NORMAL MOTOR DEVELOPMENT

Here we will talk mainly about normal motor development during the first year of life of a child or until the child starts to walk independently.

It was only in the second half of the last century that people started thinking about normal motor development, while abnormal motor development has been discussed and researched much longer.

Although normal motor development is similar in all children, the time frame within which children reach particular developmental capabilities (e.g. rolling, sitting, crawling, walking) varies from child to child and experts use different criteria to define what a normal time frame, and consequently what normal development, is. 

Here we'll describe normal motor development according to Vazlav Vojta, modified by the experience of Milena Stojčević Polovina. According to Vojta, normal development, or in his terminology "ideal" development, is determined when 50% of children of a certain age possess a particular motor ability.

A child is born with some abilities that are then developed and improved. It is important to point out that there are periods of time within which a child should be able to carry out a particular task. The way in which it is carried out is also important. These critical events in the motor development of a child are called developmental milestones.

Development has its defined sequence, and developmental milestones occur within or around defined time periods. It is important to be aware of developmental sequences in motor development so that we can know when to expect certain abilities.

Although we will focus here on the motor development of the child, we wish to stress that it is mental development that "drives" motor development. It is the child's curiosity that forces him or her to constantly explore new possibilities and gather new experiences, so in practice motor and mental development are inseparable.

The motor development of a child is assessed in supine (on the back) and prone position (on the tummy).

PRONE POSITION SUPINE POSITION
Newborn The prone position of a newborn is characterized by strong flexion of all joints, especially the hips and knees, so the bottom looks like it is lifted in the air.

The head is turned to one side and tilted. The child can not turn his head to the other side without touching the surface. He can always free his airway and breathe freely.

The arms are bent at the elbows and positioned close to the body. The fists are partially and loosely closed, the thumbs are usually outside of the fist, but sometimes tucked in.

The child bends and stretches his arms and legs; he is calmer on his tummy than on his back. The position on the tummy is regarded as more natural than on the back.

The big joints (the shoulders, elbows, hips, knees) are mostly bent when the child is lying on her back. The head is turned to one side and the spine is bent. The fists are partially and loosely closed, the thumbs are outside of the fist, but sometimes in.

The child's legs are bent at the hips and knees.

The child bends and straightens her arms and legs in a lively fashion. This is the time of massive spontaneous motor activity.  The child reacts to any inner or outer stimulus by suddenly spreading her arms (the Moro reflex).

6 weeks The child bends her joints less and looks more relaxed, although the big joints are still mainly bent.

Active social contact of the child with her environment begins. In the second month of life, the child starts to lift her head for up to a couple of seconds.

In order to do this, the child leans on her arms which are close to her body and bent at the elbow. The child supports herself on her middle forearms. The fists are partially and loosely closed and the thumbs are outside of the fists.

During this period, 75% of children have optic orientation, which means they can focus their view.

During this period the fencing posture is developed; it is the second type of massive spontaneous activity. At this time the child can focus on his mother and wants to "grasp" her, but still reacts with his entire body. In the fencing posture the head is turned to the object of interest, the arm and leg on that side of the body are stretched, the fist is open and the thumb is outside of the fist. The arm and leg on the other side of the body are bent.

2 months The child starts to play with her arms; this is called hand-to-hand coordination. At this time the child begins to form an awareness of her own body. 

It is the time of normal dystonic activity, the third form of massive motor activity. It shouldn't last longer than the third month of life, i.e. only until elbow support is achieved. It is an attempt by the child to make contact with her environment, which again is carried out with her entire body.

3 months The child is able to hold her head up better and for longer periods of time. When the child lifts her head, the shoulders and upper part of the body are lifted approximately 45º. The arm support now shifts backwards from the middle forearms to the elbows; this is an extremely important developmental milestone, because it represents the first stable position against gravity. Now the head can be turned freely without changing the position of the body. At three months the child starts to put his hands into his mouth; this is called eye-hand-mouth coordination.

The legs are lifted off the ground so they make right angles at the hips and knees.

The child develops the ability to grasp. At first the child grasps with flexed fingers and palm; this is called the radial palmar grasp.

4.5 months

At this age the child can shift his balance to one elbow in order to free one arm to grasp. In this activity he leans on his elbow and hip on one side, and the leg on the other side of the body is pulled forward and bent at a 90º angle, so the knee functions as a support as well.

With the free arm the child grasps nearby objects and immediately puts them into his mouth.

At four months the child starts to grasp objects from the middle of her body outwards; however, she can't yet cross over the midline of the body.

At four and a half months the child starts to grasp from the outside toward the middle of the body and soon she can follow objects over the midline of her body. 

5 months The child begins to lift her body more and more from the surface, stretching her arms and supporting herself on the root of her palms.

When an object is placed on her forearm, the child can turn it to move the object away.

When a child can't reach a desired object, she leans on her tummy and lifts her arms as if swimming.

The child can grab objects that are on the other side of the body directly and by doing this shifts his weight sideward. He can transfer an object from one hand to the other.

The child starts to touch his genitals and knees and by doing so, develops a greater awareness of his own body.

6 months

The child can lift himself up and support himself stably on his palms with fully-stretched arms, while almost completely leaning on his thighs.

While trying to reach for objects that are farther and farther away, the child begins to roll from back to tummy. Rolling is coordinated and controlled; the child uses both her arms and legs, and doesn't throw her head backwards.

The child begins to grab her feet; this is eye-hand-foot coordination.

When the child is placed into the sitting position she can remain in it for a short period of time, with slightly bent neck and back. In this position the child stretches her arms forward and leans on open hands with fingers spread. This is called the forward protective reaction. This is not considered to be sitting.

7 months At about seven months the child develops the ability to roll from tummy to back. This motion is coordinated and controlled; the child uses both arms and legs and the head is not thrown backwards.

The child can now lie in the side position; she does this by leaning on the elbow of one arm, her hip and thigh. If she can't reach a desired object, she will stretch out her arm and support herself on her palm. This position is called the garden elf position.

The child begins to creep. Her arms are bent, support is on the elbows and the legs are stretched and are not necessarily used. This is also called military crawling. The child can crawl a short distance in this way. This is not "true" crawling.

The four point position is a position in which the child is supported on both palms and knees. The child reaches it by lifting her body off the surface with arms stretched forward and legs bent at the knees.  In this position the child can rock herself.

The pincer grasp is developed, at first using thumb and forefinger, and later with other fingers as well. In this grasp, both fingers are stretched. In this period the child begins to develop fine motor skills.

The child can now put his feet into his mouth and this is called eye-hand-foot-mouth coordination.

8 months The child starts crawling by supporting himself on stretched arms and knees; the pelvis is lifted, and the width between the knees is the same as the width of the hips. The spine can be bent a little at the beginning, and the feet are at a right angle to the floor.

At eight and a half months the child can pull himself into the kneeling position. He uses his arms to hold onto something in order to get into and hold this position.

The child can get into the sitting position; only now can this be considered sitting. This can be achieved from the four point position or from the garden elf position. At the beginning the spine is slightly bent, and the legs are not completely straight. The arms can be stretched to the side and in this way the child protects herself from falling; this is called the sideward protective reaction.
9 months Crawling is now completely developed. The spine is straight, the lower legs are parallel, and the feet are in line with the lower legs. The child crawls faster and faster each day. Sitting skills are also fully developed. The spine is completely straight, as are the legs. The child can keep his balance without using his arms and instead uses them for play. He can turn his body and by doing so can reach objects at his sides.  He defends himself from falling backwards by stretching his arms backwards (backward protective reaction).

During this period fine motor skills continue to be developed. The child can now grasp with two fingers, both bent at all joints.

10-11 months The child can walk holding onto objects. The child uses both her arms and legs for support. First one arm is moved, then the opposite leg, then the other arm and other leg.

At 10 months the child is able to use her hands better, and she is more and more skilful. She begins to put smaller objects into bigger ones, and drops one object when grabbing another more interesting object.
12 months The child begins to walk at about twelve months. In the early stages of walking the child walks with his legs spread more or less widely apart and uses his arms to help keep his balance.During the eleventh and twelfth month of life, due to the development of sensorimotor intelligence, the child starts to combine hand movements and to play in a more organised fashion; he carries objects or drops them whenever and wherever he wants. He can build a tower two or three blocks high.
13 months The child's walking improves. The base of support is now narrower. She can stand in the middle of the room, change directions and get up in the middle of the room ("like a bear").