Overview
This lecture reviews the normal timeline and progression of motor milestones in children from birth to 24 months, outlining key developmental principles, what pediatricians assess, and important signs for parents to monitor.
Early Motor Development (Birth–4 Months)
- Newborns cannot control their head; parents must support it.
- By 1 month, babies can lift their head to 45° while on their stomach.
- By 2–3 months, head lifts to 90°; by 4 months, chest also lifts ("puppy pose").
- Primitive reflexes govern early movements and must resolve before voluntary control develops.
Reflexes and Pediatric Assessment
- Pediatricians check primitive reflexes: Moro (startle), asymmetric tonic neck (fencing), hand and foot grasp.
- Head control is assessed using the "pull to sit" maneuver.
- Resolution of reflexes and attainment of milestones are monitored over months.
Rolling and Sitting (4–9 Months)
- Rolling over starts as head and chest control improve, with tummy time on a firm surface aiding development.
- By 6 months, babies may sit briefly when placed; by 7 months, they rely less on their hands.
- By 8–9 months, babies often sit independently and get into a sitting position unaided.
- Motor control develops from head down through the body (cephalocaudal principle).
Standing, Cruising, and Walking (9–17 Months)
- Supported standing is enjoyable from 6 months.
- Between 9–12 months, babies pull to stand, then cruise while holding on, and eventually take independent steps.
- Protective reflexes, like the lateral and backward parachute, must develop before stable walking occurs.
Crawling and Later Motor Milestones (12–24 Months)
- Crawling is not a required milestone (15% skip it), but most children crawl in various styles.
- New walkers (12–17 months) show wide-legged, arms-up gait; gradually, their gait matures.
- By 18 months, toddlers climb stairs with support; by 20 months, kick a ball; by 21 months, throw a ball.
- By 24 months, toddlers jump with both feet and have a more mature heel-to-toe walking pattern.
- Most major motor milestones are achieved by 24 months, followed by skill refinement.
Warning Signs & When to Contact the Pediatrician
- No head control by 4 months—discuss with pediatrician.
- Not sitting by 9 months.
- Not walking independently by 18 months.
- Any regression or loss of skills at any age.
- Any parental concern about development warrants medical discussion.
Key Terms & Definitions
- Primitive reflexes — Involuntary movements (e.g., Moro, grasp) present at birth that must resolve for voluntary control development.
- Pull to sit maneuver — Test where the doctor pulls the baby to a sitting position to check head control.
- Parachute reflex — Protective reflex where the baby extends arms to prevent a fall.
- Cruising — Walking while holding onto furniture.
- Cephalocaudal principle — Motor development proceeds from head downward through the body.
Action Items / Next Steps
- Observe your child's movement milestones and note any concerns.
- Discuss any missed milestones or regressions with your pediatrician.
- Schedule regular check-ups for ongoing developmental assessment.