Growth and Development
Infancy
Early Childhood
Middle Childhood
Adolescent
Stages of Growth and Development
Infancy Middle Childhood
• Neonate • School age
• Birth to 1 month • 6 to 12 years
• Infancy
• 1 month to 1 year
Late Childhood
Early Childhood • Adolescent
• Toddler • 13 years to
• 1-3 years approximately 18
years
• Preschool
• 3-6 years
Principles of Growth and Development
Growth is an orderly process, occurring in
systematic fashion.
Rates and patterns of growth are specific to
certain parts of the body.
Wide individual differences exist in growth
rates.
Growth and development are influences by are
influences by a multiple factors.
Principles Continued
Development proceeds from the simple to the
complex and from the general to the specific.
Development occurs in a cephalocaudal and a
proximodistal progression.
There are critical periods for growth and
development.
Rates in development vary.
Development continues throughout the
individual's life span.
Growth Pattern
Growth Patterns
The child’s pattern of growth is in a
head-to-toe direction, or
cephalocaudal, and in an inward to
outward pattern called proximodistal.
Why developmental
assessment?
Early detection of deviation in child’s
pattern of development
Simple and time efficient mechanism to
ensure adequate surveillance of
developmental progress
Domains assessed: cognitive, motor,
language, social / behavioral and
adaptive
Gross Motor Skills
The acquisition of gross motor skill
precedes the development of fine motor
skills.
Both processes occur in a cephalocaudal
fashion
• Head control preceding arm and hand control
• Followed by leg and foot control.
Gross Motor Development
Newborn: barely able to lift head
6 months: easily lifts head, chest and
upper abdomen and can bear weight on
arms
Head Control
Newborn Age 6 months
Sitting up
2months old: needs assistance
6 months old: can sit alone in the tripod
position
8 months old: can sit without support and
engage in play
Sitting Up
Age 2 months Age 8 months
Ambulation
9 month old: crawl
1 year: stand independently from a crawl
position
13 month old: walk and toddle quickly
15 month old: can run
Ambulation
13 month old
Nine to 12-months
Fine Motor - Infant
Newborn has very little control. Objects
will be involuntarily grasped and dropped
without notice.
6 month old: palmar grasp – uses entire
hand to pick up an object
9 month old: pincer grasp – can grasp
small objects using thumb and forefinger
Speech Milestones
1-2 months: coos
2-6 months: laughs and squeals
8-9 months babbles: mama/dada as sounds
10-12 months: “mama/dada specific
18-20 months: 20 to 30 words – 50%
understood by strangers
22-24 months: two word sentences, >50
words, 75% understood by strangers
30-36 months: almost all speech understood
by strangers
Hearing
BAER hearing test done at birth
Ability to hear correlates with ability enunciate
words properly
Always ask about history of otitis media – ear
infection, placement of PET – tubes in ear
Early referral to MD to assess for possible fluid
in ears (effusion)
Repeat hearing screening test
Speech therapist as needed
Fine Motor Development
6-month-old
12-month-old
Red Flags in infant development
Unable to sit alone by age 9 months
Unable to transfer objects from hand to
hand by age 1 year
Abnormal pincer grip or grasp by age 15
months
Unable to walk alone by 18 months
Failure to speak recognizable words by 2
years.
Fine Motor - toddler
1 year old: transfer objects from hand to
hand
2 year old: can hold a crayon and color
vertical strokes
• Turn the page of a book
• Build a tower of six blocks
Fine Motor – Older Toddler
3 year old: copy a circle and a cross –
build using small blocks
4 year old: use scissors, color within the
borders
5 year old: write some letters and draw a
person with body parts
Toddler
Adele Piliterri, Child Health Nursing, Lippincott
Toddler
Safety becomes a problem as
the toddler becomes more
mobile.
Pilliterri, Lippincott
Toddlers
Issues in parenting - toddlers
Stranger anxiety – should dissipate by age 2 ½
to 3 years
Temper tantrums: occur weekly in 50 to 80%
of children – peak incidence 18 months – most
disappear by age 3
Sibling rivalry: aggressive behavior towards
new infant: peak between 1 to 2 years but may
be prolonged indefinitely
Thumb sucking
Toilet Training
Pre-School
Fine motor and cognitive abilities
Buttoning clothing
Holding a crayon / pencil
Building with small blocks
Using scissors
Playing a board game
Have child draw picture of himself
• Pre-school tasks
Red flags: preschool
Inability to perform self-care tasks, hand
washing simple dressing, daytime
toileting
Lack of socialization
Unable to play with other children
Able to follow directions during exam
Performance evaluation of pre-school
teacher for kindergarten readiness
Pool Safety
School-Age
School Years: fine motor
Writing skills improve
Fine motor is refined
Fine motor with more focus
• Building: models – legos
• Sewing
• Musical instrument
• Painting
• Typing skills
• Technology: computers
School performance
• Ask about favorite subject
• How they are doing in school
• Do they like school
• By parent report: any learning difficulties,
attention problems, homework
• Parental expectations
Red flags: school age
School failure
Lack of friends
Social isolation
Aggressive behavior: fights, fire setting,
animal abuse
School Age: gross motor
8 to 10 years: team sports
Age ten: match sport to the physical and
emotional development
School Age
School Age: cognitive
Greater ability to concentrate and
participate in self-initiating quiet activities
that challenge cognitive skills, such as
reading, playing computer and board
games.
13 to 18 Year Old
Adolescent
As teenagers gain independence they
begin to challenge values
Critical of adult authority
Relies on peer relationship
Mood swings especially in early
adolescents
Adolescent behavioral problems
Anorexia
Attention deficit
Anger issues
Suicide
Adolescents
Adolescent Teaching
Relationships
Sexuality – STD’s / AIDS
Substance use and abuse
Gang activity
Driving
Access to weapons
Adolescents
