Transcript devt1
Normal Developmental Milestones An emphasis on anticipatory guidance Ana Malinow, MD Why we should teach parents about development Parents who understand their child’s developmental state, are more likely to have appropriate expectations. Having appropriate expectations makes for a healthier relationship between parent and child. Healthier relationships facilitate development. Objectives • • • • • • Principles of development Primitive Reflexes “Locomotion”: Gross Motor “Manipulation”: Fine Motor “Cognitive”: Language and Social Behavior and Personality Principles of Development • A continuous process • Sequence of development is the same, rate of development varies • Not parallel • Related to CNS maturation • Involuntary movements give way to voluntary responses • Occurs in cephalocaudal and proximal to distal • Progresses from dependence to independence Development Occurs in a Cephalocaudal Direction Development begins in utero Age Responses/Reflexes 8 ½ wks tactile stimuli (reflex arc laid down) 12 wks sucking 24 wks sound 26 wks rhythmic breathing movements/ controls body temperature 30 wks pupilary light reflex 35 wks grasp/spontaneous orientation to light All primitive reflexes develop during gestation and disappear by the 3rd to 6th month after birth Primitive reflexes • Tonic labyrinthine reflex • Asymmetric tonic neck reflex • Positive support reflex Declining intensity of primitive reflexes and increasing role of definitive motor actions Gross motor development “Locomotion” Locomotion begins with head control Assessing Locomotion • • • • • • Ventral suspension Sitting position Prone position Standing/Forw. Walking Running/Backw. Walking Balancing NB-3m NB-8m NB-9m 9m-18m 2 yrs 3 yrs + Ventral suspension Head control 2 month head control 4 month head, arm control 6 month head, arm, trunk control 8 month head, arm, trunk, leg control 9 month pulls up to stand 12 month old locomotion 2 year old Running Backward Walking 3 year old Balance “Manipulation” Fine Motor Development Manipulation: Assessing the pincer grasp from 0-6m • • • • • • • NB 1m 2m 3m 4m 5m 6m primitive primitive starting to lose voluntary on ulnar hands together palmar grasp hand-mouth-hand; hand-to-hand Manipulation: Assessing the pincer grasp 7-12 m • 7m • 8m • 9m • 10m • 12m • >12m thenar side, raking 1 block in each hand radial-digital grasp; inferior pincer index finger isolation fine pincer letting go, stacking “Cognition” Social Development Problem solving Play Causality Language Development Assessing cognitive development Problem solving • • • • • • • • • • NB 4-6wks 2m 3m 5m 6m 7m 8m 9m 10m visual exploration smiles, fixes, follows imitates mouth movements anticipates feeds object permanence looks to floor when toy dropped grabs 2nd cube, drops first seeks object after fall (silent) uncovers hidden object under cloth isolates index finger Assessing cognitive development Play Age <12m 12m-18m 18m-24m 2-5y 6y 11y + Play stage sensory-motor functional symbolic imaginary/magical logical thinking hypothetical Piagetian stage sensory-motor sensory-motor sensory-motor pre-operational concrete operation formal operational 12-month 18-month Functional Play 18-month 24-month Symbolic Play 2-5 year Imaginary/Magical Play 6 year old Logical Thinking 11 years + Hypothetical thinking Assessing cognitive development Causality Age Cause Effect Early Early 4m 8m 10m 24m cries smiles kicks crib pulls string funny winds key mom comes mom responds mobile moves gets ring +response/repeats toy moves Conversational speech probably starts with smiling 2 month old language Assessing cognitive development: Language Age Milestone 4-6wks 2m 3m 4m 6m 7m 8m 12m smiles vocalizes with vowels vocalizes with consonants squeals syllables non-specific combinations imitates sounds, understands “no” 1-3 words Assessing language Age Expressive Receptive Jargon Sentence L. Intelligible 12m 1-3 100 Y none 18m 10-25 ID body Y giant words holophrases 2y 50 Pts. Body N 2 words 25-50% 3y 500 Prepositions N 3-4 words 75% 4y 5 def. Comparisons N 4-5 words 100% 5y 7 def. N 100% 6y masters rules of grammar Behavior • • • • • • • • One-way or two-way interactions Prenatal factors Bonding/attachment CNS maturation Match Schedule Language Instincts Behavior -continued• Cognitive, gross and fine motor development • Illness, separation, feeding issues • Birth order, family size • Secondary attachments • Environment • Gender identification Bonding Personality • • • • Factors that influence behavior Create behavior Through adaptability and flexibility Produce personality/social behavior Newborn “Personality” 4 month old “Personality” 9-month old “Personality” Other “Personality” Landmarks • 2-year old independence/dependence • 3-year old master of impulse control, sharing, wants to please, guilt • 7-year old ability to see another’s point of view • Adolescence begins identity formation (idealistic) • Adulthood completion of identity formation Conclusion • • • • • Development is a continuous process Sequence is always the same, rate varies Development does not run parallel Intimate relationship with CNS Generalized activity gives way to voluntary activity • Cephalocaudal development • Dependence to independence