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Its abt normal developmental milestones of a child from birth till 1 year.... Especially normal motor milestones...
"Because once u dont knw whts normal, u cant knw n differentiate between an abnormal"

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  1. 1. NORMAL DEVELOPMENT OF CHILD 0-1 yr BY: Sharmin Susiwala Final Year BPT
  2. 2. NORMAL DEVELOPMENT "Maturation of function with Age" • Continuous Process. • Dependent on interaction between innate genetic factors and environmental factors. Nature v/s Nurture • Intimately related to the maturation of CNS
  3. 3. PRINCIPLES OF DEVELOPMENT: Distinctive attribute of childhood Cephalocaudal order Mass activity specific and subtle individual responses. Primitive Reflex pattern
  4. 4. MILESTONES • Set of functional skills or age-specific tasks that most children can do at a certain age range. • Assessing developmental milestones or attainment of those milestones is the central part of any pediatric neuro examination. • Development is assessed by sequential attainment of milestones under following domains: 1. Gross Motor Development 2.Fine Motor Development 3.Social and Cognitive Development 4.Language 5.Vision and Hearing
  5. 5. NEWBORN
  6. 6. GROSS MOTOR DEVELOPMENT: POSTURES: 1.Prone 2.Supine 3.Sitting 4.Standing
  7. 7. 1. Prone Position: Head is turned to one side. Pelvis is raised off the surface by excessive hip flexion. Knees flexed and drawn up under abdomen.
  8. 8. 2. Ventral Suspension:  Head flops down completely.  Back is rounded.
  9. 9. 3. Supine Position:  Less flexed as gravity tends to favor extension.  Shoulders are less protracted.  Arms are more abducted.  Hips are less flexed and more ER.
  10. 10. 4. Supine and Pull to Sit:  Head completely lags behind shoulder  Back is rounded.
  11. 11. 5. Sitting:  When the newborn infants are placed in sitting, physiological flexion, joint immobility and decreased flexibilty of soft tissue allow them to maintain position briefly.  "Flopping like a rag doll"
  12. 12. 6. Vertical Suspension:  Automatic stepping reaction observed.  Legs flex and extend reciprocally.
  13. 13. POSTURAL CONTROL:  Physiological flexion/ Flexor recoil of limbs.  Primary Standing reaction.  Neck Righting Reflex.
  14. 14. REFLEXES: Primitive reflexes elicited by a specific stimulus: 1.ATNR 2.Moro 3.Sucking/Rooting 4.Galant
  15. 15. Sucking/ Rooting Reflex Galants Trunk Incurvatum Reflex
  16. 16. FINE MOTOR DEVELOPMENT: • Hand is fisted. • Grasp Reflex.
  17. 17. GROSS MOTOR DEVELOPMENT: 1. Prone: POSTURES: - Lifts and turns the head to one side. - Child lifts the chin up momentarily in midline. - Hips and knees are partially extended.
  18. 18. 2. Ventral Suspension: - Head momentarily lifts up. - Elbow Flexed. 3. Supine: - Generally more extended.
  19. 19. 4. Supine and Pull to Sit: - Greater Head lag than in newborn but attempts to lift head.
  20. 20. 5. Sitting: - Attempts to lift head. - If unsupported at trunk, results in bobbing movement of neck. - Infant fatigues easily and falls forward into flexion. 6. Vertical Suspension: - Automatic Stepping diminishes. - Usually cannot be elicited after 1st month.
  21. 21. POSTURAL CONTROL: • Physiological flexion Diminishes. • Head righting continues to develop. REFLEXES: • ATNR can be observed and serves as a pattern of postural control. • Others same as newborn
  22. 22. FINE MOTOR DEVELOPMENT: • Infant continues to exhibit Grasp Reflex • Hands mostly closed.
  23. 23. GROSS MOTOR DEVELOPMENT: POSTURE: 1. Prone Position:  Infant can lift the head about 45 deg. off the couch momentarily. 2. Ventral suspension:  Head is maintained momentarily in the same plane as the rest of the body.  Can maintain this position well.
  24. 24. 3. Supine Position:  Arms and Legs more extended.  Kicking. 4. Pull to Sit:  Head control starts to develop when the child is put to sitting position.  Chin is lifted up momentarily.  Back is rounded.
  25. 25. 5. Sitting: When placed in sitting, 2 months old baby, attempts to lift head Bobs forward. Back is rounded. 6. Vertical Suspension: Can hold head up more than momentarily.
  26. 26. POSTURAL CONTROL: • Physiological flexion further diminishes. • Active control starts to develop. • Head Righting continues to develop. • Maintains his position when held upright on adult's shoulder.
  27. 27. FINE MOTOR DEVELOPMENT: • Awareness of object placed in hand. • Scratch and Clutch tactile input such as a crib blanket.
  28. 28. GROSS MOTOR DEVELOPMENT: POSTURE: 1. Prone Position:  Pelvis is kept flat on the ground.  Infant can symmetrically lift the head and shoulder about 45 deg. off the couch. 2. Ventral Suspension:  Lifts head beyond the plane of the rest of the body.  Able to hold for sometime.
  29. 29. 3. Supine:  Hold the head in midline for sometime.  Tucks chin in  Gazes towards the chest  Bilateral activity of UE and LE dominate during this period.
  30. 30. 4. Pull to Sit:  No head lag.  But head tends to bob. 5. Sitting:  Infant can hold head upright in sitting for sometime but there may still be some wobbling of the head.  Learns to control head and trunk. The back is still rounded, so the baby slumps forward.
  31. 31. 6. Vertical Suspension:  Head erect  Take weight only briefly.  No slipping from shoulders.
  32. 32. POSTURAL CONTROL: • Active Head and Trunk Righting reactions. • Infant now begins to establish postural synergies, or a state of readiness in preparation for volitional movement.
  33. 33. FINE MOTOR DEVELOPMENT: • Hand Regard. • Hand to Hand Coordination. • Sustained Voluntary Grasp. • Tactile Awareness.
  34. 34. GROSS MOTOR DEVELOPMENT: POSTURE: 1. Prone Position:  Prop on foreams  Lifts the head and chest higher.
  35. 35. 2. Ventral Suspension:  Head is maintained well beyond the plane of the rest of the body.  Back is flat
  36. 36. 3. Supine:  Hold the head in midline for long periods of time.  Initiation of rolling. 4. Pull to sit:  When pulled up, there is slight head lag during beginning and then head is flexed beyond the plane of the body.  Spine Curvature decreases.
  37. 37. 5. Sitting:  Sits upright for 10-15 min at a time.  Attempts to lean forward to reach or touch an object and return to erect position.  Learns to control head and trunk 6. Vertical Suspension:  Stands erect with better head and trunk control.
  38. 38. POSTURAL CONTROL: • Functional Head Control starts to develop. • LANDAU REACTION:
  39. 39. Symmetrical Tonic Neck Reflex
  40. 40. ANATOMICAL CHARACTERISTICS: Primary spinal curves that exhibit posterior convexity are present in the newborn infant in the thoracic and sacral-coccygeal region. Secondary curves with an anterior convexity starts to develop in cervical and lumbar areas in order to accommodate to a vertical position. The cervical curve is seen by 4 months as the infant can hold the head erect and steady.
  41. 41. FINE MOTOR DEVELOPMENT: • Hands come together in midline. • Bidextrous Reach. • Tries to reach object, but overshoots.
  42. 42. GROSS MOTOR DEVELOPMENT: POSTURE: 1. Prone Position:  Chest is maintained off the couch  Arms in extension.  Turns head from side to side.
  43. 43. 2. Ventral Suspension:  Head is maintained beyond plane of rest of body with trunk extension. 3. Supine:  Independent movement of head.  Can also lift the head in supine and might lift the shoulders off the surface.  Symmetrically lifts the legs in air with knees extended and forcefully lowers them to the surface with a bang.  "Bridging Activity"
  44. 44. 4. Pull to Sit:  Baby flexes and lifts the head.  Tucking the chin. 5. Sitting:  Head is stable without wobbling  Back is straight  Takes support on hands  Tries to play by carefully lifting one hand to reach object.
  45. 45. 6. Vertical Suspension:  Continue with wide BOS  Controls knee in weightbearing position. POSTURAL CONTROL:  Head Righting is complete  Functional Head control is present in all positions.  Landau reaction matures. Beginning of lateral postural control.  Primitive Reflexes no longer dominate.
  46. 46. FINE MOTOR DEVELOPMENT: • Able to grasp an object with asymmetrical palmar grasp. • Brings objects to the mouth. • Begins to transfer an object from one hand to another.
  47. 47. GROSS MOTOR DEVELOPMENT: POSTURE: 1. Prone Position:  Sufficient Postural Stability.  Arms and legs outstretched.  Experiments with more movement of trunk in prone.  Begins to assume Quadruped position.  Tries to move self on floor.
  48. 48. Rolling: • Most babies can transition between supine, prone and sidelying by the end of six months. • Each baby develops an individual pattern for rolling that becomes more efficient with repetition and motor learning.
  49. 49. 2. Supine:  Greater Anti-Gravity Control.  Raises one or both arms freely in space and reaches to be picked up.  Able to hold their legs vertical with knees extended. 3. Pull to Sit:  When about to be pulled up, lifts head off the couch in anticipation.  Tucking the chin.  Baby pulls with arms and extends the kness while bringing the body weight forward.  Also the legs are flexed at the hips and are off the mat as the baby pulls himself to sitting.
  50. 50. 4. Sitting:  Able to sit well in a high chair and begin to control the limited surrounding space.  Sit independently on the floor with arm support and may easily play in this position for upto half an hour.  "Tripod Sitting"  May reach with one arm while suporting with other.
  51. 51. 5. Vertical Suspension:  Stands with less suport.  Feet closer together.  Bears almost all his weight when made to stand.  Hold on by grasping an adults finger rather than being held by the hands or arms.
  52. 52. POSTURAL CONTROL: • By 6 months of age, baby has sufficient postural tone to maintain many postures against gravity. • More mature Landau reaction. • Labyrinthe and Optical righting have fully developed. • Body on Body righting response can also be elicited. • Equilibrium reactions are present in prone and are beginning to be seen in supine. • Forward Protective Extension of arms begins to emerge at 6 months.
  53. 53. FINE MOTOR DEVELOPMENT: • Unidextrous reach. • Consistent palmar grasp. • Tranfers hand to hand. • Attempts to help with spoonfeeding and cupdrinking. • Shakes and bangs toys to create auditory and visual object. • Child cannot yet voluntarily release an object in space.
  54. 54. GROSS MOTOR DEVELOPMENT: POSTURE: 1. Prone Position:  Baby is busy reaching, weight shifting and trying to move along the floor.  Maintains Quadruped position well. 2. Supine:  Rarely stays in supine.
  55. 55. 3. Rolling:  Rolling to the side, baby pushes up on one arm to a position in which a larger area can be visually and manually explored.
  56. 56. 4. Sitting: Sit with their arms free for play. But supports with one hand while reaching any object. 5. Transitions in and out of sitting: Baby is able to get into sitting position independently but only from quadruped position. 7 month old infant also begins to transition from sitting to prone.
  57. 57. 6. Quadruped:  7 month old baby symmetrically pushes the arms straight to assume a quadruped position.  Begins to rock forward and back  Loses balance and falling to prone.
  58. 58. 7. Locomotion:  Begins to move on the abdomen by pivoting sideways.  Alternatively weight shifts from one side to other.  Baby learns to pull the body forward but his action is not propulsive.
  59. 59. 8. Pulling to stand:  Babies begin to pull themselves to a standing position.  While in a crib, from prone or quadruped, baby pulls up to standing, using the arms to climb the rails.  When seated on the floor, an adult's lap is another optimal support for first pulling to standing.
  60. 60. 9. Standing:  Unstable.  Legs are wobbly and appear disoriented.  Stands at adducted hips.  Often baby stands on toes.  Baby widens BOS by taking step side-ways. POSTURAL CONTROL: • Pelvic/Hip stability increases. • Equilibrium reactions present in prone and supine.
  61. 61. FINE MOTOR DEVELOPMENT: •Learns to hold object with radial palmar grasp. •Tranfers objects. •Learns to release object as voluntary grasping has developed.
  62. 62. GROSS MOTOR DEVELOPMENT: POSTURE: 1. Sitting: Sits independently without any support. Learns to maintain a more erect trunk for longer periods. Moves arm in greater range up and away from body. Lower portion of leg closer to the body.
  63. 63. 2. Rolling:  As the balance and coordination improves, child raises the trunk higher off the surface until close to sitting.  Now the child can move easily from here to quadruped.
  64. 64. 3. Transition in and out of sitting:  Baby develops sufficient UE, trunk and pelvis control to rotate from sitting to Quadruped. 4. Quadruped:  Baby becomes confident in assuming quadruped from different positions using variety of patterns.  In quadruped, baby develops the ability to reach laterally as well as forward.
  65. 65. 5. Locomotion:  In 8 month, baby begins to pivot or belly crawl in larger ranges and locomotes from one point to another.  Learns to crawl on all fours.  Initially baby creeps on hands and knees slowly  Pattern may not be well tolerated.  Often baby collapses.  Lateral flexion/elongation of trunk as weight is shifted during early crawling.
  66. 66. 6. Pulling to Stand:  Pulls to standing from sitting, baby tries to pull up on various objects of an optimal size and height.  Baby learns which objects are stable and which are not adequate.  When first standing up, baby may be unable to get back down and start to cry, which he soon learns to let it go and falls on buttocks.
  67. 67. 7. Standing:  Standing at 8 months becomes more controlled.  Baby can free one arm and reach in a wider BOS  Motivated to obtain objects which are out of reach, baby uses this side-stepping pattern to cruise around furniture.  With two hands held, 8 months old child begins to walk, although this may be a continuation of early automatic stepping pattern of newborn, the coordination is now disrupted.
  68. 68. POSTURAL CONTROL: • Increased postural activity to – maintain upright positions – accompany functional movts in sitting, quadruped and standing at support – transition between sitting, quadruped and supported standing. • Equilibrium reactions are present in sitting and beginning in quadruped. • Protective extension of arms sideways in sitting.
  69. 69. FINE MOTOR DEVELOPMENT: • Mature palmar grasp. • Palmar arches are active as they contribute in grasping any object.
  70. 70. GROSS MOTOR DEVELOPMENT: POSTURE: 1. Sitting: Becomes more dynamic A baby sits and plays with an object only briefly, then drops it and throws it and reaches again. Rotates the body to reach any object. (90 deg or more) Bouncing. May also begin to Side-sit, one hip ER and other IR.
  71. 71. 2. Transitions in and out of sitting:  By 9 months of age, babies have increased hip mobility as well as postural control and may use a variety of patterns to move from sitting to quadruped.  Also movement is performed more easily and quickly.
  72. 72. 3. Quadruped:  Learns to control position.  Able to reach in wider ranges.  Once mastered in quadruped, he learns to locomote.  Uses this position for play and locomotion.  Sometimes, baby pushes up on his hands to come on toes.
  73. 73. 4. Locomotion:  With continued practice, crawling becomes efficient.  By 9 months, there is less lateral excursion of trunk and improved hip control.
  74. 74. 5. Pull to Stand:  The same basic motor pattern is used to pull to standing regardless of the support.  From quadruped, baby reaches up with one arm, then the other arm, and walks knees forward.  In 9 month, baby doesnt fall on buttock as in 8 month, but now baby drops the pelvis back while reaching, keeping weight more to one side.
  75. 75. 6. Standing:  Balance in standing develops, baby begins to turn head and shoulders sideways to visually explore the environment.  Turns diagonal to the supporting surface.  Child learns to stand, reach and play.  Distal Stability is improved by leaning against a surface.  Has sufficient balance to stand with one hand-held, using hip flexion and a wide base.
  76. 76. POSTURAL CONTROL: • Uses many functional motor skills and movement to interact with the environment. • In addition to modulating postural activity during performance of a motor skill, baby learns to adapt posture prior to movement for more efficient execution.
  77. 77. FINE MOTOR DEVELOPMENT: • Child has a strong grip and maintains an object against resistance. • Immature Pincer grasp. • Learns to release an object first against a surface, in midair followed by into a large container.
  78. 78. Transitions in and out of sitting: • Atempts to sit up from sidelying.
  79. 79. Pull to Stand:  Baby develops hip control so now he kneels upright while pulling to stand with pelvis and hips aligned.  Able to shift body weight in this position.  When pulling up, baby may stop in kneeling position and reach for a toy.  With no sufficient hand control in this position, baby lowers the buttocks and sits on the heels to play.
  80. 80. VISION:
  81. 81. HEARING:
  83. 83. PHYSICAL CHARACTERISTICS OF GROWTH: • WEIGHT:  The average birth weight of a full-term newborn is approximately 3.4 kg.  Range-2.7–4.6 kg.  Usually infant loses 10% of body weight by the age of 10 days in the form of ecf.  Subsequently, they gain weight at a rate of approx. 25 to 30 g per day for the first 3 months of life.  Thereafter they gain about 400g weight every month for the remaining one year.
  84. 84. • LENGTH / HEIGHT:  The infant measures 50 cm at birth.  60 cm at 3 months.  70 cm at 9 months.  75 cm at 1 year. HEAD:  A newborn's head is very large in proportion to the body  The newborn's head is about 1/4 of total body length.
  85. 85. • HEAD CIRCUMFERENCE: Normal head circumference for a full-term infant is 33–36 cm at birth. Gains 2 cm per month for the first 3 months. Gains 1 cm per month between 3-6 months. Gains half cm per month for the rest of first year of life.
  86. 86. •At birth, many regions of the newborn's skull have not yet been converted to bone, leaving "soft spots" known as fontanels. •Anterior •Posterior •The posterior fontanelle generally closes 1-3 months after birth. •The anterior fontanelle is generally the last to close between 7-19 months.
  87. 87. REFERENCE: • Rona Alexander, Normal Development of Functional motor skills. • O P Ghai,7 ed, Essential Pediatrics. • Suraj Gupte, The Short Textbook Of Pediatrics. • Meherban Singh, 2 ed, Pediatric Clinical Methods. • Glady Samuel Raj, Physiotherapy in Neuro- Conditions.