Developmental Progress and Pitfalls:
a Physical Therapist’s Perspective
Jaime Petro, PT, C/NDT
Sheila Gonzales, PT, C/NDT
Objectives
1. Identify 3 developmental red flags in the first
year of life.
2. Explain the importance and impact of tummy
time on development.
3. Identify resources to appropriately refer a
child to address developmental concerns.
2
2 Week Old
• Age appropriate skills
– Able to lift chin off surface during tummy time for
a few seconds
– Makes eye contact
– Feeds easily
– Antigravity movements of arms and legs
3
2 Week Old
• Red flags
– Does not attempt to lift head during tummy time
• Continue to monitor
– Preference to look only one direction
• Continue to monitor
– Difficulty eating
• Refer to OP SLP
4
2 Week Old
• Recommendations to facilitate developmental
progress:
– Tummy time
– Talk and sing to baby
– Visual stimulation, let baby look at faces and
bright colors
5
2 Month Old
• Age appropriate skills
– Able to lift head off surface when lying on
stomach
– Visual fixation and starting to track/follow faces
– Social engagement with responsive smile
– Can calm with parent’s help
– Brings hands to mouth
– Can grasp your finger but not able to let go yet
6
2 Month Old
• Red flags
– Unable to lift head from surface in prone
• Continue to monitor
– Keeps hands fisted
• Continue to monitor
– Flat spot on back/side of head, only looks one
direction
• Refer to OP PT
– Stiff legs with little movement
• Refer to OP PT
– “Floppy” baby
• Refer to OP PT
7
2 Month Old
• Recommendations to facilitate developmental
progress
– Tummy time
– Eye contact, visual and auditory stimulation (talk
to your baby)
– Direct touch and holding of baby
– A variety of sensory experiences
8
4 Month Old
• Age appropriate skills
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Easily lifts head in prone
Props self up on forearms
Sits with support at hips
Independent head control
Roll from tummy to back
Holds a rattle
Makes vocalizations
Brings toys to mouth
Grasps at toys with hands
9
4 Month Old
• Red flags
– Requires full support to sit, has a hand preference or
doesn’t use one hand
• Continue to monitor
– Hold extremities very stiff into extension, unable to lift
head from surface in prone, has a flat spot on the
head/only looks one direction, poor head control
• Refer to OP PT
– Unable to track objects, unable to bring hands to midline,
inconsolable for long periods and parents unable to calm
infant, not tolerating touch, not visually attending to
people
• Refer to OP OT
10
4 Month Old
• Recommendations to facilitate developmental
progress
– Tummy time
– Direct interaction with baby, include in family
activities
– Reading books
– Provide with toys that baby can hold in hands and
shake/bang
– Hands to feet play
11
6 Month Old
• Age appropriate skills
– Rolls over both directions
– Sits with little or no help
– Transfers objects between hands, bangs objects
together
– Likes cause and effect toys
– Pushes up on extended UE’s in prone
– Plays with feet
12
6 Month Old
• Red flags
– Difficulty rolling and sitting
• Continue to monitor
– Does not bear weight through LEs, has a flat spot on the
head, only looks one direction, unable to prop self up on
forearms in prone, arching of back, stiff extremities, poor
trunk control
• Refer to OP PT
– No wanting to play with toys, unable to grasp objects,
inconsolable for long periods and parents unable to calm
infant, not tolerating touch, not visually attending to
people
• Refer to OP OT
13
6 Month Old
• Recommendations to facilitate developmental
progress
– Floor play
– Sitting encouraging use of hands to play
– Prone time as infant tolerates
– Sitting in laundry basket with toys
14
9 Month Old
• Age appropriate skills
– Sits well independently and uses both hands to
play
– Pulls to stand
– Creeps/crawls
– Responds to name
– Holds toy/object in each hands simlutaneously
– Starts to babble with “mama” and “dada”
– Claps hands
15
9 Month Old
• Red flags
– Unable to sit independently, unable to roll, stands
only on tip toes, unable to transition in/out of sit
• Refer to OP PT
– Not holding toys with both hands or using both
hands to play, avoidance of social interaction, very
irritable or rigid in routines (sensory issues)
• Refer to OP OT
16
9 Month Old
• Recommendations to facilitate developmental
progress
– Tummy time (pushing up, pivoting)
– Lots of floor time (keep toys just out of reach to
encourage movement)
– Standing play at a table top
– Play peek-a-boo games, read and sing
– Exploration with simple toys
17
12 Month Old
• Age appropriate skills
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Cruises along furniture
Pulls to stand independently
Walks with little or no assist
Stands independently for a few seconds
Communicates with gestures (waves bye, shakes head no)
Puts toys in/out of a container
Imitates (sounds, movements, gestures)
Eyes are aligned and child looks well at people and toys
Starts using fingers in play
18
12 Month Old
• Red flags
– Not yet walking
• Continue to monitor
– Weak, floppy or stiff, not bearing weight on feet,
standing on toes only, no form of intentional
movement
• Refer to OP PT
– Has trouble manipulating toys (holding, shaking,
releasing), avoidance of social interaction, very
irritable or rigid in routines (sensory issues)
• Refer to OP OT
19
12 Month Old
• Recommendation sot facilitate developmental progress
– Floor play
– “dancing” with infant; encourage bouncing with knee
bending in supported standing
– Name body parts, use gestures with simple verbal requests
– Standing play, walking to get toys
– Play in bare feet when indoors
– Encourage shape sorter toys
– Pulling up to kneeling position
– Exploration of simple toys, sensory play
20
18 Month Old
• Age appropriate skills
– Walk independently
– Scribbles
– Turns pages in a book
– Says about 15 words
– Feeds self, uses spoon and finger feeds
– Kicks and throws a ball
– Frequent tantrum but is redirectable/consoleable
21
18 Month Old
• Red flags
– Extended tantrums, inconsolable, fearful, refuses food
other than purees
• Continue to monitor
– Not walking independently, child is stiff/floppy/weak,
uses one side of the body more than the other
• Refer to OP PT
– Not using both hands to explore/manipulate toys,
avoids fine motor play
• Refer to OP OT
– Trouble chewing and swallowing
• Refer to OP SLP
22
18 Month Old
• Recommendations to facilitate developmental
progress
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Encourage opportunities to run, climb and squat
Talk/read books to child
Encourage child to help with dressing self
Encourage building toys
Allow child to explore foods with hands and self feed
Have routines and help them participate (bed time,
dressing)
23
2 Year Old
• Age appropriate skills
– Kicks a ball & throws a ball overhand
– Negotiates stairs with rail or HHA
– Points to things when named
– Puts 2-3 words together
– Builds towers of blocks
– Jumps up
– Interested in puzzles
– Attempts to participate in conversation
24
2 Year Old
• Red flags
– Not walking, frequent falls, not attempting stairs
• Refer to OP PT
– No turn taking or cooperate play (only does
cause/effect or alone play), sensory issues
• Refer to OP OT
– Does not use any words, cannot being understood
by main caregivers
• Refer to OP SLP
25
2 Year Old
• Recommendations to facilitate developmental progress
– Encourage ball play
– Continue to read to child, sing songs, talk about
surroundings
– Encourage child to dress self
– Encourage coloring
– Allow child to explore foods with hands and self feed
– Have routines and help them participate (bed time,
dressing)
– Go for walks
– Attempt to engage child in conversation
– Simple games: blowing bubbles, play-doh, pretend play,
etc
26
3 Year Old
• Age appropriate skills
– Climbs independently
– Runs well
– Jumps and hops on one
foot
– Can stand on one foot
briefly
– Can walk on tip toes
– Throws a ball underhand
– Can complete easy
puzzles
– Uses spoon, fork and cup
well
– Dresses self
– Colors with intent versus
scribbling (dots, lines,
circles)
– Speaks in 3-5 word
sentences and
understands language
well
– Engages in pretend play
– Plays alone and alongside
other children in small
group, takes turns,
recognizes the feelings of
other children
27
3 Year Old
• Red flags
– Cannot keep up with peers
• Continue to monitor
– Falls/trips frequently with running/walking
• Refer to OP PT
– Cannot sit and play with a quiet tasks for at least 5
minutes (other than video games), sensory issues
• Refer to OP OT
– Uses gestures instead of words, unable to put 2-3
words together in a sentence
• Refer to OP SLP
28
3 Year Old
• Recommendations to facilitate developmental
progress
– Trike riding
– Simple puzzles
– Encourage pretend play
– Reading to child
– Coloring
29
How Can You Have an Impact?
• Educate and encourage:
– Tummy time
• Starting at day one of life
• Benefits/importance with later developmental milestones
– Floor play
• Time out of parent arms and equipment
– Direct parent interaction
• Visual contact
• Reading books, singing
– Sensory play
• Vestibular input
• Messy play
30
Difference in Intervention Options
• Early Intervention
– Aka: Birth to 3, anyone can refer, model of
PT/OT/teacher or combo, done in the home
• School Based
– Over 3 years of age, done at school/preschool
• Home Therapy
– Home bound
• Out Patient
– Medical based
– PT/OT/SLP/aquatic/specialty clinics
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Resources
• www.helpmegrowmn.org
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Questions?
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