Normal Development Notes (0-18 mo) Flashcards
Give the 3 theories of human development.
1) Neuromaturational View
2) Dynamic Systems
3) Neuronal Group Selection Theory.
Which of the 3 theories of human development says that variation and variability are the keys to development and that while the sequence uses multiple systems the CNS is best?
NGST
Which theory states that the CNS only determines the sequence of development?
Neuromaturational
Which system has more grey areas with development and says that multiple systems are equivalent to the CNS in determining the sequence of development?
Dynamic Systems
Describe the general changes happening during each of the trimesters or pregnancy.
1) First: By 7 weeks you have a full baby who kicks and moves.
2) Second: There are no new movements and by the end the gross motor skills are decreased.
3) Third: Fine motor skills increase (things like sucking, hand to hand, etc)
What are the 6 directions in development?
1) Cephalic control before caudal
2) Extensor antigravity control before flexor antigravity control
3) WB on flexed extremities before extended extremities
4) Gross motor before fine motor
5) Proximal before distal control
6) Reflex before cortical control
Name the progression for an infant starting with prone.
Prone, supine, rolling, sitting, WB
Describe the how you would find a newborn-1 month old in prone.
1) Physiological flexion
2) Neck: flexion and full cervical rotation
3) UE: hand nuzzles mouth
4) LE: Triple flex (DF =70 with foot hitting tibia)
5) Movement: Caudally up
6) Wt Shift: backwards to lift up head
Prone Progression for the 2 month old.
1) Asymmetry
2) Neck: 45 ext 45 Rotation
3) UE: Still flexed and elbows behind shoulders
4) LE: less flexed and in a frog leg position
5) ATNR
What is the 3 month old Prone Progression?
1) Symmetry
2) Neck: 90 ext and full rotation from horizontal
3) UE: elbows underneath shoulders, shoulder girdle very active, still on forearms. Hands are still fisted with some opening and closing.
4) LE
5) Movement
Give the 4 month old prone progression.
1) Strong symmetry
2) Neck: 90 ext and bilat. 90 rotation
3) UE: on forearms working towards extending arm
4) LE: still in frog leg position
5) Weight shift: towards face side or toy/object
What would you see from a 5 month old in prone?
1) Neck: 90 ext. with a good chin tuck; can coordinate flexion/extension in prone
2) UE: ext with open hands, elbows in front of shoulders, grasping and releasing.
3) LE: still in frog leg with some dissociation between the LE
4) Wt. Shift: Lateral wt shift with reaching.
5) Swimming: trunk on ground with UE and LE off.
* *Getting ready to pivot in this stage**
What is the 6 month old model in prone?
1) Neck: all controlled at this point
2) UE: ext with mature wt shift without collapsing.
3) LE: similar to 5 mo, not stuck in frog leg
4) Movement: pivoting
Describe the 7 month old prone progression
1) UE: ext and reaching in all positions
2) LE: WB through knees
3) Transitions: sit prone, prone quad
4) Movement: not quite creeping but rocking a lot in quad
What is the prone progression for 8+ months?
1) Transitions: in and out of side sit bilat.
2) Plantigrade: UE and LE ext (down dog in yoga)
3) Creeping: This should be happening.
Give the 1 month old supine progression.
1) Physiological flexion
2) Neck: not in midline with some rotation
3) UE: Scapulas retracted back with flexion
4) LE: flexed with some frog leg
5) Movements: variable kicking and reciprocal sweeping
What is the supine progression for a 2 month old?
1) Asymmetry: ATNR
2) Neck: Can’t stay in midline for very long
3) UE: can’t do hand to mouth
4) LE: frog leg position, legs do some extension
Describe how you would find a 3 month old in supine.
1) Shift to symmetry
2) Neck: learn to track 180, neutral midline
3) UE: can bring hands to chest to play with toy
4) LE: Kicking reciprocally and increased foot-foot play
What is the supine progression for a 4 month old?
1) Neck: head at midline always with a nice chin tuck
2) UE: off chest and can bat at toys above them
3) LE: antigravity control increases in LE and abs
4) Mirroring: LE mirroring (sometimes with UE too)
Describe the position of a supine 5 month old
1) UE: reaching is bilat. and symmetrical
2) LE: decreased mirroring between the UE and LE; LE stay flexed when reaching
3) Movements: Alternate bridging and pulling into full flexion
4) Happy Baby: grabs underside of same side foot, this works abs and is when they find their feet and try to eat their toes.
Give the supine progression for a 6 month old.
1) Increased UE and LE dissociation
2) UE: can transfer toys between hands
3) Trunk: controls sway of legs and can stop roll if they want to
4) LE: dissociation happening; can put foot on opposite knee
5) Rolling starts
What is the 7 month old supine progression?
1) NOT HAPPY IN SUPINE; start fighting diaper changes
2) Neck: full flexion in antigravity
3) Movement: roll to prone
* *If the baby still likes supine at this age there may be something wrong**
Give the general characteristics and red flags for a newborn/1 month old.
1) General characteristics: Physiological flexion of all extremities in all positions and swiping movements of extremities.
2) Red Flags: Extended posture, no flexor recoil, absent primitive reflexes
In the second month what characteristics would you be looking for and what would be a red flag?
1) General Characteristics: Greatest asymmetry (ATNR), disorganized motor movements
2) Stiff or floppy extremities, little movement in extremities.
Month three would show what characteristics and red flags?
1) General Characteristics: Symmetry and midline orientation.
2) Strong asymmetry with extremities and no attempt to lift head in PTS
By month 4 what characteristics should you see in the baby? What would you not want to see?
1) General Characteristics: Strong symmetry and increased control of flexion and extension.
2) Red Flags: Poor midline and arches body when attempting to roll.
Give what characteristics you should see and the red flags for a 5 month old.
1) General Characteristics: Lat. wt. shift in pring, increasing dissociation.
2) Red Flags: Strong extension in LE or head lag in PTS.
Month 6 should show which characteristics? What would be considered a red flag at this age?
1) General Characteristics: Indep. rolling and sitting, controlled limb movements.
2) Red Flags: Inability to prop sit and elbows in prone
Between months 7 and 9 what characteristics should be present? What is a red flag at this age?
1) General Characteristics: Creeping/crawling, variety of play positions, exploring, NOT happy in supine, transitions sit-> quad and pull-> stand, cruising (lateral walking).
2) Red Flags: Content in supine, cannot sit indep.
Months 10-12 will have what characteristics and red flags?
1) General Characteristics: Lowers from stand, increasing fine motor skills, cruising with one hand and rotation, indep. walking (9-15, usually 12)
Give the two characteristics of the rolling progression for a 0-3 month old.
1) Non-segmental log rolling
2) Neck Righting Reaction (Roll head and body comes in)
How would a 4-5 month old baby progress their ability to roll?
Progress towards segmental rolling
Supine–> Prone
-supine–> sidelying (happy baby but looses balance)
-sidelying–> prone with head righting reaction
Prone to Supine
What are the two stages and substages for rolling at 6 months?
1) Supine –> Sidelying
a. Initiated with Flexion
b. Neck: Neck to side
c. UE are reaching, LE have hips flexed and ADD
2) Sidelying to Prone
a. Neck: Lateral flexion and rotation
b. Trunk: Lateral flexion then extension
c. UE: reach with flexion then WS to free arm
d. LE: Top leg flexes and ABD, then ADD;
bottom leg is extended
How would you find a one month old sitting?
Supported Neck: bobs a lot and not up very often Trunk: Very rounded LE: Frog Leg position Pelvis: Perpendicular to floor Pull to Sit: Significant Head Lag
Name the changes from month 1 to month 2 in sitting.
Still supported
Neck: Has a little more cervical extension
Trunk: Still rounded
Pull to Sit: Head lag, but want to visually fixate on the examiner
How has the baby changed in month 3 of sitting?
1) Still supported
2) Neck: Steady, can keep a steady gaze, and with full support should heave head up
3) Trunk: Shoulders are in front of hips and scapulas are ADD.
4) Pull to Sit: No head lag at the end of movement
What is the next stage of sitting for a 4 month old?
Less Support
Neck: Full flexion/extend control
Trunk: Upright with shoulders a little more over hips
Pull to Sit: No head lag
Give the characteristics for a 5 month old in sitting.
Prop sitting: hands keep them up (hands on floor) Pull to Sit Neck: Chin tuck UE: Pulls against examiner Trunk: Abs activated the whole time LE: Little bit of flexion at the end
At 6 months old how should a baby be sitting?
Independent upright sitting
Ring sitting (feet are together in a ring)
UE free to play, but in high guard
Pull to Sit: Full and anticipated rotation with sitting
What would you expect to see for a 7 month old in sitting?
Steady with all trunk and UE motions
UE: no more high guard with activity
Trunk: Full rotation with protective extension
Transitions: Sit prone via side sitting with some quad
If a baby is 8 months old what would normal sitting be for them?
Stable and upright
Transitions into and out of every position
Equilibrium reaction: Keep body steady in nearly everything
Protective Extension: helps with knocking down by sibling or outside factor ( full and bilateral)
At 9 months old how should a baby be sitting?
Variable positions: Half ring, side sit, long sit, tall kneeling
W sit: causes femoral anteversion (its ok with other sitting)
Transitions: seamlessly and quickly
Fine Motor Skills: Increase because they can sit with stability
A baby sitting at 10+ months would exhibit what?
All righting/equilibrium reactions present and full
Spends lots of time in and out of sitting retrieving toys and transporting them to new location.
The standing progression of a 1 month old would look like what?
Support at trunk
Neck: head bob
LE: Stiff because quads and HS are co contracting
Automatic Step Reflex: Tip the baby and they step
Positive support reaction: same as LE
Physiological Flexion- but increased extension relatively in this position
What would a 2 month old look like standing?
Supported at Trunk
Trunk: Shoulders are anterior to pelvis
Astasia: Lack of WB through LE
Abasia: Lack of automatic stepping reaction
At 3 months old how would a baby stand?
Supported at Trunk
LE: WB a little with lots of hip & knee flexion, supported frog leg
UE: High guard
Plantar grasp Reflex: Curls toes with pressure
What changes would you see from month 3 to month 4 in standing?
Supported at UE
Neck: Full control
Downward protective extension (LE only)
LE: Still frog leg but taking more WB
At 5 months old how would you find a baby standing?
Supported at UE
LE: hips aligned with shoulders with full WB
Pull to Stand: Comes all the way to standing
At 6 months old how does a baby stand?
Supported at UE
LE: Bouncing but poor use of quads eccentrically
7 month old babies stand how?
Pull to stand using UE at couch/bench More UE than LE No half kneeling WS: none or uses hands Poor eccentric use of quads
8 month olds would be seen standing with what characteristics?
Pull to Stand: Emerging half kneel Increased dissociations and WS Emerging cruising- lateral stepping Steppage gait: not a lot of postural control LE: Wide BoS with ER and ABD Trunk: Not much rotation with walking
When a 9 month old is standing what should you see?
Cruises on furniture
Controlled lowering
Still crawling and not walking
At 10 months old what should standing look like?
Full ECC use of quads (lowering independently)
Walks with HHA
Leans belly on table/bench to reach with one hand (this is momentary)
Up on toes/down on heels
Squatting in play
11 month olds should be standing how?
Half kneeling up and down with one hand
Stands alone momentarily
Cruises between surfaces
Independent transition to stand
At 12 months what would you expect to see in standing?
Independent ambulation (9-15 months)
UE: high guard
LE
Swing phase: little DF, knee and hip flexion
Stance phase: full foot hits floor, some triple ext.
Waddling: wide BoS
Quick Leg movements- frequent falls
What types of things would you see with babies older than 12 months?
No new prone, supine, or sitting skills learned
Variability of gross motor skills based on standardized tests, authors, etc.
What gross motor skills would you see for children 12- 15 months?
Assumes tall kneeling Assumes standing without support Stoops for objects while holding on to support Creeps up stairs Walks: stops, starts, and turns
16- 18 month olds should show what gross motor skills?
Walks up stairs non-reciprocally with HHA (hand held assist) or railing
Heel-toe gait, low guard
Runs stiffly
Stands on one foot with help
Manages ride on toy and stand when changes clothes
Carries large toy while walking
** Should not be creeping up stairs, but creeping down them is ok.
