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U.S. Medical - Normal Child & Adolescent Development
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U.S. Medical - Normal Child & Adolescent Development Presentation Transcript

  • 1. Normal Child & Adolescent Development 1 Presentation created by: Ali Buschel Training verified by: Mariana C. Gaul, M.S., M.Ed
  • 2. Normal Growth & Development  A child's growth and development can be divided into four periods: • Infancy • Preschool years • Middle childhood years • Adolescence Normal Child & Adolescent Development 2
  • 3.  Immediately after birth, an infant normally loses about 5 - 10% of his or her birth weight. However, by about age 2 weeks, an infant should start to gain weight and grow quickly.  By age 4 - 6 months, an infant's weight should be double the birth weight. During the second half of the first year of life, growth is not as rapid. Between ages 1 and 2, a toddler will gain only about 5 pounds. Weight gain will remain at about 5 pounds per year between ages 2 - 5. Normal Child & Adolescent Development 3
  • 4.  Between ages 2 - 10 years, a child will continue to grow at a steady pace. A final growth spurt begins at the start of puberty, sometime between ages 9 and 15.  The child's nutrient needs correspond with these changes in growth rates. An infant needs more calories in relation to size than a preschooler or school-age child needs. Nutrient needs increase again as a child gets close to adolescence. Normal Child & Adolescent Development 4
  • 5.  Generally, a healthy child will follow an individual growth curve, even though the nutrient intake may be different for each child. Parents and caregivers should provide a diet that is appropriate for their child's age. They should offer a wide variety of foods to ensure their child is getting enough nutrition.  Healthy eating habits should begin during infancy to prevent diseases such as type 2 diabetes, high blood pressure, and childhood obesity. Normal Child & Adolescent Development 5
  • 6. Intellectual Development & Diet Normal Child & Adolescent Development 6
  • 7.  Poor nutrition can cause serious problems with intellectual development in children. A child with a poor diet may experience fatigue and be unable to fully participate in learning at school. Also, poor nutrition can make the child more likely to become sick and miss school.  Children who regularly do not get enough nutrition have poor growth patterns and underachieve at school. Getting enough of a good variety of food choices is important for a child's intellectual development. Breakfast is particularly important. Children may feel tired and unmotivated when their breakfast is too small or they skip breakfast. Normal Child & Adolescent Development 7
  • 8.  Nutrition is so important for a child's intellectual development that the United States government put programs in place to make sure each child has at least one healthy, balanced meal a day. This meal is usually breakfast, because the relationship between breakfast and improved learning has been clearly shown. Programs are available in poor and underserved areas of the United States. Normal Child & Adolescent Development 8
  • 9. 2 YEARS OLD  Physical and motor skill markers: • Able to turn a door knob • Can browse through a book one page at a time • Can build a tower of 6 to 7 cubes • Can kick a ball without losing balance • Can pick up objects while standing, without losing balance (often occurs by 15 months, and would be cause for concern if you don't see it by 2 years) • Can run with better coordination, although the stance may still be wide • May be ready for toilet training • Should have the first 16 teeth (the actual number of teeth can vary widely) • At 24 months, they are about half their final adult height Normal Child & Adolescent Development 9
  • 10. 2 YEARS OLD  Sensory and cognitive markers: • Able to put on simple clothes without help (often better at removing clothes than putting them on) • Able to communicate needs such as thirst, hunger, need to use the restroom • Can organize phrases of 2 - 3 words • Understand 2-step command ("give me the ball and then get your shoes") • Increased attention span • Vision fully developed • Vocabulary has increased to about 50 - 300 words (healthy children's vocabulary can vary widely) Normal Child & Adolescent Development 10
  • 11. 2 YEARS OLD  Play recommendations: • Allow the child to help around the house and participate in the daily family responsibilities. • Encourage and provide the necessary space for physical activity. • Encourage play that involves building and creativity. • Provide safe copies of adult tools and equipment. Many children like to mimic activities such as cutting the grass or sweeping the floor. • Read to the child. • Try to avoid watching television at this age (recommendation of the American Academy of Pediatrics). • Control both the content and quantity of television viewing. Limit television viewing to fewer than 3 hours per day, and preferably 1 hour or less. Avoid programming with violent content. Redirect the child to reading or play activities. • Control the type of games played. Normal Child & Adolescent Development 11
  • 12. 3 YEARS OLD  These milestones are typical of children in the third year of life. Always keep in mind that some variation is normal. If you have questions about your child's development, contact your health care provider. Normal Child & Adolescent Development 12
  • 13. 3 YEARS OLD  Physical and motor milestones for a typical 3-year-old may include: • Gains about 4 - 5 pounds • Grows about 2 - 3 inches • Are about half their adult height • Has improved balance • Has improved vision (20/30) • Has all 20 primary teeth • Needs 11 - 13 hours of sleep a day • May have daytime control over bowel and bladder functions (may have nighttime control as well) • Can briefly balance and hop on one foot • May walk up the stairs with alternating feet (without holding the rail) • Can construct a block tower of more than nine cubes • Can easily place small objects in a small opening • Can copy a circle • Can pedal a tricycle Normal Child & Adolescent Development 13
  • 14. 3 YEARS OLD  Sensory, cognitive, and social milestones include: • Has a vocabulary of many hundreds of words • Composes sentences of three words • Counts three objects • Uses plurals and pronouns (he/she) • Frequently asks questions • Can dress self, only requiring assistance with laces, buttons, and other fasteners in awkward places • Has longer attention span • Feeds self without difficulty • Acts out social encounters through play activities • Has some decrease in separation anxiety for short periods of time • Fears imaginary things • Knows own name, age, and gender (boy/girl) • Starts to share • Has some cooperative play (building tower of blocks together) Normal Child & Adolescent Development 14
  • 15. 3 YEARS OLD At age 3, almost all of a child's speech should be understandable. Temper tantrums are common at this age. Children who have tantrums that regularly last for more than 15 minutes or that occur more than three times a day should be seen by a health care provider. Normal Child & Adolescent Development 15
  • 16. 4 YEARS OLD  PHYSICAL AND MOTOR  During the fourth year, a child typically: • Gains weight at the rate of about 6 grams per day • The average 4 year old weighs 40 lbs. and is 40 inches tall • Vision is 20/20 • Sleeps 11 to 13 hours, usually without a nap • Grows to a height that is double the length at birth • Shows improved balance • Hops on one foot without losing balance • Throws a ball overhand with coordination • Can cut out a picture using scissors • May still wet the bed (normal) Normal Child & Adolescent Development 16
  • 17. 4 YEARS OLD  SENSORY AND COGNITIVE  The typical 4-year-old: • Has a vocabulary of more than 1,000 words • Easily puts together sentences of four or five words • Can use the past tense • Can count to four • Will ask the most questions of any age • May use words that aren't fully understood • May begin using vulgar words • Learns and sings simple songs • Tries to be very independent • May show increased aggressive behavior • Talks about personal family matters to others • Commonly has imaginary playmates • Has an increased understanding of time • Is able to tell the difference between two objects based on things like size and weight • Lacks moral concepts of right and wrong • Rebels if too much is expected of him or her Normal Child & Adolescent Development 17
  • 18. 4 YEARS OLD  PLAY  As the parent of a 4-year-old, you should: • Encourage and provide space for physical activity • Show the child how to participate in, and follow the rules of sporting activities • Encourage play and sharing with other children • Encourage creative play • Teach children to do small chores, such as setting the table • Read together • Limit television watching to 2 hours a day of quality programs • Expose the child to different stimuli by visiting local areas of interest Normal Child & Adolescent Development 18
  • 19. 5 YEARS OLD  Physical and motor skill milestones for a 5-year- old child may include: • Gains about 4 - 5 pounds per year • Grows about 2 - 3 inches per year • Vision has reached 20/20 • Erupting the first permanent teeth (most children do not get their first permanent teeth until age 6) • Developing increased coordination • Skipping, jumping, and hopping with good balance • Maintaining balance while standing on one foot with eyes closed • Showing increased skill with simple tools and writing utensils • Can copy a triangle • Spreads with a knife Normal Child & Adolescent Development 19
  • 20. 5 YEARS OLD  Sensory and cognitive milestones: • Vocabulary increasing to over 2,000 words • Composing sentences of 5 or more words, and with all parts of speech • Identifying coins • Counting to 10 • Knows telephone number • Properly naming the primary colors and possibly many more • Questioning more deeply, addressing meaning and purpose • Responding to "why" questions • Behaving more responsibly and apologizing for mistakes • Decreasing aggressive behavior • Outgrowing earlier childhood fears • Accepting other points of view (but may not understand them) • Demonstrating increased mathematical skill • Questioning others, including parents • Strongly identifying with the parent of the same sex • Having a group of friends • Engaging in imaginative play (for example, a trip to the moon) Normal Child & Adolescent Development 20
  • 21. 5 YEARS OLD  Ways to encourage a 5-year-old's development may include: • Reading together • Providing the necessary space for physical activity • Instructing the child to participate in -- and learn the rules of -- sporting activities • Encouraging the child to play with other children, which helps develop social skills • Playing creatively with the child • Monitoring both the time and content of television viewing • Visiting local areas of interest • Encouraging the child to take responsibility for small household chores, such as helping set the table or picking up toys after playing Normal Child & Adolescent Development 21
  • 22. PRESCHOOL  PHYSICAL DEVELOPMENT • Gains about 4-5 lbs. per year • Grows 2-3 inches per year • Has all 20 primary teeth by age 3 • Vision is 20/20 by age 4 • Sleeps 11-13 hours a day, usually without a nap • Gross motor development in the 3- to 6-year-old should include: ◦ Becoming more skilled at running, jumping, early throwing, and kicking ◦ Catching a bounced ball ◦ Pedaling a tricycle (at 3 years); becoming able to steer well at around age 4 ◦ Hopping on one foot (at around 4 years), and later balancing on one foot for up to 5 seconds ◦ Doing a heel-to-toe walk (at around age 5) Normal Child & Adolescent Development 22
  • 23. PRESCHOOL • Fine motor development milestones should include: ◦ At about age 3: ◦ Drawing a circle ◦ Drawing a person with three parts ◦ Beginning to use children's blunt-nose scissors ◦ Self-dressing (with supervision) ◦ At about age 4: ◦ Drawing a square ◦ Using scissors, and eventually cutting a straight line ◦ Putting on clothes properly ◦ Managing a spoon and fork neatly while eating ◦ At about age 5: ◦ Spreading with a knife ◦ Drawing a triangle Normal Child & Adolescent Development 23
  • 24. PRESCHOOL  LANGUAGE DEVELOPMENT • The 3-year-old uses: ◦ Pronouns and prepositions appropriately ◦ Three-word sentences ◦ Plural words • The 4-year-old begins to: ◦ Understand size relationships ◦ Follow a three-step command ◦ Count to four ◦ Name four colors ◦ Enjoy rhymes and word play • The 5-year-old: ◦ Shows early understanding of time concepts ◦ Counts to 10 ◦ Knows telephone number ◦ Responds to "why" questions Normal Child & Adolescent Development 24
  • 25. PRESCHOOL  BEHAVIOR  The preschooler learns the social skills needed to play and work with other children. As time passes, the child is better able to cooperate with a larger number of peers. Although 4- to 5-year-olds may be able to start playing games that have rules, the rules are likely to change often at the whim of the dominant child.  It is common in a small group of preschoolers to see a dominant child emerge who tends to boss around the other children without much resistance from them.  It is normal for preschoolers to test their physical, behavioral, and emotional limits. Having a safe, structured environment in which to explore and face new challenges is important. However, preschoolers need well-defined limits. Normal Child & Adolescent Development 25
  • 26. PRESCHOOL  The child should display initiative, curiosity, the desire to explore, and enjoyment without feeling guilty or inhibited.  Early morality develops as children want to please their parents and others of importance. This is commonly known as the "good boy" or "good girl" stage.  Elaborate storytelling may progress into lying. If this is not addressed during the preschool years, this behavior may continue into the adult years. Mouthing-off or backtalk is usually a way for preschoolers to get attention and a reaction from an adult. Normal Child & Adolescent Development 26
  • 27. PRESCHOOL  Safety is very important for preschoolers. • Preschoolers are highly mobile and able to quickly get into dangerous situations. Parental supervision at this age is essential, just as it was during the earlier years. • Car safety is critical. The preschooler should ALWAYS wear a seatbelt and be in an appropriate car seat when riding in the car. At this age children may be riding with other children's parents. It is important to review your rules for car safety with others who may be supervising your child. • Falls are a major cause of injury in preschoolers. Climbing to new and adventurous heights, preschoolers may fall off playground equipment, bikes, down stairs, from trees, out of windows, and off roofs. Lock doors that access dangerous areas (such as roofs, attic windows, and steep staircases) and have strict rules for the preschooler about areas that are off-limits. Normal Child & Adolescent Development 27
  • 28. PRESCHOOL • Kitchens are a prime area for a preschooler to get burned, either while trying to help cook or coming in contact with appliances that are still hot. Encourage the child to help cook or learn cooking skills with safe, cool recipes. Have other activities for the child to enjoy in a nearby room while you are cooking. Keep the child away from the stove, hot foods, and other appliances. • Keep all household products and medicines safely locked out of the reach of preschoolers. Know the number for your local poison control center. The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. Call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week. Normal Child & Adolescent Development 28
  • 29. PRESCHOOL  Stuttering may occur in the normal language development of toddlers ages 3 - 4 years. It occurs because ideas come to mind faster than the child is able to express them, especially if the toddler is stressed or excited.  When the child is speaking, give your full, prompt attention. Do not comment on the stuttering. Consider having the child evaluated by a speech pathologist if: • There are other signs with the stuttering, such as tics, grimacing, or extreme self-consciousness • The stuttering lasts longer than 6 month Normal Child & Adolescent Development 29
  • 30. SCHOOL AGE (6-12)  PHYSICAL DEVELOPMENT  School-age children usually have smooth and strong motor skills. However, their coordination (especially eye-hand), endurance, balance, and physical abilities vary.  Fine motor skills may also vary widely. These skills can affect a child's ability to write neatly, dress appropriately, and perform certain chores, such as making beds or doing dishes.  There will be big differences in height, weight, and build among children of this age range. It is important to remember that genetic background, as well as nutrition and exercise, may affect a child's growth.  A sense of body image begins developing around age 6. Sedentary habits in school-aged children are linked to a risk of obesity and heart disease in adults. Children in this age group should get 1 hour of physical activity per day. Normal Child & Adolescent Development 30
  • 31. SCHOOL AGE (6-12)  There can also be a big difference in the age at which children begin to develop secondary sexual characteristics.  For girls, secondary sex characteristics include: • Breast development • Underarm and pubic hair growth  For boys, they include: • Growth of underarm, chest, and pubic hair • Growth of testicles and penis Normal Child & Adolescent Development 31
  • 32. SCHOOL AGE (6-12)  SCHOOL  By age 5, most children are ready to start learning in a school setting. The first few years focus on learning the fundamentals.  In 3rd grade, the focus becomes more complex. Reading becomes more about the content than identifying letters and words.  An ability to pay attention is important for success both at school and at home. A 6-year- old should be able to focus on a task for at least 15 minutes. By age 9, a child should be able to focus attention for about an hour. Normal Child & Adolescent Development 32
  • 33. SCHOOL AGE (6-12)  It is important for the child to learn how to deal with failure or frustration without losing self-esteem. There are many causes of school failure including: learning disabilities such a reading disability, stressors such as bulling and mental health issues such as anxiety or depression. If you suspect any of these causes, talk to your child’s teacher or health care provider. Normal Child & Adolescent Development 33
  • 34. SCHOOL AGE (6-12)  LANGUAGE DEVELOPMENT  Early school-age children should be able to use simple, but complete sentences that average five to seven words. As the child goes through the elementary school years, grammar and pronunciation become normal. Children use more complex sentences as they grow.  Language delays may be due to hearing or intelligence problems. In addition, children who are unable to express themselves well may be more likely to have aggressive behavior or temper tantrums.  A 6-year-old child normally can follow a series of three commands in a row. By age 10, most children can follow five commands in a row. Children who have a problem in this area may try to cover it up with backtalk or clowning around. They will rarely ask for help because they are afraid of being teased. Normal Child & Adolescent Development 34
  • 35. SCHOOL AGE (6-12)  BEHAVIOR  Frequent physical complaints (such as sore throats, tummy aches, arm or leg pain) may simply be due to a child's increased body awareness. Although there is often no physical evidence for such complaints, the complaints should be investigated to rule out possible health conditions, and to assure the child that the parent is concerned about his or her well-being.  Peer acceptance becomes more important during the school-age years. Children may take part in certain behaviors to be part of "the group." Talking about these behaviors with your child will allow the child to feel accepted in the group, without crossing the boundaries of the family's behavior standards. Normal Child & Adolescent Development 35
  • 36. SCHOOL AGE (6-12)  Friendships at this age tend to be mainly with members of the same sex. In fact, younger school-age children often talk about members of the opposite sex as being "strange" or "awful." Children become less negative about the opposite sex as they get closer to adolescence.  Lying, cheating, and stealing are all examples of behaviors that school-age children may "try on" as they learn how to negotiate the expectations and rules placed on them by family, friends, school, and society. Parents should deal with these behaviors privately (so that the child's friends don't tease them). Parents should show forgiveness, and punish in a way that is related to the behavior.  It is important for the child to learn how to deal with failure or frustration without losing self-esteem. Normal Child & Adolescent Development 36
  • 37. SCHOOL AGE (6-12)  Safety is important for school-age children. • School-age children are highly active. They need physical activity and peer approval, and want to try more daring and adventurous behaviors. • Children should be taught to play sports in appropriate, safe, supervised areas, with proper equipment and rules. Bicycles, skateboards, in-line skates, and other types of recreational sports equipment should fit the child. They should be used only while following traffic and pedestrian rules, and while using safety equipment such as knee, elbow, wrist pads/braces, and helmets. Sports equipment should not be used at night or in extreme weather conditions. Normal Child & Adolescent Development 37
  • 38. SCHOOL AGE (6-12) • Swimming and water safety lessons may help prevent drowning. • Safety instruction regarding matches, lighters, barbecues, stoves, and open fires can prevent major burns. • Wearing seat belts is the most important way to prevent major injury or death from a motor vehicle accident. Normal Child & Adolescent Development 38
  • 39. ADOLESCENTS  During adolescence, children develop the ability to: • Understand abstract ideas, such as higher math concepts, and develop moral philosophies, including rights and privileges • Establish and maintain satisfying relationships by learning to share intimacy without feeling worried or inhibited • Move toward a more mature sense of themselves and their purpose • Question old values without losing their identity Normal Child & Adolescent Development 39
  • 40. ADOLESCENTS  PHYSICAL DEVELOPMENT  During adolescence, young people go through many changes as they move from childhood into physical maturity. Early, prepubescent changes occur when the secondary sexual characteristics appear. Normal Child & Adolescent Development 40
  • 41. ADOLESCENTS  Girls: • Girls may begin to develop breast buds as early as 8 years old. Breasts develop fully between ages 12 and 18. • Pubic hair, armpit and leg hair usually begin to grow at about age 9 or 10, and reach adult patterns at about 13 to 14 years. • Menarche (the beginning of menstrual periods) typically occurs about 2 years after early breast and pubic hair appear. It may occur as early as age 9, or as late as age 16. The average age of menstruation in the United States is about 12 years. • Girls growth spurt peaks around age 11.5 and slows around age 16. Normal Child & Adolescent Development 41
  • 42. ADOLESCENTS  Boys: • Boys may begin to notice that their testicles and scrotum grow as early as age 9. Soon, the penis begins to lengthen. By age 17 or 18, their genitals are usually at their adult size and shape. • Pubic hair growth -- as well as armpit, leg, chest, and facial hair -- begins in boys at about age 12, and reaches adult patterns at about 17 to 18 years. Normal Child & Adolescent Development 42
  • 43. ADOLESCENTS • Boys do not start puberty with a sudden incident, like the beginning of menstrual periods in girls. Having regular nocturnal emissions (wet dreams) marks the beginning of puberty in boys. Wet dreams typically start between ages 13 and 17, with the average at about 14.5 years. • Boys' voices change at the same time as the penis grows. Nocturnal emissions occur with the peak of the height spurt. • Boys growth spurt peaks around age 13.5 and slows around age 18. Normal Child & Adolescent Development 43
  • 44. ADOLESCENTS  BEHAVIOR  The sudden and rapid physical changes that adolescents go through make adolescents very self-conscious, sensitive, and worried about their own body changes. They may make painful comparisons about themselves with their peers.  Because physical changes may not occur in a smooth, regular schedule, adolescents may go through awkward stages, both about their appearance and physical coordination. Girls may be anxious if they are not ready for the beginning of their menstrual periods. Boys may worry if they do not know about nocturnal emissions.  During adolescence, it is normal for young people to begin to separate from their parents and establish their own identity. In some cases, this may occur without a problem from their parents and other family members. However, in some families, the adolescent's rebellion may lead to conflict as the parents try to keep control. Normal Child & Adolescent Development 44
  • 45. ADOLESCENTS  As adolescents pull away from their parents in a search for their own identity, their friends become more important. • Their peer group may become a safe haven, in which the adolescent can test new ideas. • In early adolescence, the peer group usually consists of non-romantic friendships, often including "cliques," gangs, or clubs. Members of the peer group often try to act alike, dress alike, have secret codes or rituals, and participate in the same activities. • As the youth moves into mid-adolescence (14 to 16 years) and beyond, the peer group expands to include romantic friendships. Normal Child & Adolescent Development 45
  • 46. ADOLESCENTS  In mid- to late adolescence, young people often feel the need to establish their sexual identity by becoming comfortable with their body and sexual feelings. Through romantic friendships, dating, and experimenting, adolescents learn to express and receive intimate or sexual advances. Young people who do not have the opportunity for such experiences may have more difficulty with intimate relationships when they are adults. Normal Child & Adolescent Development 46
  • 47. ADOLESCENTS  Adolescents usually have behaviors that are consistent with several myths of adolescence: • The first myth is that they are "on stage" and other people's attention is constantly centered on their appearance or actions. This normal self-centeredness may appear (especially to adults) to border on paranoia, self-love (narcissism), or even hysteria. • Another myth of adolescence is the idea that "it will never happen to me, only the other person." "It" may represent becoming pregnant or catching a sexually-transmitted disease after having unprotected sex, causing a car crash while driving under the influence of alcohol or drugs, or any of the many other negative effects of risk-taking behaviors. Normal Child & Adolescent Development 47
  • 48. ADOLESCENTS  SAFETY  Adolescents become stronger and more independent before they've developed good decision-making skills. A strong need for peer approval may entice a young person to try dangerous feats, or take part in risk-taking behaviors.  Motor vehicle safety should be stressed, focusing on the roles of the driver/passenger/pedestrian, the risks of substance abuse, and the importance of using seat belts. Adolescents should not have the privilege of using cars and recreational motor vehicles unless they can show that they can use these vehicles safely. Normal Child & Adolescent Development 48
  • 49. ADOLESCENTS  Other safety issues are: • Adolescents who are involved in sports should learn to use equipment and protective gear or clothing. They should be taught the rules of safe play and healthy approaches to activities that require more advanced skills. • Young people need to be very aware of possible dangers -- including sudden death -- which may occur with regular substance abuse, and with the experimental use of drugs and alcohol. • Adolescents who are allowed to use or have access to firearms need to learn how to use them safely, properly, and legally. Normal Child & Adolescent Development 49
  • 50. ADOLESCENTS  If adolescents appear to be isolated from their peers, uninterested in school or social activities, or doing poorly at school, work, or sports -- they need to be evaluated.  Many adolescents are at increased risk for depression and potential suicide attempts, because of pressures and conflicts in their family, school or social organizations, peer groups, and intimate relationships. Normal Child & Adolescent Development 50
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