4 Months: Recognizing Early Motor Delays

A Comparison Examination of 4 Month Old Infants

Typical Atypical

Exhibits midline and Displays asymmetry of head

symmetry of head, eyes, and extremities, with head
arms and legs tilted and body curved
Shows visual engagement Does not show a balance
Supine

and reaches out against between extension and flexion

gravity Moves extremities randomly,
Demonstrates frequent but without expected
antigravity extremity antigravity movement
movement, dissociating Is not visually engaged and
from a more stable trunk does not track object

Uses upper arm and

dissociated lower extremities Exhibits sluggishness in top
Sidelying

to assist in facilitated roll arm during facilitated roll

Sustains sidelying posture Does not sustain sidelying
with a balance of trunk flexor posture; has inadequate
and extensor muscles control in position
Lifts head and upper trunk off Cannot lift head and upper
the surface in preparation for trunk off support surface
independent rolling

Brings shoulders and upper Has flexed hips which

arms forward with elbows in shifts weight forward while
front of shoulders keeping elbows behind
Prone

Shows progression toward shoulders

lower extremity extension Uses only neck extension
and adduction instead of forearm weight
Moves arms forward to reach bearing; head lifting is
for an object; turns head unsustained
freely to follow object Does not have the capability
Displays extensor activity into to shift weight onto lower
the lumbar spine extremities

Maintains head in midline

without head-lag and with Demonstrates head-lag and
Pull To Sit

good chin tuck cannot sustain head lifting

Lifts legs and activates once upright
trunk muscles to assist in Does not pull with arms;
maneuver no upper extremity
Pulls forward with both participation
arms and abdominals to Appears not to anticipate
assist further in pull to sit movement toward sitting

COPY FREELY, DO NOT CHANGE, MUST ACKNOWLEDGE PATHWAYS.ORG

Pathways.org is a 501(c)(3) not-for-profit organization. Permission to cite any part of this work must be obtained from Pathways.org.
Materials are provided at no cost; no fees or charges may be associated with any of the Pathways.org materials without prior written approval.
www.Pathways.org Facebook.com/PathwaysDotOrg (800)955-CHILD (2445)
 4 Months: Recognizing Early Motor Delays
A Comparison Examination of 4 Month Old Infants

Typical Atypical
Shows good head control
and chin tuck, with head in
Does not sustain head lifting;
midline
cannot turn head to look side-
Requires support only
Sitting

to-side
at hips and pelvis; has
Must be held high under the
extension to mid-thoracic
armpits for support
spine
Uses extremity posturing to
Begins to move in anterior-
compensate for decreased
posterior planes and comes
proximal strength
back from forward flexion at
the hips into upright sitting
Horizontal Suspension

Able to keep neck and trunk Able to hold head up briefly

extended with head upright but cannot maintain it in
to 45 degrees, steady and in midline
midline Cannot sustain thoracic
Shows trunk extension into trunk extension and does
lumbar spine and scapular not show hip extension
adduction Cannot maintain trunk
Freely moves arms and legs extension while moving
arms and legs
Protective Extension

Displays extension through Unable to sustain strong

neck, trunk and hips that is neck, trunk and hip
maintained during forward extension during forward
tilting tilting
Cannot bring arms fully Uses excessive asymmetry
forward to surface because and flexed arms to sustain
they are being used to sustain extension to avoid hitting
extension his head

Keeps hips just behind Requires support in the

shoulders upper thoracic area to
Has active extension into sustain standing
Standing

lower thoracic and lumbar Intermittent extension used

spine, but no full hip to produce head lifting
extension Shoulders remain well
Can sustain standing forward of hips
posture; requires minimal Lacks adequate hip and
support at lower trunk to trunk control for sustained
aid in balance weight bearing

COPY FREELY, DO NOT CHANGE, MUST ACKNOWLEDGE PATHWAYS.ORG

Pathways.org is a 501(c)(3) not-for-profit organization. Permission to cite any part of this work must be obtained from Pathways.org.
Materials are provided at no cost; no fees or charges may be associated with any of the Pathways.org materials without prior written approval.
www.Pathways.org Facebook.com/PathwaysDotOrg (800)955-CHILD (2445)