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
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
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
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
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