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  • 1. Normal Developmental Milestones An emphasis on anticipatory guidance Ana Malinow, MD
  • 2. Why we should teachparents about developmentParents who understand their childᾼs 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.
  • 3. Objectives• Principles of development• Primitive Reflexes• ᾿ Locomotion῀ : Gross Motor• ᾿ Manipulation῀ : Fine Motor• ᾿ Cognitive῀ : Language and Social• Behavior and Personality
  • 4. 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
  • 5. Development Occurs in a Cephalocaudal Direction
  • 6. Development begins in uteroAge Responses/Reflexes8 ½ wks tactile stimuli (reflex arc laid down)12 wks sucking24 wks sound26 wks rhythmic breathing movements/ controls body temperature30 wks pupilary light reflex35 wks grasp/spontaneous orientation to light
  • 7. All primitive reflexes develop during gestationand disappear by the 3 rd to 6th month after birth
  • 8. Primitive reflexes• Tonic labyrinthine reflex• Asymmetric tonic neck reflex• Positive support reflex
  • 9. Declining intensity ofprimitive reflexes and increasing role ofdefinitive motor actions
  • 10. Gross motor development ᾿ Locomotion῀
  • 11. Locomotion begins with head control
  • 12. Assessing Locomotion• Ventral suspension NB-3m• Sitting position NB-8m• Prone position NB-9m• Standing/Forw. Walking 9m-18m• Running/Backw. Walking 2 yrs• Balancing 3 yrs +
  • 13. Ventral suspension
  • 14. Head control
  • 15. 2 month head control
  • 16. 4 month head, arm control
  • 17. 6 month head, arm, trunk control
  • 18. 8 month head, arm, trunk, leg control
  • 19. 9 month pulls up to stand
  • 20. 12 month old locomotion
  • 21. 2 year old RunningBackward Walking
  • 22. 3 year old Balance
  • 23. ᾿ Manipulation῀Fine Motor Development
  • 24. Manipulation: Assessing the pincer grasp from 0-6m• NB primitive• 1m primitive• 2m starting to lose• 3m voluntary on ulnar• 4m hands together• 5m palmar grasp• 6m hand-mouth-hand; hand-to-hand
  • 25. Manipulation: Assessing the pincer grasp 7-12 m• 7m thenar side, raking• 8m 1 block in each hand• 9m radial-digital grasp; inferior pincer• 10m index finger isolation• 12m fine pincer• >12m letting go, stacking
  • 26. ᾿ Cognition῀Social Development Problem solving Play CausalityLanguage Development
  • 27. Assessing cognitive development Problem solving• NB visual exploration• 4-6wks smiles, fixes, follows• 2m imitates mouth movements• 3m anticipates feeds• 5m object permanence• 6m looks to floor when toy dropped• 7m grabs 2nd cube, drops first• 8m seeks object after fall (silent)• 9m uncovers hidden object under cloth• 10m isolates index finger
  • 28. Assessing cognitive development PlayAge Play stage Piagetian stage<12m sensory-motor sensory-motor12m-18m functional sensory-motor18m-24m symbolic sensory-motor2-5y imaginary/magical pre-operational6y logical thinking concrete operation11y + hypothetical formal operational
  • 29. 12-month 18-month Functional Play
  • 30. 18-month 24-month Symbolic Play
  • 31. 2-5 yearImaginary/Magical Play
  • 32. 6 year oldLogical Thinking
  • 33. 11 years +Hypothetical thinking
  • 34. Assessing cognitive development CausalityAge Cause EffectEarly cries mom comesEarly smiles mom responds4m kicks crib mobile moves8m pulls string gets ring10m funny +response/repeats24m winds key toy moves
  • 35. Conversational speech probably starts with smiling
  • 36. 2 month old language
  • 37. Assessing cognitive development: LanguageAge Milestone4-6wks smiles2m vocalizes with vowels3m vocalizes with consonants4m squeals6m syllables7m non-specific combinations8m imitates sounds, understands ᾿ no῀12m 1-3 words
  • 38. Assessing languageAge Expressive Receptive Jargon Sentence L. Intelligible12m 1-3 100 Y none18m 10-25 ID body Y giant words holophrases2y 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
  • 39. Behavior• One-way or two-way interactions• Prenatal factors• Bonding/attachment• CNS maturation• Match• Schedule• Language• Instincts
  • 40. Behavior -continued-• Cognitive, gross and fine motor development• Illness, separation, feeding issues• Birth order, family size• Secondary attachments• Environment• Gender identification
  • 41. Bonding
  • 42. Personality• Factors that influence behavior• Create behavior• Through adaptability and flexibility• Produce personality/social behavior
  • 43. Newborn ᾿ Personality῀
  • 44. 4 month old᾿ Personality῀
  • 45. 9-month old᾿ Personality῀
  • 46. 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 anotherᾼ point of s view• Adolescence begins identity formation (idealistic)• Adulthood completion of identity formation
  • 47. Conclusion• 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