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Most popular medical Questions
Why do infants have primitive reflexes, and when should they disappear?Primitive reflexes are automatisms that are usually triggered by an external stimulus. Examples are rooting, which is triggered by touching the corner of the mouth, and the asymmetric tonic neck reflex (ATNR), which is triggered by rotating the head. Some reflexes (e.g., rooting, sucking, and grasp) have survival value. Others, such as the ATNR or the tonic labyrinthine reflex, have no obvious purpose. Placing and stepping reflexes usually disappear by 2 months. Moro and grasp reflexes and the ATNR usually disappear by 3 months.
What three primitive reflexes, if persistent beyond 4-6 months, can interfere with the development of the ability to roll, sit, and use both hands together?
Moro reflex: Sudden neck extension results in extension, abduction, and then adduction of the upper extremities with flexion of fingers, wrists, and elbows.
Asymmetric tonic neck reflex: In a calm supine infant, turning of the head laterally results in relative extension of the arm and leg on the side of the turn and flexion of both on the side away from the turn (the "fencer" position).
Tonic labyrinthine reflex: In an infant who is being held suspended in the prone position, flexion of the neck results in shoulder protraction and hip flexion, whereas neck extension causes shoulder retraction and hip extension.
At what age do children develop handedness?
Usually by 18-24 months. Hand preference is usually fixed by the time a child is 5 years old. Handedness before 1 year may be indicative of a problem with the nonpreferred side (e.g., hemiparesis, brachial plexus injury).
What percentage of children are left-handed?
Various studies put the prevalence at between 7% and 10%. However, in former premature infants without cerebral palsy, the rate increases to 20-25%. Although antecedent brain injury has been hypothesized to account for this increase in prevalence of left-handedness, studies of unilateral intraventricular hemorrhage and handedness have not demonstrated a relationship. Of note is that animals such as mice, dogs, and cats show paw preferences, but, in these groups, 50% prefer the left paw and 50% prefer the right paw.
What are the most common causes of gross motor delay?
Normal variation is the most common, followed by MR. Cerebral palsy is a distant third, and all other conditions combined (e.g., spinal muscular atrophy, myopathies) run a distant fourth. The most common pathologic cause of gross motor delay is MR, although most children with this condition have normal gross motor milestones.
Do infant walkers promote physical strength or development of the lower extremities?
No. On the contrary, published data confirm that infants in walkers actually manifest mild but statistically significant gross motor delays. Infants with walkers were found to sit, crawl, and walk later than those without walkers. Safety hazards can include head trauma, fractures, burns, finger entrapments, and dental injuries. Most of the serious injuries involve falls down stairs.
Do twins develop at a rate that is comparable to infants of single birth?
Twins exhibit significant verbal and motor delay during the first year of life. The difficulty lies not in the lack of potential but in the relative lack of individual stimulation. In general, children who are more closely spaced in a family have slower acquisition of verbal skills. Twins with significant language delay or with excessive use of "twin language" (language understood only by the twins themselves) may be candidates for interventional therapy.
Do premature infants develop at the same rate as term infants?
For the most part, premature infants do develop at the same rate as term infants. In ongoing developmental assessments, they eventually "catch up" to their chronologic peers not by accelerated development but rather through the arithmetic of time. As they age, their degree of prematurity (in months) becomes less of a percentage of their chronologic age. Early in life, the extent of prematurity is key and must be taken into account during assessments. Such "correction factors" are generally unnecessary after the age of 2-3 years, depending on the degree of prematurity.
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