Normal Child Development
Why should we care about normal development?
- Need a baseline for “normal” to identify problems
- Identifies atypical behavior
Developmental sequence
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
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
- May track 180
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
- Gross motor: symmetry and midline orientation, head steadier
- Functions
- Phonation: more variety of sound
- Cognition
- Consistently tracking 180
- Exploring world with their hands
- Consistently tracking 180
- 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
- Object permanence develops
- Improved visual control
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”
- One step directions only (can follow a one step command)
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
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
- 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
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