Lecture #1-2

gestation time of a full term baby

40 weeks

at 6 months gestation, what is the survival rate of the baby outside of the womb

50%

at 34-37 weeks gestation what issues do these babies have that are born at this gestational age?

they don't have enough endurance

contact of the ovum with the sperm to produce a human being

fertilization stage; day 1-week 1

fertilized ovum

zygote

what 3 events occur during the zygote stage (week 1)

1. contains 46 chromosomes (sex is determined)
2. zygote begins to divide
3. formation of a morula; implantation begins; endoderm and ectoderm form

at what stage does the end and ectoderm form along with the morula?

zygote stage

embryo at early stage
made up of blastomeres in a solid ball
contained within the zona pellucida

morula

when does the mesoderm form and placental circulation established

embryonic stage week 2

when does the neural plate arise from the ectoderm?

embryonic stage week 3

when does neural groove and folds are formed from the neural plate?

embryonic stage end of week 3

why is the ectoderm the most important layer?

because the nervous system is evolving from here

what is the order of development?
neuroectoderm, ectoderm, neural crest & neural tube

ectoderm-->neuroectoderm-->neural crest & neural tube

when do Somites form and
GI tract develops

embryonic stage weeks 3-4

when does the neural folds begin to fuse to form the neural tube?

embryonic stage weeks 4-5

when is the neural tube closed?

by the end of the 4th week

what important things happen in the embryonic stages weeks 4-5?

-neural tube closes at end of 4th week
-main divisions of the CNS are established
-heart begins to beat

what are the 3 primary vesicles

1. prosencephalon -> forebrain
2. mesencephalon -> midbrain
3. rhombencephalon -> hindbrain

what are the 5 secondary vesicles

prosencephalon ->
1. telecephalon (end brain)
2. diencephalon (in between brain)
3. mesencephalon -> midbrain
rhombencephalon -> 4. melencephalon
5. myelencephalon

what happens during weeks 6 and 7 of the embryonic stage?

6- further divisions of the CNS
7- all essential organs formed

when is the baby structurally complete?

embryonic stage, week 8

when does development become functional rather than structural?

fetal stage, week 9

when does the cerebellum develop?

fetal stage weeks 9-12

what happens at fetal stage during weeks 13-16?

Muscles and bones develop. Bones are still soft.
Sucking motions are made with the mouth.
(self regulatory motions)
1st meconium

first stool of the infant

meconium

when does spinal cord myelination begin?

fetal stage weeks 17-19

when does the lower respiratory system develop, but without surfactant?

fetal stage weeks 23-24

enzymatic protein that allows gas exchange in the lungs

surufactant

at what age is an infant viable?

23-24 weeks

when is there rapid brain development?

fetal stage weeks 25-28

when does surfactant begin to be produced?

fetal stage, week 27

what age? resistance to passive movement=full PROM; generalized hypotonia; active motor patterns= spasmodic and random flailing

27-28 weeks

what is the popliteal angel at 27-28 weeks

180 degrees

what age? resistance to passive movement=Increase in activation of the wrist, forearm and arm (UE traction response
moror reflex with complete extension and adduction and extension of the fingers

32 weeks

what is the popliteal angle at 32 weeks?

150 degrees

what is the DF angle at 32 week?

40-50 degrees

when does the Amount of surfactant may become sufficient for breathing (I).

late preterm infant (LPI) stage, 34 weeks

when does Brain myelination begins and continues until one year chronological age.

fetal sage 35 weeks

what infants typically need more support at late preterm?

caucasian males

what age?
Resistance to Passive Movement
Moro partially complete, extension and ABDuction with flexion and ADDuction
Increase resistance to PROM LE > UE
Prone with head in midline, active rotation of head to both directions
PTS righting of head and attemp

35 weeks

what age?
Resting Postures
Increase variety of resting postures
Physiological flexion in trunk and extremities
Resistance to Passive Movement
All newborn primitive reflexes elicited
Traction/grasp response elicited but head participation is lacking
Moro c

36-37 weeks

when do small great buds appear on both sexes?

37-40 weeks

death of infant prior to 1st birthday

infant mortality rate

10 Leading Causes of Infant Mortality Rates In US

1. Congenital Malformations, deformations and chromosomal abnormalities
2. Disorders related to short gestations and low birth weight
3. Newborn affected by maternal complications of pregnancy
4. Sudden infant death syndrome
5. Accidents (unintentional in

when is CNS development highly sensitive?

beginning of 3rd week to after the first few days after the 6th week

before birth

prenatal

during birth

perinatal

after birth

postnatal

prenatal risk factors

Genetics
Maternal factors
Paternal factors
Conditions that may occur in utero
Environmental

If the infant does not have the amino acid to change phenylalanine into tyrosine then increase in phenylalanine level builds up in the blood and causes

brain damage, seizures, and intellectual disorders

maternal risk factors

age and health

are most studied non-narcotic analgesics in pregnancy. Reduce mean BW in animal studies. Since 1893 toxic effects from large doses od salicylates: anemia, antepartum and postpartum hemorrhage.

salicylates

cranial nerve 8 damage and risk of fetal ototoxicity

streptomycin

Advanced paternal age can be linked to

Achondroplasia (little people)

environmental risk factors

-social
-economical
-cultures

Increase in amniotic fluid
AFI Amniotic fluid index: above 25 cm or above the 95%ile or fluid level of 2000ml

polyhydraminos

birth defects linked to too much amniotic fluid

-Anencephaly
-Bulbar palsy
-Achondroplasia
-Meningocele
-Cleft palate

deficiency of amniotic fluid

oligohydraminous

birth defects linked to amniotic fluid deficiency

-Torticollis
-Renal and pulmonary disorders
-Congenital anomalies of the feet and ankles

Perinatal risk factors

Prolonged labor
C-section
Blood incompatibility
Abnormal presentations (breech)
Meconium aspiration
Placental/umbilical cord abnormalities
Birth trauma

Post natal risk factors

Preterm birth and sequlea -> RDS
Genetic complications post birth
Endocrine disorders
Gender & Ethnicity(WWM)
Infections
GBS
Herpes
Poor or inadequate nutrition
Exposure to harmful environmental substances
Trauma and accidents

prenatal time span

1-38 weeks

prenatal period includes

germinal, embryonic, and fetal

germinal time span

1-2 weeks

embryonic time span

2-8 weeks

fetal time span

9-38 weeks

infancy time span

birth-2 years

childhood time span for females

2-10

childhood timespan for males

2-12 years

adolescence time span for females

10-18 years

adolescence time span for males

12-20 years

young adulthood time span

18-40 years

middle adulthood time span

40-65 years

older adulthood

65-death

young-old timespan

65-74 years

middle-old time span

75-84 years

oldest-old time span

85-death

normal motor development is dependent upon

normal motor control

motor behavior changes with time over the courses of

months, years, and decades

normal motor development occurs in what directions?

cephalocaudal direction and proximal to distal direction

does normal motor development goes from gross to fine or fine to gross?

gross to fine motor control

normal motor development goes from reflexive to

automatic to voluntary

normal motor development goes from physiologic flexion to

antigravity extension

what are the 5 domains of development?

1. Gross motor
2. Fine motor
3. Social/emotional
4. Self-help
5. Language

what are an infant's 4 ADLs?

1. mobility
2. self care
3. feeding
4 play

can newborn 0-1 month detect changes or remember stimuli?

yes

0-1 month old head lag in PTS

45 degrees

0-1 month old vision

tracks slow moving objects laterally (better vision laterally)

2-3 month old head lag in PTS

10 degree

2-3 month old vision

follows toy by 180 degrees; follows up and down

when do babies have major advances in control of arms and upper trunk?

4-5 months

2 prerequisites to upright trunk control

1. extension of head and neck in prone
2. control of the pelvis and legs while using arms in supine

at 4-5 months babies can: Holds two objects 1 in each hand, holds an object with two hands, hand to hand transfer, 1 hand holds the other manipulates, coordinated action of 2 objects
what is this known as?

control of vibration

when do babies have these gross motor skills?
� Gross Motor
� Landau reflex
� Extended arm prop
� Rolls from stomach to back
� Brings hands to knees
� Rolls back to side
� Takes full weight on feet with hands held
� Tucks chin in pull to sit

4-5 months

when do babies have these fine motor skills?
� Grasps a string and pulls a toy to hands
� Brings objects to mouth
� Ulnar palmar grasp
� Holds and moves a rattle for 1 minute
� Looks at hands
� Plays in space with extended elbows
� Improved head control

4-5 months

what is a babies vision like at 4-5 months?

� Eyes move independently from head
� Develops a downward gaze

what age do babies present with this cognition?
} Calms self with sucking
} Can find pacifier independently
} Can feed self a cracker
} Infant has preference for certain stimuli
} Demonstrates pleasure and displeasure

4-5 months

At what age do babies present with these gross motor skills?
Commando crawls (Crawling)
Pivots in prone
Protective extension forward
Pulls self to sitting, hold head in front of body
Sits for 1 minute
Stands supported at waist
Brings hands to feet
Rolls f

6-7 months

At what age do babies present with these fine motor skills?
� Radial palmar grasp
� Transfers object hand to hand
� Raking grasp of a pellet
� Claps hands
� Crosses midline with reach
� Hand to foot play
� Explores various surfaces with hands
� Mouths a w

6-7 months

What is vision like at 6-7 months?

� Eyes track diagonally
� Aware of differences in depth and distance

At what age do babies present with this cognition?
� Beginning of stranger anxiety
� Beginning of recall
� Beginning to feed self
� Enjoys social play
� Enjoys repetitive bouncing
� Calms with standing

6-7 months

At what age do babies present with these language skills?
� Searches for sound with good localization
� Babbling
� Responds to change in tone of voice and affect

6-7 months

At what age do babies present with this mobility?
� Creeping- all 4's and moving (not crawling in PT), but what we usually call crawling
� Sit <-> Side sit <-> Quadruped
� Quadruped <-> Short kneeling <-> Tall kneeling

7-9 months

At what age do babies present with these skills?
� Lower trunk control in the upright position
Presence of oscillations heralds new developments
i.e. rocking in 4 point
Transitional skills allow movement out of position they are placed ->MOBILITY!!!
� Mas

7-9 months

At what age do babies present with these gross motor skills?
Rocks back and forth in four point
Gets in and out of sitting
Scoots forward 3 feet
Protective extension to the side in sitting
Bounces in standing
Walks with two hands held

7-9 months

At what age do babies present with these fine motor skills?
� Removes three pegs from a peg board
� Releases into a container
� Develops an inferior pinch
� Pokes a finger in a hole
� Imitates shaking, banging

7-9 months

At what age do babies present with this cognition?
� Beginning of object permanence
� Ability to imitate shaking, banging, noises, and sticking out tongue
� Stranger anxiety and beginning of separation anxiety
� Enjoys rough house play
� Anticipates what

7-9 months

How can babies self help at 7-9 months?

� Can finger feed
� Can bring bottle to mouth and hold
� May begin drinking from a sippy cup

Developmental milestone at 6-8 months

sitting

Developmental milestone at 9 months

creeping and standing

Developmental milestone at 10-11 months

Cruising

At what age do babies present with these gross motor skills?
Crawls on hands and knees
Crawls over objects-equilibrium reactions
Kneels without support
Pivots in sit
Raises self to standing at stable object
Walks with one hand held
Stands without support

10-12 months

At what age do babies present with these fine motor skills?
� Fine lower extremity control in the upright position
Trunk and pelvis are increasingly reliable supports that permit freedom of movement
Gradual refinement of gait
� Fine Motor Control
� Manual

10-12 months

Developmental milestone 12-15 months

walking forward

Developmental milestone 17-18 months

walking backward

At what age do babies present with these gross motor skills?
Creeps up 2 steps
Walks 4-5 steps independently
Flings a ball
Fine Motor
� Overhand grasp with wrist off the surface
Pours
Superior pinch

12-14 months

At what age do babies present with these fine motor skills and self help?
� Pinch
� Removes pellets from a container by dumping
� Overhand grasp of an object
Self help:
� Pulls off socks
� Takes off a hat

12-14 months

At what age do babies present with these cognitive/social/emotional skills?
� Uses touch/vision/hearing to assess toys
� 1-3 minute attention span
� Plays alone for 15-20 minutes
� Looks at adult when spoken to
� Follows simple directions
� Recognizes own

12-14 months

Developmental milestone 10-14 months

Runs

Developmental milestones 2-2 1/2 years

jumps with both feet

Developmental milestones 2 1/2-3 years

alternates feet on stairs

Developmental milestones 4-4 1/2 years

skips and hops on one foot

High level of GM skills:

� Jumping jacks
� Walking on a straight line
� Walking on a balance beam
� Climbing a rock wall
� Manipulating multi layer obstacle courses
� Jumping rope
� Hopping on one foot
� Rapid alternating movements
� Riding bicycle
� Skating
� Skateboarding
� Swi