Infant Development Milestones (0-18 months)

Expected Milestones

• Infants can lift their head and chest by 3 months when lying on their stomach.
• Most infants roll over from tummy to back and back to tummy between 4-6 months.
• Infants can sit with support by 6 months and sit without support by 9 months.
• Crawling typically occurs between 6-10 months.
• Infants start pulling themselves to stand between 9-12 months.

Cognitive and Psychosocial Development (0-18 months)

• Infants repeat pleasurable actions, like sucking their thumbs, during the primary circular reactions phase (1-4 months).
• Infants interact with their environment, such as shaking a rattle, during the secondary circular reactions phase (4-8 months).
• Infants develop object permanence, understanding that objects exist even when out of sight, between 8-12 months.

Social Interactions (0-18 months)

• Smiling begins around 6 weeks, social smiles develop by 2-3 months, and stranger anxiety can start around 8-9 months.

Recognizing Developmental Delays in Infants (0-12 months)

• If a 6-month-old has severe head lag when sitting up, it could indicate motor development issues or issues with muscle tone.
• Infants should roll over by 6 months. Failure to roll over may indicate a motor delay or low muscle tone.
• Most infants can sit unsupported by 9 months. Difficulty with this may suggest delays in gross motor skills.
• Infants usually start reaching for and grabbing objects by 4-5 months. Failure to do so could indicate visual or motor delays.
• Most babies start crawling between 6 and 10 months. Lack of crawling could indicate a motor delay.

Cognitive Development Delays (0-12 months)

• Infants should respond to sounds and recognize their caregiver's voice by 4 months.
• Babbling and cooing usually develop around 4-6 months. Delays in this area could indicate speech or language disorders.
• Infants should smile and make eye contact by 3 months. Lack of social engagement can be an early indicator of autism spectrum disorder or social-cognitive developmental issues.
• By 6 months infants should be making eye contact.

Social and Emotional Development Delays (0-12 months)

• Infants typically start to smile socially between 6-8 weeks. A lack of smiling could be a sign of developmental delays.
• By 6-9 months, infants typically recognize and respond to their own name.
• Persistent irritability or lack of curiosity in surroundings could be signs of developmental issues (6 months).

Red Flags for Further Evaluation

• Persistent primitive reflexes beyond 6 months, like the Moro reflex.
• Absence of object permanence by 12 months.
• No gesturing such as waving or pointing by 12 months.

Toddler Development (1-3 years)

• Toddlers typically take their first steps between 12-15 months and become proficient walkers by 18 months.
• By 2 years, toddlers can run and navigate stairs with assistance.
• Toddlers begin to climb on furniture and objects between 18-24 months.
• Toddlers start using their hands deliberately, grasping small objects, stacking blocks, and using utensils between 12-18 months.
• By 3 years, toddlers can draw simple shapes, turn book pages, and use child-safe scissors.

Toddler Development (1-3 years)

• At 18-24 months, toddlers understand object permanence, searching for hidden toys.
• Toddlers start to solve simple problems, such as opening a box or getting a toy, between 12-18 months.
• Toddlers combine two or more words to form simple sentences by 2 years; their vocabulary includes around 200-300 words.
• Toddlers can kick and throw small objects by 18-24 months.
• By 3 years, toddlers expand their vocabulary rapidly, understand more complex concepts, and use imaginative play.

Safety Interventions for Hospitalized Toddlers

• Hospital beds and cribs should have appropriate safety rails.
• Small objects, medications, and equipment should be kept out of reach to prevent accidental injury or choking.
• Parents or caregivers should be encouraged to stay with the child to provide comfort.
• Familiarity with caregivers should be maximized, minimizing the number of different caregivers to create security.
• Encourage bringing familiar items for comfort and continuity.
• Observe toddlers for increased anxiety, such as excessive crying, withdrawal, or clinginess, as they may not express discomfort verbally.

Preschool Development (3-5 years)

• Children begin to assert power and control over their environment by directing play and social interaction during Erikson's Initiative vs. Guilt stage (3-5 years).
• Preschoolers can use imaginative play to explore different roles and build social competence.
• Encourage play to help preschoolers understand and cope with medical procedures.
• Use toy medical kits and role-playing to make the hospital environment more familiar.

Safety in the Hospital

• Ensure cribs and hospital beds have safety rails.
• Keep small objects and equipment out of reach.
• Monitor for signs of anxiety or distress.

Providing Opportunities for Play

• Play can be an outlet for expressing feelings and processing experiences.
• Explain medical procedures to children in a way they can understand.
• Maintain the child's usual schedule (sleep, meals, playtimes) to maintain a sense of normalcy.

Instrument-based Guidance for Pediatric Care

• Use medical play with toy medical instruments or stuffed animals to explain procedures and reduce fear.
• Use distraction techniques such as reading, playing games, or playing with bubbles.

Addressing Common Parental Concerns

• Encourage healthy eating habits and physical activity for overweight children.
• Establish a consistent bedtime routine and minimize screen time to address sleep issues.

Peer Relationships in School-age Children (6-12 Years)

• Children at this age gravitate towards same-sex friendships – “boys play with boys” and “girls play with girls”
• These friendships are important for social development.
• Competition in school, sports, and games can foster self-esteem and motivation, but it's important to balance with cooperation and teamwork.
• Peer acceptance is crucial during these years, and can influence a child's behavior and sense of self.