SEM 4 - PEDS wk 3-5 (copy)

Infancy

(Birth to 1 y/o)

Toddler

(1-3 y/o)

Early Childhood/Preschool

(3-5 y/o)

Middle Childhood

5-8 y/o

Late Childhood

(8-~11 y/o)

Both ______ / ______and functional factors will influence Behavior

(i.e. action and interaction with environment, others, and self)

structural/physiological

From birth through adolescence vitals

Vital capacity, BP, blood volume, height ↑

• HR ↓

• Relative ↓ CO

From birth through adolescence

Growing

–Learning fundamental and activity-specific motor skills

–Some of the changes that occur until physical

growth/maturation complete

heart becomes more effecient

vitals as we grow (actualnumbers)

HR/RR: HR RR

• Birth - 122 bpm 30 breaths/min

• 2-5 yr - 114 bpm 26 breaths/min

• 5-9 yr - 103 bpm 25 breaths/min

• 9-12 - yr 89 bpm 24 breaths/min

• Adult - 76 bpm 17 breaths/min

changes: Infancy (Birth to 1 y/o)

–Trunk leads length changes

–Body fat is higher

changes: Toddler (1-2 y/o)

LE’s lead length/height changes (through childhood)

Late Childhood (8-~11 y/o)

Male and female children perform similarly on most motor skills prior to puberty (some sociocultural differences, e.g., throwing skill)

Nervous system changes in peds

Brain

~75-80% by 2-3 y/o

• ~90% by 6 y/o

Nerves (not all nerves are myelinated at birth)

• Myelination by ~2-3 y/o

development is influced by

• Genetics

• Experiences

• Contexts

• Nutrition

• Sociocultural factors

• Self-concept, self-esteem,

self-efficacy

• Fitness

• TIE

–Task

–Individual

–Environment

• Perception-action-cognition

boys decrease in _____ at puberty (much lower than girls)

body fat

girls maximal o2 intake decreases over time (only when taking into account age)

true

____ is a significant factor for gaining postural control

head control

prewalking skills that are important for walking

crawing and rolling

stand on 1 foot momentarily

22-23 mo

stair walkig pattern ascent and descend

asend: 27-29

discnd: 28-34

jump from 12 inch height 1 ft

24 months

hopping one time on either foot

41 months

W-sitting in children — key clinical evidence and management?

• Common in ages 3–6 due to normal hip anatomy (femoral anteversion)

• Position: hip flexion, adduction, internal rotation (“W” shape)

• No strong evidence it causes harm or DDH

• Low-quality evidence overall; some associations (in-toeing, flat feet) but no causation

• Likely that hypermobility allows W-sitting rather than causes issues

• Concerns largely anecdotal or from CP populations generalized to all children

• Naturally decreases with age

• Current evidence does NOT support banning W-sitting

• Clinical focus: assess movement variety; address underlying impairments

• Encourage alternative sitting positions instead of simply prohibiting it

At what age does a child typically begin to walk independently?

6 months

9 months

18 months

12 months

12 months

A toddler is able to stand on one foot for 5 second. This is most typical to obtain for what age?

5 years

3 years

2 years

18 months

3 years

A 3-year-old child can ascend stairs with a handrail using alternating feet, but descends using a step-to pattern. What does this most likely indicate?

Atypical motor development

sign of painful gait

2 years advanced motor development

Normal development with appropriate stair skill progression

Normal development with appropriate stair skill progression

Why can skipping be more difficult than galloping for some children?

. It is primarily reflex-driven

It develops earlier and fades with age

It requires bilateral coordination and alternating single-limb stance

It requires strong upper body strength

It requires bilateral coordination and alternating single-limb stance

A 4-year-old child is practicing jumping down from a 12-inch box. Which physical requirement is most essential for a safe landing?

Upper extremity strength

Trunk rotation

Eccentric control of the lower extremities

Aerobic capacity

Eccentric control of the lower extremities

Which gross motor skill typically emerges around 3.5 years and involves rhythmic, repetitive movement while balancing on a single limb?

Leaping

Skipping

Galloping

Hopping

Hopping

• Week 3-4: _____Systems Initiate

core

Neural plate → CNS begins

Heart tubes form and fuse

Week 4-5: Architecture Emerges

Head, eyes, ears, trunk

Limb buds appear

Week 8-12: Foundations of Motion****

First reflexes appear (startle, grasp)

o Mouth and limb muscles activate

o Cerebral hemispheres develop

Movement = Feedback

Early movement supports sensory and motor loop development

Week 16-25: Systems Begin Working Together

Sensory systems: hearing, touch, proprioception

o Stronger reflexes and coordinated limb motions

o Brainstem and spinal cord more active

Full-Term vs. Preterm****

Full-Term (38-42 weeks):

o Organized cycles, stronger reflexes

o Flexion posture, coordinated movement

• Preterm (<37 weeks):

o Hypotonia, extended limbs

o Immature sensory/motor systems

o Difficulty regulating temperature, feeding, and respiration

Factors Affecting Integration

• Genetics (e.g., Down Syndrome, Spina Bifida)

o Teratogens (e.g., alcohol, infection)

o Maternal health and environment

Critical Periods

CNS: Weeks 3-5

Limbs, eyes, ears: Weeks 4-12

Why This Matters for PTs*******

Movement is multisystemic

o Driven by the nervous system

o Executed by the musculoskeletal system

o Informed by the sensory system

Therapeutic Implications

o Early intervention depends on understanding where

development diverged

o PTs help build connections that didn’t fully form

Many Physical Changes in 1st Year - weight

at 6 mo- double birth weight;

• at 12 mo- triple birth weight

Many Physical Changes in 1st Year - length

Length: ½ - 1 inch every mo

Failure to Thrive (FTT):

below the 3rd percentile for weight, height, head circumference

Fontanelle Changes - when will they close and why is it important

Anterior Fontanelle 18 mo

• Posterior Fontanelle: 2 mo

Why is this important?

• When bulging concerns of hydrocephalus

• Plagiocephaly- critical time periods

• brain is still growing

Teeth

Lower incisors at 10 mos

Teething induces lots of things

Irritability

• Mouthing objects

• Significant chewing

• Significant drooling

SID Prevention // The “Back To Sleep” Program to save lives

a.Sleep position: on their back (until can roll)

a.Avoiding smoking around the infant

b.Remove extra items from the crib (blankets, toys)

c.Avoid getting too hot

d.Parent doesn’t sleep in the same bed

Period of Purple Crying - Shaken baby syndrome (period of purple crying)

i. Never shake a baby

ii. Very fragile brain

iii. Babies cry

iv. Being a new parent is stressful

v. If the baby is unconsolable and parent feels anxious or exhausted-teach parents to set the baby down

vi. Educate new parents before it’s too late

Choking Hazards - how to avoid choking

a.Bulb suction

b.CPR

c.Avoid giving small round

(grapes, raw vegetables,

small toys)

Baby’s car seat is facing _____

backwards

Burns

i. Not close to stove

i. Electrical outlets

covered

i. Avoid hot water

ii. glass covered

fireplaces HOT

Stop ____ once baby rolls

swaddling

prone on elbows

2 mo

cervical ext.

4mo

prone on hands

4mo

quad ped (creeping not crawing)

7-8mo

3 pt position

8 mo

bear crawling

10-12 mo

should infants have a prefrence in cervical rotation in the first year of life

NO (torticollis). random kicking is normal

elongates and get rid of full physiological flx

2 mo

active hip flx in suipine

4mo

good at rolling

3-6 mo

is normal for a newborn to have significant head lag?

yes

You note that a 7-year-old child's resting heart rate is 95 bpm. How would you interpret this finding?

Indicative of cardiac pathology

Normal for age

Sign of respiratory distress

Suggests poor conditioning

Normal for age

A PT consults you about a 10-year-old girl post-fall with poor endurance. Her VO2 max is lower than age-matched males. What physiologic reason explains this?

 

Girls have lower body fat percentage post-puberty

Girls experience a decline in maximal oxygen consumption when adjusted for body mass

Boys have a slower heart rate throughout childhood

Girls have less skeletal growth pre-puberty

Girls experience a decline in maximal oxygen consumption when adjusted for body mass

You're explaining to a NICU team why preterm infants often show disorganized movement patterns. What key developmental factor is incomplete?

Cardiac output regulation

Myelination of all nerves

Organized states of sleep and alertness

Lower extremity proportional growth

Organized states of sleep and alertness

A 6-month-old infant is evaluated for poor weight gain. What developmental benchmark would you expect at this age?

Weight triples from birth weight

Birth weight is doubled

Posterior fontanelle is still open

Anterior fontanelle is closed

Birth weight is doubled

Which sign would most concern you in a 4-month-old during a routine screening?

Persistent open anterior fontanelle

Bulging fontanelle

Drooling during teething

Increased mouthing of hands

Bulging fontanelle

At what point should swaddling be discontinued to prevent falls?

When rolling begins

At 12 months

At 6 months

When crawling begins

When rolling begins

During prone assessment at 2 months, a baby shows cervical extension but poor trunk strength. What is a typical milestone by this age?

Prone on elbows

Sitting independently

Full prone on hands

Bear crawling

Prone on elbows

In therapy, you observe a baby bring hands to midline while supine. At what age does this typically emerge?

Birth

2 months

4 months

8 months

4 months

Pull-to-sit testing on a newborn reveals significant head lag. This finding is:

Pathologic

Normal

Indicative of early sitting readiness

a sign of early reflex integration

Normal

In teaching safe infant sleep practices, which recommendation is most appropriate?

A. Prone sleeping during nighttime

B. Use of sleep positioners

C. Back to Sleep with daytime tummy time

D. Co-sleeping encouraged for bonding

C. Back to Sleep with daytime tummy time

When discussing burn injury prevention for infants, which environmental hazard is often overlooked?

A. Table edges

B. Fireplace glass fronts

C. Laundry baskets

D. Playpen corners

B. Fireplace glass fronts

During an infant screen, you note slowed growth in weight, length, and head circumference, below the 3rd percentile. This is called:

A. Hydrocephalus

B. Failure to thrive

C. Craniosynostosis

D. Fontanelle closure delay

B. Failure to thrive

A 4-month-old has developed sufficient cervical and hip extension. What functional change does this specifically support?

A. Rolling independently

B. Propping on elbows in prone

C. Independent walking

D. Sitting without support

B. Propping on elbows in prone

During quadruped assessment, a 10-month-old demonstrates weight shifts and limb lifting. This pattern most reflects:

A. Rolling

B. Army crawling

C. Creeping (medical term)

D. Sitting with support

C. Creeping (medical term)

During a sitting session, a therapist notes a 6-month-old can sit independently in a ring-sit position. What spinal change supports this?

A. Persistent C-curve

B. Development of lumbar and cervical lordosis

C. Lack of secondary curvatures

D. Thoracic kyphosis only

B. Development of lumbar and cervical lordosis

A 3-year-old child is referred for physical therapy due to delayed gross motor skills. Which of the following motor milestones would you expect the child to have achieved by this age?

A. Hopping on one foot

B. Standing on one foot for 10 seconds

C. Walking up stairs with alternating feet without support

D. Standing on one foot for 5 seconds

D. Standing on one foot for 5 seconds

During an assessment, a 2.5-year-old child demonstrates the ability to ascend stairs with alternating feet while holding onto a handrail. However, the child descends stairs using a step-to pattern with support. How should this be interpreted?

A. The child shows typical development for stair navigation.

B. The child is delayed in motor development.

C. The child should be able to descend stairs with alternating feet without support.

D. The child is exhibiting advanced motor skills for their age

A. The child shows typical development for stair navigation.

When assessing a 6-year-old's motor development, which of the following skills would you expect the child to perform as a new skill?

A. Skipping

B. Standing on one foot for 5 seconds

C. Hopping on one foot 2-3 times

D. Walking up stairs with alternating feet without support

Skipping

A 5-year-old child is unable to hop on one foot but can gallop. Which of the following is the most appropriate interpretation?

A. The child has a significant motor delay.

B. Hopping is less complex than galloping; the child should be able to hop.

C. Galloping typically precedes single limb hopping in motor development.

D. The child is demonstrating atypical motor development patterns.

A. The child has a significant motor delay.

A pediatric physical therapist is treating a 6-year-old child who struggles with skipping despite demonstrating typical strength and balance. What would be the most appropriate clinical next step?

A. Refer for a neurological evaluation

B. Discharge the child from therapy

C. Implement structured practice with visual and verbal cues

D. Focus treatment on flexibility of lower extremities

C. Implement structured practice with visual and verbal cues

A child is able to jump down from a 12-inch step with two feet at 3 years old. What key physical capability most supports this skill?

A. lower body strength

B. Visual perception

C. Eccentric muscle control

D. Aerobic endurance

C. Eccentric muscle control

According to recent systematic reviews, which of the following has been shown to NOT BE CORRELATED with w-sitting?

Joint laxity

Intoing Gait

Developmental Hip Dysplasia

Femoral Anteversion

Developmental Hip Dysplasia

What does the review suggest about the claim that W-sitting causes flatfeet?

A. It confirms the claim with moderate evidence

B. It finds a weak association in children with no joint laxity

C. It proposes that joint laxity may explain both conditions

D. It dismisses the claim due to sample size issues

C. It proposes that joint laxity may explain both conditions

A DPT is screening toddlers for a pediatric study on foot development. Question: Which characteristic is expected in all 11–14-month-old toddlers?

A. Normal arches with rigid foot structure

B. Early signs of cavus foot

C. Flexible pes planus

D. Fully ossified sustentaculum tali

C. Flexible pes planus

The development of postural control in infants is primarily dependent on the maturation of which neural structure? (This is harder and relies on Clinical Neuroscience)

A) Basal ganglia

B) Cerebellum

C) Brainstem

D) Cerebral cortex

C) Brainstem

which primitive reflex, if retained beyond 6 months, may interfere with the development of voluntary reaching?

A) Moro reflex

B) Palmar grasp reflex

C) Asymmetrical tonic neck reflex (ATNR)

D) Rooting reflex

C) Asymmetrical tonic neck reflex (ATNR)

Correct answer: C) Asymmetrical tonic neck reflex (ATNR)

If the ATNR is retained beyond ~6 months, it can interfere with midline control and voluntary reaching, because turning the head causes automatic extension of the arm on the face side and flexion of the opposite arm. This makes it difficult for a child to bring hands together or reach directly in front of the body.

• Moro: Birth → 4–6 months (startle reflex)

• Palmar grasp: Birth → 4–6 months (automatic hand grasp)

• Rooting: Birth → 3–4 months (turns toward touch on cheek)

Comparing typical and atypical development, which of the following is a key distinguishing factor?

A) Sequence of developmental milestones

B) Rate of developmental progression

C) Presence of primitive reflexes

D) Parental involvement

B) Rate of developmental progression

From birth to adolescence, which physiological measure decreases?

A. Blood pressure
B. Heart rate
C. Stroke volume
D. Vital capacity

 

Which physiological change is most characteristic when children progress from toddlerhood to the early school‑age years?

A.Smaller stroke‑volume output

B.Higher resting heart rhythm

C.Greater blood volume, slower breaths

D.Late rapid brain growth

In infancy, the ____ leads changes in length/height.

A. Trunk
B. Legs

At what age is approximately 90% of the nervous system developed?

A. 2 years
B. 4 years
C. 6 years
D. 10 years

At what age should a baby’s birth weight double?

A. 4 month
B. 6 months
C. 9 months
D. 12 months

At what age do babies typically cry the most?

A. 1 month
B. 2 months
C. 4 months
D. 6 months

 

What caregiver strategy is most helpful for a two‑month‑old who is not yet bringing hands to midline during play?

A.Midline toys during alertness

B.Early supported standing drills

C.Ignore reaching until later

D.Focus verbal engagement only

 

Which is more difficult for infants- rolling from tummy to back OR back to tummy?

A. Tummy to back

B. Back to tummy

At what age do approximately 50% of infants roll from tummy to back?

A. 2 months
B. 3 months
C. 4 months
D. 6 months

Parents report their 3-month-old becomes fussy during tummy time. What is the BEST recommendation?

A.Avoid prone until sitting develops

B.Use frequent short prone sessions

C.Focus only on supine play

D.Begin passive flexibility exercises

____ is when an infant moves forward on hands and knees with the belly off the ground

A. Crawling
B. Army crawling
C. Creeping
D. Cooing

At what age do approximately 50% of infants begin to crawl?

A. 5 months
B. 6 months
C. 7 months
D. 9 months

At what age do approximately 50% of infants start playing with their feet while lying on their back?

A. 3 months
B. 5 months
C. 7 months
D. 9 months

At what age do approximately 50% of infants sit without support?

A. 4 months
B. 5 months
C. 6 months
D. 8 months