Course:KIN366/ConceptLibrary/MotorMilestones

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Movement Experiences for Children
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KIN 366
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Instructor: Dr. Shannon S. D. Bredin
Email: shannon.bredin@ubc.ca
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Normal child development occurs in a synchronous fashion (Bonvillian et al, 1983), from apedal to quadrupedal to bipedal (Fiorentino, 1972). There are key milestones each child should achieve to reach full maturation of movement and mental capabilities; gross motor milestones, fine motor milestones, and cognitive milestones. All three of the milestones are intertwined with each other, one helping the progress of the next. Gross motor milestones is the development of movement using large muscle groups for locomotion or postural control, while fine motor milestones increase the ability to manipulate objects with the extremities, specifically the hands and fingers (Opper, 1996). Gross motor milestones develop through the cephalocaudal principle, meaning the child will acquire skills from the head region to the toes (Gabbard, 2011). Fine motor milestones will be acquired through the proximodistal principle; meaning muscles at the axial skeleton will progress before the distal extremities (Gabbard, 2011). Cognitive milestones are the acquisition of language and increased cognitive functioning. Language is highly correlated with motor development; speech acquisition will increase with a burst in motor skill improvement (Bonvillian et al, 1983).

Motor Milestone Development

Infant

Children develop the ability to roll over, crawl and/or creep, sit and stand (Opper, 1996). Creeping is slightly different than crawling and a child could progress through both or only acquire one. Crawling is defined as movement along the abdomen using elbows and forearms mimicking an army crawl. Conversely, creeping is movement on the child’s hands and knees. In a study by de Onis et al (2006) it was found that only 4.3% of children did not use creeping as a precursor to standing and walking and instead exhibited crawling. Some children achieved both gross motor milestones, crawling and then creeping, before progressing to standing and walking. The progression of these skills will lead to proper walking (Fiorentino, 1972). Tummy time is a huge influence at this stage discussed later based on the study by Majnemer and Barr (2007). Fine motor milestones achieved at this stage are the conversion from the palmar grasp reflex to voluntarily grasp and release objects (Opper, 1996).

Toddler

At this period children begin to walk and progress into running, jumping and going up stairs (Opper, 1996). Mobility is increasing and should be encouraged. Children are being more restricted during this stage shown in a study by Pica (2003). If a child at this stage is restricted too much, delayed motor milestones acquisition will occur. Fine motor milestones achieved are the ability to scribble, colour on paper and manipulate objects like lego and building blocks (Opper, 1996). This is an important stage to continually develop the child’s fine motor skills by introducing more toys to use as affordances.

Pre-School

During this age period walking, running, jumping, skipping, and throwing/catching balls should be proficient in a child which require a strong background in balance and coordination (Opper, 1996). These skills play a major role in the development of mental and physical health (Opper, 1996). By the age of three walking is now an automatic process (Cratty, 1986), while stopping and starting during running is more controlled by 4 years of age (Opper, 1996). When a child is 3 years old most fine motor milestones that involve manipulation are achieved (Opper, 1996). They are able to assist in dressing themselves, use scissors and build simple structures with toys (Opper, 1996). By this age, differences in gender begin to become apparent; boys are more skilled in gross motor development while girls are stronger in completing fine motor skill tasks (Opper, 1996).

Kindergarten

Children begin to perfect their movements, which become more controlled and smoother (Opper, 1996). Responding to environmental stimuli becomes key in the child’s continuation of gross motor milestone development.

Early Elementary

The main motor milestones should be fully maturated at the age of 6; these skills usually begin to be perfected through play (Opper, 1996). Gross motor, fine motor, and cognitive milestones are all enhanced during imaginative play with peers and should be encouraged by coaches and teachers (Opper, 1996).

Late Elementary

During the late elementary age group, fine motor skills have a more prominent focus and should be perfected at this point (Opper, 1996). At the age of 10 pruning occurs. Pruning is when the weak neural connections are eliminated through apoptosis and the brain ends its period of plasticity (Gabbard, 2011). Therefore, all major motor milestones should be achieved before because all of the critical periods have ended.

Factors Affecting Motor Milestone Acquisition

There are multiple factors that can affect motor milestone acquisition for children, some of which include sleeping position, affordances and rate controllers. It is important for gross and fine motor milestones to be achieved at an approximate age range for prevention of developmental deficits (de Onis et al, 2006).

Sleeping Position and Tummy Time

Majnemer and Barr (2007) found that children who slept on their backs at night had delayed motor milestone development by 6 months of age. This poses a dilemma because mothers are being advised by doctors to sleep supine to avoid Sudden Infant Death Syndrome (SIDS). Davis et al (1998) performed a longitudinal study following infant gross motor milestone development and found that the infants who slept in the supine position did have delayed onset, but caught up by 18 months. It was concluded that pediatricians shouldn’t change the infant sleeping advisements based on delayed motor milestone acquisition because the children were able to catch up. SIDS is a more deadly disease that should be adhered to first. Tummy time is an important developmental aspect for children. Sufficient playtime on their stomach allows children to gain strength in their neck and upper body to progress through the next motor milestone (Majnemer and Barr, 2007).

Affordances

Environmental

Environmental affordances include the immediate area/objects surrounding the child that can be used to enhance their development. Environmental affordances include furniture, railings, boxes, and stairs (Haydari et al, 2009). The study by Haydari et al (2009) concluded that a home with less furniture hindered the child’s development of gross motor milestones such as standing unassisted and walking. Adolph et al (2011) concluded that using affordances such as railings for attainment of unassisted standing would lead to infants searching for other affordances in their environment during walking.

Supplied Toys

There are an array of toys parents can supply their children to help achieve their fine and gross motor milestones. Some common toys for gross motor milestone acquisition are jolly jumpers, ride-ons and poppers which all increase the chance of walking. While other toys like balls, blocks and mobiles can be used to develop fine motor control and eye tracking (Haydari et al, 2009). The lack of either of these types of affordance toys can slow motor milestone development.

Rate Controllers

The majority of the rate controllers are interconnected with one another, in that one will lead to more rate controllers causing deficits in motor milestone acquisition. Obesity and muscular strength are strongly correlated to one another when affecting motor milestone acquisition. Aside from the persistence or absence of infant reflexes, the following rate controllers can be reversed to help promote the attainment of motor milestones. Due to improved nutrition and living conditions, infants are walking earlier than previous generations (Pica, 2003).

Psychological Stress

A study be Gilbert et al (2013) demonstrates that children exposed to violence causes an increased amount of stress hormones which is strongly correlated to delayed motor milestone development and decreased overall health. The decreased mental health of either parent will also increase internal stress of children. It was advised that pediatricians should screen for parental depression of children with delayed motor milestones (Gilbert et al, 2013). A common cause is postpartum depression of the child’s mother (Gilbert et al, 2013).

Obesity

While there hasn’t been significant evidence supporting the correlation between obesity and delayed attainment of motor milestones as shown in studies by Schmidt et al (2013) and Neelon et al (2013), the research does pose a different approach, the level of physical activity a child is receiving (Neelon et al, 2013). The more children are sitting in front of the TV, the less they are up and moving around. Pica (2003) discovered an astonishing statistic that children are spending about 17h a week watching television and another 60h a week in movement restricted apparatuses such as cribs or high chairs. The children with increased movement restricted time are more likely to have a delayed onset of motor milestones and a higher incidence of child obesity (Pica, 2003). The delay of motor milestones could have a serious effect on overall child development in missing critical periods.

Muscular Strength

The lack of sufficient muscular strength will cause delays in gross motor milestone attainment (Esther, 1995). If the child does not have the strength to pull itself up, it will not attempt to do it. During the infancy stage of development, the child should be exhibiting kicking, stepping, and bouncing motions, which will lead to increased leg strength (Esther, 1995). These movements are not only increasing strength in extensor and flexor muscles but also helping the child to learn coordination and limb control (Esther, 1995). Referring back to Pica’s (2003) research regarding movement restriction at a critical age will cause a decrease in muscular strength. Children are increasingly becoming more sedentary, prolonging movement experiences and delaying building muscular strength for proper gross motor milestone acquisition (Pica, 2003).

Persistance and Absence of Infant Reflexes

The persistence of infant reflexes can be caused by a number of chronic physical or developmental factors such as low birth rate (Marquis et al, 1984), but with time can be overcome and the proper motor milestones can be achieved. Conversely, continual display of reflexes or an absence at certain ages can be a sign of neurological damage (Futagi et al, 2012). The two major reflexes that are monitored by pediatricians are the palmar and plantar grasp reflexes. Both reflexes are exhibited by clenching the hand and foot during stimulation of the palm and footpads respectively (Futagi et al, 2012). Prolonged presence can indicated an upper level brain lesion or mental retardation, while weak or lack of the reflexes could be a sign of cerebral palsy (Futagi et al, 2012). The persistence of both these reflexes will inhibit gross and fine motor milestone development. The gross motor milestone standing will become a major issue in children with prolonged plantar grasp reflexes. Alternatively, a weak or absent palmar grasp reflex will inhibit the attainment of fine motor milestones needed for fine motor control of the hands (Futagi et al, 2012).

Practical Application

Early Recognition

Parents, coaches, and teachers need to be knowledgeable in the acquisition timing of motor milestones. It is a key tool in recognizing developmental delays, which can be a precursor for mental and learning disabilities (Fiorentino, 1972). Monitoring a child’s development and understanding the normal flow of motor milestones will allow caregivers to distinguish between abnormal and normal behaviour. It is difficult for caregivers to use testing methods and accurately score their child. Instead a general knowledge of basic motor milestones will help prepare them to identify abnormalities where a physician can assess the child further using the appropriate testing methods. A useful tool for new parents to learn about motor milestone acquisition is an informative book called Well Beings: A Guide to Health in Child Care, which is written by pediatricians addressing developmental processes in a simple layout. The book also distinguishes between gross motor, fine motor, social, and language/social milestones which allows parents to identify which area their child is having difficulties. In the later stages of development coaches are more likely to notice gross motor milestone delays, while teachers would notice fine motor milestone delays more easily. Coaches and teachers should be trained in recognizing deficits. Coaches should be able to assess a child’s ability to control movements, such as stopping after running. The lack of control during running can be an indicator of learning disabilities (Gabbard, 2011).

Clinicians

There is an assortment of developmental tests for clinicians to perform on infants to determine their motor milestone acquisition. The two main ones recommended after a longitudinal study by Darrah and Piper (1998) are the Alberta Infant Motor Scale (AIMS) and the Movement Assessment of Infants (MIA). The Peabody Developmental Gross Motor Scale (PDGMS) was shown to have poor predictive abilities for later deficits in motor milestones and was not recommended (Darrah & Piper, 1998). The two recommended scales have shown different strengths for different age groups and should be conducted accordingly.

Alberta Infant Motor Scale

Children should be tested with Alberta Infant Motor Scale (AIMS) during their check ups with physicians at neonatal follow-up clinics. AIMS is a four part identification tool in assessing deficits in infants 18 months and younger on their motor milestone progress. AIMS also tests mental and psychomotor capabilities. The AIMS is most accurate between 8 months and 18 months (Darrah & Piper, 1998). Based on their results, it was shown that the AIMS is the most accurate assessment in predicting future motor delays. Due to the complexity of the grading scale, materials and testing procedures, only trained professionals should use AIMS.

Motor Infant Assessment

MIA is another assessment scale for clinicians to predict motor developmental delays in infants. The MIA shows increased accuracy at 4 months of age but its predictive validity begins to diminish by 8 months and again at 18 months of age producing an increased rate of false positives when compared to AIMS (Darrah & Piper, 1998).

Overcoming Motor Milestone Delays

Once delayed motor milestones have been identified, assuming non-neurological factors are the cause, caregivers should review their child’s environment for areas of improvement. Does the child spend a sufficient amount of time on their stomach for tummy time? Are there affordances for the child to utilize within the home? Is the child in a movement-restricted apparatus for long periods of time? Parents should become aware of improvement areas to help the child progress to the next major motor milestone.

References

Adolph, K. E., Berger, S. E., and Leo, A. J. (2011). Developmental continuity? Crawling, cruising, and walking. Journal of Developmental Science. 14(2), 306-318.

Bonvillian, J. D., Orlansky, M. D., and Novack, L. L. (1983). Developmental Milestones: Sign Language Acquisition and Motor Development. Child Development. 54(6), 1435-1445.

Darrah, J., and Piper, M. (1998). Assessment of gross motor skills of at-risk infants: Predictive validity of the Alberta Infant Motor Scale. Developmental Medicine and Child Neurology. 40(7), 485-491.

Davis, B. E., Moon, R. Y., Sachs, H. C., and Ottolini, M. C. (1998). Effects of sleep position on infant motor development. Journal of the American Academy of Pediatrics. 102(5), 1135-1140.

de Onis, M., Garza, C., Victora, C. G., Bhan, M. K., and Normun K. R. (2006). WHO motor development study: Windows of achievement for six gross motor development milestones. Acta Paediatrica. 450(95), 86-95.

Esther, T. (1995). Motor development: A new synthesis. US: American Psychological Association. 50(2), 79-95.

Fiorentino, M. R. 1972. Normal and abnormal development: The influence of primitive reflexes on motor development. Springfield IL: Charles C Thomas Publishing.

Futagi, Y., Toribe, Y., and Suzuki, Y. (2012). The grasp reflex and Moro reflex in infants: Heirarchy of primitive reflex responses. International Journal of Pediatrics. 20(12), 1001-1011.

Gabbard, C. P. (2011). Lifelong motor development. San Francisco CA: Benjamin Cummings Publishing Company. 6th Edition.

Gilbert, A. L., Bauer, N. S., Carroll, A. E., and Downs, S. M. (2013). Child exposure to parental violence and psychological distress associated with delayed milestones. Journal of the American Academy of Pediatrics. 132, 1-7.

Grenier, D., and Leduc, D. (2008). Well beings: A guide to health in child care. 3rd Edition. Canadian Paediatric Society.

Haydari, A., Askari, P., and Nezhad, M. Z. (2009). Relationship between affordances in the home environment and motor development in children age 18-24 months. Journal of Social Sciences. 5(4), 319-328.

Majnemer, A., and Barr, G. R. (2007). Influence of supine sleep positioning on early motor milestone acquisition. Developmental Medicine and Child Neurology. 47(6), 370-376.

Marquis, P. J., Ruiz, N. A., Lundy, M. S., and Dillard, R. G. (1984). Retention of primitive reflexes and delayed motor development in very low birth weight infants. Journal of Developmental & Behavioral Pediatrics. 5(3), 124-126.

Neelon, S. E., Oken, E., Taveras, E. M., Rifas-Shiman, S. L., and Gillman, M. W. (2013). Age of achievement of gross motor milestones in infancy and adiposity at age 3 years. Journal of Maternal Child Health. 16(5), 1015-1020.

Opper, S. (1996). Hong Kong's Young Children: Their Early Development and Learning. Hong Kong: Hong Kong University Press, HKU. Retrieved January 22, 2014, from Project MUSE database.

Pica R. Your active child: How to boost physical, emotional, and cognitive development through age-appropriate activity. McGraw-Hill Companies, Inc.; New York: 2003.

Schmidt, M. C., Andersen, A. M., Due, P., Neelon, S. B., Gamborg, M., and Sorensen, T. I. (2013). Timing of motor milestones achievement and development of overweight in childhood: a study within the Danish National Birth Cohort. Pediatric Obesity. DOI: 10.1111/j.2047-6310.2013.00177.x.