The baby is sitting comfortably in his mother’s lap.
He is socially aware, inquisitive and readily responds to visual objects
and sounds. He smiles, laughs, and jabbers. At this age a baby will start
to make repetitive speech sounds that are nonspecific such as da, ma,
The baby is able to visually track an object throughout
the horizontal and vertical planes. An interesting or colorful object
is most helpful. To test visual fields, have the baby focus on an object
in front of him and then bring a second object from behind him until
he sees the object in his peripheral vision. He should turn toward the
new object. Saccadic eye movements are tested by using interesting toys
and sounds and watching the eyes jump from object to object. To test
hearing, produce a sound out of the baby’s sight and then watch
the baby turn and localize the sound. Facial movements are noted as the
baby smiles or cries.
Motor - Sitting
Independent sitting is accomplished by 6 to 8 months.
This baby has good sitting posture (head erect and spine straight) and
has enough stability to reach for objects with both hands. He even stretches
to obtain an object without loosing his balance.
Motor - Hand
The baby is able to reach out and pick up an object and
bring it to the midline, usually to his mouth. He reaches equally well
with either hand. Hand preference before one year of age is always abnormal
and indicates a motor deficit in the non-preferred hand.
At this age,
the baby is able to transfer an object from hand to hand. By 5 to 6
months, a baby grasps objects that are the size of a cube. An ulnar or
grasp is a raking motion with the fingers trapping the object against
The next stage of hand development is to use the thumb in concert
with the fingers to grasp an object. This is called a whole hand grasp.
The baby is starting to use the thumb so has developed a whole hand
grasp. A thumb-finger pincer grasp develops at 7 to 9 months.
Motor - Tone
Tone is assessed for the upper and lower extremities by
passive range of motion when the baby is cooperative. Distraction is
a great way to get that cooperation. Babies at this age have found their
feet and can suck on their toes. On passive range of motion, the lower
extremity should be flexible enough to bring the foot to the baby’s
mouth. There shouldn’t be any ankle clonus.
Motor - Traction
On traction, which is pulling to a sitting position,
the baby has good head and trunk control. The head and shoulders are
flexed forward and the arms are flexed. The baby actively helps himself
to get to the sitting position by pulling with the arms. Also notice
that the legs are flexed at the hips and are off the mat as the baby
pulls himself to sitting. On being laid back down to the supine position,
the baby doesn’t flop back, but is able to control the lowering
of his head and trunk to the mat.
Position - Prone
In the prone position, the baby brings his chest all
the way off the mat and supports his weight on his hands, not his forearms.
He works for toys out of his reach. He is close to crawling. He can roll
over from front to back and back to front.
|Reflexes - Deep Tendon Reflexes
is hard to get the baby relaxed and cooperative enough to get the limb
in the optimal position for obtaining deep tendon reflexes. At this age,
all the deep tendon reflexes tested in an adult exam should be obtainable.
Reflexes - Plantar Reflex
There is still a lot of plantar grasp at this
age as well as withdrawal, which makes testing for the plantar response
difficult at this age. The toes are still up going until one year of
age. The most useful finding at this age is if there is asymmetry in
the toe findings.
At six months of age this baby has lost the Moro reflex
and the asymmetric tonic neck reflex. Persistence of either one of these
primitive reflexes would be abnormal.
Postural Reflexes - Positive Support Reflex
Some consider the positive
support reflex as a primitive reflex, but others consider it a postural
reflex. I think it is a postural reflex because it is necessary for erect
posture and blends into volitional standing. Infants with prenatal or
perinatal corticospinal tract disease will often refuse to support their
weight on their feet.
The positive support reflex is the first postural
reflex to develop and is present by 3 to 4 months of age. When the
baby is placed in vertical suspension with the feet touching the mat,
baby will extend the legs and attempts to support his weight while
being balanced by the examiner. By 5 to 6 months of age the baby fully
his weight while standing and by 7 months enjoys bouncing.
Postural Reflexes - Landau
The Landau is an important postural reflex
and should develop by 4 to 5 months of age. When the infant is suspended
by the examiner’s hand in the prone position, the head will extend
above the plane of the trunk. The trunk is straight and the legs are
extended so the baby is opposing gravity. When the examiner pushes the
head into flexion, the legs drop into flexion. When the head is released,
the head and legs will return to the extended position. The development
of postural reflexes is essential for independent sitting and walking.
Postural Reflexes - Lateral Propping
Lateral propping or protective
extension is essential for the baby to be able to sit independently.
This postural reflex develops at 5 to 7 months of age. Anterior propping
actually develops first, then lateral propping. For anterior propping
the baby will extend the arms forward to catch himself and prevent falling
forward. Lateral propping occurs when the baby is falling to one side
or the other and he extends the arm laterally to catch himself. Asymmetric
lateral propping can be an early sign of hemiparesis. The baby will prop
on one side but on the paretic side he will not extend the arm to catch
Postural Reflexes - Parachute
The parachute reflex is the last of the
postural reflexes to develop. It usually appears at 8 to 9 months of
age. When the baby is turned face down towards the mat, the arms will
extend as if the baby is trying to catch himself. Prior to developing
this reflex, the baby will actually bring the arms back to the plane
of the body and away from the mat.
The head circumference should be measured and plotted.
This is usually done at the end of the exam because babies usually resent
the restriction of head movement necessary to obtain an accurate measurement.
Head shape should be noted and the sutures palpated.
(premature closure of the suture) can cause a misshaped head. Bone
growth occurs perpendicular to the suture. If one suture is closed, compensatory
growth will occur in the remaining open sutures. Synostosis of the
suture (the most common type of synostosis) results in scaphocephaly
(a thin elongated head). Synostosis of the coronal sutures results
in brachycephaly (a wide flat head). Synostosis of the metopic suture
in trigonocephaly (a triangular shaped head).
The most common cause
of a misshapen head is flattening of the occipit on one side and
is not from lambdoid synostosis but is positional in nature (caused from
baby lying supine with the head turned to one side as a preferred position).
is important not only to palpate the sutures but also the fontanelles.
The posterior fontanelle cannot be palpated after six weeks. The anterior
fontanelle is often small by six months. Closure of the anterior fontanelle
occurs between 10 and 20 months. The anterior fontanelle should be
palpated while the child is sitting and quiet and it should be flat or
concave. A full, slightly bulging fontanelle can be seen with a child
that is supine or crying.