DEVELOPMENTAL MILESTONES
Presented by Moderator
Dr (Maj) Tamanna Nain Lt Col Abhishek Pandey
Junior Resident Cl Splst Paediatrics and
Department Of Paediatrics Paediatric Neurology
Department of Paediatrics
I regard developmental examination as an essential part of everyday practice with a minimum of
equipment, in an ordinary mixed clinic, and not in a special room, or at a special time, or with special
complicated equipment or by a special doctor”
Ronald. S. Illingworth
Specific Learning Objectives
Principles of Development
Domains of development
Red Flags
References
Ghai Essential Paediatrics , 10th Edition
Definition
Development is the maturation of function and acquisition of
variety of skills for functioning optimally in a society
PRINCIPLES DEVELOPMENTS
PRINCIPLES DEVELOPMENTS
PRINCIPLES DEVELOPMENTS
PRINCIPLES DEVELOPMENTS
PRINCIPLES DEVELOPMENTS
PRINCIPLES DEVELOPMENTS
Normal Development
Factors affecting development
• Prenatal factors
i. Genetic factors
ii. Maternal Factors- Nutrition ,exposure to drugs and maternal disease and
infections
• Neonatal Risk factors
i. Small for gestational age status
ii. Prematurity
iii. Perinatal asphyxia
iv. Hyperbilirubinemia
Normal Development
• Post neonatal factors
i. Infant and Child nutrition
ii. Infectious diseases
iii. Environmental toxins
iv. Acquired insults to brain and associated imapirements
• Psychosocial factors
i. Parenting
ii. Lack of nurturing conditions
iii. Violence and abuse
iv. Maternal depression
v. Instutionalization
Normal Development
• Protective Factors- Breastfeeding ,kangaroo mother care ,optimum
nutrition ,absence of illness ,nurturing family ,secure home ,exposure to
stimulating environment and educated parents.
Reflexes
Reflexes
Asymmetric Tonic neck reflex (ATNR) ‐ appears 35 weeks,
disappears 2‐3 months
Reflexes
Palmar grasp ‐ appears 28 weeks, disappears
2‐3 months
Reflexes
Moro ‐ appears 28‐32 weeks, disappears 5‐6
months
Reflexes
Landau‐appears 3 months , disappears around 1 year
Reflexes
Parachute ‐ appears 6‐9 months remains throughout life
Domains of development
• Gross motor
• Fine motor and skills
• Personal ,social and general understanding
• Language
Gross Motor
• Supine and Pull to sit at birth
Gross Motor
• Pull to sit : Minimum head lag at 4 months
Gross Motor
• Pull to sit : Child has complete neck control and is able to flex head onto chest at 5
months
Gross Motor
• Ventral Suspension : Unable to hold the neck in line with trunk at four weeks
Gross Motor
• Ventral Suspension : Head in line with the trunk at 8 weeks
Gross Motor
• Ventral Suspension : Head in line with the trunk at 12 weeks and can hold head above
horizontal plane
Gross Motor
• Prone Position: At 2 weeks baby lies on the bed with knees drawn under the pelvis
Gross Motor
• Prone Position: Lies with flat pelvis and extended hips at 6 weeks
Gross Motor
• Prone Position: Face at 45 degrees at eight weeks
Gross Motor
• Prone Position: Face , head and chest off the couch at three months
Gross Motor
• Prone Position: Weight on hands with extended arms at six months
Gross Motor
• Prone Position: Creeping at 10 months
Gross Motor
• Prone Position: Bear walk at 12 months
Gross Motor
• Sitting: Back rounded but holding the head at eight weeks
Gross Motor
• Sitting: Back straight at four months
Gross Motor
• Sitting with support at 6 months
Gross Motor
• Sitting without support at 8 months
Gross Motor
• Pivoting : Turns around to pick up an object at 11 months
Gross Motor
• Standing and walking : Bear almost entire weight at six months
Gross Motor
• Pulls to stand at 9 months
Gross Motor
• Stands holding furniture at 9 months
Gross Motor
• Cruising around furniture at 10 to 11 months
Gross Motor
• Stands independently at 12 months
Gross Motor
• Walking with one hand held at 12-13 months
Gross Motor
• Walks independently at 15 months
Gross Motor
• Runs at 18 months
Gross Motor
• Walking upstairs and downstairs one foot per step at 4 years
Gross Motor
• Ride tricycle at 3 years and hops at 4 years
Gross Motor
• Gross motor key milestones
Gross Motor
Fine Motor
• HAND REGARS (BETWEEN 12 AND 20 WEEKS
Fine Motor
• THE CHILD BEGINS HANDS IN THE MIDLINE AS HE PLAYS AT 3 TO 4 MONTHS
Fine Motor
• FIXES ATTENTION ON A RING AT 4 MONTHS
Fine Motor
• BIDEXTROUS GRASP APPROACH TO A DANGLING RING AT 4 MONTH
Fine Motor
• IMMATURE GRASP AT 6 MONTHS
Fine Motor
• CRUDE RADIAL GRASP AT 8-10 MONTHS
Fine Motor
MATURE RADIAL GRASP AT 1 YEAR OF AGE
Fine Motor
• LOOKS FOR DROPPED CUBE AT 9 MONTHS
Fine Motor
• Pokes at small objects at 9-10 months
Fine Motor
• Immature pincer pincer grasp at 10 months
Fine Motor
• Mature pincer grasp at 10 months
Fine Motor
• Chew biscuits at 6 months
Fine Motor
• Child mouthing an object at 6 months of age
Fine Motor
• Feeding from a cup without spilling at 15 months of age
Fine Motor
• Feed herself well using spoon at 18 months
Fine Motor
• Turn 2-3 pages of book at 15 months
Fine Motor
• Scribbles on paper at 15 months
Fine Motor
• Unscrew the lid at 18 months
Fine Motor
• Makes a tower of 5-6 cubes at 2 years of age
Fine Motor
• Builds a tower of 9 cubes at 3 years
Fine Motor
• Key Fine motor milestones
Personal and social development
• Baby shows intent regard for his mother's face as she talks to him
Personal and social development
• Social smile at 2 months of age
Personal and social development
• Child smiles at himself in mirror at 6 months of age
Personal and social development
• Stranger anxiety at 6-7 months
Personal and social development
• Domestic mimicry at 18 months
Personal and social development
• Infant fixates on mother as she talks to her at 1 month
Personal and social development
• Grasping with the eye at 3 months
Personal and social development
• Diagnol localization of the source of sound at 10 months
Personal and social development
• Drawing a man at 4 years
Language milestones
Red Flags
Red Flags
Red Flags
Red Flags
Thank you
