasping more on thumb side) , rakes small objects

Functions

  • Feeding: more variable jaw and tongue mvmts
  • Phonation - cont’d babbling, more vowel - consonant sounds

Cognition

  • Cognition - responds to name :::{.callout-tip} These babies respond to the name their family calls them, not necessarily their birth name. You should ask the family what they call the baby day to day. :::

  • Walking on hands and knees , bear walking, some may stand

  • Some cruising on furniture

  • For good development- thing figure out lots of ways to move (variability)

  • Children w atypical development–> paucity of mvmt, lack of variability, 1 way to crawl/walk, if not available they do not know what to do

Month 8

Gross motor - very busy and active babies, improved pull to stand and cruising Fine motor - uses a radial digital grasp (like an OK sign almost, a pinch) and a scissor grasp and a scissor grasp w. Small objects Feeding - holds bottle, finger feeds Phonation - repeats consonant vowel string in syllables Cognition -familiar /unfamiliar items They’re ON THE MOVE!

Transportation:

Month 9

  • Gross motor - skill level differences between babies continues to inc, creeping mode of transport, cruising (stand/walking along furniture) laterally
  • Fine motor - inf pincer grasp emerging

Month 10

Motor

  • Gross motor- cruising progression (can go across gaps of furniture, single leg balance, weight shift to one leg prepares for walking = PRE gait activities!)
  • Fine motor- pincer grasp, “three-jaw chuck”, reaching across midline

Functions

  • Feeding- finger feeding, use of cup
  • Phonation- playing more with sounds, pitches, inflections
    • May have vocalizations that mirror the language vocal pattern

Cognition

  • Goal directed play
  • Container play
  • Follow simple commands
    • ie: give me block

Assessment

  • Assess simple command comprehension
    • May need to add a visual prompt w hand to help understand

Month 11

  • Gross motor: may begin independent standing and walking
  • Fine motor: uses both hands to clap, neat pincer grasp
  • Some may start walking (not a predictor of anything)

Assessment

  • If we are not seeing some of these things, go back and give child more support
  • Give them some lateral trunk support, change angle of pelvis, give a more stable base so they can now do distal mobility (prox stability →leads to distal mobility)

Month 12

Motor

Gross motor: many babies are walking independently by 12 months Fine motor: superior or fine pincer grasp, more manipulation of objects

Function

  • Feeding:
    • Drinks from cup but still spills
    • Lip closure with spoon feeding
  • Phonation: beginning to approximate words/jargons

Cognition

  • Able to follow directions
    • One step directions only (can follow a one step command)
      • “Bring me the ball”
      • “Go get shoes”

Toddler & Preschool Development

Month 12-18

  • Gross motor (generally walking):
    • Locomotion: Independent ambulation, walks fast, stairs w rail
    • Needs some single leg stance ability → or in prep for
      • More time in SLS, important ⇒ main balance center: glute meds
    • Must have pre walking skills mastered: stepping, balance, environmental responses
      • Look at surface changes, some kids don’t like certain surfaces
      • Shoes vs barefoot

Fine motor

  • beginning to “draw”
  • stacking cubes

Feeding: independent w spoon

Cognition

  • Language: 10 word vocab

Limited vocabular could include things like “ba” to refer to a ball

Cognition has developed to include imitative play: Banana = phone

When kids are mastering one skill, they are experiencing one skill down the line

Months 18-24

Gross Motor:

  • Locomotion:
    • Attempts to run but does not achieve flight, some steps unsupported
    • Gait:
      • Heel strike
      • Reciprocal arm swing (closer to 24 months)

Fine Motor:

  • Scribble
  • Turns pages of book
  • Stacks 4 cubes

Feeding: Uses cup and spoon

Note
  • SLPs no longer recommend sippy cups
  • Open cup or straw

Language:

  • More understandable
  • Combines words

Year 2

Gross motor:

  • Running
    • Unable to vary speed
    • Achieves flight
  • Stairs alone
    • Tries to jump up and down from step
  • Gait
    • Dependent on “Gait Age”
    • Heel strike

Fine motor:

  • Stack 6 cubes
  • Turn doorknobs
  • Vertical stroke w crayon,

Feeding: spills less from cup

Year 3

Note

All of this depends!

Gross motor:

  • Stairs: Independent
  • Balance: Can SLS
  • Tricycle 30-36 mos
  • Gait: more mature gait pattern

Fine motor:

  • Cuts with scissors
  • Undresses
  • Begins to dress independently

Year 4

  • Gross motor - running is more smooth/ fluid , jumps well, hops on one foot (solid milestone, makes assumptions that they have met other skills)
  • Fine motor- cuts around pictures, simple puzzles, button and unbutton

Year 5

  • Gross motor, running mature, jump rope and kick ball well (within vicinity of target)
    • Can they do 2 things at the same time basically
  • Fine motor- print letters, dresses independently

School aged (5+)

Year 7-8

7-8 years = longer attention span

Year 9-10

9-10 years = increased strength and endurance

Year 11-12

11-12 years= nearly adult skills

Citation

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