Growth and Development Growth and Development of Childrenof Children

Adele Piliterri, Child Health Nursing, Lippincott

Growth and Growth and Development of Development of

ChildrenChildrenPreparedPrepared

ByBy

Dr: Magda Abd El Dr: Magda Abd El AzizAziz

General General ObjectiveObjective : :

By the end of this lecture, the student By the end of this lecture, the student will be able to discuss growth and will be able to discuss growth and development of children. development of children.

Specific Specific Objectives:Objectives:

By the end of this lecture, the student will be able By the end of this lecture, the student will be able to:to:

• Identify the importance of growth and Identify the importance of growth and development.development.

• Define growth and development.Define growth and development.• Mention the principles of growth and Mention the principles of growth and

development.development.• List factors affecting growth and development.List factors affecting growth and development.• Mention types of growth and development.Mention types of growth and development.• Identify the stages of development.Identify the stages of development.

GrowthGrowth

Growth refers to an increase in physical Growth refers to an increase in physical size of the whole body or any of its size of the whole body or any of its partsparts . .

It is simply a quantitative change in the It is simply a quantitative change in the child’s bodychild’s body . .

It can be measured in Kg, pounds, It can be measured in Kg, pounds, meters, inches, ….. etcmeters, inches, ….. etc

Child Growth Child Growth ((ImageImage: : WHO)WHO)

Changes in bodily proportions with Changes in bodily proportions with ageage..

DevelopmentDevelopment

• Development refers to a progressive Development refers to a progressive increase in skill and capacity of increase in skill and capacity of function. function.

• It is a qualitative change in the child’s It is a qualitative change in the child’s functioning.functioning.

• It can be measured through It can be measured through observation. observation.

By understanding what to expect during each stage of By understanding what to expect during each stage of developmentdevelopment, , parents can easily capture the teachable parents can easily capture the teachable moments in everyday life to enhance their child's moments in everyday life to enhance their child's language development, intellectual growth, social language development, intellectual growth, social

development and motor skillsdevelopment and motor skills..

MaturationMaturation

• Increase in child’s competence and Increase in child’s competence and adaptability.adaptability.

• It is describing the qualitative It is describing the qualitative change in a structure. change in a structure.

• The level of maturation depends on The level of maturation depends on child’s heredity. child’s heredity.

Importance of Growth and Development Importance of Growth and Development for Nurses:for Nurses:

• Knowing what to expect of a particular Knowing what to expect of a particular child at any given age.child at any given age.

• Gaining better understanding of the Gaining better understanding of the reasons behind illnesses.reasons behind illnesses.

• Helping in formulating the plan of care.Helping in formulating the plan of care.

• Helping in parents’ education in order to Helping in parents’ education in order to achieve optimal growth & development at achieve optimal growth & development at each stage. each stage.

Principles of Growth & Principles of Growth & DevelopmentDevelopment• Continuous processContinuous process

• Predictable SequencePredictable Sequence

• Don’t progress at the same rate (↑ periods of GR in early Don’t progress at the same rate (↑ periods of GR in early childhood and adolescents & ↓ periods of GR in middle childhood and adolescents & ↓ periods of GR in middle childhood)childhood)

• Not all body parts grow in the same rate at the same time. Not all body parts grow in the same rate at the same time.

• Each child grows in his/her own unique way. Each child grows in his/her own unique way.

• Each stage of G&D is affected by the preceding types of Each stage of G&D is affected by the preceding types of development.development.

Principles of Growth & Principles of Growth & DevelopmentDevelopment

G & D proceed in regular related directions : G & D proceed in regular related directions :

- Cephalo-caudal(head down to toes) - Cephalo-caudal(head down to toes)

- Proximodistal (center of the body - Proximodistal (center of the body to the peripheral) to the peripheral)

- General to specific- General to specific

Growth PatternGrowth Pattern

Growth PatternsGrowth Patterns

The child’s pattern of growth is in a The child’s pattern of growth is in a head-to-toe direction, or head-to-toe direction, or cephalocaudalcephalocaudal, and in an inward to , and in an inward to outward pattern called outward pattern called proximodistalproximodistal..

Factors affecting growth and Factors affecting growth and

development:development: • HereditaryHereditary

• Environmental factorsEnvironmental factors

Pre-natal environmentPre-natal environment1-Factors related to mothers during 1-Factors related to mothers during

pregnancypregnancy: :

- Nutritional deficiencies- Nutritional deficiencies - Diabetic mother- Diabetic mother - Exposure to radiation- Exposure to radiation - Infection with German measles- Infection with German measles - Smoking- Smoking - Use of drugs- Use of drugs

2-Factors related to fetus2-Factors related to fetus • Mal-position in uterusMal-position in uterus• Faulty placental implantationFaulty placental implantation

Post-Natal EnvironmentPost-Natal Environment

I - I - External environmentExternal environment: : - socio-economic status of the family- socio-economic status of the family - child’s nutrition- child’s nutrition - climate and season- climate and season - child’s ordinal position in the family- child’s ordinal position in the family - Number of siblings in the family- Number of siblings in the family - Family structure (single parent or extended - Family structure (single parent or extended

family … )family … )

Internal environmentInternal environment

• Child’s intelligenceChild’s intelligence• Hormonal influencesHormonal influences• EmotionsEmotions

Types of growth and Types of growth and developmentdevelopmentTypes of growth: Types of growth: - Physical growth (Ht, Wt, head & chest - Physical growth (Ht, Wt, head & chest

circumference)circumference) - Physiological growth (vital signs …)- Physiological growth (vital signs …)

Types of development:Types of development: - Motor development - Motor development - Cognitive development- Cognitive development - Emotional development- Emotional development - Social development - Social development

Stages of Growth and DevelopmentStages of Growth and Development

• Prenatal Prenatal

- Embryonic (conception- 8 - Embryonic (conception- 8 w)w)

- Fetal stage (8-40 or 42 w)- Fetal stage (8-40 or 42 w)• InfancyInfancy

- NeonateNeonate- Birth to end of 1 Birth to end of 1

monthmonth- InfancyInfancy

- 1 month to end of 1 1 month to end of 1 yearyear

• Early ChildhoodEarly Childhood- ToddlerToddler

- 1-3 years1-3 years- PreschoolPreschool

- 3-6 years3-6 years

• Middle ChildhoodMiddle Childhood- School ageSchool age- 6 to 12 years6 to 12 years

• Late ChildhoodLate Childhood

- AdolescentAdolescent- 13 years to 13 years to

approximately 18 yearsapproximately 18 years

11 - -Newborn stageNewborn stage

Newborn stage is the first 4 Newborn stage is the first 4 weeks or first month of life. It weeks or first month of life. It is a transitional period from is a transitional period from intrauterine life to extra intrauterine life to extra uterine environmentuterine environment..

Normal Newborn InfantNormal Newborn Infant

Physical growth Physical growth

- Weight = 2.700 – 4 kg- Weight = 2.700 – 4 kg

- Wt loss 5% -10% by 3-4 days after - Wt loss 5% -10% by 3-4 days after birthbirth

- Wt gain by 10- Wt gain by 10thth days of life days of life

- Gain ¾ kg by the end of the 1- Gain ¾ kg by the end of the 1stst month month

Weight:Weight:

They loose 5 % to 10 % of weight by 3-4 They loose 5 % to 10 % of weight by 3-4 days after birth as result of :days after birth as result of :

Withdrawal of hormones from Withdrawal of hormones from mother.mother.

Loss of excessive extra cellular Loss of excessive extra cellular fluid.fluid.

Passage of meconium (feces) and Passage of meconium (feces) and urine.urine.

Limited food intake.Limited food intake.

Height Height

• Boys average Ht = 50 cm Boys average Ht = 50 cm • Girls average Ht = 49 cm Girls average Ht = 49 cm • Normal range for both (47.5- 53.75 cm)Normal range for both (47.5- 53.75 cm)

Head circumferenceHead circumference33-35 cm 33-35 cm Head is ¼ total body length Head is ¼ total body length Skull has 2 fontanels (anterior & Skull has 2 fontanels (anterior &

posterior) posterior)

Anterior fontanelAnterior fontanel

• Diamond in shapeDiamond in shape• The junction of the sagittal, corneal The junction of the sagittal, corneal

and frontal sutures forms itand frontal sutures forms it• Between 2 frontal & 2 parietal bonesBetween 2 frontal & 2 parietal bones• 3-4 cm in length and 2-3 cm width 3-4 cm in length and 2-3 cm width • It closes at 12-18 months of age It closes at 12-18 months of age

Posterior fontanelPosterior fontanel

• Triangular Triangular • Located between occipital & 2 Located between occipital & 2

parietal bones parietal bones • Closes by the end of the 1Closes by the end of the 1stst month of month of

ageage

Chest circumferenceChest circumference

It is 30.5 to 33cm (usually 2–3cm It is 30.5 to 33cm (usually 2–3cm less than head circumference).less than head circumference).

Physiological growthPhysiological growth

• Vital signsVital signs

- - Temperature (36.3 Temperature (36.3 to37.2to37.2C ).C ).

- Pulse ( 120 to 160 - Pulse ( 120 to 160 b/min ). b/min ).

- Respiration ( 35 to - Respiration ( 35 to 50C/min) . 50C/min) .

Simulation for vital signsSimulation for vital signs

APGAR scoring chartAPGAR scoring chart

Newborn SensesNewborn Senses

• SensesSenses

- Touch - Touch

- Vision- Vision

- Hearing- Hearing

- Taste - Taste

- Smell- Smell

TouchTouch

• It is the most highly developed sense. It is the most highly developed sense.

• It is mostly at lips, tongue, ears, and forehead.It is mostly at lips, tongue, ears, and forehead.

• The newborn is usually comfortable with touch.The newborn is usually comfortable with touch.

VisionVision

• Pupils react to light Pupils react to light

• Bright lights appear to be Bright lights appear to be unpleasant to newborn infant.unpleasant to newborn infant.

• Follow objects in line of visionFollow objects in line of vision

HearingHearing

• The newborn infant usually makes The newborn infant usually makes some response to sound from birth.some response to sound from birth.

• Ordinary sounds are heard well Ordinary sounds are heard well before 10 days of life. before 10 days of life.

• The newborn infant responds to The newborn infant responds to sounds with either cry or eye sounds with either cry or eye movement, cessation of activity and / movement, cessation of activity and / or startle reaction. or startle reaction.

TasteTaste

Well developed as bitter and sour fluids Well developed as bitter and sour fluids are resisted while sweet fluids are are resisted while sweet fluids are accepted. accepted.

SmellSmell

Only evidence in newborn infant’s search Only evidence in newborn infant’s search for the nipple, as he smell breast milk. for the nipple, as he smell breast milk.

Normal Newborn InfantNormal Newborn Infant

Gross Motor Gross Motor DevelopmentDevelopment

Motor development:Motor development:

The newborn's movement are The newborn's movement are random, diffuse and random, diffuse and uncoordinated. Reflexes carry uncoordinated. Reflexes carry out bodily functions and out bodily functions and responses to external stimuli. responses to external stimuli.

Fine motor developmentFine motor development

• Holds hand in fistHolds hand in fist

• When crying, he draws arms and When crying, he draws arms and legs to bodylegs to body

ReflexesReflexes

• SwallowingSwallowing

• GaggingGagging

• SuckingSucking

• GraspGrasp

• Tonic-neckTonic-neck

One month-ReflexesOne month-Reflexes

Cognitive developmentCognitive development

The cognitive development of The cognitive development of newborn infant is difficult to newborn infant is difficult to understand or observe it. understand or observe it.

Emotional developmentEmotional development

The newborn infant expresses The newborn infant expresses his emotion just through cry his emotion just through cry for hunger, pain or for hunger, pain or discomfort sensation discomfort sensation

Social developmentSocial development

Infancy Infancy

Sitting UpSitting Up

Age 2 months Age 8 months

AmbulationAmbulation

13 month old

Nine to 12-months

Fine Motor DevelopmentFine Motor Developmentin infancyin infancy

6-month-old

12-month-old

Definition of normal Definition of normal infantinfant-:-:

It is the period which starts at It is the period which starts at the end of the first month up the end of the first month up to the end of the first year of to the end of the first year of age. Infant's growth and age. Infant's growth and development during this development during this period period are rapidare rapid..

Physical growth of Physical growth of normal infantnormal infant

Weight : the infant gains :Weight : the infant gains :

- Birth to 4 months → ¾ kg - Birth to 4 months → ¾ kg /month/month

- 5 to 8 months → ½ kg / month- 5 to 8 months → ½ kg / month

- 9 to 12 months → ¼ kg /month- 9 to 12 months → ¼ kg /month

The infant will double his birth wt by 4-5 The infant will double his birth wt by 4-5 months and triple it by 10-12 months of months and triple it by 10-12 months of age age

Calculating infant’s Calculating infant’s weightweight

Infants from 3 to 12 months Infants from 3 to 12 months

Weight = Age in months + 9Weight = Age in months + 9

2 2

Wt of 7 months old infant = 7+9 = Wt of 7 months old infant = 7+9 = 16 = 8 kg16 = 8 kg

2 2 2 2

HeightHeight

• Length increases about 3 cm /month Length increases about 3 cm /month during the 1during the 1stst 3 months of age, 3 months of age,

• then it increases 2 cm /month at age then it increases 2 cm /month at age of 4-6 months, of 4-6 months,

• Then, at 7 – 12 months, it increases Then, at 7 – 12 months, it increases 1 ½ cm per month1 ½ cm per month

Head circumferenceHead circumference

• It increases about 2 cm /month It increases about 2 cm /month during the 1during the 1stst 3 months, 3 months,

• Then, ½ cm/month during the 2Then, ½ cm/month during the 2ndnd 9 9 months of age.months of age.

• Posterior fontanel closes by 6-8 w of Posterior fontanel closes by 6-8 w of age.age.

• Anterior fontanel closes by 12-18 Anterior fontanel closes by 12-18 months of age.months of age.

Chest circumferenceChest circumference

By the end of the 1By the end of the 1stst year, it will be equal year, it will be equal to head circumference. to head circumference.

Physiological growth of Physiological growth of infants:-infants:-Pulse 110-150 b/minPulse 110-150 b/min

Resp 35 ± 10 c/min Resp 35 ± 10 c/min

Breath through nose.Breath through nose.

Blood pressure 80/50 ± 20/10 mmHg Blood pressure 80/50 ± 20/10 mmHg

DentitionDentition::

Eruption of teeth starts by 5–6 Eruption of teeth starts by 5–6 months of age. It is called "Milky months of age. It is called "Milky teeth" or "Deciduous teeth" or teeth" or "Deciduous teeth" or "Temporary teeth"."Temporary teeth".

Average age for teeth eruptionAverage age for teeth eruption::

• Lower central incisors Lower central incisors • Upper central incisors Upper central incisors • Upper lateral incisors Upper lateral incisors • Lower lateral incisors Lower lateral incisors • Lower first molars Lower first molars • Upper first molars Upper first molars • Lower cuspids Lower cuspids • Upper cuspids Upper cuspids • Lower 2nd molarsLower 2nd molars

• Upper 2nd molars Upper 2nd molars

• Erupt at 6 months Erupt at 6 months • Erupt at 7.5 months Erupt at 7.5 months • Erupt at 9 months Erupt at 9 months • Erupt at 11 months Erupt at 11 months • Erupt at 12 months Erupt at 12 months • Erupt at 14 months Erupt at 14 months • Erupt at 16 months Erupt at 16 months • Erupt at 18 months Erupt at 18 months • Erupt at 20months Erupt at 20months • Erupt at 24 months.Erupt at 24 months.

Motor DevelopmentMotor Development

• At 2 monthsAt 2 months• Hold head erects in mid-position.Hold head erects in mid-position.• Turn from side back.Turn from side back.

• At 3 months, At 3 months, the infant canthe infant can• Hold head erects and steady.Hold head erects and steady.• Open or close hand loosely.Open or close hand loosely.• Hold object put in hand Hold object put in hand

Head ControlHead Control

Newborn Age 6 months

At 4 months, the infant At 4 months, the infant cancan::

• Sit with adequate supportSit with adequate support..• Roll over from front to back.Roll over from front to back.• Hold head erect and steady while in Hold head erect and steady while in

sitting position.sitting position.• Bring hands together in midline and Bring hands together in midline and

plays with fingers.plays with fingers.• Grasp objects with both hands.Grasp objects with both hands.

At 5 months, At 5 months, the infant the infant cancan::

• Balance head well when sitting.Balance head well when sitting.• Site with slight support.Site with slight support.• Pull feet up to mouth when supine.Pull feet up to mouth when supine.• Grasp objects with whole hand (Rt. Grasp objects with whole hand (Rt.

or Lt.).or Lt.).• Hold one object while looking at Hold one object while looking at

another another

At 6 months, the infant At 6 months, the infant cancan::

• Sit alone briefly.Sit alone briefly.• Turn completely over ( abdomen to Turn completely over ( abdomen to

abdomen ).abdomen ).• Lift chest and upper abdomen when Lift chest and upper abdomen when

prone.prone.• Hold own bottle.Hold own bottle.

At 7 months, the infant At 7 months, the infant cancan::

• Sit alone.Sit alone.• Hold cup.Hold cup.• Imitate simple acts of others.Imitate simple acts of others.

At 8 months, the infant At 8 months, the infant cancan::

• Site alone steadily.Site alone steadily.• Drink from cup with assistance.Drink from cup with assistance.• Eat finger food that can be held in Eat finger food that can be held in

one hand.one hand.

At 9 months, the infant At 9 months, the infant cancan::

• Rise to sitting position alone.Rise to sitting position alone.• Crawl Crawl (i.e., pull body while in prone (i.e., pull body while in prone

position).position).• Hold one bottle with good hand-Hold one bottle with good hand-

mouth coordination mouth coordination

At 10 months, the infant At 10 months, the infant cancan::

• Creep wellCreep well (use hands and legs). (use hands and legs).• Walk but with help. Walk but with help. • Bring the hands together.Bring the hands together.

At 11 months , the infant At 11 months , the infant can:can:

• Walk Walk holding on furniture.holding on furniture.• StandStand erect with minimal support erect with minimal support

At 12 months , the infant At 12 months , the infant cancan : :

• Stand-aloneStand-alone for variable length of for variable length of time.time.

• Site down from standingSite down from standing position position alone.alone.

• Walk in few stepsWalk in few steps with help or alone with help or alone (hands held at shoulder height for (hands held at shoulder height for balance).balance).

• Pick up small bits of food and Pick up small bits of food and transfers them to his mouth transfers them to his mouth

Ambulation(motor Ambulation(motor growth)growth)

• 9 month old: crawl9 month old: crawl• 10 month old: creep10 month old: creep• 1 year: stand independently from a 1 year: stand independently from a

crawl & creep positioncrawl & creep position

• 13 month old: walk and toddle quickly13 month old: walk and toddle quickly

• 15 month old: can run15 month old: can run

Emotional developmentEmotional development::

• His emotions are instable, where it is His emotions are instable, where it is rapidly changes from crying to rapidly changes from crying to laughter.laughter.

• His affection for or love family His affection for or love family members appears.members appears.• By 10 monthsBy 10 months, he expresses several , he expresses several

beginning recognizable emotions, such as beginning recognizable emotions, such as anger, sadness, pleasure, jealousy, anxiety anger, sadness, pleasure, jealousy, anxiety and affection. and affection.

• By 12 monthsBy 12 months of age, these emotions of age, these emotions are clearly distinguishable.are clearly distinguishable.

Social developmentSocial development

• He He learnslearns that crying brings attention. that crying brings attention.• The infant The infant smiles in response to smile of otherssmiles in response to smile of others..• The infant shows The infant shows fear of strangerfear of stranger (stranger (stranger

anxiety).anxiety).• He responds socially to his name.He responds socially to his name.• According to According to Erikson, the infant Erikson, the infant

develops sense of trustdevelops sense of trust.. Through the Through the infant's interaction with caregiver (mainly the infant's interaction with caregiver (mainly the mother), especially during feeding, he learns to mother), especially during feeding, he learns to trust others through the relief of basic needs.trust others through the relief of basic needs.

As an infant's vision develops, he or she may As an infant's vision develops, he or she may seem preoccupied with watching surrounding seem preoccupied with watching surrounding

objects and peopleobjects and people

Speech MilestonesSpeech Milestones• 1-2 months: coos1-2 months: coos• 2-6 months: laughs and squeals2-6 months: laughs and squeals• 8-9 months babbles: mama/dada as 8-9 months babbles: mama/dada as

soundssounds• 10-12 months: “mama/dada specific 10-12 months: “mama/dada specific • 18-20 months: 20 to 30 words – 50% 18-20 months: 20 to 30 words – 50%

understood by strangersunderstood by strangers• 22-24 months: two word sentences, >50 22-24 months: two word sentences, >50

words, 75% understood by strangerswords, 75% understood by strangers• 30-36 months: almost all speech 30-36 months: almost all speech

understood by strangersunderstood by strangers

HearingHearing

• BAER hearing test done at birthBAER hearing test done at birth• Ability to hear correlates with ability Ability to hear correlates with ability

enunciate words properlyenunciate words properly• Always ask about history of otitis media – Always ask about history of otitis media –

ear aiding devices.ear aiding devices.• Early referral to MD to assess for possible Early referral to MD to assess for possible

fluid in ears (effusion) fluid in ears (effusion) • Repeat hearing screening testRepeat hearing screening test• Speech therapist as neededSpeech therapist as needed

Red Flags in infant Red Flags in infant developmentdevelopment

• Unable to sit alone by age 9 monthsUnable to sit alone by age 9 months• Unable to transfer objects from hand Unable to transfer objects from hand

to hand by age 1 yearto hand by age 1 year• Abnormal pincer grip or grasp by Abnormal pincer grip or grasp by

age 15 monthsage 15 months• Unable to walk alone by 18 monthsUnable to walk alone by 18 months• Failure to speak recognizable words Failure to speak recognizable words

by 2 years.by 2 years.

Vision in toddler ageVision in toddler age

ToddlerToddler

Safety becomes a problem asthe toddler becomes moremobile.

Pilliterri, Lippincott

ToddlersToddlers

Normal toddlerNormal toddler::

Toddler stage is Toddler stage is between 1 to 3 years of between 1 to 3 years of age. During this period, age. During this period,

growth growth slowsslows considerablyconsiderably . .

Physical growthPhysical growth

WeightWeight::The toddler's average weight gain is The toddler's average weight gain is 1.8 to 2.7 kg/year1.8 to 2.7 kg/year..

Formula to calculate normal weight of Formula to calculate normal weight of children over 1 year of age ischildren over 1 year of age is

Age in years X 2+8 = ….. kgAge in years X 2+8 = ….. kg..e.g., The weight of a child aging 4 e.g., The weight of a child aging 4 yearsyears

= = 44 X 2 + 8 = 16 kgX 2 + 8 = 16 kg

HeightHeight::

• During 1–2 years, the child's During 1–2 years, the child's height increases by height increases by 1cm/month.1cm/month.

• The toddler's height increases The toddler's height increases about 10 to 12.5cm/year.about 10 to 12.5cm/year.

Formula to calculate Formula to calculate normal heightnormal height

Age in years X 5 + 80 = Age in years X 5 + 80 = cm. cm.

e.g., the length of 2 years old e.g., the length of 2 years old child child

= 2 X 5 + 80 = 90cm = 2 X 5 + 80 = 90cm

Head and chest Head and chest circumferencecircumference::

• The head increases 10 cm only from The head increases 10 cm only from the age of 1 year to adult age.the age of 1 year to adult age.

• During toddler years, chest During toddler years, chest circumference continues to increase circumference continues to increase in size and exceeds head in size and exceeds head circumference.circumference.

TeethingTeething::

• By 2 years of age, the toddler By 2 years of age, the toddler has 16 temporary teeth.has 16 temporary teeth.

• By the age of 30 months (2.5 By the age of 30 months (2.5 years), the toddler has 20 years), the toddler has 20 teeth teeth

Physiological growthPhysiological growth::

Pulse:Pulse: 80–13080–130 beats/min beats/min (average 110/min)(average 110/min)..

Respiration:Respiration: 20–30C/min20–30C/min..

Bowel and bladder controlBowel and bladder control : : Daytime control of bladder Daytime control of bladder

and bowel control by 24–30 and bowel control by 24–30 monthsmonths..

Fine Motor - toddlerFine Motor - toddler

• 1 year old: transfer objects from 1 year old: transfer objects from hand to handhand to hand

• 2 year old: can hold a crayon and 2 year old: can hold a crayon and color vertical strokescolor vertical strokes• Turn the page of a bookTurn the page of a book• Build a tower of six blocksBuild a tower of six blocks

• 3 year old: copy a circle and a cross 3 year old: copy a circle and a cross – build using small blocks– build using small blocks

Gross - Motor of toddlerGross - Motor of toddler At 15 months, At 15 months, the toddler canthe toddler can::

• Walk alone.Walk alone.• Creep upstairs.Creep upstairs.• Assume standing position without falling.Assume standing position without falling.• Hold a cup with all fingers grasped Hold a cup with all fingers grasped

around it.around it.

At 18 monthsAt 18 months::• Hold cup with both handsHold cup with both hands..• Transfer objects hand-to hand at will.Transfer objects hand-to hand at will.

ContinuousContinuous

At 24 monthsAt 24 months::

• Go up and down stairs alone Go up and down stairs alone with two feet on each step.with two feet on each step.

• Hold a cup with one hand.Hold a cup with one hand.• Remove most of own clothes.Remove most of own clothes.• Drink well from a small glass Drink well from a small glass

held in one hand.held in one hand.

At 30 months: At 30 months: the toddler canthe toddler can::

• Jump with both feet.Jump with both feet.• Jump from chair or step.Jump from chair or step.• Walk up and downstairs, Walk up and downstairs,

one foot on a step.one foot on a step.• Drink without assistance.Drink without assistance.

Issues in parenting – Issues in parenting – toddler (emotional toddler (emotional

development)development)• Stranger anxiety – should dissipate by Stranger anxiety – should dissipate by

age 2 ½ to 3 yearsage 2 ½ to 3 years• Temper tantrums: occur weekly in 50 to Temper tantrums: occur weekly in 50 to

80% of children – peak incidence 18 80% of children – peak incidence 18 months – most disappear by age 3 months – most disappear by age 3

• Sibling rivalry: aggressive behavior Sibling rivalry: aggressive behavior towards new infant: peak between 1 to towards new infant: peak between 1 to 2 years but may be prolonged 2 years but may be prolonged indefinitelyindefinitely

• Thumb sucking Thumb sucking • Toilet TrainingToilet Training

Cognitive developmentCognitive development::• Up to 2 years, Up to 2 years, the toddler uses his the toddler uses his

senses and motor development senses and motor development to different self from objects.to different self from objects.

• The toddler from 2 to 3 years will The toddler from 2 to 3 years will

be be in the in the pre-conceptual pre-conceptual phase of cognitivephase of cognitive developmentdevelopment (2-4 years), where (2-4 years), where he is still egocentric and can not he is still egocentric and can not take the point of view of other take the point of view of other peoplepeople..

Social developmentSocial development::

• The toddler is very social being but still The toddler is very social being but still egocentric.egocentric.

• He imitates parents.He imitates parents.• Notice sex differences and know own sex.Notice sex differences and know own sex.• According to According to Erikson,Erikson,• The development of autonomy during this The development of autonomy during this

period is centered around toddlers period is centered around toddlers increasing abilities to control their increasing abilities to control their bodies, themselves and their bodies, themselves and their environment environment i.e., "I can do it myself".i.e., "I can do it myself".

Pre-SchoolPre-School

Preschool stagePreschool stage

Definition:-Definition:-

It is the stage where child is It is the stage where child is 3 to 6 years of age. The 3 to 6 years of age. The growth during this period growth during this period is relatively is relatively slowslow..

Physical growth:-Physical growth:-

Weight: Weight: The preschooler The preschooler gains approximately gains approximately 1.8kg/year.1.8kg/year.

Height: Height: He doubles birth He doubles birth length by 4–5 years of age.length by 4–5 years of age.

Physiological growth Physiological growth • Pulse: Pulse: 80–120 beat/min. 80–120 beat/min. (average 100/min).(average 100/min).

• Respiration: Respiration: 20–30C/min.20–30C/min.

• Blood Pressure: Blood Pressure: 100/67100/67++24/25.24/25.

Fine Motor – Older Fine Motor – Older ToddlerToddler

• 3 year old: copy a circle and a cross 3 year old: copy a circle and a cross – build using small blocks– build using small blocks

• 4 year old: use scissors, color within 4 year old: use scissors, color within the bordersthe borders

• 5 year old: write some letters and 5 year old: write some letters and draw a person with body partsdraw a person with body parts

Fine motor and cognitive Fine motor and cognitive abilitiesabilities

pre-schoolpre-school• Buttoning clothingButtoning clothing• Holding a pencilHolding a pencil• Building with small blocksBuilding with small blocks• Using scissorsUsing scissors• Playing a board gamePlaying a board game• Have child draw picture of himself Have child draw picture of himself

Cognitive developmentCognitive development

Preschooler up to 4 years of Preschooler up to 4 years of age is in the age is in the pre-conceptual pre-conceptual phasephase. He begins to be . He begins to be able able to give reasons for his belief to give reasons for his belief and actions, but not true and actions, but not true cause-effect relationship.cause-effect relationship.

Emotional Development of Emotional Development of PreschoolerPreschooler

• Fears the Fears the darkdark• Tends to be Tends to be impatient and impatient and selfishselfish

• Expresses Expresses agressionagression through through physical and verbal behaviours.physical and verbal behaviours.

• Shows signs of Shows signs of jealousy of jealousy of siblings.siblings.

Social development in Social development in preschoolerspreschoolers

• EgocentricEgocentric• Tolerates short separationTolerates short separation• Less dependant on parentsLess dependant on parents• May have dreams & night-maresMay have dreams & night-mares• Attachment to opposite sex parentAttachment to opposite sex parent• More cooperative in playMore cooperative in play

Social developmentSocial development

According to According to Erikson theoryErikson theory::• The preschooler is in the The preschooler is in the

stage where he stage where he develops a develops a sense of initiativesense of initiative, Where , Where he wants to learn what to do he wants to learn what to do for himself, learn about the for himself, learn about the world And other people.world And other people.

Red flags: preschoolRed flags: preschool

• Inability to perform self-care tasks, hand Inability to perform self-care tasks, hand washing simple dressing, daytime washing simple dressing, daytime toiletingtoileting

• Lack of socialization Lack of socialization

• Unable to play with other childrenUnable to play with other children

• Unable to follow directions during examUnable to follow directions during exam

Pool SafetyPool Safety

School-AgeSchool-Age

Normal school-age childNormal school-age child::

School-age period is School-age period is between the age of 6 to 12 between the age of 6 to 12 years. The child's growth years. The child's growth and development is and development is characterized by gradual characterized by gradual growth.growth.

Physical growthPhysical growth

Weight:Weight:• School–age child gains about School–age child gains about

3.8kg/year.3.8kg/year.• Boys tend to gain slightly more Boys tend to gain slightly more

weight through weight through 12 years.12 years.• Weight Formula for 7 - 12 yrs Weight Formula for 7 - 12 yrs = = (age in yrs x 7 )– 5(age in yrs x 7 )– 5 22

HeightHeight::• The child gains about 5cm/year.The child gains about 5cm/year.• Body proportion during this period: Body proportion during this period:

Both boys and girls Both boys and girls are long-are long-leggedlegged..

Dentition:Dentition:• Permanent teethPermanent teeth erupt during erupt during

school-age period, school-age period, starting from 6 starting from 6 yearsyears, usually in the same order in , usually in the same order in which primary teeth are lost.which primary teeth are lost.

• The child acquires permanent The child acquires permanent molars, medial and lateral incisors.molars, medial and lateral incisors.

Physiological growthPhysiological growth::

• Pulse: Pulse: 9090++15 beats/min15 beats/min

(75 to 105).(75 to 105).• Respiration: Respiration: 2121++3C/min 3C/min

(18–24).(18–24).• Blood Pressure: Blood Pressure:

100/60100/60++16/10.16/10.

School Years: fine motorSchool Years: fine motor

• Writing skills improveWriting skills improve• Fine motor is refinedFine motor is refined• Fine motor with more focusFine motor with more focus

• Building: models – logos Building: models – logos • SewingSewing• Musical instrumentMusical instrument• Painting Painting • Typing skillsTyping skills• Technology: computersTechnology: computers

Motor developmentMotor development

At 6–8 years, At 6–8 years, the school–age child:the school–age child:• Rides Rides a bicyclea bicycle..• Runs Jumps, climbs and hops.Runs Jumps, climbs and hops.• Has improved eye-hand Has improved eye-hand

coordination.coordination.• Prints word and Prints word and learn cursive learn cursive

writingwriting..• Can brush and comb hair.Can brush and comb hair.

At 8–10 years, At 8–10 years, the school–age child:the school–age child:• Throws balls skillfully.Throws balls skillfully.• Uses to participate in organized sports.Uses to participate in organized sports.• Uses both hands independently.Uses both hands independently.• Handles eating utensils (spoon, fork, Handles eating utensils (spoon, fork,

knife) skillfully.knife) skillfully.

At 10–12 years, At 10–12 years, the school–age child:the school–age child:• Enjoy all physical activities.Enjoy all physical activities.• Continues to improve his motor Continues to improve his motor

coordination.coordination.

School Age: gross motorSchool Age: gross motor

• 8 to 10 years: 8 to 10 years: team team sportssports

• Age ten: Age ten: match sportmatch sport to to the physical and emotional the physical and emotional development development

School performanceSchool performance

• Ask about favorite subjectAsk about favorite subject• How they are doing in schoolHow they are doing in school• Do they like schoolDo they like school• By parent report: any learning By parent report: any learning

difficulties, attention problems, difficulties, attention problems, homeworkhomework

• Parental expectationsParental expectations

School AgeSchool Age

School Age: cognitive School Age: cognitive developmentdevelopment

At 7-11 yearsAt 7-11 years, , the child now is the child now is in the in the concrete operational stage of concrete operational stage of cognitive development.cognitive development. He is able He is able to function on a higher level in his to function on a higher level in his mental ability.mental ability.

Greater ability to concentrate and Greater ability to concentrate and participate in self-initiating quiet participate in self-initiating quiet activities that challenge cognitive activities that challenge cognitive skills, skills, such assuch as reading, playing reading, playing computer and board games.computer and board games.

Emotional developmentEmotional development

The school–age child:The school–age child:• Fears Fears injury to bodyinjury to body and fear of and fear of

dark.dark.• Jealous Jealous of siblings (especially 6–8 of siblings (especially 6–8

years old child).years old child).• Curious Curious about everything.about everything.• Has Has short bursts of anger by age of short bursts of anger by age of

10 years but able to control anger 10 years but able to control anger by 12 years.by 12 years.

Social developmentSocial development The school–age child is :The school–age child is :• Continues to be egocentric.Continues to be egocentric.• Wants other children to play with him.Wants other children to play with him.• Insists on being first in every thingInsists on being first in every thing• Becomes peer orientedBecomes peer oriented..• Improves relationship with siblings.Improves relationship with siblings.• Has greater self–control, confident, Has greater self–control, confident,

sincere.sincere.• Respects parents and their role.Respects parents and their role.• Joints group (formal and informal).Joints group (formal and informal).• Engage in tasks in the real world.Engage in tasks in the real world.

Red flags: school ageRed flags: school age

• School failureSchool failure• Lack of friends Lack of friends • Social isolationSocial isolation• Aggressive behavior: fights, fire Aggressive behavior: fights, fire

setting, animal abusesetting, animal abuse

1313 to 18 Year Oldto 18 Year Old

Adolescent ageAdolescent age

• Physical growth Physical growth • Physiological growth Physiological growth • Secondary sex characteristicsSecondary sex characteristics• Cognitive development Cognitive development • Emotional developmentEmotional development• Social development Social development

Definition of adolescentDefinition of adolescent::

Adolescence is a transition period Adolescence is a transition period from childhood to adulthoodfrom childhood to adulthood. Its . Its is based on childhood experiences is based on childhood experiences and accomplishments.and accomplishments.

It begins with the appearance of It begins with the appearance of secondary sex characteristics and secondary sex characteristics and ends when somatic growth is ends when somatic growth is completed and the individual is completed and the individual is psychological mature.psychological mature.

Physical growthPhysical growth::Weight:Weight:

• Growth Growth spurtspurt begins earlier in girls (10–14 begins earlier in girls (10–14 years, while it is 12–16 in boys).years, while it is 12–16 in boys).

• Males gains 7 to 30kg, while female gains 7 Males gains 7 to 30kg, while female gains 7 to 25kg.to 25kg.

Height:Height:• By the age of 13, By the age of 13, the adolescent triples his the adolescent triples his

birth lengthbirth length..• Males gains 10 to 30cm in height.Males gains 10 to 30cm in height.• Females gains less height than males as Females gains less height than males as

they gain 5 to 20cm.they gain 5 to 20cm.• Growth in height ceases at 16 or 17 years in Growth in height ceases at 16 or 17 years in

females and 18 to 20in malesfemales and 18 to 20in males

Physiological growthPhysiological growth::

Pulse: Pulse: Reaches adult value 60–80 Reaches adult value 60–80 beats/min.beats/min.

Respiration: Respiration: 16–20C/minute.16–20C/minute.

NB:NB: The sebaceous glands of face, The sebaceous glands of face, neck and chest become more active. neck and chest become more active. When their secretion accumulates When their secretion accumulates under the skin in face, under the skin in face, acne will acne will appearappear..

Appearance of secondary sex Appearance of secondary sex characteristicscharacteristics

1- Secondary sex characteristics 1- Secondary sex characteristics in girls:in girls:

• Increase in transverse diameter of the Increase in transverse diameter of the pelvis.pelvis.

• Development of the breasts.Development of the breasts.• Change in the vaginal secretions.Change in the vaginal secretions.• Growth of pubic and axillary hair.Growth of pubic and axillary hair.• Menstruation (first menstruation is Menstruation (first menstruation is

called menarche, which occurs between called menarche, which occurs between 12 to 13 years).12 to 13 years).

Body imageBody image

2- Secondary sex 2- Secondary sex characteristics in boys:characteristics in boys:

• Increase in size of genitalia.Increase in size of genitalia.• Swelling of the breast.Swelling of the breast.• Growth of pubic, axillary, facial and Growth of pubic, axillary, facial and

chest hair.chest hair.• Change in voice.Change in voice.• Rapid growth of shoulder breadth.Rapid growth of shoulder breadth.• Production of spermatozoa (which is Production of spermatozoa (which is

sign of puberty).sign of puberty).

AdolescentAdolescent

• As teenagers gain independence As teenagers gain independence they begin to challenge valuesthey begin to challenge values

• Critical of adult authorityCritical of adult authority• Relies on peer relationshipRelies on peer relationship• Mood swings especially in early Mood swings especially in early

adolescentsadolescents

Cognitive development:Cognitive development:Through formal operational thinking, adolescent can Through formal operational thinking, adolescent can

deal with a problem.deal with a problem.

Emotional development:Emotional development:This period is accompanied usually by changes in This period is accompanied usually by changes in

emotional control. Adolescent exhibits alternating emotional control. Adolescent exhibits alternating and recurrent episodes of disturbed behavior with and recurrent episodes of disturbed behavior with periods of quite one. He may become hostile or periods of quite one. He may become hostile or ready to fight, complain or resist every thing.ready to fight, complain or resist every thing.

Social development:Social development:He needs to know "who he is" in relation to family He needs to know "who he is" in relation to family

and society, i.e., he develops a sense of identity. If and society, i.e., he develops a sense of identity. If the adolescent is unable to formulate a the adolescent is unable to formulate a satisfactory identity from the multi-identifications, satisfactory identity from the multi-identifications, sense of self-confusion will be developed according sense of self-confusion will be developed according to to Erikson:-Erikson:-

Adolescent shows interest in other sex.Adolescent shows interest in other sex. He looks for close friendships.He looks for close friendships.

Adolescent behavioral Adolescent behavioral problemsproblems

• AnorexiaAnorexia

• Attention deficitAttention deficit

• Anger issuesAnger issues

• SuicideSuicide

Adolescent TeachingAdolescent Teaching

• RelationshipsRelationships• Sexuality – STD’s / AIDS Sexuality – STD’s / AIDS • Substance use and abuseSubstance use and abuse• Gang activityGang activity• DrivingDriving• Access to weapons Access to weapons

Developmental theoryDevelopmental theory

Freud theoryFreud theory (sexual development)(sexual development). . Piaget theoryPiaget theory (cognitive development(cognitive development ). ). Erikson theoryErikson theory (psychosocial development).(psychosocial development).

Freud theoryFreud theory(sexual development)(sexual development)

Infancy stageInfancy stage

Toddler stageToddler stage

Preschool stagePreschool stage

School-age School-age stagestage

Adolescence Adolescence stagestage

Oral-sensory Oral-sensory stagestage

Anal stageAnal stage

Genital stageGenital stage

Latency StageLatency Stage

Pubertal stagePubertal stage

Piaget theoryPiaget theory(cognitive development(cognitive development

Infancy stageInfancy stage

Toddler stageToddler stage

Preschool stagePreschool stage

School-age stageSchool-age stage

Adolescence Adolescence stage stage

Up to2 years Up to2 years sensori - sensori -motormotor

2-32-3 years years pre- pre-conceptual phaseconceptual phase..

Up to 4years Up to 4years pre- pre-conceptual phaseconceptual phase . .

7-127-12 years years concrete- concrete-operationaloperational..

12-1512-15 years years preoperational formal preoperational formal operationsoperations

1515 years - through life years - through life formal operationsformal operations

Erikson theoryErikson theory(psychosocial development)(psychosocial development)

Infancy stageInfancy stage

Toddler stageToddler stage

Preschool stagePreschool stage

School-age stageSchool-age stage

Adolescence stageAdolescence stage

Trust versus mistrustTrust versus mistrust..Autonomy and self Autonomy and self esteem versus shame esteem versus shame and doubtand doubt..Initiative versus guiltInitiative versus guilt..

Industry versus Industry versus inferiorityinferiority..

Identity and intimacy Identity and intimacy versus role versus role confusionconfusion..

Thank you Thank you Magda Abd-El AzizMagda Abd-El Aziz