Primitive Reflex Development
Reflex
Integrate
Description
Galant
2 mon
Lower spine stroked in prone, baby curves
hips outwards.
Relevance: Responsible for facilitating hip
movement & ROM in prep for crawling/
walking.
Rooting
3 mon
Stroke corner of mouth= movement of head
towards stimulus.
Relevance: Allows for searching & locating
feeding source
SuckSwallow
2-5 mon
Finger in mouth= Suck for food.
Relevance: Allows ingestion of nourishment.
Traction
2-5 mon
Stimulus: Grasp infant's forearms and
pull-to-sit.
Response: Complete flexion of UE.
Relevance: Prep for voluntary control of
grasping
Moro Reflex
4-6 mon
When startled, baby spreads arms/legs and
then pulls them back in and cries
Relevance: Acts as an alarm system “fight
or flight” with loss of support
Palmar
Grasp
4-6 mon
Reflexive curling of the infant's fingers around
an object that touches its palm
Relevance: Increases tactile stimulation on
palms.
Not integrated: poor FM, grasping, and hand
manipulation
Image
Primitive Reflex Development
ATNR
“Fencer”
4-6 mon
Baby in supine: extension of arm/leg on side
to which the head is turned & flexion of
arm/leg on opposite side
Relevance: hand-eye coordination, one
handed movements, crossing midline,
bilateral coordination
Not integrated: diff reaching into midline,
poor reading comprehension, poor
handwriting (when head trunks, arm wants to
extend), poor hand-eye coordination, poor
bilateral coordination
TLR
6 mon
When in prone, flexion of all limbs neck. In
supine, extension of all limbs
Relevance: Extensor tone, posture
coordination, head alignment
Not integrated: Difficulty extending head in
prone, diff sitting from supine, poor posture,
decreased muscle tone, poor coordination
Plantar
Grasp
9 mon
Pressure on sole= toe flexion
Relevance: Increases tactile input to sole of
foot (helps w/ standing/ walking)
Not integrated: hypersensitivity to touch &
gravitational insecurity.
STNR
O: 6 mon I:
12 mon
Neck and arms bend, legs straighten and vice
versa.
Relevance: Prep for crawling
Not integrated: diff sitting from supine, poor
muscle tone & posture 9can lead to diff
focusing)
Landau
Reflex
Superman
O: 3-4
months,
I: 12-24
months
Test: Hold infant in horizontal prone
suspension.
Response: Complete extension of head,
trunk, and extremities.
Relevance: Breaks up flexor dominance;
facilitates prone extension. Posture
development
Righting Reaction Development
Reflex
Optical/
Occulo Head
Righting
OnsetIntegrate
Birth to 2
monthsPersists
2 monthsLabyrinthine
Head Righting persists
Neck Righting
O: 4-6
months,
I: 5 years
Body Righting O: 4-6
months,
I: 5 years
Description
Test: hold baby suspended vertically and
tilt off-center
Response: upright positioning of head,
orients head in space
Mediated by the visual system
Relevance: orientation of the head/ eyes
in space
Test: Cover eyes, hold suspended
vertically & tilt off center
Response: Orients the head in space (no
visual cues)
Mediated by vestibular system
Relevance: Correcting position of the
body in relation to head position
Test: In supine, turn head to side
Response: log roll of body to align head
→ Head goes first, then rest of body
Relevance: Initiates Rolling. (transition
btw supine, side-lying, & prone)
precursor to crawling
Test: Supine, flex hip and knee towards
chest
Response: segmental rolling
→ Pelvis starts then followed by
upper body
Relevance: Initiates Rolling. (transition
btw supine, side-lying, & prone), getting
ready to sit
Image
Protective Reflex Development
Reflex
Onset (All
Persist)
Description
Downward
Parachute
Onset: 4 months Stimulus: Rapidly lower infant towards supporting surface while
suspended vertically.
Response: Extension of the lower extremities.
Relevance: Allows accurate placement of lower extremities in
anticipation of a surface.
Forward
Parachute
Onset: 6-9
months
Sideward
Parachute
Onset: 7 months Stimulus: quickly but firmly tip infant off-balance to the side while in
the sitting position
Response: arm extension and abduction to the side
Relevance: protects body to prevent a fall; supports body for
unilateral use of opposite arm
Backward
Parachute
Onset: 9-10
months
Stimulus: Suddenly tip infant forward towards supporting surface
while suspended vertically.
Response: Sudden extension of upper extremities, hand opening,
and neck extension.
Relevance: Allows accurate placement of UE in anticipation of
surface to prevent a fall.
Stimulus: Quickly but firmly tip infant off-balance backward
Response: Backward arm extension or arm extension to one side
spinal rotation
Relevance: Protects body to prevent a fall; unilaterally facilitates
Equilibrium Reflex Development
Reflex
Onset (all
persist)
Description
On tilt board, raise one side → spine curves on raised side
and arms and legs extend
Prone Tilting
5 MonthsPersists
Relevance: to maintain equilibrium w/out arm support
Supine Tilting
7-8 monthsPersists
Relevance: to maintain equilibrium w/out arm support
Quadruped Tilting
Onset 9-12
monthsPersists
Relevance: to maintain equilibrium w/out arm support
Standing Tilting
Onset 12-21
MonthsPersists
Relevance: to maintain equilibrium w/out arm support
Gross Motor Milestones
Age
Gross Motor Milestones
Newborn1 Month
•Flexed posture/ fetal position
•Movements mostly driven by primitive reflexes
2 Months
•Lifting head: Prone- raises head 45°
3 Months
•Midline orientated/symmetrical
→Hands to midline
→Head in midline
•Prone- props self on forearms
→turns head to look in both directions, with head lifted
4 Months
•Chest raise
→lifts and holds head steady to 90°
→presses through forearms to lift upper chest
•Starting to roll – prone to supine.
•Sits upright with trunk support, head steady
5 Months
•Working the core/abs and neck muscles
→Supine: grabs feet w/ hands
•Sits with pelvic support
6 Months
•Rolling both directions- supine to prone and vice versa
•Prone to sitting
•Prop sitting (leans forwards on hands)
•Pull to stand w/ furniture
7 Months
•Creeping backwards on abdomen.
•Sits without support (arm support at sides) ★
8 Months
•Starting to move forwards
→Reciprocal creeping using arms
•Pushes back into 4 point kneeling
•Perfect sitting balance ★
9 Months
•Prone to sit & sit to prone
•Stands holding on to furniture
→Pulling up into standing holding on to furniture
Gross Motor Milestones
10 Months
•Crawls on hands and knees
•Moves in/out of sitting position
•Takes steps, walks, stoops, recovers w/ support
11 Months
•Cruising with one hand for support
•Walks with hand held
•Stands independently for a short time- 2 seconds, legs wide, arms up/out
12 Months/
1 Year
•Crawls, bear walks, or shuffles on bottom
•May start walking- can take independent steps
15 Months
•Walks★ (able to start/ stop walking)
•Squats
18 Months/
1.5 Years
•18 months: Seldom falls, runs stiffly w/ eyes on the ground
•Pulls toys while walking
•Squats to play
1.5-2 Years
•Stairs: Walks up and down stairs (2 feet each step w/ support (handrail/ parent’s
hand))
•Jumps: jumps down from step
2-3 Years
•Stairs:
→2 feet to step w/out support
→ alternating feet w/ support
→ Walks down w/ 2 feet to step
•Jumps: jumps w/ two feet
→ hops on 1 foot
•Throws ball overhand
•Begins to ride a tricycle (feet on ground)
3-4 Years
•Stairs: Up/ down stairs w/out support, alternating feet
•Jumping: w/ two feet, jumps over objects, gallops
•Rides tricycle (pedaling)
•Catching a ball (using the whole body, not just arms)
•Participates in gross motor games.
4-5 Years
•Performs jumping jacks and toe touches
•Walks up and down the stairs while carrying objects
•Catches a ball with two hands
5-6 Years
•Skips
•Throws and catches a small ball
6-7 Years
•Walking on a balance beam
•Using a jump rope
•Riding a bike without training wheels
Fine Motor Milestones
Age
Fine Motor Milestones
Newborn1 Month
•Hands fisted
•Grasp reflex
2 Months
•Hands often open or loosely closed.
•Grasp reflex still strong.
3 Months
•Exploring hands
→Hands to mouth
→Hands together
→Looking at hands
4 Months
•Voluntary grasp begins
•Starts reaching for toys and bats at dangling toys
•Bilateral approach
** Bilateral approach develops before unilateral approach. Able to reach and
grasp a small toy using both hands before starts using either hand.
5 Months
•Reaches for toys
•Uses both hands to explore toys
•Grasp: Crude palmar (ulnar) grasp, no thumb used (bigger objects)
6 Months
•Reaches with one hand
•Can only hold one object at a time
•Grasp: Raking grasp (small objects)
7 Months
•Transfers object from hand to hand
•Can hold 2 objects
•Grasp: Inferior scissor grasp (small objects brought into palm in raking motion)
•Grasp: Radial Palmar Grasp (bigger objects)
8 Months
•Imitates clapping hands
•Compares 2 objects by banging together
•Radial raking
•Grasp: Radial digital grasp
→(object between opposed thumb & pads of 2 & 3 (bigger objects)
•Grasp: Scissors grasp/ lateral pinch
9 Months
•Isolates index finger
•Grasp: Inferior pincer (small objects)
10 Months
•Thumb and finger opposition begins
•Grasp: Pincer grasp (pad to pad)
Fine Motor Milestones
12 Months/
1 Year
•Scribbles after demo
•Grasp: 3-Jaw Chuck (10-12 months)
→Object held w/ opposed thumb & index, & middle fingers w/ IPs slightly flexed
→Tools: spoon/knife, picking up large beads
•Grasp: Mature Pincer grasp (thumb opposition and tip of index finger)
15 Months
•2 cube tower
•Spontaneous scribble
•Grasp: Precise Pincer grasp (can pick up crumbs)
18 Months
•4+ cube tower
•Pegs in a board
18 Months/
2 Years
•Strings 2-3 beads
•Snips paper with scissors
•Pencil Grasp: Palmar Supinate (cylindrical/fisted (transition by age 2))
2-3 Years
•Strings 4 large beads
•Rolls, pounds, squeezes, and pulls playdough
•Unscrews screw-top lid
•Begins manipulating small items within hand
→In hand manipulation: Simple rotation (roll small object between thumb &
finger (ex. opening a small jar, manipulate legos))
•Scissors: Shows interest, snips paper
•Pencil Grasp: Digital Pronate (transition by age 3)
3-4 Years
•Manipulates clay and dough (pinches, rolls balls, snakes)
•Uses non-dominant hand to assist and stabilize the use of objects
•Scissors: Snips along line (not continuous motions forward).
•Pencil Grasp: Multi-Finger Transitional (emerge around 3 years, transition to
static/quad by age 4)
•Pencil Grasp: Quadruped
•Pencil Grasp: Static Tripod
4-5 Years
•Start to use one hand consistently for fine motor tasks
•Scissors:
→4–4.5 years of age: Cuts straight line, curved line, circle
→4.5–5 years of age: Cuts square (& simple figure shapes)
5-6 Years
•Scissors: Cuts out more complex shapes
•Pencil Grasp: Dynamic Tripod (by age 5)
6-7 Years
•Demonstrates controlled pencil movement
•In hand manipulation: Complex Rotation (turn object end over end (ex. Flip
pencil to use eraser, rotate dice, puzzle pieces))
7-8 Years
•Proficient with most fine motor tasks
FEEDING DEVELOPMENT
AGE
FEEDING DEVELOPMENT
0-3 Months
•Should be holding head up (2-3 months)
•Sucking pattern
•Hands come up to bottle/breast
4 Months
•Bite & Release (B-I-T-E)
•Rooting reflex through 4 months
5 Months
•Takes puree from a spoon (P-U-R-E-E)
•Oral Motor: Up & Down JAW movement: Munching (4-5 months) (M-U-N-C-H)
6 Months
•Gag reflex starts to disappear
•Tries to hold bottle
•Shows interest in cup
•Teething at 4-6 months
•Sucking on crackers (C-R-A-K-E-R)
•Oral Motor: Up & Down TONGUE movement (T-O-N-G-U-E)
7 Months
•Soft foods/solids (B-A-N-A-N-A-S)
•Lip closure on spoon (7-9 months)
•Oral Motor: Diagonal JAW movement
→Mastication with diagonal jaw movement (7← has a diagonal in it)
9 Months
•Finger Feeding (B-L-U-E-B-E-R-R-Y)
→Inferior pincer grasp
•Use sippy cup with help
•Soft/ fast-melting foods
•Oral Motor: Lateral TONGUE movement (clock face, tongue lateralizes to 9:00)
12 Months/
1 Year
•Dips spoon in food/ inverts spoon/ spills
•Drinks independently with lid & spout
•Drinks from open cup but looses liquies
•Small bites, chews soft food before swallowing
•Interest in family mealtime routines
•Oral Motor: Rotary Chewing (chew around clock)
15 Months
•Scoops food and brings it to mouth with less mess
18 Months
•Drinks from an open cup
FEEDING DEVELOPMENT
24 Months/
2 Years
•Independent/ proficient with spoon ★
•Interest in fork
•Uses straw
30 Months/
2.5 Years
•Proficient with fork ★
•Can drink from small open cup using one hand
3-4 Years
•Swallows food in mouth before taking another bite
•Serves self at table (can pour and scoop without spilling)
•Holds cup with one hand while holding straw with other hand to drink
4-5 Years
•Can spread soft substances with a plastic/child-safe knife
5-6 Years
•Can cut foods with a knife under supervision (dull knife or slightly serrated, not
sharp)
5.5-6.5 Years •Can cut with a fork and knife (entire process of holding utensils, controlling and
cutting food, and bringing to mouth)
DRESSING DEVELOPMENT
AGE
DRESSING DEVELOPMENT
1 Year
•Cooperates with dressing (holds out arms and feet);
•Removes shoes & socks
2 Years
•Removes unfastened coat
•Helps pull down pants
•Finds armholes in pullover shirt
2.5 Years
•Pulls down elastic waistband
•Helps put on socks, coat, shirt
•Unbuttons large buttons
3 Years
•Puts things ON:
→Puts on pullover shirt with minimal assistance
→Puts on shoes without fasteners (may be on wrong foot): needs help tying
→Puts on socks (may be with heel on top)
•Zips and unzips jacket once engaged
•Buttons large front buttons
3.5 Years
•Know front/back clothing
•Manage snaps and hooks
•Unzips completely
•Buttons ★
•Don mittens
•Dress w/ supervision
4 Years
•Removes pullover garment independently
•Buckles
•Zipper independently ★
•May lace shoes (A for tying)
4.5 Years
•Puts belt in loops
5 Years
•Ties and unties knots
•Dresses unsupervised (5-6 years) ★★
6 Years
•Manages the back of clothing:
→Closes back zipper
→Buttons back buttons
→Snaps back snaps
•Ties bows/shoes ★
TOILETING DEVELOPMENT
AGE
TOILETING DEVELOPMENT
1 Year
•Indicates discomfort when wet/soiled
18 Months1.5 Years
•Sits on toilet when placed there and supervised
2-3 Years
•Regular toileting w/ occasional accidents
•Verbalizes need to go to the bathroom
•Washes hand independently
•Interest in potty training
3-4 Years
•Goes to bathroom “mostly” independently (help w/ wiping, fasteners, difficult
clothing)
4-5 Years
•Independent ★
→tears paper, flushes, wipes, manages clothing
HOUSEHOLD MANAGEMENT
AGE
HOUSEHOLD MANAGEMENT DEVELOPMENT
1.5-2 Years
•Picks up and puts away toys w/ reminders
•Copies parents routines
3-4 Years
•Carries items w/out dropping
•Dusts
•Dries dishes
•Gardens with help
•Puts toys away with reminders
•Wipes up spills
4-5 Years
•Fixes dry cereal, snacks
•Helps w/ sorting laundry
5-6 Years
•Simple errands, chores
•Cleans sink
•Washes dishes with help
•Cross street safely
PLAY DEVELOPMENT
AGE
PLAY DEVELOPMENT
0-3 Months
•Exploratory (Sensorimotor) Play (First year of life, sensory input to learn new
experiences)
–> cause and effect as result of reflexive motor patterns repeated
•Unoccupied Play (1-3 months, exploring the world around them & learning
about how their body moves)
4-6 Months
•Solitary Play (Present during the first 2 years. Children may be in other’s
presence, but prefer to play alone)
•Exploratory (Sensorimotor) Play
•Voluntary movement patterns emerge
•Plays w/ caregivers during meal times and engages in interactive routines
•Starts reaching for toys and bats at dangling toys (4 months)
•Reaches and grasps toys (5 months)
7-10 Months
•Solitary/Exploratory Play
•Recognizes strangers
•Emerging sense of self
11 Months1.5 Years
•Solitary Play
•Imaginary Play/Symbolic Play (12 months: Make believe play with increased
use of non-realistic play objects in pretending)
•Pegs in a board (18 months)
•Blocks: 2 cube tower (15 months), 4+ cube tower (18 months)
1.5-2 Years
•Solitary Play
•Child matches simple shapes into shape sorter
•Imaginary Play/ Symbolic Play
→Child has inanimate objects perform familiar activities
2-3 Years
•Imaginary Play/ Symbolic Play
→Objects that are manageable for the child in terms of symbolization, control,
and mastery are preferred by the child
•Onlooker Play (2 years, child watches and observes other children playing but
does not engage)
•Parallel Play (2+ years, playing side by side with little to no interaction)
•Child begins to relates experiences to one another and can make mental actions
without acting them out
•Child can see relationships between experiences
•Can discriminate sizes
•Blocks: horizontally and vertically
PLAY DEVELOPMENT
3-4 Years
•Symbolic/Parallel Play
•Associative Play (associating with each other during an activity (often requires
sharing)
→ Ex. Sharing a bin of blocks but each making their own structure
•Mostly involved in parallel play but is becoming more cooperative
•Organize objects by size
•Build involved structure combining various planes, symmetrical designs
and build from mental image
•Blocks: tower of 9 cubes
4-5 Years
•Cooperative Play (4+ years, child plays with others and shows interest in
activity & other children (shares goals/rules)
•Creative Play (Child explores combination of actions on multiple objects)
•Engages in sensory/motor/cognitive/social play
•Can build involved structures combining various planes as well as symmetrical
designs
5-6 Years
•Cooperative Play
→5 years: Role play based on real word activities, games with rules
→6 years: group play, BFFs
•Creative Play
→Child explores combination of actions on multiple objects