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THREE- TO FOUR- MONTH TYPICAL DEVELOPMENT CHECKLIST (┬ęDiane Bahr) Place a check mark next to the characteristics you see in your three- to four-month-old baby

 
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Typical 3- to 4- Month-Old Baby

YES   NO  
MOUTH/FEEDING DEVELOPMENT        
Anterior tongue & Babkin reflexes seem to fade (3-4 months)        
Locates the breast nipple frequently without rooting reflex (3-6 months)        
Controls gag reflex during mouthing & feeding experiences (4-6 months)        
Has closed mouth & easy nose breathing during sleep & when mouth is inactive/empty        
Rests tongue in the roof of the closed mouth to help maintain the broad palate shape        
Is free of tethered oral tissues (tongue, lip, and/or cheek tie)        
Has good suck-swallow-breathe coordination (3-4 months)        
Sequences 20 or more sucks without a pause (different in breastfeeding than bottle feeding)        
May cough or choke occasionally (3-4 months)        
Recognizes the bottle (3- 4 months)        
Pats bottle or breast with hand(s) at 3 to 4 months        
Takes sips from an open cup held by the parent or care provider (4-6 months)        
Uses increased lip control & movement (4-6 months)        
Begins using jaw, lip, cheek, & tongue muscles independently        
Brings an appropriate object to mouth around 4 months        

BODY DEVELOPMENT (Typical 3- to 4- Month-Old Baby)
       

When on the Stomach (Typical 3-Month-Old)
       
Rests arms symmetrically around the head        
Lifts the head in the middle (midline) at 45- to 90- degree angles without bobbing        
Shifts body weight from side-to-side as head moves to left or right & may roll to the side        
Visually tracks an object horizontally across 180 degrees while looking upward        
Props & bears weight on forearms with elbows in line with or in front of the shoulders (crucial for shoulder development)        
Lifts the chest & lowers the hips        
May make finger scratching movements or swimming motion with body & legs when seeing a toy        
Lowers head & shoulders when raising the hips (weight is shifted forward & minimal kicking occurs)        

When on the Stomach (Typical 4-Month-Old)
       
The flexion/bending part of the tonic labyrinthine reflex seems to disappear (become integrated by the brain)        
Controls head/neck, spine, hips, & shoulders to lift head 90-degrees, lift chest, arch lower back, & place weight on the forearms        
Has front-to-back body movement, & pivots extended/stretched body to place weight on forearms        
Maintains propped/lifted body position when head/neck are bent downward (flexed) contributing to abdominal muscle & rib cage development, as well as hip stability        
Rolls from stomach to side with weight shift        
Has increasing eye muscle control related to head control; visual attention leads head & eye movements        
Alternates between extending & bending legs to develop hip, leg, knee, & ankle muscles        

When Lying on Each Side of the Body (Typical 4-Month-Old)
       
The flexion/bending part of the tonic labyrinthine reflex seems to disappear (become integrated by the brain) around 4 months        
Demonstrates a good balance of bending & extending body when lying on each side (significant developmental milestone)        
Develops rib cage shaping/contouring by bearing/supporting body weight against gravity along with the pull/action of the oblique abdominal muscles        
Develops side bending with new head positions        

When on the Back (Typical 3-Month-Old)
       
Moro/Startle reflex begins to disappear (become integrated by the brain) between 3 & 6 months        
Has head close to or in midline (middle of body), & begins to tuck chin toward chest & look downward        
Rotates head from side-to-side while lengthening back of neck; may turn body onto side        
Looks at a toy in midline/middle with increasing attention, & may swipe at it        
Visually follows a toy/face horizontally from side-to-side        
Typically has hands open with wrists & fingers spread        
Shows increase in hands & eyes working together (eye-hand coordination)        
Demonstrates increase in moving just enough for an activity (grading) & moving one body part separate from another (dissociation)        
Brings hands to the body in an increasingly coordinated manner, & begins to gain control over palmer grasp reflex        
Uses hands with increasing intention to explore own mouth, body, clothing, & care-providers (body awareness/touch experiences)        
Often has feet together for body awareness/touch experience (frog-legged position)        
Stretches hip, leg, knee, & ankle muscles when moving legs        

When on the Back (Typical 4-Month-Old)
       
Moro/Startle reflex seems to disappear (become integrated by the brain) between 3 & 6 months        
The flexion/bending part of the tonic labyrinthine reflex seems to disappear (become integrated by the brain) around 4 months        
The asymmetric tonic neck reflex seems to disappear (become integrated by the brain) between 4 & 6 months        
Moves trunk/core as a unit in slight bending & extending/stretching related to abdominal & hip movements (lowers spine & lifts hips)        
Maintains head in midline/middle with tucked chin & elongated neck; neck & shoulder stability needed for tongue & jaw development/movement        
Looks downward when lowers chin        
Moves head toward side of sound and/or visual stimulation        
Body follows head movement to roll body to the side        
Moves arms vigorously (1 to 2 months)        
Follows & fixes eyes on objects without head movement        
Moves arms & legs actively, symmetrically, & in synchrony        
Brings hands to middle of body & other body parts developing body awareness, hand use, & beginning eye-hand coordination for reaching & grasping        
Reaches toward toys, & holds lightweight toys placed in hands        
Bang, shakes, & brings appropriate toys to mouth with hands        
Mouths appropriate toys discriminating shape, size, & texture (typifies/assists mouth & tongue sensation/awareness used in future feeding, eating, drinking, and speech)        
Kicks legs with increasing coordination stretching hip, leg, knee, ankle, & toe muscles        
Shifts weight to side when foot placed on opposite knee, & can roll to side with flexion/bending        
Foot-on-foot play & pushing with the feet increases body awareness        
 

Primary References



•Bahr, D. (2018). Feed your baby and toddler right: Early eating and drinking skills encourage the best development. Arlington, TX: Future Horizons.
•Bahr, D. C., & Hillis, A. E. (2001). Neurological and anatomical bases. In D. C. Bahr Oral motor assessment and treatment: Ages and stages (pp. 1-41). USA: Pearson College Division.
•Bly, L. (1994). Motor skills acquisition in the first year: An illustrated guide to normal development. USA: Psychological Corp.
•Feldenkrais, M. (1972). Awareness through movement (Vol. 1977). New York: Harper and Row.
•Morris, S. E., & Klein, M. D. (2000). Pre-Feeding skills: A comprehensive resource for mealtime development. (2nd ed.) . San Antonio, TX: Therapy Skill Builders.
•Neuro Restart (2019). Primitive reflexes. Retrieved from http://www.neurorestart.co.uk/primitive-reflexes/
•Vulpe, S. G. (1994). Vulpe assessment battery-revised: Developmental assessment, performance analysis, individualized programming for the atypical child. East Aurora, NY: Slosson Educational Publications.