OCTA 231 (Pediatrics Exam 1) Flashcards
period of development from conception to the moment at which the neonate can survive on its own without placental nutrients
Gestation and birth
period of development from birth to 18 mths
Infancy
period of development from 18 mths through 5 yrs
Early Childhood
period of development from 6 yrs until the onset of puberty (12 girls, 14 boys)
Middle Childhood
period of development from puberty until the onset of adulthood (21 yrs)
Adolescence
What are the general principles of development?
- Development is sequential & predictable
- Combination of: CNS Maturation,environment, movement and engagement in activities, and experience affect development
- Development involves changes in the biologic, physiological, and social systems
- Development occurs in two directions: horizontal & vertical
- Development progresses in order in 3 basic sequences. 1. Cephalad to Caudal(Top to Bottom) 2. Proximal to Distal 3. Gross to Fine Motor skills
skills involved in moving and interacting with objects or the environment and include posture, mobility, coordination, strength, effort, and energy.
Motor Skills
automatic responses to stimuli that helps the newborn adapt to the environment
Primitive reflexes
a reflex that allows the baby to open the mouth and turn head in the direction of touch
Rooting reflex
a reflex that allows the baby to close mouth, suck, and swallow
Sucking/swallowing reflex
a reflex that allows the baby’s arms to extend and hands; then the arms flex and hands close; infant usually cries (responding to loss of support)
Moro’s reflex
a reflex that allows the baby’s fingers to flex
Palmar grasp
a reflex that allows the baby’s toes to grasp (flexion)
Plantar grasp
a reflex that allows the baby’s arm and leg on face side extend; arm and leg on skull side to flex (or experience increased flexor tone)
ATNR (Asymmetric tonic neck reflex)
postural responses to changes of head and body positions, brings the head and trunk back into upright position (movements called- extension, flexion, abduction,etc)
Righting reactions
automatic response to external changes. Requires corrective action of body(compensatory movements)that keep the body upright and vertical against gravity. (rotational and diagonal ).
Equilibrium reactions
postural reactions that are used to stop a fall or to prevent injury when equilibrium reactions fail to do so
Protective extension responses
What two types of movements start at 6 mths and continues throughout life?
Righting reactions
Protective extension responses
Skills that require body movement which involve the large(core stabilizing) muscles of the body to perform everyday functions
Gross Motor Skills
Examples of gross motor skills:
Standing Walking Running Sitting upright Eye hand coordination (throwing, catching, kicking)
Newborn Gross Motor:
- Flexion in all positions
- Prone/supine “top heavy”
Able to scrap face across mat to clear airway - Neck righting
- MORO
- Gross movements
- See grasp, suck/swallow, startle & rooting reflexes
1 Month Gross Motor:
- Extensor muscles begin to become facilitated
- Reduction of flexion
- Clearance of face from mat surface
- Elongated (stretched out)
- UE still adducted, flexed but less retracted
- Decrease in primitive reflexes (sucking, rooting, grasp)
2 Months Gross Motor:
- Lower muscle tone (flexion decrease/extension increase)
- Weight shifted to middle abdomen
- With pull to sit see infant attempt to help
- Elicitation of ATNR
- Beginning of eye hand movement
- Lifts head in prone to 45 degree angle (weight bearing)
- Elbows coming just behind shoulders, out from adduction and less flexed
- More Time In Supine
3 Months Gross Motor:
- Less ATNR
- Much more symmetrical in supine
- Arms comes to midline (mouth, abdomen)
- Arms taking more weight in prone
- Head up at 60-90 degree
- Weight in prone moving into pelvis area
4 Months Gross Motor:
- Neck flexors and extensors are coming in
- Neck elongation with beginning chin tuck
- Lots of hand to hand play in supine
- Lots of mouthing in supine of toy
- Hip flexion so getting to elongation of back extensors & more of a pelvic tilt
- In pull to sit baby hold head in alignment and assists
- Not able to sit independently
5 Months Gross Motor:
- Lateral weight shift
- Equilibrium reactions in prone
- Extended weight bearing; reach on elbows
- Asymmetry in side lying
- Rolling prone to supine
- Anterior tilt
- May sit leaning forward at hips
6 Months Gross Motor:
- Good head control in all positions
- UE protective extension
- Roll supine to prone initiated with flexion
- Independently sitting LE’s positional stability
- Bears weight on LE’s in standing
- Discover they have thumbs
- Rake and get Spoon Grasp
7 Months Gross Motor:
- Equilibrium-prone to supine starting to sit
- Increased trunk control
- Prone-preferred position pivot, belly crawl
- Prone to 4 point or on hands/feet rocking
- 4 point sit
- Trunk rotation in sitting
- May pull to standing using UE’s
8 Months Gross Motor:
- Equilibrium reax in sitting; starting 4 point
- Good sideways protective extension
- Sitting most functional position
- More hip adduction and knee extension
- Kneeling and kneel to stand
- Relies more on lower extremities to stand
- Cruises sideways- abduction & adduction LE
- Stoppage gait when walking with hands held
9 Months Gross Motor:
- Use trunk control in sitting to develop finer hand manipulation skills
- Backwards protective extension
- Various LE positions (W sitting)
- Kneel with act hip extension
- Knee; to stand through half kneel
- Cruises semiturned
- Cannot lower self to floor
10 Months Gross Motor:
- May see more primitive gross motor skills/sitting to allow for finer manipulation
- Unilateral activity (mirroring-imitation)
- Increased kneeling, half kneeling, cruising in direction going
- Lowers self from standing
- Better gait pattern with support: more primitive gait when support is reduced
- Getting Superior Pinch
11 Months Gross Motor:
- Various sitting positions
- Uses trunk rotation well
- Lots of movement transitions
- Play in half kneeling
- Stands through active LE extension (kneel to half kneel to squat to stand)
- Lowers self asymmetrically
- When cruising, reaches for furniture
- May stand alone,: high guard position, may fall
12 Months Gross Motor:
Righting and equilibrium reflex
well integrated in all positions except standing
* Rising using LE’s
* Weight shift while standing
* Moves quickly during initial walking
* As trunk control increases no longer need scapular retraction
* Arms hang at side and eventually swing
2 years Gross Motor:
- Refinement in walking
- Walks sideways and backwards
- Lots of motor planning, uneven surfaces
- Gets up to stand from middle of floor
- Increased hip stability- squatting in play, stoops and recovers, kicking
development of anti-gravity movement
Mobility
development of muscle contraction at proximal joints
Stability
Newborn Fine Motor:
- Lots of physiological flexion
- UE adducted and flexed with fisting of hands
- Grasp reflex is predominate
- Moves both arms randomly and in total flexion or extension
- Beginning to look at things
1 Month Fine Motor:
- Moving arms in/out of flexion
- Thumbs in/out of palms
- Hands fisted at rest
- Involuntary grasp and release
- No attempt to reach
- Regards adult face
2 Months Fine Motor
- See emergence of ATNR, increased asymmetry of UE
- Eyes make visual contact with one hand which is extended on the face side
- Less flexion and more abduction and external rotation in supine
- Overall still alot of flexion
- Prone-no-neck, elbows behind shoulders, weight on forearms and ulna side of hands
3 Months Fine Motor:
- Most interaction with the environment is via visual inspection
- Infant use grasp reflex to grasp
- If released it is random and caused by movement of arms not intent
3-4 Months Fine Motor:
- Increases midline orientation of head
- Less physiological flexion, Increase extension
- Hands coming together over belly
- Fingers loosely flexed
- Grasp reflex dropping out
- Elbows moving under shoulders in prone, weight on forearms, hands loosely fisted, increased head control in prone
4 Months Fine Motor:
- Prone desirable play position
- good head control in midline in prone
- Elbows under shoulders with increased weight on elbows not forearms
- Flex to get hand to mouth in prone (Toy)
- Hands open with weight on palms of hands
- In supine see lots of hand to hand play, hand to mouth play and visual inspection of hands
5 Months Fine Motor:
- Lots of prone play on flexed & extended UE
- Can grasp toys & get to mouth when on elbows
- May reach for toy and manipulation on extended elbows
*
5 Months Fine Motor (Supine):
- With the increase in neck & scapular stability get increase elbow stability
- See weight on wrist & radial palmar sides of hands in prone
- Elbows forward of shoulders
5 Months Fine Motor (Prone):
- Lots of symmetry
- Lots of hand to mouth play & toys in mouth
- Lots of hand to knee play & maybe feet play
- Lots of elbow extension
- Grasping & beginning transfer by pulling object out of holding hand into other hand
- Using a palmar and ulnar grasp
6 Months Fine Motor (Supine/Prone):
- Still play in prone & be up on elbows & fully extended arms with weight on palms & radial side of hand
- Can get toys & transfer but moving out of prone into sit to be more functional with play
- Not spending alot of time playing in supine
- In supine with the beginning of transferring you have emerging bilateral integration skills
6 Months Fine Motor (Sit):
- Better independent sitter so better position to play with more mature hand skills
- Early sitter hand skills decline to more immature patterns at first
- Better in sit see improved hand skills
- Using more of a radial palmar grasp
- Transfer starting w/o pull but placement into other hand
7 Months Fine Motor:
- Play in various positions (sit, sidelying, prone)
- Using radial digital grasp
- Thumb coming from adducted to abducted to opposed position
- See beginning of controlled release (does not need to wipe, throw, or pull to get object out of hand)
8 Months Fine Motor:
- Transitional movements and plays in alot of different positions
- Increased rotation, diagonal movements, weight shifting which leads to increasing disassociation of movements, joints, fingers, extremities from one another
- Begin to preposition fingers to grasp medium size object
- Uses radial digital & sometimes inferior
- With small objects still rakes to obtain
8-9 Months Fine Motor:
- See more prepositioning of fingers to grasp (adjusts to object size)
- Radial digital grasp with wrist extended
- Lots of releasing of objects
9-11 Months Fine Motor:
- See more opposition of thumb & more use of inferior pincer grasp
- See more refinement of release with slight wrist extension & rotation of forearm (raisin in jar)
- Decrease use of ulnar fingers
- Poking with index finger
- Bilateral integration skill
12 Months Fine Motor:
- Emerging superior pincer grasp
- Use of supination with forearm
- Use of wrist extension
- Can release objects with control of shoulder, elbow and wrist
- Works on releasing skills (stacking blocks)
12 Months Fine Motor:
- Infant has sufficient fine motor control to combine objects and explore their functional use
12-15 Months Fine Motor:
- Demonstrates increasing control of intrinsic muscles so can now pick up & hold precisely flat objects
- More refinement of bilateral skills
17-18 Months Fine Motor:
- Starts to use one hand to stabilize while other manipulates- NOT handedness yet
18 Months- 3 years
- Child develops use of disk, cylinder, spherical, lateral grasps
- Increasing control with power grasp
- Increasing control with release to enable ball throwing
- Increasing use of simultaneous manipulation by both hands
Newborn Oral Motor:
- Large tongue fills oral cavity
- Fat pads
- Suck-swallow reflex- lips are touched & infant opens mouth & starts to suck
- Rooting reflex- stroke cheek & infant turns head towards stimulus
- Gag reflex- strong in first 3 mths
- Phasic bite reflex- S gums & infant makes up/down movements with jaw
1 Month Oral Motor:
- Still have physiological flexion (helps strengthen suck)
- Still have sucking, rooting & gag reflex
- Tongue does not protrude through gums anymore
- Mouth & tongue function as a unit
- Nose breather
- still use suck reflex with bottle
Two Months Oral Motor:
- Rooting dropping out so you see infant voluntarily open mouth for bottle upon visual S
- With increased controlled flexion and chin tuck you see suckling look better
4 Months Oral Motor:
- Increase hands to mouth & toys to mouth you see decrease in gag reflex
- See increase jaw stability so now pattern of suckling returns returns to suck with only movement of tongue (up/down tongue movement)
- With better sucking skills often see collapse of nipple
- Begins coo
- Hands to mouth also facilitate increased jaw stability
5 Months Oral Motor:
- With improved flexion & extension & head control see improved jaw stability
- Spoon Spoon feeding starts & infant opens mouth for spoon but does not grade mouth movements nor clear lips
- Uses suck pattern to clear
- Phasic bite gone
6 Months Oral Motor:
- Increased oral play see tongue start to lateralize
- Lips coming in for spoon & cup but then resorts to biting
- Cheeks becoming more active drawing inward
- Lots of teething
- Increase drooling
7-9 Months Oral Motor:
- Tongue laterally shifting
- Jaw begins to laterally shift
- Diagonal jaw movement when eating
- Upper lip clears spoon
- Beginning munching
- Cup drinking (one sip at a time, lose lot from corners)
10-12 Months Oral Motor:
- Licks food off lower lip
- Rotary chewing (moving food side to side)
- Can take 4-5 sips from a cup, don’t lose a lot from corners)
15-18 Months Oral Motor:
- Now takes chopped foods
2 Years Oral Motor:
- Adult eating patterns established
- Cheeks assist with tongue in gathering food into bolus & placing on molars to chew
- Mature rotary chewing skills (up/down,
- Can eat any adult foods
- Effective cup drinker
3 Years Oral Motor:
- Drinking through a straw and serving self
Progression of Food Texture for most Children:
- Liquid
- Strained
- Junior
- Mashed/Chopped fine
- Regular
A reflex when the S gums and infant makes up/down movements with the jaw
Phasic bite reflex
Jaw movements are up/down, tongue retraction in and out (tongue shows extension- forward movement)
Munching
Why work/consider families
families have the most significant environmental influence on a young child’s life and development
A code of ethics that refers to the benefit of services to consumers, which may include clients, families, and community
Beneficence
A code of ethics that refers to not imposing harm on clients
Nonmaleficence
A code of ethics that refer to the rights and privacy of clients
Autonomy
A code of ethics that refers to providing fair sand equitable OT services to all clients
Justice
A code of ethics that refer to honesty in all professional matters
Veracity
A code of ethics that refers to respect, fairness, discretion, and integrity
Fidelity
Family life cycle
Birth, Marriage, Leaving Home, Death
a pleasurable, self initiated activity that the child can control
Play
one’s disposition to play
Playfulness
Development of walking:
crawling, creeping, kneeling, half kneel, stand, cruise
Child needs developmental balance of what 2 things?
Flexion and Extension is key!
What type of movement occurs during Righting Reactions?
Weight shifting occurs every movement requires weight shift and stimulate righting reactions to take place.
