Psychomotor development of the child: assessment and features. Diagnosis and treatment of delayed psychomotor development in children.

The psychomotor development of a child includes the formation of a number of skills in the motor and emotional sphere, the formation of the foundations of behavioral reactions. The peak of this development occurs at a young age, and begins from birth. Despite the existence of certain age periods for the formation of each of these skills, it is worth taking these “norms” as a guideline and leaving room for individuality. It is not uncommon for parents to worry about the timeliness of the pace of psychomotor development of the child, and any doubts about this are a sufficient reason to contact the specialists of the multidisciplinary CELT clinic. An assessment of the child’s complex of skills, as well as an additional examination, will help determine the presence or absence of psychomotor development delay in the child and identify the cause of its occurrence. This approach will allow you to find a solution to the problem and direct all efforts to eliminate it.

How and when is psychomotor development assessed?

Determining the level of psychomotor development includes an assessment of the child’s social adaptation, the development of his emotions, speech, assessment of general motor activity, and fine motor activity.

The psychomotor development of preschool children is assessed with varying frequency in each age period. This is directly related to the speed of physical and psycho-emotional development at an early age and the slowdown in the rate of development at an older age. Thus, assessment of psychomotor development is expected

in the 1st year of life - monthly;
from 1 to 2 years - every 3 months;
from 2 to 6 years old - annually.

Assessment of psychomotor development involves determining whether the child’s level of development corresponds to his age, or stating the fact of advanced or lagging development.

Motor development of a child under 1 year of age: what is normal and what is not?

Parents often worry that the baby does not meet certain parameters of motor development specified on the Internet. Should a child develop according to certain standards? Or may his motor activity differ from the given standards and be individual? KinderKlinik pediatric neurologist About Ksana Makarova.

Oksana Vadimovna, should a child’s motor development meet the norms?

Undoubtedly, the baby development scale is a useful thing, but the child does not always strictly follow it, and this is not a problem. And sometimes, and this also happens, the parents themselves “break” or “slow down” the development of their baby a little.

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How?

I'll tell you now. I will describe the most typical situations related to the motor development of the baby. Let's consider the “average” development scale for children under 1 year of age. Let's talk about children without pathology in organs and systems.

Let's start with the fact that the baby does not know that he NEEDS to develop. He is dry, full and comfortable. All his needs are satisfied. And for a child to develop, he needs certain conditions. Only by getting into such situations and trying to solve them will the little one develop.

“Keeps head in position on stomach - 1-2 months of age”

When will your child not do this? If you don't put it on your tummy or put it on for a very short time. And also, if there are “scratches” on his arms, which prevent him from properly leaning while lying on his stomach. It is also necessary to take into account the weight of the child in development: a large baby has a harder time lifting his head. He will do it, but just with a slight delay, which is also normal.

“Keeps the head in an upright position - 2-3 months of age”

What if it doesn’t hold? First of all, evaluate how you hold your baby upright. If you always support his head, then naturally he will not hold it by this age. What for? He is already comfortable, leaning on his father’s or mother’s palm. And wonderful. Very often there are fears from parents: “the head will fall off,” “the spine will break.” This won't happen.

“Rolls over from back to stomach - 5-6 months of age, from stomach to back - 6-7 months of age”

What is the driver in a child’s motor development? First of all, desire and interest, as well as the opportunity and need to satisfy one’s interest - the interest to see more, the interest to get what is nearby. If your baby is in your arms all the time, then he may not be at all interested in turning over, since you will show him everything and give him everything. A child needs space and space to develop. Left alone, the little one will try to entertain himself, and for this he needs to learn how to do a coup, etc.

“Sits planted - 7-8 months, sits - 8-9 months”

When your little one is the happy owner of impressive cheeks and a tummy, then any stage of development will be more difficult for him, especially the one in which he needs to lift himself. These kids do everything a little later. I also “love” walkers, which parents begin to put their children in at almost 6 months, thereby breaking the natural path of development. And in this case, the baby simply does not need to try to sit up, he has no need to do so.

“Gets on all fours - 7-8 months, crawls - 9-10 months”

Why does a child need to crawl? Because he wants to move towards those objects and things that may be in different parts of the apartment in order to touch them, put them in his mouth if possible, etc. Also, in the position on all fours it is much more convenient to get things that interest the baby. When will crawling be a problem? When a child is restricted in movement for fear of dirt, pets, cold floors, etc. When a child spends a lot of time in a walker, the baby is not at all interested in crawling, since he has mastered the ability to move by pushing off the floor with his legs. And again, when the little one weighs a lot for his age.

“Climbing on a support, standing with support - 8-11 months, walking - 10-12 months”

After crawling and realizing that some interesting things are still unattainable for him in the position on all fours, the baby tries to stand on his feet. Then he tries to take small steps, and then tries to walk with the support of his arms and on his own. Walkers can again act as a brake on verticalization and walking. If the baby understands that crawling is faster than trying to walk, then walking may also be delayed. Let's not forget that your baby is old enough to be scared when he falls while trying to walk, so he may continue to crawl. Such cautious children may be afraid to walk on their own for a long time and will prefer to stomp while holding mom or dad’s hand.

When examining a child of any age, I take into account many factors that may influence his development. After all, every baby is unique, and a family is a small separate state with its own rules and principles.

So don’t worry, everything will happen on time for your child.

Grow with pleasure and be healthy!

Symptoms of psychomotor development delay

Symptoms of delayed psychomotor development in young children are expressed as follows:

sluggish mobility;
sluggish sucking or breast refusal;
inadequate (reduced) reaction to light and sound stimuli;
lack of interest in toys, disruption of play activities;
absence or poverty of emotions;
lack of response to parents;
lack of differentiation between family members and strangers;
lack of object manipulation activity;
delayed speech formation;
lack of coordination of movements.

Delay levels

Degrees of delay are distinguished depending on the number of age intervals by which the baby’s psychomotor development is delayed.

A mild degree of delay (or, as it is also called, tempo delay) is diagnosed if developmental deviations do not exceed three months. Disturbances in the development of certain motor skills are typical for children who suffer from rickets. In the absence of symptoms of brain damage, complete restoration of all psychomotor functions is observed.
The average degree of delay is diagnosed if the developmental delay is from 3 to 6 months. It occurs in children who have had meningitis, suffer from epilepsy, as well as in various forms of encephalopathy. The average degree of delay requires a comprehensive examination to diagnose the causes of developmental delay;
A severe degree of delay is diagnosed if the developmental delay is more than 6 months. It is combined with such pathological conditions as: malformations of the brain, metabolic disorders, genetic syndromic conditions, hypothyroidism, encephalitis.

Therapeutic and diagnostic measures for any degree of psychomotor development delay are strictly individual and are determined by the attending physician after examination and medical history.

Body positions and supporting surfaces

The baby develops its motor functions from the prone position, the supine position and the side position. From birth to walking without support, the child constantly straightens, his body is located higher and higher. At the same time, he is forced to struggle with the force of gravity in different ways each time, trying to hold his body and encountering varying degrees of gravity.

In the prone position, the newborn's movements are calm, thanks to the great stability of the body. It's hard to make a mistake. From this position, the child straightens up, and in the first three months moves to a position supported by his elbows.

In the supine position, the posture of the bewitched baby is at first very unstable and uncertain. It’s easy to make a mistake here, to which the child reacts with a mass of erratic and unpurposeful movements. The reason for this uncertainty lies in the lack of posture regulation skills. A newborn does not yet know how to lean his back on the bed. Only during the first three months of life does the surface of the bed become a supporting surface for the child. But the position on the back and the position on the side remain unstable positions for the child, which require more effort to regulate.

In the process of straightening the child's body and moving it forward, the area of support of the child's body continuously changes. Until the end of the eighth month of life, in the supine and lateral positions, the child still uses the entire area of the body for support. As you straighten, the support area becomes smaller. Ultimately, the child begins to rely only on his arms and pelvis when sitting on his side, or only on his hands, knees and shins when crawling on all fours. As a result of further straightening, at the end of the fourth trimester the entire body weight is directed only to the small platform of the feet.

As supporting surfaces become smaller, demands on the entire sensorimotor system increase; The body's balance becomes more sensitive to disturbances and must be continuously adjusted.

To ensure posture, the child masters various functions of the trunk muscles. As a rule, this occurs already in the first twelve months of his life when supporting himself on his hands, rolling over, standing up and walking, as well as when grasping an object. All of these different sequences of movements require posture adjustments. They show that posture and movement are mutually dependent already in the early period of development. Typically, it takes 12-18 months for a child's musculoskeletal system to reliably maintain body posture through the various stages of straightening and lifting. Meanwhile, the various functions of individual muscles are always combined in new configurations, so that the child practices and trains a variety of motor algorithms. Only after this does he have access to horizontal and vertical space, since he can turn, sit down, stand up, or crawl.

The driving force behind the use of sensorimotor algorithms in the spontaneous development process is the child’s curiosity and interest in everything that surrounds him. These sensorimotor algorithms serve as a means to satisfy the child's curiosity and need for communication.

As a child gets older, his range of interests expands, and the variety of motor algorithms that the child uses to satisfy his interests is constantly expanding. Constant practice gives the child the ability to fine-tune his motor system for a variety of purposes, and use it in a wide variety of ways. With practice, the child acquires a wide range of movement memories (body schema). If a child has developed his own individual basic motor algorithm, he will use it again and again throughout his life when learning new functions, for example, in sports, driving a car or playing a musical instrument.

But if a child in the first year of his life used any basic motor algorithm only to a limited extent, then, in all likelihood, his entire further development will be deficient, since body postures in the process of straightening become increasingly difficult, and the postural tasks of balancing and holding the torso become increasingly difficult. more difficult.

There appears to be a physiological window of time when the entire sensorimotor system responds particularly quickly and learns well during postural development. It is clear that in the first three months this window is wide open.

The twelve months of the first year of life are divided in medical terminology into 4 trimesters (4 times three months = 12 months), these periods of time smoothly flow into one another. In each trimester, the child exhibits development typical for that period; the results of this development become the basis for the child's development in the next trimester. Each trimester shows certain signs of development of body straightening and forward movement.

In the first trimester, that is, until the end of the third month of life, the child develops postural skills of the trunk in the “supine” and “lying on his stomach” positions. This allows you to then straighten up using your arms and creates the basis for further straightening of the body.
In the second trimester, the baby masters the “side-lying” position, which he achieves by turning from the “supine” position to the “stomach-lying” position. This allows the baby to move from the supine position to the tummy position, and after about 6 weeks he can roll over from his stomach to his back.
In the third and fourth trimesters, the child can already straighten up vertically from the “lying on his back” and “lying on his stomach” positions. This developmental step can be observed when a child, sitting on his side with support on his hands, grabs what is at the top, crawls on his bellies or on all fours, pulls himself up with his hands to stand up, and walks sideways, leaning on furniture. The child discovers the world around him, the radius of accessibility of this world is constantly growing. This again and again stimulates the skills of one or another body pose. Each time the child uses a variety of body poses more and more fully. Thanks to this provision of postural stability, the child gains more free space, giving room for movement of the limbs and head. New opportunities generate new curiosity and desire to possess certain objects.

► Conclusions

A child is born with motor experience that he acquired before birth. Stabilization of the posture of his trunk develops during the first years of life, forming the basis for further straightening into an upright position. Deficiencies in these early acquired postural skills can cause postural disturbances later in development. Each trimester shows certain signs of development of straightening and forward movement. This is how the child acquires a wide range of memories (body schema). With frequent repetition during the first year of life, the child remembers his individual basic algorithm, to which he returns when learning new motor functions again and again throughout his later life, for example, in sports or when playing a musical instrument. To determine the developmental status of the child, manifestations in the form of spontaneous movements are analyzed. In this case, special attention is paid to the postural regulation of the torso and spinal column. By comparing a child’s spontaneously applied motor algorithm with the motor algorithms used by approximately half of normally developed children, one can draw a conclusion about the quality of development of motor functions.

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Delayed speech development in children

Delayed speech development in children can occur for various reasons. The main ones are considered to be:

developmental pathology in the prenatal period;
head injuries at an early age;
psychological trauma;
delayed neuropsychic development;
hearing problems;
lack of communication with adults.

Clinical manifestations of speech development delay in children are as follows:

under the age of 4 months, the child does not respond to the appearance of an adult;
at the age of up to 9 months the child does not babble;
under the age of 1.5 years, the child experiences problems with swallowing and chewing;
at the age of 1.5 years, the child does not understand simple words and commands;
by the age of two, the child’s vocabulary remains limited and does not expand;
under the age of 2.5 years, the child cannot form simple sentences;
under the age of 3 years, the child’s speech is either too slow or too fast and unintelligible;
at the age of 3 years, the child does not know how to form sentences or use adult phrases;
over the age of 3 years, the child does not understand the simple explanations of an adult, his mouth is constantly open, and there is profuse salivation, which is not associated with teething.

In the first year of life

At each stage, the baby systematically masters new skills. This is especially noticeable in the first year of life, when progress is obvious even at intervals of several weeks.

1 month. The baby briefly fixes his gaze on a bright object and can follow it if it moves slowly. At sharp sounds he shudders. Can hold the head for some time while lying on the tummy. At this age, the baby begins to smile.
2 months. The child more confidently follows an object moving in front of his eyes. Turns the head towards the sound. He can hold his head upright for several minutes. An adult's address is greeted with a smile.
3 months. Focuses the gaze on an object in any position. Listens intently to different sounds. Lying on his tummy, rests on his forearms and bent legs. Reaches for a toy.
4 months. Most of the newborn's reflexes fade away, and hypertonicity of the hands disappears. The baby reacts to the appearance of his mother and may roll over onto his tummy. He can laugh loudly and turns his head in the direction of the sound. Examines his hands, can grab a toy with them and feel it. When feeding, supports the breast or bottle with its handles.
5 months. The baby distinguishes between relatives and strangers, understands whether they are speaking to him strictly or affectionately. Can stand with support, take a toy from the hands of adults, and pulls it into his mouth. It hums for a long time and actively.
6 months. The baby can roll over from his tummy to his back and crawl towards the toy. Sits with support, begins to babble, and can eat from a spoon. He moves the toy in his hands.
7 months. The child now sits and crawls more confidently. Shows an object in response to the question “where?”, can knock toys against each other, drink from a cup from the hands of an adult. He babbles for a long time with different intonations.
8 months. The toddler can sit and sit on his own, stand up holding a support, and walk with it. He tinkers with toys for a long time and actively pronounces simple syllables. Upon request, he can wave his hand and make “okay” gestures. Recognizes relatives from photos.
9 months. The baby can walk if held by both hands, repeats the syllables he hears, and fulfills simple requests: show him, give him. Responds to his name, uses gestures in communication.
10 months. The child can climb onto a chair or sofa and climb back down. Folds a matryoshka doll, an insert toy. Knows and shows different parts of the body on himself and other people. Pronounces the first simple words (mom, grandma, dad).
11 months. The baby can stand without support and tries to take a few “free” steps. Understands simple generalizations of objects (cars, dolls, balls). Reacts to the word “no”.
12 months. The baby pronounces about 8–10 words, understands about 100. Walks independently. Can use a comb and carry out simple requests (fetch, pick up). Can take a cup and drink from it, select objects according to their shape (for example, in sorters).

Treatment of speech delay

Treatment for delayed speech development is carried out in different ways and depends on the cause of the problem. This may consist of taking appropriate medications or by conducting classes with specialists: speech therapist, child psychologist, massage therapist.