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Birth Process
Parturition is the act or process of giving birth. It usually starts about two weeks before
delivery with a series of changes in the uterus, cervix, and other areas that cause labor.
Braxton Hicks contractions are false contractions that can happen during the final month
of pregnancy or even in the second trimester. During these, the uterine muscles tighten for
up to two minutes; they are typically mild and irregular. True contractions often begin a few
days after conception might seem to be the pattern, but they become more frequent, rhythmic,
painful, and increase in how often and how strong they are as labor nears.

Stages of Childbirth
Labor occurs in three overlapping stages.
1. Stage 1: Dilation of the Cervix: This first stage is the longest, typically lasting 12 to
14 hours for a first-time mother. It's often shorter in later births. During this stage,
uterine contractions become regular and more frequent (starting 15 to 20 minutes
apart) causing the cervix to shorten and dilate (widen) for delivery. Towards the end
of this stage, contractions are about 2 to 5 minutes apart. Stage 1 ends when the
cervix is fully open at 10 centimeters (about 4 inches) so the baby can move into the
birth canal.
2. Stage 2: Descent and Emergence of the Baby: This stage usually lasts up to an
hour or two. It starts when the baby's head begins moving through the cervix into the
vaginal canal and ends when the baby is completely out of the mother's body. At the
end of this stage, the baby is born but still connected to the placenta by the umbilical
cord, which needs to be cut and clamped. (It's preferred for the baby's head to come
out first).
3. Stage 3: Expulsion of the Placenta: This stage lasts between 10 minutes and 1
hour. During this time, the placenta and the rest of the umbilical cord are pushed out
from the mother.

Monitoring and Delivery Methods

• Electrical Fetal Monitoring tracks the fetus's heartbeat during labor and delivery to
see how the fetal heart is handling the stress of contractions. It's valuable in high-risk
pregnancies but has drawbacks for low-risk ones: it's costly, restricts the mother's
movements, and has very high false-positive rates (showing a problem when there
isn't one).
• Vaginal Delivery is the usual ("normal") method of childbirth.

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• Cesarean Delivery is when the baby is surgically removed from the uterus through
an incision in the mother's abdomen. It's used if labor is too slow, the fetus seems to
be in trouble, or the mother is bleeding vaginally. It's often needed if the fetus is in a
breech position (feet or bottom first), transverse position (sideways), or if the head is
too big.
o Cesarean deliveries have risks for the mother, like bleeding, infection, organ
damage, and post-surgery pain, and can increase risks in future pregnancies.
They also don't give the baby the benefits of a normal birth, such as the
hormone surge that clears lungs, provides energy to cells, and sends blood to
the heart and brain. Cesarean delivery might also negatively affect
breastfeeding, which can influence bonding. Vaginal delivery stimulates the
release of oxytocin, a hormone that causes uterine contractions and
encourages maternal behavior in animals, and possibly in humans too.
o Reasons for high C-section rates include older first-time moms, multiple births,
very premature babies, fear of malpractice lawsuits, women's preferences, and
hospital revenue.
• Natural Childbirth aims to prevent pain by educating the mother about reproduction
and training her in breathing and relaxation for delivery, thereby eliminating fear.
• Prepared Childbirth uses instruction, breathing exercises, and social support during
pregnancy to help mothers have controlled physical responses to contractions and
reduce fear and pain during labor.
o The Lamaze method teaches expectant mothers to work with their bodies
using controlled breathing, acknowledging that labor is painful. The mother
learns to relax her muscles in response to her coach's voice (often the father
or a friend).
o The LeBoyer method involves giving birth in a quiet, dimly lit room to reduce
stress, and the newborn is gently massaged to soothe crying.
o Another technique by Michael Odent involves the laboring mother being in a
soothing pool of water.
o Other methods use mental imagery, massage, gentle pushing, and deep
breathing.
o The Bradley method is perhaps the most extreme, rejecting all obstetric
procedures and medical interventions.

Pain Management
• Medicated delivery involves the use of anesthesia.
• A Pudendal Block is a local (vaginal) anesthesia, usually given during the second
stage of labor. It might slow labor, cause maternal complications, and make the baby
less alert after birth.

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• An Analgesic is a painkiller that reduces the perception of pain by slowing down the
central nervous system's activity.
• An Epidural is a regional anesthesia injected into a space in the spinal cord in the
lumbar (lower back) region.
• A Doula is an experienced mentor, coach, and helper who provides emotional support
and information and can stay with a woman throughout labor.

The Newborn Baby

Hurlock's stages of early childhood:
1. Infancy:
o Partunate: Birth to the cutting of the umbilical cord.
o Neonate: From cutting the cord to 2 weeks old.
2. Babyhood: 2 weeks to 2 years old.
• The Neonatal Period is the first 4 weeks of life, a time when the baby transitions from
depending on the mother inside the womb to independent existence.

Size and Appearance

• In the Philippines (PH), average birth weight is 2.7 kg to 3.5 kg (around 6 to 7.7 lbs).
An average neonate in the US is about 20 inches long and weighs 7 ½ pounds.
• Boys tend to be slightly longer and heavier than girls. Firstborns often weigh less at
birth than later-born babies.
• Features include a large head and a receding chin (for easier nursing). The bones of
the skull don't meet yet; these soft spots are called fontanels, which ease passage
through the birth canal and fuse together in the first 18 months.
• Some newborns are very hairy because the lanugo (prenatal hair) hasn't fallen off yet,
giving them a pinkish coat.
• They are covered with vernix caseosa, an oily, cheesy varnish that protects against
infection and dries in the first few days.
• Due to high estrogen levels from the mother, some neonates (around the 3rd day)
might have a secretion from their swollen breasts called witch's milk.
• Some newborn girls might have a whitish, blood-tinged vaginal discharge. If
premature, genitals might be swollen.

Body Systems
• After birth, the neonate's body systems must operate on their own. Most of this
transition happens in the first 4 to 6 hours after delivery.

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• The heartbeat is fast and irregular at first, and blood pressure doesn't stabilize until
about 10 days after birth.
• If a neonate doesn't start breathing within about 5 minutes, the lack of oxygen (anoxia)
or reduced oxygen supply (hypoxia) can cause permanent brain damage. This can
also happen due to birth trauma during delivery.
• For the first few days, infants secrete meconium, a stringy, greenish-black waste
matter formed in the fetal intestinal tract. They don't have control over their sphincter
or bladder.
• Layers of fat help healthy full-term infants keep their body temperature constant. They
also maintain it by increasing activity when the air temperature drops.
• About 3 to 4 days after birth, about half of all babies develop neonatal jaundice. This
is caused by an immature liver and shows as a yellowish appearance. If severe and
not treated promptly, it can cause brain damage.

Medical and Behavioral Assessment

1. Apgar Scale: This scale is used one minute after delivery and again five minutes
after birth.
o It assesses: Appearance (color), Pulse (heart rate), Grimace (reflex
irritability), Activity (muscle tone), and Respiration (breathing)[cite:1 48]. Each
is scored 0, 1, or 2.
o A maximum score is 10. A 5-minute score of 7 to 10 means the baby is in good
to excellent condition. A score below 5 to 7 means the baby needs help to
establish breathing. A score below 4 means the baby needs resuscitation; if
successful, bringing the score to 4+ at 10 minutes means no long-term damage
is likely. Scores of 0 to 3 at 10 to 20 minutes after birth are associated with
cerebral palsy or other neurological problems.
2. Brazelton Neonatal Behavioral Assessment Scale (NBAS): This is a neurological
and behavioral test to measure a neonate's responses to the environment.
o It assesses responsiveness to the physical and social environment, identifies
strengths and possible vulnerabilities in neurological functioning, and helps
predict future development. It's suitable for infants up to 2 months old.
o It assesses motor organization, reflexes, attention and interactive capacities,
CNS instability, and state changes.
3. Neonatal Screening for Medical Conditions: Screening tests done soon after birth
(like taking blood from the heel for newborn screening) can find conditions such as
PKU, congenital hypothyroidism, and galactosemia.

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States of Arousal
• States of arousal refer to an infant's physiological and behavioral status at a given
moment in the daily cycle of wakefulness, sleep, and activity (also known as sleep and
wakefulness). Babies have internal clocks.
• The establishment of stable and distinct states of arousal is linked with newborn health
and positive outcomes because they indicate neurological organization.
• (See Table 2 for different states: Regular sleep, Irregular sleep, Drowsiness, Alert
inactivity, Waking activity and crying, describing eye movements, breathing, body
movements, and responsiveness).
• Youngest babies sleep the most (e.g., 0-2 months = 14.5 hours/day) and wake up
most frequently, especially at night. Babies' sleep schedules vary across cultures.

Complications of Childbirth
1. Low Birth Weight (LBW)
• LBW babies are neonates born weighing less than 2,500 grams (5 ½ pounds) at birth.
LBW is involved in neurological birth defects and infant death.
• Preterm (premature) infants are babies born before the 37th week of gestation.
• Small-for-date infants are born at or around their due dates but are smaller than
would be expected for their gestational age. This is most commonly due to inadequate
prenatal nutrition which slows fetal growth, and maternal smoking.
• Late preterm infants (delivered between 34 and 36 weeks) tend to weigh more and
do better than those born earlier, but compared to full-term babies, they are at greater
risk of early death or problems like respiratory distress, hospitalization, and brain
injuries. Girls tend to be hardier than boys.
• Birth weight and length of gestation are the two most important predictors of an infant's
survival and health.
• Risk factors for LBW include demographic and socioeconomic factors, medical
factors predating pregnancy, prenatal behavior and environmental factors, and
medical conditions associated with pregnancy.
• Immediate Treatment and Outcomes for LBW babies:
o Their immune systems are not fully developed, making them vulnerable to
infections.
o Their nervous systems may be too immature for basic survival functions (e.g.,
sucking).
o They haven't developed enough fat, so it's hard for them to stay warm.
o They may suffer from Respiratory Distress Syndrome because preterm
babies lack enough surfactant (a substance that keeps air sacs from
collapsing). Administering surfactant increases their survival rates.

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o An LBW or at-risk preterm baby may be placed in an isolette (an antiseptic,

temperature-controlled crib) and fed through tubes.
o Kangaroo Care (KC) is a skin-to-skin contact method where a newborn is
laid face down between the mother's breasts for about an hour at a time after
birth. It helps the baby adjust from fetal life to the sensory stimuli of the outside
world. This is applicable in developing countries where incubators might not be
available.
• Long-Term Outcomes for LBW babies:
o Higher risk of high blood pressure, metabolic syndrome, adult-onset diabetes,
cardiovascular disease, and death throughout childhood.
o Diminished reproductive rates in adulthood and increased risk of their own
infants being preterm.
o Cerebral palsy and possible mental retardation.
o Low educational and job-related income levels.
o Extremely LBW infants (born before 26 weeks) who survive tend to be smaller
and are more likely to have neurological, sensory, cognitive, educational, and
behavioral problems.
o However, environmental factors like maternal education, two-parent family
structure, and higher socioeconomic status (SES) are associated with positive
outcomes for preterm infants. Parenting also matters; when parents are low in
anger/criticism or mothers are high in sensitivity/low in anxiety, preterm babies
have better outcomes. Babies are resilient, and a high-quality postnatal
environment can greatly moderate the potential negative effects of being born
small.

2. Postmaturity
• Postmature babies (more than a month overdue) tend to be long and thin because
they've kept growing in the womb but had an insufficient blood supply towards the end
of gestation.
• They have a greater risk of shoulder dystocia (shoulder gets stuck behind the
mother's pelvic bone) and meconium aspiration (breathing in fetal waste fluids). They
may also have low Apgar scores, brain damage, or die.

3. Stillbirth
• Stillbirth is the sudden death of a fetus at or after the 20th week of gestation. It's
sometimes diagnosed before birth (prenatally) or discovered during labor or delivery.

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Survival and Health

• Infant mortality in the Philippines (PH) is 17 deaths per 1000 live births.
• Chief causes of infant mortality include preterm birth complications, childbirth
complications, and sepsis. Many of these deaths are preventable and result from
poverty, poor maternal health/nutrition, infection, and inadequate medical care.
• Maternal mortality declined 44% from 1990 to 2015, but about 303,000 women and
girls still die in childbirth each year. Most (27%) are due to hemorrhage, with other
causes including preexisting medical conditions, eclampsia, embolisms, and
complications of unsafe abortions. About two-thirds of maternal deaths happen in the
immediate postnatal period, and infants whose mothers die are more likely to die
themselves. Many of these maternal deaths are also preventable.
• Leading causes of infant death in the US include birth defects, genetic abnormalities,
disorders related to LBW and prematurity, SIDS, and maternal complications of
pregnancy.

Sudden Infant Death Syndrome (SIDS)

• SIDS, also known as crib death, is the sudden death of an infant under age 1 where
the cause of death remains unexplained after a thorough investigation including an
autopsy. (Even after autopsy and investigation, the cause is often still unknown).
• SIDS peaks between 2 and 4 months of age.
• The "triple risk" model suggests SIDS results from three overlapping factors: 1) a
vulnerable infant, 2) a critical period of risk, and 3) an exogenous (external) stressor.
SIDS occurs only if all three co-occur. Research focuses on what makes infants
vulnerable and environmental triggers.
• In some cases (about 14%), genetic mutations affecting the heart may make infants
vulnerable. More commonly, some infants seem to be born with delays or defects in
the brain stem (which regulates breathing, heartbeat, body temperature, and arousal).
These defects might prevent SIDS babies sleeping face down or on their sides from
waking or turning their heads when they breathe stale air (carbon dioxide). Babies with
low serotonin levels may also not awaken under conditions of oxygen deprivation and
CO2 buildup, increasing their risk.
• An environmental trigger is sleeping on their stomachs during their critical first year.
It's also recommended they don't sleep on soft surfaces, especially face down, as it
may increase the risk of overheating and rebreathing.

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Other Infant Safety Issues

• Unintentional injuries are the 5th leading cause of death in infancy in the US. 90% are
due to one of four causes: suffocation, motor vehicle traffic, drowning, or residential
fires/burns.
• Shaken Baby Syndrome: Because an infant's brain is still developing, their head
should be protected from falls or other injuries, and they should not be shaken, as this
can cause brain swelling and hemorrhaging.

Immunization
• Common immunizations include those for measles, polio, pertussis (whooping cough),
mumps, rubella, hepatitis B, and chickenpox. Multiple vaccines fortify the immune
system against various bacteria and viruses. Immunization has lowered infant
mortality.

Early Physical Development

Principles of Development
• Cephalocaudal (top-down): We learn to use our upper body before our lower body
(e.g., learn to walk).
• Proximodistal (inner to outer): We learn to control our arms before we master fine
finger movements.

Growth Patterns
• Children grow faster during the first 3 years, especially in the first few months. As a
baby grows into a toddler, their body shape and proportions change, and they typically
grow slenderer.
• Genes strongly influence a child's physical growth but also interact with the
environment.
• Teething usually begins around 3 to 4 months, but the first tooth might not appear
until 5 to 9 months or later. By the first birthday, a baby typically has 6 to 8 teeth; by 2
½ years old, they usually have 20 teeth.
• Malnutrition in Infancy:
o Early weaning from breast milk to inadequate nutrient sources (like unsuitable
cow's milk formula) can cause protein deficiency and malnutrition.
o Marasmus is caused by a severe protein-calorie deficiency and leads to
wasting away of body tissues in the infant's first year. The infant becomes very
underweight, and their muscles atrophy (waste away).

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o Kwashiorkor, caused by severe protein deficiency, usually appears between

1 and 3 years of age. Children with kwashiorkor might look well-fed because
the disease can cause their abdomen and feet to swell with water. Vital organs
collect available nutrients, depriving other body parts. Even if not fatal, severe
and lengthy malnutrition harms physical, cognitive, and social development.
o Children whose mothers received nutritious supplements during pregnancy,
and who themselves received more nutritious, high-calorie foods in their first
two years, were more active, involved, helpful with peers, less anxious, and
happier than those without nutritional supplements.

Nutrition
• Breastfeeding is almost always best for infants. It should begin immediately after
birth and ideally continue for at least a year (AAP recommends 6 months). (However,
this isn't always followed due to many reasons).
o Benefits for Breastfed Babies: Less likely to get infectious illnesses
(diarrhea, respiratory infections, ear infections, etc.); lower risk of SIDS and
postneonatal death; less risk of inflammatory bowel disease; better visual
acuity, neurological development, and long-term cardiovascular health; less
likely to develop obesity, asthma, eczema, diabetes, lymphoma, childhood
leukemia, and Hodgkin's disease; less likely to show language and motor
delays; score higher on cognitive tests; fewer cavities and less likely to need
braces[cite:2 104, 105]. (Mother's antibodies are passed on).
o Benefits for Breastfeeding Mothers: Quicker recovery from childbirth with
less risk of postpartum bleeding; more likely to return to pre-pregnancy weight
and less likely to develop long-term obesity; reduced risk of anemia and
lowered risk of repeat pregnancy while breastfeeding; report feeling more
confident and less anxious; less likely to develop osteoporosis or ovarian and
premenopausal breast cancer.
• An acceptable alternative to breast milk is iron-fortified formula based on either cow's
milk or soy protein, containing supplemental vitamins and minerals. Only breast milk
or iron-fortified formula should be given for the first 6 months; no solid foods yet.
• Breastfeeding is inadvisable if a mother has AIDS or another infectious illness,
untreated active tuberculosis, has been exposed to radiation, or is taking any drug
unsafe for the baby.

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Brain and Reflexes

• The brain at birth is only about one-fourth to one-third of its eventual adult volume. By
age 6, it's almost adult size, but specific parts continue to grow and develop
functionally into adulthood. Brain growth happens in fits and starts called brain growth
spurts, with different parts growing more rapidly at different times. The brain develops
through stimulation.
• Brain Stem: The most ancient part, also called the reptilian brain. It's responsible for
basic functions like breathing, heart rate, body temperature, and the sleep-wake cycle.
It's fully developed by birth.
• Cerebellum ("smaller brain"): Maintains balance and coordination. It grows fastest
during the first year of life but is not fully developed at birth.
• Cerebrum: The largest part, divided into two hemispheres joined by the corpus
callosum.
o Left Hemisphere: Typically for language and logical thinking.
o Right Hemisphere: Typically for visual-spatial functions.
o Lobes of the Cerebrum:

▪ Occipital Lobe: Smallest; for visual processing.

▪ Parietal Lobe: For integrating sensory information; helps us move our
bodies through space and manipulate objects.
▪ Temporal Lobe: Interprets smell and sounds; involved in memory.
▪ Frontal Lobe: For higher-order processes.
• Cerebral Cortex: The outer layer of the cerebrum, the largest region. It governs
vision, hearing, and other sensory information and matures by age 6 months (but not
the prefrontal cortex).
• The brain growth spurt from about the third trimester of gestation until at least the 4th
year of life is important for neurological functioning. Major sensory, motor, and
cognitive milestones of infancy (smiling, babbling, crawling, walking, talking) reflect the
brain's rapid development, especially the cerebral cortex.

Brain Cells
• Glial Cells: Nourish and protect neurons.
• Neurons: Nerve cells (about 100 billion) that send and receive information.
o Axons: Send signals to other neurons.
o Dendrites: Receive incoming messages from other neurons.
o Synapses: Tiny gaps between neurons, bridged with the help of
neurotransmitters.

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• As neurons multiply, move to their assigned spots, and develop connections, they
undergo:
Integration: Neurons controlling various muscle groups coordinate their
o
activities.
o Differentiation: Each neuron takes on a specific, specialized structure and
function.
• Cell Death (Apoptosis): The normal elimination of excess brain cells to achieve
more efficient functioning.
• Myelination: The process where glial cells coat neural pathways with a fatty
substance called myelin. This enables signals to travel faster and more smoothly.
Myelination begins about halfway through gestation, peaks during the 1st year of life,
continues into adolescence, and persists through the third decade of life.

Reflex Behaviors
• Reflexes are automatic, involuntary, innate responses to stimulation. There are
about 27 major reflexes in newborns.
o Primitive Reflexes: Controlled by lower brain centers. They are related to
instinctive needs for survival and protection or may support early connection to
the caregiver. Examples include sucking, rooting, Moro (startle), and grasping.
(See Table 4 for specific reflexes like Moro, Darwinian (grasping), Tonic neck,
Babkin, Babinski, Rooting, Walking, Swimming, their stimulation, behavior, and
typical age of appearance/disappearance).
o Postural Reflexes: Reactions to changes in position or balance.
o Locomotor Reflexes: Resemble voluntary movements that appear later,
after these reflexes have disappeared.
• Most early reflexes disappear during the first 6 to 12 months. Reflexes that serve
protective functions (blinking, yawning, coughing, gagging, sneezing, shivering, pupil
dilation) remain. The disappearance of unneeded reflexes on schedule is a sign that
motor pathways in the cortex have been partially myelinated, allowing a shift to
voluntary behavior. We can evaluate a baby's neurological development by checking
if certain reflexes are present or absent.

Brain Plasticity
• Plasticity refers to the modifiability or malleability of the brain through experience.
• While plasticity allows learning from good environmental input, it can also lead to
damage from harmful input. During early life when the brain is most plastic, it's
especially vulnerable. Exposure to hazardous drugs, environmental toxins, or maternal
stress before or after birth can threaten the developing brain, and malnutrition can

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interfere with normal cognitive growth. Early abuse or sensory impoverishment can
leave an imprint on the brain, delaying neural development or affecting brain structure.

Early Sensory Capacities

1. Touch (and Pain)
• Touch is the first sense to develop and the most mature for the first several months; it
continues to be important throughout life. By 32 weeks of gestation, all body parts are
sensitive to touch.
• Newborns can and do feel pain, and they become more sensitive to it during the first
few days of life. Anesthesia is dangerous for young infants.

2. Smell and Taste

• These senses begin to develop in the womb. Flavors from the food the mother
consumes are found in the amniotic fluid and breast milk. A preference for certain
tastes and smells can be developed in the uterus and early infancy, and may last into
early childhood.
• Newborns prefer sweet tastes and strongly dislike bitter flavors.

3. Hearing
• Auditory discrimination (telling sounds apart) develops rapidly after birth. It is key to
language development.
• At 2 days old, babies can recognize a word they heard up to a day earlier. At 1 month,
babies can distinguish sounds as close as "ba" and "pa". By 11 to 17 weeks, infants
can recognize and remember entire sentences after a brief delay. By 4 months, infants'
brains show lateralization (sidedness) for language, like adults' brains. By this age, the
left side of infants' brains responds more to speech, especially their native language,
than to other sounds. Infants can also recognize music typical of their culture from a
young age and by 4 months prefer music typical of their cultural experiences.

4. Sight
• Sight is the least developed sense at birth.
• Newborns' eyes are smaller than adults', retinal structures are incomplete, and the
optic nerve is underdeveloped. A neonate's eyes focus best from about 1 foot away
(typical distance to a person holding them).
• Newborns blink at bright lights. Their peripheral vision is very narrow; it more than
doubles between 2 and 10 weeks and is well developed by 3 months. The ability to

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follow a moving target and color perception also develop rapidly in the first months,
tied to cortical maturation.
• Infant visual acuity is about 20/400 and improves to 20/20 by 8 months. In the first 2
weeks, they see red, black, and white best.
• Binocular vision (using both eyes to focus, enabling depth perception) usually
doesn't develop until 4 or 5 months.
• Infants show a special liking for faces. From the start, they prefer looking at human
faces over most other things and can tell individual faces apart within hours after birth.
Infants also prefer their own mother's face and attractive strangers' faces over
unattractive strangers' faces. Within a few months, they pay close attention to human
eyes. Between 4 to 8 months (when learning language), they pay particular attention
to the mouth. Around a year old, as they master language basics, their attention shifts
back to the eyes.
• Infants also show some ability to categorize racial groups by facial data. At 3 months,
they look longer at own-race faces. By 9 months, they look longer at other-race faces
and seem to process own-race faces more efficiently, paying more attention to their
eyes. Generally, infants show privileged attention to faces, likely due to a dedicated
neural system for processing facial stimuli.
• Infants should be examined by 6 months for visual fixation preference, ocular
alignment, and signs of eye disease. Formal vision screening occurs at age 3. Early
vision is blurred with limited color.
• Perceptual Constancy: Sensory stimulation changes, but perception of the physical
world stays constant. This development allows infants to see their world as stable.
o Size Constancy: Recognizing an object stays the same size even if its image
on the retina changes as you move closer or farther. This ability is not full-blown
at 3 months and continues to develop until 10 or 11 years old.
o Shape Constancy: Recognizing an object stays the same shape even if its
orientation to us changes. Three-month-old infants don't have shape constancy
for irregularly shaped objects.
o Perception of Occluded Objects: Perceiving an object as complete when
it's partly hidden by another object in front of it. In the first two months, infants
don't see occluded objects as complete, only perceiving what's visible. Around
2 months, they develop the ability to see occluded objects as whole. Infants
develop the ability to track briefly hidden moving objects at about 3 to 5 months.
A study explored 5- to 9-month-old infants' ability to track moving objects that
disappeared gradually, abruptly, or imploded.

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Motor Development
• Babies do not have to be taught basic motor skills like grasping, crawling, and walking.
• Babies first learn simple skills and then combine them into increasingly complex
systems of action, allowing a wider or more precise range of movement and more
effective control of the environment.
• Pincer Grasp: The thumb and index finger meet at the tips to form a circle, making it
possible to pick up tiny objects.
• The Denver Developmental Screening Test is given to children from 1 month to 6
years old to see if they are developing normally. It measures gross and fine motor
skills, language development, and personality and social development. (This test is
Western-based and not necessarily applicable to other cultures).
• (Table 5 shows Milestones of Motor Development, listing skills and the ages by which
50% and 90% of children achieve them, e.g., Rolling over, Grasping rattle, Sitting
without support, etc.).

Milestones
• Head Control: At birth, most infants can turn their heads side to side while on their
backs. Lying chest down, many can lift their heads enough to turn them. In the first 2
to 3 months, they lift their heads higher. By 4 months, almost all infants can keep their
heads erect when held or supported sitting up.
• Hand Control: Babies are born with a grasping reflex. At about 3 ½ months, most
can grasp a moderate-sized object (like a rattle) but struggle with small objects. Next,
they grasp objects with one hand and transfer them to the other, then hold (but not
pick up) small objects. Between 7 and 11 months, their hands are coordinated enough
to pick up tiny objects using the pincer grasp. By 15 months, the average baby can
build a tower of two cubes. A few months after their 3rd birthday, the average toddler
can copy a circle fairly well.
• Locomotion: After 3 months, infants begin to roll over deliberately (first front to
back, then back to front). The average baby can sit without support by 6 months and
sit up without help by about 8 ½ months.
o Between 6 and 10 months, most babies start moving around by creeping or
crawling. This self-locomotion has significant cognitive and psychosocial
effects. Crawling infants become more sensitive to where objects are, their
size, if they can be moved, and how they look. Crawling helps babies judge
distances and perceive depth. They learn to look to caregivers for clues about
whether a situation is safe or scary (social referencing).
o By holding onto help or furniture, the average baby can stand a little past 7
months. The average baby can let go and stand alone well at about 11 ½
months.
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o These developments lead to walking. Humans walk later than other species,
possibly because babies' heavy heads and short legs make balance hard. For
some months before standing alone, babies practice "cruising" (walking while
holding onto furniture). Soon after standing alone well, most infants take their
first unaided steps. Shortly after the first birthday, the average child walks fairly
well and becomes a toddler.
o During the 2nd year, children begin climbing stairs one at a time (one foot then
the other on the same step); later they alternate feet. Walking down stairs
comes later. Also in their 2nd year, toddlers run and jump. By age 3 ½, most
can balance briefly on one foot and begin to hop. These perceptions are useful
for navigating and manipulating the world.

Motor Development and Perception

• Sensory perception helps infants learn about themselves and their environment to
make better judgments about how to navigate it. Motor experience, with awareness of
their changing bodies, sharpens their perceptual understanding of what might happen
if they move a certain way. This bidirectional connection between perception and
action, managed by the developing brain, gives infants useful information.
• Visual Guidance is the use of the eyes to guide movements of the hands or other
body parts. Infants locate objects/people through vision and even hearing.
• In younger infants, clumsy corrective movements in reaching are more likely due to
immature cerebellar development. The immature cerebellum only provides a rough
guideline for reaching movements, which then need correction. Younger infants are
more likely to correct their reaching using proprioceptive feedback (from muscles
and joints) and haptic information (relating to touch) rather than vision. Instead of
using their eyes to correct movements, infants reach first, then their eyes follow.
• Depth Perception is the ability to perceive objects and surfaces in three dimensions
(how deep or far away things are). It uses kinetic cues, binocular coordination, and
motor control. Kinetic cues are produced by the movement of the object, the observer,
or both.
• Haptic Perception is the ability to get information by handling objects, rather than
just looking at them. This includes putting objects in the mouth.

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Theories of Perceptual and Motor Development

• Ecological Theory of Perception (Eleanor & James Gibson):
o Locomotor development depends on infants' increasing sensitivity to the
interaction between their changing physical characteristics and new and varied
characteristics of their environment[cite:3 213, 214].
o It describes developing motor and perceptual abilities as interconnected parts
of a functional system that guides behavior in different contexts.
o This theory used the visual cliff experiment, where infants often did not cross
willingly, even with their mother's urging, because their perception told them it
appeared dangerous. This showed babies have depth perception and can
adjust their motor functioning to the environment to reach their goals.
• Dynamic Systems Theory (Esther Thelen):
o Argued that behavior emerges in the moment from the self-organization of
multiple concepts.
o Motor development is seen as a continuous process of interaction between the
infant and the environment, which is an interconnected, dynamic system.
o The maturing brain is just one part of this dynamic process; no single factor or
predetermined timetable dictates when a skill will emerge.
o Neurotypical babies tend to develop the same skills in the same order because
they are built similarly and have similar challenges and needs. However,
because these factors can vary, this approach also allows for variability in
individual development timelines. Motor development is not purely genetic or
automatic.

Cultural Influences on Motor Development

• Although motor development follows a nearly universal sequence, its pace can
respond to certain cultural factors. Such differences may be related to ethnic
differences in temperament or may reflect a culture's child-rearing practices.

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