Supine development: Will at 6 days

General characteristics of newborn supine posture and movement

Alternating periods of quiet and activity 
When awake and alert a newborn infant's behavior alternates between periods of lying quietly and periods of active trunk and  limb movements. 

Quiet periods are often associated with visual attention to the infant's own hand or other interesting visual stimuli in the environment. 

Head posture and movements
Generally the newborn's head is rotated to one side, often with a preference for a particular side. Neck rotation is associated with neck extension. 

This tendency to rest with the head rotated to one side is in part influenced by the round shape of the head and weakness in the neck muscles (Bly 1994)

Infants often have a preferred side, usually to the right (Ronquist et al 1998). The reason for this tendency is unclear. 

 W 7d LE actions 3.jpg   W 7d LE actions 7.jpg

The infant is able to turn the head to the midline, and can sustain the position briefly, especially when supported by visual attention.  Over the next few weeks the infant will develop the the bilateral antigravity neck muscle strength and control needed to counteract the force of gravity (which creates a turning moment acting on the COG of the head)  and maintain the head in midline for longer periods of time.

The head is held in the mid-position for brief periods of time when the infant is actively moving the limbs or is distressed (Cornwell et al 1985). This is possibly due to increased activity in the neck and trunk muscles associated with the kicking actions. 

Will 7d head in midline.jpg

In neonates with typical limb stiffness (muscle tone), head turning may initiate partial rolling to the side.  This response may be due to the neonatal neck righting reflex (Bly) but may also be because turning of the neck shifts the infants weight (COP) laterally which destabilizes the trunk and the infant "'topples"  over to side lying. 

W 7d LE roll to left 3.jpg   W 7d LE roll to left 4.jpg

Visual attention 
From the first weeks infants pay attention to interesting objects that come into their field of vision.  Visual attention is usually associated with cessation of limb movements.  

If the hand is moved into the infant's field of vision, it will preferentially engage the infant's visual attention (van der Meer 1997). 

W 7d supine notices hand 1.jpg

Limb and whole body movements: General Movements 
Extensive research has described the characteristics of the spontaneous movements seen in infants from term to about 6-9 months. These movements, referred to as writhing general movements, are characterized by small to moderate amplitude and slow to moderate speed. They may last from a few seconds to several minutes or longer.

What is particular about them is the variable sequence of arm, leg, neck, and trunk movements. They wax and wane in intensity, force, and speed, and they have a gradual beginning and end. Rotations along the axis of the limbs and slight changes in the direction of movement make them appear fluent and elegant and create the impression of complexity and variability (Einspieler et al 2008).

LE ROM and kicking actions 
The ROM of the hips and knees is limited by muscle tightness and increased tone (stiffness) in the LE flexor muscles that results from the flexed posture in the restricted space of the uterus in the last weeks of intrauterine life.  This restriction is referred to as neonatal hip flexion contracture. 

The hips are flexed, abducted and laterally rotated and the infant lies with the feet lifted up off the supporting surface (SS).

W 7d supine UE movements 5.jpg   W 7d LE actions 3.jpg

The knees cannot be fully extended and when passively extended they recoil back to a more flexed postilion. 

Newborn kicking actions are characterized by a decrease in the range of hip flexion, along with some extension of the knee. The ankle remains in dorsiflexion with the toes in flexion. 

W 7d LE actions 6.jpg    W 7d supine UE movements 1.jpg  

During periods of relative quiet the amount of hip flexion decreases, but the feet still do not rest on the supporting surface. 

W 7d LE actions 7.jpg   W 7d supine UE postures.jpg

UE posture and movements 
Bly (1994) states that when the newborn infant is lying quietly, the upper arms rest on the supporting surface close to the body, with the shoulders in slight external rotation, the elbows in flexion and the forearms in pronation with the hands slightly open. 

W 7d supine UE movements 1.jpg  W 7d LE actions 3.jpg

Movements of the UEs often brings the hand into the infant's visual field and a period of quiet may ensue as the infant pays attention to the hand. 

Spontaneous movement of the UEs also brings the infant's hands into contact with the face. This is a familiar experience for the infant as hand-to-mouth is a common intrauterine movement pattern. 

W 7d supine UE movements 5.jpg   W 7d LE roll to left 2.jpg   

Large range movements of the shoulder and elbows are also seen, with opening of the fingers when the elbow is extended and flexion of the fingers seen with elbow flexion (von Hofsten 1990).

W 7d supine UE movements 4.jpg    

Strong finger flexion occurs when the hand is stimulated especially on the ulnar side – known as the palmer grasp response. When traction is applied to the arm, the fingers flex synergistically with the elbow and shoulder.

newborn pts2.jpeg       Newborn pts.jpeg

Rolling to the side 
You also see Will rolling onto the left side and remaining in this position for an extended period of tome.

The rolling action is preceded by head turning and at the same time bringing both hands forwards towards the face. This shifts the weight (COP) laterally to the left and "tips" Will onto his side. 

W 7d LE roll to left 1.jpg   W 7d LE roll to left 2.jpg   W 7d LE roll to left 3.jpg   W 7d LE roll to left 4.jpg

How supine promotes development 
Opportunities to lie in supine on a firm flat surface provide very young infants with their first experience of linking sensory input to motor actions as a first step towards voluntary goal directed actions seen just a few weeks later. 

In this way the spontaneous movements seen in the newborn create the substrate for development of differentiated limb actions, linking visual regard and UE actions, and stimulate postural stabilization of the head and trunk to support voluntary limb movements. 


Video: Will at 6 days 

Suggestions for watching the video

In this video you see Will constantly on the move,with arms upper and lower extremities moving at the same time. I find it helps to watch one aspect of his movement at a time, play it through observing his UE movements, then another time observing the LE movements, and a third time getting a more general impression. 




Useful resources 

New born exam: University of Utah    https://library.med.utah.edu/pedineurologicexam/html/newborn_n.html

References and bibliography

Bentzley, J. P., Coker-Bolt, P., Moreau, N., Hope, K., Ramakrishnan, V., Brown, T., … Jenkins, D. (2015). Kinematic Measurement of 12-week Head Control Correlates with 12-month Neurodevelopment in Preterm Infants. Early Human Development, 91(2), 159–164. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324091/#R28

Bly L. (1994) Motor Skills Acquisition in the First Year.  

Cornwell, K. S., Fitzgerald, H. E., & Harris, L. J. (1985). On the state‐dependent nature of infant head orientation. Infant Mental Health Journal, 6(3), 137-144.

Duncan K, Goodworth A, Da Costa CSN, Wininger M, Saavedra S. Parent handling of typical infants varies segmentally across development of postural control. Exp Brain Res. 2017 Dec 28. doi: 10.1007/s00221-017-5156-4. [Epub ahead of print] PubMed PMID: 29285555.

Dusing, S. C., Thacker, L. R., Stergiou, N., & Galloway, J. C. (2013). Early Complexity Supports Development of Motor Behaviors in the First Months of Life. Developmental Psychobiology, 55(4), 404–414. http://doi.org/10.1002/dev.21045

Dunsirn S, Smyser C, Liao S, Inder T, Pineda R. Defining the nature and implications of head turn preference in the preterm infant. Early Hum Dev. 2016 May;96:53-60. doi: 10.1016/j.earlhumdev.2016.02.002.

Einspieler, C., Marschik, P. B., & Prechtl, H. F. R. (2008). Human Motor Behavior Prenatal Origin and Early Postnatal Development. Journal of Psychology, 216(3), 148–154. doi:10.1027/0044-3409.216.3.148

Lee HM, Galloway JC. Early intensive postural and movement training advances head control in very young infants. Phys Ther. 2012 Jul;92(7):935-47.

Lima-Alvarez CD, Tudella E, van der Kamp J, Savelsbergh GJ. Effects of postural manipulations on head movements from birth to 4 months of age. J Mot Behav. 2013;45(3):195-203.

Lima-Alvarez CD, Tudella E, van der Kamp J, Savelsbergh GJ. Early development of head movements between birth and 4 months of age: a longitudinal study. J Mot Behav. 2014;46(6):415-22. 

Reddy, V., Markova, G., & Wallot, S. (2013). Anticipatory Adjustments to Being Picked Up in Infancy. PLoS ONE, 8(6), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3688725/

Rönnqvist L, Hopkins B. Head position preference in the human newborn: a new look. Child Dev. 1998 Feb;69(1):13-23. PubMed PMID: 9499553.

Head position preference was studied in 20 awake newborns who differed in terms of delivery and sex. They were placed supine on a custom-built platform to reduce the effects of gravity and asymmetries in trunk posture and skull shape. A global and a specific scoring method were used, the infants being in State 3 (quiet wakefulness) or 4 (active wakefulness, excluding crying). Delivery and sex did not account for differences in head position. The head turned more often to the right and was maintained longer in this position during State 3, regardless of scoring method. The maintenance of the head in midline was comparable in duration to that reported for infants at 2-3 months when using the global scoring method. This suggests that the neural mechanisms responsible for attaining and maintaining a midline position are present at birth, but are not functionally expressed due to a lack of adequate power in the antigravity muscles of the neck.

Van der Meer, a L. (1997). Keeping the arm in the limelight: advanced visual control of arm movements in neonates. European Journal of Paediatric Neurology : EJPN : Official Journal of the European Paediatric Neurology Society, 1(4), 103–8. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10728203

Ververs IA, de Vries JI, van Geijn HP, Hopkins B. Prenatal head position from 12-38 weeks. I. Developmental aspects. Early Hum Dev. 1994 Oct 28;39(2):83-91. PubMed PMID: 7875103.

Fetal head position relative to the fetal body was studied longitudinally in 10 uncomplicated pregnancies by means of real-time ultrasound. Registrations were made at 4 weekly intervals from 12 to 36 weeks, and at 38 weeks. The percentage of assessments with optimal visualization of head position for analysis increased with age. The development of head position involved a change from a midline to a lateralized preference. It was only at 38 weeks that a clear lateralized head position was found with the head being held mainly to the right. The degree of intra- and inter-individual variability was considerable, a finding typical of motor behaviour in the healthy fetus. It is hypothesized that this bias is due to neural maturation. The implications of our findings for the subsequent development of hand preferenceare discussed.

von Hofsten C, Rönnqvist L. The structuring of neonatal arm movements. Child Dev. 1993 Aug;64(4):1046-57.  PDF


Return to:
Development in Supine

Newborn to 3 months