For Parents

Assure the Best for your Baby’s Physical Development
What Every Parent Should Know


A Note to Parents

As a parent, you know your child best. It is important for you to learn what early milestones are expected while your baby is growing. Inside this brochure, a unique chart allows you to track your child’s physical development. It begins at 3 months of age and continues to 15 months. Periodically review the information on the chart, and place a check mark next to the signs you see in your baby.

As you review the chart, record your observations or concerns. If you have any concerns, we encourage you to bring this chart to your doctor or health care professional. This brochure has been approved by the American Academy of Pediatrics and the National Association of Pediatric Nurse Practitioners. You know your child best, trust your instincts.

If you feel your baby is developing at a different pace, seek help. Early treatment of early motor delays is vital in assuring the best for your baby.

Help is Available! Some sources include your pediatrician, family physician, developmental behavioral pediatricians, nurse practitioners, pediatric neurologists, physical, occupational and speech therapists and your state Early Intervention program.

For additional information visit www.pathwaysawareness.org You may also want to have your child’s speech, vision and hand function evaluated. Much can be done to improve a child’s physical skills and abilities through speech, occupational and physical



Developmental Disabilities

Parents who have just learned that their child has a disability look everywhere for information to make sense of what can be a bewildering and emotional time in their lives. Many of the medical descriptions available in textbooks and on the net seem to be written about “cases”, “patients” or specimens, with the primary focus on deficits and failure. The children we love and care for – with all that they can do – often get left out of the picture.

In this section, we give an overview of a number of commonly diagnosed conditions to help you to understand what you might expect to encounter as your child grows and develops. We have made each description as child-friendly as possible, but sometimes the information can still overwhelm. Hold on to your child in your mind as you wade through these pages. He or she is so much more than a condition!

Developmental Disabilities include disabilities such as Mental Handicap, Down Syndrome, Fragile X Syndrome, Prada-Willi Syndrome, Cerebral Palsy, Speech and Language Disorders, ADD, ADHD, Autism to name a few.


Recognizing Early Motor Delays

A Comparison Examination of 2 Month Old Infants

Supine

  • Maintains head in midline for brief periods
  • Locates objects visually and tracks from left to right
  • Begins to show antigravity movements of upper and lower extremities
  • Not yet able to reach and grasp toys

Typical

  • May show more asymmetrical movement with predominance of head to one side; or strong asymmetrical tonic neck reflex (ATNR)
  • Difficulty visually tracking, may only track to one side or only to midline
  • Decreased ability to generate upper and lower extremity antigravity movements
  • Longer periods of inactivity

Atypical

Sidelying

  • Able to lift head and upper trunk during facilitated roll, showing lateral headrighting
  • Begins to balance activity of trunk flexor and extensor muscles
  • Ability to change from predominant use of flexors to use of extensors as position requires

Typical

  • May be unable to right head during facilitated rolling
  • May look more competent in sidelying, therefore important to observe baby in all eight positions

Atypical

Prone

  • Head lifting to 45 degrees and extension through upper thoracic spine
  • Hips and knees begin to move from flexed “newborn” posture into extended, abducted position, which allows head and trunk lifting
  • Elbows typically not directly under the shoulders until 3 months

Typical

  • Posture looks more like a newborn; infant does not show hip extension; hips and knees remain in flexed abducted posture.
  • No independent head lifting; can move head only with assistance

Atypical

Pull to Sit

  • Head-lag is typical until the infant is about 15 degrees from upright.
  • Uses shoulder elevation and elbow flexion to assist
  • Able to engage neck muscles to sustain midline head control when upright
  • Good extension through the cervical and upper thoracic spine

Typical

  • May exhibit head-lag through the entire pull to sit maneuver.
  • Poor head control when in pright sitting
  • Little muscle activity in the upper extremities or cervical spine
  • When upright, rounding of the thoracic and lumbar spine

Atypical

Sitting

  • Head is aligned with ear directly over the shoulder
  • Holds and sustains posture with assistance
  • Head turning may or may not be present at 2 months, but should be seen by 3 months

Typical

  • Needs more support to sustain sitting posture
  • Inability to achieve and sustain head lifting in upright position
  • Little to no antigravity arm activity

Atypical

Horizontal Suspension

  • Able to activate adequate neck and trunk extension to sustain posture
  • Can maintain brief periods of head control, but may not be able to hold the head in midline

Typical

  • Difficulty or inability to activate neck or upper thoracic extensors to lift head
  • May try to use arm and leg movements to sustain posture

Atypical

Protective Extension

  • Aware of being tilted forward; increases head and neck extension
  • Will not be fully able to bring arms forward for full protective response protection until 6 months

Typical

  • Unable to generate antigravity head and trunk activity

Atypical

Standing

  • Able to sustain weight on lower extremities with support at the trunk
  • Typically shows intermittent bouts of extension and flexion
  • Good vertical alignment from head through trunk and feet

Typical

  • May support little if any weight on feet
  • Little or no intermittent muscle activity to attain or maintain standing

Atypical





For more information please contact Pathways Awareness Toll-free (800) 955-2445 · Fax (888) 795-5884 · TTY (800) 326-8154 http://www.pathwaysawareness.org · friends@pathwaysawareness.org Copy freely, do not change. Must acknowledge Pathways Awareness.

Recognizing Early Motor Delays

A Comparison Examination of 4 Month Old Infants

Supine

  • Exhibits midline and symmetry of head, eyes, arms and legs
  • Shows visual engagement and reaches out against gravity
  • Demonstrates frequent antigravity extremity movement, dissociating from a more stable trunk

Typical

  • Displays asymmetry of head and extremities, with head tilted and body curved
  • Does not show a balance between extension and flexion
  • Moves extremities randomly, but without expected antigravity movement
  • Is not visually engaged and does not track object

Atypical

Sidelying

  • Uses upper arm and dissociated lower extremities to assist in facilitated roll
  • Sustains sidelying posture with a balance of trunk flexor and extensor muscles
  • Lifts head and upper trunk off the surface in preparation for independent rolling

Typical

  • Exhibits sluggishness in top arm during facilitated roll
  • Does not sustain sidelying posture; has inadequate control in position
  • Cannot lift head and upper trunk off support surface

Atypical

Prone

  • Brings shoulders and upper arms forward with elbows in front of shoulders
  • Shows progression toward lower extremity extension and adduction
  • Moves arms forward to reach for an object; turns head freely to follow object
  • Displays extensor activity into the lumbar spine

Typical

  • Has flexed hips which shifts weight forward while keeping elbows behind shoulders
  • Uses only neck extension instead of forearm weight bearing; head lifting is unsustained
  • Does not have the capability to shift weight onto lower extremities

Atypical

Pull to Sit

  • Maintains head in midline without head-lag and with good chin tuck
  • Lifts legs and activates trunk muscles to assist in maneuver
  • Pulls forward with both arms and abdominals to assist further in pull to sit

Typical

  • Demonstrates head-lag and cannot sustain head lifting once upright
  • Does not pull with arms; no upper extremity participation
  • Appears not to anticipate movement toward sitting

Atypical

Sitting

  • Shows good head control and chin tuck, with head in midline
  • Requires support only at hips and pelvis; has extension to mid-thoracic spine
  • Begins to move in anterior-posterior planes and comes back from forward flexion at the hips into upright sitting

Typical

  • Does not sustain head lifting; cannot turn head to look side-to-side
  • Must be held high under the armpits for support
  • Uses extremity posturing to compensate for decreased proximal strength

Atypical

Horizontal Suspension

  • Able to keep neck and trunk extended with head upright to 45 degrees, steady and in midline
  • Shows trunk extension into lumbar spine and scapular adduction
  • Freely moves arms and legs

Typical

  • Able to hold head up briefly but cannot maintain it in midline
  • Cannot sustain thoracic trunk extension and does not show hip extension
  • Cannot maintain trunk extension while moving arms and legs

Atypical

Protective Extension

  • Displays extension through neck, trunk and hips that is maintained during forward tilting
  • Cannot bring arms fully forward to surface because they are being used to sustain extension

Typical

  • Unable to sustain strong neck, trunk and hip extension during forward tilting
  • Uses excessive asymmetry and flexed arms to sustain extension to avoid hitting his head

Atypical

Standing

  • Keeps hips just behind shoulders
  • Has active extension into lower thoracic and lumbar spine, but no full hip extension
  • Can sustain standing posture; requires minimal support at lower trunk to aid in balance

Typical

  • Requires support in the upper thoracic area to sustain standing
  • Intermittent extension used to produce head lifting
  • Shoulders remain well forward of hips
  • Lacks adequate hip and trunk control for sustained weight bearing

Atypical





For more information please contact Pathways Awareness Toll-free (800) 955-2445 · Fax (888) 795-5884 · TTY (800) 326-8154 http://www.pathwaysawareness.org · friends@pathwaysawareness.org Copy freely, do not change. Must acknowledge Pathways Awareness.

Early Infant Assessment Redefined

Comparison Examination of two six-month old infants

Supine

  • Visual Tracking of 180º
  • Head in Midline
  • Reach and Grasp
  • Anti-gravity Movement
  • Pelvic Lifting

Normal

Atypical

Lyong on Side

  • Head in Midline
  • Arms in Midline
  • Muscle Balance
  • Muscle Activation
  • Weight Shifting
  • Lateral Righting

Normal

Atypical

Prone

  • Head and Trunk Lifting
  • Forward Reach
  • Strong Hip Extension
  • Lateral Weight Shift

Normal

Atypical

Pull to Sit

  • Leads with Head
  • Forward Flexion of Head
  • Shoulder Stability
  • Abdominal Activity

Normal

Atypical

Sitting

  • Head in Midline
  • Actively Leans Forward
  • Reach and Grasp
  • Good Back Extension

Normal

Atypical

Standing

  • Postural Alignment
  • Free Movement of Arms
  • Hip Extension
  • Leg Mobility
  • Weight Bearing on Flat Feet

Normal

Atypical

Horizontal Suspension

  • Anti-Gravity Movements
  • Anti-Gravity Extensions
  • Variety of Upper and Lower Extremity Movement

Normal

Atypical

Protective Extension

  • Head in Midline
  • Forward Movement of Arms
  • Anti-Gravity Alignment

Normal

Atypical





For more information please contact Pathways Awareness Toll-free 800-955-2445 ~ Fax 888-795-5884 ~ TTY 800-326-8154 www.pathwaysawareness.org ~ e-mail: friends@pathwaysawareness.org
Copy Freely, Do Not Change, Must Acknowledge “Pathways Awareness”

What Every Parent Should Know A Note to Parents

As a parent, you know your child best. It is important for you to learn what early milestones are expected while your baby is growing. Inside this brochure, a unique chart allows you to track your child’s physical development. It begins at 3 months of age and continues to 15 months. Periodically review the information on the chart, and place a check mark next to the signs you see in your baby.

As you review the chart, record your observations or concerns. If you have any concerns, we encourage you to bring this chart to your doctor or health care professional. This brochure has been approved by the American Academy of Pediatrics and the National Association of Pediatric Nurse Practitioners.

You know your child best, trust your instincts. If you feel your baby is developing at a different pace, seek help. Early treatment of early motor delays is vital in assuring the best for your baby.


Help is Available!

Some sources include your pediatrician, family physician, developmentalbehavioral pediatricians, nurse practitioners, pediatric neurologists, physical, occupational and speech therapists and your state Early Intervention program. Visit our web site at www.pathwaysawareness.org for additional information. You may also want to have your child’s speech, vision and hand function evaluated. Much can be done to improve a child’s physical skills and abilities through speech, occupational and physical therapy.Remember too, a family’s positive attitude is a proven factor in maximizing any child’s potential. All children can learn, but intelligence may be masked by difficulty with movement or vision. Early detection is the best prevention!


About Pathways Awareness Foundation

Established in 1988, Pathways Awareness Foundation is a national non-profit organization dedicated to raising awareness about the gift of early detection and the benefit of early therapy for infants and children with early motor delays.

Our activities are based upon the expertise of the Pathways Medical Round Table—leading physicians, clinicians, nurse practitioners, and lay advisors. They are sensitive to the medical and emotional needs of infants and children with early motor delays, including cerebral palsy, and their families and/or caregivers.

If you have any questions, please call our “parent-answered” toll-free number, or send us an email. We also welcome your feedback. Your comments will provide valuable information for Pathways Awareness Foundation. We look forward to hearing from you.


We believe early detection is prevention!

1-800-955-CHILD (2445)
TTY: 1-800-326-8154
Email: friends@pathwaysawareness.org
www.pathwaysawareness.org

Early Detection is the Best Prevention!

Important Parent Ideas:

  • Keep a notebook for your concerns and observations.
  • Review this chart and check the signs you see in your baby.**
  • Share your concerns, this chart and your notebook with your child’s doctor or health care professional.

** It is okay to check boxes in both the areas of “Typical Development” and “Signs to Watch for.”

    Typical Speech Development

BY 3 MONTHS

  • Sucks and swallows well during feeding
  • Quiets or smiles in response to sound or voice
  • Coos or vocalizes other than crying
  • Turns head toward direction of sound

BY 6 MONTHS

  • Begins to use consonant sounds in babbling, e.g. “dada”
  • Uses babbling to get attention
  • Begins to eat cereals and pureed foods

BY 9 MONTHS

  • Increases variety of sounds and syllable combinations in babbling
  • Looks at familiar objects and people when named
  • Begins to eat junior and mashed table foods

BY 12 MONTHS

  • Meaningfully uses “mama” or “dada”
  • Responds to simple commands, e.g. “come here”
  • Produces long strings of gibberish (jargoning) in social communication
  • Begins to use an open cup

BY 15 MONTHS

  • Vocabulary consists of 5-10 words
  • Imitates new less familiar words
  • Understands 50 words
  • Increases variety of coarsely chopped table foods

* Remember to correct your child’s age for prematurity


Typical Play Development*


    While lying on their back…
  • Visually tracks a moving toy from side to side
  • Attempts to reach for a rattle held above their chest
  • Keeps head in the middle to watch faces or toys

Typical Physical Development*

  • Pushes up on arms
  • Lifts and holds head up

Typical Play Development*


  • Reaches for a nearby toy while on their tummy
  • While lying on their back…
  • Transfers a toy from one hand to the other
  • Reaches both hands to play with feet

Typical Physical Development*

  • Uses hands to support self in sitting
  • Rolls from back to tummy
  • While standing with support, accepts entire weight with legs

Typical Play Development*


  • In a high chair, holds and drinks from a bottle
  • Explores and examines an object using both hands
  • Turns several pages of a chunky (board) book at once
  • In simple play imitates others

Typical Physical Development*

  • Sits and reaches for toys without falling
  • Moves from tummy or back into sitting
  • Creeps on hands and knees with alternate arm and leg movement

Typical Play Development*


  • Finger feeds self
  • Releases objects into a container with a large opening
  • Uses thumb and pointer finger to pick up tiny objects

Typical Physical Development*

  • Pulls to stand and cruises along furniture
  • Stands alone and takesseveral independent steps

Typical Play Development*


  • Stacks two objects or blocks
  • Helps with getting undressed
  • Holds and drinks from a cup

Typical Physical Development*

  • Walks independently and seldom falls
  • Squats to pick up toy

Signs to Watch for in Physical Development*



  • Difficulty lifting head
  • Stiff legs with little or no movement

  • Pushes back with head
  • Keeps hands fisted and lacks arm movement

  • Rounded back
  • Unable to lift head up
  • Poor head control

  • Difficult to bring arms forward to reach out
  • Arches back and stiffens legs

  • Pushes back with head
  • Keeps hands fisted and lacks arm movement

  • Uses one hand predominately
  • Rounded back
  • Poor use of arms in sitting

  • Difficulty crawling
  • Uses only one side of body to move

  • Inability to straighten back
  • Cannot take weight on legs

  • Difficulty getting to stand because of stiff legs and pointed toes
  • Only uses arms to pull up to standing

  • Sits with weight to one side
  • Strongly flexed or stiffly extended arms
  • Needs to use hand to maintain sitting

  • Unable to take steps independently
  • Poor standing balance, falls frequently
  • Walks on toes

Parents’ Stories

Birth

Abby was born full term and had difficulty with feeding, low muscle tone and head control. At our first visit with our family physician, she was diagnosed with a chromosomal abnormality and referred immediately for physical and speech therapy. Abby improved dramatically in her movement and speech skills. Now, at age 16, she is a happy, active teenager. We are so grateful to our family physician for the early referral to pediatric physical and speech therapy.

James and Brenda A.

2-3 Months

Jeffrey was born at 42 weeks following an uneventful pregnancy. At three months, he could not push up on his arms and had difficulty holding his head up when placed on his tummy. We shared our concerns with our pediatrician who referred us to a developmentalbehavioral pediatrician. Jeffrey is now 10 months old and although he does not have a definite diagnosis, he can push up on his arms from tummy lying and get on his hands and knees. We know that he is getting the help he needs.

Robert and Cindy P.

4-5 Months

Rachel was a breech baby and experienced meconium aspiration at birth. By age four months she was not holding her head up or using her hands. Our pediatrician referred us to our state’s Early Intervention program so Rachel could learn better physical movement. Now at age four and a half, she is learning to walk, attends our neighborhood school and is maximizing her potential.

Frank and Jenni S.

6-7 Months

Jason, who was eight weeks premature, was always difficult to diaper. His legs were stiff and difficult to get apart. At six months of age, he arched backward whenever we tried to place him in sitting. At eight months, he could still not sit by himself. Our pediatrician referred him to an Early Intervention program that includes physical therapy. Jason is now learning to walk by himself.

Larry and Pam R.

8-9 Months

Matt, the second of twins, refused to be placed on his tummy. He also would not take any weight on his feet, even at nine months of age, while his twin brother was walking around furniture in our living room. Our pediatrician referred us to a developmentalbehavioral pediatrician and Early Intervention services. Matt began physical therapy at nine months of age. He took his first steps at fifteen months. He may no longer need treatment by his second birthday.

Mike and Terry S.

10-12 Months

Christopher was born five weeks early and was in the hospital two weeks before coming home. During his first year of life, we began to notice that he did not use his right hand as often as his left. As he began to pull to stand, his right leg lagged behind. In standing he leaned toward the left side and dragged the right leg when walking around furniture.At eleven months, our pediatrician prescribed physical and occupational therapy. Now, at three years of age, Christopher is walking.

Bob and Sue D.

Pathways Awareness Foundation Medical Round Table


Co-Chairmen
H. Garry Gardner, M.D., FAAP
John F. Sarwark, M.D., FAAP, FAACPDM

Committee
Suzann K. Campbell, P.T., Ph.D., FAPTA, FAACPDM
Deborah Gaebler-Spira, M.D., FAAP, FAACPDM
Gay Girolami, P.T., M.S., FAACPDM
Fredric Leary, Jr., M.D., FAAFP, MBA
Karen R. Judy, M.D.
Amy Becker Manion, RN, MSN, CPNP
Michael E. Msall, MD, FAAP, FAACPDM
Michael N. Nelson, Ph.D.
Katie Silverman, Ph.D.
Lori Walsh, M.D.
Rosemary White-Traut, DNSC, RN, FAAN
Anita Bujnowski, Parent
Margaret C. Daley
Shirley Welsh Ryan

For more information or brochures please contact:

1-800-955-2445 • 1-800-955-CHILD TTY 800-326-8154
www.pathwaysawareness.org email: friends@pathwaysawareness.org This message endorsed by the American Academy of Pediatrics and the National Association of Pediatric Nurse Practitioners. COPY FREELY, DO NOT CHANGE, MUST ACKNOWLEDGE PATHWAYS AWARENESS FOUNDATION. ©Copyright 2006

Handle me with care

Supporting your premature baby’s development

Produced in collaboration with the Association of Paediatric Chartered Physiotherapists Neonatal Group


Published by BLISS – the premature baby charity.
First edition: 2005
Reprinted 2006
© BLISS – the premature baby charity
No part of this booklet may be reproduced in any form or for any purpose without the permission
of the publisher.



The American Academy of Pediatrics recommends placing babies on their backs to sleep and their tummies to play as part of a daily routine. Just a few minutes a day, a few times a day, can help your baby get used to “tummy time” and help prevent early motor delays. If you begin early (even from just a few days old) and maintain a consistent schedule, your baby will learn to love tummy time. This helps develop the muscles in their back, neck and trunk, on their way to meeting all their infant development milestones.

Here are the top five moves you can begin as soon as your baby is born:

Tummy to Tummy~

Lie down on the floor or a bed, flat or propped up on pillows. Place baby on your chest or tummy, so that you’re face-to-face. Always hold firmly for safety.


Eye-Level Smile~

Get down level with your baby to encourage eye contact. Roll up and place a blanket under the chest and upper arms for added support.


Lap Soothe~

Place your baby face-down across your lap to burp or soothe him. A hand on your baby’s bottom will help steady and calm.


Tummy-Down Carry~

Slide one hand under the tummy and between the legs when carrying baby tummy down. Nestle the baby close to your body.


Tummy Minute~

Place your baby on her tummy for one or two minutes every time you change her. Start a few minutes at a time and try to work up to an hour a day in shorter intervals by the end of three months. Don’t get discouraged every bit of tummy time makes a difference!


For a tummy time video, more information on why tummy time is so important and a growth and development chart endorsed by the AAP, please visit or contact:

Pathways Awareness
Parent-Answered Help Line 1-800-955-CHILD - www.PathwaysAwareness.org email questions to: friends@pathwaysawareness.org