Pediatrics foundational

Developmental milestones

Developmental milestones are skills or behaviors performed by most children at a certain aga. These milestones are used to track growth and development.

Below you will find a list of developmental milestones to be achieved by children strategies by age in which they should occur:

• 2 months
  • Holds head up in prone to 45 degrees
  • Does not accept weight on lower extremities
  • No head control during support sitting
• 4 months
  • Rolls prone to side, supine to side
  • Head control demonstrated in supported sitting
  • Ulnar-palmar grasp
  • No head lag when pull up to sit
• 6 months
  • Rolls supine to prone
  • Independent sitting
  • Prone on extended arms and weight shifting with extended arms
• 8-9 months
  • Creeping
  • Pull to stand via kneeling with furniture
  • Can stand independently for 1-2 seconds
  • Able to transfer objects between hands
  • Independent with side-sitting
• 10-15 months
  • Independently walking
  • Creeps up/down steps
  • Transfer floor to standing
• 20 months
  • Ascends stairs with step to pattern
  • Uncoordinated running pattern
  • Able to jump from 2 inch step independently
• 24 months
  • Ascend steps with foot over foot pattern
  • Uncoordinated running at increased speed

Primitive reflexes

Primitive reflexes are involuntary motor responses to a newborn’s environment that originate in the brainstem and function to aid in survival. Each reflex will have a time in which it appears and then a time in which it is no longer present (age of integration).

See primitive reflexes below:

• Rooting
  • Define: stroking to cheek to allow for locating bottle nipple or breast for consuming milk
  • Age appears: birth
  • Age integrates: 3-4 months
• Moro
  • Define: protective reflex activated by sympathetic nervous system that occurs when loud noise startles infant
    • Arms and legs extend with fanned out fingers
    • Head extends
    • Infant cries
    • Infant quickly pulls arms/legs back into midline position
  • Age appears: birth
  • Age integrates: 2-4 months
• Palmar grasp
  • Define: grasping of object when placed in palm
  • Age appears: birth
  • Age integrates: 5-6 months
• Asymmetrical tonic reflex
  • Define: aids infant in developing muscle tone, hand-eye coordination, and motor skills
    • Infant turns head; face side arm causes arm/leg extend; while scalp side arm/leg flex
  • Age appears: birth
  • Age integrates: 6 months
• Spinal galant
  • Define: stroking to laterally to spinal column causes lateral flexing to the ipsilateral side
  • Age appears: birth
  • Age integrates: 3-9 months
• Tonic labyrinth
  • Define: aids infant in learning how to control head and neck
    • Neck flexion causes arm/legs to flex
    • Neck extension causes arms/legs to extension
  • Age appears: in utero
  • Age integrates: 3 ½ years
• Symmetrical tonic neck reflex
  • Define: aids infant in learning how to control upper and lower body independently
    • Infant head moves forward; arms flex and legs extend
    • Infant head moves backward: arms extend and legs flex
  • Age appears: 6-9 months
  • Age integrates: 9-11 months
• Landau
  • Define: aids infant in motor control and coordination
    • Infant held horizontally in air with their head and back extends with arch in back
  • Age appears: 4-5 months
  • Age integrates: 12 months
• Babinski
  • Define: involuntary movement that occurs when foot is stroked
    • Lateral edge of foot is stroked causing extension of the toes and fanning of the toes
  • Age appears: birth
  • Age integrates: 2 years
• Flexor withdrawal
  • Define: protective reflex that occurs when a sharp pressure is applied to sole of foot or palm of hand causing withdrawal of stimulated extremity
  • Age appears: birth
  • Age integrates: present throughout life
• Crossed extension
  • Define: protective reflex that occurs when a sharp pressure is applied to sole of foot or palm of hand causing withdrawal of stimulated extremity and extension of unaffected limb
  • Age appears: birth
  • Age integrates: present throughout life
• Primary standing
  • Define: Infant when placed in standing position will support some weight and extend lower extremities
  • Age appears: birth
  • Age integrates: 2 months
• Primary walking
  • Define: protective reflex that occurs when a sharp pressure is applied to sole of foot and trunk tilted forward causes reciprocal stepping
  • Age appears: birth
  • Age integrates: 2 months
• Plantar grasp
  • Define: pressure to sole of feet or lower foot causes toes to curl
  • Age appears: birth
  • Age integrates: 9 months

Newborn considerations

The normal gestational period is 40 weeks. Infants born prior to this time have an increased risk of developing congenital anomalies and developmental delays.

Infants are assessed at birth, minute 1 , minute 5, and minute 10 after birth via the APGAR scale. The APGAR scale assesses appearance (color), pulse, grimace (reflex irritability), activity, and respirations. Each is scored with a 0, 1, or 2 with the goal of score being between 7-10. At every assessment, the expectation is that the score will go up. If scores decline below 7, this indicates pathology present and possible complications.

Examination of the newborn also includes assessment of the musculoskeletal system, range of motion, posture, primitive reflexes as appropriate, and tone. Any abnormalities noted will be rationale for performing specific outcome measures for assessment.

Outcome measures

• Albert infant scale
  • Define: gross motor skills assessment tool used to evaluate weight-bearing, posture, and antigravity movements in infants
  • Age for use of scale: 0-18 months
• Peabody development motor scale
  • Define: assesses gross and fine motor development to include spontaneous, elicited reflexes, and automatic reactions used for primarily for developmental delay
    • More sensitive to change then Bayley scales of infant development
  • Age for use of scale: 0-42 months
• Gross motor function measure - 88 (GMFM-88)
  • Measures gross motor function in cerebral palsy population
    • Focuses on voluntary movement in five phases- prone and supine, sitting, crawling and kneeling, standing, walking, and jumping
  • Age of use of scale: 0-5 years
• Bruininks-Oseretsky test of motor proficiency (BOT-2)
  • Developed to measure gross and fine motor for individuals with developmental delay
  • Age of use of scale: 4-21 years
• Bayley scales of infant development
  • Developed to measure motor and mental scales for children with developmental delay
    • Assesses 5 domains: cognitive, language, motor, social-emotional, adaptive
  • Age of use of scale: birth - 42 months
• Functional independence measure for children (WeeFIM)
  • Assess function in self-care, mobility, locomotion, and social cognition in children status- post acute injury (such as spinal cord injury, traumatic brain injury, multiple fractures, etc)
  • Age of use of scale: 3-8 years