Pediatric Developmental Summary

Developmental Summary Through Adolescence

At birth, the human brain weighs 25% of the adult brain, accounting for about 10% of the infant's body weight. The brain will continue to grow and myelinate, tripling in weight at about age 15. There are several growth spurts when significant growth takes place, but the most critical period of CNS growth and organization takes place from birth to age three (Bertoti, pgs. 59 & 60).

Motor development in childhood follows a sequence that is considered sequential vs. linear and more spiral and flexible than previously thought. One skill must be achieved before the next, but each is not a rigid building block. The more time spent practicing and being exposed to a skill, the greater the level of mastery will be. Movement begins with reflexes, postural reactions, equilibrium and protective and associated reactions. Next come functional movements. These are movement patterns we use to perform daily tasks. These movements consist of coordinated movements of the trunk, upper and lower extremities. In order to achieve functional movements, individuals need adequate mobility and range of motion, proper muscle tone and strength, the ability to isolate movements, postural stability, the ability to bear weight and shift weight and to adjust posture. The first year of life is when the most rapid rate of change occurs. Between 12-18 months the child becomes ambulatory. Between years two and six, the child becomes more independent and fundamental movement patterns are developed. During adolescence, specialized movement patterns are developed and depend a great deal on opportunities to practice, encouragement and skilled instruction. (Bertoti, pgs. 99-130).

The development of the somatosensory system begins in utero beginning with touch then motion detection, smell, hearing, vision, taste and proprioception. By birth, the senses of touch and proprioception are ready to function, and all structural and functional changes occur to all the sensory systems as the child interacts with its environment. During infancy and childhood, vestibular and visual information merge with somatosensory information which contributes to sensory-motor mastery. This process continues throughout adolescence, as does myelination. During adolescence, tactile and proprioceptive information are essential for developing the transforming adolescent's body scheme and body image (Bertoti, pgs. 64-66).

Although central visual pathways are formed prenatally, they must be utilized and stimulated postnatally for the synaptic pathways to become functional. Newborns show a preference for patterns and human faces. Infants and preschoolers rely heavily on visual feedback for developing postural control. Throughout adolescence, sensory abilities continue to guide motor control (Bertoti, pgs. 70-72)

The vestibular system begins to develop as early as 4 weeks gestation and is completely myelinated at birth. Postures that support reaching, manipulation and locomotion are sought out by the body. Delays in motor function are seen in children with vestibular problems. Repetitive movements like rocking and spinning are thought to assist with the maturation of the vestibular system. Children often engage in these activities until middle childhood. The vestibular system reaches full maturity between 10 and 14 (Bertoti, pgs. 75-77).

By 8 weeks gestation, most skeletal muscles are present, and development of bone begins between weeks 3-8. Between weeks 7 and 12, the primary ossification centers are present. By birth the diaphyses are generally ossified. Muscle fibers increase rapidly between birth and 2 months and there is a huge growth spurt by the age of 2 years. Fiber size continues to increase until adolescence. Muscular strength continues during infancy and childhood but is thought to be greatest between age 6 and 18. In adolescence there is a growth spurt when muscle fibers double and bone growth occurs, causing sudden increases in height and weight. Girls hit this spurt around age 12-13 and boys about two years later. Once the epiphyseal plates close, skeletal maturity is achieved. This may continue as late at age 25 (Bertoti, pgs. 82 & 83).

It's vitally important for a PTA to be aware of all the stages of development in every area to be effective with their treatments. Establishing a trusting and honest relationship with parents/caregivers is key when working with children. In addition, cooperating with other team members, including school personnel, is very important for ensuring proper treatment and follow through. Keeping in mind that a child's work is play and that they need to be motivated in ways that are meaningful to them can go a long way in gaining cooperation and hopefully, making progress toward goals. Have fun, speak on their level, give them some choices and develop motivational systems if needed.

Bertoti, D.B., (2004). A Lifetime Approach to the Systems that Produce Human Movement. In M. Biblis & P. Waltner (Eds.), Functional Neurorehabilitation Through the Lifespan. Philadelphia, PA: F.A. Davis.

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