Stages for ages : Overview of infant development during the early years

1. Stages for ages :Overview of infant development during the early years Robyn Smith Department of Physiotherapy UFS 2012

2. MOST RAPID ACHIEVEMENT OF MILESTONES WITHIN FIRST 2 YEARS OF LIFE. CHILD FULLY FUNCTIONAL BY AGE OF 5-6 YEARS

3. 0-3 months

4. newborn • Physiological flexion at birth • Flexor recoil limbs • Symmetrical posture • Primitive reflexes: • Present • including rooting, sucking, automatic stepping moro, grasp and startle • Motor: • Repertoire of random movements : moving of limbs rhythmic and alternating • PTS: complete lag • Prone turns head to clear airway • Ventral and oblique suspension: no righting • Sits with flexed spine and with maximal support • Grasp reflexive • Vision: focus on moms face, little interest in objects

5. 1-2 months • Physiol. Flexion disappears die effects gravity as does flexor recoil • Primitive Reflexes: • ATNR appears, and other reflexes still present • Motor: • Supported sitting holds head up moment, then head bobs • PTS head lag asymmetrical • Prone lifts head 30 degrees 9 can maintain a safe airway) • Ventral suspension starting to lift head • More active kicking of LL • Grasp reflex diminishes, accidental grasp • Vision: • Focuses on objects. Follows periphery to midline (90 degrees) • Socialisation: social smile starts

6. 3 months • Primitive reflexes: ATNR & Moro still present • Motor: • PTS: head lag 45 degrees • Prone lifts head to 45 degrees • Ventral and oblique suspension: lifts head in line with body • Brings hand to midline/mouth • Ulnar grip when holding objects e.g. rattle • Communication: starts cooing, differential cry, starts squealing • Visual tracking: through 90 degrees and focuses on objects

7. 4-6 months

8. 4-6 months • Primitive Reflexes: • Landau appears at 4/12 . • Moro, ATNR and grasp reflex diminishing rapidly. • Motor: • PTS: no head lag (actively lifts head) • Ventral and oblique suspension: lifts head above midline • Can bring hands to knees/feet • Feet moulding/starts bridging • Rolls both sides by 6/12, from prone into supine • Tripod sitting/ supported near pelvis • Stands with more active WB on legs, bouncing • Prone lifts head to 90 degrees, strong puppy, starts pushing up extended arms

9. 4-6 months • Hand function: • Bilateral reach • Grasp voluntary (ulnar/palmar)- strongly visual drive. Can transfer objects between hands. Mouthing starts. • Vision: • Visual tracking through 180 degrees. • Fascinated own hands • Speech & language: babbling starts • Play: Interest in own reflection mirror • Feeding: starts on solid foods e.g. Porridge/Nestum , pureed vegetables

10. 6-9 months

11. 6-9 months • Primitive Reflexes: mostly integrated by now • Motor: • Rolls into prone and from prone into supine • Four point kneeling (rocking) /creeping/ crawling • Pull to kneel • By 8/12 sits well, without arm support • Stands holding on, parachute reactions now present • Hand function: • Grasp more radial, able pick up small objects. Can hold two objects. Transfers from hand to hand. • Play: • Starts banging objects • Object permanence, looks for toy if hidden

12. 6-9 months • Speech: Babbling consonants e.g. bbbb, pppp, ttttt • Socialisation: Imitates actions e.g. waving • ADL: Finger feeds and drinks cup

13. 9 -12 months

14. 9-12 months • Primitive reflexes: Integrated • Motor: • Can sit up from lying, dynamic sitting postures with good variety • Crawls for locomotion or starts cruising along furniture. In some cases children may start walking independently (wide variety here) • Pulls into kneeling/standing • Climbs off couch • Can sit from a standing position • Play: • Consists of putting objects into/taking out container. • Throwing objects. Still has difficulty releasing objects from hand. • Bangs items together • Play far more active with less mouthing

15. 9-12 months • Communication: • nonsense talks, single word e.g. Mamma, tata, dada. • Takes turns in “talking”

16. 12- 18 months

17. 12-18 months • Motor: • Side sits, variety of dynamic sitting positions • Can get up into standing through half-kneeling • Learns walk with hands held, later independently with “high guard”, • Goes down steps in reverse on all fours • Can climb up onto couch and sit down • Squats to pick up a toy from ground • Play: • Cannot stand and play with item requiring fine hand coordination, sits down to play (regression for fine fx). • Pushes, pulls toys, pages, lifts lid box to find toy. • 2 block tower built • Speech: • Can now say 5-7 words. Social gestures e.g. tata/hello • Starts naming familiar objects

18. 12-18 months • ADL : • Starts using spoon, self feeds (can be messy!!!) • normal toddlers diet (meat, vegetables, variety • Sits on potty

19. 12- 18 months

20. 18 - 24 months • Motor: • Walk well independently: start stop/change direction • Pushes toy, can stand and throw ball • Play: • shape board activities, can draw line, builds six block tower. Can start naming body parts. • Speech: • Asks for objects by name • 2-3 word sentences • Known's own name and those of family members • ADL: • cup drinking • toilets during day • plays on own

21. 24- 30 months or 2-2 ½ years

22. 24 - 30 months or 2-2 ½ years • Motor: • Starts to climb stairs, holding on • Able run • Kicks ball • Throw ball overhead • Play: • Build eight block tower • Strings large beads • Draws a horizontal line • Picture matching as well as basic colours

23. 24 - 30 months or 2-2 ½ years • Speech & language: • Vocabulary of approx. 50 words • 3 word sentences • ADL: • Toileting verbalises need for toileting • Assisted dressing • Play: • Parallel play (2 children play without interacting)

24. 30-36 months or 2 ½ -3 years

25. 30 -36 months or 2 ½ -3 years • Motor: • Climbs over obstacles • Jumps with 2 feet • Can walking carrying large toys • Rides scooter • Stands momentarily on one leg • Hand function and play: • Pincer grasp • Draws circle • Match approx. 6 colours • Completes 2 piece puzzle

26. 30 -36 months or 2 ½ -3 years • Speech and language: • Uses 4 word sentences • ADL: • Goes toilet as directed • Starts using fork • Dresses but needs help with shoes • Play; • Imaginary play starts e.g. hide and go seek

27. 3 years

28. 3 years • Motor: • Jumps in one place with both feet • Kicks a stationary ball • Stands on one foot for two seconds • Swings on a swing • Play and perception: • Builds a tower of nine blocks • Snips with a scissor • Completes a 5 -6 piece basic puzzle • Holds a crayon with three fingers • Copies a circle from one drawn on a piece of paper • Copies a cross from one drawn on a piece of paper • Able to draw a person with a head • Uses a spoon and fork properly and no longer makes a big mess when eating

29. 4 years

30. 4 years • Motor: • Hops on one foot 3-4 times • Plays catch with a large ball • Good control over a tricycle • Play & perception: • Builds a tower with ten blocks • Strings smaller beads • Holds pen with three fingers • Copies a square • Draws a person with a head, feet and body • Crosses the midline • Does not change hands in the middle of an activity • Clear dominance in right handed children • 30 minute attention span (5-10 minutes per activity)

31. 4 years • ADL: • Dresses and undresses independently, apart from clothing with buttons and zippers

32. 5 years

33. 5 years • Motor • Able to walk on a straight line • Can climb steps holding an object • Hops on each foot three times • Stands on one foot for 8-10 seconds • Rides a two wheeler bicycle with training wheels • Can swing by himself • Bounces and catches a tennis ball • Play & perception: • Builds a twelve block tower • Can build three steps out of six blocks • Can copy a triangle • Draws a person with a head, body, legs and face. • Can colour in between lines • Cuts with a scissor on a straight line • Holds a knife in the dominant hand

34. 6 years

35. 6 years • Motor: • Stands on one foot with eyes closed for three seconds • Walks on a straight line in a heel to toe fashion • Skips • Rides a bicycle without training wheels • Jumps rope • Catches and bounces a tennis ball • Play & perception: • Copies a diamond shape • Cuts with a knife • Holds a pen with three fingers with movement in the fingers • Ties shoelaces

36. References • Smith. R. 2011. Neurodevelopmental assessment • START checklists • Smith, R. 2011. Table for infant development (UFS class notes unpublished) • Smith, R. 2011. Developmental sequencing (UFS, class notes unpublished)