TIS                         

The neonatal period of development is considered to be the first three months of life. There are generally accepted motor milestones that each child achieves, though each child does develop at an individual rate. The next chapters will outline normal developmental milestones, areas of concern for each stage, differences seen in the premature infant and treatment interventions to consider for delayed milestone development. The normal neonate is dominated by the TLR, ATNR, and righting reflexes as reflected through functional approaches of the milestones attributed to this stage.

THE MILESTONES | 1 - 3 MONTHS

• Attempts to hit or swipe at moving objects with hands
• Change of expression at the sound of a familiar voice
• Enjoys interactions with others
• Attempts to use hands and eyes in coordination
• Appears to recognize familiar faces and objects
• Kicks and pushes with legs when placed supine or prone
• Automatic stepping response when held up with feet on a firm surface
• Recognizes sounds and turns head toward the sound
• Begins to coo and babble
• Will raise chest and head when placed prone
• Will open and close hands and able to mouth the hand or fingers
• Grasp and shake small toys

AREAS OF CONCERNS

• Cannot support head at 3 months
• Will not extend legs when placed on a hard surface by 4 months
• Eyes do not follow objects by 2 to 3 months
• Little babbling and does not mimic by 4 months
• No response or startle reflex to loud sounds or noises
• No smile or change of expression by 2 months
• Appears disinterested in new faces
• Does not bring objects to the mouth by 4 months
• Legs and arms appear weak, no kicking or grabbing

COMPARISON OF PRE-TERM AND FULL-TERM MOTOR DEVELOPMENT

	Full-term	Pre-term
4 weeks	Posture dominated by flexion Sitting - head in midline Arms by side	Posture dominated by extension Sitting - very rounded back and Forward head position
8 weeks	Prone suspension - head in line with body	Prone suspension - complete flexion

Atypical behaviors of the neonate include:

• Hands fisted with absence of isolated digital movement
• Head always positioned to the side
• Inability to clear face in prone
• Head thrusting that may impede finding mother’s nipple and sucking

Atypical behaviors of the one-month old include:

• Difficulty flexing legs under body
• Limited arcs of extremity movement
• Absence of reciprocal leg movements
• Lack of grasp and release

Atypical behaviors of the two to three-month old include:

• Inability to right head during pull-to-sit maneuver
• Unable to elevate pelvis to bring feet to hands
• Head elevation in prone to 90 degrees

Treatment interventions generally are directed at the developmental processes that appear lacking. If the child is ill, refer to treatment interventions of previous chapters. However, for an otherwise healthy infant, consider developing a treatment plan for the caregivers that include sensory integrative approaches such as neutral warmth with soft, warm blankets, positioning prone to encourage head rising, interesting shapes in black and white to encourage visual looking, and gentle stroking for stiffness that appears abnormal.




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