1. Normal Developmental Milestones
An emphasis on anticipatory guidance
Ana Malinow, MD

2. Why we should teach parents about development
Parents who understand their child’s developmental state, are more likely to have appropriate expectations.
Having appropriate expectations makes for a healthier relationship between parent and child.
Healthier relationships facilitate development.

3. Objectives Principles of development Primitive Reflexes
“Locomotion”: Gross Motor
“Manipulation”: Fine Motor
“Cognitive”: Language and Social
Behavior and Personality

4. Principles of Development
A continuous process
Sequence of development is the same, rate of development varies
Not parallel
Related to CNS maturation
Involuntary movements give way to voluntary responses
Occurs in cephalocaudal and proximal to distal
Progresses from dependence to independence

5. Development Occurs in a Cephalocaudal Direction

7. Development begins in utero
Age Responses/Reflexes
8 ½ wks tactile stimuli (reflex arc laid down)
12 wks sucking
24 wks sound
26 wks rhythmic breathing movements/ controls body temperature
30 wks pupilary light reflex
35 wks grasp/spontaneous orientation to light

8. All primitive reflexes develop during gestation and disappear by the 3rd to 6th month after birth

10. Primitive reflexes Tonic labyrinthine reflex
Asymmetric tonic neck reflex
Positive support reflex

11. Declining intensity of primitive reflexes and increasing role of definitive motor actions

12. Gross motor development “Locomotion”

13. Locomotion begins with head control

14. Assessing Locomotion Ventral suspension NB-3m Sitting position NB-8m
Prone position NB-9m
Standing/Forw. Walking 9m-18m
Running/Backw. Walking 2 yrs
Balancing 3 yrs +

15. Ventral suspension

16. Head control

17. 2 month head control

18. 4 month head, arm control

19. 6 month head, arm, trunk control

20. 8 month head, arm, trunk, leg control

21. 9 month pulls up to stand

22. 12 month old locomotion

23. 2 year old Running Backward Walking

24. 3 year old Balance

25. “Manipulation” Fine Motor Development

26. Manipulation: Assessing the pincer grasp from 0-6m
NB primitive
1m primitive
2m starting to lose
3m voluntary on ulnar
4m hands together
5m palmar grasp
6m hand-mouth-hand; hand-to-hand

27. Manipulation: Assessing the pincer grasp 7-12 m
7m thenar side, raking
8m 1 block in each hand
9m radial-digital grasp; inferior pincer
10m index finger isolation
12m fine pincer
>12m letting go, stacking

28. “Cognition” Social Development Problem solving Play Causality
Language Development

29. Assessing cognitive development Problem solving
NB visual exploration
4-6wks smiles, fixes, follows
2m imitates mouth movements
3m anticipates feeds
5m object permanence
6m looks to floor when toy dropped
7m grabs 2nd cube, drops first
8m seeks object after fall (silent)
9m uncovers hidden object under cloth
10m isolates index finger

30. Assessing cognitive development Play
Age Play stage Piagetian stage
<12m sensory-motor sensory-motor
12m-18m functional sensory-motor
18m-24m symbolic sensory-motor
2-5y imaginary/magical pre-operational
6y logical thinking concrete operation
11y + hypothetical formal operational

31. 12-month 18-month Functional Play

32. 18-month 24-month Symbolic Play

33. 2-5 year Imaginary/Magical Play

34. 6 year old Logical Thinking

35. 11 years + Hypothetical thinking

36. Assessing cognitive development Causality
Age Cause Effect
Early cries mom comes
Early smiles mom responds
4m kicks crib mobile moves
8m pulls string gets ring
10m funny +response/repeats
24m winds key toy moves

37. Conversational speech probably starts with smiling

38. 2 month old language

39. Assessing cognitive development: Language
Age Milestone
4-6wks smiles
2m vocalizes with vowels
3m vocalizes with consonants
4m squeals
6m syllables
7m non-specific combinations
8m imitates sounds, understands “no”
12m 1-3 words

40. Assessing language
Age Expressive Receptive Jargon Sentence L. Intelligible
12m Y none
18m ID body Y giant words
holophrases
2y Pts. Body N 2 words 25-50%
3y Prepositions N 3-4 words 75%
4y 5 def. Comparisons N 4-5 words 100%
5y def. N 100%
6y masters rules of grammar

41. Behavior One-way or two-way interactions Prenatal factors
Bonding/attachment
CNS maturation
Match
Schedule
Language
Instincts

42. Behavior -continued- Cognitive, gross and fine motor development
Illness, separation, feeding issues
Birth order, family size
Secondary attachments
Environment
Gender identification

43. Bonding

44. Personality Factors that influence behavior Create behavior
Through adaptability and flexibility
Produce personality/social behavior

45. Newborn “Personality”

46. 4 month old “Personality”

47. 9-month old “Personality”

48. Other “Personality” Landmarks
2-year old independence/dependence
3-year old master of impulse control, sharing, wants to please, guilt
7-year old ability to see another’s point of view
Adolescence begins identity formation (idealistic)
Adulthood completion of identity formation

49. Conclusion Development is a continuous process
Sequence is always the same, rate varies
Development does not run parallel
Intimate relationship with CNS
Generalized activity gives way to voluntary activity
Cephalocaudal development
Dependence to independence