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Typical Childhood Growth & Development: Critical aspects for the Physiotherapist. Robyn Smith Department of Physiotherapy UFS 2012. Objectives for this model:. After this module the learner should be able to: Define term typical development

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Typical childhood growth development critical aspects for the physiotherapist

Typical Childhood Growth & Development: Critical aspects for the Physiotherapist

Robyn Smith

Department of Physiotherapy



Objectives for this model
Objectives for this model:

After this module the learner should be able to:

  • Define term typical development

  • Explain what is meant by the term “development”

  • Identify the goals of gross motor development

  • Recall the characteristics of typical development

  • Identify intrinsic and extrinsic factors that impact on childhood development

  • Explain the basic principles of the well known developmental theories

  • Identify the main areas of development

  • Explain why physiotherapists need to be knowledgeable about normal development

  • Explain the concept of “developmental milestones”

  • Explain the concept of “developmental sequencing”

  • Recall important age related milestones

  • Understand the components and sequence of development of motor control

Controversy around the use of the terms normal versus typical when referring to development


Implies conformity to the human standard range

? What is the standard


Refers more to the specific qualities of a group e.g. humans

More accepted term

Controversy around the use of the terms “normal” versus “typical” when referring to development

What is development
What is “development” ?

  • Process that:

    • begins at conception,

    • and continues throughout life until death

  • Rate of change and growth is greatest in the first 2 years of life

Defining development
Defining development

  • Increase in the complexity of structure andsize. We grow physically in size and stature

  • Increase in the complexityfunction – human activity that becomes more organised and effective as a result of practice

  • Acquisitionand refinement of skills in a specific sequence

Defining development1
Defining development

  • The human’s ability to learn, adapt, and cope with the world largely related to the child’s constant and dynamic interaction with the environment

    normal developmental cascade or developmental sequence

  • Developmental cascade is characterised by milestones

Motor development occurs

in a specific

sequence and timing

Intrinsic and extrinsic factors

impact on the timing of,

and reaching of these milestones

Factors that may impact on a child s development

Intrinsic factors






Medical conditions

Often cannot avoid internal factors

Extrinsic factors

Inadequate bonding or nurturing with mother/caregiver

Opportunities to learn or practice


Environmental risks

Parental and child-rearing practices


Socio-economic factors


Often factors that can be avoided or altered

Factors that may impact on a child’s development

Some interesting facts
Some interesting facts ….

  • The child triples his birth weight in the first year of life

  • Achieves 2/3 of his/her brain size in the 1st 2-3 years

  • Progress from a completely dependent baby to a verbal, independent being by 2-3 years.

What are the requirements for development in a baby
What are the requirements for development in a baby?

  • Stable behavioural and physiological states

  • Be able to interact with the environment

  • Spontaneous movements

  • Gradual development of postural and antigravity control

  • Balanced muscle activity

The goal of gross motor development
The goal of gross motor development?

  • Develop antigravity control, ultimately allowing us as humans to move in an erect posture ….. walk

  • Maintain our center of gravity over our base of support, initially in lower positions such as sitting and ultimately in standing

  • Develop isolated and dissociation of movement

What characterises of typical development
What Characterises of typical development?

The following may be considered important principles of development:

  • Movement is initially more reflexive after birth as maturation occurs becomes more complex andvolitional

  • Movement is initially generalised and becomes more localised

  • Developmental maturation was believed to only develop in a cephalo-caudal direction, but we now know that it develops in both directions at the same time.

  • Development is medial to lateral, trunk and head control develop before shoulder and pelvic girdle and then lastly limb control

What characterises of typical development1
What Characterises of typical development?

  • Gross motor skills develop before fine motor skills

  • Develop flexor muscle tone before extensor muscle tone

  • Development of antigravity extensionbefore antigravity flexion

  • Development is proximal to distal

    Mobility then stability, then mobility with stability and the development of skills

No single theory can explain typical development in its entirety

Many theories contain valuable insights

Many developmental theories


Only going to look at some

of the important ones

Developmental theories
Developmental theories entirety

  • Milestone approach (Illingsworth) –improved postural control dependent on the natural maturation process of the CNS. The order of development is same for all children, rate vary. characterised by milestones

  • Neural maturation theory/ hierarchial(Piaget, Gesell, Bayley)– Emphasis on the changes maturation in the CNS which enables development to proceed. Believed the CNS driving force in development. Emphasised the normal developmental sequence common to all humans. nature

Developmental theories1
Developmental theories entirety

  • Behaviouralappraoch(Pavlov) – conditioning of a response to specific stimuli. By manipulating the environment create a response from an individual (used in our therapy)

  • Dynamic systems theory – CNS only one aspect, and the child’s experience and interaction with his environment (intrinsic and extrinsic factors) are critical to his development.

    No one system is more important than the other. Also sees the CVS, musculoskeletal and peripheral nervous system as important systems.

    Functional outcomes are the reason human’s perform tasks.


Developmental theories2
Developmental theories entirety

  • Latest and most widely accepted current theory on development

  • NB √ Neuronal group selection theory

  • Suggests that the infant has an inherent capacity for self generated activity, specific motor behaviourrepertoires,

  • which are then refined by experience enabling the child to choose the most effective motor plan for the task at hand

Developmental theories3
Developmental theories entirety

Theory also recognises the importance of:

  • opportunity for experience

  • Environment extrinsic

  • trial and error practice

  • varied practice

  • interactive nature of all aspects of motor

    control including sensory, cognitive and intrinsic


    behavioral (personality)

    biomechanical aspects

  • Ability to learn and adapt to acquire new skills

Main areas of development
Main areas of development: entirety

There are4 main areas of developmentthat need to be assessed

  • Gross motor

  • Fine motor

  • Speech and language

  • Socialization/ behaviour

  • As physiotherapists our focus is on gross motor development

  • Have to now basics of other areas of development to be able to interpret information/ refer

Why must physiotherapists be knowledgeable regarding normal development
Why must physiotherapists be knowledgeable regarding normal development?

  • Provides a foundationfor understanding typical and therefore atypical development

  • Serves as the basis for our developmental/ neurological assessment


    Monitor a child’s developmental progression or regression

    Interpret developmental findings

  • Aids us in identifying delays and/ or abnormalities in development as the earliest possible point in time

Why must physiotherapists be knowledgeable regarding normal development1

Aids us in development?planning and executing our treatment of children, but also adults with motor delays or disturbances

NB !!!! developmental sequencing

By being knowledgeable about the developmental sequence we can identify the limitingcomponents and focus on them in treatment to aid the developmental sequence.

Why must physiotherapists be knowledgeable regarding normal development?


Milestones development?

What are developmental milestones
What are developmental milestones? development?

  • Defined by Illingworth in his milestone theory as

    • Set of functional skills or age-specific tasks

    • that most children can do at a certain age range

  • Milestone = standardfor skill acquisition

  • Defines the child’s “developmental age”

  • NB norms are based for children of full gestational age

  • Although each milestone has an age level, every child is unique, and the impact of intrinsic and extrinsic factors may vary Therefore it is accepted that standard deviation/variation of one month on either side is allowed

So where do i get information on childhood milestones
So where do I get information on childhood milestones? development?

  • Many different milestone guidelines in table and picture format

  • Internet – huge source of information regarding milestones available

  • Peabody infant development charts

Developmental screening tests
Developmental Screening tests development?

Objective & quantifiable = gives a score

  • Bayley scales III

  • Denver II

  • NDS

  • AIMS

  • Bruininks-Oseretsky test of motor proficiency

  • MABC

  • START programme: checklists – not quantifiable

Milestones importance to know by heart

Head control in supine (PTS) and in prone development?

Ventral suspension



4 point kneeling /crawling


Pull to stand










Starts 6/12 arm support /well 8/12

Start 7/12 well 9/12

FWB 6/12 –holding on 10/12



12-18/12 even 24/12 in cases





Milestones importance: to know by heart

Milestones vs developmental sequence
Milestones vs. developmental sequence development?

  • Both are important components to consider when assessing and treating children with developmental concerns

  • Developmental sequence refers to the typical pattern or development of the components of movement & timing thereof

  • Need to understand the components and the sequencing of the components in the developmental sequence

  • Whilst when looking at milestones your are assessing the skills or tasks a child has achieved for his age

References: development?

  • Images courtesy of GOOGLE (2009)

  • Growth and Development. In Coovadia, H.M. & Wittenberg, D.F. (eds) in Paediatrics and Child Health. A manual for health professionals in developing countries. 4th ed. Oxford city Press: Cape Town pp 21-40

  • Van derVyver, A.E. Normal Growth in Paeditric doctors lectures for Physiotherapy students. (Unpublished)

  • Goldson, E. & Reynolds, A. Child development and Behaviour Hay, W.W.; Myron, J. L.; Sondheimer, J.M. & Deterding, R.R. (eds). In current diagnosis and treatment in Paediatrics. 18th ed. McGraw-Hill companies: NewYork pp65-101

  • Aubert, E.J. Motor development in the normal child in Pediatric Physical Therapy. Tecklin, J.S. (Eds) in Pediatric Physical Therapy. Lippincott, Williams & Wilkins. Baltimore pp17 -65

  • Smith, R. 2009. Paediatric dictate, UFS (Unpublished).

  • Smith, R. 2009. Normal development (Unpublished)

  • Mosby Medical dictionary