Developmental Milestones: Motor Development

Abstract

1. R. Jason Gerber, MD* 2. Timothy Wilks, MD† 3. Christine Erdie-Lalena, MD‡ 1. *Major, USAF, Medical Corps, Developmental & Behavioral Pediatrics Fellow, Madigan Army Medical Center, Joint Base Lewis-McChord, Wash. 2. †LCDR, USN, Medical Corps; Developmental & Behavioral Pediatrics Fellow, Madigan Army Medical Center, Joint Base Lewis-McChord, Wash. 3. ‡Lt Col, USAF, Medical Corps, Program Director, Developmental & Behavioral Pediatrics Fellowship, Madigan Army Medical Center, Joint Base Lewis-McChord, Wash. After completing this article, readers should be able to: 1. Identify the milestones for gross and fine motor development. 2. Recognize the child whose development falls outside of the expected range. 3. Describe the sequences involved in gross and fine motor development. This is the first of three articles on developmental milestones; the second and third articles will appear in the September and November 2010 issues of Pediatrics in Review, respectively . Infancy and childhood are dynamic periods of growth and change. Neurodevelopmental and physical growth proceed in a sequential and predictable pattern that is intrinsically determined. Skills progress from cephalic to caudal; from proximal to distal; and from generalized, stimulus-based reflexes to specific, goal-oriented reactions that become increasingly precise. As one clinician has stated, “infants [and children] are very orderly in their ways; they actually behave [and develop] according to laws that can be explored, discovered, confirmed, reconfirmed, and celebrated.” (1) By convention, these neurodevelopmental “laws” or sequences often are described in terms of the traditional developmental milestones. Milestones provide a framework for observing and monitoring a child over time. According to recent American Academy of Pediatrics and Bright Futures guidelines, pediatricians should incorporate developmental surveillance at every health supervision visit. Surveillance involves analyzing the milestones in the context of a child's history, growth, and physical examination findings to recognize those who may be at risk for developmental delay. A thorough understanding of the normal or typical sequence of development in all domains (gross motor, fine motor, problem-solving, receptive language, expressive language, and social-emotional) allows the clinician to formulate a correct overall impression of a child's true developmental status. However, it …