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 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 circumference › Abdomen remains protuberant until child learns to walk › Lower extremities lengthen in preparation for walking
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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 1 st year Liver remains immature Legs appear short and bowed Respiratory rate slows to 20-30 bpm by the end of 1 st year • • • • • • •
Body Systems Cardiovascular Cardiovascular system
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100 – 120 bpm; BP 80/40 – 100/
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Prone to develop physiologic anemia at 2-3 mos
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Decreases serum iron levels at 6-9 mos
Respiratory Respiratory System ›
30 – 60 breaths per minute
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Prone to upper respiratory infections
Gastrointestinal Gastrointestinal System ›
Ability to digest protein is present at birth
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Unable to digest complex carbohydrates carbohydrates until 3mos
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Liver is still immature
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Until 3 – 4 months, extrusion reflex prevents infants from eating effectively
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Drinking from a cup at 4 months with parental control of fluid flow
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Independently drinks from a cup at age 8 – 10 months old
Immune System ›
Functional immune system by at least 2 mos of age
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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 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 Differentiates a cry › Increase in cooing, gurgling and throaty signs Toy: Enjoys bright-colored bright-colored mobiles, mobiles, light light small rattles 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 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. appropriately. Discriminates smile. Toy: Small blocks/rattles blocks/rattles Vision: Hand regard (Spends time looking at hands or uses them as toys) Hearing: Turns head round to sound Cognitive Development: Development: Primary circular reaction
4 MONTHS
Motor Development ›
Prone: lift the chest off the bed and look around actively
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Neck righting reflex:
Turns from back to side
Sitting: No head lag when pulled to a sitting position
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Standing: fading moro reflex and tonic neck reflex thus infants sustain their weight actively on the legs
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Fine Motor: Thumb opposition develops: Scooping or raking
Palmar and plantar reflex has faded
Language Development ›
Very “talkative” “talkativ e” 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 demonstrates the PARACHUTE REACTION well until 9 months Prone: rest their weight on their hands with extended arms; raises their chest chest and upper part part of the abdomen 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: Development: May show 'stranger shyness‘ Cognitive Development: Development: Secondary Secondary Circular reaction •
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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 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: 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: 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: Development: Coordination of Secondary Schema •
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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 •
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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 › ›
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4–6 ›
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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 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 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 surface unattended › Side rails should be raised Safety with siblings ›
Children under 5 years old are not responsible and knowledgeable 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 ›
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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 ›
Seborrhea ›
Paroxysmal abdominal pain that generally occurs in infants under 3 months of age
Cradle cap: scaly cap condition that results from infant head that is not washed frequently 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 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 pencil/crayon › Holds a spoon well but may turn it upside down on the way to the mouth › Walks alone, creep upstairs, 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 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
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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 ›
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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
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Accidental ingestions
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Aspirations
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Falls
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Burns
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Motor vehicle accident
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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 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 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 Developmental Task: Initiative VS Guilt
Imitation
Fantasy
Oedipus and Electra Complexes
Gender Roles
Socialization
Moral and Spiritual Development Development
Determines right from wrong based on self interest
Elemental concept 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 Brea st Bud Formation
11 – 12 Hair at the base base of the penis Scrotum becomes textured Growth of penis and testes Sebaceous gland secretion Perspiration Increases
Hair at the labia Vaginal epithelium cornified
12 – 13 Pubic hair present across pubis Dramatic linear growth spurt Breast enlargement occurs
Darkening of pubic hair Spreads over entire pubis Breasts enlarge no protrusion of nipples Axillary hair present Menarche 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 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
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Breast growth completed around 16 years of age
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Adult height reached by 15-16 years old
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Fat deposits increase in hips, breasts, legs and arms
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Muscle development in girls is much less than that of boys
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Sleep time generally declines because adolescents stay up much later
Physical Changes: Boys •
A dramatic spurt in strength, speed, and endurance
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Develop large skeletal muscles
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Heart and lungs enlarge dramatically
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An increase in the number of red blood cells which carry oxygen from the lungs to the muscles-this does not occur in girls
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Voice change occurs during the middle of puberty
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Around 17-18 years of age physical changes are complete
Body Image •
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Boys who mature earlier than their peers tend to have a positive self-image. 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 •
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Both males and females show an increase in the capacity for abstract thinking. This results in both sexes becoming more argumentative, argumentative, idealistic, 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
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Imaginary Audience
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Personal fABLE
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false sense of invulnerability
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Risk-taking behaviors
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teens sometimes become overwhelmed
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Difficulty making decisions
Emotional and Social Development •
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The major personality achievement of adolescence is the formation of an individual identity. Adolescents Adolescents explore and test ideas, values, morals, and religious and political beliefs. Day dreams about the future Adolescents 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. self-esteem.
Emotional and Social Development •
Friendships are extremely important
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Peers influence Short term goals
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Parents influence the long term
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The negative impact of having anti-social, drug-using friends is strongest for teenagers whose parents are either extremely lax and disinterested disinterested or very controlling and harsh. Sig. Person
Fears
Play
Age Appro. Toys
Death and Dying
Infancy
Mother
Stranger
Solitary
Hanging crib No concept at mobiles all
Toddler
Parents
Separation anxiety
Parallel
Push-pull toys
Temporary /reversible
Building blocks Preschool
Parents and siblings
Dark
Associative
Any toy used Temporary in school act. /reversible
Comp Compet etit itiv ive e
Boar Board d game gamesPe sPerrmane manent nt
Ghost Castration
School age
Teacher
Body mutilation Unknown
Irreversible
death Adole doles. s.
Peers eers
Body Body imag image, e, Recr ecreatio eationa nall acne
Picn Picnic ic,, spor sportsUn tsUniv iver ersa sall
