NORMAL DEVELOPMENTAL MILESTONES TILL 1 YEAR

NORMAL DEVELOPMENT
OF CHILD
0-1 yr
BY:
Sharmin Susiwala
Final Year
BPT

NORMAL DEVELOPMENT
"Maturation of function with Age"
• Continuous Process.
• Dependent on interaction between
innate genetic factors and
environmental factors.
Nature v/s Nurture
• Intimately related to the maturation
of CNS

PRINCIPLES OF DEVELOPMENT:
Distinctive attribute of childhood
Cephalocaudal order
Mass activity specific and subtle
individual responses.
Primitive Reflex pattern

MILESTONES
• Set of functional skills or age-specific tasks that
most children can do at a certain age range.
• Assessing developmental milestones or attainment
of those milestones is the central part of any
pediatric neuro examination.
• Development is assessed by sequential attainment
of milestones under following domains:
1. Gross Motor Development
2.Fine Motor Development
3.Social and Cognitive Development
4.Language
5.Vision and Hearing

GROSS MOTOR DEVELOPMENT:
POSTURES:
1.Prone
2.Supine
3.Sitting
4.Standing

1. Prone Position:
Head is turned to one
side.
Pelvis is raised off
the surface by excessive
hip flexion.
Knees flexed and
drawn up under
abdomen.

2. Ventral Suspension:
 Head flops down
completely.
 Back is rounded.

3. Supine Position:
 Less flexed as
gravity tends to
favor extension.
 Shoulders are less
protracted.
 Arms are more
abducted.
 Hips are less flexed
and more ER.

4. Supine and Pull to
Sit:
 Head completely lags
behind shoulder

5. Sitting:
 When the newborn
infants are placed in
sitting, physiological
flexion, joint
immobility and
decreased flexibilty
of soft tissue allow
them to maintain
position briefly.
 "Flopping like a rag
doll"

6. Vertical Suspension:
 Automatic stepping
reaction observed.
 Legs flex and extend
reciprocally.

POSTURAL CONTROL:
 Physiological flexion/ Flexor recoil of
limbs.
 Primary Standing reaction.  Neck Righting Reflex.

REFLEXES:
Primitive reflexes elicited by a specific stimulus:
1.ATNR
2.Moro
3.Sucking/Rooting
4.Galant

Sucking/ Rooting Reflex
Galants Trunk
Incurvatum Reflex

FINE MOTOR DEVELOPMENT:
• Hand is fisted.
• Grasp Reflex.

1. Prone:
POSTURES:
- Lifts and turns
the head to one
side.
- Child lifts the chin
up momentarily in
midline.
- Hips and knees are
partially extended.

- Head momentarily
lifts up.
- Elbow Flexed.
3. Supine:
- Generally more
extended.

4. Supine and Pull to
Sit:
- Greater Head lag
than in newborn but
attempts to lift
head.

5. Sitting:
- Attempts to lift head.
- If unsupported at trunk,
results in bobbing
movement of neck.
- Infant fatigues easily and
falls forward into flexion.
- Automatic Stepping
diminishes.
- Usually cannot be elicited
after 1st month.

POSTURAL CONTROL:
• Physiological flexion Diminishes.
• Head righting continues to develop.
REFLEXES:
• ATNR can be observed and
serves as a pattern of
postural control.
• Others same as newborn

• Infant continues to
exhibit Grasp Reflex
• Hands mostly closed.

POSTURE:
1. Prone Position:
 Infant can lift the
head about 45 deg.
off the couch
momentarily.
2. Ventral suspension:
 Head is maintained momentarily in the same
plane as the rest of the body.
 Can maintain this position well.

3. Supine Position:
 Arms and Legs more
extended.
 Kicking.
4. Pull to Sit:
 Head control starts
to develop when the
child is put to sitting
position.
 Chin is lifted up
momentarily.

5. Sitting:
When placed in
sitting, 2 months
old baby,
attempts to lift
head
Bobs forward.
Back is rounded.
Can hold head up more than
momentarily.

POSTURAL CONTROL:
• Physiological flexion
further diminishes.
• Active control
starts to develop.
• Head Righting
continues to
develop.
• Maintains his
position when held
upright on adult's
shoulder.

• Awareness of object placed in hand.
• Scratch and Clutch tactile input such as a
crib blanket.

POSTURE:
1. Prone Position:
 Pelvis is kept flat on the
ground.
 Infant can symmetrically
lift the head and shoulder
about 45 deg. off the
couch.
 Lifts head beyond the
plane of the rest of the
body.
 Able to hold for sometime.

3. Supine:
 Hold the head in
midline for
sometime.
 Tucks chin in
 Gazes towards the
chest
 Bilateral activity of
UE and LE dominate
during this period.

4. Pull to Sit:
 No head lag.
 But head tends to bob.
5. Sitting:
 Infant can hold head
upright in sitting for
sometime but there may
still be some wobbling of
the head.
 Learns to control head
and trunk.
The back is still
rounded, so the baby
slumps forward.

6. Vertical
Suspension:
 Head erect
 Take weight only
briefly.
 No slipping from
shoulders.

POSTURAL CONTROL:
• Active Head and Trunk Righting
reactions.
• Infant now begins to establish postural
synergies, or a state of readiness in
preparation for volitional movement.

• Hand Regard.
• Hand to Hand
Coordination.
• Sustained Voluntary
Grasp.
• Tactile Awareness.

POSTURE:
1. Prone Position:
 Prop on foreams
 Lifts the head and
chest higher.

 Head is maintained
well beyond the
plane of the rest of
the body.
 Back is flat

3. Supine:
 Hold the head in
midline for long periods
of time.
 Initiation of rolling.
4. Pull to sit:
 When pulled up, there
is slight head lag during
beginning and then
head is flexed beyond
the plane of the body.
 Spine Curvature
decreases.

5. Sitting:
 Sits upright for 10-15
min at a time.
 Attempts to lean
forward to reach or
touch an object and
return to erect
position.
 Learns to control head
and trunk
 Stands erect with
better head and trunk
control.

POSTURAL CONTROL:
• Functional Head Control starts to develop.
• LANDAU REACTION:

ANATOMICAL CHARACTERISTICS:
Primary spinal curves that exhibit posterior convexity are
present in the newborn infant in the thoracic and sacral-coccygeal
region.
Secondary curves with an anterior convexity starts to
develop in cervical and lumbar areas in order to accommodate
to a vertical position.
The cervical curve is seen by 4 months as the infant can
hold the head erect and steady.

• Hands come
together in midline.
• Bidextrous Reach.
• Tries to reach
object, but
overshoots.

POSTURE:
1. Prone Position:
 Chest is maintained
off the couch
 Arms in extension.
 Turns head from
side to side.

 Head is maintained beyond plane of rest of body
with trunk extension.
3. Supine:
 Independent movement of head.
 Can also lift the head in supine and might lift
the shoulders off the surface.
 Symmetrically lifts the legs in air with knees
extended and forcefully lowers them to the
surface with a bang.
 "Bridging Activity"

4. Pull to Sit:
 Baby flexes and lifts the
head.
 Tucking the chin.
5. Sitting:
 Head is stable without
wobbling
 Back is straight
 Takes support on hands
 Tries to play by
carefully lifting one
hand to reach object.

 Continue with wide BOS
 Controls knee in weightbearing position.
POSTURAL CONTROL:
 Head Righting is complete
 Functional Head control is present in all
positions.
 Landau reaction matures.
Beginning of lateral postural control.
 Primitive Reflexes no longer dominate.

• Able to grasp an
object with
asymmetrical palmar
grasp.
• Brings objects to
the mouth.
• Begins to transfer
an object from one
hand to another.

POSTURE:
1. Prone Position:
 Sufficient Postural
Stability.
 Arms and legs
outstretched.
 Experiments with more
movement of trunk in
prone.
 Begins to assume
Quadruped position.
 Tries to move self on
floor.

Rolling:
• Most babies can
transition between
supine, prone and
sidelying by the end of
six months.
• Each baby develops an
individual pattern for
rolling that becomes
more efficient with
repetition and motor
learning.

2. Supine:
 Greater Anti-Gravity Control.
 Raises one or both arms freely in space and reaches to be
picked up.
 Able to hold their legs vertical with knees extended.
3. Pull to Sit:
 When about to be pulled up,
lifts head off the couch in
anticipation.
 Tucking the chin.
 Baby pulls with arms and
extends the kness while bringing
the body weight forward.
 Also the legs are flexed at the
hips and are off the mat as
the baby pulls himself to
sitting.

4. Sitting:
 Able to sit well in a
high chair and begin to
control the limited
surrounding space.
 Sit independently on
the floor with arm
support and may easily
play in this position
for upto half an hour.
 "Tripod Sitting"
 May reach with one
arm while suporting
with other.

 Stands with less
suport.
 Feet closer
together.
 Bears almost all his
weight when made
to stand.
 Hold on by grasping
an adults finger
rather than being
held by the hands
or arms.

POSTURAL CONTROL:
• By 6 months of age, baby has sufficient postural
tone to maintain many postures against gravity.
• More mature Landau reaction.
• Labyrinthe and Optical righting have fully
developed.
• Body on Body righting response can also be
elicited.
• Equilibrium reactions are present in prone and are
beginning to be seen in supine.
• Forward Protective Extension of arms begins to
emerge at 6 months.

• Unidextrous reach.
• Consistent palmar grasp.
• Tranfers hand to hand.
• Attempts to help with spoonfeeding
and cupdrinking.
• Shakes and bangs toys to create
auditory and visual object.
• Child cannot yet voluntarily release an
object in space.

POSTURE:
1. Prone Position:
 Baby is busy
reaching, weight
shifting and trying
to move along the
floor.
 Maintains Quadruped
position well.
2. Supine:
 Rarely stays in
supine.

3. Rolling:
 Rolling to the side,
baby pushes up on
one arm to a
position in which a
larger area can be
visually and manually
explored.

4. Sitting:
Sit with their arms free for play.
But supports with one hand while reaching
any object.
5. Transitions in and out of sitting:
Baby is able to get into sitting position
independently but only from quadruped
position.
7 month old infant also begins to transition
from sitting to prone.

6. Quadruped:
 7 month old baby
symmetrically pushes
the arms straight
to assume a
quadruped position.
 Begins to rock
forward and back
 Loses balance and
falling to prone.

7. Locomotion:
 Begins to move on
the abdomen by
pivoting sideways.
 Alternatively weight
shifts from one side
to other.
 Baby learns to pull
the body forward
but his action is not
propulsive.

8. Pulling to stand:
 Babies begin to pull
themselves to a
standing position.
 While in a crib, from
prone or quadruped,
baby pulls up to
standing, using the
arms to climb the
rails.
 When seated on the
floor, an adult's lap is
another optimal
support for first
pulling to standing.

9. Standing:
 Unstable.
 Legs are wobbly and appear disoriented.
 Stands at adducted hips.
 Often baby stands on toes.
 Baby widens BOS by taking step side-ways.
POSTURAL CONTROL:
• Pelvic/Hip stability increases.
• Equilibrium reactions present in prone
and supine.

•Learns to hold object with radial palmar grasp.
•Tranfers objects.
•Learns to release object as voluntary grasping
has developed.

POSTURE:
1. Sitting:
Sits independently without any
support.
Learns to maintain a more erect trunk
for longer periods.
Moves arm in greater range up and
away from body.
Lower portion of leg closer to the
body.

2. Rolling:
 As the balance and
coordination
improves, child raises
the trunk higher off
the surface until
close to sitting.
 Now the child can
move easily from
here to quadruped.

3. Transition in and out of sitting:
 Baby develops sufficient UE, trunk and pelvis control to
rotate from sitting to Quadruped.
4. Quadruped:
 Baby becomes confident in assuming quadruped from
different positions using variety of patterns.
 In quadruped, baby develops the ability to reach laterally
as well as forward.

5. Locomotion:
 In 8 month, baby begins to pivot or belly crawl
in larger ranges and locomotes from one point to
another.
 Learns to crawl on all fours.
 Initially baby creeps on hands and knees slowly
 Pattern may not be well tolerated.
 Often baby collapses.
 Lateral flexion/elongation of trunk as weight is
shifted during early crawling.

6. Pulling to Stand:
 Pulls to standing from sitting, baby tries to pull up on
various objects of an optimal size and height.
 Baby learns which objects are stable and which are not
adequate.
 When first standing up, baby may be unable to get back
down and start to cry, which he soon learns to let it go
and falls on buttocks.

7. Standing:
 Standing at 8 months becomes more controlled.
 Baby can free one arm and reach in a wider BOS
 Motivated to obtain objects which are out of reach, baby
uses this side-stepping pattern to cruise around furniture.
 With two hands held, 8 months old child begins to walk,
although this may be a continuation of early automatic
stepping pattern of newborn, the coordination is now
disrupted.

POSTURAL CONTROL:
• Increased postural activity to
– maintain upright positions
– accompany functional movts in sitting,
quadruped and standing at support
– transition between sitting, quadruped and
supported standing.
• Equilibrium reactions are present in sitting
and beginning in quadruped.
• Protective extension of arms sideways in
sitting.

• Mature palmar grasp.
• Palmar arches are active as they
contribute in grasping any object.

POSTURE:
1. Sitting:
Becomes more dynamic
A baby sits and plays with an object only
briefly, then drops it and throws it and
reaches again.
Rotates the body to reach any object.
(90 deg or more)
Bouncing.
May also begin to Side-sit, one hip ER and
other IR.

2. Transitions in and
out of sitting:
 By 9 months of
age, babies have
increased hip
mobility as well as
postural control and
may use a variety
of patterns to move
from sitting to
quadruped.
 Also movement is
performed more
easily and quickly.

3. Quadruped:
 Learns to control
position.
 Able to reach in
wider ranges.
 Once mastered in
quadruped, he learns
to locomote.
 Uses this position
for play and
locomotion.
 Sometimes, baby
pushes up on his
hands to come on
toes.

4. Locomotion:
 With continued practice, crawling
becomes efficient.
 By 9 months, there is less lateral
excursion of trunk and improved hip
control.

5. Pull to Stand:
 The same basic motor
pattern is used to pull to
standing regardless of the
support.
 From quadruped, baby
reaches up with one arm,
then the other arm, and
walks knees forward.
 In 9 month, baby doesnt
fall on buttock as in 8
month, but now baby
drops the pelvis back while
reaching, keeping weight
more to one side.

6. Standing:
 Balance in standing develops,
baby begins to turn head and
shoulders sideways to visually
explore the environment.
 Turns diagonal to the
supporting surface.
 Child learns to stand, reach
and play.
 Distal Stability is improved
by leaning against a surface.
 Has sufficient balance to
stand with one hand-held,
using hip flexion and a wide
base.

POSTURAL CONTROL:
• Uses many functional motor skills and
movement to interact with the
environment.
• In addition to modulating postural
activity during performance of a motor
skill, baby learns to adapt posture
prior to movement for more efficient
execution.

• Child has a strong
grip and maintains
an object against
resistance.
• Immature Pincer
grasp.
• Learns to release an
object first against
a surface, in midair
followed by into a
large container.

Transitions in and out of sitting:
• Atempts to sit up from sidelying.

Pull to Stand:
 Baby develops hip control so
now he kneels upright while
pulling to stand with pelvis
and hips aligned.
 Able to shift body weight in
this position.
 When pulling up, baby may
stop in kneeling position and
reach for a toy.
 With no sufficient hand
control in this position, baby
lowers the buttocks and sits
on the heels to play.

PHYSICAL CHARACTERISTICS
OF GROWTH:
• WEIGHT:
 The average birth weight of a full-term newborn
is approximately 3.4 kg.
 Range-2.7–4.6 kg.
 Usually infant loses 10% of body weight by the
age of 10 days in the form of ecf.
 Subsequently, they gain weight at a rate of
approx. 25 to 30 g per day for the first 3
months of life.
 Thereafter they gain about 400g weight every
month for the remaining one year.

NORMAL DEVELOPMENTAL MILESTONES TILL 1 YEAR

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