SEQUENCES OF DEVELOPMENT:

The First Trimester of Development

M Tshabalala
DEVELOPMENT OF LOCOMOTION:
VENTRAL SUSPENSION

A Newborn held in prone position with the hand under the abdomen,
almost complete lack of head control is observed.
At 6 weeks begins to momentarily hold the head in plane of the body
At 8 weeks maintain position & at 12 weeks head held beyond the
plane of the rest of body
 Development of Head control
First ± 4 weeks: complete head-lag, PTS
Newborn baby: PTS shows head lag

± 2 months: head lag not complete, PTS 3 - 4 mo: slight to NO Head lad
One Month (First 4 weeks):
At 4 wks, gravity and development of ext. reduce
physiological flexion, baby more extended
Head lifting in prone is improved, and wt is shifted
caudally, thus improving head control
Neck flexion in supine appear minimal during PTS,
indicates that muscles are elongated by gravity and dev. Of
active extension
NB: Antigravity action of muscles not yet developed!
 One Month (4 weeks…)
Gross Motor: Ventral suspension (VS) – Elbows flexed, hips partly
extended, knees flexed.
Prone: pelvis high, kns under abdomen. Momentarily lifts chin off the
couch. Head predominantly turned to one side.
PTS: almost complete head lag,
Supine: ATNR seen at rest
Held in standing: flops at kns and hips. Walking reflex when sole of foot
stimulated.
Hands: mostly fisted, Grasp reflex evident.
General Understanding: watches mother’s face when spoken to.
 TWO MONTHS (8 WEEKS):
Stage of asymmetry characterized by hypotonia, thus the child has
decreased flexion and increased extension
Physiological flexion significantly reduced by gravity and extensor activity
Extensor activity not yet balanced by active antigravity flexion
Prone: hips more ext, pelvis closer to the surface at rest.
This decreases fwd wt shift, making head turning & lifting easier, but the head
cannot be maintained in midline during ext. The hands wt-bear a little due to
increased active shoulder abd.

6 – 8 wks: Hips ext, pelvis flat

± 8 wks: chin off the couch
 TWO MONTHS (8 WEEKS…)
Supine: the head rotates predominatly to one side due to effects of
gravity and unilateral activity of neck extensors without counter flexor
activity.
This simulates ATNR, which is seen in babies with more ext. tone.
Hands: frequntly open, grasp reflex disappearing. Hand eye regard and
uncontrolled swiping at the toys.
Vision: follows moving person, in supine can focus on objects beyond
midline.
Communication: makes cooing sounds using his mouth , these are
vowels, smiles and vocalizes when spoken to.
Social dev: more arlet, 1st smile at familiar faces. Bright colours excites
child and encourage progress.
 THREE MONTHS (12 WEEKS)
3rd Month: Characterized by beginning of symmetry & bilateral control of
neck muscles
Antigravity flexor activity of the head and upper trunk region evident
Midline orientation of head, eyes and hand developing
ATNR less frequently stimulated
Gross motor: VS- head conrol much improved, held in same plane of the
body
Prone: neck ext followed by trunk ext when lifting and turning the head.
Achieve ‘puppy prone’ since trunk extensors & chest flexors are activated
at humerus. Thus develop stability. Pelvis flat on couch, marked hip ext.
rot.during spinal ext – background for Lx spine hyperextension &
ant.pelvic ext
There is also foot on foot contact play – future standing & body awareness
 THREE MONTHS (12 WEEKS…)
Supine: beginning of symmetry evident. Head frequently in midline, thus
less ATNR. Baby’s UL rest on the chest and hands come together. Body
awareness improved, also feet come feet come together as in prone.

NB:Neck flexor action, facilitate action of

trunk flexors, thus antigravity flexion dev
in a cephalo-caudal direction!

PTS: slight or no head lag.

Held in sitting: head held up, may still bob. Baby still dev trunk
control, thus back becomes rounded.
Vision: has hand regard, follows dangling toys through 1800, looks at
objects in midline.
Three Months: continued…
Communication: squeals with anger or delight. Progress from ‘vowel
sounds’ to ‘consonant sounds’ at this stage he gurgles.
e.g. Ah…roo
G…roo
K…roo
Ah…groo
Social dev: open to outside world, prolonged vocalization, mimicry.
Cries rarely and not during daytime. Uses body language to be
understood. Has established sleeping ‘habits’. Could start to be
weaned.
Takes an interest in his hands, puts them in his mouth & sucks them for
long periods. Oral contact allows him sensory stimulation.
Stage of ‘mouthing’ to explore objects!