Main Milestones Of
Child’s Psycho-motor
Development
Neurologic Assessment.
Signs Of Deviations
Of Psycho-motor Development.
The categories of
adaptive behaviors:
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(1) gross motor,
(2) fine motor,
(3) language, and
(4) personal-social behavior.
General guidelines for
neurological assesment of
the newborn
1. General appearance:
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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
a newborn
General hypotonus
(‘rag-doll’ baby)
Muscle Hypertonus
2. Neuromuscular system:
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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 ‘heel-to-ear’
manoeuvre
Potential signs of
distress/major abnormalities
• 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:
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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 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
Symmetric neck-righting reflex
Rooting reflex
Babkin’s reflex
Defence reflex
Grasp
Moro’s reflex
Placing and Dance
reflexes
Crawling (Bauer’s) reflex
Babinski’s reflex
Trunk incurvation
(Galant) reflex
Peres’s reflex
Asymmetric tonic neck
reflex
Steps of neurological
assesment in infants and
elder children
1. Mental status
2. Motor functioning:
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gross motor
fine motor
test muscle strength, tone, and development
test cerebellar functioning
3. Sensory functioning
4. 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
thumb 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
meningeal irritation is suspected. Positive
signs require immediate referral.
Psycho-motor
development of children
• 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 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
psychomotor development
of the child
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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
Attention