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Gross Motor Milestones 2 – 5 Years

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  1. Gross Motor Milestones2 – 5 Years Group 1

  2. Gross Motor Milestones2 – 5 Years During the Second Year: • Jumps in place with both feet • Jumps down from a bottom step • Kicks a large ball forward • Tosses a large and small ball • Develops a consistent heel strike in gait • True running emerges with a non-support phase, stops are difficult requiring a large turn area

  3. Gross Motor Milestones2 – 5 Years During the Second Year: • Stands on one foot 1-3 seconds • Catches a large ball using arms and body • Walks on tiptoes • Walks backwards • Goes up and down stairs independently using a rail • Pushes a riding toy with feet while steering

  4. Gross Motor Milestones2 – 5 Years Gait Pattern Matures During the Third Year: • Narrower BOS • Feet closer together • Heel toe progression • Shoulders in neutral • Elbows extended • Hips and knees extended • Reciprocating arm swing

  5. Gross Motor Milestones2 – 5 Years Gait Pattern Matures During the Third Year: • Pelvic rotation • Out-toeing reduced • Consistent heel strike and knee flexion present in early stance. • Walking velocity for height is consistent with that of an adult. • Cadence decreases, velocity increases • Step length and stride length increase • Balance mechanisms when walking continue to be refined as single leg stance balance is immature.


  6. Gross Motor Milestones2 – 5 Years During the Third Year: • Goes up steps alternating feet w/o rail • Goes down steps marking time w/o rail • Climbs up and down slide independently • Makes sharp turns while running • Pedals a tricycle

  7. Gross Motor Milestones2 – 5 Years During the Third Year: • Catches ball with outstretched arms • Balances on toes in standing • Stands with one foot in front of the other • Stands on one foot up to 5 seconds • Hops on one foot 1-3 times

  8. Gross Motor Milestones2 – 5 Years During the Fourth Year: • Gallops • Goes down stairs without w/o a rail alternating feet • Stands on one foot 8 seconds • Catches smaller balls • Rides 3-wheeled toys • Catches bounced ball most of the time

  9. Gross Motor Milestones2 – 5 Years During the Fifth Year: • Skips • Stands on one foot 10 seconds • Runs on tiptoes • Long jumps • Interested in performing dance steps • Capable of learning complex body coordination skills like swimming, roller skating, and riding bicycles • Overhand throwing accomplished

  10. Balance • Steady State • Body morphology of child = top heavy = more sway. COM = T 12 instead of L5-S1. • Study 2-14 y.o. amplitude of sway and variation of sway decrease with increasing age • Adult values at 9-12 with eyes open and 12-15 with eyes closed.

  11. Balance cont. • Dynamic • Anticipatory • 9 mo-activation of postural muscles of trunk in most reaching movements while sitting. • 12-15 mo-postural muscles of trunk activate before reaching in standing. • Postural reactions seen before step initiation with as little as 1-4 mo of walking experience. • 4-6 years, anticipatory reactions essentially mature. • Between 1-4 yo, shift from “enbloc” to “articulated” mode of anticipatory balance

  12. Balance cont • Head and Trunk Stability • Until 6 yo - “en bloc” mode - head moves with trunk, reactive balance organized from feet up using proprioceptive and cutaneous clues • By 7 yo - “articulated” mode - head moves freely, reactive balance organized top down using vision and vestibular info. • Reactive • Study 15 mo - 10 yo showed younger children to have increased coactivation and slower, longer, and more variable responses to a moveable platform. Mature responses by 7-10 years.

  13. Balance cont. • Activation of monosynaptic stretch reflex until 2.5 yo when reduces and gone by 4 yo • 4-6 yo responses slower and more variable. Theory due to dimensional growth changes but more likely due to developmental changes in nervous system itself. • Independent steps do not translate into stepping strategy. Begins with 1- 3 mos walking experience and is refined after 6 mos experience.

  14. Balance cont. • Proactive • Has been suggested that children acquire feedback control of balance before feed forward control • Very little research • Run, Gallop, Hop, Skip • develop in order, each requiring additional strength and balance. • These milestones have been said to be better indicators of balance development than chronological age.

  15. Fine Motor/Self Help Milestones 2-5 years Group 1

  16. Fine Motor Manipulation Milestones2 – 5 Years By 2 years of age: • Uses a mature pincer grasp to hold tiny objects • Uses radial palmar grasp to pick up a 1” cube • Pronated finger grasp on cylindrical objects • Able to point isolating the index finger • Beginning in-hand manipulation (finger to palm) • Controlled release of objects (inserts large puzzle pieces, stacks 3-5 blocks) • Scribbles when given a crayon • Uses both hands to hold and carry objects, clap hands together • Can stabilize with one hand and manipulate with the other • Able to turn pages of a book

  17. Self Help Milestones2 – 5 Years By two years of age: Dressing • Dresses/undresses self in simple clothing with assistance e.g. finds arm hole, doffs socks, shoes, hat, holds leg out to assist with putting pants on, helps doff pants Toileting • Indicates need to go to the bathroom • Indicates when wet/soiled Bathing/Grooming • Enjoys bath time but may resist grooming tasks Feeding • Uses spoon with minimal spillage and drinks from a sippy cup • Begins to drink from small cup without lid

  18. Fine Motor Manipulation Milestones2 – 5 Years By 3 years of age: • In hand manipulation develops (palm to finger translation) • Controlled release with shoulder, elbow, and wrist stability • Stacks 4-7 1” blocks • Opens simple containers with lids • Winds wind-up toys • Can string large beads • Copy a simple line and circle • Colors large forms • Snips with scissors

  19. Self Help Milestones2 – 5 Years By three years of age: Dressing • Independent doffing clothing items • Dons front opening shirt/coat, needs assistance to don pullover clothing • Unfastens large buttons and zippers Toileting • Assistance for clothing management and hygiene • Daytime control, night time requires diapers Bathing/Grooming • Participates in washing self but not independent • Washes hands at sink with supervision and cues • Assists with but often resists grooming Feeding Able to self-feed independently

  20. Fine Motor Manipulation Milestones2 – 5 Years By four years of age: • In hand manipulation improves rapidly (moves small objects efficiently with one hand, can hold small objects in palm and move objects with fingers-translation with stabilization) • Able to manipulate large buttons • Mature tripod or quadropod grasp on a pencil (clear hand preference) • Cuts out large shapes with scissors • Colors in the lines • Copies simple shapes • Stacks tower of 9-10 blocks • Draws tadpole images of people

  21. Self Help Milestones2 – 5 Years • By four years of age: Dressing: • Independently undresses • Occasional cues for clothing orientation for pull over clothing • Dons shoes and socks independently • Manipulates zippers independently after set-up (zipper is engaged), able to fasten large buttons Toileting: • Day and night time control • Assist may be needed for appropriate hygiene and to manage fasteners Bathing/Grooming: • Supervision in the bathtub, needs assist to wash hair • Independently washes hands/face at the sink • Assists with grooming tasks (tooth brushing, nose wiping, brushing hair) Feeding: • Able to use a fork independently, • Arranges items on table correctly

  22. Fine Motor Manipulation Milestones2 – 5 Years By five years of age: • Hand dominance is usually established • Draws a person with 6 parts • Can print their name, copy some numbers, and simple words

  23. Self Help Milestones2 – 5 Years • By age five: Dressing: • Assistance with clothing selection, belts, back zippers • Learns to tie shoelaces (between ages 5-6) Toileting: • Complete independence Bathing/Grooming: • Set-up and supervision for bathing (for safety) Feeding: • Manages soup with a spoon • Can drink from an open cup without spilling

  24. Speech/LanguageDevelopmental Milestones Group 1

  25. Speech and Language Milestones2-5 years • By the age of 2: • Points to a few body parts when asked • Follows simple commands and understands simple questions (ex. “Roll the ball,” “Kiss the baby,” “Where is your shoe?”) • Listens to simple stories, songs, and rhymes • Points to pictures in a book when named • Says more words every month • Uses some one- or two- word questions (ex. “Where’s kitty?” “Go bye-bye?”)

  26. Speech and Language Milestones2-5 years • By 2 years of age (cont): • Puts two words together (ex. “more cookie”, “no juice”, “mommy book”) • Uses many different consonant sounds at the beginning of words.

  27. Speech and Language Milestones2-5 years • By 3 years of age: • Understands differences in meaning • Ex. “go-stop”, “in-on”, “big-little”, “up-down” • Follows two requests • Ex. “Get the book and put it on the table.” • Listens to and enjoys hearing stories for longer periods of time. • Has a word for almost everything • Uses 2- or 3- words to talk about and ask for things.

  28. Speech and Language Milestones2-5 years • By 3 years of age (cont): • Uses /k, g, f, t, d, and n/ sounds. • Speech is understood by familiar listeners most of the time. • Often asks for or directs attention to objects by naming them.

  29. Speech and Language Milestones2-5 years • By 4 years of age: • Hears you when you call from another room • Hears television or radio at the same loudness as other family members • Answers simple “who?”, “what?”, “where?”, and “why?” questions • Talks about activities at school or at friends’ homes • People outside of the family usually understand the child’s speech

  30. Speech and Language Milestones2-5 years • By 4 years of age (cont): • Uses a lot of sentences that have 4 or more words • Usually talks easily without repeating syllables or words

  31. Speech and Language Milestones2-5 years • By 5 years of age: • Pays attention to a short story and answers simple questions about it • Hears and understands most of what is said at home and in school • Makes voice sounds clear like other children’s • Uses sentences that give lots of details (ex. “I like to read my books.”) • Tells stories and are able to stay on topic

  32. Speech and Language Milestones2-5 years • By the age of 5 years (cont): • Communicates easily with other children and adults • Says most sounds correctly (except perhaps certain ones such as /l, s, r, v, z, ch, sh, th/) • Uses the same grammar as the rest of the family Reference: http://www.asha.org/public/speech/development/language speech.htm

  33. Social and Emotional Milestones2-5 years • By the end of 2 years: • Imitates behavior of others, especially adults and older children • Is more aware of self as separate from others • Is more excited about the company of other children • Demonstrates increasing independence • Begins to show defiant behavior

  34. Social and Emotional Milestones2-5 years • By the end of 2 years (cont): • Separation anxiety increases toward midyear then fades

  35. Social and Emotional Milestones2-5 years • By the end of 3 years: • Imitates adults and playmates • Spontaneously shows affection for familiar playmates • Can take turns in games • Understands the concept of “mine” and “his/hers” • Expresses affection openly • Expresses a wide range of emotions

  36. Social and Emotional Milestones2-5 years • By the end of 3 years (cont): • Separates easily from parents • Objects to major changes in routine

  37. Social and Emotional Milestones2-5 years • By the end of 4 years: • Interested in new experiences • Cooperates with other children • Plays “Mom” or “Dad” • Increasingly inventive in fantasy play • Dresses and undresses • Negotiates solutions to conflicts • More independent

  38. Social and Emotional Milestones2-5 years • By the end of 4 years (cont): • Imagines that many unfamiliar images may be “monsters” • Views self as a whole person involving body, mind, and feelings • Often cannot tell the difference between fantasy and reality

  39. Social and Emotional Milestones2-5 years • By the end of 5 years: • Wants to please friends • Wants to be like his/her friends • More likely to agree to rules • Likes to sing, dance, and act • Shows more independence and may even visit a next-door neighbor by self • Aware of gender • Able to distinguish fantasy from reality

  40. Social and Emotional Milestones2-5 years • By the end of 5 years: • Sometimes demanding, sometimes eagerly cooperative

  41. Typical Developmental Skills2 – 5 year olds References

  42. References • Ames LB, Gillespie S, Haines AB & Ilg FL. The Gesell Institute’sChild from One to Six: Evaluating the Behavior of the PreschoolChild. New York: Harper & Row; 1979. • Aubert EJ. Motor Development in the Normal Child. In: Tecklin JS. Pediatric Physical Therapy. 4th ed. Baltimore, MD: Lippincott Williams & Williams; 2008:63. • Berk LE. Development Through the Lifespan. 2nd ed. Boston: Alyn and Bacon; 2000. • Berger KS. The Developing Person: Through the Life Span. New York: Worth Publishers; 1998. • Campbell SK. The Child’s Development of Functional Movement. In: Campbell SK, Vander Linden DW, Palisano RJ. Physical Therapy for Children. Philadelphia, PA: Saunders;1995:3-37.

  43. References • Campbell SK. The Child’s Development of Functional Movement. In: Campbell SK, Vander Linden DW, Palisano RJ. Physical Therapy for Children. 3rd ed. St. Louis, Missouri: Saunders/Elsvier; 2006:33-76. • Case-Smith J. Occupational Therapy for Children. 4th ed. St. Louis: Mosby; 2001. • Cech DJ and Martin S. Motor Development and Motor Control. In: Functional Movement Development Acrossthe Life Span. 2nd ed. Philadelphia, PA: Saunders; 2002:77-79. • Centers for Disease Control and Prevention: Learn the Signs. Act Early. Available at: www.cdc.gov/actearly. Accessed on 05/10/09. • Davis MA. Infant Growth and Development. Available at: http://www.medical-library.org/journals/. Accessed on: 09/10/00.

  44. References • Eisenberg A, Hathaway SE, & Murkoff HE. What to Expect: The First Year. New York: Workman Publishing; 1989. • Eisenberg A, Hathaway SE, & Murkoff HE. What toExpect: The Toddler Years. New York: Workman Publishing; 1994. • Feldman RS. Development Across the Lifespan. New Jersey: Prentice Hall, Upper Saddle River; 1997. • Hannan J. et al. The Development of Complexity within the Vocabularies of Late Talkers, Children with Hearing Loss, and Typically Developing Children. Ohio: Bowling Green State University; 2008.

  45. References • Landsdown R & Walker M. Your Child’s Development. New York: Alfred A. Knopf, Inc; 1991. • Margolin E. Young Children, Their Curriculumand Learning Processes. New York: Macmillan Publishing Co., Inc.; 1976. • Mulligan S. Occupational Therapy Evaluation for Children. A Pocket Guide. Philadelphia, PA: Lippincott, Williams & Wilkins; 2003. • Mussen P. The Psychological Development ofthe Child. 3rd ed. Englewood Cliffs, NJ: Prentice Hall, Inc.; 1979. • Noller K and Ingrisano D. Cross-Sectional Study of Gross and Fine Motor Development: Birth to 6 Years of Age. Physical Therapy. 1984;64(3):308-313.

  46. References • Oeseterreich L. (1995). National Network for Childcare. Ages & Stages – Two-Year-Olds. Available at: http://www.nncc.org/Child.Dev/ages.stages.2y.html. Accessed on: 04/19/09. • Oeseterreich L. (1995). National Network for Childcare. Ages & Stages – Three-Year-Olds. Available at: http://www.nncc.org/Child.Dev/ages.stages.3y.html. Accessed on: 04/19/09. • Oeseterreich L. (1995). National Network for Childcare. Ages & Stages – Four-Year-Olds. Available at: http://www.nncc.org/Child.Dev/ages.stages.4y.html. Accessed on: 04/19/09. • Oeseterreich L. (1995). National Network for Childcare. Ages & Stages – Five-Year-Olds. Available at: http://www.nncc.org/Child.Dev/ages.stages.5y.html. Accessed on: 04/27/09.

  47. References • Powell ML. Assessment and Management of DevelopmentalChanges and Problems in Children. 2nd ed. St. Louis: C.V. Mosby Company; 1981. • Ryckbost L & Brackenberry T. Phonological and lexical influences on vocabulary development predicting the ages at which individual words are acquired. Poster presentation at the Symposium on Research in Child Language Disorders, Madison, WI. 2006 June. • Salkind N. Child Development. 6th ed. Fort Worth: Holt Rinehart & Winston, Inc.; 1990. • Shelov SP. Ed. Caring for Your Baby and Young Child. The American Academy of Pediatrics. New York: Bantam Books; 1993. • Shelov SP. Ed. The Complete and Authoritative Guide Caring For Your Baby andYoung Child Birth to Age 5. The American Academy of Pediatrics. New York: Bantam Books; 2005:302-388.

  48. References • Short-DeGraff MA. Human Development for Occupational and Physical Therapists. Baltimore: Williams & Wilkins; 1998. • Stout JL. Gait: Development and Analysis. In: Campbell SK, Vander Linden DW, Palisano RJ. Physical Therapy for Children. 3rd ed. St. Louis, Missouri: Saunders/Elsvier; 2006:161-190. • Shumway-Cook A and Woollacott M. Motor Control Theory andPractical Applications. 2nd ed. Baltimore: Lippincott, Williams & Wilkins; 2001. • Storkel HL. Do children acquire dense neighborhoods? An investigation of similarity neighborhoods in lexical acquisition. Applied Psycholinguistics. 2004;25:201-222. • Storkel HL & Morrisett ML. The lexicon and phonology: Interactions in language acquisition. Language, Speech, and Hearing in Schools. 2002;33:24-37.

  49. References • Tecklin JS. Pediatric Physical Therapy. 3rd ed. Baltimore: Lippincott, Williams & Wilkins; 1999:22-25. • University of Kentucky Medical Center. Milestones. Available at: www.uky.edu/med/depts/. Accessed on: 09/19/00. • Zero to Three: National Center for Infants, Toddlers and Families. Zero to Three: Young Explorers. Available at: http://zerotothree.org. Accessed on: 09/22/00.