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Developmental Milestones: Motor Development R. Jason Gerber, Timothy Wilks and Christine Erdie-Lalena Pediatr. Rev. 2010;31;267-277 DOI: 10.1542/pir.31-7-267

The online version of this article, along with updated information and services, is located on the World Wide Web at: http://pedsinreview.aappublications.org/cgi/content/full/31/7/267

Pediatrics in Review is the official journal of theAmerican Academy of Pediatrics. A monthly publication, it has been published continuously since 1979. Pediatrics in Review is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2010 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0191-9601. Online ISSN: 1526-3347.Downloaded from http://pedsinreview.aappublications.org. Provided by Health Internetwork on July 27, 2010

Article growth & development

Developmental Milestones: Motor Development
R. Jason Gerber, MD,* Timothy Wilks, MD,† Christine Erdie-Lalena, MD
‡

Objectives

After completing this article, readers should be able to:

1. Identify the milestones for gross and fine motor development. 2.Recognize the child whose development falls outside of the expected range. 3. Describe the sequences involved in gross and fine motor development. This is the first of three articles on developmental milestones; the second and third articles will appear in the September and November 2010 issues of Pediatrics in Review, respectively.

Author Disclosure Drs Gerber, Wilks, and Erdie-Lalena havedisclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/ investigative use of a commercial product/device.

Introduction
Infancy and childhood are dynamic periods of growth and change. Neurodevelopmental and physical growth proceed in a sequential and predictable pattern that is intrinsically determined. Skills progress from cephalicto caudal; from proximal to distal; and from generalized, stimulus-based reflexes to specific, goal-oriented reactions that become increasingly precise. As one clinician has stated, “infants [and children] are very orderly in their ways; they actually behave [and develop] according to laws that can be explored, discovered, confirmed, reconfirmed, and celebrated.” (1) By convention, theseneurodevelopmental “laws” or sequences often are described in terms of the traditional developmental milestones. Milestones provide a framework for observing and monitoring a child over time. According to recent American Academy of Pediatrics and Bright Futures guidelines, pediatricians should incorporate developmental surveillance at every health supervision visit. Surveillance involves analyzing themilestones in the context of a child’s history, growth, and physical examination findings to recognize those who may be at risk for developmental delay. A thorough understanding of the normal or typical sequence of development in all domains (gross motor, fine motor, problem-solving, receptive language, expressive language, and social-emotional) allows the clinician to formulate a correct overallimpression of a child’s true developmental status. However, it must be emphasized that even experienced pediatricians cannot rely solely on their knowledge of the milestones to identify children who have developmental concerns. Developmental screening using validated and standardized tools should occur at the 9-month, 18-month, and 30-month (or 24-month) health supervision visits or whenever surveillanceuncovers a concern. Although neurodevelopment follows a predictable course, it is important to understand that intrinsic and extrinsic forces produce individual variation, making each child’s developmental path unique. Intrinsic influences include genetically determined attributes (eg, physical characteristics, temperament) as well as the child’s overall state of wellness. Extrinsic influences...