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Develop38.ppt[1]
- 1. Normal Developmental Milestones An emphasis on anticipatory guidance Ana Malinow, MD
- 2. Why we should teach parents about development Parents who understand their childᾼs 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.
- 3. Objectives • Principles of development • Primitive Reflexes • ᾿ Locomotion῀ : Gross Motor • ᾿ Manipulation῀ : Fine Motor • ᾿ Cognitive῀ : Language and Social • Behavior and Personality
- 4. 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
- 5. Development Occurs in a Cephalocaudal Direction
- 7. 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
- 8. All primitive reflexes develop during gestation and disappear by the 3 rd to 6th month after birth
- 10. Primitive reflexes • Tonic labyrinthine reflex • Asymmetric tonic neck reflex • Positive support reflex
- 11. Declining intensity of primitive reflexes and increasing role of definitive motor actions
- 12. Gross motor development ᾿ Locomotion῀
- 13. Locomotion begins with head control
- 14. Assessing Locomotion • Ventral suspension NB-3m • Sitting position NB-8m • Prone position NB-9m • Standing/Forw. Walking 9m-18m • Running/Backw. Walking 2 yrs • Balancing 3 yrs +
- 16. Head control
- 17. 2 month head control
- 18. 4 month head, arm control
- 19. 6 month head, arm, trunk control
- 20. 8 month head, arm, trunk, leg control
- 21. 9 month pulls up to stand
- 22. 12 month old locomotion
- 23. 2 year old Running Backward Walking
- 24. 3 year old Balance
- 25. ᾿ Manipulation῀ Fine Motor Development
- 26. Manipulation: Assessing the pincer grasp from 0-6m • NB primitive • 1m primitive • 2m starting to lose • 3m voluntary on ulnar • 4m hands together • 5m palmar grasp • 6m hand-mouth-hand; hand-to-hand
- 27. Manipulation: Assessing the pincer grasp 7-12 m • 7m thenar side, raking • 8m 1 block in each hand • 9m radial-digital grasp; inferior pincer • 10m index finger isolation • 12m fine pincer • >12m letting go, stacking
- 28. ᾿ Cognition῀ Social Development Problem solving Play Causality Language Development
- 29. Assessing cognitive development Problem solving • NB visual exploration • 4-6wks smiles, fixes, follows • 2m imitates mouth movements • 3m anticipates feeds • 5m object permanence • 6m looks to floor when toy dropped • 7m grabs 2nd cube, drops first • 8m seeks object after fall (silent) • 9m uncovers hidden object under cloth • 10m isolates index finger
- 30. Assessing cognitive development Play Age Play stage Piagetian stage <12m sensory-motor sensory-motor 12m-18m functional sensory-motor 18m-24m symbolic sensory-motor 2-5y imaginary/magical pre-operational 6y logical thinking concrete operation 11y + hypothetical formal operational
- 31. 12-month 18-month Functional Play
- 32. 18-month 24-month Symbolic Play
- 34. 6 year old Logical Thinking
- 35. 11 years + Hypothetical thinking
- 36. Assessing cognitive development Causality Age Cause Effect Early cries mom comes Early smiles mom responds 4m kicks crib mobile moves 8m pulls string gets ring 10m funny +response/repeats 24m winds key toy moves
- 37. Conversational speech probably starts with smiling
- 38. 2 month old language
- 39. Assessing cognitive development: Language Age Milestone 4-6wks smiles 2m vocalizes with vowels 3m vocalizes with consonants 4m squeals 6m syllables 7m non-specific combinations 8m imitates sounds, understands ᾿ no῀ 12m 1-3 words
- 40. 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
- 41. Behavior • One-way or two-way interactions • Prenatal factors • Bonding/attachment • CNS maturation • Match • Schedule • Language • Instincts
- 42. Behavior -continued- • Cognitive, gross and fine motor development • Illness, separation, feeding issues • Birth order, family size • Secondary attachments • Environment • Gender identification
- 43. Bonding
- 44. Personality • Factors that influence behavior • Create behavior • Through adaptability and flexibility • Produce personality/social behavior
- 46. 4 month old ᾿ Personality῀
- 48. 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 anotherᾼ point of s view • Adolescence begins identity formation (idealistic) • Adulthood completion of identity formation
- 49. 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