Pediatric Growth And Development

Pediatric Growth and Development INFANT Age

1 Month

Physical

Rapid weight gain in the first month, primitive reflexes are preset and strong, obligatory nose breathing for most infants

Gross/Fine Motor Gross: Assumes flexed position, can turn head from side to side when prone; lifts head momentarily from bed; marked head lag; body limp when standing, absence of head control when sitting

Sensory

Fixate on object within range of 45-degrees, does not have good vision and follows light to midline; Quiets when a voice is heard.

Fine: Hands predominantly closed, grasp reflex strong and hands clench

2 Months

Crawling reflex disappears Posterior fontanel closed

Gross: Less flexed position, less head lag, can maintain head in the same plane as the rest of the body, head is held up but bends forward when sitting up Fine: Hands often open and grasp reflex is fading Gross: Head is held more erect, but still bobs forward; slight head lag noted; symmetric body positioning

3 Months

Primitive reflexes are fading

Fine: Can hold rattle but not reach for it, grasp reflex absent and hands kept loosely open; pulls at blankets and clothes

Cognition

Sensorimotor phase: use of reflexes and primary circular reactions Able to watch the parents’ face intently when he or she is spoken to

Binocular fixation and convergence to near objects beginning, follows dangling toys from side to side to point beyond the midline; visual searching; turns head to sound

Social smile in response to various stimuli

Follows objects to periphery; locates sound by turning head and looking in same direction; coordinate stimuli from various sense organs

Interest in surroundings; can recognize familiar faces and objects and shows awareness of strange situations

Gross: Almost no head lag when pulled to sitting position, balances head well, able to sit erect if propped up, rolls from back to side

4 Months

5 Months

Drooling! Moro, tonic and rooting reflexes have disappeared

Beginning signs of tooth eruption, birth weight doubles

Fine: Inspects and plays with hands, pulls clothing or blanket over face; reaches for objects with hands, grasps objects with both hands, cannot pick up objects if dropped, can carry objects to mouth.

Gross: No head lag present Able to hold head erect and steady, able to sit for longer periods if supported, turns from abdomen to back (tummy to back)

Accommodate near objects; binocular vision, beginning hand-eye coordination

Laughs aloud and makes consonant sounds, demands attention by fussing and enjoys social interaction, anticipates feeding, shows interest in strange stimuli and begins to show memory

Pursues a dropped object with eyes, sustains visual inspection and can localize sounds

Smiles at a mirror image, pats bottle or breast with both hands, more enthusiastic, able to differentiate between friends and family, discovers parts of body

Adjusts position to see an object, complex visual stimuli, localize sounds above ear and will turn head to the side and look up and down; begins to imitate sounds, babbling resembles one-syllable utterances; takes pleasure in hearing self

Recognizes parents and begins to fear strangers, holds arms out, definite likes and dislikes, imitation occurs, excites on hearing footsteps, object permanence begins—searches for dropped objects

Fine: Grasps objects voluntarily, palmar grasp, plays with toes, takes objects to mouth

6 Months

Growth rate may begin to decline; teething may begin with eruption of two lower central incisors, chewing and biting occur

Gross: can lift chest and upper abdomen off surface, weight on hands, lifts head, sits in high chair with back straight, rolls from back to abdomen, bears almost all weight Fine: Resecures a dropped object, grasps and manipulates small objects, holds bottle and grasps feet and pulls to mouth

7 Months

Eruption of upper central incisors

Gross: Can lift head spontaneously off surface, sits leaning forward on both hands, bears full weight on feet, can bounce actively Fine: Transfers object from one hand to the other; unidextrous approach and grasp

8 Months

Shows regular patterns in bladder and bowel elimination; parachute reflex appears

Gross: Sits steadily unsupported, readily bears weight on legs and may stand holding on to furniture; adjusts position to reach an object

Fixate on very small objects and responds to own name; localizes sound; awareness of depth and space and has taste preferences

Produces vowel sounds and chained syllables; talks when others are talking; increasing fear of strangers, shows distress when parents disappear; imitates simple acts and noises and tries to attract attention; plays peek-a-boo, oral aggressiveness

No major developments

Consonant sounds; listens selectively to familiar words, emphasis and emotion, combines syllables; increasing anxiety over loss of parent, fear of stranger, responds to word “no” and dislikes dressing and diaper changes

Localizes sound by turning head, depth perception is increasing and responds to simple, verbal commands

Parent is increasingly important, shows increasing interest in pleasing parent, shows fears of going to bed and being left alone; puts arms in front of face to prevent washing

No major developments

Says “mama and dada” with comprehension of meaning, inhibits behavior to verbal command and imitates facial expressions; waves goodbye; development of object permanence and plays interactive games

Fine: Pincer grasp, releases objects at will, secures an object and reaches persistently for toys out of reach

9 Months

10 Months

Eruption of upper lateral incisors

Labyrinth-righting reflex is strongest when infant is prone or supine; raises head

Gross: Creeps on hands and knees; sits steadily on the floor for prolonged time; recovers balance leaning forwards only; pulls self to standing position and stands holding furniture Fine: Thumb and index finger in crude pincer grasp and dominant hand now evident Gross: Change from prone to sitting position, sits by falling down, recovers balance easily while sitting; lifts one foot to take a step Fine: Crude release of object beginning; grasps by handle

Gross: Sitting, pivots to reach objects, cruises or walks holding on to furniture with both hands

11 Months

12 Months

Eruption of lower lateral incisors

Birth weight tripled, birth length increased by 50%, six to eight deciduous teeth, anterior fontanel almost closed, Babinski reflex disappears, lordosis is evident during walking

Fine: explores objects more thoroughly, neat pincer grasp, drops objects deliberately, sequential play and able to manipulate objects Gross: Walks with one hand held, cruises well; may attempt to stand alone momentarily, can sit from a standing position without help Fine: Attempts to build tower, tries to insert pellet into a narrow-necked bottle, can turn pages in a book, many at a time

No major developments

Discriminates simple geometric forms, amblyopia may develop, can follow rapidly moving objects, controls and adjusts position, listens for sounds to recur

Imitates definite speech sounds; Experiences joy and satisfaction, reacts to restriction with frustration, rolls ball to another on request, anticipates body gestures; plays games and shakes head for “no”

Says three to five words; shows emotions, enjoys familiar surroundings and explores away from the parents, fearful in strange situations; may develop habit of security blanket or favorite toy, searches for an object even if it hasn’t been hidden (where object was last seen

TODDLER Age

15 Months

Physical

Steady growth in height and weight

Gross/Fine Motor Gross: walks without help, creeps up stairs, kneels without support, cannot walk around corners or stop suddenly without losing balance, cannot throw ball without falling and runs clumsily; falls often Fine: Constantly casting objects to floor, releases a pellet into a narrow-necked bottle; scribbles spontaneously, uses cup well but often rotates spoon before it reaches mouth

Sensory

Able to identify geometric forms, binocular vision welldeveloped, displays an intense and prolonged interest in pictures

Cognition uses expressive jargon and knows four to six words including names; asks for objects by pointing, understands simple commands, may use headshaking, tolerates some separation from parent and is less likely to fear strangers; imitate parent actions like cleaning; kisses and hugs parents

18 Months

24 Months (Two years)

30 Months

Picky eater because of decreased growth needs and need to assert independence, anterior fontanel closed, physiologically able to control sphincters

Adult height double height at age 2, primary dentition of sixteen teeth, may demonstrate readiness for beginning daytime control of bowel and bladder

Birth weight quadrupled Primary dentition completed (twenty teeth); may have daytime bowel and bladder control

Gross: Assumes standing position, walks up stairs with one hand, pulls and pushes toys, jumps in place, seats self on chair, throws ball overhand without falling No major developments

Says ten or more words, points to a common object and two or three body parts, forms word combinations, form gestureword combinations, forms gesture-gesture combinations; expresses emotions, takes off clothing, temper tantrums, begins awareness of ownership; dependence on transitional objects

Accommodation is welldeveloped in geometric discrimination

Vocabulary of approximately 300 words, uses two or three word phrases, uses pronouns and understands directional commands; gives first name and refers to self by name, verbalizes needs, talks, able to remember and imitate arbitrary gesture sequences; parallel play, sustained attention span and temper tantrums decrease, dresses self in simple clothing, visual/verbal self-recognition, awareness that feelings and desires of others may be different

No major developments

Gives first and last name, refers to self by appropriate pronoun, uses plurals and can name one color; Separates more easily from parent; helps put things away, begins to notice gender differences and knows own gender; may attend to toilet needs without help except for wiping; emotions expand

Fine: Release, prehension and reach well developed, turns pages in book two or three at a time, makes strokes imitatively in drawing, manages spoon without rotation

Gross: Goes up and down stairs alone with two feet on each step, runs fairly well with wide stance, picks up objects, kicks ball forward Fine: Turns doorknobs, unscrews lids and imitates vertical and circular strokes

Gross: Jumps with both feet, jumps from chair to step, stands on one foot momentarily, takes a few steps on tiptoe Fine: Good hand-finger coordination, imitates vertical and horizontal strokes and makes two or more strokes for cross, draws circle

PRESCHOOL Age

3 Years

Physical

May have achieved nighttime control of bowel and bladder

Gross/Fine Motor Gross: Rides tricycle, jumps off bottom step, stands on one foot, goes up stairs; balance may not be adequate Fine: can draw a circle with facial features, names what has been drawn

4 Years

5 Years

Pulse and respiration rates decrease slightly; growth rate remains similar; maximum potential for development of amblyopia

Eruption of permanent dentition may begin; handedness is established

Gross: skips and hops on one foot, catches ball reliably, throws ball overhead, walks down stairs using alternate footing Fine: Uses scissors to cut successfully, following an outline; can lace shows but cannot tie bow, copies a square, can trace and add three parts to stick figure

Gross: Skips and hops on alternate feet; throws and catches ball well, jumps rope, skates with good balance, walks backward with heel to toe, balances on alternate feet with eyes closed

Sensory Vocabulary of about 900 words, uses telegraphic speech, complete sentences, asks questions, prepare simple meals; parallel and associative, learns simple games, begins to share, feeds self and dresses self; knows genders of self and others; learns how to follow rules Has 1500 words or more in vocabulary, sentences contain four or five words, tells stories, asks many questions, obeys four prepositional phrases, names one or more colors, comprehends analogies; very independent, tends to be selfish and impatient as well as aggressive, family tales are told with no restraint, imaginary playmates are common, sexual exploration and curiosity are demonstrated through play Vocabulary increases to 2100 words; uses sentences of six to eight words with all parts of speech, names coins, knows names of days of week, months and time-associated words; can follow three commands in succession

Cognition Preconceptual phase and egocentric in thought and behavior; understanding of time, improve concept of space and ability to view concepts from another perspective; attempts to please parents Intuitive thought, understands time better, unable to conserve matter, judges everything according to one dimension, perceptual clues dominate judgment, less egocentric and more social awareness; count correctly but has poor mathematical concept of numbers obeys because parents set limits; does not understand right and wrong; can rebel and takes aggression out on family members, may have rivalry with siblings and identifies strongly with parent of the opposite sex Less rebellious and quarrelsome, more settled and eager to get down to business, independent but trustworthy, has better manners, total selfcare, associative play; begins to question what parents think and may notice prejudice and bias, is able to view from

Fine: ties shoelaces, uses scissors and simple tools or pencil very well, prints a few letters or numbers, such as first name

Has fewer fears and relies on outer authorities to control the world; hand-eye coordination is less refined; may cheat to avoid losing

others’ perspective; uses timeoriented words with increasing understanding, cautious about factual information regarding the world; gets along with parents, may seek out parent more often, questions thinking and principles, identifies with parent of the same sex

SCHOOL-AGE Age

6 Years

7 Years

8 – 9 Years

Physical and Motor

Mental

Height and weight gain continues, central mandibular incisors erupt, loses first tooth, increase in dexterity and activity and vision reaches maturity at this age

Develops sense of numbers, can count 13 pennies, knows morning and afternoon, obeys three commands in quick succession, defines common objects and says which is pretty and which is ugly, describes objects in a picture

Begins to grow at least two inches per year, maxillary central incisors and lateral mandibular incisors erupt, more cautious in approaches to new performances, jaw begins to expand to accommodate permanent teeth Continues physical growth pattern, cuspids erupt as well as lateral incisors, movement is fluid, always moving, increased smoothness and speed in fine motor control and uses cursive writing, likely to overdo, more limber

Adaptive Uses knife, can cut, fold and paste paper, takes bath without supervision and performs bedtime activities alone; reads from memory and enjoys oral spelling games, likes table games; giggles; steals; difficulty owning up to misdeeds, tries out own abilities

Personal-Social Can share and cooperate better, has great need for children of own age, will cheat to win, rough play, jealous of younger siblings, boaster, independent, has own way of doing things and increases socialization

Notices certain items missing from pictures, repeats three numbers backwards, develops concept of time and can read clock or watch, mechanical in reading

Uses table knife, brushes and combs hair acceptably, likes to help, less resistant and stubborn

Real member of family group, takes part in group play; samesex group play; spends a lot of time alone and does not require companionship

Gives similarities and differences between two things from memory, describes common objects in detail, can make change, reads more, can grasp fractions, classifies objects and has collections, produces simple drawings

Uses common tools and household and sewing utensils, assumes responsibility, looks after all of own needs, buys useful articles, runs errands, likes school, is afraid of failing a grade and is ashamed of bad grades, more critical of self

Easy to get along with, likes reward system; interested in boy-girl relationships, goes about home and community freely and likes to compete and play games, plays mostly with groups of own sex, modest, group sports begin

10 – 12 Years

Posture is more similar to an adult’s and remainder of teeth will erupt—not wisdom teeth Pubescent changes may begin to appear in girls; boys may become obese in this period of growth

Writes brief stories, writes occasional short letters to friends and relatives, uses telephone, responds to advertising, reads for practical information or own enjoyment

Makes useful tools or does easy repair work, raises pets, washes and dries own hair, may need reminding to be hygienic, can be left alone for a few hours, successful in looking after others left in their care

Loves friends; chooses friends more selectively, enjoys conversations and develops beginning interest in opposite sex; more diplomatic, likes family, likes mother and demonstrates affection; father may be more idolized, respects parents

Relationships

Sexuality and Psychology

ADOLESCENCE Age

Early Adolescence (11 – 14)

Middle Adolescence (15 – 17)

Physical

Rapidly accelerating Reaches peek velocity Secondary sex characteristics appear (look at Tanner Stages)

Growth decelerating in girls, stature reaches 95% of adult height, secondary sex characteristics are well advanced

Cognition and Identity Explores newfound ability for limited abstract thought, clumsy groping for new values and energies, comparison of “normality” with peers of same sex Preoccupied with rapid body changes, measurement of attractiveness by acceptance of peers and conformity to group norms Developing capacity for abstract thinking, enjoys intellectual powers, concerns with philosophic, political and social problems Modifies body image, very selfcentered and tendency toward inner experience and selfdiscovery; rich fantasy life and is idealistic, perceive future implications of current behavior and decisions

Defining independencedependence boundaries, strong desire to remain dependent on parents, no major conflicts over parental control Seeks peer affiliations to counter instability, close and idealized friendship with numbers of same sex, struggle for mastery takes place within peer group Major conflicts over independence and control, low point in child-parent relationship, greatest push for emancipation; disengagement and final and irreversible emotional detachment from parents Behavioral standards set by peers, exploration of ability to attract opposite sex

Self-exploration and evaluation, limited dating, usually group, limited intimacy Wide mood swings, intense daydreaming and outwardly expressed with moodiness, temper outburst and verbal insults and name calling

Multiple plural relationships Internal identification of heterosexual, homosexual and bisexual attractions, exploration of “self appeal” and feeling of “being in love,” tentative establishment of relationships More introspective, tendency to withdraw, vacillation of emotions and feelings of inadequacy common

Established abstract thought, can perceive and act on longrange options, views problems comprehensively and intellectual and functional identity established Late Adolescence (18 – 20)

Physically mature Structure and reproductive growth almost complete

Body image and gender role definition nearly secured, mature sexual identity; consolidation of identity; stability of self-esteem, comfortable with physical group and social roles defined and articulated

Emotional and physical separation from parents completed, independence from family with less conflict, emancipation nearly secured Peer groups recedes in importance in favor of individual friendship, testing of romantic relationships against possibility of permanent alliance, relationships characterized by giving and sharing

Forms stable relationships and attachment to another, growing capacity for mutuality and reciprocity, dating as a romantic pair, may publicly identify as LGBTQIA, intimacy involves commitment More constancy of emotion Anger likely to be concealed