DEVELOPMENTAL MILESTONES Age Newborn
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Flexor tone predominates (physiologic fexion) In prone, turns head to side Automatic refex walking Rounded spine when held sitting
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6 month
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8 months
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- months
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Attempts to li%t head in midline Fencer7s posture Astasia Abasia Rolling supine to side$lying non$ segmentally /eginning midline head control ead midline, ead held when pulled to sit In prone li%ts head at 9+:
Fine Motor Adaptive ands !sted "rasp refex #tate$ dependent ability to !x and %ollow bright ob&ect
Personal/ So Social •
abituation and some control o% state
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Speech and Language 'ry #tate dependent uieting and head turning to rattle or *oice
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#ensorimoto r +$- .os Refex stage
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Emotional
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/asic trust *s basic mistrust0 ( !rst year) Normal symbiotic phase does not di1erentiate between sel% and mother
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and grasp refex (birth to -23 mos) 4isual regard (birth to mos)
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#wipes with whole hand ($8 mos)
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4isually directed reaching (8$3 mos) .idline clasping o% hands (8$3 mos) ands mostly open .idline hand play 'rude palmar grasp
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Recogni;es bottle
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5urns 5urns o% *oice and bell consistently
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'ircular reaction, the interesting result o% an action moti*ates
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3 months
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and li%ts chest slightly 5urns to supine
=>?, head to 9+ degrees, chin tuck ands to midline @nilateral reaching prone$on$ elbows =rone$on$ extended$arms =i*ot prone posture /eginning intra$axial rotation Rolling prone to supine, segmentally ead li%ting in supine #upine, hands to knees and %eet #upine, hands to %eet #upine, %eet to mouth =ropped sitting
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Responsi*e *ocali;ation /lows bubbles, raspberries
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Reaches out to grasp ob&ect (-$ 3 mos)
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=lays with %eet bangs ob&ects together 'rude palming, ulnar !ngers predominating (3$B mos)
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#upine bridging
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C months
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B months
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Rolling supine to prone, segmentally Ring sitting, unsupported with %ull trunk extension and high guard 5rans%erring ob&ects hand to hand .aintains sitting, may lean on arms Rolls to prone /ears all weight,
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5rans%ers ob&ect %rom one hand to the other
Intermediate grasp 5rans%ers cube %rom hand to hand /angs ob&ects
/egan to di1erentiate between mother and sel%, i0e0, beginning o% separation indi*iduation
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Di1erentiate s between %amiliar person and stranger olds bottle
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@ses single words and double$ consonant$ *owel combination
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as a sense o% .olnar belonging to a central person0
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G months
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6+ months
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bounces when held erect 'er*ical lordosis Independent sitting with secondary cur*es /eginning uadruped /eginning pull$ to$standing 'reeps on all %ours =i*ots in sitting #tands momentarily 'ruises #light bow leg Increased lumbar lordosis, acute lumbosacral angulation
=lantigrade posture =lantigrade creeping =ulls to standing and lowers sel%
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=incer grasp, mature thumb to index bangs cubes /angs two cubes held in hands
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=lays peek$ a$boo Finger %eeds 'hews with rotary mo*ement
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=incer grasp, %ore!nger and thumb in opposition (6+$ 66 mos) Fore!nger dominance poking and prodding with index !nger (6+$66 mos)
#houts %or attention Imitates speech sounds Ha*es byebye @ses Emama and Edada with meaning, Inhibits beha*ior to Eno
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'an retrie*e an ob&ect hidden %rom *iew
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=racticing phase o% separation$ indi*iduali;ati on =ractices initiating separations
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66 months 6 months
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=ulls to standing through hal%$ kneeling Halking independently
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6months
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Halks alone, arms in high guard or mudguard0 Hide base, excessi*e knee and hip fexion Foot contact on entire sole #light *algus o% knees and %eet =el*ic tilt and rotation
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olding crayon /eginning to release @ses graded pressure *aries pressure depending in ob&ect uses !nger tip with thumb opposition in !ne pincer grasp 5urns pages o% book =iles two cubes #cribbles spontaneously old crayon %ull length in palm 'asts ob&ects
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@ses spoon with o*erpronatio n and spilling0 Remo*es garments
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@ses single words @nderstand simple commands
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?gocentric symbolic play (e0g0, pretends to drink %rom cup)
Di1erentiate s a*ailable beha*ior patterns %or new words i0e0, pulls rug on which is a toy0
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Rapprocheme nt phase o% separation$ indi*iduation ambi*alent beha*ior to mother #tage o% autonomy *s0 shame and doubt ( 6$8 y2o) Issue o% holding on and letting go0 =leasure in controlling muscles and sphincters
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63 months
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'reeps up stairsJ
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=recision grasp with !ne pincer and controlled release #cribbles on paper /uilds tower o% cubes
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#peaks -$C words (Nelson)
6B months
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6G months
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Arms at low guard .ature supporting base and heel strike #eats sel% in chair Halks backward Halks up stairs with help or handrail Halks backward Attempts to kick ball urls ball 8 %eet Fast walk
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?merging hand dominance 'rude release old crayon but end in palm Dumps raisin %rom bottle spontaneously
olds paper with other hand when scribbling =uts ob&ect in the container and dumps contents /uilds tower o% three cubes
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Imitates housework 'arries, hugs doll Drinks %rom cup neatly
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=oints to named body part Identi!es one picture #ays Eno to &argons0
#peaks 6+$ 63 words
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@ses stick to reach toy =retend play with doll (Nelson) 'apable o% insight, i0e0, sol*ing a problem by mental combination s, not physical groping0
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6 months
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8 years
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/egins running Halks up and down stairs alone Kumps on both %eet in place #tands on low balance beam Kumps %rom bottom step Licks ball ($8 yrs) 5hrows ball ($ 8 yrs) 5rue run with nonsupport phase ($8 yrs) Runs well =edals tricycle /road &umps Halks up stairs alternating %eet
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5urns pages o% book, perhaps two or three at a time and dominance is usual /uilds eight cube tower Aligns cubes hori;ontally Imitates *ertical line =laces pencil sha%t between thumb and !ngers Draws with arm and wrist action0
Imitates three cube bridge 'opies circle @ses o*erhand throw with anteroposterior arm and trunk motion 'atches with
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=ulls on garment @ses spoon well >pens door turning knob Feeds doll with bottle or spoon 5oilet training usually begun
.ost children toilet trained day and night =ours %rom pitcher @nbuttons washes and
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5wo word phrases are common @ses *erbs Re%ers to sel% by name @ses Eme, Emine Follows simple directions
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5hree word sentences are usual @ses %uture tense asks what, who, where, Follows prepositional
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=reoperation al period ( $B years) Able to e*oke an ob&ect or e*ent not present >b&ect permanence established 'omprehen ds symbols
=reoperation al period continues0 'hild is capable o% de%erred imitation symbolic play
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Stage of initiatives vs. guilt 0 ( 8$3 years ) Deals with issue o% genital sexuality0
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extended arms hugging against body0
Halks straight line ops 8 times 'atches ball using body and hands
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dries hands and %ace0 =arallel play 'an take turns 'an be reasoned with
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- years
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Halks down stairs alternating %eet0 ops on one %oot =lantar arches de*eloping #its up %orm supine position without rotating
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Halks circular line "allops
andles a pencil by !nger and wrist action, like adults 'opies a cross Draws a %roglike person with head and extremities0 5hrows underhand 'uts with scissors
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'ooperati*e play sharing and interacting Imaginati*e make belie*e play0 Dresses and undresses with super*ision distinguishin g %ront and back o% clothing and buttoning Does simple errands outside home
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commands0 i0e0, put it under "i*es %ull name .ay stutter in eagerness0 Identi!es sel% as boy or girl0 Recogni;es three colors "i*es connected account o% recent experiences0 Muestions why, when, how, @ses past tense, ad&ecti*es, ad*erbs, Lnows opposite analogies, Repeats %our digits0
drawing o% graphic images *erbal e*ocation o% e*ents
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3 years
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#kips tiptoes0 /alances 6+ seconds on each %oot0
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C years
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/alances on one %oot %or 8 3 sec ops G6+ times on same %oot ops distance o% 3+ %eet 'atches ball using hands only Rides bicycle0 Roller skates
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#kips
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=rints alphabet letter re*ersal is still acceptable0 .ature catch and throw o% ball,
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B years
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'ontinuing re!nement o% skills
'reati*e play 'ompetiti*e team play @ses %ork %or stabbing %ood, /rushes teeth, Is sel% sucient in toileting0 Dresses without super*ision expect tying shoelaces0
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and dominance expected0 Draws man with head, body, and extremities0 5hrows with diagonal arm and body rotation0 'atches with hands0
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5eacher is an important authority to child @ses %orm appropriatel y @ses kni%e %or spreading =lays table games ?ats with %ork and kni%e0 'ombs hair Is responsible %or grooming
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Fluent speech0 .isartiulatio ns o% some sounds may persist0 "i*es name, address, age0 De!nes concrete nouns by composition, classi!cation , or use0 Follows three part commands0 as number concepts to 6+0 #hows mastery o% grammar @ses proper articulation
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Stage of industry vs. inferiority 0 ( 3 years adolescence) Ad&usts himsel% to the inorganic laws o% the tool world0
Stage of industry vs. inferiority continues0
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Period of concrete operational thought ( B years $ adolescence )
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'hild is capable o% logical thinking
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when lying prone (+8 months) on %orearms (83 months) on hands (-C months) on hands and knees
Postural stability of the trunk •
fexion with hips o1 the sur%ace and then tips o*er into side lying with weight bearing continuing %orward on cheek or
Postural stability of the shoulder girdle •
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Hhen taking weight on %orearms (83 months) on hands with elbows semi$ fexed (-C months) elbows straight (CB months)
Postural stability of the pelis •
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on knees with hips at right angles (months) on elbows and knees (-C months) on hands and knees
!ounterpoising of the head
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head partial raise and turn (+8 months) head mo*ements whilst holding the head up against gra*ity (83 months) Free head
!ounterpoisin g the ar" "oe"ents •
creeping actions (83 months) when weight bearing on one %orearm whilst reaching with the other (3B
!ounterpoisin g leg "oe"ents •
=rone lying during creeping actions (8 3 months) leg mo*ement on knees with upper trunk and arms being
Tilt rea#tions in prone •
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lies at about C month s hands and knees at about 96
Saing fro" falling rea#tions •
in the arms at 3B months downw ard$ and$ %orwar d Oparach
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(C9 months) in hal%$ kneeling hand support (9 66 months) on hands and %eet (6 months) ead held in alignment with spine (- months) with chin well in (3C months)
side o% %ace and shoulders (+8 months) Height then shi%ts towards the legs0 As head, shoulder and trunk stability de*elops the child can control side lying and symmetrical prone lying (C9 months) 5he back becomes straight and then slightly extended on %orearms (8 3 months) becoming %ully extended on hands (CB months) In Opi*ot prone7 (36+ months) the trunk stabili;es well in extension Hhen a child is on %orearms, he shi%ts his weight backwards and •
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weight bear on hands and knees (C9 months) prone lying with arms held stretched %orward along the ground to hold a toy (3C months) when holding an ob&ect in the air (CB months) Opi*ot prone7 (begins 3C months and established G 6+ months) with weight on abdomen and pel*is with extended trunk and legs in the air as well as with arms held abducted$ extended in the air to stabili;e shoulder girdle (Ohigh guard7 position) In other positions, stability de*elops %urther during hal%$kneeling or in upright kneeling, leaning on
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(C9 months) #tability o% pel*is and hips on the sur%ace (C 9 months) enables on hands with straight elbows, stabilises in hal%$ kneeling and upright kneeling with support (9 6 months) and without support (66G months)
mo*ements are counterpoise d in prone$ kneeling postures (C 6 months)
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months) leaning on a hand reaching with the other (B months) Arms are counterpois ed in crawling (9 66 months) and on hands and %eet (6 months)
supported (3C months) leg li%t when on hands and knees (CG months) counterpois ing o% arms in crawling (966 months) and in bear$ walk (6 months) #tand lean on hands on low table (modi!ed bear$walk position), weight shi%t laterally de*elops to allow counterpois ing o% leg li%ting and also prepares %or cruising at low %urniture0 5his o*erlaps into the de*elopme nt o% cruising in standing at normally 96 months •
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month s in uprigh t kneeli ng around 636G month s
ute7, %ollowe d by arm proppi ng
%orwards and to each side (83 months) and similarly when on hands (CB months) Hhen a child is on %orearms, he shi%ts his weight backwards and %orwards and to each side (83 months) and similarly when on hands (CB months) •
#upine de*elopment Postural stabili$ation of the head 5he normal neonate7s head is in midline with physiological fexion but on the side by 6 month, 5he body is tipped to the same side as the %ace, as there is no postural control yet and neck$ righting response is acti*e ead stabilisation in midline is (-3 months normally) on a sur%ace and •
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hands (96 months) and during grasping a support, within all prone de*elopmental stages, especially around 96 months
Postural stability of the shoulder girdle holds the arm up to %ace in midline or when hands are held in midline (months) %or hand to mouth and %or hand regard, which o*ercomes the shoulder retraction o% 8 months reach, reach and grasp, and hand eye coordination (-C months) including *isually directed reach to •
le*els
Postural stability of the pelis •
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posterior tilt in being pulled to sit (-C months) child holds legs in the air with %eet touching in dorsifexion supination (3 months) one leg up in the air (-C months) in order to grasp a knee and then a %oot and %oot to mouth 5here is then anterior pel*ic tilt and stability (3B
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5here is acti*ation o% limb muscles together with neck fexors, pectorals, serratus anterior and abdominals (3B months) =i*oting on the back using weight shi%t to each side counterpoises lateral arm and leg mo*ements so that a child can mo*e in circles (96+ months)
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#upine, head rising (righting) and the o*ercoming o% head lag (-C months) prepares rising out o% supine Normal asymmetries in supine lying are %rom + to months, becoming symmetrical in - 3 months
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less important in supine than in sitting and standing0 5hey may be used only laterally %or trunk strengthening exercises and %or correcting a postural scoliosis0 #a*ing and posterior tilt correct round backs and strengthen back extensors
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with head held o1 the sur%ace (3C months) ead turn to look keeping body midline or with pel*is to the opposite side (-C months) (ead raise (-C months) is part o% the rising reactions)
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raised %oot %or touching and Omouthing7 5here is anticipatory mouth opening to Omouth7 at 3 months
months) when a child bridges his hips in extension with %eet on the sur%ace