Name : Nuramalina Yahaya (10-5-257)

DEVELOPMENT
What is development?
It means maturation of organs and system, acquisition of functions and new skills
and ability to adaptation and assuming responsibilities.
FACTORS AFFECTING NORMAL DEVELOPMENT
1. Neurological: Nervous system have important role in normal development
of other systems in the body
2. Endocrinal factor: as growth hormone and thyroid hormone helps in
development of brain maturation.
3. Skeletal and muscular: bone works together with muscles to maintain
body position and control precise movement in gross and motor
development.
4. Environmental and socioeconomic: overcrowding, low income of parents
may affect the nutritional aspect of the child and quality of childcare.
5. Nutritional factors: Good nutrition of mother during pregnancy and
lactation also nutrition of the infant is important as to prevent from any
malnutrition. Malnutrition will give bad influence for the infant's growth
and development.
6. Biological factors :
- Gender ; most probably boy have lower level of school readiness
- General health; child born with low weight, with inadequate medication
and prenatal care of the mother may give bad influence in
development.
7. Physical activity as bed ridden and hypoactive child may not grow
normally

ASSESSMENT OF DEVELOPMENT
Development is continuing process from conception to maturity which involves
THREE processes:
1. Loss of primitive reflex in certain age such as Moro reflex disappears at 5
to 6 months, palmar grasp reflex disappears by 3 to 4 months and plantar
grasp reflex disappears 6 to 8 months.
2. Acquisition of postural reaction. Failure to develop postural reactions may
indicate failure of CNS maturation
3. Acquisition of new skills in the developmental milestones
There are four fields in assessment of development which are:
1. Gross motor (locomotion) including the posture and ability to control large
body movement

2. Fine motor (sensori-motor or manipulative): coordination of hand and

eyes, using fingers for grasping and manipulating objects
3. Personal-social (adaptive): social reaction with surrounding and ability to
adapt with environment
4. Language (language): ability to communicate verbally and non-verbally

Milestones of gross motor development:

Age
(month
s)
1

Gross motor skill

Turns from side lying to back by turning head

Brings hand to mouth when on back and when lying on side
Lifts head and turns to sides when on tummy

Holds head in midline when on back

Lifts head and upper trunk while placing weight on forearms 3
seconds when on tummy
Glances at toy that is placed in hand when on back
Holds hands open or loosely closed when on back
Brings hand together (midline) when lying on back (supine)
Able to see with downward gaze when on back or supported sitting
(chin tucking

Rolls from back to side

Holds head steady and erect in supported position (head control is
completed)
Plays while on side
Reaches with both hands to toy
Brings rattle to mouth with both hands when on back

Brings feet to hands and holds for 3 seconds when on back

Begins to roll from tummy to back
Extends both arms fully when on tummy

Rolls from tummy to back purposefully

Rolls from back to tummy purposefully
Sits alone 5-10 seconds while placing hands forward on surface to
support self
Pushes entire chest off surface with extended arms and open hands
in prone
Reaches with 1 hand for toy while on extended arm when on tummy
Brings feet to mouth when on back
Catches self forward by extending arms forward and opening hands
in sitting when losing balance

Turns head from cheek to cheek when on tummy

Lifts head momentarily when on tummy
Lifts head (bobbing) when held in vertical at shoulder
Kicks legs rhythmically 2-3 cycles when on back
Looks at faces and objects

Raises to hands and knees position and rocks

Creeps on hands and knees 5 feet using alternating arm and leg
movement
Transitions from hands and knees position by turning via side-sitting
to sitting on bottom
Pivots on bottom when sitting using arms or legs
Sits steadily and unsupported for more than 1 minute
Catches self to side by extending arm to side with open hand in
sitting when losing balance
Stands while holding on to furniture with wide base of support

12

Pulls to standing at furniture by leading with 1 leg

Lowers self to sitting on floor from standing at furniture without
falling
Stands alone 3-5 seconds
Walks with 1 hand held 4 steps
Walks along furniture (cruising)
Catches self-backwards by extending arm in backward direction
with open hand when losing balance
Flings tennis ball by straightening shoulder or elbow when standing
Rolls ball forward in sitting by using hand or arm contact

15

Stands alone well

Creeps up stairs 3 steps
Transfers to standing by pushing through hands and feet
Stoops to pick up toy from floor and return to standing without
losing balance
Able to change direction while walking without losing balance

18

21

Squats to play
Walks up stairs with 1 hand on rail using step-to gait (placing both
feet on 1 step)
Walks down stairs with 1 hand held using step- to gait (placing both
feet on 1 step) Kicks ball forward 3 feet without falling
Throws tennis ball overhead 3 feet while standing
Moves on ride-on toy without pedals

24

Runs without falling

Walks up stairs 3 steps using step-to gait (placing both feet on 1
step) without holding on
Walks down stairs 3 steps with 1 hand on rail using step-to gait
(placing both feet on 1 step)

Climbs in adult chair and turns around to sit

Seats self in small chair
Pushes and pulls large toys around the room
Carries large toy while walking without losing balance
Steps on or kicks into ball in attempt to imitate kicking ball
Walks backwards 5 steps while pulling toy on string

 Throws tennis ball underhand 3ft while standing

Throws tennis ball 3-5 feet in direction of target
Jumps up 2 inches from floor with both feet
30

Imitates one foot standing 1 second

Walks on tiptoes 5 steps and maintains balance
Throws tennis ball overhead 7 feet by moving arm upward and
back
Jumps down 8-10 inches with both feet without losing balance

There is normal variation between individual. The ages mentioned in the table
are average of the child but may have early or some delay in acquisition of new
motor skills.
There are also sex differences as girls usually have early development as a whole
from boys

DELAYED MOTOR
DEVELOPMENT
Definition: Developmental delay is when an infant does not progress as
expected in achievement of specific milestones.
Developmental delay is expected to develop if there is one of the following:
1. Global developmental delay: delay in acquisition of new skills more than
one field
2. Specific developmental delay: developmental delay in one specific skill.
3. Suspected perceptual defect
4. Presence of risk factors during prenatal, perinatal or postnatal duration.
Dyspraxia difficulty in planning and carrying out skill, unfamiliar motor action in
the correct sequence.
Developmental Disabilities deficits related to cognitive and physical
development (mental retardation, Downs syndrome, cerebral palsy, autism,
Fragile X, etc.)
Sensory processing challenges difficulty processing, modulating, and adapting
to information from the environment (sounds, sights, movement, touch, smell).

CAUSES OF DELAYED GROSS MOTOR DEVELOPMENT:

1. Familial: Some delay may happen according in variation of every individual
and sex differences.
2. Genetic;

Trisomy 21 appears physical phenotype of Down syndrome as mental

retardation, hypotonia and other abnormalities of delay the development.

3. Skeletal disorder;

Rickets: Vitamin D deficiency will lead to decrease absorption of calcium

which manifest as hypotonia of muscles and laxity of ligament. The
children may have bow legs and knock knees lead to delay sitting,
standing and walking.

Achondroplasia is a short-limbed dwarfism particularly has short stature

with short upper arms and thighs that limiting the range of movement.

4. Nutritional disorder

Severe protein malnutrition is chronic deficiency of energy in infants

maybe due to inability to obtain the necessary food for maintenance of
health or sequences of other primary diseases. PEM either marasmus or
kwashiorkor usually having muscle wasting which is hypotonic, weak and
unable to stand or walk. The child is hypoactive and lack interest in
surrounding.

5. Systemic disorder;

Congenital heart disease has poor systemic blood flow that lead to
retarded growth and easily fatigue infant.

6. Perceptual disorder; blindness may interfere the normal pattern of gross

motor development.
7. Environmental factors; emotional deprivation or lack of stimulation due to
over protective parents.
8. CNS disorder;
Cerebral palsy is non progressive, permanent impairment of
neuromuscular system leading to motor disorder of movement, posture
and coordination. The causes may be due to lesion in the brain. CP may
manifests as paralysis of the limbs (hemiplegia or quadriplegia) that
prevent movement of the limbs and will delay gross motor development of
the child.

Mental handicap which have limitation in many adaptive skills and

intellectual function.

9. Muscular disorder; any diseases that lead to myopathies and muscle

dystrophy also delay the normal gross motor development f the child.
10.Metabolism;

Phenylketonuria is the most common amino acid disorders which manifest

at the end of first year as severe mental handicap. Later on, the child
becomes hyperactive with purposeless movement, rocking and athetosis.

The child also having growth retardation that may affect the gross motor
development of the child.
11.Endocrinal;
Cretinism (hypothyroidism) child usually are sluggish physically and
mentally. The child is passive and lies quietly with little interest in
surrounding also with delayed developmental milestones, stunted height
with long trunk and short legs.

REFERENCES:
1. Madkour Essentials of Pediatrics (Paediatrics, Members of the Department
of Paediatrics Faculty Of Medicine- University Of Alexandria 12th Edition.
2.

http://www.beststart.org/OnTrack_English/2-factors.html

3.

http://www.brookshealth.org/motor-skills.pdf

4.

http://education-portal.com/academy/lesson/what-are-gross-motor-skills-in-children-development-definitionexamples.html#lesson

5.

http://www.abilitypath.org/milestone-concerns/signs-of-possible-delays-gross-motor-and-sensory-development.html

6.

http://www.healthline.com/symptom/developmental-delay

7.

http://www.growingup.ie/fileadmin/user_upload/Conference_2010/Session_D_Factors_Affecting_Gross_Motor_Devel
opment_Outcomes.pdf