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Normal Developmental Milestones

Normal Developmental Milestones. An emphasis on anticipatory guidance Ana Malinow, MD. Why we should teach parents about development. Parents who understand their child’s developmental state, are more likely to have appropriate expectations.

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Normal Developmental Milestones

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  1. Normal Developmental Milestones An emphasis on anticipatory guidance Ana Malinow, MD

  2. Why we should teach parents about development Parents who understand their child’s developmental state, are more likely to have appropriate expectations. Having appropriate expectations makes for a healthier relationship between parent and child. Healthier relationships facilitate development.

  3. Objectives • Principles of development • Primitive Reflexes • “Locomotion”: Gross Motor • “Manipulation”: Fine Motor • “Cognitive”: Language and Social • Behavior and Personality

  4. Principles of Development • A continuous process • Sequence of development is the same, rate of development varies • Not parallel • Related to CNS maturation • Involuntary movements give way to voluntary responses • Occurs in cephalocaudal and proximal to distal • Progresses from dependence to independence

  5. Development Occurs in a Cephalocaudal Direction

  6. Development begins in utero Age Responses/Reflexes 8 ½ wks tactile stimuli (reflex arc laid down) 12 wks sucking 24 wks sound 26 wks rhythmic breathing movements/ controls body temperature 30 wks pupilary light reflex 35 wks grasp/spontaneous orientation to light

  7. All primitive reflexes develop during gestation and disappear by the 3rd to 6th month after birth

  8. Primitive reflexes • Tonic labyrinthine reflex • Asymmetric tonic neck reflex • Positive support reflex

  9. Declining intensity of primitive reflexes and increasing role of definitive motor actions

  10. Gross motor development“Locomotion”

  11. Locomotion begins with head control

  12. Assessing Locomotion • Ventral suspension NB-3m • Sitting position NB-8m • Prone position NB-9m • Standing/Forw. Walking 9m-18m • Running/Backw. Walking 2 yrs • Balancing 3 yrs +

  13. Ventral suspension

  14. Head control

  15. 2 month head control

  16. 4 month head, arm control

  17. 6 month head, arm, trunk control

  18. 8 month head, arm, trunk, leg control

  19. 9 month pulls up to stand

  20. 12 month old locomotion

  21. 2 year old Running Backward Walking

  22. 3 year old Balance

  23. “Manipulation”Fine Motor Development

  24. Manipulation: Assessing the pincer grasp from 0-6m • NB primitive • 1m primitive • 2m starting to lose • 3m voluntary on ulnar • 4m hands together • 5m palmar grasp • 6m hand-mouth-hand; hand-to-hand

  25. Manipulation: Assessing the pincer grasp 7-12 m • 7m thenar side, raking • 8m 1 block in each hand • 9m radial-digital grasp; inferior pincer • 10m index finger isolation • 12m fine pincer • >12m letting go, stacking

  26. “Cognition” Social Development Problem solving Play Causality Language Development

  27. Assessing cognitive developmentProblem solving • NB visual exploration • 4-6wks smiles, fixes, follows • 2m imitates mouth movements • 3m anticipates feeds • 5m object permanence • 6m looks to floor when toy dropped • 7m grabs 2nd cube, drops first • 8m seeks object after fall (silent) • 9m uncovers hidden object under cloth • 10m isolates index finger

  28. Assessing cognitive developmentPlay Age Play stage Piagetian stage <12m sensory-motor sensory-motor 12m-18m functional sensory-motor 18m-24m symbolic sensory-motor 2-5y imaginary/magical pre-operational 6y logical thinking concrete operation 11y + hypothetical formal operational

  29. 12-month 18-monthFunctional Play

  30. 18-month 24-monthSymbolic Play

  31. 2-5 yearImaginary/Magical Play

  32. 6 year oldLogical Thinking

  33. 11 years +Hypothetical thinking

  34. Assessing cognitive developmentCausality Age Cause Effect Early cries mom comes Early smiles mom responds 4m kicks crib mobile moves 8m pulls string gets ring 10m funny +response/repeats 24m winds key toy moves

  35. Conversational speech probably starts with smiling

  36. 2 month old language

  37. Assessing cognitive development: Language Age Milestone 4-6wks smiles 2m vocalizes with vowels 3m vocalizes with consonants 4m squeals 6m syllables 7m non-specific combinations 8m imitates sounds, understands “no” 12m 1-3 words

  38. Assessing language Age Expressive Receptive Jargon Sentence L. Intelligible 12m 1-3 100 Y none 18m 10-25 ID body Y giant words holophrases 2y 50 Pts. Body N 2 words 25-50% 3y 500 Prepositions N 3-4 words 75% 4y 5 def. Comparisons N 4-5 words 100% 5y 7 def. N 100% 6y masters rules of grammar

  39. Behavior • One-way or two-way interactions • Prenatal factors • Bonding/attachment • CNS maturation • Match • Schedule • Language • Instincts

  40. Behavior-continued- • Cognitive, gross and fine motor development • Illness, separation, feeding issues • Birth order, family size • Secondary attachments • Environment • Gender identification

  41. Bonding

  42. Personality • Factors that influence behavior • Create behavior • Through adaptability and flexibility • Produce personality/social behavior

  43. Newborn “Personality”

  44. 4 month old “Personality”

  45. 9-month old“Personality”

  46. Other “Personality”Landmarks • 2-year old independence/dependence • 3-year old master of impulse control, sharing, wants to please, guilt • 7-year old ability to see another’s point of view • Adolescence begins identity formation (idealistic) • Adulthood completion of identity formation

  47. Conclusion • Development is a continuous process • Sequence is always the same, rate varies • Development does not run parallel • Intimate relationship with CNS • Generalized activity gives way to voluntary activity • Cephalocaudal development • Dependence to independence

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