Let the infant lie on a firm surface. It is best to observe the infant wearing only a diaper, so if the room is warm enough and the caregivers have no objections, let them remove all other clothing. Some infants get upset when their clothes are removed, so it may be that you have to compromise on the clothing.
Observe the infant's posture and movement when:
- lying quietly but alert;
- presented with interesting objects to look at;
- moving actively.
Posture and movements of the head and and neck
By 2 months infants will usually have learned to maintain the head in the midline, especially when looking at an interesting event or object. They are also able to actively turn the head to look at an interesting object and will visually follow a toy that moves to the side, up and down. .
Neck rotation is associated with neck extension and lateral flexion.
To assess head control:
- First observe the infant lying undisturbed.
- Next present an interesting toy in the midline, above the head to encourage the infant to sustain the midline position.
- Lastly move the toy from the midline to one side and back to the midline, also up and down.
- Infant lies with the head in the midline most of the time.
- Infant lies with the head turned to the side, some of the time and alternates left and right turning.
- Infant easily follows a moving object in all directions. Following from one side to the other across the midline may still be difficult.
- Infant tends to maintain head in rotation. Midline position of the head not seen or maintained.
- Infant's head rotation is strongly associated with fencing posture of the UEs
Infant has difficulty following a moving object to the side, up or down.
Posture of the upper extremities during periods of relative quiet.
At 2-3 months the infant will usually lie with the shoulders in abduction with variable amounts of lateral rotation and elbow flexion (Bly 1994). The hands are often loosely flexed, but isolated movements are often seen.
- Shoulders are abducted with some degree of lateral rotation and elbows flexed or extended.
- Fingers are lightly flexed.
- Isolated extension movements of the fingers are observed.
- One or both shoulders are adducted with arm positioned close to the torso, elbow tends to be extended.
- Hand is a fisted.
- Thumb is adducted across the palm.
Trunk posture and stability
Observe trunk symmetry and lateral flexion (lateral pelvic tilt) as well as small range lateral oscillatory movements of the trunk (postural sway).
- Lateral displacement of the trunk is observed (postural sway)
- Trunk symmetrical some of the time - but lateral flexion is common, alternating between left and right.
- Trunk side flexion predominates - often to a particular side.
Lower extremity when not actively kicking
Observe position adopted by LEs when not actively kicking - with feet resting on the SS. During the 2-3 month period LE posture tends to be more extended with the feet resting on the SS, than during the newborn period. Periods of lying with hips and knees flexed and feet off the SS may also be see.
- At rest the hips and knees are both extended with feet resting on the SS.
- Alternatively the hip and knee of one LE may be flexed with the foot flat on the SS. In this position the foot may push down on the SS and associated forward rotation of the pelvis on the same side.
- The infant may also lie with full flexion of the hips and knees with the feet lifted up off the SS.
- Isolated flexion and extension of the toes is usually intermittently present.
Infants at this age when awake and alert will usually engage in bouts of kicking interspersed with periods of minimal LE activity.
A kicking action consists of flexion of the hip with associated hip abduction and lateral rotation and flexion of the knee. This is followed by extension of the hip and knee associated with abduction of the hip. Hip and knee movements are are still coupled at the age. The foot is held in DF with a small decrease in the range of DF when the LE is extended.
Kicking can be stimulated by raising the infant's level of arousal by talking to the infant or providing an interesting object for the infant to look at. A small bell attached to the ankles will also stimulate more LE activity.
Note the presence of the following kicking patterns:
- unilateral single leg kick,
- repeated kicking with one LE,
- reciprocal kicking actions involving both LEs,
- bilateral kicking with both LEs flexing and extending at more or less the same time. .
- hip extension is associated with a small range of hip abduction.
- Kicking movements are not fluent
- One leg is less active than the other
- Extension of the hips is associated with hip adduction.
Adaptations to support more active LE actions
If the infant does not engage in exploration of the SS with the feet, or in bouts of kicking, active exploration and kicking can be encouraged by providing enhanced feedback.
- Attach a small bell just above the ankles to encourage kicking.
- Let the infant lie on a support surface that makes a noise when the infant moves. A plastic carrier bag inserted into a pillow case and positioned under the infant provides an interesting but not too loud noise.
- Let the infant lie on a pillow. The compliant surface of the pillow provides some postural support for the infant.
For subscribers: Infant supine in a nest - video clip
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