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Skye is four months old. She has come to see you with her parents following a referral from her General Practitioner for macrocephaly. She was born by normal vaginal delivery at term. Her mother was on the methadone during pregnancy.
Please assess her gross motor skills.
Attempt this task before looking at the answer
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Gross motor development assesses movements that are generated by large muscle groups. They are carried out in a coordinated fashion and accomplish a single movement or a series of movements. This can be expressed in the form rolling, sitting, standing, walking, running, throwing, jumping and many others.
To be able to carry out a developmental examination one must know what is expected at each stage or age of development. It is also important to know that gross motor development progresses from simple to more complex movements.
Introduce yourself to the young infant and parent and gain their consent. Have in mind a variety of test that will help you reach your goal.
Examine the young infant using the 360 degree examination.
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Start with the infant in the supine position. Comment on their posture, the position of their head with respect to the rest of their body and their limbs.
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Pull the young infant holding on both arms to a sitting position from supine position. Observe the young infant during the pull-to-sit and the sitting position. Comment on their tone, head lag, and the shape of their back when they are sitting.
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Hold the young infant around the chest with both arms and try to help the young infant to stand. Do they take any weight on their legs? What is their tone? Observe the young infant in the upright and ventral suspension position.
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Return the young infant onto the couch in a prone position and do further observations. Remember not to leave the child in this position. At each stage check primitive reflexes.
The following table show what is expected at different ages.
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Supine position
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Newborn
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Elbows and legs semi flexed.
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The posture is symmetrical if the head is in the midline
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There is head lag on pull to sit until the body is upright when it is held for a few seconds
First 6 weeks
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Asymmetrical tonic reflex- with the baby supine and the head to one side, the arm and the leg on the side facing the occiput flex while the other arm and leg extend
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From six weeks a child will keep his/her head in the midline
3months
6months
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Sitting
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4-8weeks -Curved back when held sitting
20weeks -Straight back
3months -Holds head when held sitting but bobs forward
6months -Sits with support
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Standing
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Newborn •Walking and placing reflex when held standing
3months •Tends to sag on the knees and cannot bear weight
6months •Can bear weight when held standing. Likes to bounce
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Ventral suspension
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Birth •The head is held just below the plane of the body the hips are semi flexed
One month •Head lifts momentarily with the hips and knees semi flexed
6weeks •Holds head in line with the body for a few seconds
12 weeks •Hold head higher than the rest of the body
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Prone position
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Birth -4weeks • Lies with his face turned to the side. The arms are flexed towards the chest. The pelvis is high and the Knees are flexed
4weeks • Turns head from side to side readily
6 weeks • Hold head in line with the body for a few seconds
12weeks • Lifts head and upper chest off the couch
24 weeks • Rolls from front to back
28 weeks • Rolls from back to front
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Video provided thanks to http://www.medivisionfilms.com/,
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