Gross motor development

Key motor developmental milestones

Head control

• Newborn: head lag on pulling to sit; head extension in ventral suspension.

• 6wks: lifts head on lying prone and moves it from side to side.

• 3mths: infant holds head upright when held sitting.

Primitive re exes ‘Primitive’ re exes are found in normally developing infants that disappear by 4–
6mths (Box 15.1).

By 6–8mths an infant usually can sit without support. To achieve this, the baby must have developed two
re exes:

• Propping or parachute re ex in response to falling.

• Righting re ex to position head and body back to the vertical on

tilting.

Children not sitting by 9mths should be referred for evaluation

• Locomotor skills
An infant initially becomes mobile, usually by crawling, but some will bot- tom shuf e and others will
commando crawl (creep).

• By 10mths infants are usually cruising round the edge of furniture.

• By 12mths 50% of infants are walking independently; however, the age

range for this is broad.

Children not walking by 18mths must be referred for evaluation

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 • Further development of motor skills
Children learn to run and jump and by 24mths they start to kick a ball

• Age 3yrs: can jump from a bottom step, stand on one leg brie y, and
pedal a tricycle.

• Age 4yrs: can balance on one leg for a few seconds, go up and down
stairs one leg at a time, and pedal a bicycle with stabilizers.

• Age 5yrs: can skip on both feet.

Fine motor development

Fine motor development and vision

Fine motor skills are dependent on good vision. Therefore ne motor skills are usually assessed alongside visual
development.

Early visual alertness

• A newborn infant will x and follow a near face or light moving across the eld of view.

• By 6wks infant is more alert and will turn the head through 90° to follow an object.

• By 3–4mths a baby will spend a lot of time watching their hands (i.e. hand regard).

Note: Some infants may demonstrate an intermittent squint. Fixed squints and all those persisting beyond the 8-
week check must be referred to an ophthalmologist (see b Chapter 24 pp.908–910).

• Early ne motor skills

As the primitive grasp re ex starts to decrease infants will start to reach for objects.

• At 6mths:
• grip is usually with the whole palm (palmar grasp);
• holds objects with both hands and will bang them together; • transfers objects between hands.

• By 10mths infant is developing a pincer grip using thumb and rst nger.

• By 12mths infant will use index nger to point to objects.

Preschool ne motor development
Fine motor skills can be assessed with pencil control and with building bricks (Table 15.1).
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Speech and language development
Speech is assessed in conjunction with hearing (b p.896). Impaired hear- ing will affect language development.
Age of acquisition of language is very varied.

Early signs of normal hearing and vocalization

• Newborn will quieten to voices and startle to loud noises. • By 6wks: responds to mother’s voice.
• By 12wks:

• will vocalize alone or when spoken to; • begins to coo and laugh.

Early language development

• At 6mths will use consonant monosyllables, e.g. ‘ba’ or ‘da’.

• By 8mths will use non-speci c two-syllable babble, e.g. ‘mama’ or

‘dada’.

• By 13mths two-syllable words become appropriate and develops

understanding of other single words (e.g. ‘drink’ or ‘no’).

• By 18mths:
• vocabulary of 10 words;
• demonstrate 6 parts of the body.
Phrase and conversation development
Conversation becomes increasingly complex with sentence development in the 2nd year.

• By24mths begin to combine 2 words together progressing to 3-words

phrases by the age of 2yrs (e.g. ‘Give me toy’ or ‘get me drink’).

• By 3yrs knows age, name and several colours.

Social, emotional, and behavioural

development
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Early social development

• At 6wks:
• starts smiling;
• becomes increasingly responsive socially.

• At 10mths shows separation anxiety when separated from parent and an increased wariness of strangers.

• By 10mths begins to wave ‘good-bye’.

Social and self-help skills development
• At 8mths begins to start to feed self using ngers.
• At 12mths will drink from a cup.
• At 18mths uses spoon to feed self.
• By 2yrs removes some clothes and will soon start to try to dress self.
Bladder and bowel training
Very variable. Some children are potty trained by 2yrs, but others can be much older when they develop
this behaviour. Night-time dryness always takes longer. 10% of 5-year-olds still wet the bed at night.
Symbolic play

• By 24mths children start to copy actions and activities that they see around them (e.g. feeding a
doll, making tea, dusting, and cleaning).

• They progress in the 2nd year to play on their own or alongside peers in parallel play.

• From 3yrs they start to have interactive play, taking turns and following simple rules.
Cognitive function
Cognition refers to higher mental function.

• Pre-school children:
• thought processes are called pre-operational; children are at the
centre of their world;
• ‘magical’ thinking and play with toys as if they were alive.

• Junior school age: thoughts become operational and thought processes are more practical and orderly.

• Teenage years: formal operational thought has developed including abstract thought and complex
reasoning.
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