Below you will find a list of developmental milestones to be achieved by children, milestones by age at which they should occur:
2 months
Holds head up in prone to 45 degrees
Does not accept weight on the 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 pulling 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
Transfers floor to standing
20 months
Ascends steps with step-to-step pattern while holding unilateral rail or hand
Uncoordinated running pattern
Able to jump from a 2-inch step independently
24 months
Ascends steps with step-to-step pattern independently without holding unilateral rail or hand
Uncoordinated running at increased speed
Primitive reflexes
See primitive reflexes below:
Rooting
Define: stroking the cheek to allow for locating the bottle nipple or breast for consuming milk
Age appears: birth
Age integrates: 3-4 months
Moro
Define: protective reflex activated by the sympathetic nervous system that occurs when a loud noise startles an 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 an object when placed in the 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 to extend; while scalp-side arm/leg flexes
Age appears: birth
Age integrates: 6 months
Spinal galant
Define: stroking laterally to the spinal column causes lateral flexing to the ipsilateral side
Age appears: birth
Age integrates: 3-9 months
Tonic labyrinth
Define: aids the infant in learning how to control the head and neck
Neck flexion causes arms/legs to flex
Neck extension causes arms/legs to extend
Age appears: in utero
Age integrates: 3 ½ years
Symmetrical tonic neck reflex
Define: aids the infant in learning how to control the 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 the air with their head and back extended with an arch in the back
Age appears: 4-5 months
Age integrates: 12 months
Babinski
Define: involuntary movement that occurs when the foot is stroked
The lateral edge of the 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 the sole or the palm, causing withdrawal of the stimulated extremity
Age appears: birth
Age integrates: present throughout life
Crossed extension
Define: protective reflex that occurs when a sharp pressure is applied to the sole or the palm, causing withdrawal of the stimulated extremity and extension of the unaffected limb
Age appears: birth
Age integrates: present throughout life
Primary standing
Define: An infant, when placed in a standing position, will support some weight and extend lower extremities
Age appears: birth
Age integrates: 2 months
Primary walking
Define: A protective reflex that occurs when a sharp pressure is applied to the foot, and the trunk is tilted forward, causing reciprocal stepping
Age appears: birth
Age integrates: 2 months
Plantar grasp
Define: pressure on the sole or lower foot causes the 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 the 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 the 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 primarily for developmental delay
More sensitive to change than the 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 the 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 skills 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)
Assesses 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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