Peds, part 8: G&D - Infant Fine/Gross Motor, Social, and Psychosocial Development
by Meris Shuwarger BSN, RN, CEN, TCRN December 20, 2021 Updated: June 16, 2022 11 min read
In this article, we discuss normal growth and development milestones for infants. These include gross motor milestones, fine motor milestones, and cognitive and psychosocial milestones.
The Pediatric Nursing series follows along with our Pediatric Nursing Flashcards, which are intended to help nurses and nursing students learn and retain information about caring for pediatric patients. The flashcards are a clear, complete study tool and a helpful reference for practicing RNs, PNs, and other medical professionals.
Infant gross motor milestones
Gross motor milestones means big body movements, typically, the larger muscles. These are the expected gross motor milestones infants normally achieve, from birth to one-year of age:
- Birth – 1 mo. The child may lift their head briefly when prone (lying on their stomach), but they will have a “head lag,” which means the infant does not have good control of their head or neck. For example, if an infant is on their back and they pull up with their hands, their head is not going to come up as easily.
- 2 – 4 mos. The infant can turn from their back onto their side, and from their side to their back. Also, when prone, the infant can hold their head up and support their weight on their arms. By four months, the infant should have head control (and no longer lag when raising their body up).
- 4 – 6 mos. By age 4 months, the infant can turn from their front to their back; and by 6 months, they can turn from their back to their front. It usually takes a little longer to develop the muscles that allow them to rotate from their back to their tummy.
- 6 – 8 mos. One of the biggest milestones is when a child is able to sit unsupported. This usually occurs by 8 months of age. An infant will start trying at around 6 or 7 months, but by the eighth month, they should be able to sit up unsupported. It’s a big milestone because now they can sit up and see the world around them. Now they will start to play with toys and other things within reach.
- 8 – 10 mos. The infant begins to move. They crawl or creep, which is when they “walk” by holding on to furniture, like a coffee table. By 10 months, the infant should be able to pull up to a standing or sitting position.
- 10 – 12 mos. Between 10 and 12 months, the infant should be able to stand alone and sit down from standing. And they will continue to creep, holding onto furniture as they “walk” about.
Infant fine motor milestones
Fine motor skills are actions and movements that engage the small muscles, the fingers, for instance. These are the expected fine motor milestones infants normally achieve, from birth to one-year of age:
- Birth – 1 mo. The infant will hold their hand in a fist, sometimes a very tight fist!
- 2 – 4 mos. The infant should be able to hold a rattle or similar simple toy when it is placed in their hands.
- 4 – 6 mos. The infant will reach for and pick up small objects. They will also begin to hold a bottle.
- 6 – 8 mos. At this stage, the infant should be able to transfer objects from one hand to the other. This takes a lot of coordination, as it works the left and right sides of the brain.
- 8 – 10 mos. By now, the infant should be able to pick up small objects using what is called the pincer grasp. For example, intently picking up a single Cheerio and putting it in their mouth. Again, this takes a lot of skill and coordination to achieve a relatively small set of movements.
- 10 – 12 mos. At this stage, the infant should be able to place objects into containers through holes. They will also attempt to build a two-cube tower. Note that they will likely not be successful, but that is part of the development process. The key thing is that they attempt to put one cube on top of the other.
Infant cognitive development — sensorimotor stage
The sensorimotor stage is when infants are exploring their world through their senses. This is the time when they are most likely to put all sorts of things in their mouths, which means they are at risk for choking.
In terms of a child’s cognitive development, among the expected milestones for infants from birth to one-year of age are their beginning to understand language, as well as experiencing anxiety when interacting with strangers or being left alone.
Language development in infants
By 9 months, the child will understand what the word “no” means.
At 10 months, they will be able to combine syllables, for example, saying things like “dada” or “mama.”
Within a year, the child will be able to string three to five words together when they talk. These words will have discernible meaning, though the infant might not articulate them with clarity. Essentially, the parent will understand the words the child uses, even when the word is “made up” or used uniquely by the child. For example, a pacifier goes “pop” when removed from an infant's mouth, so if the parent says “pop” each time the pacifier is removed, the child may call their pacifier a “pop.”
Normal behaviors in infants
Starting at about 6 months old, infants begin to exhibit certain behaviors, often related to familiarity with the people around them.
An infant usually displays stranger anxiety when they are held by an unfamiliar person. They don’t recognize that person, so it causes stress. In this instance, an infant will often start to cry.
Separation anxiety is when the infant shows signs of distress when the parents aren’t present. If a parent places their child in a room and then leaves the room (e.g., to go to the bathroom), the child will start to cry or whimper; they will appear distressed.
Infant psychosocial development — trust vs. mistrust
This milestone, trust versus mistrust, relates to Erikson’s Stages of Psychosocial Development. At this early stage, the child is reassured by things it can trust. For example, when they cry, does somebody come? When they have a need, is that need met? Fulfilling the child’s needs at this stage builds trust.
Age-appropriate play for infants
How we play with others is part of our psychosocial development, so play is extremely important in children. How a child plays is a strong indicator both of their development and their health.
Solitary play is when infants play by themselves. This is normal behavior.
Interactive play with an infant
Interactive play includes things like playing “pat-a-cake” or “peek-a-boo” with a baby. Interaction includes talking to an infant as if they were an adult, for example, “Mommy's going to go make coffee right now.” It includes adults narrating what they’re doing, singing, and reading books to the child.
Playing with toys
Infants love playing with toys, like rattles. They like colorful picture board books, balls, and blocks. And the more contrast, the better, as the infant begins to understand the world around them.
Hi, I'm Meris with Level Up RN, and in this video, I'm going to be talking to you about some normal growth and development milestones for the infant. We talked about physical ones in a previous video, so these are going to be our gross motor milestones, our fine motor milestones, and then we're also going to be talking about cognitive and psychosocial milestones. I'm going to be following along using our pediatrics flashcards. These are available on our website, leveluprn.com, if you want to get a set for yourself, and if you already have your own, I would invite you to follow along with me. Okay, let's get started.
Okay, so, first up, we're talking about gross motor milestones. Gross motor milestones; that means big body movements. So fine motor are these little, small ones using the small muscles like of our fingers, whereas gross motor milestones are big movements using, typically, larger muscles. So there's a lot of them, and for that reason, we have this nice table here for you. The first two years of life are a period of rapid growth and development in every way. And so there's a lot of information to take in here. We put this into a table that makes sense so that you can look at it in this nice, big overview. You can see the whole picture here rather than getting lost in the small details, and you can see we bolded the items that we think are the most important to grasp and be able to apply in your clinical practice. So everything is sorted here by age, so the age at which the child should reach the milestone. So between birth to one month of age, the child may lift their head briefly when they are prone, meaning on their stomachs. And we encourage tummy time, right? We do a lot of development on our stomachs, so we would expect that they'll briefly lift their heads when they are prone. But there is head lag present, meaning that they don't really have good control of their head and neck yet. So, for instance, if I had an infant on their back and they pulled them up by their hands, their head isn't going to just come up like this also. Their head is going to lag back. So if you pull them up, they're going to have head lag. So that's what that means. We have poor control here of our head and neck. Two to four months.
There's a lot on here, but a big one is we're turning from back to side and side to back. We haven't mastered getting all the way onto our tummies yet, but we can kind of roll up a little bit here. They should have head control by four months of age. From four to six months, they should be able to turn front to back by four months and then back to front by six months. So it's just a little bit-- it's a little bit harder to develop those muscles to go back to front, so it takes a little bit longer. Now, big, bold, red text here: between six to eight months, the biggest milestone we see is that a child should be able to sit unsupported by eight months of age. They'll start trying in that six- or seven-month time frame, but by eight months, they should be able to sit up unsupported. And that's a big milestone because they are now able to kind of sit up and see the world around them and start playing with toys and things of that nature. 8 to 10 months, they're going to crawl or creep. Creeping means walking while holding on to furniture, and they should be able to pull to a standing or sitting position by 10 months of age. And then, between 10 to 12 months of age, they should be able to stand alone and sit down from standing. Okay, so this is-- it's actually really hard to sit down from standing without toppling over. So that is a skill that they will learn about that age.
Okay, now, we have some more here. These are fine motor skills. So we talked about big movements. Now, let's talk about little, small ones. Birth to one month old, they're going to hold their hand in a fist, and actually, they hold their hands in a fist so tightly that I used to have to take a washcloth and scrub my son's palm because it would trap sweat and dirt inside his tightly clenched fist and start to smell if I didn't intentionally scrub it out. So they hold that fist tight. Two to four months, they should be able to hold or rattle or a toy when it's placed in their hands, but we're talking about a rattle because you can imagine it's just-- it's a simple toy, right? It's not like a big toy. Between four to six months, they should be able to reach and pick up small objects and hold a bottle. I know that was an exciting milestone for me with both of my kids because, when I bottle-fed them, I didn't have to hold it for them the whole time. I could just supervise them.
Six to eight months, they should be able to transfer objects from one hand to the other. Takes a lot of coordination and actually, left and right sides of the brain to do this, right, to transfer an item from one hand to the other. 8 to 10 months, they should be able to pick up small objects using what is called the pincer grasp, which is this, right? And I always think of, when I fed my child Cheerios and she would sit in the high chair, she would just very intently go for that one Cheerio, and she would grab it just like that and then put it in her mouth. It takes a lot of skill and coordination and very small movement to do that motion. And then, from 10 to 12 months, they're going to be able to place objects into containers through holes, and they're going to try to build a two-cube tower. They will likely not be successful. That's okay. We just want to see that they are attempting to put one cube on top of the other. It's all right if they're unsuccessful.
Okay, moving on to the last card here, we're talking about cognitive and psychosocial development. So, cognitive development, they are in the sensorimotor stage, which means that they are at risk for choking. They are at huge risk for choking because they explore the world through their senses, including through their mouths. They put everything in their mouths, which means that everything is a choking hazard for them. They should be able to understand the word no by nine months. And I can tell you from experience, once they get that word, oh, boy, they know that word. They're going to be able to combine syllables by 10 months, so things like dada or mama, right? That's why those are frequently the first words, combining syllables. Three to five words with meaning by one year. It doesn't mean that, suddenly, they're going to be able to say with perfect clarity, "Mother," right? It just means that they have a word like mama that means something and that, when they say that word, you know what that meaning is.
So, for instance, my children, when they used pacifiers, called them pops, because when I would pull it out of their mouths, I would go, "Pop." And so they started calling them pops. So my son, when he was in that age range, would say, "Pop, pop." And it's not a word. That's not in the dictionary that pop means pacifier, but it had a meaning behind it.
Okay. Normal behaviors. These are normal behaviors, so we are not concerned when we see them. Stranger anxiety means that, if a person I don't know holds me, I really don't like it, and I get really scared and start to cry. So this is very common when you know someone is meeting a new baby for the first time. The baby is six months old, but they never got to meet them yet, and they hold them, and the baby starts crying, and they're like, "Oh, no, she hates me." No, she just has stranger anxiety. It's okay. Now, separation anxiety is when the infant shows signs of distress when the parents aren't present. So if I put my child in a room and then left the room to go to the bathroom and they start to cry or whimper or look distressed, that is separation anxiety.
Psychosocial development. Here, we're talking about Erikson. They are in the trust-versus-mistrust phase. When I cry, does somebody come? When I have a need, is it met? Right? That is the whole point of this phase. Now, when we talk about play, because play is so important in children, play is a really big indicator of development and of health. So when we talk about play, we put that under psychosocial development because play can be both by myself and with others. So how we play with others is part of our psychosocial development. So they should be engaging in solitary play at this age. That's very normal. So we want to play patty cake. We want to play peekaboo. Those are all fun things. Talking to them like an adult, just, "Okay, Mommy's going to go make coffee right coffee right now." Narrating what you're doing, singing, reading books, all of these are great things. And when it comes to toys, we like rattles, colorful picture books. More contrast is better. They like contrast at that age. Balls and blocks. All right. I'm going to ask you some quiz questions to test your knowledge of some key facts I provided in this video.
Okay. So, first up, by what age should a nurse expect that a child will sit unsupported? Describe the tower of blocks that a child should build at approximately one year of age. The nurse observes that a hospitalized infant shows signs of distress when the parents are not present in the hospital room. What is the name for this behavior? All right, let me know how you did in the comments. I can't wait to hear. Thanks so much, and happy studying.
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