NORMAL DEVELOPMENTAL MILESTONES TILL 1 YEAR

NORMAL DEVELOPMENT
OF CHILD
0-1 yr
BY:
Sharmin Susiwala
Final Year
BPT

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

PRINCIPLES OF DEVELOPMENT:
Distinctive attribute of childhood
Cephalocaudal order
Mass activity specific and subtle
individual responses.
Primitive Reflex pattern

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

GROSS MOTOR DEVELOPMENT:
POSTURES:
1.Prone
2.Supine
3.Sitting
4.Standing

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.

2. Ventral Suspension:
 Head flops down
completely.
 Back is rounded.

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.

4. Supine and Pull to
Sit:
 Head completely lags
behind shoulder

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"

6. Vertical Suspension:
 Automatic stepping
reaction observed.
 Legs flex and extend
reciprocally.

POSTURAL CONTROL:
 Physiological flexion/ Flexor recoil of
limbs.
 Primary Standing reaction.  Neck Righting Reflex.

REFLEXES:
Primitive reflexes elicited by a specific stimulus:
1.ATNR
2.Moro
3.Sucking/Rooting
4.Galant

Sucking/ Rooting Reflex
Galants Trunk
Incurvatum Reflex

FINE MOTOR DEVELOPMENT:
• Hand is fisted.
• Grasp Reflex.

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.

- Head momentarily
lifts up.
- Elbow Flexed.
3. Supine:
- Generally more
extended.

4. Supine and Pull to
Sit:
- Greater Head lag
than in newborn but
attempts to lift
head.

5. Sitting:
- Attempts to lift head.
- If unsupported at trunk,
results in bobbing
movement of neck.
- Infant fatigues easily and
falls forward into flexion.
- Automatic Stepping
diminishes.
- Usually cannot be elicited
after 1st month.

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

• Infant continues to
exhibit Grasp Reflex
• Hands mostly closed.

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.

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.

5. Sitting:
When placed in
sitting, 2 months
old baby,
attempts to lift
head
Bobs forward.
Back is rounded.
Can hold head up more than
momentarily.

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.

• Awareness of object placed in hand.
• Scratch and Clutch tactile input such as a
crib blanket.

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.
 Lifts head beyond the
plane of the rest of the
body.
 Able to hold for sometime.

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.

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.

6. Vertical
Suspension:
 Head erect
 Take weight only
briefly.
 No slipping from
shoulders.

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.

• Hand Regard.
• Hand to Hand
Coordination.
• Sustained Voluntary
Grasp.
• Tactile Awareness.

POSTURE:
1. Prone Position:
 Prop on foreams
 Lifts the head and
chest higher.

 Head is maintained
well beyond the
plane of the rest of
the body.
 Back is flat

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.

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
 Stands erect with
better head and trunk
control.

POSTURAL CONTROL:
• Functional Head Control starts to develop.
• LANDAU REACTION:

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.

• Hands come
together in midline.
• Bidextrous Reach.
• Tries to reach
object, but
overshoots.

POSTURE:
1. Prone Position:
 Chest is maintained
off the couch
 Arms in extension.
 Turns head from
side to side.

 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"

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.

 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.

• Able to grasp an
object with
asymmetrical palmar
grasp.
• Brings objects to
the mouth.
• Begins to transfer
an object from one
hand to another.

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.

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.

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.

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.

 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.

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.

• 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.

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.

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.

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.

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.

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.

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.

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.

•Learns to hold object with radial palmar grasp.
•Tranfers objects.
•Learns to release object as voluntary grasping
has developed.

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.

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.

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.

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.

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.

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.

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.

• Mature palmar grasp.
• Palmar arches are active as they
contribute in grasping any object.

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.

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.

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.

4. Locomotion:
 With continued practice, crawling
becomes efficient.
 By 9 months, there is less lateral
excursion of trunk and improved hip
control.

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.

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.

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.

• 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.

Transitions in and out of sitting:
• Atempts to sit up from sidelying.

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.

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.

• 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.

• 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.

•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.

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.

NORMAL DEVELOPMENTAL MILESTONES TILL 1 YEAR

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