Part I

What is developmental milestones?

This is an assessment of what the child is capable of doing with respect to the age of the child.

Early childhood development can be divided into four functional skill areas:

i) Gross motor.

ii) Fine motor and vision

iii)Speech, language and hearing

iv) Social, emotional ,behaviour.

Why should a child’s development be assessed?

Most parents wish to know if their child’s development is normal

A young child’s development should be assessed for the following reasons:

i) Parental concern.

ii)As part of a child health surveillance programme.

iii)Should always be assessed if the child is seen for another reason by a health professional.

What are the factors which affect the eventual attainment of development milestones?

The development of a child is an interaction of hereditary and the environment on the developing brain.

The potential of the child is determined by heredity ,while the environment determines the extent to which he achieves that potential.

The environment is very important for the development of speech, language and social skills.

Developmental Milestones

Gross Motor Development

In the first 18 months of life there is fast gross motor development. Black infants achieve the motor development milestones at an earlier age than whites or Asian’s. However this is not an indicator of later cognitive and language abilities.

1) Acquisition of Tone and Head Control:

Muscle tone increases gradually in infancy. This enables infants to sit, stand and achieve head control. Head control can be easily tested by pulling up the arms, if there is marked head lag head control has not been achieved yet.

Head control is achieved at the age of 6 weeks (that is if the baby is in a prone position he can raise his head and move it from side to side. At the age of 3 months the infant should be able to hold his head upright when held sitting.

2) Disappearances of the Primitive Reflexes:

Newborn infants have primitive reflexes which include the moro reflex(on head extension), grasp reflex (when an object is placed on the palm of the hand), the stepping and atonic reflexes. These reflexes will be discussed in a subsequent post.

These primitive reflexes should disappear by the age of 4 to 6 months to allow the progression of motor development.

3) Sitting:

Infants should be able to sit without support at the age of six months.

4) Crawling:

Infants should be able to crawl at the age of 7 months. They may also bottom-shuffle or commando crawl (creeping).

5) Standing with support:

Infants are usually able to stand with support (usually holding onto furniture) at the age of 10 months.

6) Standing Unsupported:

This is usually achieved at the age of 12 months. Just like the other development milestones, there is slight variation among infants on the age. eg the percentage of children who are walking unsupported are:

-25% by 11 months

-50% by 12 months

-75% by 13 months

-90% by 15 months.

97.5% by 18 months.

7) Running, Jumping, Pedalling and Hopping:

These are usually achieved at the age of 20 months

Fine Motor Development

1) Hand Regard:

Infants spend a lot of time looking at their hands at the age of 3 to 4 months, this is known as hand regard.

2)Grasp Reflex:

The newborn infant grasps an object placed across the palm of the handThis is  a primitive reflex and it disappears giving way to the palmar grasp.

3) Palmar Grasp Reflex:

This is the ability of the infant to grasp with the whole hand. This is achieved by the age of 6 months.

4) The Pincer Grasp:

This is the ability of the infant to hold objects with the thumb and the second or third finger. This is usually achieved at 10 months of age. It is a refined form of palmar grasp reflex.

5) Handling and Transferring Objects:

This is achieved by six months of age. Transfer of objects from one hand to another is also achieved by the age of six months. There is no hand dominance in the first year of life.

6) Building bricks, writing,cutting,dressing and manipulation of small objects:

Pencil scribbling is usually achieved at 14 months.

Other development milestones such as vision, speech, hearing, social and emotional behavior etc will be covered extensively in Part II of this post .

References:

Pages 21 to 29 . Chapter 3. Child Development, Hearing and Vision. Illustrated Textbook of Paediatrics. 2nd Edition by Tom Lissauer and Graham Clayden.

Chapter 13. Part IV. General Pattern of Growth and Development by K.E.O Nkaginieme. Paediatrics and Child Health in a Tropical Region, by J.C. Azubuike and K.E.O. Nkaginieme.

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