Motor development in children follows a generally predictable sequence, progressing from primitive reflexes in newborns to independent walking and running by age 2. Variability within and between children is normal and allows for exploration, but atypical development may show less variability and delays in achieving milestones. The focus of intervention is to provide varied experiences that expand a child's motor strategies and skills based on their readiness.

1. Motor Development,
Motor Control,
and Motor Learning
in Children

2. Unit Objectives
• Discuss importance of providing family-centered care, as
well as possible barriers.
• Describe variation and variability of typical and atypical
human development.
• Identify various developmental theories.
• Describe the presentation of a normal newborn vs a
preterm infant.
• Describe motor developmental progression in normal
children.
• Describe typical pediatric reflexes.

3. Motor Development and Control
Motor Control
– Control & organization of processes underlying movement
– Milliseconds
Motor Learning
– Acquisition of skill through practice & experience
– Hours, days, weeks
Motor Development
– Age related process of change in motor development
– Months, years, decades

4. Kinesiological Concepts of Development
Physiological Flexion
Antigravity Extension
Antigravity Flexion

5. Postural Control
1. Mobility
2. Stability
– Structural stability
– Positional stability
– Internal stability
– (External stability*)
3. Controlled mobility
4. Skill

6. Asymmetry to Symmetry to Controlled
Asymmetry

7. Normal Newborn Characteristics
• Physiological flexion
• Flexor recoil with passive stretch
• Hands lightly fisted
• Head in midline
• Visually alert
• Moves head side to side to clear airway
• Head and trunk are linked
• Typical Newborn Examination (video):
https://www.youtube.com/watch?v=M8uAPShqjGE

8. Premature Newborn Characteristics (<37 weeks)
• Decreased physiological flexion
• Low muscle tone
• Limited ability to self-calm
• Can not lift head and neck to clear airway
• Immature development of organ systems
• Poor feeding skills
• Premature Newborn (video):
https://www.youtube.com/watch?v=T_d4winmGr4
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9. The Newborn- Assessment
• APGAR score
• Measurements
– Head circumference
– Abdominal circumference
– Length
– Weight
• Physical Examination
• Gestational Assessment (http://www.ballardscore.com)
– Physical maturity
– Neuromuscular maturity
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10. APGAR
APGAR Item 0 1 2
Appearance Skin Color Pale or Blue Body normal
color, extremities
blue
Completely
normal color
Pulse Heart Rate Absent Below 100 Over 100bpm
Grimace Reflex irritability response to
stimulation to the sole of the
foot (light slap)
No response Grimace Cry
Activity Muscle tone Limp Some flexion of
the extremeties
Active motion
Respiration Breathing Absent Slow, irregular Good, strong cry

11. Neonatal/Primitive Reflexes
• Part of intrauterine development
– Usually appear at end of second trimester
– Integrated during first year of life
• Developmental trajectory
– Deviations indicate abnormal neuromuscular development
• Need to observe:
– Presence/absence of reflex
– Quality of reflex
– Symmetry of reflex

12. Neonatal/Primitive Reflexes
• Needed for survival and development
• Used to assess newborn alertness
• Many are present in utero but emerge and fade (integrate)
gradually
• Can be tested through specific procedures
• May be elicited passively or actively
• Not normally obligatory
• Influenced by factors such as body position, behavioral
state, time since last feeding, etc…

13. Videos of Typical Developmental Reflexes
• Rooting Reflex: https://www.youtube.com/watch?v=v7_Y_jg2soc
• Moro Reflex: https://www.youtube.com/watch?v=PTz-iVI2mf4
• Plantar Grasp Reflex: https://www.youtube.com/watch?v=6Ch48Sg9mVE
• Palmar Grasp Reflex: https://www.youtube.com/watch?v=tZa9XxRthdA
• Stepping Reflex: https://www.youtube.com/watch?v=CkGjOwPXsvo
• ATNR: https://www.youtube.com/watch?v=pxrnFKwKJUc
• Landau Reflex: https://www.youtube.com/watch?v=jEDixMrg1nw
• Babinski Reflex: https://www.youtube.com/watch?v=8sbFQQYbYLk
• Protective Extension Forward: https://www.youtube.com/watch?v=6fIIbY0WD_M
• Protective Extension Sideways: https://www.youtube.com/watch?v=B6ylrJsIzVU
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14. Test Your Knowledge: Reflexes
What is reaction that occurs with a stretch to a muscle called?
A
B
C
D
Deep Tendon Reflex
Equilibrium Reaction
Neonatal Reflex / Primitive Reflex
Righting Reactions
Select the correct letter.

15. Equilibrium Reactions
• Fully developed equilibrium reactions are complex
• Function to maintain postural control
– Static
– Active
– Reactive
• Described according to neck, trunk and extremity movements
• Normally appear at 4-6 months of age in prone & supine
• Mature at 4-6 years of age

16. Order of Postural Control
Prone
Supine
Side lying
Sitting
Quadruped
Kneeling
Standing

17. Gross Motor Milestones
2-3 months
• Assumes prone on elbows (when placed in prone)
3-4 months
• Rolls supine to side lying
5 months
• Pull to sit without head lag
• Rolls prone to supine
• Feet to mouth
• Self-supported sitting propped forward on arms

18. Gross Motor Milestones
6 – 7 months
• Rolls supine to prone
• Sits alone without support (hands free)
• Sitting equilibrium: Protective extension forward
• Transitions quadruped to/from sitting
8-9 months
• Cruises sideways
• Sitting equilibrium: Protective extension laterally
• Creeps (reciprocal on all fours)
• Pulls to stand at furniture

19. Gross Motor Milestones
10-11 months
• Sitting equilibrium: Protective extension backward
• Stands alone for short periods
• Climbs on hands and knees/feet up stairs
• Walks with 1 HHA
12 - 15 months
• Walks independently
• Squats to play and resumes standing

20. Gross Motor Milestones
16 - 18 months
• Runs “stiffly”
• Walks up and down stairs holding rail (step-to)
2 – 2.5 years
• Walks backwards
• Walks up and down stairs without support (step-to)
3 years
• Emerging adult-like gait
• Jumps with 2 feet together
• Able to rise on toes and maintain
• Throws perpendicular to target

21. 4 years
• Walks up and down stairs without support (alternating
feet)
• Tandem walking
5 years
• Skipping
• SLS for 10 seconds
• Hops 8-10x on one foot
• Mature throwing pattern (diagonal arm swing, LE wt
shift)
Gross Motor Milestones

22. Resource for Developmental Milestones
https://pathways.org/
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23. Motor Development - Summary
• Motor development for typically developing children has a generally
predictable sequence.
• With deviations in muscle tone, poor quality of movement can be
expected.
• An assessment should help define if the problem relates to a decreased
range of strategies available to the system or an inability to match an
appropriate strategy to the motor function

24. Typical Motor Development Includes Variability
• Motor development is viewed as an innate maturational process that is largely
affected by experience
• Variability within and between individuals is an essential element in the
developmental process
• Used for exploration and selection
• Provides flexibility in motor performance and motor strategies

25. • More stereotyped motor behavior
• Delay in achievement of milestones (impaired selection)
• Mild or major deviation in muscle tone
• Persistence of infantile reflexes
• Repertoire of motor strategies is reduced
Less Variability in Atypical Development

26. Focus of Intervention
• Increase amount and variability of experiences
• There is not one correct postural control strategy
• Design activities that are based on the requirement for the
action you are trying to advance
• Readiness for new skills
• Expand activities for the right challenge
• Variable practice

27. References
• Palisano R, Orlin M, Schreiber J. Campbell’s Physical
Therapy for Children, 5th Edition. St. Louis, MO:
Saunders/Elsevier; 2017.
• Plack, M. Management of the Pediatric Patient
Handout. The George Washington University Program
in Physical Therapy. 2014
• www.pathways.org