Motor Development

BASIC COMPONENT OF MOTOR DEVELOPMENT

• There are four basic component

Head control

Increased extensor control

Developing rotatory components

Equilibrium Reactions
 Development in the Infant and Child
• A newborn infant responds to his or her environment in an involuntary or
reflexive way
• Over the first few years of life, through physical growth and learning
experiences, the child learns to actively participate in the world
• This development occurs in a step-wise, sequential manner. These steps along
the way are called developmental milestones
• While the sequence of development is the same for all children, the
rate of development is different for each child
• The direction of motor development is from head to toe – the child
learns to control his head and neck, then his trunk, and eventually his
arms and legs
• Early development leads the infant to master four major types of
skills: gross motor, fine motor, language and social skills
 Development in the Infant and Child
• Gross motor skills require the use of large muscles to achieve sitting, crawling and walking in
the first year of life
• Fine motor skills involve the use of small muscles in the hands and fingers, in tasks such as
picking up small objects, and later for feeding and dressing
• Language refers to communication skills – both the ability to understand others (receptive
language) and to express oneself (expressive language)
• Communication skills are both verbal and non- verbal
• Social skills are those that describe the child’s interactions with their family and other children
• The developmental “norms” we are going to discuss are not absolute – there is an age range for
each one, as children don’t all progress at exactly the same pace
• A child may lag in one area of development such as speech, while making rapid progress on
motor skills, then catch up in language while they plateau on their motor skills
 Role of Pediatric Therapists

• Pediatric Physical Therapist assist infants and children with gross motor Skills such as prone
skills, sitting, crawling, walking, jumping, skipping and transitions between these skills.

• Pediatric Occupational Therapists work with children who have sensory integration (e.g.
sensory integration dysfunction, autism, prevent developmental disorder) difficulties and
have difficulties with fine motor skills that will impact their ability to explore their
environment. They also work on self-help skills such as dressing, self feeding etc.

• Pediatric Speech Therapists work with children who have difficulties with feeding. They
also assist children with communication - including speech production, articulation,
receptive and expressive language, language processing and fluency.
 Newborn-1 Month
Months Gross Motor Fine Motor Speech/Language
Newborn-  Physiologic flexion  Hands are loosely fisted  Belly breather
1 Month  Random Movements  Observe hands open & closed  Oral reflexes present,
 When placed on stomach  Brings hands to mouth due to roots when hungry
with head down, able to clear close proximity of hands to  Response to noises with
airway, bring head off face with physiologic flexion shock
surface & rotate  Visual preference is faces 8-12
 Will take weight on feet inches away
when placed in standing  Enjoys being in prone!
 2 Months
Months Gross Motor Fine Motor Speech/Language
2 Months  Period of maximal  Continues with random  Social smile
asymmetry upper extremity movements  Baby attending to more
 Head rarely in midline but  Hands open & closed sounds by orienting head
observe Head to both sides  Visual Tracking uses head & towards the sound
 Do not observe as much eyes together
physiologic flexion  Tracking with eyes across
 Lifts head to 45 degrees midline horizontally
when placed on tummy
 Pushes through elbows when
placed on tummy
 May not take weight in
standing
 3 Months
Months Gross Motor Fine Motor Speech/Language
3 Months  Head in midline in supine  Briefly holds a thin light  Facial Expressions more
 Hands in midline when in toy when placed in hand varied
supine  Reaches with vision more  Sounds often associated with
 Prone, head between 45- than arms movement of body
90  Batting at toys under baby
 Pull to sit-able to lift head gym, continues to over
last 30-40 degrees of arc swipe
of motion  Hands to mouth all the
time!
Typical Development Signs to watch for
Typical Physical Development
While laying on tummy • Difficulty lifting head
• Pushes up on arms • Stiff legs with little or no movement
• Lifts & Holds head Up • Pushes back with head
Typical Speech Development • Keeps hands fisted and lacks arm movement
• Sucks & swallows well during feeding
• Quiets & smiles in response to sound or voice
• Coos or vocalizes other than crying
• Turns head toward direction of sound
Typical Play Development
While lying on their back
• Visually tracks a moving toy from side to side
• Attempts to reach for rattle held above their chest
• Keeps head in the middle when watching faces or
toy
 Typical Development 4 Months To 9 Months
Months Gross Motor Fine Motor Speech/Language
4  Period of active symmetry  Hands open most of the time • Variation of vowel
 Mirrored movements of arms and  Hand to hand play sounds
Months legs  Starting to grab objects with • Begins consonant sound
 Hands to knees when in supine
more directed movement of production
 Rolls to side when in hands to
knees position
arms • Begins babbling
 Prone on elbows with head 45 -  Tolerates/enjoys a variety of • Recognizes and responds
90 degrees sensory input in daily routines to own name
 Elbows below or in front of  Able to dissociate eye
shoulders movement from head
 When in standing legs are loose, movement
not locked, will play with small  Smooth tracking horizontally
bend/straighten of knees and vertically across midline
 Likes to stand with hands held
 Months Gross Motor Fine Motor Speech/Language
5 Months  Hands to feet when in  Banging toys • Moving towards sucking
supine  Reaching in all pattern for bottle/breast
 Prone on extended directions • Babbling 3-4 syllables at
arms  Improved a time
 Rolls to supine from directionality of
prone movement in arms
 Pull to sit NO head  Transfers objects from
lag and assists with hand to mouth
movement by pulling  Reaches with both
with arms arms
 Prop sitting
 Month Gross Motor Fine Motor Speech/Language
s
6 Months  Rolls from supine to  Transfers objects hand • True suck with up/down
prone to hand tongue movement
 Brings feet to mouth  Explores objects in • Begin cup drinking - may
 Reaching in prone on mouth see cough/choking at
extended arms  Banging, shaking, beginning due to
 Sits without upper mouthing irregularity of volume of
extremity support liquid
 Will bounce when in • Vocalizes for social contact
standing • Spoon feeding
 By 6 month
Typical Development Signs to watch for

Typical Physical Development •Rounded back

• Uses hands for support in sitting •Unable to lift head up
• Rolls from back to tummy •Poor head control
• While standing with support, accepts entire weight •Difficulty to bring arms forward to reach out
with legs
•Arches back and stiffens legs
Typical Speech Development
• Begins to use consonant sounds in babbling. e.g •Arms held back
'dada' •Stiff legs
• Uses babbling to get attention
• Begins to eat cereals and pureed foods
Typical Play Development
• Reaches for a nearby toy while on their tummy
While lying on their back...
• Transfers a toy from one hand to the other
• Reaches both hands to play with feet
Months Gross Motor Fine Motor Speech/Language
7 Months  Does not like supine, will  Starts to use thumb and  Gives appropriate gestures to
often roll out of it finger for pincer simple commands e.g. up,
 Achieves a variety of belly off  Can hold 2 objects and bye-bye, no
ground positions, e.g. hands reach for third  Enjoys vocal play with others,
and knees  Reaching purposefully for laughs when own sounds are
 Rocking in hands and knees objects imitated
 Pivots on when on tummy  Begins finger feeding  No used to express dislike
 May belly crawl  Uses both hands for tasks  Begins thoracic breathing
 Plays in side-lying •Pull to sit equally, NO
will bring legs off surface to HANDEDNESS
assist with movement OBSERVED until 2-3 years
 Pulls self to stand with of age
caregiver's hands
 Months Gross Motor Fine Motor Speech/Language
8 Months  Rarely plays in supine  Visually interested in detail  Disappearance of rooting
 Plays in prone, side-lying -  Mouthing decreased, looks reaction
and sitting and inspects objects more  Begins to separate sound
 May Creep on hands and  Bangs toys together production from body
knees a few cycles movement
 Assumes sitting from the floor  Exploring spatial concepts,
independently in/out, on/off, up/down
 May pull to kneel at a surface  Imitation skills increase both
 Pulls to stand using arms in gestures and familiar
more than legs sounds
 Months Gross Motor Fine Motor Speech/Language
9 Months  Creeps on hands and knees for long distances as  Holds and  Controlled bite for
primary means of locomotion drinks from a firm solids
 Uses a variety of sitting positions due to strong bottle while in  Begins to eat mashed
trunk sitting table food
 Pulls to stand using more lower extremity
movement
 Climbs up stairs, hands and knees
 By 9 month
Signs to watch for
Typical Development
Typical Physical Development
•Uses one hand predominately
• Sits and reaches for toys without falling
• Rounded back
• Moves from tummy to back Into sitting
•Poor use of arms In siting
• Creeps on hands and knees with alternate arm and leg
•Difficulty crawling
movement
•Uses only one side of body to move
Typical Speech Development
•Inability to straighten back Can not take
• Increases variety of sounds and syllable combinations in
weight on
babbling
• Looks at familiar objects and people when named
• Begins to eat junior and mashed table foods
Typical Play Development
• In a high chair, holds and drinks from a bottle
• Explores and examines an object using both hands
• Turns several pages of a chunky (board) book at once
• In simple play, imitates others
 TYPICAL DEVELOPMENT
10 MONTHS TO 15 MONTHS & RED FLAGS
Month Gross Motor Fine Motor Speech/ language
10 Months • Creeping continues to be • Work on different • Uses objects to reach goal
primary means of locomotion. groups shows problem solving
• Pull to stand using ½ kneel • Lots of manipulation of • Long chains of different
• Begins cruising along toys consonant vowel combinations.
furniture. • Desire for independence
observed in motor & feeding
 Month Gross Motor Fine Motor Speech/
language
11 months • Decreased use of upper extremities for • Full overhead reach
standing. • Will release objects with good
• Stands momentarily independently accuracy into a container
• Proficient at cruising. • Combines vision reach and grasp
• Squats to retrieve a toy and return to well
standing. • Primitive tool use
• Cruising between furniture out of reach • Holds toy with one hand and
(1-2 feet) manipulates with other.
Month Gross Motor Fine Motor Speech/ language

12 Months • Stands from the floor • Uses hands well in sitting • Mat have consistent 2-3 words.
independently. • Uses hands for transitions • Uses jargon (with inflection) to
• Stands independently for a longer • Enjoy climbing converse with toys, pets, people
period of time • Points to desire objects with • May vocalize some familiar songs
• Walks with hands held index finger. with melody and intonation.
• May begin to take some steps • Begins goal directed play.
independently.
Typical Physical Development:
• Pulls to stand and Cruises along furniture.
• Stands alone and takes several independent steps
Typical Speech Development: Sign to watch for
• Meaningfully uses “Mama” or “Dada”
• Difficulty getting to stand because of stiff legs and
• Responds to smile commands e.g “Come here”
pointed toes
• Produces long strings of gibberish (jargoning) in social
• Only uses arms to pull up to standing
communication.
• Begins using an open cup. • Sits with weight to one side
Typical Play Development: • Strongly flexed or stiffly extended arms
• Finger feeds self. • Needs to use hand to maintain sitting.
• Releases objects into a container with a larger opening
• Uses thumb and pointer finger to pick up tiny objects.
 Month Gross Motor Fine Motor Speech/ language
Other • Stair climbing, walking up and stairs • Imitates a vertical line 18 – 24 • 10-15 words, 18 months
Milestones with support from a wall 18 -24 months months. • Combines to words 24
• Jumping off floor 18-24 months • Copies a circle 28 – 36 months.
• Riding Tricycle, 3 years months. • Uses plurals 21-36 months
• Dresses self without • Completes simple puzzles
supervision 2 ½ - 3 years 18 – 28 months.
Typical Physical Development:
• Walks Independently and seldom falls
• Squats to pick up a toy
Typical Speech Development:
• Vocabulary consists of 5 – 10 words
• Imitates new less familiar words
• Understands 50 words
• Increases variety of coarsely chopped table foods.
Typical Play Development: Sign to watch for
• Stacks two objects or blocks • Unable to take steps independently
• Helps with getting undressed • Poor standing balance, falls frequently
• Holds and drink from a cup. • Walks on toes.
 RED flags that should prompt Assessment
• Rolling prior to three months  Evaluate for Hypertonia
• Head observed to rotate or tilt to one side only  Evaluate for Torticollis, Visual Deficits.
• Persistent fisting by three months  Evaluate for neuromuscular dysfunction.
• Failure to alert to environmental stimuli  Evaluate for sensory impairment.
• Head lag when pulled to sit after 4 months of age  Evaluate for hypotonia.
• Failure to reach for objects by 5 months  Evaluate for motor, visual or cognitive deficits.
• Inability to proper sit by 6 months  Evaluate for hypotonia.
• Absent smile by 4-6 months  Evaluate for visual loss, attachment problems, maternal major depression.
• Persistence of primitive reflexes after 6 months  Evaluate for neuromuscular disorder.
• Absent babbling by 6 month  Evaluate for hearing deficit.
• Absent stranger anxiety by 7 months  may be related to multiple care providers.
• W sitting and bunny hopping at 7 months  Evaluate for hypertonia or hypotonia
• No back and forth sharing of sound, smiles or other facial expression by age 9 months or thereafter 
Evaluate for autism of pervasive developmental disorder.
• Lack of tool use (Crayon, Spoon) by 12 months  Evaluate for fine motor and cognitive delay.
 RED flags that should prompt Assessment
• Lack of imitative play by 18 months  Evaluate for hearing deficit or cognitive/ socialization
deficit,  Evaluate for autism
• Hand dominance prior to 18 months  Evaluate for hemiplegia or brachial plexus injury.
• Lack of prodeclarative pointing by 16 months of age  Evaluate for autism due to problem in
social relatedness.
• No first word, other than mama/Dada by 18 months  Evaluate for auditory expressive
language delay.
• Does not follow simple 1 step commands by 15 months  Evaluate for receptive language
delay
• Persistent poor transition by 24 months  Evaluate for pervasive developmental disorder.
• No two word sentences by 2 years  Evaluate for auditory expressive language delay
• Advance non communicative speech (Echolalia) by 24 months  Evaluate for autism or
pervasive developmental disorder.
• Any loss of speech  Babbling or social skills at any age,  Evaluate for autism or pervasive
developmental disorder.