Developmental Milestones

Growth

progression of changes in height, weight, and head circumference according to established standards for a given population

Development

neuro-maturation

Growth velocity

change of growth over time - more sensitive index of growth rather than a single measurment

What are the growth domains we measure?

- height

- weight

- BMI

When should a child reach a stable rate of growth?

1.5 years old (growth plateaus expected between 4-18 months but not after!!)

What childhood conditions/illnesses may affect growth?

- neurologic impairment/CP

- Oro-motor dysfunction (leads to failure to thrive)

- endocrine dysfunction

- skeletal disease

- genetic conditions

What are some factors outside of illness that can impact growth in infancy and early childhood?

- inadequate caloric intake**

- infrequent feed offers

- improper formula mixing

When do you use the WHO growth chart?

ages 0-24 months

When do you use the CDC growth chart?

ages 2-19 years old

T/F: growth of premature babies is measured on the same growth chart as other term infants.

false; they have different standards

Premature infant

Term infant

37-42 weeks gestation

Small for gestational age (SGA)

below 10th percentile for gestational age

Large for gestational age (LGA)

Weight is above 90th percentile for gestational age

When should babies return to their birth weight?

by 2 weeks of life

After 2nd week of life, how much weight should baby gain?

1 oz daily for first 3 months

When should baby be 2x their birth weight?

by 4 months old

When should baby be 3x their birth weight?

by 1 year old

Underweight

BMI less than 5th percentile

Normal or healthy weight

BMI 5th percentile to less than 85th percentile

Overweight

BMI 85th percentile to less than the 95th percentile

Obese

equal to or greater than the 95th percentile

What routine care should be done for a child in a healthy weight category?

non-fasting lipid profile for all children between the ages of 9-11 and again between 18-21 to screen for genetic dyslipidemia

What lab screening should be done for children in the overweight and obesity categories?

-fasting glucose

- fasting lipid profile

- ALT and AST

- A1C

How much does a baby's length increase in the first year of life?

increases by about 50%

When is arm span used to measure height?

When a child has a marked deformity or the spine or lower extremity

What is a normal growth expectation for head circumference?

The head circumference should show a rapid increase in the first year of life. It represents normal growth and maturation of the brain. The brain more than doubles in the first year of life

When do we stop measuring head circumference?

3 years of life

When is ASQ screening performed?

9 months, 18 months, 30 months, and then annually after 3 years old

When is MCHAT screening performed?

18 months, and then 24 months if not already done at 18 months

What is ASQ screening?

a developmental questionnair for ages 1 month - 5 years old

What is MCHAT screening?

an autism-specific screening available for ages 16-30 months

What is the difference between fine and gross motor skills?

gross motor skills involves using large muscles whereas fine motor skills involves using hands, smaller muscles, and daily living skills

T/F: Primitive reflexes are present from birth

True; absence of primitive reflexes at birth or persistent primitive reflexes beyond the expected time frame can indicate abnormal neurological development

When does the rooting reflex disappear?

4 months

When does the suck reflex disappear?

becomes voluntary at 4 months

What is the suck reflex?

when baby feels pressure on the roof of its mouth it starts sucking

What is the Moro reflex?

baby has a sudden feeling of falling backwards, extends upper extremities, then flexes, then cries

When does the Moro reflex disappear?

5-6 months

What is the asymmetric tonic neck (ATNR)/fencing posture reflex?

baby's arm extends on the side their head is turned, and the opposite arm bends

When does the fencing reflex go away?

6-9 months

What is the Palmar reflex?

curling of fingers if palm is stroked

When does the palmar grasp reflex disappear?

5-6 months

What is the planter grasp reflex?

touch/pressure on plantar foot causes baby to flex toes

When does the plantar grasp reflex disappear?

12-14 months (when walking is achieved)

What is the Babinski reflex?

aka extensor plantar reflex, stroking of lateral plantar foot from proximal to distal results in extension/flaring of all toes

When does the Babinski reflex disappear?

9-12 months usually but up to 24 months is okay

should never recur after suppression

What is the stepping reflex?

plantar contact with a firm surface results in alternating automatic "steps" with support

When doe the stepping reflex disappear?

3-4 months

T/F: It is normal for children to vary in the process of sequences of developmental milestones.

False; individual variations can occur in timing but not the process of sequences

When do babies hold their chest up in prone position?

2 months (aka tummy time)

When do babies have their hands unfisted 50% of the time?

2 months

When do babies start to hold a rattle if placed in their hands?

2 months

When do babies hands meet at the midline?

2 months

When do babies start to sit without trunk support?

4 months

When do babies stop having head lag when pulled to sit?

4 months

When do babies start to prop themselves up on their wrists?

4 months

When do babies start to have their hands predominantly open?

4 months

When do babies start to reach for objects frequently?

4 months

When do babies start to play with a rattle?

4 months

When do babies start to sit propped up on their hands?

6 months

When do babies start rolling both ways?

6 months

When do babies start to transfer objects across the midline?

6 months

When do babies start to reach with one hand?

6 months

When do babies start placing both hands on the bottle?

6 months

When do babies start to pivot on their belly and bear weight on one hand when in prone?

6 months

When do babies start pulling to stand?

9 months

When do babies start to sit without support?

9 months

When do babies start grasping with 2 fingers and a thumb (Pincer grasp)?

9 months

When do babies start banging 2 objects together?

9 months

When do babies start to stand well?

12 months

When do babies start to take independent steps?

12 months

When do babies have a fine pincer grasp?

12 months (one finder and thumb)

When will a baby start holding a crayon and try to scribble after a demonstration?

12 months

When will a baby try to stack 2 cubes?

12 months

When will a baby start to stoop to pick up a toy?

15-18 months

When will a baby start to creep up stairs?

15-18 months

When will a baby run stiff legged?

15-18 months

When will a baby start walking backwards?

15-18 months

When will a baby start climbing on furniture?

15-18 months

When will a baby start scribbling (without demonstration)?

15-18 months

When will a baby build a 3-4 cube tower?

15-18 months

When will a baby be able to feed itself with a spoon?

15-18 months

When will a baby start walking up and down stairs one step at a time?

2 years

When will a baby start throwing a ball over hand?

2 years

When will a baby start kicking a ball forward?

2 years

When will a baby start trying to draw a circle and a horizontal line?

2 years

When will a baby start walking on tiptoe?

30 months

When will a baby start jumping with both feet in place?

30 months

When will a baby start to help with dressing/undressing?

30 months

When will a baby be able to stack 8 blocks?

30 months

When will a baby wash hands?

30 months

When will a baby start being able to copy a crude circle?

30 months

When will a baby be able to imitate vertical and horizontal lines?

30 months

When will a child be able to run?

3 years

When will a child throw a ball without losing balance?

3 years

When will a child start jumping from the bottom step to the floor?

3 years

When will a child start alternating feet going up steps?

3 years

When will a child ride a tricycle?

3 years

When will a child unbutton their shirt?

3 years