Developmental milestones in children

• Growth and development in children encompasses physical maturation and the acquisition of skills.

Definitions

• Growth involves physical maturation, increasing the size of the body and its organs through cell multiplication and increased intracellular substances.
• Growth is quantitative and measurable, using units like inches, centimeters, pounds, and kilograms.
• Development entails functional and physiological maturation.
• Development is a progressive increase in skills and the capacity to function, relating to the maturation and myelination of the nervous system.
• Development includes motor, psychological, emotional, and social changes.
• Development is qualitative and difficult to measure.
• Maturation is the physical, intellectual, or emotional process of development, primarily influenced by genetics.
• Assessing growth and development is crucial for determining a child's health and nutritional status.
• Abnormal growth can indicate disease, making growth measurement an essential part of physical examinations.
• Assessment helps understand expected behaviors at certain ages and plan nursing management.
• Recognizing condition variations across age groups and guiding parents in promoting optimal development are key benefits.

Factors Influencing Growth and Development

• Heredity is responsible for transmitting conditions like Dwarfism and Diabetes.
• Sex influences growth; male infants are initially longer and heavier, with boys maintaining superiority until age 11.
• Girls mature earlier and are taller on average but boys are taller again during the prepubertal stage.
• Bone development is more advanced in girls.
• Racial characteristics, like height, vary among races.
• Intermarriages have led to mixed racial characteristics in societies.
• Diseases may cause growth retardation.
• Maternal malnutrition can impair fetal development.
• Lack of quality food and cultural taboos also impact fetal growth.
• Environmental factors like seasons, sunshine, health, and socioeconomic status can affect child-rearing practices.

Principles of Growth and Development

• Growth progresses from head to tail (cephalocaudal direction).
• Before birth the head end of the embryo and fetus develops faster than the tail end.
• Postnatally, infants gain head control before controlling feet movement.
• Development proceeds from the center of the body to the periphery (proximo-distal).
• During the prenatal period the limb buds develop before fingers and toes.
• During infancy large muscles develop before fine muscles.
• Growth and development are continuous, with new skills building on acquired ones.
• Example: An Infant lifts and turns their head before turning over.
• Development moves from simple to complex behaviors and specific patterns.
• Broad, global behavior become more specific, defined patterns.
• Development proceeds from general to specific, like grasping with the whole hand, then later with thumb and forefinger.
• Predictability allows anticipation of adult structure and size based on a child's bone knowledge.
• Interrelation suggests a healthy body contributes to a healthy mind and stable emotions.
• Inadequate physical or mental development leads to social or emotional maladjustment.

Stages of Growth and Development

• Prenatal period/intrauterine life
  • Ovum: conceptions to 14 days
  • Embryo: 14 days to 8 weeks
  • Fetus: 8 weeks to birth
• Postnatal period/extrauterine life
  • Neonate: birth to 4 weeks
  • Infancy: first year of life
  • Toddler: 1–3 years
  • Preschool child (early childhood): 3–6 years
  • School-age child (middle childhood):
    • 6–10 years (girls)
    • 6–12 years (boys)
  • Adolescent-From puberty to adulthood:
    • Early adolescent/prepubescent/late childhood:
      • 10–12 years (girls)
      • 12–14 years (boys)
    • Middle adolescent/pubescent:
      • 12–14 years (girls)
      • 14–16 years (boys)
    • Late adolescent/post pubescent:
      • 14–18 years (girls)
      • 16–20 years (boys)

Types of Growth and Development

• Types of growth:
  • Physical growth (height, weight, head and chest circumference)
  • Physiological growth (increase in size of organs, organ systems)
• Types of development:
  • Motor development
  • Cognitive development
  • Emotional development
  • Social development

Assessment of Growth

• Assessment is done using anthropometric measurements and physical growth velocity study.
• Criteria:
  • Weight
  • Length/Height
  • Head circumference
  • Chest circumference
  • Mid-upper arm circumference
  • Other
    • Body Mass Index
    • Fontanelle closure
    • Dentition and bone age

Newborn Stage (First 4 Weeks/First Month)

• Transitional period from intrauterine to extrauterine life.

Physical Growth:

• Normal birth weight = 2.700–4 kg.
• Weight loss of 5–10% within 3–4 days after birth.
• Weight gain by the 10th day.
• Gain of 3/4 kg by the end of the 1st month.
• Reasons for weight loss
  • Hormone withdrawal from the mother
  • Loss of excessive extracellular fluid
  • Passage of meconium (feces) and urine
  • Limited food intake

Height

• Normal range for both is 48–53 cm.

Head circumference

• Measures 33-35 cm.
• The skull has two fontanels: anterior and posterior.
• Anterior fontanel:
  • Diamond-shaped
  • Closes at 12–18 months
  • Size varies from barely palpable to 4–5 cm
  • Flat, soft, and firm feel
• Posterior fontanel:
  • Triangular shape, 0.5–1 cm
  • Located between occipital and two parietal bones
  • Closes by the end of the first month.
• Chest circumference usually 2-3cm less than head circumference
• Measured 30.5 to 33 cm

Physiological Growth

• Temperature is 36.5°-37°C.
• Heart rate is 120–140 beats/min (apical).
• Respiration rate is 30–60 breaths/min.
• Blood pressure is 65/41 mm Hg (Oscillo metric, arm and calf).
• General appearance includes flexion of head and extremities resting on the chest and abdomen.

Newborn Senses

• Touch:
  • Is the most developed sense
  • concentrated mostly at lips, tongue, ears, and forehead
  • Newborn is usually comfortable with touch.
  • Vision:
    • Eyes are structurally uncompleted, with the ciliary muscles are still immature
    • Pupils react to light.
    • Bright lights may be unpleasant.
    • Poor visual acuity.
    • Follows objects in line of vision.
    • Can momentarily fixate on a bright, moving object within 20 cm.
• Hearing
  • Usually responds to sounds from birth.
  • Ordinary sounds are heard well before 10 days.
  • Responds to sounds with cry, eye movement, cessation of activity, or startle reaction.
• Taste
  • Well developed, resisting bitter and sour fluids while accepting sweet fluids.
• Smell
  • Evident in the search for the nipple, as he seeks breast milk.

Motor Development

• Gross Motor skills of newborns:
  • Movements are random, diffuse, and uncoordinated.
  • Reflexes are the primary method of performing bodily functions and responding to external stimuli.
• Fine Motor Skills of newborns:
  • Holds hand in a fist
  • When crying, draws arms and legs to body.
  • Grasp reflex is strong at birth.
  • Can grasp an object in hand but drops it immediately.

Reflexes

• Numerous reflexes both primitive (disappear during infancy) and normal.
• Includes swallowing, gagging, sucking, grasp, tonic-neck, and rooting reflex

Cognitive Development

• The cognitive development is difficult to understand or observe in newborns.
• Emotions are expressed through crying for hunger, pain, or discomfort.

Language Development :

• Startles to loud noises.
• Responds to the human voice.
• Makes comfort sounds during feeding.
• Begins to coo.

Normal Infant (End of First Month to End of First Year)

• Rapid growth and development.

Physical Growth

• Weight gain of 150-210 g/week or 5-7 oz for the first 6 months.
• Doubles birth weight by 4–5 months.
• Triples birth weight by 10–12 months.
• Calculating Expected Weight:
  • Weight= age in months + 9 divided by 2
• Length increases 2.5 cm (1 inch) per month for the first 6 months, then 1.5 cm per month for the 7-12 months.
• Head circumference increases 1.5 cm (0.6 inches) per month for the first 6 months, then 0.5 cm per month during the second 6 months.
• End of the first year head and chest circumference and roughly equal.
• Posterior fontanel closes by 6–8 weeks of age.
• Anterior fontanel closes between 12–18 months.

Physiological Growth

• Pulse is 110–150 beats/min.
• Respiration is 35 ± 10 breaths/min.
• Breath through nose.
• Blood pressure is 80/50 ± 20/10 mmHg.
• Tooth eruption begins around 5-6months called "Milky Teeth", "Deciduous Teeth", or "Temporary Teeth".

Motor Development Milestones:

• 2 months:
  • Can hold head erect in mid-position.
  • Able to turn from side to back.
• 3 months:
  • Can move head
  • Hold head erect and steady
  • Open and close hands loosely
  • Hold object placed in hand
• 4 months:
  • Can sit with adequate support
  • Roll over from front to back
  • Hold head erect and steady while in a sitting position
  • Bring hands together at the midline and play with fingers
  • Grasps objects with both hands.
• 5 months:
  • Balance head well when sitting
  • Sit with slight support
  • Pull feet to mouth when supine
  • Grasps objects with whole hand (Rt. or Lt.).
  • Hold one object while looking at another.
• 6 months:
  • Sit alone briefly
  • Roll completely over from abdomen to abdomen
  • Lift chest and upper abdomen when prone
  • Hold own bottle.
• 7 months:
  • Sit alone
  • Hold a cup
  • Imitate simple acts of others.
• 8 months:
  • Sit alone steadily
  • Drink from cup with assistance.
  • Eat finger food that can be held in one hand.
• 9 months:
  • Rise to sitting position alone.
  • Crawl (i.e., pull body while in prone position)
  • Hold one bottle with hand-mouth coordination.
• 10 months:
  • Crawl well (use hands and legs)
  • Walk with help
  • Bring the hands together.
• 11 months:
  • Walk holding on furniture
  • Stand erect with minimal support.
• 11 months:
  • Stand alone for variable length of time.
  • Sit down from standing position alone.
  • Walk in few steps with help or alone (hands held at shoulder height for balance)
  • Pick up small bits of food and transfers them to their mouth.
• 9 months: Crawl
• 10 months: Creep
• 1 year: stand independently from a crawl and creep position.
• 13 months old: walk and toddle quickly
• 15 months old: can run

Emotional and Social Development:

• Emotions are unstable, shifting from crying to laughter quickly.
• Affection for family appears.
• By 10 months he expresses self, emotions as anger, sadness, pleasure, jealousy, anxiety, and affection become distinguishable.
• Crying bring attention.
• Smiling in response to others by the infant indicates social development
• Development is showed through fear of strangers
• Erickson's developmental stage: Trust vs. Mistrust.

Speech Development:

-First verbal communication is crying.

• Vocalizations during crying become syllables/words.
  • By 2 months: Single vowel sounds (ah, eh, uh).
  • By 3 to 4 months: Consonants (n, k, g, p, b); they coo, gurgle and laugh .
  • By 6 months: Imitate sounds; consonants (t, d, w); combine syllables (dada), and don't ascribe meaning to the word until 10 to 11 months of age
  • By 9 to 10 months: Comprehend "no" and obey simple commands with gestures.
  • By age 1 year: Able to say 3 to 5 words with meaning

Hearing development:

-Birth: Responds to loud noise by startle, or Moro reflex / responds to sound of human voice better.

• Quieting sound of lullaby, metronome, or heartbeat
• 8 to 12 Weeks: Turns head to side when sound is made at level of ear
• 12 to 16 Weeks: Locates sound by turning head to side and looking in same direction
• 16 to 24 Weeks: Locates sound by turning head to side and then looking up or down
• 24 to 32 Weeks: Locates sounds by turning head in a curving are and responds to own name
• 32 to 40 Weeks: Localizes sounds by turning head diagonally and directly toward sound
• 40 to 52 Weeks: Knows several words and their meaning, such as “no” and names.

Danger Signs in Infant Development:

• Unable to sit alone by age 9 months
• Unable to transfer objects from hand to hand by age one year
• Abnormal pincer grip or grasp by age 15 months
• Unable to walk alone by 18 months
• Failure to speak recognizable words by age 2 years

Normal Toddler (1–3 Years)

• Growth slows considerably during this stage. Physical Growth:
• Weight: Average gain is 1.8 to 2.7 kg/year.
  • Normal Weight Calculation: Weight=age in years x 2+8
• Height:
  • During 1-2 years the child's height increases 1cm/month.
  • The toddler's height increases ~10 to 12.5cm/year.
  • Normal Height Calculation: age in years x 5+80
• Head increases by only 10 cm to adult age.
• Chest circumference increases and exceed head circumference at this stage.
• By 2 years: Has 16 temporary teeth.
• By 30 months (2.5 years): Has 20 teeth.

Physiological Growth:

• Pulse: 80–130 beats/min (average 110/min).
• Respiration: 20–30C/min.
• Daytime control of bladder and bowel control by 24–30 months.

Fine Motor

• 1 year old: Transfers objects from hand to hand
• 2 year old:
  • Can hold a crayon and color vertical strokes
  • Turn the page of a book
  • Build a tower of six blocks
• 3 year old: Copy a circle and a cross and build with small blocks

Gross Motor

• At 15 months, the toddler :
  • Walk alone
  • Creep upstairs
  • assume standing position without falling
  • hold a cup with all fingers grasped around it.
• At 18 months:
  • Hold cup with both hands
  • Transfer objects hand-to hand at will.
• At 24 months:
  • Go up and down stairs alone two feet on each step
  • Hold a cup with one hand
  • Remove most of own clothes
  • Drink well from a small glass held in one hand. At 30 months:
• Jump with both feet
• Jump from chair or step
• Walk up and downstairs, one foot on a step
• Drink without assistance

Cognitive and Social Development:

• By two years old the toddler uses his senses and motor development to different himself from objects.

• Piaget stage :

  • Preconceptual stage of cognitive development stage from 2 to 3
  • Still egocentric and can not take the point of view of other people

• The toddler is very social being but still egocentric at this stage.

• He imitates parents.

• Notice sex differences and acknowledges own gender.

• Ericson's stage of Autonomy vs. shame and doubt. Development of autonomy through controlling their body and self.

• They shows independence by trying to do things “themself”.

Emotional Development

• Erickson's concept of Autonomy is the development of a sense of autonomy versus. shame or doubt.
• To develop a sense of autonomy is to promote a sense of independence.
• Children are still enthusiastic about interacting with people.
• By 18 months, toddlers imitate what they see a parent do
• By 2 years, children become aware of gender of all persons.

Preschool Stage (3–6 Years)

• Growth is relatively slow. Physical growth:
• Weight: Gains approximately 1.8 kg/year.
• Height: Doubles birth length by 4–5 years.
• Pulse: 80–120 beats/min (average 100/min).
• Respiration: 20–30 cycles/min.
• Blood Pressure: 100/67+24/25
• Motor development:
  • Can copy circles
  • Can draw a cross
• Older toddler:
  • 3 year old: Copies a circle and a cross and is able to build with small blocks
  • 4 year old: Able to use scissors and color within the borders
  • 5 year old: Able to write some letters and draw a person with body parts

Fine motor and cognitive abilities pre-school

• Buttoning clothing
• Holding a pencil
• Building with small blocks
• Using scissors
• Playing a board game
• Have a toddler draw pictures of others and self

Cognitive development

• Preschooler (up to 4 years) is in the pre-conceptual phase.
• They are able to give reasons for his belief and actions, but not true cause-effect relationship.
• Emotional Development of Preschoolers
  • Fears the dark, Impatient, and selfish.
  • Expresses aggression through physical and verbal behaviors.
  • Shows signs of jealousy of siblings.
• Social development in preschoolers:
  • Egocentric, Tolerates short separation, Less dependant on parents, May have dreams & nightmares, Attachment to opposite sex parent & More cooperative in play

Social Development

• Erickson stage of initiative vs. Guilt
• Develops a sense of initiative to learn and explore the world.
• Danger signs include inability to perform self-care tasks and a lack of socialization.

School-Age Child (6–12 Years)

• Growth is gradual. Physical Growth:
  • Weight: Gains - 3.8 kg/year. -Boys tend to gain weight longer than girls.
• Weight (lbs) = (age in yrs x 7)-5 divided by 2 Height: Gains about 5 cm/year. Both boys and girls have long legs.
• Physiological growth:
  • Pulse: (75 to 105).
  • Respiration: (18-24).
  • Blood Pressure: 100/60+16/10
  • Permanent tooth eruption starts around 6 years in the same order they were first lost.

Fine Motor Skills

- Writing skills improve
- Building Models
- Sewing
- Musical instrument
- Typing Skills
- Fine motor skills are refined
- Fine motor skills require more focus

Gross Motor skills

At 6-8 years, the school age child:

• Can ride a bicycle
• Runs, jumps, climbs, and skips
• Improved eye hand coordination. Prints word and learn cursive writing skillful with both hands.

At 8-10 years:

-Throws balls skillfully.

• Uses both hands independently.
• Handles utensils (spoon, fork, knife) skillfully.

At 10-12 years:

• Enjoy all physical activities.
• Continues to improve his coordination skill
• Plays team sports
• Matches sport to their emotional development.
• Able to work at a higher level of thinking.
• Concentration is greatly improved.
• Can play simple computer games
• Emotional fears of injury and darkness.
• Jealousy of siblings commonly occurs at the 6-8 year old stage.
• Short term temper by age 10 but anger is commonly controlled by age 12.

Social Development

• Is self centered
• Can work with others to accomplish a goal
• Wants other kids that involve him
• Becomes peer oriented
• Improves relationship with siblings

Danger Signs School Age

• School failure
• Lacks friends, Socially isolated
• Shows aggressive tendencies
• Has Aggressive behavior: fights

Adolescent Phase

• Growth spurt.
• Physical changes occur-Physiological growth is apparent.
  • Secondary sex characteristics are apparent
  • Emotional shifts occur
  • Social skills refined. This phase the transition from puberty to adulthood.

Physical Growth:

• Growth spurt begins earlier in girls then boys.
• Gain of weight occurs around 7 to 30kg dependent on male versus female.
• The child is 13 y/o they will triple their birth length
• 10 to 30 cm increase expected over this phase Hormonal development is dependent upon gender traits.
• Height spurt ceases at 16 to 20 years depending on gender. Menarche first menstruation occurs occurs between 12 to 13 years.

Growth:

• Increases diameter of pelvis -Breast Development Vaginal secretions change. -Growth of pubic and axillary hair

By the 13-16 range boys exhibit:

• increase genitalia
• Breast tissue forms
• Hair in the auxillary is noticed
• Voice changes
• Rapid growth occurs more rapidly here.

Emotionality in adolescence

• As teenagers gain independence they start to question the moral.

Cognitive development: Adolecent

• Thinks abstract not in concrete terms
• Changes in emotional control occurs here.
• Social development: Adolescence
• The child needs to fit in
• Identity diffusion is a real thing: they seek the need to fit in in their peer group.
• He looks for identity outside is inner group. Major Theories impacting development:
• Erik Erikson Piaget
• Sigmund Freud Kohlberg

Erik Erikson's Stages of Development:

Trust vs. Mistrust is first stage for infants which creates a sense of trust in their early lives.

• Autonomy versus shame as the child wants to grow and do thinks on their own
• Industry - child versus inferiority
• Child may be confused about the role as pre-adolecents/adolescence

Theories of development

• sensorimotor
• Preorperational
• Thinking Logically
• concrete

Freud's -Oral to anal phase

• Phallic- genital focused

Kohlberg ethical standards

• 1 Preconventional morality -A childs obedience -2 Conventional morality -Conformity and interpersonal accord; -3 post conventional: Is guided y internal concepts