peds: development Flashcards
grasp patterns.. when do these occur?
raking
pincer grasp
raking begins at 6 months - thumb curled against index finger
pincer grasp at 8-12 months - pad of thumb & pad of index finger
4 quarters of development (cephalocaudal direction)
first quarter: head control in all positions
second quarter: arms & upper trunk control
third quarter: lower trunk & pelvic control
fourth quarter: mobility & control of lower legs & upright postural control
when does hand preference come in?
starts around 2, established btwn 3 &4.
if it comes in before that, indicates motor impairment
moro reflex aka starts/ ends caused by... how to test & what happens
aka startle reflex
starts in utero by 28-32 weeks, integrates by 4-5 months
caused by loud noises, change in light or body position (hyperextension of neck)
to test: put neck in hyperextension they cry => abduction & extension of UE with palms up (trying to grab something)
followed by aDduction & flexion of UE and relxation
reasons moro reflex doesn’t integrate by 4-5 months
if it persists… (3)
it normally diminishes with head control, poor neck stability prolongs it
if persists:
- can throw baby off balance in upright positions
- excessive extensor tone develops
- associated with CP
absences of moro reflex on one side can suggest (3)
absence of moro reflex bilaterally can suggest
absences of moro reflex on one side can suggest
- fx of clavicle or humerus
- brachial plexus injury (BPI)
- hemiplegia
absence of moro reflex bilaterally can suggest damage to brain or spinal cord
rooting reflex
what it is
what absence can indicate
- tactile stimulation to cheek rotates head and opens mouth
absences seen in neurologically impaired infants
sucking reflex begins & fully develops by... integrates by how to stimulate what it helps (2) how to test
begins around 32wks of gestation, fully developed at 36 weeks (so immature babies may have weak sucking reflex)
integrated by 2-5 months
to elicit response, stimulate roof of mouth
helps develop oral musculatures
sucking promotes flexion
test by removing bottle, if its easy, baby doesnt have strong suck
palmar grasp reflex
elicited & fully developed by…
asymmetrical response caused by (2)
no response =
elicited at 28 weeks, integrated around 6 months when baby can voluntarily release
asymmetrical response from:
BPI
humeral fx
no response = severe neurological deficit
plantar grasp reflex
begins and integrated by…
what it is
begins at 28 week of gestation & integrates when baby walks
when u apply firm pressure to base of toes, they flex
babinski
normal response in babies
when does it disappear
great toe DF and toes fan out
disappears btwn 12m -2 years
after 2 = UMN lesion
step or walk reflex
onset & integration
response
how to elicit
onset at 37 weeks of gestation, integration at 2 months
support infant upright with feet touching surface and incline infant forward to accompany stepping,
baby will alternate rhythmic and coordinated steps (walking on toes and scissoring is normal)
ATNR
seen from…
what it is
seen from 2-4 months
turn head to one side => extension, occiput side gets flexed
tonic labyrinthine
what it is
if it extends to______ suggests____
supine => extensor tone
if it lasts 12-24 months it indicates limited motor control and decreased possibility of walking
neck righting on body
begins and integration
test & normal response
begins at 34 weeks of gestation & integrates btwn 4-6 months
test baby in supine, head midline and turn head to one side. entire body turns to that side
body righting on body
test
rotate infants hips and log rolling occurs to re-align body
landau reflex
onset & integration
test & normal response
onset at 3-4 months, integrates 12-24 months
testing: infant prone, place hands under chest and stomach. baby should extend head then trunk, hips and legs into full extension (superman)
STNR
onset
test
active from 4-7 months
flex neck => flexed uppers & extended lowers
parachute
appears…
test
last to develop*
appears from 6-9 months. face baby face down and arms extend as if trying to catch himself.
this lasts throughout life
physiological flexion
occurs in utero during last trimester, so premies don’t do this
after birth occurs in all positions the first month
promotes calming
swaddling benefits (5)
- promotes physiological flexion
- self calming by hand to mouth sucking
- increased proprioception & kinesthetic stimulation
- increases midline orientation
- helps infants sleep better in supine
summary of first month (4)
- more extended (less physiological flexion)
- proximal tightness in shoulders & hips decreasing to allow aB, ER & extension
- in prone- can lift and turn head to either side
- follows with eyes to midline*
summary of second month (5)
- visual tracking past midline*
- continues to extend (gravity continues to elongate flexors)
- asymmetrical head & extremities predominates
- which means asymmetrical WB in prone on elbows
- bilateral symmetrical kicking * can’t dissociate yet* (this is important because if its not symmetrical its spasticity)
summary of third month (6)
- symmetry and midline orientation dominate (baby can keep head in midline)
- in supine baby can turn head side to side or maintain in midline
- in prone can lift head 45-90 degrees
- accidental rolling
- frog-legged
- unsupported sitting => falling forward (but head righting occurs and extends hands)
indications of possible disturbances in motor development by 3 months (2)
- inability to assume & maintain head in midline (can’t break ATNR)
- inability to WB on forearms
which 3 reflexes emerge during infancy
STNR
Landau
parachute
which develops first?
medial or lateral?
extensor or flexor antigravity?
WB on flexed or extended extremities?
medial before lateral
3 ulnar finger grasp > thumb and index grasp
extensor (lift head in prone at 4 m) > flexor (5 m)
prone on elbows > prone on extended arms
order of movement by plane
saggital -> frontal -> transverse
order to teach new skill/ movement
- assume (or place baby)
- maintain
- rock
- reach
how long does a baby need each day to spend in tummy time?
81 minutes
3-5 month developmental milestones (2)
3-5 months:
- hand to midline
- prone on elbows
4-6 month developmental milestones (10)
4-6 months
- prone unilateral reaching
- prone extended arms
- pivot prone
- segmental rolling prone -> supine
- supine head lifting
- supine bridging
- supine hands -> knees
- supine hands -> feet
- supine feet -> mouth
- propped sitting
5-7 month developmental milestones (2)
5-7 months
- unsupported ring sitting
- segmental rolling supine -> prone
6-10 month developmental milestones
6-10 months
assumes sitting independently
7-9 months developmental milestones (2)
7-9 months
- independent sitting
- quadruped
9-11 month developmental milestones (2)
- crawling/ creeping
2. cruising sideways
10-12 month developmental milestones (4)
- bear walking
- pull to stand
- pull to stand & lower
- walks with both hands held
11-13 month developmental milestone
11-14 month
11-15 month
11-13 months
pull -> stand via 1/2 kneel
11-14 months
stand alone
11-15 months
walk alone
5 clinical signs or red flags for ASD
- no babbling by 12 months
- no back and forth gestures such as pointing, showing, reaching by 12 months
- no words by 16 months
- no 2 word meaningful phrases by 24 months
- any LOSS of speech, babbling or social skills at any age*
