Friday, July 3, 2015

Age-appropriate Neuroassessment

Age-appropriate neuroassessment table. A brief guide to developmental milestones in children from infancy to age 12 years as a guide when performing a neurological assessment (Phoenix Children’s Hospital)

Age
Gross Motor
Fine Motor
Personal/social
Language
Newborn
Head down with ventral suspension
Flexion Posture
Knees under abdomen-pelvis high
Head lag complete
Head to one side prone
Hands closed
Cortical Thumbing (CT)
With sounds, quiets if
crying; cries if quiet;
startles; blinks
Crying only
monotone
4 weeks
Lifts chin briefly (prone)
Rounded back sitting
head up momentarily
Almost complete head lag
Hands closed (CT)
Indefinite stare
at surroundings
Briefly regards toy
only if brought
in front of eyes
and follows only
to midline
Bell sound
decreases activity
Small, throaty noises
6 weeks
In ventral suspension head up
momentarily in same plane as body
Prone: pelvis high but knees no
longer under abdomen
Hands open 25% 
of time
Smiles
Social smile 
(1st cortical input)
2 months
Ventral suspension; head in same
plane as body
Lifts head 45° (prone) on flexed
forearms
Sitting, back less rounded, head
bobs forward
Energetic arm movements
Hands open most of
the time (75%)
Active grasp of toy
Alert expression
Smiles back
Vocalizes when talked to
Follows dangled toy
beyond midline
Follows moving person
Cooing
Single vowel sounds
(ah. eh, uh)

3 months

Ventral suspension; head in same
plane as body
Lifts head 45° (prone) on flexed
forearms
Sitting, back less rounded, head
bobs forward
Energetic arm movements

Hands open most of
the time (75%)
Active grasp of toy

Smiles spontaneously
Hand regard
Follows dangled toy 180°
Promptly looks at object
in midline
Glances at toy put in hand

Chuckles
“Talk back” if
examiner nods head
and talks
Vocalizes with two
different syllables
(a-a. oo-oo)

4 months

Head to 90° on extended forearms
Only slightly head lag at beginning
of movement
Bears weight some of time on
extended legs if held standing
Rolls prone to supine
Downward parachute

Active play with
rattles
Crude extended reach
and grasp
Hands together
Plays with fingers
Toys to mouth when
supine

Body activity increased
at sight of toy
Recognizes bottle and
opens mouth
For nipple (anticipates
feeding with excitement)

Laughs out loud
increasing
inflection
No tongue thrust

6 months

Bears full weight on legs if held
standing
Sits alone with minimal support
Pivots in prone
Rolls easily both ways
Anterior proppers

Reaches for toy
Palmar grasp of cube
Lifts cup by handle
Plays with toes

Displeasure at removal
of toy
Puts toy in mouth if
sitting

Shy with
strangers
Imitates cough and
protrusion of tongue
Smiles at mirror
image

7 months

Bears weight on one hand prone
Held standing, bounces
Sit on hard surface leaning on
hands

 

Stretches arms to be taken
Keeps mouth closed if offered
more food than
wants
Smiles and pats at mirror

Murmurs “mom”
especially if
crying
Babbles easily
(M’s, D’s, B’s, L’s)
Lateralizes sound

9 months

Sits steadily for 15 min on hard surface
Reciprocally crawls
Forward parachute

Picks up small objects
with index finger
and thumb
(Pincer grasp)

Feeds cracker neatly
Drinks from cup with
help

Listens to conversation
Shouts for attention
Reacts to “strangers”

10 months

Pulls to stand
Sits erect and steadily (indefinitely)
Sitting to prone
Standing: collapses and creeps on
hands knees easily
Prone to sitting easily
Cruises – laterally
Squats and stoops – does not
recover to standing position

Pokes with index
finger, prefers small
to large objects

Nursery games
(i.e., pat-a-cake),
picks up dropped bottle,
waves bye-bye

Will play peek-a-boo
and pat-a-cake
to verbal command
Says Mama,
Dada appropriately,
finds the hidden toy
(onset visual
memory)

12 months

Sitting; pivots to pick up object
Walks, hands at shoulder height
Bears weight alone easily
momentarily

Easy pinch grasp with
arm off table
Independent release
(ex: cube into cup)
Shows preference for
one hand

Finds hidden toy under
cup
Cooperated with dressing
Drinks from cup with two
hands
Marks with crayon on
paper
Insists on feeding self

One other word
(noun) besides
Mama, Dada
(e.g., hi, bye, cookie)

13 months

Walks with one hand

Mouthing very little
Explores objects with
fingers
Unwraps small cube
Imitates pellet bottle

Helps with dressing
Offers toy to mirror image
Gives toy to examiner
Holds cup to drink, tilting
head
Affectionate
Points with index finger
Plays with washcloth,
bathing
Finger-feeds well, but
throws dishes on floor
Appetite decreases

Three words besides
Mama, Dada
Larger receptive
language than
expressive

14 months

Few steps without support

Deliberately picks up
two small blocks in
one hand
Peg out and in
Opens small square
box

Should be off bottle
Puts toy in container if
asked
Throws and plays ball

Three to four words
expressively
minimum

15 months

Creeps up stairs
Kneels without support
Gets to standing without support
Stoop and recover
Cannot stop on round corners suddenly
Collapses and catches self

Tower of two cubes
“Helps” turn pages
of book
Scribbles in imitation
Completes round peg
board with urging

Feeds self fully leaving
dishes on tray
Uses spoon turning upside
down, spills much
Tilts cup to drink, spilling
some
Helps pull clothes off
Pats at picture in book

Four to six words
Jargoning
Points consistently to
indicate wants

18 months

Runs stiffly
Rarely falls when walking
Walks upstairs (one hand held-one
step at a time)
Climbs easily
Walks, pulling toy or carrying doll
Throws ball without falling
Knee flexion seen in gait

Tower of three to four
cubes
Turns pages two to
three at a time
Scribbles
spontaneously
Completes round peg
board easily

Uses spoon without rotation
but still spills
May indicate wet pants
Mugs doll
Likes to take off shoes and
socks
Knows one body part
Very negative oppositions

One-step commands
10-15 words
Knows “hello” and
“thank you”
More complex
‘jargon’ rag
Attention span
1 min
Points to one picture

21 months

Runs well, falling some tires
Walks downstairs with one hand
held, one step at a time
Kicks large ball with demonstration
Squats in play
Walks upstairs alternating feet with
rail held

Tower of five to six
cubes
Opens and closes small
square box
Completes square peg
board

May briefly resist bathing
Pulls person to show something
Handles cup will Removes
some clothing purposefully
Asks for food and
drink Communicates toilet
needs helps wit h simple
household tasks 3 body
parts

Knows 15–20 words
and combines
2–3 words
Echoes 2 or more
Knows own name
Follows associate
commands

24 months

Rarely falls when running
Walks up and down stairs alone
one-step-at-a time
Kicks large ball without
demonstration
Claps hands
Overthrow hand

Tower of six to seven
cubes
Turns book pages
singly
Turns door knob
Unscrews lid
Replaces all cubes in
small box
Holds glass securely
with one hand

Uses spoon, spilling little
Dry at night
Puts on simple garment
Parallel play
Assists bathing
Likes to wash 6 dry hands
Plays with food
+ body parts
Tower of 8. Helps put
things away

Attention span 2 min
Jargon discarded
Sentences of two to
three words
Knows 50 words
Can follow two-step
commands (ain’t)
Refers to self by
name
Understands and
asks for “more”
Asks for food by
name
Inappropriately uses
personal pronouns
(e.g., me want)
Identifies three
pictures

3–5 years

Pedals tricycle
Walks up stairs alternating feet
Tip toe
Jump with both feet

Copies circles
Uses overhand throw

Group play
Can take turns

Uses three-word
sentences

5–12 years

Activities of daily living

Printing and cursive
writing

Group Sports

Reads and understands
content
Spells words
 

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