Early Diagnosis & Intervention for

Developmental Delay (0 - 3yrs)

Child development is a basic science of child health care. Here is the key to best outcome the development delays to attain better future.

Gross Motor Development Chart

Age Ventral suspension Prone Pull to sit / sitting position Supine Held in standing
4 weeks Held in prone position with hand under abdomen Head held up momentarily. Elbows flexed, hips partly extended, knees flexed Pelvis high, knees drawn up largely under abdomen. Intermittent partial extension of hip and knee. Momentarily lifts chin off couch. Head predominantly to one side. @Almost complete head lag, back uniformly rounded. May hold up momentarily ATNR seen when at rest Flops at knee and hips. May be residual walking reflex when sole of foot is pressed on flat surface.
6 weeks Head held up momentarily in same plane as rest of body. Some extension of hips and flexion of knees. Flexion of elbows Pelvis high, but knees no longer under abdomen. Chin raised intermittently off couch. Head turned to one side head lag considerable nut not complete tonic neck reflex at rest intermittently seen No walking reflex, head sags forward. May hold head up momentarily
12 weeks Head held up for prolonged period beyond plane of rest of body Pelvis flat. Chin and shoulder off couch for prolonged periods. Plane of face at angle of 45 to 95 degrees from couch, weight borne on forearms Only slight head lag. Head mostly held up, but still bobs forward No more ATNR
6 weeks Head and chest off couch so that plane of face is at angle of 90 degrees to couch Only slight head lag at the beginning of movement. Head held up constantly. Head wobbles when child is gently swayed Head in midline
20 weeks Weight on forearms No head lag, no head wobble when swayed, back straight Feet to mouth, Bears most of weight
24 weeks Weight on hands, not forearms chest and upper part of abdomen off couch, Rolls prone to supine When about to be pulled to sit, lifts head off couch. Sits supported in high chair Bears full weight on legs
28 weeks Weight bears on one hand, rolls from supine to prone Sits with hands on couch for support, Spontaneously lifts head off couch Bounces with pleasure
36 weeks In trying to crawl progresses backwards, may progress by rolling Sits steadily on floor for 10 minutes Leans forward and recovers balance but cannot lean over sideways Stands holding on to furniture, pulls self to stand
40 weeks Crawl position on abdomen, crawls by pulling self forward with hands Can go over into prone, or change from prone to sitting, sits steadily can pull self to sitting position Can stand holding onto furniture. Collapses with a bump.
44 weeks Creeps abdomen off couch Lifts foot
48 weeks Sitting, pivots, twisting round to pick up object Walks holding on to furniture. Walks two hands held
1 year Walks on hands and feet like a bear Walks one hand held
15 months Creeps up stairs Walks without help, can get into standing position without support, cannot go round corners or stop suddenly

Gross Motor Development Chart

18 months 2 years 30 months 3 years 4 years
Goes up and down stairs, holding rail, walks up stairs, one hand held,carrying doll, seats self on chair, beginning to jump both feet Goes up and down stairs alone, 2 feet per step. Walks backward in imitation. Picks up object without falling. Runs, kicks ball without overbalancing Jumps with both feet, walks on tiptoes when asked Jumps with both feet, walks on tiptoes when asked Goes down stairs, one foot per step. Skips on one foot

Primitive Reflexes - Overview

Reflex reaction Normal until Stimulus Response
Sucking 3 months Introduce a finger into the mouth Sucking action of lips and jaw
Rooting 3 months Touch baby’s cheeks Head turns towards stimulus
Grasp 3 months Press finger into palm from ulnar side Fingers flex and grip object
Foot grasp 9 months press the sole of the foot behind the toes Grasping response of feet
Placing remains Bring the anterior aspect of foot against the edge of table Lifts limb up to step onto table
Reflex stepping 2 months Hold baby upright and tip forward, sole of foot presses against table Initiates reciprocal flexion and extension of legs, simulating walking
Galant’s trunk incurvation 2 months Stroke back lateral to the spine Stroke back lateral to the spineFlexion of trunk towards side of stimulus
Moro 0-6 months Baby supine and back of head is supported above table. Drop head backwards, associated with loud noise Abduction and extension of arms. Hands open. This phase is followed by adduction of the arms as if in an embrace
Startle remains Obtained by sudden loud noise or tapping the sternum Elbow flexed( not extended as in the moro reflex) and hand remains closed
Landau From 3 months to 2 and a half years, strong 10 months Child held in ventral suspension, lift head Depress head: Head, spine and legs extend. Extend arms at shoulders The hip, knees and elbows flex
Crossed extension 2 months Supine head in mid position legs extended – stimulate medial surface of one leg by tapping Opposite leg adducts, extends, internally rotates and foot plantar flexes (typical scissor position)
ATNR 6 months usually pathological Patient supine: head in mid position, arms and legs extended – turn head to one side Extension of arm and leg on face side, or increase in extensor tone; flexion of arm and leg on skull side or increase in flexor tone
STNR Rare and usually pathological Patient in quadruped position or over tester’s knees – ventroflex the head b) dorsiflex the head Arms flex or flexor tone dominates, legs extended or extensor tone dominates Arms extend or extensor tone dominates: legs flex or flexor tone dominates
Positive support 3 months Hold baby in standing position – press down on soles of feet Increase of extension in legs. Plantar flexion, genu recurvatum may occur
Negative support 3 – 5 months Hold in weight bearing position Child ‘sinks’ astasia
Body righting derotative 4 – 6 months Supine – rotate head or one knee one side passively Active derotation at waist, segmental rotation of trunk between shoulders and pelvis
Rotative 6 – 10 months Rotate hip and knee or arm or head actively Active segmented rotation (hyperactive at 10 months, cannot lie supine)
Parachute Appears 6- 9 months and persists throughout life Hold the child in ventral suspension and suddenly lower him towards the couch The arms extend as if to protect from falling
Propping reaction 5 -7 months Child in sitting position, tilted to one side or backwards. Arms extend to the appropriate position as if to protect from falling

Fine Motor, Vocalization, Cognition and Social Development Chart

Age Hands Vocalisation General understanding Social behavior
4 weeks Predominantly closed, grasp reflex Crying. Variation in crying for hunger, pain and fatigue Watches mother’s face when she talks to him and he is not crying. Opens and closes mouth While suckling, baby’s face towards mother, regards mother’s face intermittently
6 weeks Often open. Grasp reflex may be lost Smiles at mother in response to overtures Is pacified by being carried social smile
8 weeks Frequently open. Only slight grasp reflex Smiles and vocalizes when talked to
12 weeks No grasp reflex, hands loosely open, hold rattle placed in hand for a minute or two Squeals of pleasure, ‘talks’ a great deal when spoken to, gutteral noises Smile is integral part of infant behavior. Responds with smile
16 weeks Hands come together in play, try to reach for object but overshoots. plays with rattle, shakes it gurgling Excites when food prepared, toys seen, showing mass reaction involving all 4 limbs and respirations Laughs aloud
20 weeks Able to grasp objects voluntarily, plays with toes, splashes in bath, objects taken to mouth. Razzing; ‘ah- goo’ Smiles at mirror image, pats bottle Differentiates between stern and affectionate tones of voice
24 weeks Holds bottle, grasps feet, palmar grasp of cube, drops one cube when another is given Rhythmic syllable chains When he drops a toy he looks to see where it has gone to and tries to recover it, smiles and vocalizes at mirror image, shows likes and dislikes, displeasure at removal of toy Differentiated social smile. Child smiles more readily when it sees familiar faces.
28 weeks Feeds self with biscuit, Babbles. likes to play with paper, bangs cube on table, transfers it from hand to hand, if he has one cube in hand, he retains it when second is offered Imitates simple acts, pats image of self in mirror, responds to name, tries to establish contact with person by cough or other method Can clearly differentiate between familiar people and strangers
36 weeks Can pick up object of size of currant between tip of finger and thumb, compares two cubes by bringing them together Combines syllables da-da, ba-ba, ma-ma Puts arms in front of face to prevent mother washing his face Is interested in its own reflection, observes adults at work
40 weeks Goes for objects with index finger, beginning to let go of objects(release) Has a dialogue with the mother. When she voices baby’s single or double syllables, the child repeats the syllables. If asked where is papa/ light, it turns the head to look for the person / light Looks round corner for objects, responds to words, where is daddy, pulls clothes of another to attract attention repeats performance laughed at
1 year Mouthing virtually stopped, beginning to throw objects to floor 2 or 3 words with meaning, knows meaning of more words, understands simple instructions May understand meaning of phrases where is your shoe, may kiss on request, apt to be shy Can play games. Ex., when mother crawls behind on all fours and tries to catch the Child
15 months Constantly throwing objects on floor, builds tower of 2, holds 2 cubes in one hand Jargoning, several intelligible words Asks for objects by pointing, beginning to imitate mother in domestic duties – sweeping, cleaning, inserts round block without being shown
18 months Tower of 3 or 4, Spontaneous scribble, makes stroke imitatively Tower of 3 or 4, Spontaneous scribble, makes stroke imitativelyPoints to 2or 3 body parts, follows simple orders like bring it to me, speech is jargon, many intelligible words, points to pictures of car or dog, knows one common object Domestic mimickry, copies mother in dusting, washing, cleaning Uses mother as secure base, checking back with her frequently
2 years Turns door knob, unscrews lid, washes and dries hands, tower of 6 or 7, imitates train of cubes, without adding chimney, imitates vertical and circular stroke Points to 4 body parts, asks for drink, food, obeys 4 simple orders, names 3 – 5 common objects, points to 5 pictures, asks for drink, toilet, food, uses I, you, me, joins 2 or 3 words in sentences Pulls people to show them toys, wraps up doll. Puts it to bed parallel play, watches others play and plays near them, but not with them
2 and a half years Tower of 8, imitates train, adding chimney. Imitates horizontal and vertical stroke Names 5 common objects, points to 7 picture cards, repeats 2 digits in 1 of 3 trials Knows full name, knows sex, names one color
3 years Tower of 9, imitates building of bridge, copies circles, imitates cross Names 8 picture cards, repeats 3 digits in 1 of 3 trials prepositions obeys 2 Knows some nursery rhymes, may count upto 10 Separates from mother easily in strange environment, identifies own gender, Begins to understand taking turns