Selected primitive reflexes


ONSET
INTEGRATION
STIMULUS
RESPONSE
Developmental
Delays Due to
Persistence
ATNR^
20 weeks PMA*
4-5 months
Head turns to the right
The right arm extends, the left arm is flexed
Retention primarily interferes with child's learning process (handwriting and reading)
STNR~
4-6 months
8-12 months
Head flexion
Flexion of upper extremities, extension of lower extremities (the opposite will happen with head extension)
Retention can affect ability to crawl on hands and knees
ROOTING
28 weeks PMA
3 months
Stroke cheek
Turn head toward same cheek and make sucking motions with mouth

PALMAR
GRASP
28 weeks PMA
4-7 months
Object placed in hand
Fingers close on object to grasp it

PLANTAR
GRASP
28 weeks PMA
9 months
Object placed on sole of foot
Baby will flex foot around object

FLEXOR
WITHDRAWAL
28 weeks PMA
1-2 months
Infant is supine with lower extremities extended. Apply a noxious stimuli to sole of foot
Infant will withdrawal foot away from stimuli by flexing LE

CROSSED
EXTENSION
28 weeks PMA
1-2 months (inconsistent)
One leg is extended and firm pressure applied to sole of foot of that same leg
Infant will flex and extend opposite leg, trying to push hand of tester away

GALANT
28 weeks PMA
3 months (inconsistent)
Scratch skin on infants back from shoulders downwards, lateral to spinous processes
Incurvation of trunk, with concavity to stimulated side
Retention can cause restlessness, fidgeting, and bedwetting is sometimes associated
MORO
28 weeks PMA
3-5 months
Infant is supine. Head is gently lifted and then suddenly released.
Infant may look startled. Infant's arms and legs should extend out sideways with extended wrist and fingers. After the reflex, the infant relaxes and draws his or her arms back to the body.
Retention can cause poor coordination, balance problems, motion sickness
POSITIVE
SUPPORT
35 weeks PMA
1-2 months (inconsistent)
In supine or holding infant in the vertical position, simulate bouncing by lightly tapping the bottom of the infants foot or tapping the foot againsthe table surface several times. (10.)
Infant will attempt leg extension and weight support while the examiner is balancing the infant. The infant should fully support his/her weight while standing by 5-6 months old and should enjoy bouncing by 7 months old. (11)

WALKING/
STEPPING
37 weeks PMA
2-4 months
Holding an infant underneath his arms with his head supported while allowing his feet to touch a flat surface
Infant should appear to take steps and walk

*PMA= post menstrual age
^ATNR= asymmetrical tonic neck reflex
~STNR= symmetrical tonic neck reflex

Postural control is the primary and one of the most critical stages in developing overall motor control. Understanding the development of postural control is key in understanding the emergence of stability and mobility skills. Research has shown that the development of an immature postural system is a pre-cursor to limitations in other behaviors such as coordinated arm and hand movements. It could potentially even inhibit the child's ability to be independently mobile.

Moro reflex should be replaced by the adult "Startle" reflex between 3-5 months.

Persistence of any primitive reflex past the normal age it is lost, absent or abnormal reflexes, or redevelopment of a primitive reflex at a later point in the child's life may suggest significant CNS, nerve trunk, or peripheral nerve problems.

Videos

Below is a video outlining developmental milestones from 0-12 months:

Here are two videos with infants demonstrating an Asymmetric Tonic Neck and a Moro reflex.

Below is a link to Galant reflex:

Below is a link to Palmar/Plantar Grasp reflexes:

Positive Support Reflex


Developmental milestones, birth-12 months


ROLLING
CRAWLING
SITTING
STANDING
WALKING
1 MO
At birth an infant can turn head side to sideas well as right head position from flexion or extension for only a second
Lying prone will illicit hand to mouth movement



2 MO
Can hold head up and begins to push up
when lying on tummy;
Makes smoother movements with
arms and legs




3 MO
Baby begins to discover and explore intentional hand movements, building the foundation for manipulating tools. Brings hands to mouth, priming baby for independent feeding.
Raises head and chest in prone.
Prone on elbows while holding head up on own*
Hand and arm movement refinement serves to prepare baby for crawling.

Pushes down on legs into extension posture when feet placed on firm surface.
Stretches legs and kicks when lying supine.
4 MO
Holds head steady, unsupported;
May be able to roll over from tummy to back;
When lying on stomach, pushes up to elbows


Can bear weight through
legs by pushing down on
legs when feet are on hard surface

5 MO
Bends when rolling
Moves by pushing a flat surface
Prop sits, Can begin sitting with support for longer periods and can turn in all directions.


6 MO
rolls over in both directions
rocks back and forth,
sometimes crawls backwards
before moving forward; belly crawl
Sits without support*;
may use arms for balance;
may be able to pull self up into
sitting position if you grasp
baby's hands
supports weight on legs and
might bounce when
held in standing position
N/A
7 MO
Can roll over in both directions.
Can scoot, rock back and forth and belly crawl (army crawl) across the room
Most babies can sit on their own while some still need support.
Some babies can pull themselves up to a standing poistion

8 MO

hands/ knees crawl (creep)*



9 MO

Creeps independently
Can get in and out of sitting position;
Sits without support
Stands, holding on;
Pulls to stand
walk with assistance
10 MO

Creeps well, without belly on floor.


Cruises along couch or coffee table; furniture walking ("cruising")*
11 MO

ascend stairs



12 MO
independent
independent;
crawl on hands and knees, descends stairs by backing down
can get into sitting position
independently;
can sit independently
pulls up to standing position;
stands alone
may take a few steps without holding on;
can walk with one hand held; walks alone* with hands out and wide base of support; co contracts muscles
(For 2 mo, 4 mo, 6 mo, 9 mo, and 12 mo, CDC and NNCC websites used for developmental milestones.)
Information also obtained from Cambell's Physical Therapy for Children, table 2-2, page 55.
Red flags for 1 month: Floppy baby

Movement Milestone: 1 MONTH

  • jerky, quivering arm thrusts
  • brings hands within range of eyes and mouth
  • moves head side to side while lying on stomach
  • keeps hands in tight fists
  • strong reflex movements
Visual and Hearing Milestones
  • can focus 8-12 inches away
  • eyes wander and occasionally cross
  • prefers black and white or high contrast
  • hearing is fully mature
  • may turn towards some familiar sounds
Smell and Touch Milestone
  • prefers sweet smells
  • avoids bitter or acidic smells
  • recognizes scent of own mother's breast milk
  • prefers soft to coarse sensations
  • dislikes rough or abrupt handling
Signs of Developmental Delay
  • sucks poorly and feeds slowly
  • doesn't blink when shown a bright light
  • doesn't focus and follow a nearby item from side to side
  • rarely moves arms and legs
  • doesn't respond to loud sounds
  • seems excessively loose/floppy in limbs

Developmental Milestones: Age 4 months


Motor Skills:
  • very little head droop in sitting position
  • sit straight if propped
  • raise head to 90 degrees in prone position
  • grasp and let go of object
  • roll prone to supine
  • attempt to reach for objects
  • bring objects to mouth
  • sleep around 14-16 hours a day (2 naps, and around 9 hours at night)
Sensory Skills/Cognition
  • see clearly at close distance
  • increased eye contact with adults
  • binocular vision has developed and depth changes can now be identified
  • begin babbling and cooing
  • laugh out loud
  • recognize parents voices
  • demand attention with babbles or fussing
  • understand its time to eat when see a bottle (if bottle-fed)
  • start showing memory
Ideas for Progressing Play
  • place baby in front of mirror
  • bright colored toys
  • encourage tummy time
  • help baby roll over
  • "talk" with them, mimic their sounds

Videos

Here are a few videoes providing an overview of some developmental milestones listed above:
0-3 months:
http://www.youtube.com/watch?v=gZ-sjf9itW4&feature=related
4 to 6 months:
http://www.youtube.com/watch?v=GCm4UYCVX6I
belly crawl

7-9 months:
http://www.youtube.com/watch?v=yZ9bvVlZZp8&feature=related
9 months:
http://www.youtube.com/watch?v=EUlLFy4jFwY&feature=related
10-12 months:
http://www.youtube.com/watch?v=h4P32ah-6cI&feature=related

Developmental milestones, 15 months-6 years


STANDING
WALKING
STAIR CLIMBING
JUMPING/
HOPPING
BALL HANDLING
15 MO
Independent
Walking may begin at 9 months, with 15 months being the end range for walking initiation
Able to walk up stairs with 1 hand held and creeps down the steps
Unsuccessful
attempts at hopping-unable to clear floor
Is able to hurl or "fling" small ball-motion is coming from the elbow (no shoulder rotation and no directionality)
18 MO
Can stoop and recover (i.e. to pick up a toy)
Independent with walking, beginning to run stiffly (a hurried walk), can pull toys around while walking
Walk upstairs holding rail one step at a time probably still crawling. Not walking downstairs yet
Able to stand on one leg with help
Beginning stages of kicking (can walk into a ball to kick), able to throw underhand in sitting
2 YRS
independent, can stand on tip toes
independent, can pull and carry toys while walking, begins to run and climb/ Beginning to see heel strike with walking
walk up and down with holding onto support (step to pattern)
jumps in place
able to kick a stationary ball, hand dominance may start to show, able to throw and catch a ball using arms and body
3 YRS
SLS 3-5 sec
Runs easily, can walk a line, walk on tiptoes for a few steps
Walk up and down stairs, one foot on each step (may still place both feet on each step walking down)
Jumps down 18-24 inches, Hops on one foot
Able to catch a large ball using hands and body. Learning to kick a rolling ball and beginning to get directionality
4 YRS
independently
Runs well, Normative (mature) gait pattern shown
Walk down stairs with one foot per step (reciprocal gait pattern with no rail)
Jumps forward 30 inches, hops 3-5 times
Catch with hands, throws at a target
5 YRS
SLS 10 sec
Begin to learn to dodge well and can
skip and do acrobatic tricks (somersaults)
Can climb with sureness
Are able to jump rope &
long jump 30 in, jumps over a 10-inch hurdle, skips
Handedness is well
established -
overhead throwing is
accomplished, catches small ball (tennis ball) with hands
6 YRS
Independent

They are running up and down stairs easily
Can skip with a rope
Can shoot baskets and abilities like hitting a ball with a bat start to emerge

2 year olds

-Between 2 years and 2.5 years, children are 50% of their adult height. Other milestones reached in this year are dressing by themselves, eating with a spoon, and galloping. They are able to climb on and off of furniture without assistance. They will imitate others' actions, whether it be gross motor or verbal. Two year olds are able to sort out objects and put them into categories based on color or shape. They are able to understand the meaning of hiding and finding objects when they are hidden.

3 year olds

-According to the CDC a 3 year old should be able to reach motor milestones such as climbing well and pedaling a tricycle. It's also important to consider cognitive development which will influence motor milestones. 3 year old children should be able to work with toys, levers and moving parts. They should be able to perform tasks such as turning a page one at a time, unscrewing jar lids and turning door handles. They should also be able to dress and undress themselves, begin feed themselves (w/spilling), and use the toilet with little assistance.

4 year olds

-A typical four year old also typically shows an interest in learning how to use a small bike and roller skates. Also a four year old should be capable of buttoning large buttons, lace shoelaces, feed themselves independently except for cutting, cut out pictures using scissors, talk and eat at the same time, wash hands a face independently, brush teeth, dress and undress independently except for tying shoe laces, and might need some help differentiating front from back in some clothing items.
feed herself (with little spilling). Children will attempt to write their name, although drawing is done with whole arm movement rather than hands. Catching a slowly bouncing ball, swinging, and descending stairs alternating are all new developments in the fourth year.

5 year olds

-5 year olds tend to be more conforming than the exuberant 4 year old. The 5 y.o. likes to help with household tasks, play with blocks, and build houses. Eating is independent, including using a knife except for cutting meat, although dawdling and wriggling in the chair may be trying to parents. The challenge of dressing oneself is past, so they may ask for more help than they need, and overall, undressing is generally easier than dressing.The child may be able to stand on one foot for 10 seconds or longer, perform somersaults and can use the toilet on their own. At this time, vision reaches 20/20. Children begin writing letters, drawing people, and are able to outline geometric shapes at this age.

6 year olds

-At 6 years old you will continue to see the maturation of physical abilities. Activities such as walking will start to become as coordinated as an adult. Advanced skills such as dribbling, hopping, skipping, catching and throwing a ball, as well as riding a bike are starting to emerge. Running in straight paths is fairly proficient, but kids will still have difficulty with agility moves such as quick stopping and direction changes. Balance is another skill that kids at this age will focus on developing. You may see them balancing on curbs, chairs, and other narrow surfaces. Differences can be seen in children’s development when comparing more sedentary kids to active kids that participate in sports and physical activities (ParentFurther, 2012).

References

1. Campbell, S., Vander Linden, D., & Palisano, R. (2006). Physical Therapy for Children (3rd Ed.). P 35-36, 39. St. Louis: Saunders Elsevier.
2. "Developmental Milestones." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 01 Sept. 2011. Web. 21 Feb. 2012. <http://www.cdc.gov/ncbddd/actearly/milestones/index.html>.
3. Smith, Charles A., and Joyce Powell. "NNCC Developmental Milestones." NNCC Homepage. National Network for Child Care, 1994. Web. 21 Feb. 2012. <http://www.nncc.org/Child.Dev/mile1.html>.
4. "Child Development Tracker". PBS Parents. 22 Feb 2012. http://www.pbs.org/parents/childdevelopmenttracker/three/index.html
5."Crossed extension reflex (foot reflex)." General Practice Notebook. Web. 22 Feb. 2012. <http://www.gpnotebook.co.uk/simplepage.cfm?ID=-1650851791>.
6. ParentFurther (2012). "Ages 6-9: physical development." Search Institute. http://www.parentfurther.com/ages-stages/6-9/physical-development.
7. "Infant Development: Milestones from 7 to 9 months". MayoClinic. 22 Feb 2012.
http://www.mayoclinic.com/health/infant-development/FL00100.
8. "Developmental Milestone: 1 Month." Healthy Children. American Academy of Pediatrics, 27 January 2012. Web. 22 Feb 2012. <http://healthychildren.org>
http://www.birthsource.com/scripts/article.asp?articleid=249
9. "Newborn Reflexes and Characteristics." Perinatal Education Associates. Birthsource.com. Web. 22 Feb 2012. <http://www.birthsource.com/scripts/article.asp?articleid=249>
10.Crocetti, M.A, Barone, M.A.(2004). Oski's Essential Pediatrics (2nd Ed.) P. 603. Philadelphia: Lippencott, Williams, and Wilkens.
11. "Postural Reflexes-Positive Support Reflexes." Pediatric Neurologic Examination. Web. 22 Feb 2012.
<http://library.med.utah.edu/pedineurologicexam/html/06month.html>
12. Votroubek, Wendy L., and Julie Townsend. Pediatric Home Care. Gaithersburg, MD: Aspen, 1997. 448. Print
13."Developmental Milestones Record-4 months." U.S. National Library of Medicine. MedlinePlus. 2 Nov. 2010. Web. Feb 2012.
http://www.nlm.nih.gov/medlineplus/ency/article/002007.htm.
14. "The Learning Clinic." Retained Reflexes That Contribute to Learning Difficulties and Reading Difficulties. Web. <http://www.thelearningclinic.ie/index.php/programs/movement-therapy/reflexes/>.