Week 2 Development - peds

Typical pregnancy is how many weeks?

Trimesters are how many weeks each?

40 wks

13 wks each

Periods of Motor development

Neural tube development happens around?

Spina bifida - what supplement for mom?

4-6 wks (pregnancy test won’t show)

folic acid supplement

Critical Milestones - First Trimester

implantation occur; placenta & neural tube begin to form

weeks 3-4

Critical Milestones - First Trimester

Heart start beating

Tiny limb buds appear

Week 5

Critical Milestones - First Trimester

Major internal organs & body systems develop

Fingers & toes take shape

Critical Milestones - First Trimester

Fetus start making urine

External genitalia begin to form

Critical Milestones - Second Trimester

Movement becomes coordinated

heartbeat is clear via Doppler

Skin is thin

Critical Milestones - Second Trimester

“Quickening” occurs: mother feels first movement

Anatomy US can check development & gender

Critical Milestones - Second Trimester

Tastebuds form

Fingerprints lock in place

Real hair begins to grow

Critical Milestones - Second Trimester

Lungs start producing surfactant - vital for breathing after birth

When is fetus viable - higher change of surviving birth at this point

25 wks

Critical Milestones - Third Trimester

Eyes can open & blink

Fetus often in head down position

Critical Milestones - Third Trimester

Week 32:

Fetal movements peak

Body fat continues to accumulate

Critical Milestones - Third Trimester

Week 36:

Skin becomes smooth as more fat is stored

Boddy prepares for birth

When is full term delievery milestone reached?

38-40 wks

Neonatal/Infant

• Reflex:

• Within a few weeks should be able to?

• What changes?

Physiologic flexion

Primitive reflexes present

Within few weeks - turn head to either side when in prone (with tummy time)

Head shape changes - back of head may be flat due to laying on their back when sleeping

What is the breached position

feet first

FIgure out what chart to use

email her

Our standard

Skills associated with positioning

Prone - lengthens which muscles? develops which muscles?

Lengthen flexor muscles

• have to lengthen mm before strengthening it

• Flexor lengthening before strengthening extensors

Develops extensor muscles (antigravity)

Skills associated with positioning

Supine - 3 things? Early development of which muscles?

Hands to mouth, object manipulation, visual development

Early development of abdominal/flexor muscles

Skills associated with positioning

Sitting - at how many months? 4 things?

5-6 months

Feed self, play, visual/social/cognitive development

Tummy time position

Sit

The baby sits by leaning forward and propping themselves up on their hands

Name? When?

Tripod/Prop sitting

5-6 months

Sit

The baby sits steadily without using their hands for balance, typically able to reach for toys

Name? When?

Independent sitting

6-8 months

Sit

The baby pivots, shifts weight, and transitions into and out of the sitting position on their own.

Name? When?

Functional/Dynamic Sitting

7-11 months

a floor-sitting posture where a person sits on their hip with both knees bent and pointing to the same side

Side sit

refers to a crucial gross motor milestone where an infant supports their full body weight on all fours—specifically, on both hands and both knees

Quadruped

moving forward with the belly resting on the floor

Crawl

moving forward on hands and knees with the belly lifted entirely in the air

Creep

developmental stage where a child bears weight on both knees while keeping their hips fully extended and their torso completely upright

Tall kneel

a crucial transitional position where a child places one knee on the floor (stacked directly under the hip) while the other leg is brought forward with the foot planted flat on the ground

Half kneel

Prone progression - 1 month

Slightly elevates, may rotate head side to side

Prone progression - 2-3 month

Elbow in line with shoulders

Forearm support

Lateral wt shift

Head/neck at 45 deg

Prone progression - 4-5 month

Weight shifting

Reaching w/ 1 arm

Pivot in prone

Prone progression - 6-7 month

Push up on extended arms

Rocking on hands and knees

Pushes self backwards on tummy

May “army” crawl

Head is more at 90 deg angle

Prone progression - 8-9 month

Transitions in/out of quadruped, sitting, and prone

Pulls to stand with support

Prone progression - 9-10 month

Pulls to stand via half kneel

Prone progression - 10-12 month

Stand through squat

Supine Progression - 1-3 months

Reciprocal and symmetrical kicking and

arm swinging

Supine Progression - 4-5 months

Feet to mouth (working abdominal mm’s)

Supine Progression - 6-7 months

Rolls back to belly

May push self to sit

Supine Progression - 8-9 months

Raises self to sit

Supine Progression - 9-12 months

Transition out of supine easily and quickly

What are the most sensitive parts of the body

Palms

bottom of feet

around mouth

When do they push self to sit?

6-7 months

Sitting progression - 1 month

Forward flexion, head inline with trunk

Sitting progression - 2-3 month

•Propped sitting with support

•Some head lag with pull to sit

Sitting progression - 4-5 month

•no head lag

•Sitting with support

•Lateral shifts

Sitting progression - 6-7 months

•Sits independently when placed, no support

•Plays with toy in sit

Sitting progression - 8-9 months

•Protective reactions emerging

•Transitioning to sit

Sitting progression - 10-12 months

•Pivots on bum, plays with toys

Summary of mobility in 1st year

3-5 months

•Pivoting in prone

•May rock in quadruped

•Push self backwards

Summary of mobility in 1st year

6-7 months

•Rolling both ways

•Forward motion - Army type crawling

Summary of mobility in 1st year

8-9 months

•Crawls, creeps, and pulls to stand

•Walks with assist

Summary of mobility in 1st year

10-12 months

•Cruises, stands alone, walks with one hand held

•Walks independently

Reach & Grasp

Goal: match motor control of their own body to?

Normal UE movements:

Initially, each child will have a somewhat individual style of reaching depending on?

“Normal” reach and grasp start around? Refinement period?

proprioceptive and visual cues from the environment

Flapping, swinging, variable & w/out intent

Environment

2 y/o, 8-12 y/o

Reach & grasp are input dependent

• 3 inputs?

• What also has an impact?

Vision, environment (toys, motivators in environment), opportunity

Gross motor skills

Reach is followed by?

Reach - Grasp - Release

Reaching 0-5 months

0–2 months

1–3 months

1–4½ months

2–6 months

3½–4½ months

0–2 months	Visual regard of objects
1–3 months	Swipes at objects
1–4½ months	Alternating glance from hand to object
2–6 months	Inspects own hands; reaches for, but may not contact, object
3½–4½ months	Visually directed reaching

Reaching 0-5 months

3½–6 months

4 months

5 months

Hands are oriented to object, rapid reach for object without contact

Shoulders come down to natural level; hands are together in space; in sitting bilateral backhand approach with wrist turned so thumb is down

In prone bilateral approach, hands slide forward; two-handed corralling of object

Reaching 5-12 months

5–6 months

6 months

7 months

5–6 months	Elbow is in front of shoulder joint; developing isolated voluntary control of forearm rotation
6 months	In prone, reaches with one hand while weight-bearing on the other forearm; elbow is extended, wrist is straight, midway between supination and pronation
7 months	Prone: reaches with one hand while weight-bearing on the other extended arm

Reaching 5-12 months

8–9 months

9 months

10 months

11–12 months

8–9 months	Unilateral direct approach, reach and grasp single continuous movement
9 months	Controls supination with upper arm in any position, if trunk is stable
10 months	Wrist extended, appropriate finger extension
11–12 months	Voluntary supination, upper arm in any position

Grasp

0–3 months

2–7 months

3–3½ months

4 months

0–3 months	Hands are predominantly closed
2–7 months	Object is clutched between little and ring fingers and palm
3–3½ months	Hands clasped together often
4 months	Able to grasp rattle within 3 inches of hand

Grasp

3–7 months

4 months

4–6 months

4–8 months

3–7 months	Able to hold a small object in each hand
4 months	Hands are partly open
4–6 months	Hands are predominantly open
4–8 months	Partial thumb opposition on a cube; attempts to secure tiny objects; picks up cube with ease

Grasp

5–9 months

6–7 months

6–10 months

7–12 months

8 months

5–9 months	Rakes or scoops tiny objects using ulnar grasp
6–7 months	Objects held in palm by finger and opposed thumb (radial palmar grasp)
6–10 months	Picks up tiny objects with several fingers and thumb
7–12 months	Precisely picks up tiny objects
8 months	Tiny objects are held between the side of index finger and thumb (lateral scissors)

Grasp

8–9 months

9–10 months

10 months

12 months

8–9 months	Objects are held with opposed thumb and fingertips; space is visible between palm and object
9–10 months	Small objects are held between the thumb and index finger, first near middle of index (inferior pincer) finger; later between pads of thumb and index finger with thumb opposed (pincer)
10 months	Pokes with index finger
12 months	Small objects are held between the thumb and index finger, near tips, thumbs opposed (fine pincer)

Release

0–1 month

1–4 months

4 months

4–8 months

5–6 months

6–7 months

0–1 month	No release, grasp reflex is strong
1–4 months	Involuntary release
4 months	Mutual fingering in midline
4–8 months	Transfers object from hand to hand
5–6 months	Taking hand grasps before releasing hand lets go
6–7 months	Taking hand and releasing hand perform actions simultaneously

Release

7–9 months

7–10 months

8 months

9–10 months

10–14 months

12–15 months

7–9 months	Volitional release
7–10 months	Presses down on surface to release
8 months	Releases above a surface with wrist flexion
9–10 months	Releases into a container with wrist straight
10–14 months	Clumsy release into small container; hand rests on edge of container
12–15 months	Precise, controlled release into small container with wrist extended

10 stages of Manipulation

Stage 1 - Skill & age

10 stages of Manipulation

Stage 2 - Skill & age

10 stages of Manipulation

Stage 3 - Skill & age

10 stages of Manipulation

Stage 4 - Skill & age

Stage 4: Bilateral Hold of Two Objects

•4-5 months

10 stages of Manipulation

Stage 5 - Skill & age

Stage 5: Bilateral Hold of One Object

•4-5 months

•Typically starts with a bottle

•Progresses to larger/heavier toys   that need to be rotated

10 stages of Manipulation

Stage 6 - Skill & age

Stage 6: Hand to Hand Transfer

•4-6 months

•Typically will do the same thing with   both hands

10 stages of Manipulation

Stage 7 - Skill & age

Stage 7: Coordinated Action with One object

•5-7 months

•Hold it in one hand and use the other hand to manipulate it

10 stages of Manipulation

Stage 8 - Skill & age

Stage 8: Coordinated Action with Two Objects

•6-9 months

•Banging two blocks together è driven by sound or vibration

10 stages of Manipulation

Stage 9 - Skill & age

Stage 9: Deformation of Objects

•7-9 months

•Rip, squeeze, bend etc

10 stages of Manipulation

Stage 10 - Skill & age

Stage 10: Sequential Actions

• 7-10 months

• Sequential use of two hands to reach a goal

When does ulnar palmar grasp develop

6 months - scooping motion

When does radial palmar grasp develop

6-9 months

When does 3-jaw chuck grasp develop

10 months

When does pincer grasp develop

12 months

3 requirements for locomotion

1. Progression

2. Stability

3. Adaptability

3 requirements for locomotion

1. Progression - what kind of stepping pattern? reflex?

•Rhythmic Stepping Pattern

•Reflex? (primitive stepping reflex)

3 requirements for locomotion

2. Stability - requires what 2 things?

•Balance

•Postural Control

3 requirements for locomotion

3: Adaptability - modify gait based on? Refined after?

•Modify gait based on environment

•Refined after the initiation of gait

7 Phases of Bipedal Development

Phase 1

7 Phases of Bipedal Development

Phase 2

7 Phases of Bipedal Development

Phase 3

7 Phases of Bipedal Development

Phase 4

7 Phases of Bipedal Development

Phase 5

Phase 5: Walking with High Guard

•10-15 months

•Pic a

7 Phases of Bipedal Development

Phase 6

Phase 6: Low Guard - arms down at side

•10-12 weeks AFTER the initiation of gait

•Pic b

7 Phases of Bipedal Development

Phase 7

Phase 7: Head and Trunk Erect

•24+ months

Why is walking so hard???

•Top Heavy

•Practice

•Growth (baby is still growing)

•Motivation

Early Gait NORMAL Characteristics

•Hip : knee flexion

•Flat footed gait

•Wide BoS

•Arm Swing?

•Variable Steps

•Variable Path

Initial walking

Age:

Balance:

Gait:

Step length:

Arms:

Initial contact:

BOS:

Toe position:
Stance:

Knee flexion:

Falls:

Initial Walking

First 3–6 months after learning to walk

Unpredictable loss of balance

Rigid, halting stepping

Short step length (22 cm)

High hand guard/outstretched arms

Flat-foot contact

Wide base of support

Toes turned out/external rotation

Brief single limb stance (32% of gait cycle)

Knee flexion in stance

17 falls/hour

Immature Walking

Age:

Balance:

Gait:

Step length:

Arms:

Initial contact:

BOS:

Toe position:
Stance:

Knee flexion:

Falls:

Immature Walking

Approximately 2 years of age

Occasionally loses balance

Gradual smoothing of pattern

Increased step length (28 cm at 2 years and 33 cm at 3 years)

Reciprocal arm swing1

Heel strike1

Base of support within lateral dimensions of the trunk

Minimal out toeing/external rotation

Vertical lift

Longer single limb stance (34% of gait cycle)

Greater knee flexion af1ter foot strike and then extends before toe-off

Seldom falls

Mature Walking

Age:

Balance:

Gait:

Step length:

Arms:

Initial contact:

BOS:
Stance:

Knee flexion:

Mature Walking

7 years of age; approximates adult gait

Rarely loses balance without perturbation

Relaxed, elongated gait

Increased step length (48 cm)

Reciprocal arm swing

Heel strike

Narrow base of support

Minimal vertical lift

38% of gait cycle single limb stance