Everything about Important Motor Milestones

When do babies develop neck control? When can they finally differentiate between day and night? These are a few developmental milestones that you will learn about in this article. Dive in to learn everything about important motor milestones including age for weight chart, fine motor skills, gross motor skills, social skills, language skills and activities related to each of them. 

What is Development?

Development refers to attainment of maturity of functions

Rules of Development

1. Continuous process starting in utero
2. Sequence of attainment of milestones remain sames
3. Depends on neurological status of child
4. Usually proceeds in a cephalo caudal direction
5. Truncal development followed by the limbs
6. Certain primitive reflexes need to be lost to gain some milestones

Domains of Development

1. Gross motor- deals with posture 
2. Fine motor- deals with hands
3. Social 
4. Language

• Development assessment of preterm neonates (born before 37 weeks of gestation) is done using corrected or adjusted age. Assessment is basically done on a adjusted age till 2 years 

Corrected or adjusted age=(Gestational age + Chronical age)- 40 week

• For ex: If a baby is born at 30 weeks and now the baby is 12 weeks old. What will be the corrected age of the baby?

Gestational age-30 weeks

Chronical age - 12 weeks old

Corrected age= (30+12)-40= 2 weeks (normal)

So the developmental milestone of a 12 week or 3 month old baby will be considered ok. 

Important Motor Milestones

Gross motor milestones (1st year of life)

In ventral suspension-

  Ventral suspension means the baby is lying in a prone position and then the baby is lifted up in  such a way that the back of the baby is facing upward, face facing downward and limbs are hanging).

 At 1 month, the head of the baby will be below the plane of the rest of the body, as there is no neck control. In 2 months , it will come in the plane of the rest of the body, and neck controls begin to develop. At 12 weeks, head  above the plane of the rest of the body, neck control develops but it will fully develop around 5 months or 24 weeks of age

In Prone position- 

Prone position means the baby lies on the bed with high pelvis and knees are drawn under the abdomen. At 2 weeks, the baby is in a prone position. At 4 weeks, lifts the chin of the bed momentarily. At 6 weeks, the baby lies on the bed with flat pelvis and extended hips. At 8 weeks, lifts face up at 45 degrees. At 12 weeks , the baby can bear weight on the forearms with chin and shoulder lifted off the bed. At 6 months, can now support his weight on his hands or on extended arms. 

Other Gross motor milestones

 At 4 months, partial weight bearing when made to stand. By 5 months, the baby can take feet to mouth and neck control completely develops. At 6 months, the baby can sit with support  or sitting in a tripod position( with support of its own hand) and also learn to roll over from prone to supine. At 7 months, roll over from supine to prone. At 8 months, sits without support and learns to crawl (movement of 4 limbs, abdomen touching the ground) . Creeping means movement of 4 limbs, abdomen not touching the ground. Crawling comes earlier than creeping. At 9 months, standing with support. At 10 months, learns creeping. By 10-11 months, pivoting (turning around an axis in sitting position) and cruising comes ( walking around the edges of furniture slowly ). At 12 months, learns to stand without support and walking with one hand held

Gross Motor milestones ( beyond 1^st year of life)

At 13 months , the child can walk without support. At 15 months, able to creep upstairs. At 18 months, can go upstairs and downstairs by holding the side railing. The child can run at the level of the ground, and can pull a toy. At 2 years of age , the child goes upstairs and downstairs ( 2 feet per step), kicks a ball, walks backwards. At 3 years , a child goes upstairs with alternating feet, but downstairs with 2 feet per step and can ride a tricycle. At 4 years, goes upstairs and downstairs with alternating feet and can hop. At 5 years,  can do skipping and can stand one 1 leg for > 10 sec.

Developmental implications 

It means attainment of these milestones indicate what? Or what is the reason of attaining these milestone

Developmental implications in Gross motor

Holding the head steady while sitting allows more visual exploration of interaction. Sitting without support increases exploration. Walks alone indicate exploration and control proximity with parents. 

Fine motor milestones

At 1 month, hands kept closed and palmar grasp reflex is present at this time. At 2 months, hands open intermittently. At 3 months, hand regard appears ( disappears by 20 weeks of age), hands kept open and palmar grasp reflex is lost at this time because at this time the child learns to hold an object, when placed in hand. At 4 months, tries to reach for an object but overshoots. At 5 months, bidextrous grasp usually appears. At 6 months, an unidextrous or palmar grasp appears, and can take a biscuit to his mouth. At 7 months of age, transfers objects from one hand to another. By 9 months, immature/ assisted pincer grasp comes. At 12 months, mature/ unassisted grasp appears, can pull off cap, mittens or socks. At 15 months, can scribble spontaneously, feeds himself with a cup, and makes a tower of 2 cubes. At 18 months, makes a tower of 3 cubes, feeds himself with a spoon, turns 2-3 pages at a time, unzips clothes at a time. At 2 years, can make a tower of 6-7 cubes, can make a train with blocks or cubes, turn door knobs and screw a lid, turn pages one by one, put on socks and shoes, and copy a horizontal or vertical line. At 2^1/2 years, I can make a train with a chimney. At 3 years, handedness gets established ( Handedness appears at 24 months), can make tower 9-10 cubes, copies a circle, can dress and undress except buttons. At 4 years ,the child can copy a rectangle or a plus sign, can make a bridge with cubes, can button and unbutton, and catch a ball reliably. At 5 years, copies a triangle, multiplication sign or a tilted cross, can tie shoelaces, and can make a gate with cubes. At 6-7 years, copies diamonds, and can make steps with cubes. 

Developmental implications in Fine motor

The appearance of hand regard indicates self discovery of hands. Grasping of rattle indicated object use. Reaches for objects, shows visual motor coordination. Once the palmar grasp is gone, the child is able to voluntarily release objects. Once the child learns to transfer objects from one hand to another, indicates that the child is able to compare objects. Appearance of pincer grasp indicates that the child can explore small objects. Scribbling indicated visual motor coordination. Building a tower of 2 cubes indicates the child can use objects in combination. 

Social milestones (Till 1 year of age)

At 1 month, look at the mother intently when talked to. By 2 months, appears social smile appears, but it is abnormal if it does not appears even at 6 months of age. By 3 months , starts recognizing mother. At 6 months, mirror play appears. By 7 months, stranger anxiety is going to appear. At 8 months, object permanence appears. By 9 months, waves Bye Bye. At 10 months, plays peek-a-boo. By 12 months, baby kisses on request, plays a simple ball game

Social milestones (Beyond 1 year of age)

At 15 months, it points to objects and indicates wet paints. At 18 months, develops domestic mimicry, dry during day time. By 2 years,  parallel play can point to 3-4 body parts, and 5-6 familiar objects. At 3 years, joins and play, knows name,age and gender, usually dry at night (consider abnormal if nocturnal enuresis goes beyond 5 years of age). At 4 years, goes to the toilet alone, start asking questions, and pretend to play. By 5 years, starts helping in household tasks, distinguishing morning from evening, able to compare weights and can follow 3 step commands.  

Developmental implications in Social milestone

Social smile indicates more active social participation. Follows one step command with gesture, indicating non verbal communication. Points to objects, indicates more interactive communication. Uncovered toys after its hiding, indicates object permanence. Pretends to drink from a cup, indicates symbolic thought. Uses stick to reach toys, would indicate link actions to solve problems. 

Language milestones (Till 1 year of age)

By 1 month, the baby quietens when the bell is rung. At 2 months, vocalizes. By 3 months, cooking. At 4 months, laughs a lot. By 5 months, razzing appears. By 6 months, monosyllabic babbling comes (ma, ba, da). At 9 months, bisyllabic babbling (mama, papa without meaning). By 1 year, a child can speak 2-3 words with meaning.  

Language milestones (Beyond 1 year of age)

At 15 months, Jagan's speech appears. By 18 months, the child has a vocabulary of 8-10 words. By 2 years speaks 2 word sentences, has vocabulary of 50-100 words, uses pronouns like I, Me , You. At 3 years, uses plurals and past tense , can repeat 3 digits and can make 3 word sentences. By 4 years, can tell a story, poem or sing a song. By 5 years, can repeat 4 digits, name 4 colors, and ask the meaning of words. 

Developmental implications in Language milestone

Monosyllabic babbling would indicate experimentation with sound. Follows one step command without gesture, indicating verbal receptive language ( comes around 10 months of age). Mama or Dada indicates expressive language. Speaks the first real word ( around 1 year of age), indicating the beginning of labelling. Speaking 4-6 real words indicates acquisition of objects and real names. Speaks 2 word sentences, which would indicate beginning of grammatization. 

Vision 

At birth, the baby can fixate on a red dangling ring and follow it to 45 degrees. By 4 weeks , follow 90 degrees and 12 weeks 180 degree. At 3 months, fixates instantaneously on an object shown to him ( called grasp with eye). Binocular vision begins to develop by 6 weeks and usually established by 4 months. A 1 year follows rapidly moving object

Hearing

Newborns respond to sound by startle, blinking , crying. By 3-4 months, the child turns head towards the source of sound. By 5-6 months, turns head towards the source and downwards, if the source of the sound is by the level of his ear. By 7-8 months, the child localizes sound produced above the level of ears. At 10 months, the child looks directly towards the source of sound diagonally. 

The sequence in which these hearing milestones develop is called Murphy's sequence. That means, first the child is able to localize the sound at the level of the ear, then localize sound produced below the level of the ear, then localize sound above the level of the ear and find it can turn diagonally.

To study this topic in detail for NEET PG exam preparation, download the PrepLadder app and get access to engaging video lectures covering the topic.