Unit 2 healthy child

SUBJECT: CHILD HEALTH NURSING
UNIT NO:2 THE HEALTHY CHILD
GROWTH & DEVELOPMENT OF CHILDREN (0-12 YEARS)
PREPARED BY: SANJAY SIR
LECTURER
GOVT.CON
NEW CIVIL HOSPITAL
SURAT

INTRODUCTION
Today's child is tomorrow's citizen. They are
the nation building blocks. - Should it be desired
that any nation/ country progresses towards
development, it is to be ensured that the growth
& development of the children of that nation/
country is executed initially with utmost care and
attention. If the country neglects/ faulters on this
aspect, it is doomed for a gloomy & unhealthy
future of the country as a whole.

Objectives
 To observe and assess each child in terms of
norms for specific levels of growth &
development.
 To identify the developmental deviations.
 To plan for nursing management and to help in
formulating the plan for the total care of each
child.
 To understand better the reason for particular
conditions and illnesses that occur in various age
groups.
 To teach parents how to observe and to use
their knowledge so that they may help their
children achieve optimal growth and
development.

GROWTH AND DEVELOPMENT OF CHILDREN
• Definition of Terms:
Growth;
• Growth encompasses the biological and physiological
basis of behavior through the multiplication of cells
which results in increase in size
• The term ‘Growth’ denotes “ a net increase in the size or
mass of tissues. It is largely attributed to multiplication
of cells and increase in the intracellular substances.
Hypertrophy or expansion of cell size contributes to a
lesser extent to the process of growth.”
--------Dr. O. P. Ghai, AIIMS, Delhi.

Cont’d..
• “ Growth- an increase in the number and size of
cells as they divide and synthesize new
proteins; results in increased size and weight of
the whole or any of its parts.”
--- Donna L. Wong Nurse
Consultant, Oklahoma.
• “ Growth is the physical increase in size and
appearance of the body caused by increasing
numbers of new cells.”
--- Margaret G. Marks, Nurse Instructor,
Pennsylvania.

• Growth refers to an increase in physical size of the
whole or any of its parts and can be measured in
inches or centimeters or in kgs. Growth result
because of cell division and the synthesis of protein.
It causes a quantitative change in the child's body.
• Maturation;
Maturation generally refers to changes in
behavior resulting mainly from the individuals'
genetic inheritance rather than from practice such
as sequence of sitting, crawling and walking. Little
direct learning from the environment involved in
the behavior of maturation
Cont’d..

Development;
• It refers to the process of psychological, social,
intellectual and physical change that occurs
throughout the life span of an individual. It causes a
qualitative change in the child's functioning.
Development is orderly not haphazard; there is a
direct relation between each stage and the next.
• Development” specifies maturation of functions. It is
related to the maturation and myelination of the
nervous system and indicates acquisition of a variety
of skills for optimal functioning of the individual.”
—Dr. O.P. Ghai, AIIMS, New Delhi.
Cont’d..

• “Development”- a gradual change and
expansion; advancement from a lower to a
more advanced stage of complexity; the
emerging and expanding of the individual’s
capacities through growth, maturation and
learning.”
---Donna L. Wong, Nurse Consultant,
Okalahoma.
• “Development is the progressive change in the
child’s maturation”
---- Margaret G. Marks, Nurse Instructor,
Pennsylvania
Cont’d..

Factors Influencing Growth and Development
1. Heredity;
 The most important influencing on a child's
growth and ultimate size i.e. heredity. Birth length
is related primarily to maternal size and
intrauterine environment. As the child grows
genetic influences are gradually expressed. They
are largely responsible for transmission of
abnormal genes, familial illnesses etc.

CONTI…
2. Sex;
 Sex is determined at conception. After birth, the
male infant is both longer and heavier than the
female infant. Boys maintain this superiority till 11
yrs of age, than girls mature. Again during
pubertal spurt boys are taller than girls.
3. Race and Nationality;
4. Nutrition;
 Both prenatal and postnatal nutritional have long
lasting effects on growth and ultimate size. At any
age malnutrition results in decreased growth of
the child.

5. Environment :
a) Physical Surrounding - like of sunshine and poor
hygiene may produces differences in rate of
growth.
b) Climate and Season; Climatic variations influence
the child's health.
c) Psychological Factors - like inter-relationships
with parents, teachers and others may affect
growth and development.
d) Socio-Economic Factor - like poverty, is
associated with poor nutrition.
e) Cultural Influences
Cont’d..

6. Intrauterine Environment;
The influence of the intrauterine environment
on the child's future development is great. Fetus
may suffer when there is:
• Nutritional deficiencies of mother during
pregnancy.
• Mother is suffering from any endocrine disorder
or infectious disease during gestation.
• Mother is Rh -ve.
• Mother smokes or takes alcohol or drugs.
• Faulty placental implantation.
• IUGR
• Congenital malformations etc.
Conti.....

7. Deviations from Positive Health:
This may be caused by hereditary or
congenital conditions, illnesses or injury and
may result in altered levels of growth and
development.
8. Ordinal Position in the family.
9. Intelligence;
Intelligence is correlated to some degree
physical development. Also intelligence
influences mental and social development.
Cont’d..

10. Hormonal Influences/Endocrine factor
 like hypothyroidism and hypopituitarism
causes retardation.
11. Emotional Factors;
 Lack of love and security in childhood may
distort the Childs personality and impede
emotional maturity.
 Relationship with significant other persons,
mother, father, siblings, teachers, peers play a
vital role in the total development of the
child.
Cont’d..

12. Birth Injuries.
13. Socio-Psychological Factors;
 Play an important part in the
development of children. The balance
between the socio-psychological and
physical changes in the child and his
environmental and social codes of conduct,
determine his final development.
Cont’d..

SOCIO
-
ECONO
MICAL ENVIR
ON
MENT
AL,
SEASO
NAL
CHRO
NIC
DISEA
SES
NUTRITI
ONAL
EMOTI
ONAL
PRENA
TAL
AND
INTRA
UTERIN
E
GROWT
H
POTEN
TIALS
GENE
TIC
GROWTH
AND
DEVELOP
MENT
Factors of
G & D

1. Development is Similar for All.
 All children follow a similar pattern of
development with one stage leading into the
next. e.g. the baby stands before he walks, the
baby draws circle before a square. In no instance
is this order normally reversed.
 The very bright child and the very dull child
likewise follow the same developmental
sequence as the average. The very bright child
develops at a more rapid rate and the very dull
at a slower rate.
BLUE PRINT OF DEVELOPMENT:
( BASIC PREDICTABLE
CHARACTERISTICS OF DEVELOPMENT )

2 Development Proceeds from General to Specific.
• In mental as well as motor responses general activity always
precedes specific activity. Before birth the fetus moves the
whole body but is incapable of making specific responses.
• Generalized body movements occur before fine muscle
control is possible. At first the infant can make random
movement of the arm.
• There is a normal sequence in the development of physical
abilities just as it is for mental development and emotional
and social adequacy.
• A child should be given an opportunity to practice the skills
by either experience or instruction wherever readiness
occurs.
Cont’d..

3. Development is Continuous.
• Development is continuous from the moment of
conception to death but occurs at different rates
sometimes slowly and sometimes rapidly.
• What happen at one stage has influence on the
following stage. e.g. the speech, in a child does
not develop overnight; the child coos, gurgles and
babbling sounds are made by the child from the
time of birth and keep getting refined into
language.
Cont’d..

4. Development Proceeds at Different Rates.
 During the period of growth and development of the
total body and its subsystems, growth is sometimes
rapid and at times it slows down.
 Rapid growth occurs during gestation and infancy.
 In the preschool years growth levels off. It slows
down again during school years.
 A spurt of growth occurs in puberty and early
adolescence. The pubertal growth broadens the
physical difference among boys and girls. Women
become the weaker sex but become physically
attractive to men.
Cont’d..

5. There is correlation in Development.
• Correlation in physical and mental abilities is
especially marked.
• There is marked relationship between sexual
maturation and patterns of interest and behavior.
Cont’d..

6. DEVELOPMENT COMES FROM MATURATION
AND LEARNING.
 The sudden appearance of certain traits that
develop through maturation is quite common; for
example a baby may start to walk literally
overnight. Behavioral changes occur at the time
of puberty suddenly without any reason.
Cont’d..

 Learning is development that comes from exercise and
effort on the part of an individual . Unless the child had
opportunity for learning, many of his hereditary
potentials will never reach their optimum
development.
 A child may have aptitude for musical performance
because of his superior neuromuscular organization
but if he is deprived of opportunity for practice and
systematic training, he will not reach his hereditary
potential.
 Maturation sets limits beyond which development
cannot go even if learning is encouraged. Intrinsic
growth is the gift of the nature. It can be guided, it can
not be created. Innate capacities however should be
stimulated by environmental factors.
Cont’d..

7. There are Individual Differences:
 Although the pattern of development is similar for all
children, each child follows a predictable pattern in his
own way and at his own rate.
 Each child with his unique heredity and nurture
(environment) will progress at its own rate in terms of
size, shape, capacity and developmental status.
 Mental development too is influenced by heredity and
environment. Therefore, we can not expect all children
of the same age to be ready for the same learning
experience at the same time.
Cont’d..

8. Early development is more significant
than later development.
 In building the house the foundations are more
important than the superstructure, so is the
development of physical and mental traits.
 Unfavorable environmental conditions during
prenatal and postnatal period can have damaging
effect on the later growth and development of
the child.
Cont’d..

9. Development proceeds in stages.
 Development is not abrupt; it proceeds in various
stages such as fetal, infancy, babyhood, childhood
and adolescence.
Cont’d..

10. Predictable patterns of Development.
 Both during the prenatal and postnatal period, two
laws of predictable pattern of development emerge.
 The Cephalocaudal law.
 The Proximodistal law.
Cont’d..

• According to the cephalocaudal law development
spreads over the body from the head to foot. This means
that improvement in structure and functions of the body
comes first in the head region than in the trunk and last
in the leg region.
• According to the proximodistal law development takes
placed from near to far that is outward from the central
axis of the body towards the extremities. In prenatal
period the head and trunk are fairly well developed
when the limb buds appear. Slowly the arms lengthen
followed by hands and fingers. Functionally too the baby
can use his arms before his hands and child can use the
whole hand before his fingers.
• Teeth also follow the predictable pattern of physical
development. The lower teeth erupt before the upper
teeth
Cont’d..

Patterns of Growth
 Both growth and development proceed in an
orderly manner. The development proceeds in a
cephalocaudal manner with the CNS leading the
other systems and developing far ahead of them.

• Neural Growth; The CNS growth rapidly and the
nervous tissues may be a quarter of the adult size
by the end of a year. Most of the growth of the
brain, spinal cord, eyes etc. are almost complete
by the age of 6-7 yrs.
• Somatic Growth or General Body Growth -
follows an entirely different course. The whole
process is characterized by a slow and steady
growth pattern with the spurts - One in the
prenatal period and other at adolescence. Some
peak of a middle spurt somewhere between the
age of 6 and 7 yrs.
• Lymphoid Growth; The lymphoid tissues also
show a very rapid growth in infancy and
childhood, so that the adult size is doubled by
about 10 yrs.
Cont’d..

• Genital Growth;
• This is the opposite of the neural growth
pattern.
• The genital organs continue to grow at a
very slow pace until adolescence, when
they grow rapidly.
Cont’d..

Physical Growth and Development
Physical growth can be divided into three
areas:
1. Biologic Growth; Changes in size and form
- Height
- weight
- Head and chest circumference
- Changes in body proportions
- Changes in body systems
2. Motor Development
3. Sensory Development.

1) Biological Growth;
a) Height; Growth of skeletal system is rapid
during the first years of life and then
decelerates to a slow, steady growth
through school age until pubescent growth
spurt.
b) Weight; Childs body weight is a good
indicator of nutritional status. Birth weight is
doubled within 3 months after which it
correlates fairly closely with the height
curves.

c) Head Circumference; Head circumference is an
important measurement since it is related to
intracranial volume.
d) Chest Circumferences; At birth chest circumference
is 30 cm. Barrel-shaped chest at birth becomes
elliptical, the transverse diameter increases with
growth and exceeds AP diameter.
e) Change in Body Proportions; Infants appear to have
big heads, large trunks and short extremities up to 2
yrs. In infancy midpoint of the body falls slightly
above the umbilicus and in adult it is at the
symphysis pubis.
Cont’d..
HC = 1/2 BL + 10 in cm.

f) Change in Body System;
• i) Cardiovascular system; The heart is more transversely
placed in the young infant. The apex being in the 4th Lt.
intercostals space till 4 yrs of age. It gradually moves
down to become more vertical due to assumption of the
real position and growth the chest and by 7-8 yrs the
apex lies in the 5th ICSpace in mid-clavicular line.
• ii) Lymphatic System; This is more hyperplastic during
childhood and after puberty the lymphatic tissue
undergoes involution.
• iii) Nervous System; The brain grows rapidly during
infancy, specially in the first year of life. 80% of total
brain growth is achieved by 4th yr. At birth brain weight
is 250-300 gms constituting 10 per cent of body wt. The
correlation of the skull size and the pattern of brain
growth has a definite and close relationship. H.C. can be
estimated during birth .
Cont’d..

iv) Special Senses:
• Eyes; The full-term newborn can distinguish between
light and darkness. Has defective binocular fixation.
Binocular fixation achieved by 4th - 5th months.
Withhead control comes the perception of small
objects by 7th month.
• Ears :The normal newborn exhibits his auditory acuity
to loud noises by crying. With head control child is
capable of turning the head towards the source of a
sound.
Cont’d..

• Nose: The nose is fully developed at birth and
functions perfectly.
• Sinuses and mastoids; The maxillary, ethmoidal and
sphenoidal sinuses are present at birth, but the frontal
sinuses begin to develop only after about 5-6 yrs.
• Digestive Systems :The month and oropharynx are well
developed to sucking and swallowing. Oesophagus is
variable in length and extends from 5-9 thoracic
vertebra. The stomach lies in transverse position in
first month of life. The intestines are underdeveloped
in its musculature as compared to adult. The
ascending colon is shorter while the transverse colon
and rectum are longer in neonates than older children
and adults.>
Cont’d..

• Liver: The liver is normally palpable below the
costal margin in infancy and early childhood.
The liver increases in weight more than 12
times from birth to childhood.
• Pancrease; Islet cells are noticeable from the
3rd foetal month and no new Islet cells are
formed after after 4th, 5th yrs.
Cont’d..

• Dentition :
• Eruption of teeth usually begins at
about 6 months but there may be variations
also upto I yr.
• 1 yr. All the 20 temporary teeth should have
erupted by 3 yrs of age.
• Permanent teeth starts coming from 6-7
yrs of age till 12-13 yrs of age.
• Ossification Centres At birth 5 ossification
centres are present - 2 in each knee (distal
femur and proximal tibial epiphysis) and 3 in
each ankle. At 6 months 2 Carpal bones in
wrist develops ossification centre.
Cont’d..

2) Motor Development:
• Motor development depends on the maturation
of the muscular, skeletal and nervous systems.
Motor development is usually termed as gross
and fine.
a) Gross motor development means acquisition of
mobility and independent locomotion. It
includes turning, sitting,
• standing and walking.
b) Fine Motor development evolves as the reflexes
give way to the acquisition of motor dexterity.
The child learns to use the fingers and thumb,
pincer grasp etc.

3) Sensory Development
Although the sensory system is functional
at birth, the child gradually learns the
process of associating meaning with a
perceived stimulus. Most acute at birth-are
the senses of taste and smell.

DEVELOPMENTAL THEORIES
 Personality and cognitive skills
develop in much the same manner as
biologic growth—new accomplishments
build on previously mastered skill. Many
aspects depend on physical growth and
maturation. First we will see the summary
of personality, cognitive and moral
development theories of various
Psychologists.

Stage/Age Psychosexual
Stage(Freud)
Psychosocial
Stage(Erikson)
Radius of
Significant
Relationship
(Sullivan)
Cognitive
Stage
(Piaget)
Moral
Judgment
Stages
(Kohlberg)
I Infancy
Birth to
1 Year
Oral sensory Trust vs mistrust Maternal
Person
( Unipolar-
bipolar )
Sensori-
Motor
Birth to 2
Year.
II Toddler
hood.
1-3 year.
Anal-urethral Autonomy vs
shame and
doubt
Parental
persons
(tripolar)
Pre-
operational
thought,
Preconceptual
phase
(transductive
reasoning)
e.g. specific-
to specific)
( 2-4 years)
Pre-
conventional
(premoral)
level
punishment
and
obedience
orientation.
III
Early
Childhood
3-6 years.
Phallic-
locomotion
Initiative vs
guilt.
Basic family Pre-
operational
thought,
intuitive
phase
(transductive
reasoning)
( 4- 7 years)
Pre-
conventional
(premoral)
level
Native
instrumental
orientation.
IV
Middle
Childhood
Stage/Age
Latency
Psychosexual
Stages
(Freud)
Industry vs
Inferiority
Psychosocial
Stages
(Erikson)
Neighbour-
hood.
Radius of
significant
Relationship
(Sullivan)
Concrete
Operations
(inductive
reasoning and beginning
logic.
(7-11 years)
Cognitive
Stages
(Piaget)
Conventional
level
Good-boy,
Nice-girl
orientation
Law and
order
orientation
Moral
judgment
Stages.
(Kohlberg)

V
Adolescence
12-19
years.
Genitality Identity and
Repudiation vs
Identity confusion.
Peer group
and out
groups.
models of
leadership
partners in
friendship,
sex,
Competition,
cooperation
Formal
operations
(deductive
and abstract
reasoning)
( 11-15 years)
Post
Conventional
or
principled
level
Social
contract
orientation.
VI
Early
adult
hood.
Intimacy and
solidarity vs
isolation.
Divided
labour and
shared
house-
hold
VII
Young
and
middle
adult
hood.
Generativity
and
self
absorption.
Mankind
“my kind”
VIII
Later
adult
hood.
Ego
integrity
Vs
despair.
Stage/Age Psychosexual
Stage(Freud)
Psychosocial
Stage(Erikson)
Radius of
Significant
Relationship
(Sullivan)
Cognitive
Stage
(Piaget)
Moral
Judgment
Stages
(Kohlberg)

PSYCHOSEXUAL DEVELOPMENTAL STAGE
( SIGMUND FREUD) :
 Most modern psychologist base their
understanding children at least partly on the work
of Sigmund Freud. His theories are concerned
primarily with the libido (sexual drive or
development). Although Freud did not study
children, his work focused on childhood
development as a cause of later conflict. Freud
believed that a child who did not adequately
resolve a particular stage of development would
have a fixation (compulsion) that correlated with
that stage.

PSYCHOSEXUAL DEVELOPMENTAL STAGE
( SIGMUND FREUD) :
 Freud described three levels of
consciousness: the id, which controls physical need
and instincts of the body; the ego, the conscious
self, which controls the pleasure principle of the id
by delaying the instincts until an appropriate time;
and the superego, the conscience or parental value
system. These consciousness levels interact to
check behavior and balance each other. The
psychosexual stages in Freud’s theory are the oral,
the anal, the phallic, the latency and the genital
stages of development.

Oral sensory stage: ( Infancy – Ages 0- 1
year )
 The newborn first relates almost entirely to
the mother (or someone taking a motherly
role), and the first experiences with body
satisfaction come through the mouth.
 Not only of sucking but also of making
noises, crying, obsessive eating and often,
breathing.
 Through the mouth baby expresses needs
and finds satisfaction and thus begins to
make sense of the world.
Cont’d..

Anal stage : ( Toddlerhood, 1-3 years )
 Interest during the second year of life
centers in the anal region as sphincter
muscles develop and children are able to
withhold or expel fecal material at will.
 At this stage climate surround toilet
training can have lasting effects on
children’s personalities.
Cont’d..

Phallic stage: ( Early childhood, 3-6 years )
 During the phallic stage the genitals become
an interesting and sensitive area of the
body.
 Children recognize differences between the
sexes and become curious about the
dissimilarities.
 This is the period around which the
controversial issues of the Oedipus (desire
to be a male) and Electra complexes (girls’
attraction with father). Penis envy and
castration anxiety are centered.
Cont’d..

Latency stage: ( Middle childhood, 6-12 years )
 During the latency period children elaborate
on previously acquired traits and skills.
 Physical and psychic energy are channeled
into the acquisition of knowledge and
vigorous play.
Cont’d..

Genital stage: ( Adolescence, 12-19 years)
 The last significant stage begins at puberty
with maturation of the reproductive system
and production of sex hormones.
 The genitals become the major source of
sexual tension and pleasure, but energies are
also invested in forming friendships and
preparing for marriage.
Cont’d..

PSYCHOSOCIAL DEVELOPMENTAL STAGE (ERIK ERIKSON):
 The most widely accepted theory of
personality development is that advanced by
Erikson (1963). Although built on Freudian
theory, it is known as the theory of
psychosocial development and emphasizes a
healthy personality as opposed to a pathologic
approach. Erikson also uses the biological
concepts of critical periods and epigenesist,
describing key conflicts or core problems that
the individual strives to master during critical
periods in personality development.

• Each psychosocial stage has two
components—the favorable and the
unfavorable aspects of the core conflict—and
progression to the next stage depends on
resolution of this conflict. No core conflict is
ever mastered completely but remains a
recurrent problem throughout life. No life
situation is ever secure. Each new situation
presents the conflict in a new form. For
example, when children who have
satisfactorily achieved a sense of trust
encounter a new experience (e.g.
hospitalization), they must again develop a
sense of trust in those responsible for their
care in order to master the situation.
Cont’d..

1. Trust vs mistrust (birth to 1 year)
• The first and most important attribute to develop for
a healthy personality is a basic trust; establishment
of basic trust dominates the first year of life and
describes all of a child’s satisfying experiences at this
age.
• Corresponding to Freud’s oral stage, it is a time of
“getting” and “taking in” through all the senses. Trust
exists only in relation to something or someone;
therefore consistent, loving care by a mothering
person is essential to its development.
• Mistrust develops when trust-promoting
experiences are deficient or lacking or when basic
needs are inconsistently or inadequately met.
Cont’d..

2. Autonomy vs shame and doubt (1 to 3 years)
 Corresponding to Freud’s anal stage, the problem of
autonomy can be symbolized by the holding onto
and letting go of the sphincter muscle.
 The development of autonomy during the toddler
period is centered around children’s increasing ability
to control their bodies, themselves, and their
environment.
Cont’d..

 Children want to do things for themselves by using
their newly acquired motor skills of walking,
climbing, and manipulating and their mental powers
of selection and decision making.
 Much of children’s learning is acquired through
imitating the activities and behavior of other.
 Negative feelings of doubt and shame arise when
children are made to feel small and self-conscious,
when their choices are disastrous, when others
shame them, or when they are forced to be
dependent in areas in which they are capable of
assuming control.
 The favorable outcomes are self-control and
willpower.
Cont’d..

3. Initiative vs guilt (3 to 6 years)
• The stage of initiative corresponds to Freud’s phallic stage
and is characterized by vigorous and intrusive behavior,
enterprise, and a strong imagination.
• Children explore the physical world with all of their senses
and powers. They develop their conscience.
• Children sometimes undertakes goals or activities that are
in conflict with those of parents or others, and being made
to feel that their activities or imaginings are bad produces a
sense of guilt.
• Children must learn to retain a sense of initiative without
impinging on the rights and privileges of others. The lasting
outcomes are direction and purpose.
Cont’d..

4. Industry vs inferiority (6 to 12 years)
• The stage of industry is the latency period of Freud.
• Having achieved the more crucial stages in personality
development, children are ready to be workers and
producers.
• They want to engage in tasks and activities that they can
carry through to completion; they need and want real
achievement.
• Children learn to compete and cooperate with others, and
they learn the rules.
• It is decisive period in their social relationship with others.
• Feeling of inadequacy and inferiority may develop if too
much is expected of them or if they believe they cannot
measure up to the standards set for them by others.
• The ego quality developed from a sense of industry is
competence.
Cont’d..

5. Identity vs role confusion (12 to 18 years)
• Corresponding to Freud’s genital period, the development
of identity is characterized by rapid and marked physical
changes.
• Previous trust in their bodies is shaken, and children
become overly preoccupied with the way they appear in
the eyes of others as compared with their own self-
concept.
• Adolescents struggle to fit the roles they have played and
hope to play with the current roles and fashions adopted
by their peers, to integrate their concepts and values with
those of society and to come a decision regarding an
occupation.
• Inability to solve the core conflict results in role confusion.
• The outcome of successful mastery id devotion and fidelity
to others and to values and ideologies.
Cont’d..

INTERPERSONAL DEVELOPMENTAL THEORY
(SULLIVAN)• Also built on Freudian theory, the
interpersonal development theory by Sullivan
emphasizes the interpersonal relationship in
which children engage and the importance
of social approval and disapproval in
developing a self-concept. What children
interpret as unfavorable interactions results in
tension and anxiety; the outcome of favorable
relationships is a sense of comfort and
security. Through repeated interactions
children acquire a repertoire of actions and
behaviors that produce a feeling of security
and avoid anxiety.

• The first interactions are those between infants and
their “mothering” figure, usually the mother, who
gratifies and comforts. This bipolar relationship
gradually extends to include others in the family
group. Between ages 2 and 5 , children not only
become more outgoing but also direct their social
gestures to a wider audience outside yet still near
the home land family, such as relatives and
neighborhood children. They engage in peer play,
family events, and other aspects of social learning.
Observational studies suggest that 2 to 3 years olds
are more likely than older children to remain near
an adult and to seek physical affection, whereas
the sociable behaviors of 4 to 5 year olds normally
consist of playful bids for attention or approval that
are directed at peers rather than adults.
Cont’d..

• During the school years, children enter into
a wider range of relationships with other
persons and authority figures at school and
in the community. They develop “chump
ships,” a special relationship between two
peers—the shared intimacy and common
interests of genuine friendships that are
lacking in earlier relationships. Personal
identity in adolescence is an outgrowth of
intimate relationships, first with friends of
the same sex then friends of the opposite
sex.
Cont’d..

COGNITIVE DEVELOPMENT
(JEAN PIAGET)
• Cognitive development consists of age-related
changes that occur in mental activities. The best-known
theory regarding children’s thinking, and a more
comprehensive developmental theory than those already
described, has been developed by the Swiss psychologist
Jean Piaget. According to Piaget, intelligence enables
individuals to make adaptations to the environment that
increase the probability of survival; through their
behavior individuals establish and maintain equilibrium
with the environment.
• Piaget proposes three stages of reasoning :
(1)Intuitive,
(2) concrete operational, and
(3) formal operational.

• When children enter the stage of concrete
logical thought at approximately 7 years of
age, they are able to make logical
inferences, classify, and deal with
quantitative relationships about concrete
things. Not until adolescence are they able
to reason abstractly with any degree of
competence.
Cont’d..

• According to Piaget, children proceed through the
stages of mental activity in an orderly and sequential
manner. The mechanisms that enable them to adapt
to new situations and to move from one stage to the
next are assimilation and accommodation. By
assimilation children incorporate new knowledge,
skill, ideas, and insights into cognitive schemes
(Piaget uses the term ‘schema’=pattern of action and
/ or thought.) already familiar to them. For new
situations that do not fit into an established schema,
children accommodate. They change and organize
existing schemas to solve more difficult tasks and
form new schemas, children’s understanding of a new
experience is based on all relevant previous
experiences.
Cont’d..

• Thus children achieve an accurate
understanding of reality and come to deal with
increasingly complex problems in an
increasingly effective manner.
• Piaget believed there are four major stages in
the development of logical thinking. Each stage
is derived from and builds on the
accomplishments of the previous stage in a
continuous, orderly process.
Cont’d..

• Sensorimotor (birth to 2 years)
– The sensorimotor stage of intellectual development consists of
six sub stages and that are governed by sensation in which
simple learning takes place.
– Children progress from reflex activity through simple, repetitive
behaviors to imitative behavior. They develop a sense of “cause
and effect” as they direct behavior toward objects.
– Problem solving is primarily trial and error. They display a high
level of curiosity, experimentation, and enjoyment of novelty
and begin to develop a sense of self as they are able to
differentiate themselves from their environment.
– They become aware that objects have permanence—the objects
exist even when no longer visible.
– Toward the end of the sonsorimotor period, children begin to
use language and representational thought.
Cont’d..

Preoperational ( 2 to 7 years )
• The predominant characteristic of the preoperational stage
of intellectual development is egocentrism, which in this
sense does not mean selfishness or self-centeredness but
rather the inability to put oneself in the place of another.
• Children interpret objects and events not in terms of
general properties but in terms of their relationships or
their use to them.
• They are unable to see things from any perspective other
than their own; they cannot see another’s point of view,
nor can they see any reason to do so.
• Preoperational thinking is concrete and tangible. Children
cannot reason beyond the observable, and they lack the
ability to make deductions or generalizations. Thought is
dominated by what they see, hear, or otherwise
experience.
Cont’d..

• Through imaginative play, questioning, and other
interactions, they begin to elaborate concepts and
to make simple associations between ideas.
• In the latter stage of this period their reasoning is
intuitive (e.g. the stars need to go to bed just as
they do).
• Reasoning is also transductive—because two
events occur together, they cause each other or
knowledge of one characteristic is transferred to
another. (E.g. all women with big bellies have
babies.)
Cont’d..

Concrete operations (7 to 11 years )
• At this age thought becomes increasingly logical
and coherent. Children are able to classify, sort,
order, and otherwise organize facts about the
world to use in problem solving.
• Develop new concept of permanence—
conservation i.e. they realize that physical factors
such as volume, weight, and number remain the
same even though outward appearances are
changed.
Cont’d..

• They are able to deal simultaneously with a
number of different aspects of a situation. They do
not have the capacities to deal in abstraction; they
solve problems in a concrete, systematic fashion
based on what they can perceive.
• Reasoning is inductive. Through progressive
changes in thought processes and relationship
with others, thought becomes less self-centered.
• Children can consider points of view other than
their own. Thinking has become socialized.
Cont’d..

• Formal operations ( 11 to 15 years )
• Formal operational thought is characterized
by adaptability and flexibility. Adolescents
can think in abstract terms, use abstract
symbols, and draw logical conclusions from a
set of observations, e.g. they can solve “ if A
is larger than B, and B is larger than C, which
symbol is the largest?” ( the answer is A)
• They can make hypotheses and test them;
they can consider abstract, theoretic, and
philosophic matters.
• They may confuse the ideal with the
practical; most contradictions in the world
can be dealt with and resolved.
Cont’d..

MORAL DEVELOPMENT (KOHLBERG)
• It is theorized that children develop moral reasoning
in an invariant developmental sequence. To understand
the stages in the development of moral judgment, it is
important to be aware of the stages of logical thought
and its relationships to cognitive development and moral
behavior. Moral development is based on cognitive
developmental theory and consists of three major levels,
each with two stages (Kohlberg, 1968)
• Kohlberg’s theory allows for prediction of behavior
but pays little attention to individual differences.
Questions arise relative to observed sex differences in
attainment of the various sequences of moral
development. It has been argued that the theory was
derived from interviews with male adults and may not
reflect feminine moral reasoning.

• The preconventional level of morality parallels the
preconceptual level of cognitive development and
intuitive thought. At this level morality is external
because children conform to rules imposed by
authority figures. Culturally oriented to the labels of
good/bad and right/wrong, children integrate these
labels in terms of the physical or pleasurable
consequences of their actions. The two stages of this
level are:
Stage: 1. The punishment-and-obedience orientation.
• Children determine the goodness or badness of an
action in terms of its consequences.
• They avoid punishment and obey unquestioningly
those who have the power to determine and enforce
the rules and labels.
• They have no concepts of the underlying moral order
that supports these consequences.
Cont’d..

Stage: 2.The instrumental-relativist orientation.
• The right behavior consists of that which
satisfies the child’s own needs (and
sometimes the needs of others).
• Elements of fairness, reciprocity, and equal
sharing are evident; they are interpreted in a
very practical, concrete manner without the
element of loyalty, gratitude, or justice.
Cont’d..

• At the conventional level children are concerned with
conformity and loyalty; actively maintaining,
supporting, and justifying the social order; and
personal expectations of those significant in their
lives. They value the maintenance family, group, or
national expectations regardless of consequences.
This level correlates with the concrete operational
stage in cognitive development and consists of two
stages:
Stage: 3. The interpersonal concordance or “good boy-
nice girl” orientation.
• Behavior that meets with approval and pleases or
helps others is viewed as good.
• Conformity to the norm is the “natural” behavior,
and one earns approval by being “nice”.
Cont’d..

Stage: 4. The “law and order” orientation.
• Obeying the rules, doing one’s duty, showing
respect for authority, and maintaining the social
order is the correct behavior.
• The rules and authority can be social or religious,
depending on which is most valued.
• At the postconventional, autonomous, or
principled level children have reached the
cognitive formal operational stage, and they
endeavor to define moral values and principles
that are valid and applicable beyond the authority
of the groups and persons holding these
principles. This level is not associated with the
individual’s identification with these groups.
Cont’d..

Stage: 5. The social-contract, legalistic orientation.
• Correct behavior tends to be defined in terms of general
individual rights and standards that have been examined
and agreed on by the entire society.
• Procedural rules for reaching consensus become
important, with emphasis on the legal point of view;
there is also emphasis on the possibility of changing law
in terms of societal needs and rational considerations.
• Agreement and contract outside the legal realm are
binding elements of obligation.
• The most advanced level of moral development is one in
which self-chosen ethical principles guide decisions of
conscience. These are abstract, ethical, and universal
principles of justice and human rights with respect for the
dignity of persons as individuals. It is believed that few
persons reach this stage of moral reasoning.
Cont’d..

Reflexes of the Normal Neonate;
1. Rooting reflex; By touching or stroking the
cheek near
the corner of the mouth and the Infant turns his
head in direction of the stimulation to find
food. It disappears at 3-4 months,of age.
2. Sucking Reflex; By touching the lips with the
finger or nipple or bottle or other object and
the infant tries to suck.
3. Swallowing Reflex; Accompanies the sucking
reflex and food
reaching the posterior of the mouth is
swallowed. It does not disappear.

4. Moro Reflex; Startling the infant with a loud voice or
apparent loss of support due to a change in equilibrium.
The neonate is held in a supine position above the table
or bed. Infants' head is suddenly allowed to drop
backwach an inch or so and there is generalized muscular
activity with symmetric abduction and extension of the
arms and legs with fanning of the fingers. Disappears by
3-4 months.
5. Palmar Grasp; Any object or finger placed in
newborn'sarm and the infant grasp the object by closing
fingers around it.
Cont’d..

6. Planter Grasp; By touching the sole of the foot at
the base of the toes and the infant grasp the
object ground the object by toes. Disappears at 8-
9 months of age.
7. Tonic Neck Reflex; When the infant is placed on
supine position turns the head to one side and the
arm and leg on the side on the side the head is
turned extend. Arm and leg on the opposite side
flex. Both hand may make fists. Disappears at 4-5
months.
Cont’d..

GROWTH & DEVELOPMENT OF
INFANT
1 MONTH
A.Physical or Biologic
• Weight 4.4 ± 0.8 kg (10 ± 1.5 Ib); gains
above 680 gm (1.5 Ib) a month during first 6
months, or 1 50 to 210 gm (5 to 7 oz) a week
• Length Approximately 53 ± 2.5 cm (21 ± 1
in); increases about 2.5 cm (I in) a month
during first 6 months

• Head circumference Increases about 1.5
cm (0.5 in) a month during first 6 months
• Pulse 130 ± 20
• Respirations 35 ± 10
• Blood pressure 80/50 ± 20/10
Cont’d..

• Reflexes Primitive reflexes govern
movements. Has well-developed sucking,
rooting, swallowing, and extrusion (tongue
thrust) reflexes, Moro reflex (startle reflex),
and asymmetric tonic neck reflex (head
turned to one side, one arm extended on the
same side, the other arm flexed to shoulder) .
Dance and doll's eye reflexes fading
Cont’d..

B. Motor
GROSS MOTOR
• Lies in flexed position. When prone, pelvis is
elevated
• but knees are not beneath abdomen as they
were after birth
• Head lags when baby pulled from a supine to
a sitting position
• Head sags forward when baby is held in sitting
position May lift head periodically when held
over adult's shoulder or placed in prone
position
Cont’d..

• Cervical curve begins to develop as infant
learns to hold head erect
• Turns head to the side when prone
• Makes crawling movements when prone on flat
surface Pushes with the feet against a hard
surface to move forward
FINE MOTOR
Holds hands in tight fists
• Can grasp an object placed in the hand
Cont’d..

Cont’d…
C. Sensory
• Startled by sounds (Moro reflex) Attentive to
speech of others Indefinite stare at
surroundings Fixates on objects brought in
front of eyes
• Notices faces especially and bright objects,but
only if they are in the line of vision
• Protective blinking in response to bright light
Follows a bright object to the midline of vision
if 6 to 8 inches from eyes

D. Psychosocial, Psychosexual, Spiritual
Development
PSYCHOSOCIAL
• Beginning development of sense of trust.
Negative counterpart:mistrust
• Totally egocentric Complete dependence on
,caregivers, usually mother Bonding
progresses Shows regard for human face.
• Activity diminishes when a human face can be
seen Establishes eye contact ,Smiles briefly
Quiets, cuddles, and moldswhen held
Perceives self and parents as one.
Cont’d..

E. Language, Speech Development
RECEPTIVE LANGUAGE Responds to human
voices
EXPRESSIVE LANGUAGE Opens and closes
mouth as adult speaks
• Utters small throaty sounds Utters sounds
of comfort when feeding
• Cry patterns developing.
Cont’d..

• Cries when hungry or uncomfortable
• Begins to coo
Play Stimulation
(Visual. Auditory, Tactile, And Kinetic)
• Hold, touch, and rock infant gently Talk and
sing softly to infant at close range
• Encourage mutual eye contact Provide pacifier
for sucking
Cont’d..

• pleasure Place cradle gym or crib mobile
within infant's reach Place large bright
pictures on crib or wall
• Repeat noises made by infant Coo to infant
Respond to crying signals Have ticking
clock, wind chimes, radio, television, or
music box nearby
• Provide soft, cuddly toys and clutch toys
too large to swallow
Cont’d..

• Use soothing lotion when massaging
infant's body Swaddle to soothe infant
Place infant when awake where household
activities are in progress
• Take infant for rides in carriage or car
• Provide regular periods of affectionate play
when infant is alert and responsive
Cont’d..

2 MONTHS
A. Physical or Biologic
• Posterior fontanel closed at 6 to 8 weeks of age
B. Motor
GROSS MOTOR
• Less fixed prone position: arms flexed, hips flat,
legsextended, head in mid position or side No
head droop when suspended in prone position
• Less head lag when pulled from a supine to a
sitting position Lifts head almost 45 degrees
above a flat surface when lying prone Holds head
erect in midposition Holds head erect when held
upright Turns from side to back

2 MONTHS
FINE MOTOR
• Hands may be open
• Holds a rattle briefly when placed in the hand

Cont’d…
C. Sensory
• Turns head to side when a sound occurs at
ear level
• When on back, follows a dangling object or
a moving light beyond the midline of vision
• Beginning binocular fixation and
convergence to objects nearby
• Eyes follow moving person nearby

Cont’d…
D.Psychosocial, Psychosexual
• Sense of Trust Distinguishes "mother" or
primary caregiver from others and is more
responsive to that person eye-to-eye
contact, & face orientation, smiling, and
vocalization are the evidences of
attachment between infant and parents,
especially the mother

Cont’d…
• Smiles back in response to another's smile.
This is the beginning of social behavior. The
true social smile may not appear until the
3rd month
• Has learned that crying brings attention

Cont’d…
E.RECEPTIVE LANGUAGE
Alert expression when listening
• Direct definite regard Soothed by
caregiver's, mother's, voice
EXPRESSIVE LANGUAGE
• Cry patterns develop
• Crying becomes differentiated, varying
with the reason for crying, e.g., hunger,
sleepiness, or pain. Pitch and intensity vary
• Responds vocally to caregiver's voice: "ah,"
"eh," "uh" Coos

Cont’d…
Play Stimulation (Visual, Auditory, Tactile, and
Kinetic)
• Same as at 1 month
• Offer a rattle, pull from supine to sitting
position Hold or dangle toy in front of infant
to encourage eye Movement
• Change patterns of objects from bright and
shiny to dull and dark for further stimulation
• Place in vertical infant seat so that
environment can be viewed from a different
angle

3 MONTHS
• Weight 5.7 ± 0.8 kg (12.3 ± 2 Ib)
• Length 60 ± 2 cm (23.5 ± I in)
• Pulse 130 ± 20
• Reflexes
• Grasping (palmar) reflex absent
• Landau reflex appears: an infant suspended in a horizontal
prone position with the head flexed against the chest reflexly
draws the legs up against the abdomen

B.GROSS MOTOR
• Symmetric posture of head and body
• Very slight head lag when pulled from supine to sitting
position
• Sits, back rounded, knees flexed when supported in sitting
position
• Raises chest, usually supported on forearms, when in prone
position Holds head erect and steady
FINE. MOTOR
• Hands open or closed loosely
• Holds hands in front of face and stares at them
• Holds object put in hand with active grasp
• Carries hand or object to mouth at will .
• Reaches for bright objects but misses them

Cont’d…
C. Sensory
• Turns head and looks in same direction to locate sound
• When on back, turns eyes to a dangling object or a moving
light to marginal field of vision
• (180 degrees) Binocular coordination (vertical and
horizontal vision) when an object is moved from right to
• left and up and down in front of face
• Regards toy dangled in midline of chest promptly
• Loses interest in objects that are suddenly removed from
the perceptual field
• Blinks at objects that threaten the eyes

Cont’d…
E.psychosodal, Psychosexual, Spiritual
Development
• PSYCHOSOCIAL
• sense of Trust
• Recognizes and smiles in response to (usually
the mother's) face
• Stop cying when familiar person approaches
interested in surroundings

Cont’d…
F. Language, Speech Development
• RECEPTIVE LANGUAGE Looks in direction of speaker
• EXPRESSIVE LANGUAGE
• Cries less
• Shows pleasure in making many sounds Vocalizes in
response to
• others: coos and chuckles May laugh aloud Babbles from
3rd to 8th month, but it is not linked with specific objects
or persons

Kinetic)
• Same as at 1and 2 months Encourage infant to
raise head when in prone position
• Pull baby to sitting position, thus encouraging
head control
• Hold bright toys in front of infant to encourage
reaching
• Provide greater variety of toys as baby shows
interest in playthings

4 MONTHS
• Drools between 3 and 4 months of age,
indicating increased production of saliva.
• Unable to swallow it, therefore, it runs
from mouth
Reflexes
• Tonic neck, Moro, sucking, and rooting
(when awake) reflexes absent; extrusion
reflex fading

Cont’d…
B.Motor
GROSS MOTOR
• Symmetric body postures predominate
• Sits with adequate support. Enjoys being propped up
• Holds head erect and steady when placed in sitting
position Lifts head and shoulders at a 90 degree angle
when on abdomen and looks around
• Attempts to roll or actually rolls over from front to
back Sustains small portion of own weight when held
in standing position
• Activates arms at sight of proffered toy

Cont’d…
FINE MOTOR
• Holds hand predominately open
• Brings hands together in midline.
• Plays with fingers
• Grasps object held near hand. Cannot pick it up
when dropped
• Grasps objects with both hands Attempts to
reach objects with hands but overshoots them
• Objects are carried to mouth
• Thumb apposition in grasping occurs between

Cont’d…
C. Sensory
• Follows moving objects well with eyes.
• Even the most difficult types of eye movements are
present
• Fairly good binocular vision
• Looks briefly for toy that disappears Accommodation
begins to
develop. Can accommodate to nearby objects
• Can focus on small objects.
• Stares at rattle placed in hand and takes it to the mouth
Recognizes familiar objects, such as feeding bottle and
toys
• Beginning hand-eye coordination
• Comforts self by sucking thumb or pacifier.

Cont’d…
D.Psychosocial, Psychosexual, Spiritual Development
PSYCHOSOCIAL
• Sense of Trust
• Smiles in response to smiles of others or when they appear nearby
• Initiates social play by smiling or vocalizing
• Shows evidence of wanting social attention and of increasing
interest in other family members Shows interest in new stimuli
• Fusses if left alone or bored, thereby demanding attention from
others Shows eagerness when feeding bottle appears
• Breathes heavily when excited
PSYCHOSEXUAL
• Oral Stage (0 to I year)
• SPIRITUAL
• Undifferentiated (0 to 1 year)

Cont’d…
• RECEPTIVE LANGUAGE Responds differently to
• pleasant or angry voice Does not cry when
scolded
EXPRESSIVE LANGUAGE
• Laughs aloud
• Vocalizes socially: coos and
• gurgles when spoken to Very "talkative" to self,
• people, or toys "Talking" and crying follow
• each other quickly Can vocalize consonants: b,
• g, h, k, n, p

Cont’d…
Play Stimulation (Visual, Auditory, Tactile,
and Kinetic)
• Hold, touch, and rock infant gently
• Smile when talking and singing to infant
• Encourage mutual eye contact
• Laugh when infant laughs
• Echo sounds that infant makes

Cont’d…
• Observe subtle clues from infant's body language and
respond to them
• Light tickling stimulates laughter Provide variety of
small multitextured (fuzzy, smooth) and colored
objects that infant can hold but not swallow
• Shake rattle placed in infant's hand
• Offer toys for grasping
• Move rattle around the infant so that it can be followed
visually and grasped.
• This helps develop hand-eye coordination and improve
head control

5 MONTHS
• Weight At least twice the birth weight.
Mean age for doubling birth weight is 3.8
months
• Physical growth slowing down
• Can breathe

Cont’d…
B. Motor
• GROSS MOTOR
• Sits with slight support
• Balances head well when sitting
• Holds back straight when pulled to a sitting
position
• Rolls from back to front

Cont’d…
FINE MOTOR
• Tries to obtain object beyond reach.
• Grasp object with whole hand
• Holds object while looking at another
C. Sensory
• position Pulls feet up to mouth when supine
• Can localize the sound made below the ear.
• Can fixate object 3 feet away.
D. Psychosoclal, Psychosexual, Spiritual Development
• PSYCHOSOCIAL
• Sense of Trust
• Smiles at self in mirror
• Begins to discriminate family members from strangers
• Accepts an object from another person
• Plays enthusiastically.
• Shows displeasure when toy is lost Pays with own feet

Cont’d…
• RECEPTIVE LANGUAGE Responds when own name
is spoken
• EXPRESSIVE LANGUAGE Squeals when happy or
excited
• Vocalizes displeasure when a desired object is
taken away
• Consonant sounds increase
• Sounds like vowels appear with consonants, such
as "goo" Begins to mimic sounds

Play Stimulation (Visual, Auditory, Tactile,
and Kinetic)
• Same as 4 months Provide sufficient
different objects for play (small objects
that are too large to swallow) Make various
sounds near ear
• Hold infant in standing position and
bounce to exercise legs and to develop
balance
Cont’d…

6 MONTHS
• Weight 7.4 ± 1 kg (16.5 ± 2.5 lb); gains about 340 gm (0.75
Ib) a month, or 90 to 150 gm (3 to 5 oz) a week during second
6 months
• Length 65.5 ± 3 cm (26 ± 1 in); gains about 1.25 cm (0.5 in) a
month during second 6 months
• Head circumference 43 cm (17 in). Increases about 0.5 cm
(0.25 in) per month during second 6 months
• Pulse 120 ± 20
• Teething Two lower central incisors erupt (6 ± 2 months)
• Begins to bite and chew

Cont’d…
B. Motor
• GROSS MOTOR
• Sits alone briefly if placed in a favorable leaning
positionon hard surface.
• Holds arms out Back is straight when sitting in high
chair
• Pulls to a sitting position Springs up and down when
sitting
• Lifts chest and upper abdomen when prone, putting
the weight on the arms and hands
• Turns completely over, with rest periods during the
turn.
• Infant must be protected from falling

Cont’d…
• Sustains most all of own weight when held in
standing position
• Hitches—moves backward when in a sitting position
by using the arms and hands
FINE MOTOR
• Grasps with simultaneous flexion of fingers: begins to
use fingers to feed self.
• Retains transient hold on two objects, one in each
hand.
• Drops one object when another is offered Begins to
transfer object from one hand to the other
Manipulates small objects
• Begins to bang objects that are held (rattles, spoon,
toy) Holds own bottle but may prefer for it to be held

C. Sensory
• Localizes sounds made above the ear
• Retrieves a dropped object that can be seen
and reached
• Enjoys more complex visual stimuli
• Moves in order to see an object
Cont’d…

Psychosocial/Psychosexual/spiritual
development:
• Sense of Trust
• Recognizes parents
Cont’d…

Cont’d…
• Recognizes strangers (5th and 6th month) as
different fromfamily members
• Begins to extend arms to be picked up
• Excites on hearing foot steps.

Cont’d…
• Laughs when head is hidden in a towel.
• Thrashes arms and legs when frustrated
• Imitation of others is beginning: sticking
tongue out
• Knows what is liked and disliked
Intellectual development
• Biggining of object permanence when
infant briefly searches for dropped object

Cont’d…
• RECEPTIVE LANGUAGE Recognizes familiar words
• EXPRESSIVE LANGUAGE Actively vocalizes pleasure
with cooing or crowing Cries easily on slight or no
provocation (withdrawal of a toy)
• Vocalizes several well-defined syllables
• Imperfect imitation begins (6 to 9 months)
• Shows enjoyment in hearing own vocalization
• "Talks" to image in mirror.
• May pat image of self if close to mirror

Cont’d…
Play Stimulation (Visual, Auditory, Tactile and Kinetic)
• Same as 4 and 5 months Encourage infant to look in a
mirror; repeat names of parts of face, such as mouth, nose,
and eyes Make funny faces for infant to
• imitate Point out people, food, objects and repeat their
names
• Talk to infant about own and surrounding activities
• Repeat infant's name
• Encourage response to simple commands
• Use the word "no" only when necessary
• Provide more complex soft cuddly toys Provide harder large
toys,

7 MONTHS
Reflexes
• Sucking and rooting reflexes disappear at 7 to 8 months
when asleep
• Parachute reflex appears between 7 to 9 months. An
infant suspended in a horizontal prone position and
towered suddenly will extend the hands forward to
provide protection from failing.
• This reflex continues indefinitely
Teething
• Upper central incisors erupt (7.5 ± 2 months)
• Lower lateral incisors erupt (7 ± 2 months)
• Ultimate color of iris is established

Cont’d…
B. Motor
• GROSS MOTOR
• Sits alone on hard surface, leaning forward on hands
• Lifts head as if trying to sit up when supine
• Control of trunk is more advanced
• Rolls more easily from back to abdomen

• Sustains all of weight on feet when held in
standing
• position Bounces actively when held in standing
position
FINE MOTOR
• Holds 2 toys at once
Cont’d…

Cont’d…
• Approaches a toy and grasps it with one
hand (uni dextrous)
• Transfers a toy from one hand to the
other, usually successfully
• Imitates simple acts of others
• Bangs objects that are held Uses a raking
motion to try to obtain small objects.
• Holds cup.

Cont’d…
C. Sensory
• Head turns in a curving arch to localize sounds
• Depth perception beginning to develop

Cont’d…
• Fixates on very small objects and details
• Discrimination between simple geometric
forms begins to develop
• Has preferences in taste for foods

Cont’d…
PSYCHOSOCIAL
• Sense of Trust
• Shows increasing fear of strangers (7 to 8
months)
• Actively clings to a familiar person when
distressed
• Unhappy when caregiver, usually mother,
disappears
• Responds socially to own name
• Emotional instability—rapidly changes from
crying to laughter
• Closes lips tightly when disliked food is
offered

Intellectual development:
• Demonstrate expectation in response to
repetition of stimuli.
Cont’d…

Cont’d…
• RECEPTIVE LANGUAGE Recognizes own name
Responds with gestures to words such as "come"
• EXPRESSIVE LANGUAGE Vocalizes eagerness Vocalizes
"m-m-m" when crying
• Imitates simple noises and speech sounds
• Makes polysyllabic vowel sounds
• Vocalizes "da," "ma," "ba"
• Babbling decreasing
• Some jargon (own language)
• Vocalizes with adult like inflections when others are
speaking

Play Stimulation (Visual, Auditory, Tactile and
Kinetic)
• Same as 4, 5, and 6 months Place toy under
blanket and
• encourage infant to find it Repeat simple sounds:
"dada," "mama" Provide objects or food that can
• be bitten and chewed safely Continue to
encourage playing in water and perhaps
"swimming" in shallow tub or pool Encourage
banging of toys and clapping hands on objects
• Continue to help infant learn balance

8 MONTHS
• Beginning of a pattern in bowel and bladder
elimination

B. Motor
GROSS MOTOR
• Sits alone steadily
• Pulls self into standing position with help
• Hand-eye coordination is perfected so that
random reaching and grasping no longer occur
Cont’d…

FINE MOTOR
• Holds 2 objects while looking at a third
• Persistently reaches for objects beyond range
of grasp
• Releases objects from hands voluntarily
Cont’d…

• Complete thumb apposition
• Pincer grasp beginning to develop, using the
fingers against the lower portion of the thumb
• Eats finger foods, such as crackers, that can
be held in one hand
• Drinks from cup with assistance (7 to 9
months)
Cont’d…

Cont’d…
C. Sensory
• Recognizes familiar words and sounds

Cont’d…
C. PSYCHOSOCIAL
• Sense of Trust
• Greets strangers with joy or bashful behavior,
turning away, crying or even screaming
• Refuses to play with strangers
• Separation or stranger anxiety, to be
distinguished from anaclitic depression, occurs
between the 6th and 8th months; caused by the
infant's increased capacity to discriminate
between family members, close friends, and
strangers

Cont’d…
• Affection for or love of family members
appears stretches arms to loved family
members increased anxiety over loss of
parent, especially mother motional
instability still evident
• Just likes changing clothing and diapers

Cont’d…
• SYCHOSEXUAL Oral Stage (0 to 1 year)
• SPIRITUAL
• Undifferentiated (0 to 1 year)

Cont’d…
• E. INTELLECTUAL Sensorimotor Stage
Substage III:
• Secondary Circular Reaction (4 to 8
months)
• Knows that objects are separate from self
• Searches briefly for objects seen being
placed elsewhere.

Cont’d…
• The search is confined to only one
modality
• Actions to produce a result have been
memorized
Substage IV:
• Coordination of Secondary Schemas (8 to
12 months)
• Perception of space becomes refined
between 8 – 12 months

Cont’d…
• Abilities learned earlier are combined and
extended to deal with new situations: behavioral
and
• perceptual patterns are coordinated and applied
to new situations
• Object permanence progresses and is related to
the increasing ability to deal with matters of time
and space.

Cont’d…
• Perceptions of space become refined
between 8 to 12 months
• Beginning perception of cause and effect
relationship
• Early beginning of anticipatory and
intentional behavior
• Problem solving beginning to develop

Cont’d…
E. LANGUAGE :
RECEPTIVE LANGUAGE
• Stops activity when own name is spoken
• Beginning to understand meaning of "no"
EXPRESSIVE. LANGUAGE
• Shouts for attention
• Imitates sound sequences
• combines syllables: "da-da,“ "ma-ma" (nonspecific
meaning)
• Can vocalize consonants d, i,and w

Cont’d…
Play Stimulation (Visual, Auditory, Tactile, and Kinetic)
• Hold, touch, and rock infant gently
• Talk and sing to infant Place infant in a sitting position
against a wall and encourage leaning away from the wall
to improve balance
• Gently push infant from a sitting position to improve
balance

9 MONTHS
• Reflexes
– Plantar grasp absent ,
• Teething
– Upper lateral incisors erupt (9 -2 months)

Cont’d…
B. Motor
GROSS MOTOR
• Raises to a sitting position alone with good
coordination
• Sits steadily for longer period of time

Cont’d…
• Recovers balance when leaning forward,
but not sideways
• Crawls instead of hitching. Crawling may be
done as early as the 4th month; the
average age is 8 to 9 months.
• Creeping. This is a more advanced type of
locomotion than crawling. The trunk is
carried above the floor, but parallel to it.
• The infant uses both hands and knees in
moving forward.
• Beginning to pull self to standing position
alone while holding on to furniture

Cont’d…
FINE MOTOR
• Bangs two objects together
• Pokes objectives with fingers
• Uses thumb and index finger in early pincer grasp
• Has preference for the use of one dominant hand
• Holds own bottle with good hand-mouth
coordination.
• Puts nipple in and withdraws it from mouth at will
• Drinks from cup with some spilling (9—12 months)
• Attempts to use a spoon but spills contents

Cont’d…
C. Sensory
• Head turns directly to source of sound
• Increased depth perception
• Recognizes by looking or moving toward
familiar object when named
• Able to follow objects through transition
from one place to another

Cont’d…
Psychosocial, Psychosexual, Spiritual Development
• PSYCHOSOCIAL
• Sense of Trust
• Knows what "no" means
• Beginning to play simple games
with adult such as "so big," "bye-bye"
• Caregiver, usually mother, becoming more important as a
person
• Wants to please caregiver,usually mother
• Beginning fears about being left alone, as when put into
the crib
• Dislikes having face washed so covers face with arms and
hands

E. Intellectual development:
• Able to follow through transition from 1 place
to another
Cont’d…

E. Language :
RECEPTIVE LANGUAGE
• Stops activity in response to "no"
• Beginning to respond to simple commands
given verbally
• Responds to adult anger
Cont’d…

EXPRESSIVE. LANGUAGE
• Cries when scolded Echolalia or correct
imitative
expression of sounds made by others (9 to
10 months)
• Association of words with persons or
objects.
• Says "ma-ma," "da-da" as names of
persons
• Intonation beginning to become patterned
through imitation
Cont’d…

Kinetic)
• Same as 8 months Encourage exploration of
toys with eyes and fingers (examine and poke)
• Show infant large pictures in book
• Encourage to bang two toys together
• Continue to vocalize with infant Play infant
games such as "so big" and "bye-bye," with
appropriate motions
Cont’d…

Cont’d…
• Begin to play "peek-a-boo" (covering the
infant's face with a towel) and "pat-a-cake,"
• with appropriate motions
• Encourage crawling by moving a toy away
from the prone infant Encourage creeping by
playing
• "wheelbarrow" (infant walks on hands while
adult holds the body up at the hips or legs)
• Help infant learn to stand by encouraging
reaching for an object held overhead Provide
a larger environment in which the infant can
move safely: crawling, creeping, cruising

10 MONTHS
A.Motor
GROSS MOTOR
• Moves from prone to sitting position
• May sit by falling down from standing
position

• Sits steadily for indefinite period of time.
• Does not want to lie down unless sleepy
• Creeps well Pulls to standing position well,
holding to the crib rail o other support
• Cruises well (walks sideways while holding
on to a supporting object with both hands)
Cont’d…

• Makes stepping movements forward when
two hands are held
FINE MOTOR
• Picks small objects up with index finger and
thumb (pincer grasp)
• Releases an object after holding it brings
the hands together
Cont’d…

Cont’d..
C. Sensory
• Marked interest in very small objects
• Searches for a lost toy with greater
persistenc

Cont’d…
E. Psychosoclal, Psychosexual, Spiritual
Development
• PSYCHOSOCIAL
• Sense of Trust
• Expresses several beginning recognizable
emotions such as anger, sadness, jealousy,
anxiety, pleasure, excitement, and
affection

Cont’d…
• Plays social games with adults, such as "pat-a-cake" and "peek-a-
boo"
• May object to being away from parent
• Improves in the ability to imitate others: imitates facial expressions
Shows preference for one toy over another Offers toy to another
but will not release or give it up Looks at pictures in a book with
another person
• Attracts the attention of others by pulling on their clothes or fussing
• Whatever action that attracts attention is repeated
• Intellectual development:
• Demonstrate independence in dressing.
• Develops objects permanence.

Cont’d…
E. Language :
RECEPTIVE LANGUAGE
• Understand simple commands: gives a toy
on a request that is accompanied by
gestures
EXPRESSIVE LANGUAGE

Cont’d…
• May speak one word besides
• "ma-ma" and "da-da," such as "no," "hi"
• Understands meaning of "bye-bye" and
waves
• Imitates adult's inflection, pitch variations
• Imitates sounds of animals.

Cont’d…
Play Stimulation (Visual, Auditory, Tactile, and Kinetic)
• Same as 8 and 9 months Obtain infant's attention
when requests are made and use gestures to indicate
meaning Make facial expressions and sounds that
infant can imitate Show infant a cardboard or cloth
• picture book Continue infant games, including "pat-a-
cake" and "peek-a-boo," with appropriate motions
Provide opportunities for holding and releasing
objects
• Encourage cruising by placing furniture in a circle
• Encourage infant to bounce in a standing position by
holding the hands for support Place infant in a jumper
seat to encourage standing and jumping

11 MONTHS
B. Motor
GROSS MOTOR
• Stands erect with minimal support and lifts one foot to
take a step
• Cruises: walks holding on to furniture
FINE MOTOR
• Explores toys and other objects more carefully
• Removes covers from boxes
• Takes toy out of box or cup Puts toy inside box or cup but may
not let go yet Beginning to hold a crayon and make a mark on
paper
C. Sensory
• Tilts head backward to see upward

Cont’d…
D. PSYCHOSOCIAL
• Sense of Trust
• Shows pleasure when a desired act is
accomplished
• Becomes frustrated when activities are
restricted
• Asserts self among family members Seeks
approval, avoids disapproval

E. Intellectual :
• Anticipates body gestures when a familiar
nursery rhymes or stories being told.

RECEPTIVE LANGUAGE
• Responds to simple questions: for example,
"Where is the kitty?" by pointing and
looking toward object
EXPRESSIVE LANGUAGE
• Imitates specific speech sounds of others
Cont’d…

Cont’d…
Kinetic)
• Same as 8, 9, and 10 months
• Provide opportunities for placing small objects
into larger objects and for taking them out
again
• Play simple games such as rolling a ball to
infant. Show infant how to "throw" it back
• Encourage play with other persons
• Encourage infant to stand alone by gradually
decreasing support (furniture or adult's hands)
• Place infant in a walker and encourage letting
go by offering a toy to grasp

12 MONTHS
A. Physical Growth and Development
Physical or Biologic
• Weight 10 ± 1.5 kg (22 ± 3 pounds); has tripled birth
weight
• Length 74.5 ± 3 cm (29 ± 1.5 inches); length has
increased by almost 50 per cent from birth
• Head circumference 46 cm (18 inches); head
circumference has increased by one third since birth
• Brain weight has increased rapidly since birth,
resulting in significant developmental achievements
• Head and chest are equal in circumference
• Anterior fontanel closes between 12 and 18 months

• Pulse 115 ± 20
• Reflexes
• Babinski reflex disappears
• Teething Has 6 to 8 deciduous teeth
• Lumbar curve and the compensating dorsal
curve develop as walking continues
• Physiologic stability achieved and
maintained during first year
Cont’d…

B. Motor:
GROSS MOTOR
• Stands alone for variable length of time
• Sits down from standing position alone
• Walks in few steps with help or alone (hands
held at shoulder height for balance
• Improves competence in motor skills through
practice
FINE MOTOR
• Good pincer grasp
• Picks up small bits of food and transfers them
to mouth.
Cont’d…

• Enjoys eating with fingers
• Attempts to put a small pellet into a narrow-
necked
bottle but does not succeed Releases one or more
objects inside another object or container
• Attempts to put one block on top of another but
does not succeed
• Turns pages in a book but usually not one at a
time Drinks from a cup and eats from a spoon
but still requires some held
• Holds crayon adaptively to make a stroke or a
mark on a piece of paper
Cont’d…

C. Sensory
• Listens for recurring sounds
• Full binocular vision well established.
• Follows fast-moving object with eyes
• Discriminates simple geometric
forms: squares, circles
• Visual acuity: 20/100 to 20/50
Psychosocial, Psychosexual, Spiritual
Development
Cont’d…

D. PSYCHOSOCIAL
• Sense of Trust theoretically achieved.
• If not, a sense of mistrust predominates
• Infant's emotion, such as fear, jealousy, anger, can be more clearly
interpreted
• Attachment developed to primary caregiver(s)
• Clings to caregiver, usually mother, when fearful explores away
from caregiver if secure
• Responds to requests for affection such as a kiss or a hug
• Has established beginning view of self as a separate person
"Security blanket" or favorite toy beginning to provide comfort
• Cooperates in dressing: puts arms through sleeves, feet into shoes.
• Takes off socks
• Drops objects on purpose so someone can pick them up
Cont’d…

E. INTELLECTUAL:
• Object permanence
• Early beginning of anticipatory &
intentional behaviour.
• Problem solving beginning to develop
although the infant has not leart to think.
Cont’d…

RECEPTIVE LANGUAGE Responds with
gestures or actions to more complex verbal
requests, such as "Please give it to me"
EXPRESSIVE LANGUAGE
• May speak two or more words besides
"ma-ma" and "da-da"
Cont’d…

• Understands meaning of many more words than
can be spoken
• Knows names of increasing number of objects
• Imitates sounds animals make
• Intonation becoming more like adult speech
• Continues using jargon
• Indicates "no" by shaking head
• Beginning voluntary control over responses to
sound: may or may not respond or may delay
response to another's voice
• Vocalization decreases as walking increases
Cont’d…

F. Play Stimulation (Visual, Auditory, Tactile, and Kinetic)
• Same as 8, 9, 10, and II
• months Provide large crayons for drawing
• Provide stacking discs or blocks Provide objects to place inside
• larger containers Place infant in walker several times a day to
encourage walking movements
• Encourage infant to push a chair or stroller around
• Provide push-and-puil toys toencourage walking
• Give infant "piggyback" rides to improve balance
• Encourage infant to walk, eventually holding only one hand
• Provide roughhouse activity
• Provide increasing visual, auditory, tactile, and kinetic stimulation.
Cont’d…

AGE 15 MONTHS
A. Motor
Gross. Motor;
- Assumes standing position without support.
- Walks without support from 13 months of age
- Looses balance when walking around corners or
stopping suddenly.
- Kneek without support
- creeps up staires
- Throws small objects repeatedly & picks them up again
but may fall.
- Cannot throw ball without falling.
Fine Motor:
- Builds a tower 2-3 cubes
- Opens boxes, pokes finger in hole
- Scribbes spontaneously, makes line with crayon.

- Pats pictures in books & begins to turn pages.
- Inserts pellet in a narrow packed bottles.
- May give up bottle.
- Holds a cup with all fingers grasped about it.
- Cannot fill the spoon well. Spoon is likely to
be turned upside down before reaching
mouth.
- Enjoys finger feeding.
- Sticks out arm & leg to help in dressing.
- Removes socks.
- Indicates when diaper is wet or soiled
Cont’d…

C. Sensory;
- Sound localization indicated by head movement
in all planes.
- Binocular vision fully developed.
- Displays an intense and prolonged interest in
pictures.
- Can identify geometric forms & place bound
object into its approximate place or hole.
Cont’d…

Development
Ego centric
- Tolerates some separation from parent
- Less fearful of strangers
- Coping decreased in unfamiliar environment.
- Paternal person increasingly significant
- Hugs & kisses parents
- Kisses pictures in book
- Begins to imitate parents doing housekeeping
chores
- Very early temper tantrums.

D. Intellectual Development
- Experiences only the present.
Lanquage development:
- Comprehends more than can communicate
- Recognizes names of various parts of body.
- Responds to familiar, simple commands.
- Says 4-6 words including names
- Asks for objects by pointing.
- May use head shaking gesture to denote "no"
- Communicates "No" even when following a
request.
Cont’d…

AGE 18 MONTHS
A. Gross Motor;
- Walks sideways & backwards
- Walks upstairs with one hand held
- Runs clumsily, falls often
- Moves quickly from place to place.
Jumping attempted both feet.

Seats self in small chair
- Climbs on furniture
- Gets into everything: explores drawers etc.
- Pulls & pushes toys
- Pushes light furniture around room.
- Throws ball overhand without falling.
Fine Motor;
- Builds Tower of 3-4 Cubes
- Scribber vigorously and imitates a vertical stroke
with crayon.
Cont’d…

- Turn pages in a book 2-3 at a time.
- Puts block into hole
- Transfer objects hand to hand at will.
- Holds cup with both hands. Hands it to
caregiver, put sit down or drops it on floor.
- Eats with spoon, may play with food
- Negativism and high activity level may
interfere with eating.
- Removes simple garments
- May complain when wet or soiled
- increased readiness for bladder & bowel
control.
- May swear faces.

C. Sensory;
- Cans see pictures thus has intense
interest in pictures.
- Identifies various shapes
- Convergence well established.
- Some depth perception
Cont’d…

- Temper tantrums may be more evident
- Less fear to strangers
- Seeks helps from others when in trouble
- May resist sleep for sometime after being put to bed.
- Calls for primary caregiver
- Thumb sucking may peak, especially before or
dursing sleep for comfort
- kisses parents
- imitates, parents behaviour & domestic activities.
- Begining awareness of ownership: possessiveness
begins,
- Awareness of gender identity begins
Development

E. Intellectual development
- Concept of object permanence is fully
developed is comforted when nearing parent's
voice even if parent cannot be seen.
- Can differentiate self from object.
- short attention span.
- Beginning sense of time & anticipation of
events.
- Begins to think
- Beginning traces of memory
- Experiments actively to achieve goals.
Cont’d…

F. Language _Development:
- Identified pictures of familiar objects when
named
- Identified one or more parts of body
when named
- Speaks 10 real words
- uses words more than gestures to express
desires
- Points to a common object, e.g. shoe or
ball
- About 25% of vocalizations are intelligible
- One word used to communicate
Cont’d…

AGE 24 MONTHS
A. Gross Motor;
- More grown up, steady gait.
- Can walk with heel-toe gait
- Walks backward well in imitation
- Runs more quickly in more controlled way;
has fewer falls.

- Walks up & down stairs, both feet on one
step at a time, holding onto a railing or
the wall.
- Jumps crudely with both feet in place
- Kicks large ball without falling.
- Picks up object from floor without losing
balance,
Fine Motors
- Builds a tower of 6-7 cubes
- Scribbles in more controlled way.
- Imitates a circular and horizontal stroke.

- Turn one page of a book at one time.
- Opens door by turning door knob; may
run away
- Unscrews lid of jar.
- Folds paper once imitatively.
Cont’d…

- Is proud of accomplishment of motor skill,
Self Care;
- Drinks well from a small glass held in one
hand
- Plays with food, can use straw
Cont’d…

- Removes most of own clothing
- Verbalizes toilet needs
- Toilet-trained in daytime generally
- May brush teeth with help
- Attempts to wash self in tub or shower
C. Sensory;
- Accommodation well developed
- inserts square objects into its appropriate
place or hole.

- Separation anxiety from primary caregiver
is at height
- Has great sense of possessiveness
- Behaves as though other children were
physical objects
- Pulls other persons to show them
something
- Does not readily ask for help.
- Sleep resisted overtly; has many demands
before bedtime,
D. Psychosocial, Psychosexual, Spiritual Development

- Thumb sucking decreases
- Temper tantrums decreasing
E. Intellectual Development:
- preoccupation with symbols in language,
dreams and fantasy.
- Attention span longer
- Memory increases
- Very early understanding of past, present
and future.

- increased sense of time.
- Symbolic thought begins, can "pretend".
- Imitation becoming more symbolic
- Moral
If punished for doing it/ it's wrong; if not
punished, it must be right.
F. Language Development
- Understands more complex sentences

- Enjoys stories with pictures
- Has vocabulary of about 300 words
- Refers to self by first name
- Uses pronouns - 'I'/ 'me', 'you',
- Verbalizes need for toileting, food or drink.
- Talks incessantly
- About 66% vocalization are intelligible.

AGE 30 MONTHS
A. Gross Motor;
- Stands on one foot alone momentarily
- Walks on tiptoe for few steps on request
- Walks up & down stairs, one foot on a step
- jumps from step or loss chair.
- Jumps with both feet.
- Can throw a large ball overhand
- Rides a walker or pedal car.
FINE MOTOR
- Builds tower of 8 cubes
- Makes vertical & horizontal strokes but may or may not join
them to make across.
- Holds cray on with Fingers instead of entire hand.
- Good hand finder coordination; moves ringers.

Self care:
- Self feeding with occasional spilling
- Gets a drink without assistance
- Chews with mouth closed
- puts arm through large armhole
- Buttons & unbuttons large front buttons
Cont’d…

- Help puts thing away
- Has mastered daytime bladder control
- Beginning night time bladder control
- May go to toilet byself .
- Adequate attempt to wash hands
C. Sensory:
- Visual acuity: 20/30
- Recall visual images.
Cont’d…

- Sense of shame & doubt predominates
- Egocentrism still present
- Separates more easily from parent
- Ritualistic behaviour speaks
- Reluctant to go to bed
- Temper tantrums may or may not decrease

- in play, helps put things away, can carry
breakable objects, pushes with good
steering.
- Begins to notice sex differences; knows
own sex.
- May attend to toilet needs without help
except for wiping.
E. Intellectual Development:
- Concept of time improved but still limited.
- Begins casual thinking
- Problem-solving through trial & error

F. Language Development;
- Identifies five body parts when named
- Gives full name if asked
- Refers to self by appropriate pronoun
- Uses pleurals & past tense of verbs.
- Talks constantly
- Asks why?
- Uses 4-5 words sentences.
- About 75% of vocalizations are intelligible,
Cont’d…

AGE 3 YEARS,
A. Gross Motor:
- Walks a straight line
- Walks backward & on tiptoes

- Runs without looking at feet
- Jumps of bottom step
- Rides tricycles
- Goes upstairs using alternate feet.
Fine Motor
- Builds a tower of 9-10 blocks.
- Copies a circle
- Uses blunt scissors with one hand to cut.
- Puts beads on strings.
- Can help with simple household work.
Cont’d…

Self care,
- Can put on coat without assistance
- Can undress self in most instances.
- Can pull pant up & down
- Can go to toilet alone
- Brushes teeth with help.
Cont’d…

C. Sensory:
Visual acuity 20/20

- Egocentic in thought & behaviour
- Alternative between reality & imagination.
- Dresses self almost completely if helped
with back buttons and told which shoe is
right or left.
- Pulls on shoes
- Fears the dark
- May have dreams and nightmares.

- Knows own sex & sex of others
- Less dependant on parents but needs
reassurance and help.
- Can help to set table; Can dry dishes
without breaking any.
F. Intellectual
- Language acquisition
- Tries to please & conforms to requests.
- Able to follow directional command
• Has a beginning understanding of time.

G. Language Development
- Has vocabulary of about 900 words
- uses 4 word sentences
- Talks incessantly.
- Repeats sentences of six syllables.
- Asks many questions
- Names figures in a picture
Cont’d…

AGE 4 YEARS-
1. Gross Motor;
- Skips and hops on one foot
- Jumps from greater heights
- Pedals a tricycle quickly; turn sharp corners.
- Catches ball with extended arms and with
hands
- Climbs, ladder, trees, playground
equipment
- Walks down stairs using alternate footing.
Fine Motor::
- Cuts around picture with scissors

- Draws a simple face
- Copies a square
Self Care;
- Manages spoon with little spilling
- Buttons side buttons, small buttons
- Can put on shocks with help.
- Can lace shoes, but may not be able to tie bow.
- May bathe self, with assistance,
- Vsadhes and dries hands without supervision.
Cont’d…

C. sensory
- Visual acuity 20/20
Cont’d…

- Tends to be impatient and selfish.
- Usually separates easily from parents
- Physically &verbally aggressive
- Still has fears
- Dreams & nightmares continue.
- Sexually curious
Development

- Demonstrates strong attachment for parent
of opposite sex
- Jealousy of sibling may be evident
- More cooperative in play
E. Intellectual Development;
- Classified objects according to one
characteristic,
- Not able to conserve matter.
- Obeys because parents set limits.
- Highly imaginative.
- Uses alibis to excuse behaviour

F. Language Development
- understands directives (On, under, in back,
in front)
- Names one or more colours correctly
- uses I
- Uses 3-7 wors sentences.
- Has a vocabulary of 1500 words
Cont’d…

AGE 5 YEARS
1. Gross Motor :
- Skips & hops one alternate feet
- Throws and catches ball well.
- Jumps rope and jumps over object
- Skates with good balance
- Walks backward with heel to toe
- Balances on alternate feet with eyes closed.
Fine Motor;
- Copies a triangle & diamond
- Copies letters, may be able to write own name.
- Adds 7-9 parts to stick figure.
- uses scissors, pencils very well.
Self Care;
- Select form over spoon when appropriate

- May be able to lace shoes.
- Bathes Self
- Combs hair
- wipes self independently.
B. Sensory;
Visual acuity 20/20

- Separates easily from parents
- Less rebellious & quarrelsome
- Independent it trustworthy
- Has fantacies & daydreams
- Looks for parental support & encouragement
- Engages in co-operative play
- Strongly identifies with parent of same Sex,
specially boys with their fathers.
- Enjoys activities e.g. sports, cooking,
shopping with parent of same sex.

E. Intellectual _Development;
- Classifies objects according to relationships that
are similar.
- accurately describes events.
- Aware of cultural differences
- Very curious
- Use time-oriented words with increased
understanding.

_F. Language Development:
- Has vocabulary of 2100 words
- Uses sentences of 6-8 words
- Names primary colours
- Knows names of days of week, months & other
time associated words
- Can follow three commands in succession.
Cont’d…

AGE 6-8 YEARS,
A. Gross Motor:
- Rides bicycle without training wheels.
- Runs, jumps, climbs, hops
- Constantly in motion
- Coordination improving
Fine Motors
- Knows right from left hand
- Draws a person with 12-16 parts
- prints words - learns cursive writing
- Has improved eye-hand coordination

Self Caret
6 Years - like to eat with fingers
- Talkative while eating
7 Years - Improved table manners
- less talking.
- Has a tendency to dawdle in bathtub
- Needs to be reminded to wash hands
- Weaves whatever is selected by parents
- Leaves clothes where they are removed
- Can brush and comb hair
- sensory;
Cont’d…

- is becoming real member of the family group
- Take parts in group play
- Boys prefer playing witn boys; girls prefer playing
with girls.
- spends a lot of time alone.
- Jealous of Siblings
- Fears injury to body
- Insists on being first is everything
- Has a "know it all" attitude.
- Does what are adults seen doing
- Has own way of doing things
- May steal or may cheat to win

F. Intellectual Development;
- Attention span increasing
- Can describe objects in picture, knows their use
- Can see differences more than similarities
- Can tell time
- Knows date, month & season
- Is learning to read
- follows rules to avoid punishment
Cont’d…

F. Language Development;
- Follows series of 3 commands, response
dependent on mood.
- Responds to praise & recognition
- Can repeat sentences of 10-12 words
- uses all forms of sentence structure
- Develops a sense of humor, enjoys telling jokes.
Cont’d…

A. Gross Motor
- perform tricks on bicycles; races
- Begins to participate in organized sports.
- Throws a ball skillfully - over hand or under hand
Fine Motor;
- Uses both hands independently.
- Draws a person with 18-20 parts
- Has increased smoothness and speed in fine motor
control.
- Cursive writing improved.
8-10 Years

Self Care:
- Handles eating utensils skillfully
- Dresses self completely, enjoys selecting
own clothes.
- Unaware of dirty clothes
- Needs to be reminded to brash teeth.
C. Sensory
Visual acuity of adult value.
.

- Becoming piece oriented
- Is easy to get along with at home
- Is more sociable and better behaved.
- Compare self with others
- Enjoys scouts, group work etc.
- Relationship with siblings a improved

- Begins hero worship
- Curious about everything
- Interested in boy-girl relationship but will
not admit it.
F Intellectual Development;
- Give similarities and differences between
two things from memory.
- Counts backward
- Interested in school work

- Time -usually punctual.
- Repeat days of the week, and months in order;
knows the date.
- Describes common objects in detail.
- Attend 3rd or 4th grades.
- Reads more. Reads classic books/ but also
enjoys comics.
- Can grasp concepts of parts and whole.
G. Language Development:
- Follows suggestions better than command
- Begins to use shorter and more compact
sentences

A. Gross Motor ;
Enjoys all physical activities.
Fine Motor
Co-ordination continues to improve
Self care
- Criticizes table manners of parents.
- May wear some clothes continually.
- Leave clo tries where they fall.
- Enjoys wearing current style of clothes
- Needs constant reminding of personal hygiene.
- Bathes frequently - prefers showers.
C. Sensory;

- Has greater self control
- Respects parents & their role
- Chooses friends more selectively; may have a
"best friend"
- Develops beginning interest in opposite sex.
- Likes mother and wants to please her in many
ways.
- Likes dad, top; he is adored & idolized.
- Loves friends; talks about them constantly.

- Has out bursts of anger (10 yrs.)
- Able to control anger (12 yrs.)
- Hero worship of adult continues.
- Still fears the dark.
F. Intellectual Development:
- Develops abstract and deductive reasoning
- Uses problem solving methods

- Can define abstract terms
- Collect facts for future use.
- produces simple paintings & drawings
- Writes brief stories
- Attends 5th - 7th grades
- Uses telephone for practical purposes.
- Writes occasional short letters to friends and
relatives.

G. Language Development :
- Follows suggestions better than requests; is
obedient.
- Oral vocabulary of 7200 words, reading
vocabulary of 50,000 words.
- User parts of speech correctly.
- Able to give precise dictionary definition of
words.
- Enjoys riddles.
Cont’d…

REFERENCES:
1. Marlow R. Borothy & Redding A. Barbara, "Text book
of ' Paediatric Nursing" 6th edn. London, W.B.
Saunders Company, 1988, pp-163-1011.
2. Achar, S.T. "Text book of Paediatrics" 2nd ed.,
Madras, Orient Longman, 1982, pp.31-74.
3. Waechter et al, "Nursing Care of Children" 10th ed. St.
Louis, J.B. Lippincott Company, 1985,
4. Wong & Whaley, "Nursing Care of Infant & children"
5th ed., St. Louis, C.V. Mosby, 1995. pp.282-
435

Unit 2 healthy child

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Ähnlich wie Unit 2 healthy child

Ähnlich wie Unit 2 healthy child (20)

Mehr von SANJAY SIR

Mehr von SANJAY SIR (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Unit 2 healthy child