It describes the normal developmental milestones

1. Normal development of a child
Dr.Sanghamitra Ray

2. Learning objectives
 To identify the importance of development
 Definition of development
 Principles of growth and development
 Factors affecting growth and development
 Domains of development
 Stages of development
 Assessment of development

3. Definition
 Development:
 Maturation of function
 Acquisition of skills
 Due to myelination of neurons and formation of new synapses

4. Principles of development
 Development is a lifelong process
 Its similar for each individual
 But proceeds at an individual rate
 Different areas of development are interrelated
 Early primitive reflexes are lost first
 Prerequisite for proper development of a child are
 Intact neurological system
 Appropriate exposure

5. Pattern of development
 Pattern of growth is in a head-to-toe
direction / Cephalocaudal
 Inward to outward pattern called
Proximodistal

7. Factors affecting development
 Genetic - chromosomal / gene defects
 Sex
 Environmental influence

8. Factors affecting development
Postnatal factors
 Neonatal – IUGR, Prematurity,
Asphyxia
 Post- neonatal factors
Nutrition
Infections
Trauma
Toxin
Hormonal influences
Emotional factors
Cultural practices
Intrauterine factors
Maternal nutrition
Drugs or toxin exposure
Infections

9. Ages and Stages of Child Development

10. What is milestones of development?
 Milestones- time of acquisition of a key skill
 Median age – age at which half population acquire the skill
 Limit – age at which a skill should have been achieved,
- 2SD from the mean

11. Domains of development
 Gross Motor
 Fine Motor
 Language
 Social Emotional/ Adaptive
/Cognitive

12. Gross motor development
 Involves control of child over his body
 Evaluated by- Observation in supine position
Pull to sit
Ventral suspension
Axillary suspension
Prone position

15. Key Gross motor milestones
 3 months – neck holding
 5 months – sitting with support
 8 months – sitting without support
 9 months –standing with support
 10 months – cruising
 12 months – standing without support
 14 months – walking without support
 18 months – running
 24 months – walking upstairs

16. FINE MOTOR OR ADAPTIVE MILESTONES
Includes
 Eye coordination
 Hand eye coordination
 Hand mouth coordination
 Manipulation with hands

17. Fine motor (Hand eye coordination )
 4 months – tries to grasp red ring dangling in front but may overshoot
 5 months – reaches out & grasps object with ulnar side
 6 months – radial grasp, transfers objects from hand to hand
 10 months – pincer grasp
 Hand-mouth coordination:1 year – tries to feed with spoon but may
spill
 15 months – feeds with spoon
 18 months – feeds self from cup

19. Fine motor (Hand skills: Book)
 13 months – turn 2-3 pages at a time
 24 months – turns 1 page at a time
Scribbling
 12-24 months – scribbles
 2 years – copies vertical line
 2 ½ years –copies horizontal line
 3 years – circle
 4 years – cross, rectangle
 5 years – copies cross, triangle

20. Language
Language development involves
 Ability to produce words
 Articulation, pronunciation
 Motor production of sounds
 Language
 Expression with appropriate emotion
 Ability to understand spoken words

21. Language milestones
 1 month - turns head towards sound
 3 months – coos, vowel sounds
 4 months- laughs loud
 6 months - monosyllables
 9 months – bisyllables, mama/dada as sounds

22. Language milestones…
 12 months - speaks 2 words with meaning, “mama/dada specific
 18 months - 10 words
 24 months - joins 2-3 words in a short sentence, use I and ME
 3 years – asks questions, knows full name and gender
 4 years- tells story, sings song

23. Cognitive Domain
 Thought processes and intellectual abilities including
attention, memory, problem solving, imagination, creativity,
academic and everyday knowledge, metacognition, and
language

24. Social/Emotional Development
 Self-knowledge (self-esteem, sexual identity, ethnic identity),
moral reasoning, understanding and expression of emotions,
self-regulation, temperament, understanding others,
interpersonal skills, and friendships

25. Personal and social development milestones
 1 month - regards face of mother/caretaker
 2 month - social smile
 3 months - recognizes mother/caretaker
 6 months - enjoys mirror
 7-8 months - separation anxiety
 9 months - waves bye-bye

26. Personal and social development milestones..
 12 months – plays simple ball game
 18 months- copies parents in task
 2 years- ask for food, drink
 3 years- shares toys, knows full name and gender can dress and undress
fully
 4years – goes to toilet alone
 5 years – helps in household tasks

27. Tools for developmental assessment
 Red ring
 Pen torch
 Red cubes (2.5 cm)
 Pellet
 Cup with handle
 Spoon
 Book with thick pages
 Red pencil/crayon
 Paper
 Wooden blocks
 Doll
 Mirror

29. Developmental Quotient
 To derive DQ at the end of evaluation
 DQ calculated as –
Average age at attainment x 100
Observed age at attainment
 A value below 70% - abnormal

30.  Practice with every child you meet

31. Thank you