Pediatrics Exam 1: Lecture 2

prenatal development

process in which a baby develops from a single cell after conception into an embryo & later a fetus

38-42 weeks

full-term human gestation

40 weeks

average full-term gestation

- germinal stage

- embryonic stage

- fetal stage

(3) primary stages of prenatal development

- from conception until implantation

- 0 to 2 weeks

describe germinal stage of prenatal development (2)

3 to 8 weeks after conception

describe embryonic stage of prenatal development

9 weeks gestation til birth

describe fetal stage of prenatal development

5

til about ___ weeks gestation is a very critical & sensitive period for fetal development which is where a lot of anomalies can happen

20-38

___ weeks gestation is CNS critical period for fetal development

motor

____ skills start developing in utero

14-16

spontaneous activity or movement occurs at ___-___ weeks in utero

- learn about consequences of movement

- get neural feedback to encourage more movement

movement in utero allows fetus to (2)

locomotion

____ rhythms are seen in embryonic movements

- movements in forelimbs precede hindlimbs --> cephalocaudal direction

- intralimb then interlimb coordination development

- 1st detectable movement in proximal joints --> development of movement activity progresses distally --> proximodistal direction

(3) control mechanisms seen in prenatal gait

9

isolated arm & leg movements seen by __ weeks gestation

16

alternating movements of LEs like walking movements after birth seen by ___ weeks gestation

before delivery

when can the fetus be capable of producing complex motor behaviors

adapting to new forces imposed by gravity

motor behaviors observed in utero are not evident after birth UNTIL infant learns new motor strategies by

- upright posture

- mobility

- manipulation

primary goals for the motor skill development in the first 12-18 months of life according to Campbell (3)

- anti0gravity control

- maintain COM in the BOS

- performance of inter- & intra-segmental movements

- learn to dissociate movement

primary goals for the motor skill development in the first 12-18 months of life according to Tecklin (4)

- ability to separate movement in one body part form movement in another body part

- characteristics of mature movement

what is dissociation (2)

12-18 months

major gross motor milestones develop in first ___-___ months that are basic/foundational skills for self-care, feeding, & play

variability

key feature of typical development

- quality of movement

- timing of developmental skill acquisition

- repertoire of motor solutions

- trial & error

components of variability in motor development (4)

- spontaneous arm, leg, & head movements in newborn

- uncoordinated movements of a child learning to seat, walk, or reach

- amount of quality of variability changes over time in the typical developing infant

characteristics of quality of movement component of variability in motor development (3)

having a& choosing a wide set & picking one most appropriate for a specific situation

characteristics of repertoire of motor solutions component of variability in motor development

trail & error

process for learning motor skills that will lead to new movement strategies

- typical development

- motor control

variability is a sign of (2)

lack of or limited variability in a child's motor skill's repertoire

definite red flag

- reflexive control --> cortical control

- generalized total response --> localized response

- gross motor control --> fine motor control

- cephalic --> caudal

- proximal --> distal

- postural control precedes the attainment of motor milestones

- medial --> lateral

- symmetrical --> asymmetrical

- extensor anti-gravity --> flexor anti-gravity

- WB on flexed LE --> WB on extended LE

principles of developmental direction & what directions come first (10)

cephalocaudal

development & improvement in structure & function begins in the head, followed by the trunk, & then the LE

proximodistal

development & function progresses from the body's central axis towards the extremities --> from near to far

- head to side

- not able to keep head midline

neonate head control in supine (2)

labyrinthine optical beginning

when baby is in physiological flexion

lifts & clears head partially

neonate head control in prone

- flexed head

- head falls forward, backward, & sideways

neonate head control in supported sitting (2)

head lags but attempts to right

neonate head control in pull to sit

vision

___ drives head control

head righting

physiological flexion can look like

- random arm movements writhing at 90° plane

- positional hand-on-hand contact

- reflexive hand-to-mouth contract in side-lying

neonate reaching arms (3)

- grasp reflex

- hands open as arms Abduct

neonate fine motor skills (2)

head to side

newborn head control in supine

consistent head in midline

3 months age infant head control in supine

eyes

functional head control starts with

at birth

eye gaze shifts are present

- faces or people,

- contrasting patterns

eye gaze trend at first

more interested in mom & dad's faces, not toys

0-3 months eye gaze

more interested in toys

3-6 months eye gaze

smooth visual pursuit

eye gaze by 6 weeks

adult-like visual pursuit

eye gaze by 14 weeks

decrease

dynamic system explain that during early development, infants will experience a temporary ____ in visual skills in response to the effort required while acquiring a new motor skill

head turning

use vision to elicit

- intially exhibit no head lag due to physiological flexion

- then there will be a head lag until head control develops

- head will drop forward at the end

newborn head control in pull to sit

forward

which way will a newborn's head fall with a pull to sit

head lags behind body until pulled up to sit vertical

head control during a pull to sit for birth to 3 months

chin tucks

head control during a pull to sit for 4 to 5 months

keeps head in line with body

what does a chin tuck help do in head control for a 4-5 month old during a pull to sit

- lifts & clears partially

- attempts to clear head

newborn or neonate head control in prone (2)

- head at 80-90° extension

- head in midline

- propping on forearms

4 month old head control in prone (3)

- unsteady head movements

- able to lift head to midline vertically from full flexion or extension

- held for 1-2 seconds-->not sustained

newborn or neonate head control in supported sitting with full trunk support (3)

- head in midline in frontal plane with eye gaze about 30° below horizontal plane

- head turning still not steady

- head oscillations seen when attempting to maintain head upright

2 month old head control in supported sitting (3)

- stable head conrol

- stable head turn lead by visual pursuit

- may show brief head oscillations & loss of control

3-4 months old head control in supported sitting (3)

45

4 months old should be able to hold head up ___° in prone

stable head

prerequisite for initial ability to perceive depth cues from kinetic information

3 months

when should babies have a stable head for initial stability to perceive depth from kinetic information

binocular vision

allows infants to identify depth cues

4-5 months

wen should binocular vision be well established

steady steady head control & vision

there must be ______ & _______ for appropriate depth perception

- head turned to side

- physiological flexion

newborn progression in prone (2)

decreased hip flexion

1st month progression in prone

- COM cephalocaudal shift towards LE

- ability to achieve POE

2-4 months progression in prone (2)

- head & neck extension

- T-spine extension

- moving arms to forearm support

- stable pelvis

(4) ways a 2-4 months of can achieve POE

- prone on extended arms

- pivot prone

- strong extension

5 months progression in prone (3)

- stable head control in supine in midline, smooth turning full R to/from L

- stable head control in prone & supported sitting/upright to vertical, emerging rotation R to/from L

- upper trunk extensor motor control/function

4 months head control & progression in prone (3)

- eye-head-hand control

- independent sitting

upper trunk extensor motor control/function are foundation to further develop (2)

red flag

if upper trunk extensor motor control/function are not seen by 4 months

prone scooting or belly crawling

3-8 months prone progression

quadruped & quadruped rocking

8 months prone progression

- quadruped, hands, & knees mobility without trunk touching the ground

- plantargrade creeping & bear crawl

- hands & feet mobility without trunk or knees touching ground

10 months prone progression (3)

9

how many phases on prone progression are there according to mcgraw

LE flexion & extension in a primarily flexed posture

phase 1 of prone progression

spinal extension begins as well as development of head control

phase 2 of prone progression

- cephalocaudal progression of spinal extension to the T-spine area

- prop on extended arms lifting chest off surface

phase 3 of prone progression (2)

propulsion movements starts in arms & legs

phase 4 & 5 of prone progression

begin to assume quadruped & plantigrade

phase 6 of prone progression

disorganized attempts at progression

phase 7 of prone progression

organized propulsion in the creeping position emerges

phase 8 & 9 of prone progression

midline control symmetry

3 months age supine progression

- bridging-gaining pelvic control

- feet to mouth

- hands to knees & feet

5 months age supine progression (3)

side-lying to supine

rolling at 1-2 months

supine to side-lying aka log roll

rolling at 3 months

prone to supine emerging segmental

rolling at 5 months

supine to prone

rolling at 6-8 months

segmental

pattern changes from log room with no rotation to ____ rolling with dissociation

3

independent sitting develops in ___ stages

- 4-5 months

- prop sitting

- experiments with limits of head & trunk with tripod stability

- trial & error

- may try to lift arms, but does not work well

- primitive batting below shoulder level when attempting to reach

stage 1 of independent sitting according to Campbell (6)

- 5-6 months

- ability to sit without use of arms for 1-2 minutes

- cannot maintain posture while engaged visually with surroundings or using arms to play

- upgraded trunk control when trying to control COM

- persists on exploring limits of stability with many falls

- reaching beyond legs & above shoulders

stage 2 of independent sitting according to Campbell (6)

- 6-7 months

- sits indefinitely without falling

- reaches in all directions

- not yet able to get out of sitting with control

- better postural control when manipulating objects

- learning to anchor pelvis to ground by activating HS & back extensors before reaching

stage 3 of independent sitting according to Campbell (6)

- ring sitting

- half ring sitting

- long sitting

- side sitting

- w sitting

() independent sitting postures

- easily shift weight w/in BOS with variable leg positioning & variety of sitting positions

- control trunk rotation

- anticipatory postura control

- effective protective response in all directions

- reaches further out of BOS in all directions

- pivots in sitting

- transitions in & out of sitting with ease & rotation

characteristics of mature/refined sitting skills (7)