Growth and Development

The Infant ( 1 month – 1 year )

Physical Growth
 Weight
› Doubles by 6 mos
› Triples by 1 yr
 Height
› Increases 50% during the first year
 Head circumference
› Increases rapidly during infancy owing to rapid brain growth (at 1 year,
the brain reaches 2/3 of the adult size)
› Important to measure head circumference for the first two years
 Body proportion
› Chest circumference is lesser by 2cm than the head circumference
› Abdomen remains protuberant until child learns to walk
› Lower extremities lengthen in preparation for walking
›
The Average Infant
• Triples weight by 1 yr
• Abdomen is protuberant
• Social smile at 2 mos
• Heart rate slows to 100-120 bpm by the end of 1st year
• Liver remains immature
• Legs appear short and bowed
• Respiratory rate slows to 20-30 bpm by the end of 1st year

Body Systems
 Cardiovascular system

› 100 – 120 bpm; BP 80/40 – 100/

› Prone to develop physiologic anemia at 2-3 mos

› Decreases serum iron levels at 6-9 mos

 Respiratory System

› 30 – 60 breaths per minute

› Prone to upper respiratory infections

 Gastrointestinal System

› Ability to digest protein is present at birth

› Unable to digest complex carbohydrates until 3mos

› Liver is still immature

› Until 3 – 4 months, extrusion reflex prevents infants from eating

effectively

› Drinking from a cup at 4 months with parental control of fluid flow

› Independently drinks from a cup at age 8 – 10 months old

 Immune System

› Functional immune system by at least 2 mos of age

 › Able to produce IgG and IgM antibodies by 1 year of age; inadequate
IgA, IgE, IgG

 Ability to adjust to cold is mature by 6 mos

 Kidneys are not yet mature

 Endocrine system: immature

 Extracellular fluid accounts for 35% of infant’s weight; 40% to intracellular

Developmental Milestones

Motor Development

Cephalo caudal – gross to fine

Gross Motor Development: large body movements
> Ventral Suspension
> Prone
> Sitting
> Standing
Fine Motor Development: measured by testing prehensile ability

Language Development

Emotional Development

Cognitive Development

DEVELOPMENTAL MILESTONES

1 MONTH

 Motor development
› Ventral Suspension: lifts head momentarily, then drops again
› Prone: lift their head and turns side to side
› Sitting: Complete head lag
› Standing: stepping reflex
› Fine Motor: Strong grasp reflex
 Language Development
› Cooing; Cry without tears
 Toy
› Mobile over the crib (musical) (black/white, brightly colored)
 Vision: Visual fixation on human face
 Hearing: infant quiets momentarily when hearing a distinctive sound
 Emotional Development: Smiles at parent

2 MONTHS

 Motor Development
› Ventral Suspension: hold their head in the same plane as the
rest of the body
› Prone: raises their head and maintain their position; head is
still facing downward
› Fine Motor: grasp reflex begins to fade thus infant drops
objects; hands held open
 Language Development
› Differentiates a cry
› Increase in cooing, gurgling and throaty signs
 Toy: Enjoys bright-colored mobiles, light small rattles
  Vision: Binocular vision
 Hearing: infants listen and stop activity
 Emotional Development: Social smile

3 MONTHS

 Motor Development
› Ventral Suspension: lifts and maintains the head well above
the plane of the rest of the body
 Development of the LANDAU REFLEX well until 6 months
› Standing: stepping reflex is fading thus infant begins to try to
support part of their weight
› Fine Motor: reaches for attractive objects but misses
 Language Development
› Squeals with delight appropriately. Discriminates smile.
 Toy: Small blocks/rattles
 Vision: Hand regard (Spends time looking at hands or uses them as
toys)
 Hearing: Turns head round to sound
 Cognitive Development: Primary circular reaction

4 MONTHS

 Motor Development

› Prone: lift the chest off the bed and

look around actively

 Neck righting reflex:

 Turns from back to side

› Sitting: No head lag when pulled to a

sitting position

› Standing: fading moro reflex and tonic neck reflex thus infants
sustain their weight actively on the legs

› Fine Motor: Thumb opposition develops: Scooping or raking

 Palmar and plantar reflex has faded

 Language Development

› Very “talkative” cooing, babbling and gurgling when spoken

too; laughs out loud

 Toy: playpen or sheet on the floor

 Vision: recognizes familiar objects

 Hearing: turns to sound and look in that direction

 Emotional Development: displeasure when a person leaves

5 MONTHS
  Motor Development
› Prone: child rests weight on forearms during prone
 Some can roll over completely
› Sitting: Can straighten his/her back when propped in a sitting
position
› Standing: Bears partial weight on feet
› Fine Motor: infant accepts an object handed to him/her
 Picks up an object without its being offered
 Plays with toes; Handles rattles well
 Language Development
› Say simple vowel sounds
› Enjoys vocal play
 Toy: objects that can be handled
 Hearing: locates sound downward and to the side
 Emotional Development: Displeasure when objects are taken away
from them

6 MONTHS

• Motor Development
• Ventral Suspension: infant demonstrates the PARACHUTE
REACTION well until 9 months
• Prone: rest their weight on their hands with extended arms;
raises their chest and upper part of the abdomen off the table
• Sitting: sits momentarily with support; sits with legs spread
apart and their arms stiffened between them as props
• Fine Motor: child can hold objects on both hands, drops one
toy if another one is offered; can hold spoon and start feeding
with much spilling
• Language Development
• Learn the art of imitating
• Toy: bath tub toys and teethers
• Vision: organized depth perception
• Hearing: Locates sound above them
• Emotional Development:
• May show 'stranger shyness‘
• Cognitive Development: Secondary Circular reaction

Teething

 Typical central incisors erupt at age 6 months

 Natal and neonatal teeth
 Gums are sore and tender before a tooth comes out
 Infants are slightly cranky, excess salivation
 High fever, seizures, vomiting, diarrhea, and earache are never
normal signs of teething
 More Signs and Symptoms
› Poor mood
› Loss of appetite
› Chewing of objects
› Bruises/swelling in gums
› Excess salivation
› Runny nose

7 MONTHS

 Motor Development
› Sitting: sits alone, but only with hands held forward for
balance
 › Standing: child bounces in enjoyment in standing position
› Fine motor: Can transfer toy from one hand to another
 Language Development
› Can imitate vowel sounds well
 Toys: transfer toys, bright balls
 Vision: pats their image in the mirror
 Emotional Development: Start of stranger anxiety; Reaches out in
anticipation of being picked up

8 MONTHS

 Motor Development
› Sitting: Sits securely without support
› Fine Motor: advanced eye hand coordination
 Toys: objects with texture
 Emotional Development:
› Has peaked fear for strangers
› Ability to tell known from unknown people
 Enjoys manipulation

9 MONTHS

 Motor Development
› Prone: child can creep parallel to the floor
› Sitting: infants sit steadily and regains balance by leaning
forward
› Standing: can stand holding on to a steady object when placed
in that position
 Language Development
› Says first word
 Toy: toys that go inside another, stacking toys
 Feeds self from a bottle – 9 mos
 Needs space for creeping

10 MONTHS

• Motor Development
• Standing: pulls themselves to standing position but cannot let
back down again
• Fine Motor: Development of PINCER GRASP
• Language Development
• Infant masters another word
• Toys: peek – boo, hand and cloth game
• Family feeling begins to grow with active involvement in
games
• Vision: Object Permanence
• Hearing: Recognizes names and listens acutely when spoken to
• Cognitive Development: Coordination of Secondary Schema

11 MONTHS

• Motor Development
• Standing: child begins to cruise
• let her know where you are going and that you will be back
• Be consistent
• Finger foods are a favorite with the 11 month old
INFANT NUTRITION

 BREAST MILK
› Best food for the infant during the first 12 months/2 years
› The only food necessary for the first 6 months
 30ml: capacity of a newborn’s stomach
 240ml: by 1 yr
 Normal full-term infants can thrive on an iron-fortified formula or
breast milk without the addition of solid food for the first 6 months

HIGHLIGHTS

 0-3
› Feeding only breast milk or formula for first year
› Always hold infant when feeding, do not prop bottle when
feeding
› Limit water intake to 0.5 oz to 1 oz at a time
› Avoid use of honey or corn syrup
› Allow non nutritive sucking
› 2 – 3: amylase present in saliva
› 3 months: biting movement is present
 4–6
› Introduce solid food without added salt or sugar, iron-fortified
cereal, one food at a time
› Avoid use of juice or sweetened drinks
› Feeding from spoon only
 7–9
› Introduce finger foods and cup when infant is able to sit up
› Have infant join family members at mealtime
› Allow self feeding
› Offer fluids after solids
› Introduce diluted juice in a cup
› Avoid sugary desserts and soda
› Chewing movement develops
 10 – 12
› Offer 3 meals and healthy snacks
› Begin weaning from the bottle and begin table foods
› Avoid fruit drinks and flavored milk
› Allow self feeding with spoon

Pre requisites in giving solid foods

 wanting to put things in his/her mouth
 able to suck small amounts of pureed food from a spoon
 interested in food eaten by others
 more frequent feeding
 can sit upright when supported with good control of the
head and neck

 Techniques for Feeding Solid Food

› Offer new foods one at a time (1 week interval)
 Helps detect possible food allergy
 Helps to establish a sense of trust
› Babies should be held in parent’s arms when introducing solid
food for the first time

Age Food to introduce Rationale

5–6 Iron fortified infant cereal Prevents iron-deficiency anemia, least allergenic,
mixed with breast milk, easily digested
orange juice or formula
7 Vegetables Source of Vitamin A, new texture and flavor to diet
8 Fruit Vitamin C, Vitamin A
9 Meat Protein, Iron and B complex
10 Egg yolk Iron

INFANT NUTRITION

 Introduce solids slowly. All babies are different and progress at

different paces.
 Start with single foods.
 Avoid nuts, whole peas, raw or undercooked pieces of fruit or
vegetables (such as apple and carrot) as they can cause choking in
babies.
 Always watch your baby when he/she is eating.

INSTITUTING SAFETY PREACAUTIONS

 Aspiration prevention
› Cylindrical objects are dangerous
› Do not prop bottles when feeding
› Clear small objects that could fit into an infant’s mouth
› Safety with siblings

 Fall prevention
› Don’t leave infants on an elevated surface unattended
› Side rails should be raised

 Safety with siblings

› Children under 5 years old are not responsible and

knowledgeable enough about infants

 Some preschoolers may be so jealous of a new baby that they may

physically harm the infant if left alone

 Childproofing

› Check for possible sources of lead (plastic/rubber toys, wall

paints, crib, etc)
› Infants are fascinated with holes
› Install safety gates on top and bottom of stairs
› Check bottom cupboards for safety
› Tables should be cleared of dangerous items
› Check play areas for small objects that could be swallowed

PARENTAL CONCERNS

 Fostering Achievement of Developmental task

› Trust VS Mistrust
  Colic

› Paroxysmal abdominal pain that generally occurs in infants

under 3 months of age

 Seborrhea

› Cradle cap: scaly cap condition that results from infant head
that is not washed frequently

 Miliaria

› Prickly heat rash that occurs most often in warm weather,

overdressed babies or those who sleep in overheated rooms.

SENSE OF TRUST

 Meeting of infant's needs appropriately

 Consistency of care with active interaction
› A synonym of trust is love
 Development is sequential; cyclical
› Trust arises primarily from a sense of confidence that one
knows what is coming next
› Learning family traditions that will help them feel secure in the
world as they will grow

BABY BOTTLE SYNDROME

 No formula, fruit juice, or liquid with sugar during night time

 do not put baby to bed with a bottle

 give plain water only

The Toddler ( 1 – 3 years)

• Respiration and heart rate slows

• Speaks in two-word sentences
• Start of toilet training
• Baby fat disappearing
• Chest circumference greater than the head at 2 years
• Prominent Abdomen
• Noticeable lordosis
• Wide-based gait
• 20 deciduous teeth at 2 ½ years

Body Systems

 Respirations slow slightly but remain abdominal

 HR slows, BP increases
 Less prone to lower respiratory infection
 Stomach capacity increases
 Less prone to gastrointestinal infections
 Bowel and bladder control are possible
 IgG and IgM antibody production is mature; passive natural
immunity effects are no longer effective
DEVELOPMENTAL MILESTONES

15 MONTHS

 Motor Development
› Puts small pellets to small bottles
› Scribbles voluntarily with a pencil/crayon
› Holds a spoon well but may turn it upside down on the way to
the mouth
› Walks alone, creep upstairs, sit in a chair
 Play
› Stacks 2 block, enjoys being read to, drops toys

18 MONTHS

 No longer rotates the spoon to bring it to the mouth

 Drinks from a cup
 Can run and jump in place
 Can walk up and down the stairs holding a person or a railing
› Places both feet on one step before advancing
 Enjoys pull toys; toys should be strong enough
 Imitates household chores

24 MONTHS

 Can open doors by turning doorknobs

 Walks up the stairs alone
› Uses both feet at same step at same time
 Parallel play evident

30 MONTHS

 Makes simple lines

 Drinks from a straw
 Can jump down from chairs
 Imitates parent’s actions
 Play is active

LANGUAGE DEVELOPMENT

 Toddlerhood is a critical time for language development

 NO is a word frequently used by toddlers
› A manifestation of their developing autonomy
› To refuse or does not understand the task
 Exposure to conversation and reading
 Pronouns are difficult for this age
 Learn to speak language from imitating what they hear
PARALLEL PLAY
 play side by side or back to back
 paying little or no attention to each other
 Toys that require action
 like being together, and they may occasionally enjoy watching each
other play, but, mostly, each is interested in what he is doing
 they don't understand sharing
 haven't learned it's not right to hit and shove and bite other people

PARENTAL CONCERNS

 Toilet Training
Prerequisites:
› Sphincter control
› Understands the need and act of elimination
› Desire for socially accepted action
› Can walk
› Ritualistic Behavior
› Negativism
› “No” to every question
› The more parents try to make toddlers obey them, the more
they resist
› Make statements instead of questions
› Offer choices
› Discipline
› Discipline: setting of rules
› Punishment: consequence of breaking rules
› General rules
› Be consistent
› Praise correct behavior than punish the wrong
› Separation Anxiety

› From 6 months to preschool years

 › Prolonged goodbyes lead to more crying
› Sneaking out should be discouraged; fear of abandonment
› Protest, despair, denial
› Temper Tantrums

› Best approach: verbalize the disapproval of the tantrum and

then ignore

› Sibling Rivalry

› Jealousy of younger siblings

› Occurs during the preschool years but may also occur during
toddlerhood

› Accidental ingestions

› Aspirations

› Falls

› Burns

› Motor vehicle accident

› Playground injuries

The Preschooler ( 3 – 5 years )

• No new teeth develop

• Body contour becomes more childlike
• Palpable bladder
• Genus valgus (knock-knees)
• Vocabulary increases markedly
• Increased muscle coordination
• Childs ability to learn extended languages
• Localized illnesses with increase in size of lymphatic tissue
• AP and transverse diameters of the chest reach adult proportions

DEVELOPMENTAL MILESTONES

3 YEAR OLD

 Undresses self
 Stacks tower of blocks
 Draws a cross
 Runs
 Alternates feet on stairs
 Rides tricycle
 Stands in one foot
 Vocabulary of 900 words; egocentric
 Able to take turns and are very imaginative

COOPERATIVE PLAY - Preschoolers are capable of sharing

4 year old
  Do simple buttons

 Constantly in motion

 Jumps and skips

 Pretending is major activity

5 year old

 Draws a six part man

 Ties shoe laces

 Throws overhand

 Likes games with numbers or letters

Emotional Development

 Developmental Task: Initiative VS Guilt

 Imitation

 Fantasy

 Oedipus and Electra Complexes

 Gender Roles

 Socialization

Moral and Spiritual Development

 Determines right from wrong based on self interest

 Elemental concept of God if provided with some religious training

Parental Concerns

 Health problems
  Common fears
› Imagination is so active
› Fear of the dark, mutilation, and separation and abandonment
 Behavior variations
› Telling tall tales
› Imaginary friends
› Difficulty sharing
› Regression
› Sibling rivalry
 Sex education
› Aware of the difference between a boy and a girl
› Begin to ask where babies come from
 Preparing for school
 Broken fluency and swearing

The School Age Child

Physical Growth

 Period of rapid cognitive and developmental growth

 Physical growth slows down
 Begin to make truly independent judgments
 More influenced by the attitudes of their peers
 Brain growth is complete by 10 years
 Fine motor coordination becomes refined
 IgG and IgA reach adult levels
 Sexual Maturations and Concerns

Age Boys Girls

9 – 11 Pre pubertal Weight Gain Breast Bud Formation

11 – 12 Hair at the base of the Hair at the labia

penis Vaginal epithelium cornified
Scrotum becomes
textured
Growth of penis and
testes
Sebaceous gland
secretion
Perspiration Increases
12 – 13 Pubic hair present across Darkening of pubic hair
pubis Spreads over entire pubis
Dramatic linear growth Breasts enlarge no protrusion of nipples
spurt Axillary hair present
Breast enlargement Menarche occurs
occurs

The Average School-Age Child

• Refined fine motor coordination

• Maturation of respiratory system
• Annual increase in height: 1-2 in
• Left vetricle enlarges; HR slows downn
• Posture becomes more erect

DEVELOPMENTAL MILESTONES

6 YEAR OLD

 Constant motion
 Skipping
 First molars erupt
 Authority figure: first grade teacher
 Defines words by their use
 Rough and tumble

7 YEAR OLD

 Difference between sexes becomes apparent in play

 The eraser Year
 Conservation is learned
 Can tell time
 Interest in collecting items

8 YEAR OLD

 Coordination improved
 Fully developed eyes
 Best friends develop
  Can write and print
 Understands concepts of past present and future
 Likes table games but hates losing

9 year old

 The gang age

 Rough play; not interested in perfection
 Discovery of dirty jokes, swear words

10 year old

 Ready for camp away from home

 Collecting age
 Likes rules and fairness
 Ready for competitive games
 Hand held or remote control games
 Interest of the opposite sex is apparent

11 year old

 Active, but awkward and ungainly

 Insecure with the opposite sex
 Repeats off color jokes

12 year old

 Enjoys dancing to pop music, table games

 Likes to do jobs for money
 Sense of humor is apparent

Cognitive Development

 Transitional Stage for Concrete operational thoughts

› Decentering
› Accommodation
› Conservation
› Class inclusion

Moral and Spiritual Development

 conventional Reasoning
 Concentrates on niceness and fairness
 Learns about rituals and meanings behind religious practices
 Expects their God to follow rules also

- Learns to ride a bicycle by 7 yo

- Energy is focused in school activities

- Competitive Play

The Adolescent ( 13 – 18 years old )

DEVELOPMENTAL MILESTONES

Physical Changes: Girls

• Gross motor skills (strength, endurance, and speed), improve slowly

but steadily

• Breast growth completed around 16 years of age

• Adult height reached by 15-16 years old

• Fat deposits increase in hips, breasts, legs and arms

• Muscle development in girls is much less than that of boys

• Sleep time generally declines because adolescents stay up much

later

Physical Changes: Boys

• A dramatic spurt in strength, speed, and endurance

• Develop large skeletal muscles

• Heart and lungs enlarge dramatically

• An increase in the number of red blood cells which carry oxygen

from the lungs to the muscles-this does not occur in girls

• Voice change occurs during the middle of puberty

• Around 17-18 years of age physical changes are complete

Body Image

• Boys who mature earlier than their peers tend to have a positive
self-image. To friends, relatives, and teachers they appear stronger
and more mature than late maturing boys. They may be chosen for
leadership roles and many excel athletically.

• Early maturing girls are oftentimes very self-conscious about their

bodies and tend to engage in more adult behaviors like drinking
alcohol and sexual activity.

• Girls who mature later tend to do better in school, are more

sociable, and considered physically attractive by their peers.

Mental Abilities

• Both males and females show an increase in the capacity for

abstract thinking. This results in both sexes becoming more
argumentative, idealistic, and critical.

• Girls tend to have a slight advantage in verbal skills while boys do

better with mathematical reasoning.

Self-Consciousness and Self Focusing

 • Imaginary Audience

• Personal fABLE

• false sense of invulnerability

• Risk-taking behaviors

• teens sometimes become overwhelmed

• Difficulty making decisions

Emotional and Social Development

• The major personality achievement of adolescence is the formation

of an individual identity.

• Adolescents explore and test ideas, values, morals, and religious

and political beliefs.

• Day dreams about the future

• Adolescents who feel attached to their parents but also free to

explore, develop and voice their own opinions, show greater
emotional stability and higher self-esteem.

Emotional and Social Development

• Friendships are extremely important

• Peers influence Short term goals

• Parents influence the long term

• The negative impact of having anti-social, drug-using friends is

strongest for teenagers whose parents are either extremely lax and
disinterested or very controlling and harsh.

Sig. Person Fears Play Age Appro. Death and

Toys Dying

Infancy Mother Stranger Solitary Hanging crib No concept at

mobiles all

Toddler Parents Separation Parallel Push-pull Temporary

anxiety toys /reversible
Building
blocks

Pre- Parents Dark Associative Any toy used Temporary

school and in school act. /reversible
Ghost
siblings
Castration

School Teacher Body Competitive Board gamesPermanent

age mutilation
Irreversible
Unknown
 death

Adoles. Peers Body image, Recreational Picnic, sports Universal

acne