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  1. 1. Normal Developmental Milestones An emphasis on anticipatory guidance Ana Malinow, MD
  2. 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. 3. Objectives• Principles of development• Primitive Reflexes• ᾿ Locomotion῀ : Gross Motor• ᾿ Manipulation῀ : Fine Motor• ᾿ Cognitive῀ : Language and Social• Behavior and Personality
  4. 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. 5. Development Occurs in a Cephalocaudal Direction
  6. 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. 7. All primitive reflexes develop during gestationand disappear by the 3 rd to 6th month after birth
  8. 8. Primitive reflexes• Tonic labyrinthine reflex• Asymmetric tonic neck reflex• Positive support reflex
  9. 9. Declining intensity ofprimitive reflexes and increasing role ofdefinitive motor actions
  10. 10. Gross motor development ᾿ Locomotion῀
  11. 11. Locomotion begins with head control
  12. 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. 13. Ventral suspension
  14. 14. Head control
  15. 15. 2 month head control
  16. 16. 4 month head, arm control
  17. 17. 6 month head, arm, trunk control
  18. 18. 8 month head, arm, trunk, leg control
  19. 19. 9 month pulls up to stand
  20. 20. 12 month old locomotion
  21. 21. 2 year old RunningBackward Walking
  22. 22. 3 year old Balance
  23. 23. ᾿ Manipulation῀Fine Motor Development
  24. 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. 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. 26. ᾿ Cognition῀Social Development Problem solving Play CausalityLanguage Development
  27. 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. 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. 29. 12-month 18-month Functional Play
  30. 30. 18-month 24-month Symbolic Play
  31. 31. 2-5 yearImaginary/Magical Play
  32. 32. 6 year oldLogical Thinking
  33. 33. 11 years +Hypothetical thinking
  34. 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. 35. Conversational speech probably starts with smiling
  36. 36. 2 month old language
  37. 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. 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. 39. Behavior• One-way or two-way interactions• Prenatal factors• Bonding/attachment• CNS maturation• Match• Schedule• Language• Instincts
  40. 40. Behavior -continued-• Cognitive, gross and fine motor development• Illness, separation, feeding issues• Birth order, family size• Secondary attachments• Environment• Gender identification
  41. 41. Bonding
  42. 42. Personality• Factors that influence behavior• Create behavior• Through adaptability and flexibility• Produce personality/social behavior
  43. 43. Newborn ᾿ Personality῀
  44. 44. 4 month old᾿ Personality῀
  45. 45. 9-month old᾿ Personality῀
  46. 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. 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