 Children have very differing needs from those

of adults
 Children present with different medical
conditions have vulnerabilities of dependence
and age and are very much developing
individuals with social, emotional and
educational needs
 Involving children, young people and their
families in decision making around their care is
 fundamental to successful health interventions
 Decision making regarding possible
physiotherapy intervention thus needs to be a
joint venture
 History is given by second person.
 The parents may place their own interpretation
on events
 The cooperation of the child cannot be
guarantied
 The expression of the disease may be
influenced by the child’s developmental status
 Motor development is very basis of practice of
paediatric physical therapy
 It provides the norms, for functioning of
children at various ages that guide diagnosis
and treatment planning through emphasis on
selection of age appropriate skills as functional
out comes
 Development of effective plans of care for
children also require knowledge of milestones
that must be recognized in order to provide
intervention in a stimulating and motivating
environment and to take advantage of
interactions among cognitive, perceptual and
motor development
 Behaviour is an intrinsic property of organism,
with maturation leading to an unfolding of
predetermined patterns,supported,but not
fundamentally altered by environment
 Stages of development occur as a result of CNS
maturation so it depends on assumption of
hierarchic maturation of neural control
structures
 Nature of development forms a spiralling
function with alterations between extremes in a
variety of behaviours,includinng alternating
dominance between flexor and extensor muscle
activity
 There should be a functional asymmetry in
which the child must break free of symmetric
movement patterns to achieve functional goals
such as manipulation
 Paediatric physical therapy developed
according to this theoretic model.
 Emphasis was placed on examination of stages
of reflex development and motor milestones as
reflections of increasingly higher levels of
neural maturation
 Treatment of child with CNS dysfunction was
organized around inhibition of primary
reflexes
That were believed to persist and produce
activity limitations along with facilitation of
equilibrium reactions that are coordinative
structure for development of skilled voluntary
motor behaviour
 Its of two types
Behavioural theory:
 In this approach environment is the site of
developmental control
 Development occurs through interaction of the
individual with the environment
 clinical problems are approached based on the
beliefs that each problem has its unique history
and intervention programme should be
individually tailored to
Specific problem behaviour so critical feature is
psychology of individual in interaction with
environment
Piagetion theory:
It emphasizes on interaction between maturation
of cognitive neural structures and
environmental opportunities to promote action
Individual possess a self regulating system of
psychological processes that provides balance
between assimilation of environmental
experiences and accommodation of existing
cognitive structures to that experience
 Individual adjust itself to maintain equilibrium
despite disturbances from the environment,
thus driving developmental progress
 Therapist use problems and problems
involving means-ends relationships and
container contained ideas as therapeutic media
to motivate children to move and to examine
and promote the perceptual cognitive aspects
of development and motor learning
 In this approach internal components (MSK
components, sensory systems, central sensory
motor integrative mechanisms arousal and
motivation ) of the organisms and external context
of task are equivalent in determining the out come
of behaviour because behaviour is task specific
 In the dynamical systems view of development, the
movements of locomotion are conceived not as
derived from a set of instructions from the CNS nor
as built from chains of reflexes the locus of control
for function shifts over time, depending on
dominance or constraints of various subsystems.
 Prone
 Physiological flexion
 Lifts head briefly
 Head to side

 Supine
 Physiological roll partly to side

 Sitting
 Head lag in pull to sit

 Standing
 Reflex standing and walking
Regards object in line of gravity.
Follow A object to midline.
Hands fisted.
Arm movement Jerky.
Movement may be purposeful or random.
Smiles or moves when primary senses are activated
(hearing, smell, taste, touch, vision)
Prefers objects with contrasting colors
Briefly looks at people and objects within 12 inches
Interacts and explores the environment by using their
senses and movement
Explores the environment freely by looking, tasting,
smelling, feeling and hearing
Parent-Infant bonding, learning to read each
other’s cues
Regulation of sleep-wake cycle; regulation of
feeding and elimination
Begins to recognize primary caregiver
Relies heavily on attachment figures/primary
caregivers for emotional and soothing support
Makes variety of gurgling sounds and cooing
when content
Babbles or coos when someone talks to them
Cry is monotonous, one breath long
Listens to a caretaker’s voice for 30 seconds
Responds to sounds and voices
Cries when hungry or uncomfortable
 Developmental Milestones
Oral Motor and Feeding

Opens and closes mouth to food

source
Primary nutrition through breast or
bottle feeding
Rooting response (turns mouth
towards touch on face)
Sucks on objects that are near the
mouth
Strong gag reflex evident
Developmental
Milestones
--------------
Gross Motor & Fine Motor
Skills
2 To 3 Months…...
Developmental Milestones
Gross Motor Skills
2-3 Months…
Prone
Lifts head 900
Chest up in prone position with
some weight through forearm

Roll prone to supine

Supine
Influence strong
Legs kicks reciprocally
Prefer head to side
Developmental Milestones
Gross Motor Skills
2-3 Months…

Sitting
Variable head lag in pull to sitting position
Needs full support to sit
Head upright but bobbing

Standing
Poor weight bearing
Hip in flexion, behind shoulders
Developmental Milestones
Fine Motor Skills
2-3 Months…

Can see further distance

Hands open movement
Visually follow through 1800
Grasp is reflexive
Use palmar grasp
Developmental Milestones
Sensory
2-3 Months…

Enjoys physical contact

Calms with rhythmical movements
(e.g. swinging)
Able to self-regulate (e.g. falls asleep
in over-stimulating environments)
Cries more rhythmically with opening and closing
mouth
Uses different cries for different needs (hunger, fatigue,
discomfort)
May smile at familiar faces and voices, especially mom
Begins to learn that making sounds gets a response
Turns head to a voice
Attends to a speaker’s mouth
Quiets to a familiar voice
Searches with eyes for a sound
Watches a speaker’s eyes and mouth
Uses lips and tongue to suckle when feeding
Opens mouth when food source is near
Developmental
Milestones
--------------
Gross Motor & Fine Motor
Skills
4 To 5 Months…...
Developmental Milestones
Gross Motor Skills
4-5 Months…
Prone
Bears weight on extended arms
Pivot in prone to reach the toys
Supine
Roll from supine to side lying
position
Play with feet to mouth
Developmental Milestones
Gross Motor Skills
4-5 Months…
Sitting
Head steady in supporting
sitting position
Turn head in sitting position
Sits alone for brief period

Standing
Bears all weight through legs
in supported standing
Developmental Milestones
Fine Motor Skills
4-5 Months…

Grasp & release toys

Uses ulnar palmar grasp
Developmental Milestones
Sensory 4-5 Month
Uses his/her hands and mouth for
sensory exploration of objects
Searches with his/her eyes for sound
and scans objects briefly
Enjoys movements and touch
Able to self regulate by looking away
from or falling asleep in over-
stimulating environment
Developmental Milestones
Speech, Language and Hearing
4-5 Month
Vocalizes to express displeasure
Finds sound with eyes
Babble increases
Babble in chains (ex: babababa)
Laughs
Initiates “talking” by babbling to another person
Turns head to find a hidden voice
Responds to sound by vocalizing
Vocalizes when playing alone or with caregiver
Recognizes friendly or angry tone of voice
Recognizes own name
Developmental Milestones
Oral Motor and Feeding
4-5 Month

Mouths toys
Strong gag
Begin to introduce solid foods around 5
months of age
Developmental Milestones
Social Emotional Development
4-5 Month

Expresses unhappiness when an object

or toy is taken away
Expresses self using verbal/non-verbal
cues (cries, laughs, reaches for a
familiar adult)
Begins to initiate ways to calm self
Developmental
Milestones
--------------
Gross Motor & Fine Motor
Skills
6 To 7 Months…...
Developmental Milestones
Gross Motor Skills
6-7 Months…
Prone
Roll from supine to prone
Holds weight on one hand to reach the toys

Supine
Lifts head and helps when pulled to sitting position
Gets to sitting position without assistance
Sits independently

Mobility
May crawl backward
Developmental Milestones
Fine Motor Skills
6-7 Months…
Approaches objects with one hand
Arm in neutral when approaching the
toy
Radial palmar grasp
pick up small objects with fingers
Voluntary release to transfer objects
between hands
Developmental Milestones
Sensory
6-7 Months…
Investigates objects with vision, touch,
and taste
Shows increased tolerance of various
social and environmental situations
May enjoy playing with food
 Developmental Milestones
Speech, Language and Hearing
Responds to sounds when source is not visible
Shouts to gain attention
Responds to a simple request like “come here”
Shows interest in the sounds of objects
Responds to facial expressions
Imitates familiar gestures
Looks at a picture when it is named NOTE: These ranges
Recognizes family members’ names
Responds to “no” most of the time from 6 to 9 Months
Waves “bye-bye”
Vocalizes during games
Begins to recognize common words
Attempts to imitate sounds
Increase in babbling
Produces repeated syllables (ma ma ma, ba ba ba)
Produces four or more different sounds (ma, da, ba, ga)
 Developmental Milestones
Social Emotional Development
Simple imitative toy play with caregiver
Experiences wide range of emotions
Plays with toys briefly, more independently
Increased interest in self, others, world
Entertains self briefly
Initiates play
Enjoys mirror play
Has increased separation anxiety
Able to predict repeated events
Enjoys the freedom that their new movement brings
Object permanence (i.e. able to find a toy hidden under a
blanket)
Enjoys repeating interesting experiences (shaking a rattle)
NOTE: These ranges from 6 to 9 Months
 Developmental Milestones
Oral Motor and Feeding

Decrease in gag response

Spoon feeding
Opens mouth when food approaches
Begins drinking with a cup, but a lot of
liquid is spilled
Uses jaw movements to “chew” soft
foods
NOTE: These ranges
Self-feeds finger food from 6 to 9 Months
Holds a spoon
Developmental
Milestones
--------------
Gross Motor & Fine Motor
Skills
8 To 9 Months…...
Developmental Milestones
Gross Motor Skills
8-9 Months…
Prone
Gets into hands-knee position

Supine
Does not tolerate supine position

Sitting
Move from sitting to prone position
Sit without hand support for longer periods
Pivot in sitting position
Developmental Milestones
Gross Motor Skills
8-9 Months…
Standing
Stands at furniture
Pulls to stand at furniture
Lowers to sitting position from supported standing

Mobility
Crawl forward
Walk along furniture
Cruising
Developmental Milestones
Fine Motor Skills
8-9 Months…
Takes objects out of container
Develop active supination
Uses inferior pincer grasp
Extends wrist actively
Pivot with index finger
Pokes with index finger
Release of objects is more refined
Fine pincer grasp developed
Put objects into container
Grasps adaptively
 Developmental
Milestones
--------------
Gross Motor & Fine Motor
Skills
10 To 11 Months…...
Developmental Milestones
Gross Motor Skills
10-11 Months…

Stands without support

Pulls to stand using half kneel
intermediate position
Pick up objects from flow from
standing with support
Walk with both hands held
Walk with one hand held (Bean Walk)
Creep on hand & feet (Bear Walk)
 Developmental
Milestones
--------------
Gross Motor & Fine Motor
Skills
12th
Month…...
Developmental Milestones
Sensory
10-12 Months
Explores food with fingers
Eats a variety of textured and flavored
foods using his/her fingers
Enjoys bath time, splashing, playing in
the water
Developmental Milestones
Speech, Language and Hearing
10-12 Months
Begins to use one or two words spontaneously
Begins to use “mama” or “dada” meaningfully
Begins to use a word to call a person
Vocalizes to change activities or call others
Imitates consonant and vowel combinations
Imitates non-speech sounds
Begins to imitate the name of familiar objects
Vocalizes with intent frequently
Imitates new gestures
Begins to follow simple commands
Verbalizes or vocalizes in response to verbal requests
Identifies two body parts on self by pointing or gesturing
Listens selectively to new words
Vocalizations have rising and falling sounds like adult speech
Developmental Milestones
Social Emotional Development
10-12 Months
Moves around but will look to caregiver for approval
of his/her actions.
Uses caregiver as a secure base from which to
explore (will explore environment,
but makes sure that parent is still physically present
while doing so.)
Imitative learning; baby copies caregiver’s actions as
a way of learning
Performs for social attention
Begins to anticipate familiar events Note: Some of
Begins to learn the idea of turn takingthese appear even
Stranger anxiety in 9th Month
Developmental Milestones
Oral Motor and Feeding
10-12 Months

Begins to drink from sippy cup

Chews food
Drools due to teething
Begins to bite on soft solid foods
Developmental Milestones
Self-help
10-12 Months

Likes to feed self

Drinks from a cup
Helps with dressing and undressing
THANK YOU