Main Milestones Main Milestones Of Child’s Psycho-Of Child’s Psycho-

motor motor DevelopmentDevelopment

Main Milestones Main Milestones Of Child’s Psycho-Of Child’s Psycho-

motor motor DevelopmentDevelopment

Neurologic Assessment.Neurologic Assessment.Signs Of Deviations Signs Of Deviations

Of Psycho-motor Of Psycho-motor Development.Development.

TheThe categories of categories of adaptive behaviors:adaptive behaviors:

• (1) gross motor, (1) gross motor, • (2) fine motor, (2) fine motor, • (3) language, and (3) language, and • (4) personal-social behavior.(4) personal-social behavior.

General guidelines for General guidelines for neurological neurological

assesment of the assesment of the newbornnewborn

1. General appearance:• Posture – flexion of head and

extremities, which rest on chest and abdomen.

• Frank breech is assesed as common variation – extended legs, abducted and fully rotated thighs, flattened occiput, extended neck

General appearance of of a newborna newborn

General hypotonus General hypotonus (‘rag-doll’ baby)(‘rag-doll’ baby)

Muscle HypertonusMuscle Hypertonus

2. Neuromuscular system:• Extremities usually maintain some

degree of flexion• Extension of an extremity followed

by previous position of flexion• Head lag while sitting, but

momentary ability to hold head erect• Able to turn head from side to side

when prone• Able to hold head in horisontal line

with back when held prone• Movements – the envoluntary reflex

responce• Quivering or momentary tremors are

assesed as minor abnormalities

Muscular hypotonus of the back muscles

The The ‘heel-to-ear’ ‘heel-to-ear’ manoeuvremanoeuvre

Potential signs of Potential signs of distress/major distress/major abnormalitiesabnormalities

• Hypotonia• Hypertonia – jittery, arms and hands

tightly flexed, legs stiffly extended• Asymmetric posturing (except tonic

neck reflex)• Opisthotonic posturing – arched back• Signs of paralysis• Tremors,twiches, and myoclonic jerks• Marked head lag in all positions

Opisthotonus

3. Assesment of reflexes:• the unconditioned reflexes that

persist throughout life (swallowing reflex, papillary reflex, sneeze reflex, blinking or corneal reflex, glabellar reflex, yawn reflex, cough reflex, gag reflex, and tendon reflexes)

• the transitional reflexes or reflexes of neonate and infancy, which disappear during infancy

• the righting reflexes that are absent in a newborn and appear during infancy

Reflexes of neonate and Reflexes of neonate and infancy:infancy:

• 1. The reflexes of oral automatism.– Sucking reflex, Doll’s eye reflex, rooting,

extrusion, lip or trunk reflex, and Babkin’s reflex

• 2. The reflexes of spinal automatism.– Reflex of defence, grasp, Moro reflex,

startle, placing, dance (stepping), crawling (Bauer’s) reflex, Kernig’s reflex, Babinski’s reflex, trunk incurvation (Galant) reflex, Perez reflex

• 3. Myelocephalic reflexes.– Asymmetric tonic neck reflex and Asymmetric tonic neck reflex and

Symmetric neck-righting reflexSymmetric neck-righting reflex

Rooting reflex

Babkin’s reflex

Defence reflex

Grasp

Moro’s reflex

Placing and Dance Placing and Dance reflexesreflexes

Crawling (Bauer’s) reflex

Babinski’s reflex

Trunk incurvation Trunk incurvation (Galant) reflex(Galant) reflex

Peres’sPeres’s reflex reflex

Asymmetric tonic Asymmetric tonic neck reflexneck reflex

Steps of neurological Steps of neurological assesment in infants assesment in infants

and elder childrenand elder children1. Mental status2. Motor functioning:

• gross motor gross motor • fine motorfine motor• test muscle strength, tone, and development• test cerebellar functioning

3. Sensory functioning4. Reflexes (deep tendon)5. Cranial nerves

Tests for cerebellar function:

• Finger-to-nose test: with the child’s arm extended, have touch nose with the index finger

• Heel-to-shin test: with child standing, have run the heel of one foot down the shin of the other leg

• Romberg test: have child stand erect with feet together and eyes closed. Falling or leaning to one side is abnormal and is called the Romberg sign

• Have child touch tip of each finger with Have child touch tip of each finger with thumb in rapid successionthumb in rapid succession

Sensory functioning• Test vision and hearing• Sensory intactness: touch skin lightly

with a pin and have child point to stimulated area while keeping eyes closed

• Sensory discrimination:– Touch skin with pin and cotton; have child

describe it as sharp or dull– Touch skin with cold and warm object (such

as metal and rubber heads of reflex hammer); have child differentiate between tenperatures

– Using two pins, touch skin simultaneously with both or one pin; have child discriminate when one or two pins are used

Reflexes (deep tendon)• Biceps, triceps, brachioradialis, knee jerk

or patellar reflex, achilles, ankle clonus• Tendon reflexes are assesed in grades

from 0 to 4. Grade 2 (++) is normal. Grade 0 is absent.

• Kernig sign: flex cchild’s leg at hip and knee while supine; note pain or resistance

• Brudzinski sign: with the child supine, flex the head; note pain and involuntary flexion of hip and knees

• These special reflexes are elicited when These special reflexes are elicited when meningeal irritation is suspected. Positive meningeal irritation is suspected. Positive signs require signs require immediate referralimmediate referral..

Psycho-motor Psycho-motor development of development of

childrenchildren• Gross motor behavior includes

developmental maturation in posture, head balance, sitting, creeping, standing, and walking.

Head and neck control in prone position at 6-8

weeks.

Upper Landau’s reflex

Sitting with support (at 5 mo) and without (8

mo)

At 8 -10 months: Sitting and standing

At 9-11 months: Crawling

First stepsFirst steps

At 16 months

• Postural control and co-ordinate hand and finger movements

• Note the knock knees and broad base stance

At 3-4 years: Fully

controlled posture

The stages of the The stages of the psychomotor psychomotor

development of the development of the childchild

• I stage - 0-1 month• II stage - 1 - 3 months• III stage - 3-6 months• IV stage - 6-9 months• V stage - 9-12 months• VI stage - 1 - 3 years

Thank You for Thank You for AttentionAttention

Thank You for Thank You for AttentionAttention