MC Content - Milestones & Reflexes

Question 1

Differentiate between growth & development

Answer 1

Growth = cells divide & grow in number. Quantitive measure ie height/weight
Development = myelination of our nervous system. Qualitative measurement eg can they socialise, follow commands, share a toy, etc

Question 2

What are the periods of growth?

Answer 2

Prenatal - Before birth (Ovum, embryo & foetus)
Perinatal - 22 weeks of gestation to 7 days after birth
Post-natal - Young infant (3-6 months), older infant (7-11 months), Toddler (12-24 months), pre-schooler (3-5 years), etc

Question 3

Chronological age vs corrected age

Answer 3

Chronological = age from their DOB
Corrected = Number of weeks from DOB - number of weeks the baby was premature (assume 40 weeks is full gestation)

Question 4

True or false: A babies birthweight is a key indicator of infant health?

Answer 4

True! it indicates a baby’s chance of survival and health later in life.

Question 5

What is a healthy birthweight?

Answer 5

2.5-4kgs

Question 6

Jared was born at 1.8kg, where does this classify him in terms of his birthweight?

Answer 6

Low birth weight (<2.5kg)

Note: very low birth weight (<1.5kg)

Question 7

What does APGAR stand for?

Answer 7

• Appearance ie skin colour (0 = cyanotic, 1 = peripheral cyanosis, 2 = pink)
• Pulse ie heart rate (0=0, 1 = < 100, 2 = 100-140)
• Grimace: reflex irritability ie to a light pinch (0 = no response to stimulation, 1 = Grimace or weak cry when stimulation, 2 = cry when stimulated)
• Activity (tone): (0: floppy, 1 = some flexion, 2 = well flexed and resisting extension)
• Respiration: (0: apneic, 1 = slow, irregular breathing, 2 = strong cry)

Question 8

What is the purpose of APGAR?
Minimum vs maximum score?
After birth how often is it checked?
What is the significance?

Answer 8

• Determines the time taken for a newborn to adapt to normal physiological cycle
• Minimum score = 0 & max = 10 (7+ is good = no need to monitor)
• 0, 1, 5 & 10 mins and then continuously until 24hrs post birth
• Note: no baby will have a score of 100% at birth

Question 9

What is the significance of the APGAR?

Answer 9

Babies receive oxygenated blood through the placenta when in the womb. Once they are born, the babies lung then start participating in the oxygenation cycle.

The APGAR score is assessing the time needed to adapt to their normal physiological cycle of breathing + start taking active breaths

Question 10

What milestone can we expect at 2-3 months?

Answer 10

Head in midline in supine/hold head upright when carried

Question 11

What milestone can we expect at 3-4 months?

Answer 11

Rolling

Question 12

What milestone can we expect at 6 months?

Answer 12

Sitting

Question 13

What milestone can we expect at 7-9 months?

Answer 13

Crawling

Question 14

What milestone can we expect at 8-10 months?

Answer 14

Pull to stand/standing with support

Question 15

What milestone can we expect at 10-11 months

Answer 15

Cruising around furniture

Question 16

What milestone can we expect at 11 months?

Answer 16

Standing without support

Question 17

What milestone can we expect at 12-18 months?

Answer 17

Independent walking

Question 18

What milestone can we expect at 18 months?

Answer 18

Running

Question 19

What milestone can we expect at 24 months?

Answer 19

Walking up/down stairs

Question 20

Fine motor development - Milestones
- Birth
- 2 months?
- 3 months?
- 4 months?
- 5 months?

Answer 20

• Birth: hand fisted, grasp reflex
• 2 months: hands open, may retain a placed rattle briefly
• 3 months: hands to mouth and midline
• 4 months: 2 handed reach, can retain object in hand, shaking objects
• 5 months: Bidextrous grasp - holds objects with 2 hands

Question 21

Fine motor development - Milestones
- 6 months
- 7 months
- 9 months
- 11 months

Answer 21

• 6 months: transfer object between hands
• 7 months: palmar grasp and thumb adducting, one handed reach
• 9 months: pincer grisp (pellets), pointing with index finger
• 11 months: takes object out of container, claps hands

Question 22

Motor development milestones:
- What is expected of a 12-24 month old toddler?
- What is expected of a pre-schooler: 3-5?

Answer 22

Toddler (12-24 month): lateral cruising –> pushing a walker, independent walking, basic GMS (kicking, scoop catch, jump, run, step up and step down with railing)

Pre-schooler (3-5 years) –> more complex GMS (single leg stance, hopping, catch, drop kick, jump rope, hopscotch, ride bike, ride scooter, ascend/descend stairs independently, faster running and agility).

Question 23

What are the milestones for personal social development?
- 2 months
- 3 months
- 6 months
- 9 months
- 1 year

Answer 23

2 months = social smile
3 months = recognises mother
6 months = smiles at mirror image, identifies familiar face/stranger
9 months = waves bye - bye, sociable/chatty (babbles)
1 year = plays simple ball games, feeds self with a spoon

Question 24

What is the Galant reflex? Primitive Spinal reflex

Answer 24

Stimulus: Infant is on their stomach & a downward stroke is applied
Response: Infant will twitch their hips towards the touch
Appearance: In utero: 20 weeks
Disappearance: 3-9 months

Question 25

What is the crawl reflex? Primitive Spinal reflex

Answer 25

Stimulus: infant is placed on their stomach
Response: pulls their legs under their body and kicks them out in a crawling motion
Time of appearance: at birth
Time of disappearance: by 12 weeks

Question 26

What is the rooting reflex? Primitive Spinal reflex

Answer 26

Stimulus: stroke corner of their mouth
Response: face turns towards the side
Time of appearance: at birth
Time of disappearance: By 12 weeks

Question 27

What is the sucking reflex? Primitive Spinal reflex

Answer 27

Stimulus: introduce a finger into the mouth
Response: sucking action of the lips and jaw
Time of appearance: at birth
Time of disappearance: 3-4 months

Question 28

What is the moro (startle) reflex? Primitive Spinal reflex

Answer 28

Stimulus: supine and back of the head is supported. Drop the head backwards associated with a loud sound.
Response: abduction and extension of arms followed by adduction of the arms (as in embrace). often accompanied by a cry
Time of appearance: 9 weeks in utero, fully present at birth
Time of disappearance: 3-4 months

NOTE: if only one limb is ext/abd consider an issue with the limb eg hemiparesis (a normal response should be bilateral & symmetrical)

Question 29

What is the babinski reflex? Primitive Spinal reflex

Answer 29

Stimulus: baby is in supine or sitting and a stroke is applied to the lateral aspect of foot from heel to the base of the great toe
Response: Fanning of all 5 toes, extension of the hallux
Time of appearance: at birth
Time of disappearance: 1-2 years (stays until maturation/myelination of the nervous system has happened)

If still fanning after 2 years = pathological ie neurological concern

Question 30

What is the flexor withdrawal? Primitive Spinal reflex

Answer 30

Stimulus: noxious stimuli to the sole of the foot
Response: uncontrolled flexion response of the stimulated leg
Time of appearance: at birth
Integration: 1-2 months

Question 31

What is the Crossed extension reflex? Primitive Spinal reflex (stimulus & response)

Answer 31

Stimulus: noxious stimuli to ball of foot
Response: opposite lower extremity adducts and extends and foot goes into PF

Question 32

What is the stepping reflex? Primitive Spinal Reflex

Answer 32

Stimulus: support the infant by holding around their thorax and place their feet flat on a surface.
Response: Alternating steps forward are observed
Time of appearance: at birth
Time of disappearance: 6 months

Question 33

What is the grasp reflex? Primitive Spinal Reflex

Answer 33

Stimulus: press finger/suitable object into palm from ulnar side
Response: fingers flex and grip the object
Time of appearance: at birth
Time of disappearance: By 12 weeks

Note: a negative reflex is a good indicator of spasticity or prolonged reflex ie 3 mths + = something is wrong neurologically

Question 34

What is the TLR reflex? Brainstem/Tonic reflex

Answer 34

Tonic Labrinthine Reflex (commonly present with galant reflex)
Stimulus: changes of orientation of the head in space
Response: prone position = flexion of all limbs as they try to lift their head. Supine position = extension of all limbs as the head is moved backward.
Time of appearance: Birth
Time of disappearance: 2-4 months

Question 35

What is the ATNR reflex? Brainstem/Tonic reflex

Answer 35

Asymmetrical Tonic Neck Reflex
Stimulus: supine position - head in mid position, arms and legs extended (fencing reflex). Attract infants attention to turn head and look across one shoulder.
Response: increase in “extensor tone” on face side and increase in “flexor tone” on skull side.
Time of appearance: at birth
Time of disappearance: 6 months

Rolling is going to be impaired because the reflexive response will cause their arm to go into extension

Question 36

What is symmetrical tonic neck reflex? Brainstem/Tonic reflex

Answer 36

Stimulus: baby is in supine with head in mid position (arms and legs extended). Flexion or extension of the head.
Response: flexion of head: arms flex legs extend. Extension of head: arms extend, legs flex.
Time of appearance: emerges after ATNR phases out (6-9 months)
Time of disappearance: 9-11 months

This is a reflex which basically prepares the baby for walking