S TAGES FOR AGES : O VERVIEW OF INFANT DEVELOPMENT DURING THE EARLY YEARS Robyn Smith Department of Physiotherapy UFS 2012

MOST RAPID ACHIEVEMENT OF MILESTONES WITHIN FIRST 2 YEARS OF LIFE. CHILD FULLY FUNCTIONAL BY AGE OF 5-6 YEARS

0-3 MONTHS

NEWBORN Physiological flexion at birth Flexor recoil limbs Symmetrical posture Primitive reflexes: Present including rooting, sucking, automatic stepping moro, grasp and startle Motor: Repertoire of random movements : moving of limbs rhythmic and alternating PTS: complete lag Prone turns head to clear airway Ventral and oblique suspension: no righting Sits with flexed spine and with maximal support Grasp reflexive Vision: focus on moms face, little interest in objects

1-2 MONTHS Physiol. Flexion disappears die effects gravity as does flexor recoil Primitive Reflexes: ATNR appears, and other reflexes still present Motor: Supported sitting holds head up moment, then head bobs PTS head lag asymmetrical Prone lifts head 30 degrees Ventral suspension starting to lift head More active kicking of LL Grasp reflex diminishes, accidental grasp Vision: Focuses on objects. Follows periphery to midline (90 degrees) Scoialisation: social smile

3 MONTHS Primitive reflexes: ATNR & Moro still present Motor: PTS: head lag 45 degrees Prone lifts head to 45 degrees Ventral and oblique suspension: lifts head in line with body Brings hand to midline/mouth Ulnar grip when holding objects e.g. rattle Communication: starts cooing, differential cry, starts squealing Visual tracking: through 90 degrees and focuses on objects

4-6 MONTHS

Primitive Reflexes: Landau appears at 4/12. Moro, ATNR and grasp reflex diminishing rapidly. Motor: PTS: no head lag (actively lifts head) Ventral and oblique suspension: lifts head above midline Can bring hands to knees/feet Feet moulding/starts bridging Rolls both sides by 6/12, from prone into supine Tripod sitting/ supported near pelvis Stands with more active WB on legs, bouncing Prone lifts head to 90 degrees, strong puppy, starts pushing up extended arms

4-6 MONTHS Hand function: Bilateral reach Grasp voluntary (ulnar/palmar)- strongly visual drive. Can transfer objects between hands. Mouthing starts. Vision: Visual tracking through 180 degrees. Fascinated own hands Speech & language: babbling starts Play: Interest in own reflection mirror Feeding: starts on solid foods e.g. Porridge/Nestum, pureed vegetables

6-9 MONTHS

Primitive Reflexes: mostly integrated by now Motor: Rolls into prone and from prone into supine Four point kneeling (rocking) /creeping/ crawling Pull to kneel By 8/12 sits well, without arm support Stands holding on, parachute reactions now present Hand function: Grasp more radial, able pick up small objects. Can hold two objects. Transfers from hand to hand. Play: Starts banging objects Object permanence, looks for toy if hidden

6-9 MONTHS Speech: Babbling consonants e.g. bbbb, pppp, ttttt Socialisation: Imitates actions e.g. waving ADL: Finger feeds and drinks cup

9 -12 MONTHS

Primitive reflexes: Integrated Motor: Can sit up from lying, dynamic sitting postures with good variety Crawls for locomotion or starts cruising along furniture. In some cases children may start walking independently (wide variety here) Pulls into kneeling/standing Climbs off couch Can sit from a standing position Play: Consists of putting objects into/taking out container. Throwing objects. Still has difficulty releasing objects from hand. Bangs items together Play far more active with less mouthing

9-12 MONTHS Communication: nonsense talks, single word e.g. Mamma, tata, dada. Takes turns in “talking”

MONTHS

Motor: Side sits, variety of dynamic sitting positions Can get up into standing through half-kneeling Learns walk with hands held, later independently with “high guard”, Goes down steps in reverse on all fours Can climb up onto couch and sit down Squats to pick up a toy from ground Play: Cannot stand and play with item requiring fine hand coordination, sits down to play (regression for fine fx). Pushes, pulls toys, pages, lifts lid box to find toy. 2 block tower built Speech: Can now say 5-7 words. Social gestures e.g. tata/hello Starts naming familiar objects

12-18 MONTHS ADL : Starts using spoon, self feeds (can be messy!!!) normal toddlers diet (meat, vegetables, variety Sits on potty

MONTHS

MONTHS Motor: Walk well independently: start stop/change direction Pushes toy, can stand and throw ball Play: shape board activities, can draw line, builds six block tower. Can start naming body parts. Speech: Asks for objects by name 2-3 word sentences Known's own name and those of family members ADL: cup drinking toilets during day plays on own

MONTHS OR 2-2 ½ YEARS

Motor: Starts to climb stairs, holding on Able run Kicks ball Throw ball overhead Play: Build eight block tower Strings large beads Draws a horizontal line Picture matching as well as basic colours

MONTHS OR 2-2 ½ YEARS Speech & language: Vocabulary of approx. 50 words 3 word sentences ADL: Toileting verbalises need for toileting Assisted dressing Play: Parallel play (2 children play without interacting)

30-36 MONTHS OR 2 ½ -3 YEARS

Motor: Climbs over obstacles Jumps with 2 feet Can walking carrying large toys Rides scooter Stands momentarily on one leg Hand function and play: Pincer grasp Draws circle Match approx. 6 colours Completes 2 piece puzzle

MONTHS OR 2 ½ -3 YEARS Speech and language: Uses 4 word sentences ADL: Goes toilet as directed Starts using fork Dresses but needs help with shoes Play; Imaginary play starts e.g. hide and go seek

3 YEARS

Motor: Jumps in one place with both feet Kicks a stationary ball Stands on one foot for two seconds Swings on a swing Play and perception: Builds a tower of nine blocks Snips with a scissor Completes a 5 -6 piece basic puzzle Holds a crayon with three fingers Copies a circle from one drawn on a piece of paper Copies a cross from one drawn on a piece of paper Able to draw a person with a head Uses a spoon and fork properly and no longer makes a big mess when eating

4 YEARS

Motor: Hops on one foot 3-4 times Plays catch with a large ball Good control over a tricycle Play & perception: Builds a tower with ten blocks Strings smaller beads Holds pen with three fingers Copies a square Draws a person with a head, feet and body Crosses the midline Does not change hands in the middle of an activity Clear dominance in right handed children 30 minute attention span (5-10 minutes per activity)

4 YEARS ADL: Dresses and undresses independently, apart from clothing with buttons and zippers

5 YEARS

Motor Able to walk on a straight line Can climb steps holding an object Hops on each foot three times Stands on one foot for 8-10 seconds Rides a two wheeler bicycle with training wheels Can swing by himself Bounces and catches a tennis ball Play & perception: Builds a twelve block tower Can build three steps out of six blocks Can copy a triangle Draws a person with a head, body, legs and face. Can colour in between lines Cuts with a scissor on a straight line Holds a knife in the dominant hand

6 YEARS

Motor: Stands on one foot with eyes closed for three seconds Walks on a straight line in a heel to toe fashion Skips Rides a bicycle without training wheels Jumps rope Catches and bounces a tennis ball Play & perception: Copies a diamond shape Cuts with a knife Holds a pen with three fingers with movement in the fingers Ties shoelaces

R EFERENCES Smith. R Neurodevelopmental assessment START checklists Smith, R Table for infant development (UFS class notes unpublished) Smith, R Developmental sequencing (UFS, class notes unpublished)