Infant and Child Gross Motor Development

Gross Motor Development

• Gross motor function involves maintaining body position and moving by changing position or location.
• Postural control is essential for managing gravity, staying upright, and providing a stable base for movement.
• Gross motor function enables exploration in infants.
• Weight shifting, body rotation control, and bilateral coordination are vital for gross motor control.

Infant Development (0-2 Years)

• Typical child development must be understood before therapeutic engagement with babies, children, and young adults.
• Gross motor development rapidly changes during the first two years.

Child Development (2-5 Years)

• Focuses on gross motor development milestones during this period.

Primitive Reflexes and Postural Reactions

• Understanding primitive reflexes and postural reactions supports development and identifies red flags.

Activity 3 – Infant’s gait and motor control

• Typical infant gait demonstrates balance, weight shift, rotation, and upper limb use.

Gross Motor Development Timeline

• Create a timeline of gross motor development milestones from 0-18 months and 2-5 years.
• Consider the implications of delayed milestones.

Balance Bikes vs. Training Wheels

• Balance bikes are used to commence teaching bike riding to children.

Musculoskeletal/Biomechanical Development Definitions

• Growth refers to the increase in total body size or a specific organ.
• Development refers to the physical changes of maturation as a child ages.
• Musculoskeletal development involves forming skeletal muscles, bones, and cartilage.
• Biomechanical development applies mechanical principles to an immature musculoskeletal system to understand human motion.

Skeletal Growth

• Skeletal growth typically happens during the first 14-18 years of life.
• Children have more cartilage in their bones.
• Growth plates in long bones enable longitudinal growth.
• Growth plates can be affected by trauma, disease, genetic anomalies, and environmental causes.

Types of Growth Plates

• Epiphyseal growth plates at the ends of long bones facilitate longitudinal growth.
• Ring epiphyses surround round bones.

Salter-Harris Classification

• The Salter-Harris Classification system shows the range of severity of growth plate fractures.

Activity 1 : Implications of paediatric growth plate fractures

• Common mechanisms
• Orthopaedic treatment
• Physiotherapy treatment
• Long term outcomes and common complications

Activity 2: Musculoskeletal pain

• The patient, a 15-year-old male presents with progressively worsening right knee pain for the past 5 months.

Cranial Sutures

• Infant skull bones do not fully fuse until 1-2 years of age.
• A fontanelle is a ‘soft spot’ of a newborn baby’s skull.
• The baby's skull is made of bone sections (the plates) joined by fibrous joints (the sutures).
• There are two fontanelles: anterior (top of the head) and posterior (back of the head).

Activity 3: Fontanelles

• List conditions associated with delayed and early closure of fontanelles.
• List clinical signs that physiotherapists should be aware of when treating infants?
• Conditions associated with delayed closure.
• Clinical signs associated with delayed closure.
• Conditions associated with early closure.
• Clinical signs associated with early closure.

Biomechanical Development

• Children undergo significant biomechanical changes, especially in early years.
• Ignoring these typical developments can cause long-term implications.
• Lower limbs progress from genu varum to genu valgum, reaching near final alignment around age 7.
• Infants have little or no tibia rotation relative to the fibula, leading to an internally rotated foot position. This gradually changes to mild external rotation by age seven.
• Infants often have pronated feet with flexible flat feet, where feet invert and supinate when standing on their toes.

Activity : Biomechanical case study

• A 22-month-old infant presents with delayed walking, hypermobility with wide base, everted hind foot and strong plantar grasp.

Common Conditions in Paediatrics

• Practitioners need knowledge of conditions that will arise in real world practice.

Disability

• Autism Spectrum Disorder
• Cerebral Palsy
• Down syndrome
• Duchenne Muscular Dystrophy
• Spina Bifida

Delay/Other

• Developmental Coordination Disorder
• Global Developmental Delay

Musculoskeletal

• Slipped upper femoral epiphysis
• Talipes equinovarus
• Idiopathic scoliosis
• Idiopathic toe-walking
• Plagiocephaly and torticollis
• Osgood Schlatter and Sever’s disease
• Perthes disease

Cardiothoracic

• Cystic fibrosis

At risk

• Prematurity
• Low birth weight
• Acquired brain injury

Autism Spectrum Disorder

• Autism affects how a child perceives the world, changing how they think, feel, and interact.
• It involves difficulties socializing and processing sensory information, alongside rigid or repetitive behaviors.

Cerebral Palsy

• Cerebral palsy is a term for non-progressive motor impairment syndromes from early brain lesions.
• The disorders are accompanied by sensation, perception, cognition, and communication disturbances.

Spina Bifida

• Spina bifida is a neural tube defect where the spine and spinal cord don't properly form.

Down Syndrome

• Down syndrome is a genetic disorder caused by anomalies with the 21st chromosome.
• Children with Down syndrome have intellectual disability, motor development difficulties, and medical abnormalities.

Activity 1

• Provide a clinical pattern for two of the following conditions.

Activity 2

• Summarise your understanding of the difference between the terms equality and equity and how they apply to interventions in paediatric physiotherapy.

Activity 3

• Describe what you see

Activity 4: Communication

• Outline your initial thoughts on the concept of sympathy, empathy and compassion - especially when thinking of the balance between supporting parents to have genuine expectations and the need to avoid removing hope.