normal developmental milestones an emphasis on anticipatory guidance ana malinow, md
TRANSCRIPT
Normal Developmental
Milestones
Normal Developmental
MilestonesAn emphasis on anticipatory
guidanceAna Malinow, MD
Why we should teach parents about development
Parents who understand their child’s 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.
Objectives• Principles of development• Primitive Reflexes• “Locomotion”: Gross Motor• “Manipulation”: Fine Motor• “Cognitive”: Language and Social• Behavior and Personality
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
Development Occurs in a Cephalocaudal
Direction
Development begins in utero
Age 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
All primitive reflexes develop during gestation and disappear by the 3rd to 6th month after birth
Primitive reflexes• Tonic labyrinthine reflex• Asymmetric tonic neck reflex• Positive support reflex
Declining intensity of primitive reflexes and
increasing role of definitive motor actions
Gross motor development“Locomotion”
Locomotion begins with head control
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 +
Ventral suspension
Head control
2 month head control
4 month head, arm control
6 month head, arm, trunk control
8 month head, arm, trunk, leg control
9 month pulls up to stand
12 month old locomotion
2 year old Running Backward Walking
3 year old Balance
“Manipulation”Fine Motor
Development
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
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
“Cognition”Social Development
Problem solvingPlayCausality
Language Development
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
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
12-month 18-monthFunctional Play
18-month 24-monthSymbolic Play
2-5 yearImaginary/Magical Play
6 year oldLogical Thinking
11 years +Hypothetical thinking
Assessing cognitive developmentCausality
Age Cause EffectEarly cries mom comesEarly smiles mom
responds4m kicks crib mobile moves8m pulls string gets ring10m funny +response/repeats
24m winds key toy moves
Conversational speech probably starts with
smiling
2 month old language
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
Assessing language
Age Expressive Receptive Jargon Sentence L. Intelligible
12m 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
Behavior• One-way or two-way interactions• Prenatal factors• Bonding/attachment• CNS maturation• Match• Schedule• Language• Instincts
Behavior-continued-
• Cognitive, gross and fine motor development
• Illness, separation, feeding issues• Birth order, family size• Secondary attachments• Environment• Gender identification
Bonding
Personality• Factors that influence behavior• Create behavior• Through adaptability and flexibility• Produce personality/social
behavior
Newborn “Personality”
4 month old “Personality”
9-month old“Personality”
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 another’s point
of view• Adolescence begins identity formation
(idealistic)• Adulthood completion of identity
formation
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