CHILD NEUROLOGICAL DEVELOPMENT 0 - 5 YEARS

 PRINCIPLES OF DEVELOPMENT :

• Development is a continuous process from conception to maturity.
• Sequence of development is same in all children but rate varies.
• Development is intimately related to the maturation of the nervous system.
• Generalized mass activity is replaced by specific individual responses.
• Development is in cephalocaudal direction.
• Certain primitive reflexes, such as the grasp reflex and walking reflex, have to be lost before the corresponding voluntary movement is required.

THE AVERAGE LEVEL OF DEVELOPMENT AT DIFFERENT AGES

Following, the sequence of development in locomotion, manipulation and other fields, basing it almost entirely on the work of Arnold Gesell is explained.

IMAGE COURTESY : The University of Utah

4 WEEKS: 1 MONTH :

A. GROSS MOTOR :

1. Ventral Suspension: (held in prone position with hand under abdomen)

• Head is up momentarily.
• Elbows flexed, hips partly extended, knees flexed.

2. Prone:

• Pelvis high, knees drawn up largely under abdomen. Intermittent partial extension of hip and knee. Momentarily lifts chin off couch. Head predominantly to one side.

3. Pulled up to sit:

• Almost complete head lag.

4. Held in sitting position:

• Back uniformly rounded. May hold head up momentarily.

 5. Supine:

• ATNR seen when at rest.

 6. Held standing:

• Flops at knees and hips. Walking reflex when sole of the foot is pressed on the surface.

B. HANDS :

• Predominantly closed. Grasp reflex present.

C. GENERAL UNDERSTANDING :

• Watches mother’s face when she talks.
• Opens and closes mouth.
• Bobs head up and down.

D. VISION :

• In Supine – Regards dangling objects, when brought into line of vision (3 feet from the eyes), but not otherwise when in midline. Follws it less than 90 degrees.

E. SOUND :

• Quiets when bell is rung.

6 WEEKS: 1.5 MONTHS :

 

A. GROSS MOTOR :

• A. Ventral Suspension: Head held up momentarily in same plane as the body. Some extension of hips and knees.
• B. Prone: Knees no longer under abdomen.
• C. Pulled to sit: Considerable head lag.
• D. Held in sitting position: intermittently holds head up.
• E. Held standing: head sags forward.
• F. Supine: ATNR intermittently seen at rest.

B. HANDS :

• Often open. Grasp reflex may be lost.

C. GENERAL UNDERSTANDING :

• Smiles at mother in response to overtures.

D. VISION :

• Eyes fixate on objects, follow moving persons. In supine lying looks at object held in midline, following it as it moves from side to midline (90degrees)

8 WEEKS: 2 MONTHS :

A. GROSS MOTOR :

• A. Ventral suspension- Can maintain head in same plane as rest of the body.
• B. Prone: head in midline, intermittently lifts chin off couch so that plane of the face is at angle of 45 degrees.
• C. Pulled to sit: less head lag.
• D. Held in sitting position: less rounding of back. Head is held up but recurrently bobs forward.
• E. Supine: Head chiefly to side. ATNR seen intermittently.
• F. Held in standing position: Can hold up head more than momentarily.

B. HANDS :

• Frequently open. Only slight grasp reflex.

C. VOCALIZATION :

• Smile and vocalizes when talked to.

D. VISION :

• Fixation, convergence and focusing. Follows moving person. In supine- follows dangling toy from side to point beyond midline.

12 WEEKS: 3 MONTHS :

A. GROSS MOTOR :

• A. Ventral suspension: Head held up for prolonged period of time beyond plane of rest of the body.

• B. Prone: Pelvis flat on couch. Weight is borne on forearms.

• C. Pulled to sit: only slight head lag.

 

• D. Supine: ATNR absent.

B. HANDS :

• No more grasp reflex. When rattle is placed in hand, holds it for a minute or more.

C. VOCALIZES :

• Squeals of pleasure. ‘Talks’ a great deal when spoken to.

D. VISION : 

• Supine- Hand regard. Follows dangling toy from side to side. (180 degrees). Promptly looks at object in midline.

E. HEARING :

• Turns head to sound.

16 WEEKS: 4 MONTHS :

A. GROSS MOTOR :

• Prone: head and chest is off the couch so that the plane of face is at an angle of 90 degrees to the couch.
• ‘Swimming’: limbs stretched out in full extension.
• Pulled to Sit: only slight head lag in the beginning of the movement.
• Head in sitting position: head held up constantly.
• Supine: head in midline.

B. HANDS :

• Hand regard still present. Pulls dress over face as he plays. Tries to reach object with hands but overshoots it. Plays with rattle placed in hand for long period and shakes it, but cannot pick it up if he drops it.

C. GENERAL UNDERSTANDING :

• Excites when food is prepared, toys seen, showing massive reaction involving all four limbs and respirations. Shows pleasure when pulled to sitting position. Likes to be propped up.

D. VOCALIZATION :

• Laughs aloud.

E. VISION :

• Supine – immediate regard of dangling object.

20 WEEKS: 5 MONTHS :

A. GROSS MOTOR :

• Prone: weight on forearms.
• Pulled to sit: No head lag.
• Held in sitting position: no head wobble when body is swayed by examiner. Back is straight.
• Held in standing position: bears most of the weight.

B. HANDS :

• Able to grasp objects voluntarily. Plays with toes. Crumples paper. Splashes water in bath. Can objects taken in mouth. CUBE: grasps; bidextrous approach; takes it to mouth.

C. VOCALISATIONS :

• Razzing; ‘Ah-goo’.

D. GENERAL UNDERSTANDING :

• Smile at mirror image. Pats bottle. No more hand regard.

24 WEEKS: 6 MONTHS :

A. GROSS MOTOR :

• Prone: Weight on hands, not forearms; chest and upper part of abdomen off couch.

 

• When about to be pulled to sit, lifts head off couch.

 

• Sits supported in high chair.

•  Held in standing position: Almost full weight on legs.

B. HANDS :

• Holds bottle. Grasps his feet. CUBE: Palmer grasp of cube. Drops one cube when another is given.

C. FEEDING :

• Drinks from cup when it is held to lips.

D. GENERAL UNDERSTANDING :

• When he drops a toy he looks to see where it has gone to and tries to recover it. May excite on hearing steps.
• Mirror- smiles and vocalizes on mirror image. Stretches arms out to be taken. Shows like and dislikes. Many show fear of strangers and are ‘coy’. Shows displeasure at removal of toy.

E. PLAY :

• Laughs when head is hidden in towel.

F. IMITATION :

• Imitates cough or protrusion of tongue.

28 WEEKS: 7 MONTHS :

A. GROSS MOTOR :

• Prone: bears weight on one hand.
• Sits with hands on couch for support.

B. HANDS :

• Feeds self with biscuit. Likes to play with paper. Unidextrous approach.

C. CUBES :

• Bangs cube on table. Transfers it from hand to hand. If he has one cube in hand he retains it when second is offered.

D. FEEDING :

• Chews. Keeps lips closed when he is offered more food than he wants.

E. GENERAL UNDERSTANDING :

• Imitates simple acts. Pats image of self in the mirror. Responds to name. Tries to establish contact with person by cough or other method. Expectation in response to repetition of stimulus.

F. SPEECH :

• Syllables- ba, da, ka.

32 WEEKS: 8 MONTHS :

A. GROSS MOTOR :

• Sits momentarily on floor without support. Adjusts posture to reach object, e.g. leans forward to reach. Readily bears whole weight on legs when supported. May stand holding on.

B. GENERAL UNDERSTANDING :

• Reaches persistently for toys out of reach. Responds to ‘No’. looks for dropped toy.

C. IMITATION :

• Imitates sound.

D. SPEECH :

• Combines syllables- da-da; ba-ba.

36 WEEKS: 9 MONTHS :

A. GROSS MOTOR :

• Prone: in trying to call progresses backwards. May progress by rolling.
• Sits steadily on floor for 10 minutes. Leans forward and recovers balance but cannot lean over sideways.

B. HANDS :

• Can pick up object of size of currant between tip of finger and thumb.

C. CUBES :

• Compares two cubes by bringing them together.

D. GENERAL UNDERSTANDING :

• Puts arms in front of face to prevent mother from washing his face.

40 WEEKS: 10 MONTHS :

A. GROSS MOTOR :

• Prone: Crawl position, on abdomen. Crawls by pulling self forward with hands.
• Sitting: Can go over to prone, or change from prone to sitting. Can pull self to sitting position. Sits steadily with little risk of overbalancing.
• Standing: can stand holding on to furniture. Collapses with a bump.

B. HANDS :

• Goes for objects with index finger.

C. CUBES :

• Beginning to let go of objects (release).

D. GENERAL UNDERSTANDING :

• Looks round the corner for object. Responds to words, e.g. ‘Where is Daddy?’ Pulls clothes of others to attract attention. Holds object to examiner but will not release it. Repeats performance laughed at.

E. IMITATION :

• Waves bye –bye. Plays patacake.

44 WEEKS: 11 MONTHS :

A. GROSS MOTOR :

• Prone: creeps, abdomen off the couch.
• Standing: Lifts foot.

B. CUBES :

• Beginning to put objects in and out of containers.

C. DRESSING :

• Holds arms out for sleeve or foot out for shoe.

D. GENERAL UNDERSTANDING :

• Will not give object to examiner. Drops objects deliberately so that they will be picked up.

48 WEEKS: 12 MONTHS :

A. GROSS MOTOR :

• Prone: When creeping, sole of foot may be flat on the couch.

• Sitting: pivots, twisting round to pick up object.
• Walks, holding on to the furniture. Walks, two hands held.

B. GENERAL UNDERSTANDING :

• Will now give toy to examiner, releasing it. Anticipates body movements when nursery rhymes being said. Shows interest in picture book. Shakes head for “no”.

C. PLAY :

• Plays peep-boo, covering face.

D. SPEECH :

• One word with meaning.

1 YEAR OLD :

A. GROSS MOTOR :

• Walks on hands and feet like a bear. Walks one hand held. May shuffle on buttock and hand.

B. HANDS :

• Mouthing virtually stopped. Beginning to throw objects to floor (casting).

C. GENERAL UNDERSTANDING :

• May understand meaning of phrases. May kiss on request. Apt to be shy.

D. SPEECH :

• Two or three words with meaning knows meaning of more words.

E. SLOBBERING :

• Virtually stopped.

15 MONTHS: 1 YEAR 3 MONTHS :

A. GROSS MOTOR :

• Creeps upstairs. Kneels without support. Walks without help. Can get into standing position without help. Falls by collapse. Cannot go round the corners or stop suddenly.

B. HANDS :

• Casting less.

C. CUBES :

• Builds tower of two. Holds two cubes in one hand.

D. BALL :

• Cannot throw without falling.

E. DRESSING :

• Likes to take off shoes.

F. FEEDING :

• Feeds self, picking up cup, drinking, putting it down. Manages spoon but rotates it near mouth.

G. PENCIL :

• Imitates scribble or scribbles spontaneously.

H. GENERAL UNDERSTANDING :

• Asks for objects by pointing. Mouthing stopped. May kiss pictures of animals. Imitates mother in household duties- sweeping, cleaning.

I. SPHINCTER CONTROL :

• Begins to tell mother that he wants to use pot. Indicates wet pants.

J. SPEECH :

• Jargoning. Several intelligent words.

18 MONTHS :

A. GROSS MOTOR :

• Gets up and down stairs, holding rail without help. Seats self on chair. Begins to jump.

B. CUBES :

• Tower of 3 or 4.

C. DRESSING :

• Takes off gloves, socks, unzips.

D. FEEDING :

• Manages spoon well without rotation.

E. PENCIL :

• Spontaneous scribble. Makes strokes imitatively.

F. GENERAL UNDERSTANDING :

• Domestic mimicry.

G. PARTS OF BODY :

• Points two or three (nose, eyes, hair, etc).

H. BOOKS :

• Turns pages, two or three at a time. Shows sustained interest.

I. SPHINCTER CONTROL :

• Dry by day, occasional accident.

J. SPEECH:

• Jargon. Many intelligent words.

2 YEARS :

A. GROSS MOTOR :

• Goes up and down the stairs alone, two feet per step. Walks backward in imitation (from 21 months). Picks up objects without falling. RUNS and KICKS.

B. HANDS :

• Turns door knob, unscrew lids. Washes and dries hands.

C. CUBES :

• Tower of six or seven.

D. DRESSING :

• Puts on shoes, socks, pants. Takes off shoes and socks.

E. PENCIL :

• Imitates vertical and circular strokes.

F. GENERAL UNDERSTANDING :

• Pulls people to show them toys.

G. BOOKS :

• Turns pages singly.

H. SPHINCTER CONTROL :

• Dry at night if lifted out in the evening.

I. SPEECH :

• Asks for drink toilet food. Repeats things said. Uses ‘I’, ‘Me’, ‘You’. Joins two three words in sentences. Talks incessantly.

J. PLAY :

• Parallel play. Watches others play and plays near them not with them.

2.5 YEARS :

A. GROSS MOTOR :

• Jumps with both feet. Walks on tiptoes when asked.

B. CUBES :

• Tower of eight.

C. PENCIL :

• Holds pencil in hands instead of fists.

D. GENERAL UNDERSTANDING :

• Helps to put things away. Begins to notice sex differences. Knows full name. Knows gender.

E. SPHINCTER CONTROL :

• Attends to toilet without help, except for wiping. Climbs on to lavatory seat.

3 YEARS :

A. GROSS MOTOR :

• Jumps off bottom step. Goes upstairs, one foot per step and downstairs two feet per step. Stands on one foot for seconds. Rides tricycle.

B. CUBES :

• Tower of nine. Imitates building of bridge.

C. DRESSING :

• Dresses and undresses fully.

D. PENCILS :

• Copies circle. Draws a man on request.

E. GENERAL UNDERSTANDING :

• Knows some nursery rhymes. May count up to 10.

F. SPEECH :

• Now constantly asks questions. Uses pronoun.

G. PLAY :

• Now joins play.

3.5 YEARS :

A. PLAY :

• Imaginary companion.

4 YEARS :

A. GROSS MOTOR :

• Goes downstairs one foot per step. Skips on one foot.

B. HANDS :

• Can button clothes fully.

C. GENERAL UNDERSTANDING :

• Questioning at its peak. Tells tall stories. Right- left discrimination.

D. SPHINCTER CONTROL :

• Attends to own toilet needs.

5 YEARS :

A. GROSS MOTOR :

• Skips on both feet.

B. DRESSING :

• Can tie shoe laces.

C. GENERAL UNDERSTANDING :

• Gives age. Distinguishes between morning and afternoon. Compares two weights.

THOSE ABOVE ARE COLLECTED FROM SOME BOOKS AND WEBSITES..

THANK YOU,

SRIKUMARAN PHYSIOTHERAPY CLINIC & FITNESS CENTER