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DEVELOPMENTAL MILE STONES

NORMAL DEVELOPMENT :

Child’s development from birth onwards occurs in 4 main areas

A.GROSS MOTOR
B.FINE MOTOR & VISION

C.SOCIAL,BEHAVIOUR,EMOTIONAL

D.SPEECH ,LANGUAGE,& HEARING.

A.GROSS MOTOR :

Ø NEW BORN: Limbs flexed symmetrical postures.


Marked head lack on pulling up.
Ø 6-8 WEEKS : Raises head to 45 degrees
Ø 6-8 MONTHS : Sits with out support ,
a.AT 6 MONTHS : with round back
b. AT 8 MONTHS : with straight back.
Ø 8-9 MONTHS : Crawling
Ø 10 MONTHS : Walks around furniture ,
Ø 12 MONTHS : Walks unsteadily ,broad gait ,hands apart .
Ø 15 MONTHS : Walks alone steadily .

B.FINE MOTOR & VISION :

Ø FOLLOWS FACE :
NEW BORN :-Follows face in midline
AT 6 WEEKS : Follows moving objects
Ø REACHES :
AT 4 MONTHS : Reaches out for toys.
Ø TRANSFERS :
AT 6 MONTHS :-Transfers toys from one hand to another .
Ø PALMAR GRASP :
AT 6 MONTHS: Palmar grasp.
Ø PINCER GRIP :
AT 10 MONTHS :-Mature pincer grip .
Ø SCRIBBLES :
AT 14 MONTHS : Scribbles with pencil .
Ø PENCIL SKILLS :
CIRCLE -3 YRS , CROSS -4 YRS ,SQUARE -4 ½ yrs .TRIANGLE -5 YRS .
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Ø HAND SKILLS – BUILDING WITH BRICKS –


TOWER OF THREE ; 18 MONTHS ,
TOWER OF SIX -2 YRS,
TOWER OF EIGHT OR A TRAIN WITH FOUR BRICKS -2 ½ YRS,
BRIDGE (from a model)- 3 YRS ,
STEPS (After demonstration ) 4 YRS .

C.SPEECH ,LANGUAGE, HEARING :

Ø NEW BORN : STARTLES TO LOUD SOUND .


Ø 3 MONTHS ;Vocalises alone or when spoken to coos and laughs .
Ø 7 MONTHS :Turns to soft sounds out of sight .
Ø 7-10 MONTHS : Sounds used indiscriminately .
At 10 months sounds used discriminately to mothers .
Ø 12 MONTHS ; Two to three words other than dada /mama .
Ø 18 MONTHS :10 Words & shows 4 parts of the body .
Ø 20-24 MONTHS :Uses two or more words to make simple phrases .
Ø 2 ½ YRS -3YRS :Talks constantly in 3-4 word sentences .

D.SOCIAL ,EMOTIONAL,& BEHAVIOUR

Ø 6 WEEKS : Smiles responsibily


Ø 8 MONTHS :Puts food in mouth
Ø 10 MONTHS : Waves bye bye ,plays peek a boo
Ø 12 MONTHS : Drinks from a cup
Ø 18 MONTHS : Holds a spoon & gets food safely to mouth.,symbolic play .
Ø 2 YEARS : Dry by day .
Ø 3 YEARS : Interactive play .Takes turns .

NEONATAL REFLEXES

Ø Reflexes are involuntary movements or actions. Some movements are spontaneous,


occurring as part of the baby's usual activity. Others are responses to certain actions.
Ø Reflexes help identify normal brain and nerve activity. Some reflexes occur only in
specific periods of development. The following are some of the normal reflexes seen in
newborn babies:
Ø In neonates we see primitive reflexes,each of these reflexes are governed at a specic level
CNS.
Ø The age of appearance and disappearance is more or less fixed.
Ø As the motor development progresses the centres at higher level in the nervuous system
dominate the lower level reflexes.
Ø Dissappearence of reflexes doesn’t mean that the reflexes are destroyed but these are
inhibited by stronger reflexes at a higher level in nervous system .
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THE NEONATAL REFLXES ARE DEVIDED IN TO 4 GROUPS


1.PRIMITIVE REFLEXES

2.SPINAL LEVEL REFLEXES

3.BRAIN-STEM REFLEXES

4.MID-BRAIN REFLEXES

PRIMITIVE/SPINAL REFLEXES STIMULUS RESPONSE


1.Flexor withdrawl Noxious stimulus to sole of foot Toes extend,foot
tested in supine/sitting position dorsiflexes,entire leg flexes
uncontrollably.
Onset;28 wks of gestation.
Integrated;1-2mths

2.Extensor thrust One leg in extension & other Uncontrolled extension of same
fully flexed ,apply pressure on leg
the ball of foot of the flexed leg

3.Crossed extension Noxious stimulus to ball of foot Opposite lower extremity


of extremity fixed in flexes,then adducts &extends.
extension;tested in supine lying Onset;28wks of gestation
Integrated;1-2 mths

4.Traction Grasp forearm & pull up from Grasp & total flexion of upper
supine into sitting position extremity
Onset;28wks of gestation
Integration;2-5 mths

5.Mororeflex Sudden change in position of Ext ,Ab,of upper


head in relation to trunk; drop extremities,hand
patient backwards from sitting opening,&crying followed by
position. flex,Ad of arms across chest.
Onset;28wks of gestation
Integrated;5-6mths

6.Rooting reflex Light touch around lips Turning of head,lower lip &
tongue on the side of stimuli
onset :birth integrated :3-4
months

7.Startle Sudden loud/harsh noice Sudden extension/abduction of


arms,crying.
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Onset ;birth
Integrated;persists

8.Grasp reflex Maintained pressure to palm of Flexion of fingers & toes.


hand(palmar grasp),/to ball of Onset;palmar-birth,plantar-
foot under toes(pantar grasp) 28wks of gestation.
Integrated;
palmar-4-6 mths.
Plantar-9 mths

9.Sucking reflex Place a finger on baby’s lips Sucking movements of lips


Onset –birth
Integrated -3-4 months

10.Placing reflexes
a. Placing of upper extremity Brush the dorsum of one of the Flexion of arm & placement of
pt’s hands against under the hand on to table top.
edge of table top . Onset –birh
Integrated -6months
b. Placing of lower extremity Brush the dorsum of the pt’s Flexion of lower limb ,&
foot against under the edge of placement of foot on table top.
table . Onset –birth
Disappear -1 ½ months .

MORO REFLEX ATNR SPINAL GALANT REFLEX


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BRAIN STEM REFLEXES

TONIC/BRAINSTEM REFLEX STIMULUS RESPONSE


1.ATNR-Asymmetric tonic neck Rotation of head to one side. Flex of skull limbs,extension of
reflex jaw limbs,”bow &
arrow”/fencing posture
Onset;birth
Integrated;4-6 mths

2.STNR-Symmetric tonic neck Flexion/extention of head With head flexion:flexion of


reflex arms,extension of leg;
With head extension: extension
of arms,flexion of legs
Onset;4-6 mths
Integrated;8-12 mths.

3.TLR/STLR-Symmetrical tonic Prone /supine position With prone :increased flexor


labyrinthine reflex tone/flexion of all limbs;
With supine: increased
tone/extension of all limbs.
Onset;birth
Integrated;6mths

4.Positve supporting Contact to the ball of the foot in Rigid extension of the lower
upright standing position extremities(co-contraction) of
the lower extremities
Onset;by birth
Integrated;6mths.

5.Associated reactions Resisted voluntary movt in any Involuntary movement in resting


part of the body extremity
Onset;birth-3mths
Integrated;8-9 yrs

MID BRAIN REFLEXES

MIDBRAIN /CORTICAL STIMULUS RESPONSE


REFLEXES
1.Neck righting action on the Passively turn head to one side . Body rotates as a whole(log rolls)
body(NOB) to align the body with head.
Onset ;4-6 mths
Integrated;5yrs

2.Body righting acting on the Passively rotate upper /lower Body segment not rotated
body(BOB) trunk segment ;tested in supine. follows to align the body
segments
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Onset;4-6 mths
Integrated;5yrs
3.Labyrinthine head righting(LR) Occlude vision;alter body
position by tipping body in all Head oriented to vertical
directions position with mouth horizontal
Onset;birth-2yrs
Integrated;persists
4.Optical righting Same above
Same above
5.Body righting acting on Place in prone or supine
head(BOH) Same
Integrated;5yrs

6.Protective extension Displace centre of gravity


outside the base of support Arms /legs extend &abduct to
support & to protect the body
against falling
Onset;arms:4-6 mths,
7.Equilibrium reactions – Displace the centre of gravity by legs;6-9mths integrated persists
tilting(ER) tilting/moving the support curature of trunk towards the
surface upward side along with ext,&ab
of extremities on that
side,protective extension on the
opposite side(down ward)
onset; prone-6mths,supine;7-
8mths,sitting;7-8
mths,quadripod;9-12
mths,standing 12-21 mths.
Integrated; persists
8.Equilibriulm reactions-postural Applying a displacing force to the
fixation body,altering the cog in relation Curvature of the trunk toward
to the base of support ,can also the extr force with extn &ab of
be observed during voluntary extremities on the side to which
activity the force was applied
Onset; prone: 6 mths,supine:7-8
mths,sitting:7-8
mths,quadripod:9-
12mths,standing:12-21 mths.
Integrated: persists.
9.Parachute reflex Push the body to the side &
(Baby is held in prone sufficient surprise force that he Extension of all 4 limbs
suspension at pelvis) belives his head will contact Onset –birth .
supporting surface . Integrated –life long .