Infant Motor Development: Rolling & Reflexes

Rolling and Gross Motor Development

• Purposeful rolling typically starts at 5-6 months.
• Core strength, proprioception, and head & neck control are key requirements for rolling.
• Speech development is NOT a key requirement for rolling.
• Red flags if an infant cannot roll by 7 months include limited engagement, asymmetrical rolling, and persistence of primitive reflexes.
• Lower limb mobility and visual & tactile feedback contribute to successful rolling.
• Primitive reflexes influence movement patterns in early infancy.

Primitive Reflexes

• The Moro reflex's primary role is to provide a startle response for survival.
• The Moro reflex typically integrates between 3 to 6 months.
• Asymmetry in the Moro reflex could indicate peripheral nerve injury or clavicle fracture.
• A persistent Moro reflex beyond 6 months could indicate neurological conditions.

Infant Gait & Motor Control

• Infants typically develop the ability to squat while playing between 12-18 months.
• Early walking is characterized by a high guard arm position.
• Squatting contributes to better balance and postural control in early walking.
• Red flags for an infant’s gait development include frequent falls, persistent asymmetry, and lack of postural control.

Growth & Development Monitoring

• The average height gain in the first year of life is 250mm.
• Motor development is influenced by genetics, environmental stimulation, and nutrition.
• A common feature of the adolescent growth spurt (AGS) is rapid growth acceleration.

Growth Plate Fractures & Musculoskeletal Conditions

• Salter-Harris Type II fractures are the most common type of growth plate fracture.
• Growth disturbances are a potential long-term complication of a poorly managed growth plate fracture.
• Slipped Capital Femoral Epiphysis (SCFE) is suspected in a 15-year-old male presenting with an externally rotated leg and hip pain.
• The primary treatment for SCFE is in situ pinning.

Biomechanical Development & Intervention

• A key characteristic of an infant’s foot posture is flexible flat foot.
• The toe-walking test helps confirm normal foot biomechanics in a child with flat feet.
• Strengthening and balance training is the most appropriate intervention for a 22-month-old infant with hypermobility and delayed walking.
• A balance bike is the recommended method for teaching a child to ride a bike.
• A balance bike is preferred over training wheels because it teaches natural weight shifting.

Musculoskeletal/Biomechanical Development

• Growth is an increase in body size, while development includes physical maturation.
• Musculoskeletal development is the formation of skeletal muscle, bone, and cartilage.
• Biomechanical development in children helps to understand mechanical principles in a developing musculoskeletal system.
• The primary function of growth plates is to provide longitudinal bone growth.
• Growth typically occurs for 14-18 years in life.
• A common misconception is that children should receive the same treatment as adults for musculoskeletal injuries.

Salter-Harris Classification

• The Salter-Harris Classification describes growth plate fractures.
• Type II is the most common Salter-Harris fracture.
• Type V Salter-Harris fracture has the worst prognosis.
• The primary concern with growth plate fractures is growth disturbances and limb length discrepancies.

Musculoskeletal Conditions in Children

• Slipped Capital Femoral Epiphysis (SCFE) is the most likely diagnosis for a 15-year-old male presenting with an externally rotated leg, hip pain, and knee pain.
• Plagiocephaly is an asymmetrical flattening of the skull.
• Idiopathic scoliosis is most commonly diagnosed in adolescents aged 10-18 years.
• Idiopathic Toe-Walking is associated with developmental disorders such as autism or cerebral palsy.
• The tibial tuberosity is the most common site affected by Osgood-Schlatter disease.

Fontanelles & Cranial Development

• Fontanelles in infants allow for brain growth and skull flexibility.
• Early closure of the fontanelles is associated with Craniosynostosis.
• Delayed closure of the fontanelles can be caused by Hydrocephalus.

Biomechanical Development

• A child under 2 years old naturally has genu varum (bow legs).
• A child’s lower limb alignment reaches near-adult positioning around 7 years.
• The heel raise test (toe-standing test) is used to assess normal pronation in children.

Paediatric Physiotherapy Interventions

• Physiotherapy (stretching & positioning) is the first-line intervention for mild Plagiocephaly and Torticollis.
• Strength training and proprioceptive exercises are the best intervention for a child with hypermobility and delayed walking.
• A child with severe SCFE should be treated with non-weight-bearing and surgical fixation.
• Osgood-Schlatter disease is the most common paediatric lower limb condition.

Autism Spectrum Disorder

• Autism affects how a child perceives the world, thinks, feels, and interacts with others.
• Autism is a lifelong disability with key components of difficulty with socialization and processing sensory information.

Cerebral Palsy

• Cerebral palsy is a group of non-progressive motor impairment syndromes due to brain lesions in early development.
• Motor disorders are often accompanied by disturbances of sensation, perception, cognition, and communication.
• The original brain injury does not change, but secondary complications need management.

Spina Bifida

• Spina bifida is a neural tube defect where the spine and spinal cord do not properly form.
• Spina bifida leads to mild to profound disability.

Down Syndrome

• Down syndrome is a genetic disorder caused by anomalies with the 21st chromosome.
• All children with Down syndrome present with a degree of intellectual disability and difficulties with motor development.
• Heart and gastrointestinal disorders are common medical abnormalities for children with Down syndrome.