Growth and Development: Major Motor Milestones

how do we calculate a baby's corrected age

step 1: compare baby's due date to actual birth date to determine how premature they were

step 2 subtract prematurity from chronological age

what is the revised way of listing predicted milestones? why the shift?

milestones now listed at age when 75% (used to be 50%) or more of children have achieved them, because it decreases the number of false alarms and missed delays

why do we track milestones

early identification and intervention, parent/caregiver education, document service eligibility

first 5 stages for fine motor object interaction

holding, translation, shaking, bilateral holding, bimanual holding

what is translation

reaching for an object in prone and bringing it to the mouth

what is bilateral holding

when an infant realizes they can do two different things in each hand

what is bimanual holding

using two hands to hold and eventually rotate objects

what are stages 6-10 of fine motor object interaction

hand-to-hand transfer, coordinated action w/ 1 object, coordinated action w/ 2 objects, deformation objects, instrumental sequential actions

what are instrumental sequential actions

using two hands for goal oriented functions (ex. opening box w/ one hand and taking out contents w/ the other hand)

grasp at birth

reflexive grasp (fingers close around objects placed in palm w/o voluntary control)

grasp at 2 months

starting to have voluntary swiping and contact but no sustained voluntary grasp yet

grasp at 3 months

emerging voluntary palmar contact, hand starting to open in anticipation of objects

grasp at 4 months

crude palmar grasp (whole hand able to close around objects)

what do we see sustained, controlled, voluntary palmar grasp

5 months

what are the benefits of taking a sequence approach in clinical practice

interventions are not tied to age, building on prerequisite skills, skills translate across contexts, helps with planning treatment sessions

what are the benefits of a timeline approach to clinical pratice

timelines aid in parent/caregiver education, allows for comparison across population norms, justification for insurance, easier collaboration with other providers

key motor milestones 0-3 months

push up on arms and lift/hold head up while lying on tummy, move fists from closed to open, bring hands to mouth, move legs and arms off surface when excited

causes for talking to provider 0-3 months

trouble lifting head, stiff legs w/ little to no movement, hands stay fisted, lacking arm movement, pushes back with head while lying on back

key milestones 4-6 months

supports self with hands in sitting, rolls from tummy to back and vice versa, accepts entire weight while standing with support, reaches for toys on tummy, plays with feet and transfers toys between hands on back

causes for talking to provider 4-6 months

sits w/ rounded back, poor head control/can't lift head, trouble bringing arms forward to reach, arches back/stiffens legs in sitting, stiff legs/reaches arms back in supported stand

key milestones 7-9 months

sit w/o support, sit and reach for toys w/o falling, moves from tummy/back to sitting, starts to creep/crawl, picks up head and pushes through elbows during tummy time, turns head to visually track objects in sitting, inc rolling/sitting control, pick up small objects with thumb and fingers, imitates others

causes to talk to provider 7-9 months

use of 1 hand predominantly, rounded back in sitting, poor use of arms in sitting, difficulty crawling, use of only 1 side of body to move, inability to bear weight on legs, inability to transfer toys between hands

key milestones 10-12 months

pull to stand, furniture cruising, standing alone, independent steps, moving in/out of positions to explore environment, maintain sitting when throwing objects, clapping hands, release objects into container w/ large opening, use of thumb and pointer finger to pick up tiny objects

reasons to talk to provider 10-12 months

trouble standing, uses only 1 arm to pull up to standing, sits w/ weight on one side, strongly flexed/extended arms, requires arms to maintain sitting, poor head control in upright

key milestones 13-18 months

walking independently w/o many falls, squatting to pick up toys, stack objects/blocks

reasons to talk to provider 13-18 months

unable to walk independently, poor standing balance/frequent falls, toe walking, doesn't pull up to stand, can't crawl to climb stairs, no pincer grasp

key milestones 19-24 months

walking up stairs w/ hands or rails, crawls down stairs, runs but falls easily, kick ball forward

how should an infant be walking at 19-24 months

heel toe pattern (not toe walking)

key gross motor milestones 2-3 years

walking/running wel, walking up/down stairs independently, balancing on one foot, kicking ball with either foot, jump in place, catching large balls

how should coordination look at 2-3 years

using both hands to play, precise hand/finger movements, able to ambulate on uneven surfaces

when do kids begin to skip

4-6 years

how do fine motor skills develop

through orderly sequence of manual manipulation stages from simple holding to complex