Growth and Development Organized PDF

**Newborn (Birth - 1 month)** **[Physical Development]** Rapid brain growth continues. Growth follows cephalocaudal and proximodistal patterns. Lifts head if prone (on belly). Holds finger in fist. Anterior and posterior fontanels are open and should be flat and pulsating. Several reflexes ar...

**Newborn (Birth - 1 month)** **[Physical Development]** Rapid brain growth continues. Growth follows cephalocaudal and proximodistal patterns. Lifts head if prone (on belly). Holds finger in fist. Anterior and posterior fontanels are open and should be flat and pulsating. Several reflexes are present, including rooting, grasp (palmar and plantar), Babinski, Moro (startle), tonic neck, dance/stepping, and crawling. Weight doubles between 4-6 months. **[Cognitive Development]** Sensorimotor stage: Learns about the world through senses and motor activity. Prefers faces and follows line of vision. **[Social and Emotional Behaviors]** Trust vs. Mistrust stage: Develops a sense of trust when needs are met consistently. Spends most of the time sleeping. **[Nutrition]** Breastfeeding every 2-3 hours on demand or bottle-feeding 60-90cc every 2-3 hours. Adequate breastfeeding is indicated by frequent feeding, alertness and satisfaction, audible swallowing, breast softening after feeding, adequate weight gain, and wet and stool diapers. **[Other]** Oral hygiene should be started at birth by gently wiping gums with a clean washcloth. **Infancy (1 - 12 months)** **[Physical Development]** Brain growth continues rapidly until 2-3 years. Decreased head lag at 2-4 months, no head lag at 4-6 months. Rolls from belly to back at 4-6 months. Sits with support at 2-4 months, develops sitting alone at 8 months, sits from standing position at 10-12 months. Crawls at 4-6 months, creeps at 8-10 months. Pulls to standing at 8-10 months, stands alone at 10-12 months, walks at 10-12 months. Holds rattle at 2-4 months, plays with fingers, brings objects to mouth, looks at fingers often. Palmar grasp and reaching at 4-6 months, reaches for objects, transfers objects hand to hand. Crude pincer grasp at 6-8 months, transfers objects, bangs objects. Fine pincer grasp at 8-10 months, grasps small objects. Holds crayon (small objects) at 10-12 months, builds tower. Posterior fontanel closes between 2-3 months. Anterior fontanel closes between 12-18 months (can take up to 24 months). Birth weight triples between 10-12 months. Head circumference (HC) should be equal to chest circumference (CC) at 10-12 months. **[Cognitive Development]** Continues in the sensorimotor stage. Develops object permanence at 8-10 months. Enjoys looking at self-image in the mirror at 6-8 months. **[Social and Emotional Behaviors]** Trust vs. Mistrust stage continues. Smiles and laughs at 2-4 months, develops social smile (beginning of memory). Develops nocturnal sleep and sleeps for longer periods; sleep problems are mostly learned. Separation anxiety begins at 4-6 months, needs reassurance. Stranger anxiety begins at 6-8 months. Responds to name at 6-8 months. Engages in \"peek-a-boo\" and patty cake at 10-12 months. **[Nutrition]** Breast or bottle feeding every 3-4 hours at 2-4 months. Introduction of baby food and weaning from breast milk to solid foods begins at 6 months due to digestive maturity. Eruption of lower central incisors at 6-8 months. Finger foods are introduced at 8-10 months, ensuring they are large enough to avoid airway obstruction. Self-feeds with a spoon at 10-12 months, eats soft table food. Juice consumption should be avoided under 6 months, diluted with water and limited to 4oz/day for infants 6-12 months. **[Language Development]** \"Cooing,\" gargling, and laughing begin at 2-4 months. Starts putting sounds together (e.g., \"da-da\") at 6-8 months. Understands \"no\" at 8-10 months; discipline can be introduced. Says 3-5 words and understands \"ma-ma\" and \"da-da\" at 10-12 months. **[Other]** Once teeth erupt, gently brush with a soft toothbrush and a smear of toothpaste appropriate for young children. First dentist appointment should be before 1 year of age. **Toddlerhood (1 - 3 years)** **[Physical Development]** Growth slows down. Birth weight quadruples. Reaches half of adult height. Chest circumference (CC) is greater than head circumference (HC). Legs elongate, giving a potbellied appearance. Anterior fontanel closes between 12-18 months (can take up to 24 months). Locomotion develops, increasing the risk of falls. Develops the ability to dress themselves (autonomy). Scribbles and makes block towers. **[Cognitive Development]** Transitions from sensorimotor to preoperational stage. Understands cause and effect. Demonstrates object permanence. Less fearful of strangers when parents are present. Engages in imitation. Develops a concept of time. **[Social and Emotional Behaviors]** Autonomy vs. Shame and Doubt stage: Develops a sense of autonomy by controlling their body and environment. Exhibits holding on/letting go behaviors, rituals, and frequent use of the word \"no.\" Requires consistent limit setting. **[Nutrition]** Experiences physiological anorexia (eats less due to slower growth). Milk intake should be limited to 16-24 oz/day to prevent iron deficiency anemia. Whole cow\'s milk is recommended until 2 years of age for neuro development. Appetite is erratic, and toddlers often prefer familiar foods. **[Language Development]** Comprehension increases significantly. **[Play]** Engages in parallel play (playing alongside others without interaction). **[Other]** Toilet training begins as anal and urinary sphincter control develops around 18 months. Physiological stress can cause regression in toilet training, which should be ignored and addressed normally. Brush teeth twice a day for 2 minutes with a soft toothbrush and a smear of toothpaste. **Preschool (3 - 5 years)** **[Physical Development]** Weight gain slows down. Growth occurs mostly in long bones. Becomes more coordinated, decreasing the risk of falls. Uses scissors, draws circles and squares, draws a 6-part person, buttons clothes. **[Cognitive Development]** Transitions from preoperational to magical thinking stage. Engages in symbolic thinking, pretend play, and imagination. Exhibits egocentrism (difficulty seeing things from other perspectives) and believes their actions or thoughts can cause events. Displays animism (belief that inanimate objects have life or feelings). Engages in magical thinking (belief that their thoughts can influence the world). **[Social and Emotional Behaviors]** Initiative vs. Guilt stage: Learns to assert independence and initiate activities. Develops a sense of initiative if supported, and guilt if not, becoming fearful of trying new things. Success in this stage requires a balance of autonomy and supportive boundaries. Experiences temper tantrums as a way of exerting independence and autonomy. Develops a greater number of fears, including the fear of mutilation. Exhibits modesty and fear of mutilation. At 3 years old, most can label their gender, differentiate toys by gender, and play with same-gender peers. By 4 years old, most have a stable sense of their gender identity. **[Nutrition]** Appetite remains erratic, with a preference for familiar foods. Mealtime becomes a social event, often shared with family or peers. **[Language Development]** Develops a vocabulary of 2000 words. Speaks in complete sentences. Has a literal grasp of meaning. At 3 years old, primarily talks to themselves, toys, and pets. At 4 years old, uses words to communicate information beyond their own needs and feelings. **[Play]** Engages in four types of play: Associative play: Plays side-by-side with others and interacts, but without working towards a common goal. Dramatic play: Engages in imaginative scenarios, acting out roles and using pretend play. Cooperative play: Works with others towards a common goal or plays in a group with shared rules. Solitary play: Explores and engages with their environment independently. All play types contribute to social skills, language development, and problem-solving abilities. **[Sleep]** Develops sleep rituals. Uses transitional objects to reduce separation anxiety and provide familiarity. **[Other]** Toothpaste amount increases to pea size at 3 years old (36 months). Juice consumption should be limited to 4-6oz/day and only given during meals for children 1-6 years old. **School Age (6 - 12 years old)** **[Physical Development]** This is the last stage where boys and girls have similar proportions. Girls experience a prepubertal growth spurt around age 10, while boys experience it closer to 12-13. Approaching puberty. Height increases, weight decreases, and muscle development increases. Jaw changes to accommodate permanent teeth. Engages in activities requiring balance and strength. **[Cognitive Development]** Concrete Operational stage: Thinks logically about objects and events, and solves problems with concrete reasoning. Develops conservation (understanding that quantity remains the same despite changes in appearance). Understands reversibility (actions can be reversed). Develops classification skills (grouping objects based on common attributes and understanding hierarchies). **[Social and Emotional Behaviors]** Industry vs. Inferiority stage: Develops self-esteem based on experiences of success and encouragement. Experiences a sense of industry and confidence with success, but may feel inferior with repeated failure or criticism. Success in one area can compensate for struggles in another, helping maintain self-worth. Requires mentors and a support system. Social media can negatively impact self-esteem. **[Nutrition]** Needs a balanced diet according to MyPlate recommendations. Faces peer pressure and the influence of fast food. Requires calorie-dense foods to support puberty and growth spurts, with a focus on Vitamin D3, calcium, protein, and iron. Building a healthy relationship with food is important. **[Sleep]** Experiences a pre-adolescent growth spurt. **[Social Development]** Focuses on school, peers, and body image. **[Other]** Girls are screened for scoliosis twice (at ages 10 and 12), while boys are screened once (at age 13 or 14). **Adolescence (12 - 21 years old)** **[Physical Development]** Puberty and ongoing brain development. Early adolescence (12-14 years) Middle adolescence (15-17 years) Late adolescence (18-21 years) Thelarche: Breast development. Adrenarche: Pubic hair development. Menarche: Onset of menstruation. Thelarche occurs approximately 1 year after the growth spurt. Adrenarche occurs 2-6 months after thelarche. Menarche occurs 2 years after thelarche, with a regular cycle established 6-14 months after the start of menses. Average age for menarche is 12.5 years. Delayed development concerns: Females: No breast development by age 13, or lack of menses 4 years after thelarche. Males: No initial stages of puberty by 13.5-14 years old. Tanner stages describe the progression of pubertal development: Breast development: 1 (prepubertal) to 5 (adult). Pubic hair development: 1 (preadolescent, no hair) to 5 (adult distribution). Male genital development: 1 (preadolescent) to 5 (adult genitalia). Peak height velocity occurs: Females: Linear growth stops 2-2.5 years after menarche. Males: Linear growth continues until approximately 18-20 years. Prepubertal growth spurt: Girls: Around age 10. Boys: Around age 12. **[Cognitive Development]** Formal Operational stage: Develops abstract thinking, inductive and deductive reasoning, and increased decision-making ability. Prefrontal cortex and amygdala are still developing, which can impact impulse control and emotional regulation. May not fully consider probabilities when making decisions. **[Social and Emotional Behaviors]** Identity vs. Role Confusion stage: Develops a sense of personal identity. Success in this stage leads to a sense of identity and purpose, while failure leads to role confusion and uncertainty. Previous stage development is crucial for identity formation. Re-establishes tasks from previous stages, such as developing trust, autonomy, and initiative. Peer groups become a safe haven. Risky behavior is more common in early adolescence (15-16 years) due to brain development, peer pressure, identity formation, and desire for autonomy. **[Other]** Brain development continues until 25 years old, including the prefrontal cortex and amygdala, which are crucial for emotional regulation and impulse control. Medication dosages for HIV positive adolescents change between Tanner stages 2 and 3. Tanner 1-2: Pediatric dose. Tanner 3-5: Adult dose. Adolescents may need support with medication adherence. Transition of care from pediatric to adult healthcare providers is important