Body Part Identification
in 1- to 4-Year-Old
Children
Kathryn MacWhinney,
Sharon A. Cermak, Anne Fisher
Key Words: body image. child
development. pediatrics
The purpose oj this study was to examine the sequence in which body parts are learned and can be
identified by very young children. The 101 children
tested were divided into Jour age groups: 1-yearaIds, 2-year-olds, 3-year-olds, and 4-year-olds. The
children were requested to point to 20 body parts on
a doll. Analysis oj the results indicated significant
diiferences in the ability to identify body parts by
age and sex. The greatest increase in scores occurred between the ages oj 1 and 2 years, with girls
achieving a slightly higher score in each age group.
The percentage ojsubjects at each age who identified diiferent body parts is presented, indicating the
sequence in which body parts are learned.
At the time this study was conducted Kathryn MacWhinney
was an occupational therapy graduate student in the postprofessional master of science degree program at Boston
University. She is now an occupational therapist at North
Shore Special Education Consortium, Peabody, Massachusetts. (Mailing address: 75 Orchard Street, Medford. Massachusetts 02155.)
Sharon A Cermak, EdD, OTR, FAOTA, is Associate Professor of Occupational Therapy at Boston University and a
faculty member of Sensory Integration InternationaL
Anne Fisher, ScD, OTR, FAOTA, is Assistant Professor of
Occupational Therapy at Boston University and a faculty
member of Sensory Integration International.
454
T
he purpose of this study was to examine the
sequence in which body parts are learned and
can be identified by very young children. Until
recently, minimal information on the development of
body part identification in young children has been
available although several developmental assessments include items that involve pointing to or naming body parts. One of these assessments was implemented by Gesell (1940), who investigated pointing
responses in 18- and 24-month-old infants by comparing scores from his sample (n = 19) of 18-monthold infants to the scores of the 24-month-old infants
(n = 50) studied by Muntz (1921) Both groups of
infants were asked to point to their hair, eyes, nose,
and mouth. However, specific criteria for correct responses were not discussed. Gesell reported that only
5% of the 18-month-old infants he studied were able
to point to the four body parts whereas 96% of Muntz's
24-month-old infants were able to point to the four
parts. These body parts are similar to items on tests
such as the Bayley Scales of Infant Development
(Bayley, 1969) and the Revised Stanford Binet Test of
Intelligence (Terman & Merrill, 1970), which require
a pointing response. The stimulus used on the Bayley
is a 3-dimensional doll, whereas a paper doll is used
on the Stanford Binet. Age ranges and criteria for receiving credit also vary slightly. On the Bayley, the
child receives credit at the 19-month level (age range
of 15 to 26 months) if he or she points to three out of
the seven parts (hair, mouth, ears, hands, eyes, feet,
and nose). On the Stanford Binet, the child receives
credit at 24 months of age by pOinting to three or
more parts (on form 1: hair, mouth, ear, and hands; on
form M: hair, eyes, feet, and nose).
The naming of body parts has also been studied
extensively. Cratty (1970) compiled normative data
on the verbal identification of body parts based on a
review of the literature; however, the results from the
various studies are not presented very clearly. On the
basis of this review Cratty observed that at the age of 2
years, children named tummy, legs, feet, arms, and
facial parts; that at the age of 3 years they named
"planes of the body (ie., front, back, and side) related
to objects" (p. 120); and that at the age of 4 years, they
named thighs, elbows, and shoulders.
Williams (1983) also investigated the age at
which children "identify major parts" (p. 302). Although the standard "to identify" was not defined, we
felt it described a naming response. Also, the words
"major parts" were vaguely defined as "eyes, ears,
hands, knees, etc." (p. 302). In Williams' sample of
children aged 5 to 9 years
= 250), 55% of the 5year-olds were able to identify (ie, name) major
parts. Williams' conclusion that only slightly over half
of the 5-year-olds tested were able to identify body
parts seemed in contradiction to other studies on
en
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younger children that indicated identification of body
parts occurred at much younger ages (Bayley, 1969;
Cratty, 1970; Gesell, 1940; Muntz, 1921). This apparent contradiction may actually reflect a difference in
the learning sequence between naming parts versus a
pOinting response. Data from studies on pOinting
versus studies on naming as means to identify body
parts have suggested sLlch a developmental sequence.
Gesell (1940) indicated that there was a developmental progression in the numbers of parts children were
able to identifYi while Cratty's (1970) study indicated
a sequence with some parts learned before other parts
(see Table 1 for a comparison of the studies and assessments discussed).
The sequences through which children learn to
identify body parts have been studied by examining
children's performances on a variety of tasks. MeiliDworetski (as cited by Harris, 1963) who gathered
information from more than 100 children through observations, interviews, and studying children's drawings, determined that children initially develop an
understanding of their head, trunk, and legs. He hypothesized that the knowledge of head, trunk, and
legs forms a basis for the development of further
knowledge of the body. Gellert (1975) determined a
similar progression from studying 250 elementary
school children, aged 5 to 12 years. Each child was
asked to construct a person from a selection of 37
body pieces. Gellert found that younger children
made more errors and omissions of the upper extremities. He hypothesized that, in normal development, a
knowledge of the position of one's trunk, head, and
legs is developed prior to a knowledge of the position
of one's arms and hands. In older children, draWings
of the human figure have also indicated a progression
of awareness of the body (Harris, 1963). The head and
a vertical orientation of a body were established first.
The existence of parts was perceived prior to the
knowledge of their spatial relationships to each other,
and parts that were important to the child were represented first.
Data on the developmental progression of body
part awareness (pointing, naming, draWing a person,
etc.) are incomplete. None of the studies differentiated between the abilities of boys and girls, nor were
they in agreement on the critical ages when particular
body parts are learned. Moreover, there was a lack of
data on the progressions of types of parts learned (i.e.,
whether young children learn (a) body parts and then
joints [the relationships of parts], or Jearn (b) parts in a
cephalic-to-caudal or proximal-to-distal progression).
Developmental delays and dysfunctions in body
part awareness have been noted in various populations, including persons with physical disabilities
(Critchley, 1950), emotional disabilities (McCrae,
Summerfield & Rosen, 1982), and neurological impairments (Ayres, 1961). Ayres and MacDonald
(1960) are among occupational therapists who have
Table 1
Normative Data of Body Part Identification
Subjects
(n)
Ages
Gese II (1940)
19
18 momhs
pointing on self
hair, eyes
nose, mouth
42%-no parts
21%-1 part
5%-4 parts
Bayley (1969)
360
19 momhs
(15-26 momhs
range)
pointing on
doll
hair, mouth
ears, hands
feet, nose
credit for 3 parts
Muntz (1921)
50
2 years
pOinting on self
hair, eyes
nose, mouth
96% pOinted to 4 parts
2 years
pOinting on a
paper doll
hair, mouth
ear. hand or
hair, eyes
feet, nose
credit for 3 or more
parts
2, 3. & 4 years
naming
5-9 years
"idemifying"
Stanford Binet"
Cratty (1970)
Williams
(1983)
from a su rvey of
available
literature
240
Task
Parts
Criteria/Response
2 years-tummy, feet,
legs, arms, face pans
3 years- "planes of
body"
4 years-thighs,
elbows, lingers,
shoulders, thumb
"eyes, ears, hands.
knees, etc,"
55%-"identified
maior parts" at 5
years
Nole. For complete citations, see reference list.
'As discussed by Terman and Merrill, 1970
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455
theorized that dysfunction in spatial awareness of
body parts hinders the ability to plan movements in
everyday living activities, Therefore, the assessment
of body part awareness may be an essential component in occupational therapy treatment and should be
performed accurately A variety of assessments are
presently used by occupational therapists to determine body part awareness, including pointing to and
naming body parts, drawing a person, imitating movements, and completing person puzzles (Bayley, 1969;
Harris, 1963; Gellert, 1975; Ayres, 1961), However,
normative data have been incomplete, Response rates
then become difficult to interpret and make the implementation of appropriate occupational therapy
programs difficult. Data from a normative sample, indicating a developmental progression and/or critical
ages when particular body parts are learned, would
assist occupational therapists' efforts to objectively
identify developmental delays in abilities to identify
body parts. These delays may have a crucial impact on
the relationship between body scheme and motor
planning, The current study sought to provide addi·
tional data on the development of the ability to point
to body parts in male and female children, ages 1 to 4
years, and to consider the possible progressions of
other types of responses. The following hypotheses
were tested: (a) Older age groups will point to signifi·
cantly more body parts than younger age groups and
(b) there will be no significant sex effect. An additional gUiding question was as follows: Does pointing
to body parts show a sequence of types of parts
learned (i.e., individual parts, and then spatial relationships of parts [joints], cephalic to caudal, or proximal to distal);>
Methodology
Subjects
Of the 101 normal (nondisabled) subjects tested, approximately 24 were drawn from each of the following four age groups: 1-year-olds (10 to 14 months),
2-year-olds (22 to 26 months), 3-year-olds (34 to 38
months), and 4-year-olds (46 to 50 months). There
were 12 boys and 12 girls in each of the groups of land 2-year-olds. The group of 3-year-olds consisted
of 10 boys and 14 girls, and the group of 4-year-olds
consisted of 13 boys and 16 girls. An additional 10
children (six 2-year-old boys, one 3-year-old boy, two
3-year-old girls and one 4-year-old boy) would not
partici pate in the test. Two of the children started the
test, but would not complete it. Subjects were recruited from nursery schools, well-baby clinics, and
day-care centers from the Boston, Massachusetts, and
Rochester, New York, areas. Children belonged to
predominantly white, middle-class families. Only
456
Table 2
Percentage of Subjects Correctly Identifying Body Parts
(Parents' Scores in Parentheses)
Body Part
l·year-olds
(n = 24)
Ankle
Arm
Back
Chin
Ears
Elbow
Eyes
Finger
Foot
Hair
Hand
Knee
Leg
MOlHh
Neck
Nose
Shoulders
Toes
Tummy
Wrist
a
a
a
a
8 (21)
a
25 (50)
0(4)
a (8)
4 (21)
4(17)
0(4)
o (4)
0(13)
0
a (50)
0
8 (29)
4 (21)
a
2-year-olds
(n = 24)
a
71 (75)
71
67
96
21
100
92 (96)
96
96 (100)
96 (100)
46
58 (63)
92 (96)
42
96
21
100
92 (96)
4
3-year-olds
(n = 24)
4-year·olds
(n = 29)
25
96
96
75
100
71
100
100
96
100
96
83
92
100
96
100
71
100
100
17
28
93
97
90
100
69
97
100
93
100
100
90
90
100
97
100
76
90
100
28
those children who showed no observable physical
disabilities were included in the study.
Instruments
A 19 in Baby Tunene doll l was used for this study,
and each child was asked to point to 20 body parts
(see Table 2) (Barval, 1985). Body parts were selected to depict appropriate categories, such as cephalocaudal, proximal-distal, and parts versus joints.
Procedure
After the child entered the testing room and the parent Signed the informed consent form, the child was
presented with a doll to hold or to play with, As the
child played with the doll, the examiner asked the
child to point to the specified body parts. The easiest
method of evaluating the children's awareness of
body parts seemed to be through a painting response,
which enabled very young children to be included in
the sample and decreased the effects of verbal abilities. Because research has shown that children asked
to point to parts on themselves often became selfconscious (Terman & Merrill, 1970), a doll was used.
Questions such as "Where's the doll's hair?" or "Show
me the doll's eyes" were asked. Each of the 20 body
parts was randomly assigned a number and all were
grouped into 15 ordered sequences by random selection. The order of body parts to be identified varied
for each child. Therefore, each boy and girl in each
age group was assigned a randomly selected se1 The doll is manufactured by Barval Toys, Inc., 8801 Northeast
23rd Street, Miami, Florida 33137
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quence of parts to identify from the possible 15
orders. One point was recorded for each correct
painting response. Correct identification was recorded when the child placed his or her hand or
finger on the specified body part or painted clearly
towards the body part. When responses were questionable, encouragement was provided to attain a
clear response. Yes or no questions such as "Is this
the doll's hair / " were not used.
Additional information was obtained concerning
the child's ability to identify body parts from parental
reports when available If the child did not point to
specified body parts, the parent or caretaker was
asked which items the caretaker felt the child knew.
This information was not used in statistical analyses
but was used in descriptive analysis to further examine types and progressions of parts learned. A parent
or caretaker was present for the testing of all the 1-,2-,
and 3-year-olds The majority of 4-year-olds were
tested in nursery schools; however, 34% (10) of those
children were tested in the presence of their caretaker.
Results
Statistical analyses were performed on accuracy
scores, the total scores for correct painting on the doll
(see Table 3 for means and standard deviations)
Analysis of variance was performed for accuracy
scores using a 4 X 2 (Age X Sex) design. Age was
significant, F(3,93) = 418.24, P < .0001, and sex was
significant, FO,93) = 6.82, P < .Oll The Age X Sex
interaction was not significant, F(3,93) = 1.3, P = .28.
Post hoc tests were performed on accuracy scores
to examine the age effect. The Newman-Keuls test
(Bruning & Kintz, 1977) revealed a Significant difference in scores between the ages of 1 and 2 years, (p
< .01), and between the ages of 2 and 3 years, (p
< .01). There was no significant clilference between
the ages of 3 and 4 years.
Table 2 depicts the percentage of children in
each age group who were able to correctly identify
specific body parts. The additional information obTable 3
Accuracy Scores of Body Part Identification
by Age and Sex
Age
Boys
Girls
058
067
042
0.67
SD
12.83
3.27
1.3.67
2.90
3·year-olds
M
SD
16.10
179
17.86
1.66
4 ·year-olds
M
SD
1646
127
1806
J6J
I·year-olds
2-year-olds
1\1
SD
1\1
tained from parental reports is proVided in parentheses next to the accuracy scores.
Discussion
Age and Sex Effects
The findings of this study support Gesell (1940) and
others who have indicated that there is a developmental progression in the number of parts that children
are able to identify (Bayley, 1969; Terman & Merrill,
1970; Cratty, 1970). Older children pointed to signifi·
cantly more body parts than younger children. It is
interesting to note that there was a large increase in
the number of parts identified between 1- and 2-yearaIds, and the 2- and 3-year-olds, with 3- and 4-yearaIds achieving similar scores. This suggests that there
is a critical time period between the ages of 1 and 3
years during which children learn to identify body
parts. In this age span, children encounter increased
experiences and interactions with the environment.
They are more mobile and may become more aware
of their own body parts through new sensory and
motor experiences. Attention span, language abilities,
and abilities to follow directions also improve, all of
which would improve the ability to perform on a task
such as pointing to requested parts on a doll.
The majority of 1-year-old children were unable
to point to specified body parts. No body parts were
reported by 50% of the children at 1 year although,
according to parental reports, half of the children
knew eyes and nose On the other hand, a substantial
increase occurred in the number of reported responses recorded for the 2-year-old children's sample; 11 body parts or more were identified by 75% or
more of the children (parent scores). The two older
age groups were able to identify all but one to two
parts_
This study coincides with the information from
preVious studies regarding some of the parts learned
first by young children (hair, eyes, nose, mouth,
hands, feet, ears) and has similarities with items on
the Bayley Scales of Infant Development and the Revised Stanford Binet Test of Intelligence. However,
the new information suggests that 2-year-old children
are able to identify a much greater number of body
parts than has preViously been reported by Gesell
(1940), Bayley (1969), and Cratty (970)
Male/female differences have not preViously
been reported. However, this study found a significant overall sex effect, with girls' scores slightly
higher than the boys' scores. A variety of factors may
have influenced this male/female difference Girls
may typically have more experience playing with
dolls ancl may be more familiar with dolls' body parts_
In this sample, girls were not as reluctant to participate in the test as were boys (70% of the children who
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457
chose not to participate were boys). Other differences
in language abilities, attending, attending to detail,
and following directions may have intluencecl the results. A replication of this study with a larger sample
of children using both a doll and a male-specific referent would assist in further delineating the presence
of male/female differences in knowledge of body
parts.
Testing Method
The designed testing situation was found to be useful
with older age groups; however, it was found to be
inadequate in determining the abilities of 1-year-olds
and some of the 2-year-olds. Many of the very young
children did not appear to understand what was asked
of them; they were fearful or shy of the examiner or
unable to attend for the duration of the time reqUired
to complete the task. Many of the very young children
were unable to complete the task but showed some
understanding of it; for example, they would look at a
body part or touch their own body part. Some of the
young children's abilities seemed to diminish toward
the end of the test, suggesting the duration was too
long for a young child's attention span. Although accuracy scores indicated the child's actual performance
on the task, they may not have been indicative of his
or her actual knowledge. Therefore, in order to learn
more about the typical parts that very young children
know, parental reports were also obtained. Information obtained in this manner relies heavily on the
reliability of parental reports. If one uses parental reports, the scores increase, particularly in the younger
age groups. Parents of 1- and 2-year-olds reported that
the child "knew" an average of one body part more
than the child demonstrated knOWing. There was no
change in older children's scores.
Progressions and Types of Parts Learned
Table 2, which lists specific body parts identified by
each age group, indicates that there was no apparent
sequence or progreSSion of types of parts learned in
terms of proximal to distal, or cephalic to caudal.
However, body parts were correctly identified more
frequently than joints, suggesting that joints were
harder parts to learn_ In the sample of 2-year-olds,
none of the joints were correctly identified by 50% or
more of the children. Three- and 4-year-olds showed
an increase in knowledge of joints, although they
were still unable to identify all the joints.
Conclusion
Tools to evaluate body scheme functioning are varied.
Drawing a person, pointing to and naming body parts,
imitating movements, and completing person puzzles
are a few of the methods that can be used. This study
458
provides baseline data on the ability of young children to identify body parts. This information is important because body scheme has been implicated as
an important construct in the child's development of
motoric and perceptual abilities. Motor skills, spatial
awareness, learning abilities, and social!emotional
growth are areas of development that are of crucial
concern to occupational therapists. These areas of development have all been implicated as functions that
result from the development of body scheme (Ayres,
1961; Arnheim & Sinclair, 1979; Cleveland & Fischer,
1957; Head, 1911; MacDonald, 1960; Schilder, 1964).
Ayres and others (Arnheim & Sinclair, 1979; Cratty,
1970) theorize that movement of body parts is the
groundwork for the development of spatial awareness
and the understanding of spatial concepts_ Kephart
(1971) states that "we use our own bodies as this
point of reference. Objects about us are referred to
our body and oriented in space with reference to it"
(p. 93). Feeding, dressing, using a pencil, or sitting at
a table, all rely on the knowledge of where one's body
is in space.
The evaluation method that employs pointing to
body parts on a doll can be a useful tool in assessing a
child's knowledge. However, consideration must be
given to very young children who are not easily persuaded to complete the entire task. Longer durations
of time in additional sessions and additional methods
of assessing the child's abilities may be useful. For
1-year-olds the task could be pared down to 12 items,
omitting those items that none of the children could
identify and that none of the parents reported as
known by the child. Parental reports may also proVide
valuable information that cannot be obtained in a traditional testing situation and that may help to establish emerging knowledge, or knowledge that has not
yet been generalized to different situations. Therapeutic intervention can then be initiated at the child's
perceived level of emerging knowledge and proceed
in the appropriate sequence. Facial parts seemed to
be learned first, with detailed parts, or joints learned
last. This finding is not consistent with studies that
show that the head, trunk, and legs are learned first
(Harris, 1963).
Further research to supplement this investigation
would be beneficial. Detailed research focused on the
emerging of abilities of children between the ages of
1 and 3 years would provide more detailed information on the progression of parts learned and help to
establish the age at which the ability to identify body
parts is realized.
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