Normal Develolpment

NEWBORN – Minutes old

•Physiological Flexion
•Brings hands to mouth ( due primarily to proximity)
•Visual preference 8-12 inches
•Highly relies on vision for the first three months

Newborn-Prone -First 10 days

•Head is rotated to the side

–Since his is greater than 45
degrees, What is being stretched?

•Shoulders are adducted toward
body and elbows are flexed

•Hips and knees are flexed under
body

•Increased weight bearing on the
face (due to the anterior pelvic
rotation over flexed LE)

•Shoulders elevated off the surface

What do you see?

•upper and lower extremities are
symmetrically flexed

•He LIKES to be in prone and how
relaxed he is

•Hips elevated off the surface,
increased weight bearing on the
face

Newborn-Supine-First 10 days

•Head rotation is less than 45
degrees

•Notice the symmetry of the body

•upper extremities very flexed but
hands are soft and relaxed

•LE’ s flexed

Prone-2 weeks old

•Eyes are lifting up and the forehead is
creased, this means that he is using
tonic activation of his cervical
extensors to lift his head off the
surface – strengthening capital
extensors

•The eyes leading the movement is
called Optical righting – where the
infant tries to right the eyes to
horizontal with the horizon

•mouth is slightly opened, which
suggests that he is also working hard

•As he lifts and turns head side to side
he is stretching the hyoids and
Sternocleidomastoid bilaterally

Prone-2 weeks old

•A towel roll placed under his chest
moves the weight posterior –
Facilitating- his head higher off
the surface.

•Notice again the furrowing of the
brow and how the vision directs
the movement – suggests tonic
lifting of the cervical extensors

Prone- 2 Weeks

•Notice hand to mouth when in
prone

•Less weight is shifted cephalically

•The shoulders are closer to the
mat-suggesting decreasing
physiologic flexion

•Notice the relaxed hands

•Hips are less flexed.

Supine- 2 weeks

•Still has physiologic flexion, but
less

•flexed symmetrically

•Head is rotated more than 45
degrees

•Gravity is pulling UE into ‘neutral’
shoulder rather than adducted and
IR

Sitting-

•Supported sitting – the pelvis is
vertical

•Forward flexion head, neck and
trunk

•relaxed hands

1 month- supported sitting

• Although active

movements are
present, symmetry is
apparent.

• May hold a toy when

placed in extended
arm but unlikely to
bring it to mouth

Standing-1 Month

•Positive support

•takes weight when placed on feet

•Demonstrates slightly increased
activation of extensors when
placed in positive support posture

1 month

Supine
•Full neck rotation

•With increasing ROM there is not
always simultaneous increase in
control- this child can not yet
maintain his head in midline constantly
due to the pull of gravity.

Prone- 2 months

•Clearing head when in prone-
usually to 45 degrees

•Notice kicking movements of the
lower extremities- What is his
ROM like now?

Prone- 2 months

•Demonstrating nice lifting of his
head with elbows behind
shoulders taking some weight

•Notice he is still using elevation of
frontalis muscle (forehead) and
lifting of eyes to lift the head –
this suggests tonic lifting of the
head

•Notice the elbows are behind the
shoulders – at 3 months the
elbows will be under the shoulders

•What is being elongated?
(stretched)

•What is being strengthened?

Supine- 2 months

•2 months is the period of
MAXIMAL asymmetry.

•Infants at two months
demonstrate decreased tone in
their upper and lower extremities

• demonstrating an ATNR

2 months- Sitting

•Notice improved head control
when in supported sitting

•The head typically should be more
elevated and midline (His head is
a little side bent just due to when
the picture was taken!)

2 months- supported standing

•Attempted positive support –
infants at 2 months typically do
not take weight on lower
extremities during positive support

•He is no exception!!! He does not
take weight during positive
support

3 months-prone

• Notice how much better prone

is – elbows are under his
shoulders demonstrating
improved shoulder girdle
control

• You can kind of see the

increased anterior pelvic tilt of
the pelvis in this picture –
therefore lengthening of the
abdominals, hip flexors, recturs
femoris, iliopsoas

3months- prone

•Labrythine head righting stronger –
therefore head is lifted higher

•Nose to 90 degrees with the horizon

•He is demonstrating stability in this
posture, not skill. He is not able to
reach and play with toys at this time or
hold this for several minutes.

•As he weight shifts from side to side
(as you see here he is shifting to the
right) what is lengthening?

•As he lifts head up – What is
strengthening?

3 months -Supine

•Three months is the period where
the infant starts to demonstrate
excellent midline control.

•Notice the chin tuck – this signifies
improved flexor control

•Increased midline orientation of
the head

•Notice the relative symmetry of
the upper extremities – this is
typical for three months

3 months-Prone

Progression
• UE reaching—same side

then across midline

• Landau begins
• Rolls to supine by 5 mos
• Progression to controlled

mobility in the form of
crawling and creeping
later

Photo of full Landau and
same side reaching

Landau reflex

Supine-4 months

• Still active symmetry but

there is control and
functional goals

• Against gravity shoulder

flexion with elbow
extension and hand
flexion to grab feet and
other objects placed in
front of them.

Prone-4 months

• Head lifted 45-90

degrees

• Elbows below or in

front of shoulders

• Standing—Likes to

stand with both hands
held

Sitting- Positions

• Ring sit propped forward on extended

elbows, then without UE support

• Indep sitting normally at 6 mos
• Half long sit/ half ring sit
• Long sit
• Side sit

Sitting progression

Prop Sitting

Ring sitting

Advanced Sitting Postures

Sidesitting

Longsitting

Functional Mobility

• Rolling supine to prone volitionally occurs by 6 mos.
• Pivot prone—7 mos.
• ‘commando crawling’- belly crawling—7-8 mos.
• Bear crawling
• Creeping (hands and knees)- reciprocal—8-9 mos.. What

if it is not? ‘Salamander's

Upright mobility

• Stands holding onto furniture/

bounces (5-8 months)

• Pulls to stand (6-9 months) various

quality until 12 months

• Pulls to stand using half kneel (by 9

months)

• Most children by a year old can

stand without pulling with upper
extremities.

Walking:
Cruising- immature
• Along furniture to
• Between furniture

(1-2 feet)

• Slowed, accurate

stepping

• Indep amb by 14

mos.

Upright mobility

Pulling to stand thru ½
kneel

Cruising at furniture

Upright Mobility

Amb with lordotic
posture and mid-guard

Squat to stand