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Psychomotor development of the child

We must approach the child's development comprehensively. It concerns not only motor skills but all aspects of personality, including sensory and mental development. That is why we also speak of psychomotor development or the development of a child in terms of movement and psychology.


It is a complex and comprehensive process that includes many components, such as gross motor skills, which include turning from stomach to back, crawling, standing, and walking. It also includes fine motor skills, such as hand manipulation and playing with toys. The psychomotor development of a child also involves social, cognitive, mental, oral (food processing in the mouth, lip and speech movements), and other skills.


Many factors contribute to the speed and quality of a child's psychomotor skill development. Genetic and hereditary traits can affect overall strength, agility, and general aptitude for physical activity. Culture, sufficient physical activity, and overall lifestyle also play a significant role.


Most children acquire motor skills in well-predictable phases referred to as developmental milestones. Every child is different, and we must take into account whether the child was born prematurely or at term.


However, according to the American pediatrician Gesell, there are several key moments in which a child should be able to do certain things at certain times. Arnold L. Gesell (1880-1961) formulated some laws of child development:

  1. Body control progresses from head to toe (cephalocaudal progression of development). Therefore, a child must be able to hold its head correctly in order to engage the deep stabilizing muscles of the trunk, which is a prerequisite for proper body posture and coordination of movements.

  2. Progress from the center of the body to the periphery means that limb movements begin in the shoulder and hip joints and pass through the wrist to the fingers. From this, it follows that the development of motor skills progresses from gross to fine motor skills.

  3. The development direction of the elbow and radial bone indicates a progression from the little finger side of the palm to the thumb side in active grip ("pinch"), which is why a young child first grasps objects with the whole hand, and only later can a proper grip on a pencil, for example, occur.

However, it is not only important when a child begins to do something, but also whether and how well all stages of development have occurred and whether any of them have been skipped.

Below is a description of a child's development by trimesters:

1st trimester (0-3 months)

​A newborn baby sleeps most of the day, even up to 20 hours a day in the first two weeks after birth. A small baby can often only stay awake for an hour at a time before their brain becomes overloaded. Some babies become so tired that they fall asleep, while others paradoxically appear more alert. Their brain becomes so overloaded that they are unable to sleep (which can be one reason why babies often cry a lot in the evening). If there are problems with falling asleep, it may be helpful to try putting them to bed earlier, before they become too "active". About 70% of three-month-old babies and 80% of eight-month-old babies sleep from midnight to 5 am at night.

All primary (newborn) reflexes are well-equipped. In the first hours after birth, the newborn begins to take in food through their mouth for the first time. To do this, they have a system of reflexes, automatic reactions that facilitate their acquisition of food. The most important ones are the rooting and sucking reflexes. If the little person feels touch on their face, they turn their head towards the place of touch thanks to the rooting reflex, as they expect their mother's nipple, the source of food, to be there. Therefore, it is not recommended to stroke the baby's face during breastfeeding. When evaluating primary reflexes, their symmetry (equal reaction on both sides) is also important.


The child reacts to strong auditory or visual stimuli with the movement of their whole body - the Moro reflex. Global movement patterns are present in a newborn, where the position of the head affects the position of the limbs and trunk, and therefore also the body posture, which is still physiologically asymmetrical. When the baby lies on their back, their head automatically turns to one side, and their arms and legs reflexively react accordingly. The arm and leg on the side of the face stretch out, while the arm and leg on the other side are flexed. A healthy newborn can turn their head to both sides.


Motor skills

The muscle tone of a newborn is naturally higher. During the second month, muscle tone decreases and physiological (natural) hypotonia (lower muscle tone) appears, which disappears by the end of the first year.

In a supine position, the newborn is still unstable. When viewed from above, you can see that they are not lying flat but in a curved shape. Sometimes, rotation of the head can also cause rotation of the trunk, even turning to the side. When pulled up to a sitting position, the newborn's head falls backward.


Gradually, during the first three months, the baby learns to gain stability on their back, and at around three months, you will see that they can lift their arms and legs into the air for a moment without falling to the side. You will also notice this when changing the baby's diaper. At the beginning, every time you lift their legs, the baby startles and throws their arms to the side - the primary startle, or Moro reflex, is activated. But after three months, they will lie still and happily play with their hands.

In a prone position, at first, the legs are bent under the baby. The buttocks are higher than the head, and the center of gravity is on the forehead. Occasionally, the baby briefly lifts their head asymmetrically above the surface. Gradually, the center of gravity moves from the head to the chest, belly, and even to the pubic bone (symphysis). At three months, they lean on their elbows, and their legs are almost extended. They can hold their head straight with their neck extended for several minutes (not just in a flexed position). Note that if your baby is lying in a prone position at three months with their fists under their chest and their head flexed backwards, this is not the correct way to lift the head!

At first, the thumb of the hand is bent in a fist. In the second month, the palms are already open, and at three months, we see the beginnings of grasping. They grasp objects from the side with their little finger.

Senses

Surprisingly, newborns have well-developed sensory abilities that have only recently been recognized in detail. These senses help them perceive the surrounding world, orient themselves in it, and learn to respond to it from the first days of life.

Newborns may have a slight cross-eye and turn towards light, with eye movements being only horizontal. They can only see objects that are larger (especially colorful) within an angle of 45-60 degrees (that is, they briefly fixate on a large object in their line of sight), with alternating monocular fixation with each eye. Visual acuity at birth is low (around 20/400). Newborns are not yet able to accommodate (focus on objects at varying distances). By the end of the third month, vertical eye movements appear, and accommodation and convergence are more advanced. The baby begins to fixate and track objects, freely turning its head at an angle of 150 degrees. When the mother leans over the baby, they briefly make eye contact and smile (reactive social smile).

In response to acoustic stimuli, the baby may blink (acoustic facial reflex) or jerk their whole body (Moro reflex - startle response) depending on their strength. Newborns can recognize human speech sounds well. They become more alert when they hear a female voice with a higher pitch, as they expect the source of food is approaching. A deeper male voice with lower tones, on the other hand, tends to calm them. Loud screaming with a high pitch can cause anxiety in them, just as in an adult. During the first weeks of life, newborns learn to distinguish their mother's voice (the person who brings them food) from other female voices.

In addition to a well-developed sense of hearing, newborns also have a good sense of smell, and they already have developed taste preferences (preferring a sweet taste). Smell helps them orient themselves in the surrounding environment the best. Newborns turn away from unpleasant smells, while pleasant smells attract them. Within a week of birth, they can recognize the scent of the mother's nipple, and it has been found that they can perceive the scent of the mother, not just the smell of breast milk.

Social skills and speech

At two months old, a baby starts to say long vowels like "aaa, eee". Their main means of communication at this age is crying. The baby quickly learns that crying is an effective way to get not only care and protection, but also positive attention from their mother. In the first few months after birth, the amount of crying increases and reaches its peak for most babies around two months of age. By three months, crying is less frequent and more differentiated. Babies also start to laugh loudly at three months.

BEWARE OF FALSE "SUCCESSES"

  • If a baby almost rolls over onto their stomach at two months old, it's not a success but a warning. The baby is able to perform the movement due to increased muscle tension, so the baby first tilts their head and then there's increased tension in the back muscles usually on one side, causing the baby to turn.

  • The same applies in reverse. At this age, the baby doesn't turn from their stomach to their back, they simply fall over. If the baby tries to turn their head towards you, it's a head tilt with the head turned to one side. The head is large and heavy, so it can tilt back and fall onto their back.

  • Pay close attention to how the baby lifts their head and where their hands are when they are lying on their stomach. At the beginning, their hands are by their chest, with their fists clenched and their head lifted only briefly. Gradually, they learn to place their hands further forward, supporting themselves with their entire forearms. At the end of the third month, they can place their hands even further forward so that their elbows are under their shoulders and they can relax their fists while keeping their back straight. This means that their head is not only tilted (with a sunken chest), but their spine is extended.


DEVIATIONS THAT REQUIRE CONSULTATION WITH AN EXPERT

Within six weeks:

  • If the baby holds their head only on one side while lying on their back

  • Significant tilting of the head

  • Uneven movement of the arms or legs, or if they do not lift their legs equally high

  • Limited movement of the legs

Between six weeks and three months:

When lying on their back

  • if the baby predominantly holds their head to one side

  • Very little leg movement or one leg is significantly lower than the other

  • At three months, the head is not aligned with the body's axis and center of the face when looking forward

When lying on their stomach

  • if the baby cannot lift their head

  • their elbows are not equally positioned

  • if they fall to one side

  • The baby's fists remain under their chest or shoulders, their elbows are not positioned under their shoulders, and their hands are not relaxed by the end of the third month.


Second trimester, months 4-6

The baby is already interested in its surroundings, actively observing and reacting with a smile or cry. If the baby had enough time to practice the prone position, from the end of the twelfth week it gradually masters the so-called "tummy time". In the fourth month, there is a significant decline in primary reflexes, except for the reflexive grip on the lower limbs. The baby should already have open palms to begin the development of a free grip.

Motor skills

The baby is stable on its back (center of gravity between the shoulder blades) and moves actively. It holds its head in the middle position and spontaneously turns it to both sides, while having a symmetrical posture of the limbs (holding them equally, unlike the asymmetry of newborns). It lifts its legs high above the surface, grasping them with its hands and later putting them in its mouth.

It grasps toys with both hands and, in the sixth month, even with one hand from the side using the little finger and adjacent fingers. It starts playing with its hands, with eye-hand-mouth coordination appearing. It brings its hands to the center of its visual field. The baby begins to put toys in its mouth and pass them from hand to hand under visual control.


During traction testing (a test used by pediatricians, you don't have to do it!), when pulled into a sitting position, the baby begins to hold its head in the axis of the trunk, but then repeatedly falls forward. At the end of the fourth month, the head only slightly falls backwards. In the fifth month, the baby begins to turn from its back to its belly. The baby starts pulling itself into a sitting position at six months, while also bending its head and trunk forward and bending its legs (so-called "ball" position). However, the baby still cannot sit up by itself. If we sit the baby without support, it sits in a forward position, in the so-called "frog position". It turns from its back to its side and gradually to its belly. Therefore, we do not passively seat the baby!

The child is already holts his head upright - meaning, their head is symmetrically upright at an angle of about 45-50° above the surface with their head lifted and freely rotating towards stimuli (such as a rattle). The trunk is erect between the shoulders, and the child is supported by their entire forearms, including their elbows, with their palms slightly open or fully open. The child must be stable in this position and not fall back onto their back. This position is crucial for further development of upright posture. At six months, the child learns to shift their weight to one arm and release the other hand to grasp objects (meaning, their head and grasping hand are no longer within the support base). By the end of the sixth month, the child can lift themselves into a "high support," which means they prop themselves up on their outstretched upper limbs with open palms and an upright head. They then lean against their thighs, shifting their center of gravity downward.

A six-month-old child can hold larger objects with their palm grasp, using their entire hand with four fingers, without opposition of the thumb. Opposition of the thumb (towards the palm) gradually becomes incorporated into the grasp. The child can grasp a toy even across the midline of their body and can bang it against the surface.

Senses

The child can detect smaller objects in their visual field within a 180-degree angle. They have better color perception and prefer the color red, which also has an activating effect on several brain centers, stimulating development. Moving visual stimuli can capture a six-month-old child's attention for several minutes without causing significant eye strain. Fixation is now binocular. Until the sixth month, it is still normal for the eyes to occasionally alternate looking inward. However, if this persists after the sixth month, the child should be examined by an ophthalmologist. The child's attention is increasingly directed towards auditory stimuli, and they react even to quiet sounds.

Social skills and speech

The child smiles at the image in the mirror. They begin to babble (throat sounds) and coo (a-a-a, e-e-e). Gradually, they babble in their own language, which serves to activate their auditory and speech centers. They are already able to express their emotions well with their voice; they also show their dissatisfaction in ways other than crying. The child begins to distinguish strangers, from whom they may feel fear.

BEWARE OF FALSE "SUCCESSES"

  • Do not put children in walkers or jumpers. It often happens that if you put children in walkers when they are not yet crawling or walking independently, they begin to walk on tiptoes. These children often have problems in school with reading and writing, and hyperactivity is often typical. In general, walkers and jumpers are not suitable because the muscle corset of the trunk is not yet prepared for such stress.

DEVIATIONS THAT REQUIRE CONSULTATION WITH AN EXPERT

  • If you notice that a child is using one hand significantly less or only grabbing the toes of one foot

  • if they only roll to one side

  • if they don't gradually lean on their outstretched arms

it may be a sign of concern.


Third trimester, 7th-9th month

By seven months, a baby can turn from their belly to their back and touch their raised legs. They may also play with two toys at once. They start to crawl actively, and it's only a small step to crawling on all fours.

Motor skills

At seven months, a baby plays with their legs and sometimes even puts them in their mouth (coordination of hand-foot-mouth-eye). They become more stable on their side. On their belly, they do the "airplane," lifting their hands, head, and legs up. They turn around their own axis and later roll over – coordinated movement from belly to back via a certain side position and then on to the other side.


hey gradually move into a position on all fours, where they rock for two to three weeks. Then they start to crawl – initially backward, later forward, alternating upper and lower limbs.They can begin to attempt a slanted sitting position from all fours. They can sit passively but not yet by themselves. The baby starts to sit on its own via the slanted position at around eight months. It can now support its weight if held by both hands.


By nine months, the baby will not lie on its back for long any more, immediately turning over to its belly. It moves onto all fours, sits up, and tries to stand up. It can sit by itself, with several ways to do so, including from all fours, from the belly, from standing, and the most mature way is independent sitting from the back position. Depending on the way they sit, it is called slanted, obstacle, heel, Turkish, or straight sitting. At eight months, the baby can sit for about 10 minutes. Crawling is now steady and coordinated (leaning on hands, knees, and ankles, with differentiated limbs). At eight months, the baby can get into an upright squatting position with support. It can stand if held by, for example, a playpen.

Fine motor skills

Fine motor skills significantly improve and move towards the thumb. The child begins to be interested in details and small objects. They can already reach for a ball directly. They purposefully grasp objects above their head, where they must lift their little arm. At eight months, they enjoy manipulating objects, putting them inside each other or in a pile, and throwing them. They cannot yet deliberately place objects. They pick up small crumbs from the carpet, grab a ball, hit blocks together, and remove a cube from a cup. They can hold a bottle by themselves, grip a roll or cookie and start eating.

In the ninth month, the child begins to grasp small objects with their thumb and index finger, with the thumb in opposition - so-called pincer grasp. They explore space and actively and purposefully release objects from their hand (throwing toys, pulling objects out of drawers, etc.). They only take objects with one hand.

Social skills and speech

The child pronounces syllables and begins to double them. At eight months, the child repeats and doubles syllables ("da-da", "ba-ba", "ma-ma", etc.), imitates sounds (cough, etc.), and gestures. They begin to understand speech - they turn to their name when called. They already have rich facial expressions.


The period of first separation begins, meaning that they start to move away from their mother for a short time when crawling or walking and then return. At the same time, they experience fear when they cannot see or hear their mother. In this period, the child has a significant fixation on their mother or caregiver and is less friendly towards strangers.


The child begins to learn that many things exist even though they cannot see them at the moment. They start to follow an object that has fallen. They usually lose sight of it for a moment, but then tilt their head and body to look for it on the ground. They also begin to understand the functions of some objects, such as using a comb to brush their hair or turning the pages of a book. In the ninth month, their first word with meaning may appear. They understand phrases and respond to their first playful interactions (such as "bye-bye", "daddy", etc.). They can eat a cookie or roll by themselves.


BEWARE OF FALSE "SUCCESSES"

  • If a child is walking at ten months, it is a warning sign for us. It has likely skipped some developmental stages, most commonly the crawling stage. If the child still has a large symmetrical tonic neck reflex or tonic labyrinthine reflex, it cannot perform alternating movements of the arms and legs well. Therefore, it is easier for them to stand up and walk in small steps (there is no need for such a large movement in the hips and knees, the arms are outstretched and do not move).

  • Pay attention to how the child crawls. The child should crawl in a coordinated, crossed pattern (right hand and left knee, left hand and right knee), with the arms and knees shoulder-width apart, and the tips of the toes slightly turned towards each other. If children have too low muscle tone and weak abs (due to a persistent primitive reflex or other reasons), they crawl with a curved back and a protruding bottom, with their arms and legs in a wide base and their toes turned outwards.

  • Sometimes, a homologous (one-sided) model of movement also appears, i.e., the right arm and leg, and then the left arm and leg.

Beware of W-sitting. Children with lower muscle tone, delayed gross motor skills, or weak abs tend to sit with their buttocks between their legs (if you looked from above, their legs "draw" a large letter W), with their feet positioned with the toes pointing out and the heels inwards. This creates a wider base, making them more stable. On the other hand, the trunk does not have enough freedom of movement. The child has less rotation in the trunk, does not reach over the center of the body, which subsequently affects the cooperation of the brain hemispheres. Children with normal muscle tone sit on their heels with their toes pointing inward. If you see suboptimal crawling or sitting, do not hesitate to consult a physiotherapist.



DEVIATIONS THAT REQUIRE CONSULTATION WITH AN EXPERT

  • If the child doesn't catch both legs (always only one or not at all).

  • If the lower arm stays under the body after rolling over.

  • If the child continues to crawl by pulling with only one arm or always bending the same leg (i.e., always pulling with the right or left hand only). If the child pulls the trunk with one hand, alternating regularly with the other hand, it is called "crawling (seal crawling)," which is okay. In a healthy child, this crawling period lasts only briefly.

  • If the child pulls with both arms at the same time while crawling, and the legs are stretched out.

  • Once the child gets to "all fours," they still fall on the same side.

Fourth trimester, 10-12 months

From the tenth month of a child's life, development slows down slightly. The body begins to physically and mentally prepare for the first steps and walking. It is important for parents during this period to remove all dangerous objects within the child's reach that could harm them. The infant will soon become a toddler. A one-year-old child is very independent, exploring the surrounding world, curious, and very willing to help and tidy up. The child discovers the world, and it often happens that they fall and hurt themselves. In such cases, the parents should be there to comfort and soothe the child, blow on the painful spot, so that the child can go back to exploring, knowing that they have the option to cry it out.


Motor skills

The child stands at furniture and begins to walk around it using steps while holding onto both hands and stepping with their full feet. They alternate between sitting and crawling. The child gradually stands with support on the entire surface of the foot, releases one arm for activities other than supporting themselves, and becomes increasingly agile and quickly climbs stairs, furniture, etc. Sitting is firm with a balanced lumbar spine. The first independent steps appear (usually between the 12th and 15th month, up to 18 months is within the norm). This is primitive and immature walking (type 1): the upper limbs have a balancing function, there is no swing of the leg during stepping, only bending at the hip and knee joints, the tips of the feet slightly point towards each other, and the foot lands on the full surface. There are no joints in the limbs during walking. Steps are short (shorter than the length of the foot). Walking is not stable, and falls are frequent. The squat puts the child on their full feet with the center of gravity on the heels and the outer edge of the foot.

Fine motor skills

The child is now able to eat with a spoon and drink from a cup on their own. They can grasp a small ball with their thumb and index finger in opposition and release it spontaneously. They are able to put the ball in a cup. The function of the upper limb shifts definitively from supporting to grasping.


Social skills and language

At ten months, the child can already utter one or two meaningful words, as well as babble (syllables with strong intonation). They understand simple commands and can perform a movement on demand. When prompted to "give it to me," they will hand over the object, but will not let go of it. They put a cube in a cup but won't let go of it.


Laughter is becoming more frequent. Children begin to understand humor and fun. They express their joy through smiles, squeals, or loud throaty laughter. They learn children's games ("peek-a-boo," "bye-bye," "tick-tock," etc.) and reveal hidden toys. They start cooperating with dressing (lifting their legs and arms).


In the first year, they use two or more meaningful words. They understand simple commands and questions (they look for things by name, hand over objects and let go of them when told to, etc.), respond to their name, and can engage in cooperative play (with a ball, etc.). They are interested in pictures in books. The child gives kisses, but may be shy. They express their desires through gestures. They care for dolls or stuffed animals.


From a developmental perspective, we refer to the first year as the period of physiological infancy. The period of physiological non-speaking lasts until the age of three (a broader norm), so we don't need to worry if the child is not yet speaking (as long as they are making some sounds and responding to prompts). If the child has no problems with vision, hearing, speech organs, intellect, and receives good stimulation from the family, it may simply be a slower maturation that will catch up over time.

DEVIATIONS THAT REQUIRE CONSULTATION WITH AN EXPERT

  • If the child does not crawl

  • If the child skips the crawling stage and stands on their feet right away.

  • If crawling is irregular and not in a cross pattern.

  • If the child does not transition from crawling to sitting.

  • If the child still needs help to stand up by pulling themselves up with one hand and stepping forward with the same foot, while only pulling the other foot.

  • If the child cannot get into a squatting position on both knees.

Article author: PhDr. Marja Volemanová, PhD.

Main sources used:

  • Hudák, Radovan; Volný Ondřej; Kachlík David (2019). Memorix anatomie. Praha: Triton. ISBN 978-80-7553-420-0

  • Volemanová, Marja. 2019. Primární reflexy, opomíjený faktor problémů učení a chování u dětí. 2. rozšířené vydání. Statenice : INVTS, 2019. 978-80-907369-0-0

  • Langmeier, Josef; Krejčířová, Dana (2006). Vývojová psychologie, 2. aktualizované vydání. Praha: Grada. ISBN 978-80-247-1284-0

  • Velemínský, Miloš (2017). Dítě od početí do puberty. Praha: Triton. ISBN 978-80-7553-148-3

  • Kleplová, Věra; Pilná, Dobromila (2007).Našemu sluníčku. Praha: Anag. ISBN 978-80-7263-357-9

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