1 2009 Pediatrcs 留学生 Fang1


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1 2009 Pediatrcs 留学生 Fang1

  1. 1. PEDIATRCS MBBS.weebly.com
  2. 2. <ul><li>Pediatrics is a medical sciences of researching on : </li></ul><ul><li>● The growth and development of children. </li></ul><ul><li>● The physical and psychological health </li></ul><ul><li>● Prevention and treatment of diseases , </li></ul><ul><li>from the fetal to adolescence </li></ul>
  3. 3. <ul><li>Age Group Distribution And The Principles Of </li></ul><ul><li>Health Care </li></ul><ul><li>1. FETAL PERIOD </li></ul><ul><li>2. NEONATAL PERIOD (neonatal infant) </li></ul><ul><li>3. INFANCY (infant period) </li></ul><ul><li>4. TODDLER'S AGE </li></ul><ul><li>5. PRESCHOOL AGE </li></ul><ul><li>6. SCHOOL AGE </li></ul><ul><li>7. ADOLESCENCE </li></ul>
  4. 4. 1. FETAL PERIOD <ul><li>  </li></ul><ul><li>Time-- From fertilized ovum to birth : about </li></ul><ul><li>294 days ( 40 wk from fertilization) </li></ul><ul><li>※ Early period of gestation (1st trimester) : </li></ul><ul><li>from fertilization to 12 th wk. </li></ul><ul><li>● organs of systems formed </li></ul><ul><li>● heart beat by the end of 4 wk </li></ul><ul><li>● fetus formed about 8-10 wk </li></ul><ul><li>● sex distinguished </li></ul><ul><li>● important period of fetal, deformation by many factors (infection, radiation, chemistry, genetics, etc) </li></ul>
  5. 5. <ul><li>※ Middle period of gestation (2nd trimester) : from 13th wk to 28th wk. </li></ul><ul><li>● organs growth rapidly </li></ul><ul><li>● function of organs maturate gradually. </li></ul><ul><li>● by the end of 28th wk, weight ≈ 1000 g, alive birth. </li></ul>
  6. 6. <ul><li>※ Later period of gestation (3rd trimester) : From 29 th wk to 40 th wk </li></ul><ul><li>● increase in size of fetus involves primarily subcutaneous tissue and muscle mass. </li></ul><ul><li>● function of organs mature further </li></ul>
  7. 7. <ul><li>fetal development hindered: </li></ul><ul><li>still birth, abortion, premature labor, congenital malformation, etc. </li></ul>
  8. 8. <ul><li>Health care of pregnant and fetus is very important: </li></ul><ul><li>Fetus live dependent to mother. maternal health, nutrition, emotion, circumstance, diseases impact fetal development greatly. </li></ul><ul><li>Mother invaded by harmful factors ( physical or chemical injury, malnutrition, infection, drugs and psycholgical wound, immune reaction) </li></ul>
  9. 9. <ul><li>2. NEONATAL PERIOD </li></ul><ul><li>Time --from the ligature of umbilical cord at birth to 28 days. (<7 d , early period of neonate). </li></ul><ul><li>Character : independent to mother, circum-stance change greatly. </li></ul>
  10. 10. <ul><li>Health care : </li></ul><ul><li>emphasize the nursing (warmth, feeding, cleaning, sterilization, separation). </li></ul>
  11. 11. <ul><li>※ Prenatal period </li></ul><ul><li>--from the end of 28th wk of pregnancy to 7 days after birth (weight ≥1000g). </li></ul><ul><li>Include 3 period: later gestation, the course of delivery, early neonate. </li></ul><ul><li>● Fetus undergo a great change. </li></ul><ul><li>● High prenatal mortality (still birth, birth death and neonate death). </li></ul><ul><li>● prenatal mortality is the criterion of evaluating the quality of obstetrics and pediatrics </li></ul>
  12. 12. <ul><li>3. INFANCY (infant period) </li></ul><ul><li>Time-- from deletion of UC to 1 yr old </li></ul><ul><li>Character : </li></ul><ul><li>● The fastest period of growth and </li></ul><ul><li>development. </li></ul><ul><li>● High demands of energy and nutrition </li></ul><ul><li>but immature digestive function </li></ul><ul><li>-> malnutrition, disturbance of digestion. </li></ul><ul><li>● Immature immunity -> infective and infectious diseases. </li></ul>
  13. 13. <ul><li>Health care : </li></ul><ul><li>● Advocate breast feeding </li></ul><ul><li>● reasonable nutrition and supplemental food. </li></ul><ul><li>● planning inoculation vaccination </li></ul><ul><li>● Training good habit of hygiene </li></ul><ul><li>● prevent infection and wound </li></ul>
  14. 14. <ul><li>4. TODDLER'S AGE </li></ul><ul><li>Time-- from the end of l yr to 3 yr old </li></ul><ul><li>Character: </li></ul><ul><li>● Slower speed of growth and development </li></ul><ul><li>● Extended range of activity, increased contact with people and things </li></ul><ul><li>● intelligence development faster: increased language, thinking, adaptive, social ability. </li></ul><ul><li>● Poor ability of recognizing danger </li></ul><ul><li>● Easy to suffer from infection </li></ul>
  15. 15. <ul><li>Health care </li></ul><ul><li>● prevention of accident wound and the toxic </li></ul><ul><li>● pay attention to feeding and nutrition to </li></ul><ul><li>prevent malnutrition </li></ul><ul><li>● prevention of infectious and infective diseases </li></ul>
  16. 16. <ul><li>5. PRESCHOOL AGE </li></ul><ul><li>Time--from the end of 3 rd yr. to enter school (6 ~ 7 yr old) </li></ul><ul><li>Character : </li></ul><ul><li>● physical growth and development steady </li></ul><ul><li>● intelligence development fast, understanding </li></ul><ul><li>gradually </li></ul><ul><li>● curious and like mimic </li></ul><ul><li>● express language, thinking and emotions by language </li></ul><ul><li>● changeable character </li></ul>
  17. 17. <ul><li>Health care: </li></ul><ul><li>● Train good morality and good habit of hygiene, learning and work. </li></ul><ul><li>● pay attention to the hygiene of eyes and mouth </li></ul><ul><li>● Prevention of infection diseases, nephritis and rheumatic disease </li></ul><ul><li>● Prevention of accidence and wound </li></ul>
  18. 18. <ul><li>6. SCHOOL AGE </li></ul><ul><li>Time--from 6 ~ 7 yr old to 12 (girl) ~ 13(boys) yr old </li></ul><ul><li>Character : </li></ul><ul><li>● except genital system, organs of systems are </li></ul><ul><li>similar to the adult level. </li></ul><ul><li>● morphology of brain is similar to adult </li></ul><ul><li>● more mature intelligent development </li></ul><ul><li>● Important period of getting knowledge and receiving education. </li></ul><ul><li>● Education for the development of the good morality, intelligence, physics, beauty and labor. </li></ul>
  19. 19. <ul><li>Health care : </li></ul><ul><li>● Train correct posture of sitting, standing and walking, reason schedule of live, study and exercise. </li></ul><ul><li>● prevention of near sight and dental caries. </li></ul><ul><li>● pay attention to the change of emotion and behavior, to avoid nervousness. </li></ul>
  20. 20. <ul><li>7. ADOLESCENCE </li></ul><ul><li>Time--girls from 11 ~ 12 yr old to 17 ~ 18yr old </li></ul><ul><li>boys from 13 ~ 14 yr old to 18 ~ 20 yr old </li></ul><ul><li>Character : </li></ul><ul><li>● Faster physical growth and development (2 nd </li></ul><ul><li>peak) </li></ul><ul><li>● Reproductive system develop fast, and mature gradually. </li></ul><ul><li>● Unstable psychology, behavior and mind, Great impact from social contact </li></ul>
  21. 21. <ul><li>Health care : </li></ul><ul><li>● provide enough nutrition and rest, encourage do more exercise </li></ul><ul><li>● Strengthen education and guidance to establish good morality </li></ul><ul><li>● pay attention to education of physiology and hygiene </li></ul><ul><li>● prevention of goiter and hypertension </li></ul>
  22. 22. <ul><li>THE BASIC AND CLINICAL FEATURES </li></ul><ul><li>OF PEDIATRICS </li></ul>
  23. 23. <ul><li>  1. The character of basic medicine </li></ul><ul><li>⑴ ANATOMY </li></ul><ul><li>※ Changing continuously with age in appearance(weight,height, head </li></ul><ul><li>circumference, etc ) body proportions, bone development (fontanels, ossification </li></ul><ul><li>centers), teeth, the size and position of organs, and skin, muscles, nouves and lymphatic system. </li></ul><ul><li>※ familiar with the normal regularity, help to judge the normal or abnormal </li></ul>
  24. 24. <ul><li>⑵ PHYSIO-BIOCHEMISTRY </li></ul><ul><li>● The normal values change: HR, BP, RR, haematology, component of body fluid </li></ul><ul><li>● Functions mature gradually </li></ul><ul><li>● Immature function, easy to suffer from diseases </li></ul><ul><li>● high metabolism and immature renal function </li></ul><ul><li>-> disturbance of water and electrolyte. </li></ul>
  25. 25. <ul><li>⑶ IMMUNITY </li></ul><ul><li>※ Immune function of skin, mucous, lymphatic system, and cytokines mature with the age increase. physiologic low immunity of infancy ->easy suffer from infection. </li></ul><ul><li>● Ig G from mother disappear 3 ~ 5 mo, active IgG reach adult level in 6 ~ 7 yr. old-> respiratory and digestive system infection </li></ul><ul><li>● Ig M cannot transit ->easy to sepsis of G - in neonates </li></ul><ul><li>● S Ig A deficiency in respiratory </li></ul><ul><li>● Lower cytokines factors (complement, migration factor, etc) and phagocyte ability </li></ul>
  26. 26. <ul><li>⑷ PATHOLOGY </li></ul><ul><li>response to </li></ul><ul><li>pathogenic factors is different : </li></ul><ul><li>● pneumonococcus ->bronchopneumonia </li></ul><ul><li>in infants, lobar peumonia in adult </li></ul><ul><li>● Vit D deficiency -> ricket (infants), </li></ul><ul><li>achondroplasia (adult) </li></ul>
  27. 27. <ul><li>2. CLINICAL FEATHUR </li></ul><ul><li>⑴ Disease Pattern </li></ul><ul><li>※ The kinds of diseases are quite different from adult: congenital, hereditary, infective </li></ul><ul><li>diseases more common. </li></ul><ul><li>● Congenital heart diseases (children) </li></ul><ul><li>atherosclerosis heat diseases (adult). </li></ul><ul><li>● acute leukemia (children), </li></ul><ul><li>malignent tumor (adult). </li></ul><ul><li>● hyperbillirubinemia of the newborn, febrile convulsion not in adult </li></ul>
  28. 28. <ul><li>⑵ CLINICAL MANIFESTATION </li></ul><ul><li>● Onset acute or abrupt </li></ul><ul><li>● Clinical course: repeat (relapse), fluctuate, change fast. </li></ul><ul><li>● Lacking limitation ability->easy to complicate septicemia, while the prime focal infection is not discovered </li></ul><ul><li>● Severe infection in newborn or weak infants: hypothermia, refuse to eat, dull expression, WBC↓. </li></ul>
  29. 29. <ul><li>⑶ DIAGNOSIS </li></ul><ul><li>● cannot complain and describe symptoms </li></ul><ul><li>diagnosis based on the history ( from parent),epidemic data, signs and lab data </li></ul><ul><li>● Clinical manifestation and the kinds of diseases are special to every age period, pay attention to age when diagnosis, </li></ul>
  30. 30. same symptom - different diagnosis <ul><li>● Convulsion in neonates : birth trauma asphyxia, intracranial hemorrhage and congenital abnormalities </li></ul><ul><li>● <6 mo infants : vitamin D deficiency or CNS </li></ul><ul><li>infection </li></ul><ul><li>● >3 yr old (no fever): epilepsy </li></ul>
  31. 31. <ul><li>⑷ TREAMENT </li></ul><ul><li>● Doses of drug change with age or weight </li></ul><ul><li>● Some methods special in children </li></ul><ul><li>● Fluid therapy is special </li></ul><ul><li>● Poor immunity, modulation and adaptive capability->complications. pay attention to complication when treat origin disease </li></ul><ul><li>● Well nursing and support treatment are important </li></ul>
  32. 32. <ul><li>⑸ PROGNOSIS </li></ul><ul><li>● Recovery fast by prompt and proper treatment </li></ul><ul><li>● Vigorous recovery ability of tissue and organs->less sequels </li></ul><ul><li>● Exacerbation fast ->death </li></ul>
  33. 33. <ul><li>3. Character of prevention </li></ul><ul><li>Prevention is very important in pediatrics </li></ul><ul><li>● plan immunization is the most important one->eliminate or decrease infectious disease </li></ul><ul><li>● Monitoring the growth and development-> find </li></ul><ul><li>problem and correct them </li></ul><ul><li>● Hereditary consult->prevent the development of some diseases </li></ul><ul><li>● Neonatal screen prevent some diseases development. </li></ul><ul><li>● prevent some adult diseases from child </li></ul>
  34. 34. <ul><li>GROWTH AND DEVELOPMENT </li></ul>
  35. 35. <ul><li>THE REGULARITY OF GROWTH AND DEVELOPMENT </li></ul><ul><li>Growth: grow up of body and organs, quantitative increment </li></ul><ul><li>Development: functional maturity of cells, tissues and organs, qualitative changes. </li></ul><ul><li>Both can't be separated definitively. </li></ul>
  36. 36. <ul><li>  Some regularity of development </li></ul><ul><li>⑴ Development is a continuous course but the speed of development varies in different stage. there are two peaks : first & 2 nd peak. </li></ul><ul><li>⑵ Unbalance development of different organs or systems: </li></ul><ul><li>nerve system earlier, genital system later, lymph system fast in early period and then shrunk. </li></ul>
  37. 38. <ul><li>⑶ General regularity of development </li></ul><ul><li>from up to down: lift head, chest, sit, stand, walk </li></ul><ul><li>from proximal to distal: arm->hand, leg-> </li></ul><ul><li>foot </li></ul><ul><li>from gross to fine: hold object by palm-> </li></ul><ul><li>finger </li></ul><ul><li>from simple to complex: draw line->circle -> </li></ul><ul><li>picture of person </li></ul><ul><li>from elementary to advanced : see, feel, recognize, remember, think, analyze, judge. </li></ul>
  38. 39. <ul><li>⑷ individual variation of development </li></ul><ul><li>influence on sex, hereditary, environment, cultural factors. </li></ul><ul><li>with age increase, difference obviously. </li></ul>
  39. 40. <ul><li>THE INFLUENCE FACTORS OF DEVELOPMENT </li></ul><ul><li>⑴ Heredity(inheritance): The feature, potentiality, trends and limitation </li></ul><ul><li>⑵ Sex </li></ul><ul><li>⑶ Nutrition </li></ul><ul><li>⑷ Conditions of pregnant mother: environment, </li></ul><ul><li>nutrition, emotion, diseases </li></ul><ul><li>⑸ Living environment: sun light, fresh air, clean water; living schedule, nursing, education, exercise. </li></ul><ul><li>⑹ Diseases: Acute or chronic diseases, endocrine </li></ul><ul><li>diseases, congenital diseases. </li></ul>
  40. 41. <ul><li>Indicators of Physical Growth </li></ul><ul><li>  </li></ul><ul><li>1.THE GROWTH BEFORE PUBERTY </li></ul><ul><li>⑴ BODY WEIGHT </li></ul><ul><li>● The sum of all tissues (bone, organs, muscle, fat) and body fluid </li></ul><ul><li>reflect the physical growth, esp. </li></ul><ul><li>nutrition. </li></ul><ul><li>The basis of calculating dose of drugs and fluid infusion. </li></ul>
  41. 42. <ul><li>● Body weight: at birth, 3 kg (2.5 ~ 4kg); decrease 3 ~ 9 % 1st wk; fast increase 1 ~ 6 mo (1st peak); 1yr old 9 kg, 2yr old 12 kg; 2 ~ 12yr old 2 kg/yr; fast increase in adolescence (2nd peak) </li></ul>
  42. 43. <ul><li>● The formulas for average weight of normal infants and children. </li></ul><ul><li>1 ~ 6 mo: Wt (kg) = Wt at birth + mo×0.7(kg) </li></ul><ul><li>7 ~ 12 mo: Wt (kg) = 6(kg) + mo×0.25(kg) </li></ul><ul><li>2 ~ 12 yr: Wt (kg) = Age×2(kg) + 7(8)(kg) </li></ul><ul><li>10 % individual difference </li></ul>
  43. 47. <ul><li>⑵ INCREASE OF STATUS </li></ul><ul><li>① body height(standing height) </li></ul><ul><li>● The length from the top of head to sole (foot- plate), an index of evaluating bone growth. </li></ul><ul><li>● Height 50 cm at birth; increment of 1st yr 25 cm(1st peak), (<6 mo 2.5 cm/mo, >6 m 1.5 cm/mo) , 75 cm at 1yr old; 85 cm at 2 yr old; after 2 yr old, 5 ~ 7cm / yr; fast in adolescence (2 nd peak). </li></ul>
  44. 48. <ul><li>● The formulas for average height of normal children (2 ~ 12 yr old) </li></ul><ul><li>Height (cm) = Age (years)×7 + 70 cm </li></ul><ul><li>● Height include 3 parts : head, spine, lower extremities. </li></ul><ul><li>The proportion of head, trunk, lower extremities different with age. </li></ul><ul><li>In 1st yr head increase fastest, spine secondary, </li></ul><ul><li>In adolescence, lower extremities increase mainly, </li></ul>
  45. 51. <ul><li>● Upper segment : from head top to the upper border of pubic symphysis. </li></ul><ul><li>● Lower segment : from the upper border of symphysis pubis to sole. </li></ul><ul><li>● Midpoint: At birth: on umbilicus, </li></ul><ul><li>2yr old: below umbilicus, </li></ul><ul><li>6 yr old: on the midpoint between umbilicus </li></ul><ul><li>and pubic, </li></ul><ul><li>12 yr old : on the upper border of pubic </li></ul><ul><li>symphysis (upper segment = lower). </li></ul>
  46. 52. <ul><li>② SITTING HEIGHT </li></ul><ul><li>● The length from head top to ischial bone (head + spine) </li></ul><ul><li>● The regularity of sitting height increase≈ upper height, </li></ul><ul><li>Sitting height / body height decrease with age increased. </li></ul><ul><li>③ Span: distance of finger-tip </li></ul><ul><li>represent the growth of the long bone of upper extremities </li></ul>
  47. 53. <ul><li>(3)HEAD CIRCUMFERENCE (HC) </li></ul><ul><li>● The length surrounding a circle of head via upper border of eyebrow bow and occipital node. </li></ul><ul><li>● Related closely to brain development . </li></ul><ul><li>● Head circumference: 34 cm at birth, 44 cm in 6 mo, 46 cm in 1 yr old, 48 cm in 2 yr old, 50 cm in 5 yr old. </li></ul><ul><li>● HC=1/2Ht+10cm </li></ul>
  48. 55. <ul><li>(4)CHEST CIRCUMFERENCE (CC) </li></ul><ul><li>● The length of a circle of chest. (lower border of nipple). </li></ul><ul><li>● Related closely to the development of lung and bone, muscle, and fat of thorax. </li></ul><ul><li>● Chest circumference: 32 cm at birth, 46 cm by the end of 1 yr ( = head), after 1 yr old, > head circumference. </li></ul><ul><li>(5) UPPER ARM CIRCUMFERENCE(UAC) </li></ul><ul><li><1yr 、 fast, 1~5yr. Slow(1 ~ 2cm) </li></ul><ul><li>as a index of evaluating nutrition </li></ul><ul><li>>13.5cm good, <12.5cm poor </li></ul>
  49. 56. <ul><li>Proportion of body and the symmetry </li></ul><ul><li>⑴ Proportion of head and stature </li></ul><ul><li>Changes during the growth </li></ul><ul><li>⑵ Weight by stature </li></ul><ul><li>● Weight-for-height W/H </li></ul><ul><li>● Weight(kg)/height(cm) ×1000--Quetelet index </li></ul><ul><li>● Weight(kg)/height(cm)×10 4 --Kaup index </li></ul>
  50. 58. <ul><li>⑶ Trunk-leg ratio </li></ul><ul><li>● Sitting height/standing height </li></ul><ul><li>● represent the growth of lower extremities </li></ul><ul><li>● at birth(0.67)->14 yr (0.53) </li></ul><ul><li>● Some diseases (hypothyrodism) affect the ratio </li></ul><ul><li>⑷ span and height </li></ul><ul><li>● span < height(1 ~ 2cm) </li></ul><ul><li>● if span> height (Marfan syndrome) </li></ul>
  51. 59. <ul><li>2. GROWTH ON PUBERTY </li></ul><ul><li>● 2 nd peak height velocity(PHV) </li></ul><ul><li>● Sex difference (boy later 2yr, increase/yr> girl) </li></ul><ul><li>● girl 8cm/yr. boy 9cm/yr </li></ul><ul><li>● weight increase parallel with the height </li></ul>
  52. 60. <ul><li>3. Assessment of growth </li></ul><ul><li>⑴ The express methods of the measure value </li></ul><ul><li>1) Express method of statistics and cut off point </li></ul><ul><li>● Dispersion method x ± SD: ±2SD, 95.4% </li></ul><ul><li>● Percentage method: P 3 ~P 97 , 94% </li></ul><ul><li>● Z score=(x – x ) /SD </li></ul><ul><li>● mean Value method: M≈x 、 P 50 </li></ul>
  53. 61. <ul><li>2) The express of result </li></ul><ul><li>● Grade dividing </li></ul><ul><li>● growth chart </li></ul>
  54. 63. <ul><li>⑵ The contents of the growth evaluation. </li></ul><ul><li>1) Development level </li></ul><ul><li>● growth value vs conference </li></ul><ul><li>● premature: correct fetal age to 40 wk. </li></ul><ul><li>Ht 40mo, HC 18mo. wt 24mo catch up the growth of mature neonates </li></ul>
  55. 64. <ul><li>2) Growth velocity </li></ul><ul><li>● continuously measure an index during a period </li></ul><ul><li>3) proportion of body: </li></ul><ul><li>● weight by stature weight for height, W/H </li></ul><ul><li>● trunk-leg ratio (sitting W/H) </li></ul>
  56. 65. <ul><li>What is the pediatrics ? </li></ul><ul><li>● The growth and development of children. </li></ul><ul><li>● The physical and psychological health </li></ul><ul><li>● Prevention and treatment of diseases , </li></ul><ul><li>from the fetal to adolescence </li></ul>Remind of 1
  57. 66. Remind of 2 <ul><li>AGE PERIOD </li></ul><ul><li>1. FETAL PERIOD </li></ul><ul><li>2. NEONATAL PERIOD </li></ul><ul><li>3. INFANCY </li></ul><ul><li>4. TODDLER'S AGE </li></ul><ul><li>5. PRESCHOOL AGE </li></ul><ul><li>6. SCHOOL AGE </li></ul><ul><li>7. ADOLESCENCE </li></ul>
  58. 67. Remind of 3 <ul><li>  Some regularity of development </li></ul><ul><li>⑴ Development is a continuous course but the speed of development varies in different stage. there are two peaks : first & 2 nd peak. </li></ul><ul><li>⑵ Unbalance development of different organs or systems: </li></ul><ul><li>nerve system earlier, genital system later, lymph system fast in early period and then shrunk. </li></ul>
  59. 68. Remind of 3 <ul><li>⑶ General regularity of development </li></ul><ul><li>from up to down: lift head, chest, sit, stand, walk </li></ul><ul><li>from proximal to distal: arm->hand, leg-> </li></ul><ul><li>foot </li></ul><ul><li>from gross to fine: hold object by palm-> </li></ul><ul><li>finger </li></ul><ul><li>from simple to complex: draw line->circle -> </li></ul><ul><li>picture of person </li></ul><ul><li>from elementary to advanced : see, feel, recognize, remember, think, analyze, judge. </li></ul>
  60. 69. Remind of 3 <ul><li>⑷ individual variation of development </li></ul>
  61. 70. Remind of 4 <ul><li>Indicators of Physical Growth </li></ul><ul><li>⑴ BODY WEIGHT </li></ul><ul><li>(2) body height (standing height) </li></ul><ul><li>(3)HEAD CIRCUMFERENCE (HC) </li></ul><ul><li>(4)CHEST CIRCUMFERENCE (CC) </li></ul><ul><li>(5) UPPER ARM CIRCUMFERENCE(UAC) </li></ul>
  62. 71. Remind of 4 <ul><li>Proportion of body and the symmetry </li></ul><ul><li>⑴ Proportion of head and stature </li></ul><ul><li>⑵ Weight by stature </li></ul><ul><li>⑶ Trunk-leg ratio </li></ul><ul><li>⑷ span and height </li></ul>
  63. 72. Remind of 5: the chart
  64. 73. <ul><li>DEVELOPMENT OF SYSTEMS </li></ul>
  65. 74. <ul><li>1.DEVELOPMENT OF BONES </li></ul><ul><li>⑴ Development of Cranial bone </li></ul><ul><li>● Evaluation base on head circumference, fontanels, cranial sutures. </li></ul><ul><li>● Anterior fontanel : a rhombic gap composed of the border of parietal and frontal bones. </li></ul><ul><li>Length 1.5 ~ 2 cm at birth, increase gradually, after 6 mo, decrease with ossification gradually, closed 12 ~ 18 mo. </li></ul>
  66. 75. <ul><li>● Posterior fontanel : a triangular gap composed of the border of parietal and occipital bones. </li></ul><ul><li>very small or closed at birth, finally closed 6 ~ 8 wk. </li></ul><ul><li>● Cranial sutures: still separated at birth, closed 3 ~ 4 mo. </li></ul>
  67. 77. <ul><li>Anterior fontanel : </li></ul><ul><li>closed early or too small--microcephalia; closed later or large--ricket or cretinism; </li></ul><ul><li>full (plump) -- cranial pressure↑ (hydrocephalus, encephalitis, cephalitis meningitis, tumor of brain); </li></ul><ul><li>sunken (depression)--dehydration, severe emaciation (wasting). </li></ul>
  68. 78. <ul><li>(2).DEVELOPMENT OF SPINAL COLUMN </li></ul><ul><li>● reflect to the development of spinal bones, faster during 1st yr. </li></ul><ul><li>● 3 mo when lift head, cervical vertebra forward protruding (1st bend) ; </li></ul><ul><li>6 mo when sitting, thoracic vertebra backward protruding (2nd bend) ; </li></ul><ul><li>after 1 yr when walking, lumbar vertebra forward protruding (3 rd bend) </li></ul><ul><li>● 3 bends help body balance. abnormal posture or diseases-> spind deformity. </li></ul>
  69. 79. <ul><li>(3) DEVELOPMENT OF LONG BONES </li></ul><ul><li>● Growth of long bones : ossification of meta-physical cartilage and osteogenesis of sub- periosteum. </li></ul><ul><li>The fusion of diaphyseal epiphysis--the mark of the end of long bone growth. </li></ul><ul><li>● Growth of flat bones : ossification of periosteum. </li></ul>
  70. 80. <ul><li>● Evaluation of bone development status: </li></ul><ul><li>Ossification centers--bone age </li></ul><ul><li>In neonates: ossification center of heal, ankle and femoral bone appeared. </li></ul>
  71. 81. <ul><li>Generally X-Ray of left hand is taken : </li></ul><ul><li>neonates: no ossification center in wrist, 3 mo : capitate bone and hamate bone, 1 yr old : lower radial epiphysis. </li></ul><ul><li>2 ~ 2.5 yr old : pyamidal (triangulur) bone, 3 yr old : lumar bone </li></ul>
  72. 82. <ul><li>3.5 ~ 5 yr old : large and small mulangular bone </li></ul><ul><li>5 ~ 6 yr old : scaphoid </li></ul><ul><li>6 ~ 7 yr old: lower ulnar epiphysis </li></ul><ul><li>9 ~ 10 yr old: postular bone </li></ul><ul><li>In 10 yr old, all (10) ossification have been appeared. </li></ul>
  73. 83. <ul><li>from 1 ~ 9 yr old: the number = year(s)+1 </li></ul><ul><li>● Significance: retarded bone age--deficiency </li></ul><ul><li>of growth hormones, hypothyroidism, </li></ul><ul><li>renal tubular acidosis; </li></ul><ul><li>advanced bone age--- central precocious </li></ul><ul><li>puberty, congenital adenalhyperplasia </li></ul>
  74. 85. <ul><li>2. DEVELOPMENT OF TEETH </li></ul><ul><li>● Two sets of teeth: deciduous teeth (20), </li></ul><ul><li>permanent teeth (32) </li></ul><ul><li>● Eruption of deciduous teeth: appear at 4 ~ 10 mo, complete before 2.5 yr old </li></ul><ul><li>● The order of deciduous teeth: ①lower central incisors, ② upper central incisors, ③ upper lateral incisors, ④ lower lateral incisors, ⑤ lower first molars, ⑥ upper first molars, ⑦ lower cuspids, ⑧ upper cuspids, ⑨upper second molars, ⑩ lower second molars. </li></ul>
  75. 87. <ul><li>● After 6 yr old : 1 st permanent tooth (1st molar) erupt </li></ul><ul><li>From 7 ~ 8 yr old on, deciduous teeth shed </li></ul><ul><li>as eruption order, instead by permanent </li></ul><ul><li>teeth : the 1st and 2nd bicuspid instead of the 1st and 2nd molars, 2nd molars erupt in 12 yr old, 3 rd molars (wisdom teeth) erupt after 18 yr old </li></ul><ul><li>● Eruption of teeth; a physiologic phenomenon. some symptoms may occur in some babies : low fever, ptyalism, salivation, restless sleep, irritation. </li></ul><ul><li>● Retard eruption or bad quality of teeth : malnutrition, ricket, hypothyroidism, down's syndrome. </li></ul>
  76. 88. <ul><li>3. Development of fat tissue and muscle </li></ul><ul><li>⑴ Development of fat tissue </li></ul><ul><li>● number increase and bulk enlargement </li></ul><ul><li>of the fat cell </li></ul><ul><li>● subcutaneous fat measurement </li></ul><ul><li>⑵ Develop of skeletal muscle </li></ul><ul><li>● increase of the number and bulk of muscle fiber </li></ul><ul><li>● closely related to the nutrition, live style and physical exercise </li></ul>
  77. 89. <ul><li>3. DEVELOPMENT OF GENITAL SYSTEM </li></ul><ul><li>● regulate by hypothalamus-pituitary-gonad axis </li></ul><ul><li>● pre-adolescence ( female 9~11yr , male 11~13 yr ) physical growth acceleration, sexual sign appear </li></ul><ul><li>● mid-adolescence (14~16 yr old) </li></ul><ul><li>2 nd peak of physical grow, all sexual sign appear </li></ul><ul><li>● later-adolescence (female 17~21yr, male 19~24yr </li></ul><ul><li>finish of genital development </li></ul><ul><li>● Precocious puberty:girl<8yr, boy <10yr </li></ul><ul><li>delayed puberty: girl >14yr, boy>16yr. </li></ul>
  79. 91. <ul><li>1. DEVELOPMENT OF SENSE PERCETION </li></ul><ul><li>⑴ Visual sense (vision) </li></ul><ul><li>Neonate : has visual function and light reflex of pupilla, tremor of eye ball some time </li></ul><ul><li>2nd mo: stares at object with primary coordination of head and eye, follows moving object 90 。 . </li></ul><ul><li>3~4 mo: has coordination of head and eye, follows moving object 180 。 </li></ul>
  80. 92. <ul><li>⑵ Hearing (audition) sense </li></ul><ul><li>poor at birth, good in 3~7 day. turns head to origin of sound (directional capability) 3 rd mo. 4yr old audition development complete </li></ul><ul><li>ABR measure hearing capability. </li></ul><ul><li>⑶ Taste sense sensitive at bith. </li></ul><ul><li>⑷ Smell (olfactory) sense </li></ul><ul><li>has smell sense at birth, unpleasant expression to strong smells by the end of 1 mo, can identify good or bad smell 3 ~ 4 mo, more sensitive 7 ~ 8 mo, </li></ul>
  81. 93. <ul><li>⑸ Sense of skin (tactile, pain, warmth sense and deep sense) at birth, tactile and warmth sensitive in oral and perior area, second in eye, palm, sole; pain sense retarded in neonate, improve in 2nd mo; warmth sense good at birth. </li></ul>
  82. 94. <ul><li>⑹ Reflex </li></ul><ul><li>● inborn reflex at birth: rooting, sucking </li></ul><ul><li>swallowing, grasp, Moro </li></ul><ul><li>● conditioned reflex: </li></ul><ul><li>2 W: the 1st conditioned reflex appear </li></ul><ul><li>2 m: conditioned reflex relate to vision, </li></ul><ul><li>audition, taste, smell </li></ul><ul><li>3~4m: inhibitory conditioned reflex formation </li></ul>
  83. 95. <ul><li>2. MOTOR DEVELOPMENT </li></ul><ul><li>The regular of motor development: from upper to lower, from the proximal to the distant, non-ordinate to coordinate,from front motion to reverse motion </li></ul><ul><li>( 1) Gross motor </li></ul><ul><li>① lift head : neonate, 1~2 second; 3 mo, steady; 4 mo, turn head </li></ul><ul><li>② roll over: neonate, in born from lateral </li></ul><ul><li>position to supine position. 4~5mo, lateral to supine, 7~8 mo active from lateral to </li></ul><ul><li>supine </li></ul><ul><li>③ sitting : 6 mo can sit, 8 mo steady </li></ul>
  84. 96. <ul><li>④ creeps : 3~4 mo, hand support, 8 mo, creeps forward; 12 mo, creeps with hand and knee </li></ul><ul><li>⑤ stand and walk : </li></ul><ul><li>neonate: stepping reflex </li></ul><ul><li>5~6 mo. Stand supported by arm </li></ul><ul><li>8 mo. Stand a moment </li></ul><ul><li>10 mo. deliberate stepping </li></ul><ul><li>15 mo. Walk independent (walk alone) </li></ul>
  85. 97. <ul><li>( 2) Fine activity </li></ul><ul><li>Neonate : make a fist of hands </li></ul><ul><li>3~4 mo : grasp reflex disappear </li></ul><ul><li>play the hands, want grasp object </li></ul><ul><li>6~7 mo : transfer object hand to hand </li></ul><ul><li>9~10 mo : thumb-finger grasp </li></ul><ul><li>12~15 mo : can use spoon, scribbles </li></ul>
  86. 98. <ul><li>3. LANGUAGE DEVELOPMENT </li></ul><ul><li>● A high nervous activity, peculiar in human being </li></ul><ul><li>● Express thinking, idea, related with intelligence </li></ul><ul><li>● Basic conditions : organ, hearing sense, language center, contact with people </li></ul><ul><li>● 3 step : sound production, understand, expression </li></ul><ul><li>● From a word->simple sentence ->complex sentence </li></ul>
  87. 99. <ul><li>Table Development of Language </li></ul><ul><li>Age(mo) Reception language expression language </li></ul><ul><li>6 self name crying “ yi ya” </li></ul><ul><li>12 name of family members hand express </li></ul><ul><li>“ good by”, “give me” mama, papa </li></ul><ul><li>15 name of body hand express </li></ul><ul><li>simple word group two words </li></ul><ul><li>simple order </li></ul><ul><li>18 name of people, thing, picture hand express </li></ul><ul><li>name of body(part) 15~20 words </li></ul><ul><li>simple order know family member </li></ul><ul><li>24 name of people, thing, picture hand express </li></ul><ul><li>name of body(> 7 parts) words increase </li></ul><ul><li>simple order know unfamiliar people </li></ul><ul><li>36 all name of things use words correctly </li></ul><ul><li>position sentence of 2~4 words </li></ul><ul><li>Conception of 2 phases </li></ul><ul><li>sex differentiate </li></ul>
  88. 100. <ul><li>4. PSYCHOLOGICAL DEVELOPMENT </li></ul><ul><li>● psychological process: the cognition process, emotion, willing </li></ul><ul><li>● psychological character: personality tendency, personality psychological feature </li></ul><ul><li>● not psychological phenomenon in early neonate. </li></ul><ul><li>● Psychological active when reflexes formation </li></ul>
  89. 101. <ul><li>(1)DEVELOPMENT OF ATTENTION </li></ul><ul><li>● the begin of cognitive process </li></ul><ul><li>● unconscious attention: nature occur based on cognition process. </li></ul><ul><li>● conscious attention: self aware has purpose. </li></ul><ul><li>● unconscious attention mainly in infancy, conscious attention develop gradually. 5 ~ 6 yr old, control attention </li></ul>
  90. 102. <ul><li>⑵ Development of Memory </li></ul><ul><li>a complex neuro-activity course of the storage and read out of message </li></ul><ul><li>● 3 system: feeling, short and long memory (recognition, reappear) </li></ul><ul><li>● In infancy, only recognition, not reappearance, the reappearance ability increase with age increase </li></ul><ul><li>● young children, only flax memory, abstract logical memory develop with age </li></ul>
  91. 103. <ul><li>⑶ DEVELOPMENT OF THINKING </li></ul><ul><li>a high neuro-activity of recognizing the essence of matter and master its development regularity through understand, memory and analysis. </li></ul><ul><li>kinds: formal thinking, abstract logical </li></ul><ul><li>thinking </li></ul><ul><li>● 1~3 yr. Primary thinking </li></ul><ul><li>● 3 ~ yr. Primary abstract thinking </li></ul><ul><li>● 6~11 yr. Synthesis analysis, </li></ul><ul><li>classification compare </li></ul>
  92. 104. <ul><li>⑷ DEVELOPMENT OF IMAGINATION </li></ul><ul><li>● Imagination : a new thinking activity created in brain </li></ul><ul><li>● 1~2 yr. image begin </li></ul><ul><li>● 3 yr ~ . primary image </li></ul><ul><li>● school age. image develop fast   </li></ul>
  93. 105. <ul><li>⑸ DEVELOPMENT OF MOOD AND </li></ul><ul><li>EMOTIDN </li></ul><ul><li>● Mood : the expression produced from </li></ul><ul><li>things or idea </li></ul><ul><li>● Emotion: the experience in heart produced </li></ul><ul><li>from the relationship of persons or things </li></ul><ul><li>based on the mood </li></ul><ul><li>● In young children, manifestation of emotion </li></ul><ul><li>and mood--short time, strong response </li></ul><ul><li>easy change, expressive and true; </li></ul><ul><li>with age increase, emotion and mood </li></ul><ul><li>response steady gradually. </li></ul>
  94. 106. <ul><li>⑹ DEVELOPMENT OF WILL </li></ul><ul><li>● will : a psychological course, actively overcome difficulties to achieve target. </li></ul><ul><li>● will begin in young children and develop gradually. </li></ul><ul><li>● Formation of will related with environment, people and circumstances within which the child lives. </li></ul>
  95. 107. <ul><li>⑺ DEVELOPMENT OF PERSONALITY AND </li></ul><ul><li>CHARACTER </li></ul><ul><li>● synthesis model of psychological activity. </li></ul><ul><li>⑻ EARLY PERSONAL-SOCIAL BEHAVIOR </li></ul><ul><li>● synthesis manifestation of psychological function every age period </li></ul>
  96. 108. <ul><li>EVALUATION OF PSYCHODEVELOPMENT </li></ul><ul><li>1. CONCEPTS </li></ul><ul><li>⑴ Intelligence: the ability of knowing the world and respond to the changes of conditions </li></ul><ul><li>⑵ Intelligent quotient (IQ) </li></ul><ul><li>primary based on mental age (MA) </li></ul><ul><li>Intelligence reach the level of the age </li></ul><ul><li>Deviation IQ (DIQ): express by standard score </li></ul><ul><li>DIQ=100±15z </li></ul><ul><li>⑶ Development quotient (DQ ) </li></ul><ul><li>Evaluating the neuro-psycho development of young children, include sense, motor, language, personal-social, etc. </li></ul>
  97. 109. <ul><li>2. PSYCHOMETRY </li></ul><ul><li>⑴ Screen of single development </li></ul><ul><li>① Direction of vision-space </li></ul><ul><li>② Relation of time-order </li></ul><ul><li>③ Test of memory </li></ul><ul><li>④ Test of language </li></ul>
  98. 110. <ul><li>⑵ TEST OF ABILITY </li></ul><ul><li>1) SCREENING TESTS </li></ul><ul><li>① Denver developmental screening test(DDST) </li></ul><ul><li>103 items, 4 capability areas(social, language, </li></ul><ul><li>fine-, gross-adaptive), < 6 yr old. </li></ul><ul><li>② Peabody picture vocabulary test (PPVT) </li></ul><ul><li>120 pictures, each has 4 pictures-vocabulary, for 4 ~ 9 yr old.   </li></ul><ul><li>③ Draw –α– man </li></ul><ul><li>Draw a person─evaluation for 5 ~ 9.5 yr old </li></ul>
  99. 111. <ul><li>2)DIAGNOSTIC TESTS </li></ul><ul><li>① Bayley infantile development scale </li></ul><ul><li>163 neurodevelopment scale, 81 motor scale, 24 infantile behavior record, for 2 ~ 30 mo. </li></ul><ul><li>② Gesell development scale </li></ul><ul><li>● for 4 wk ~ 3 yr old; </li></ul><ul><li>● 5 aspects: gross motor, fine motor, adaptive, language, social </li></ul><ul><li>● Express by DQ </li></ul>
  100. 112. <ul><li>③ Standford-Binet intelligent scale </li></ul><ul><li>● for 2 ~ 18 yr old </li></ul><ul><li>● concrete knowledge: recognition, identification, memory. </li></ul><ul><li>● abstract knowledge : thought, logic, quantity and vocabulary. </li></ul><ul><li>● evaluate learning faculty </li></ul><ul><li>diagnosis and degree classification of mental retardation </li></ul>
  101. 113. <ul><li>④ Wechsler preschool and primary scale of intelligence (WPPSI) </li></ul><ul><li>● for 4 ~ 6.5 yr old </li></ul><ul><li>● contents: words and expression, operation -> </li></ul><ul><li>express by IQ </li></ul><ul><li>⑤ Wechsler intelligence scale for children revised (WISC-R) </li></ul><ul><li>● for 6 ~ 16 yr old </li></ul><ul><li>● contents: word and expression, operation. </li></ul>
  102. 114. <ul><li>⑶ ADAPTATION TEST </li></ul><ul><li>social living ability scale for infant-student of primary school </li></ul><ul><li>● for 6 mo ~ 15 yr. </li></ul><ul><li>6 kind ability for every age period: independent living ability, motor ability, home work, contact (with people), attend collective activity, self administration </li></ul>
  103. 115. <ul><li>DISTURBANCE OF PHYSICAL GROWTH </li></ul><ul><li>1.DEVIATION OF GROWTH </li></ul><ul><li>(1) Deviation of weight </li></ul><ul><li>① Overweight + 2SD (97th percentage) </li></ul><ul><li>② Underweight – 2SD (3th percentage) </li></ul>
  104. 116. <ul><li>⑵ deviation of height </li></ul><ul><li>① Tall status + 2 SD (97th percentage) </li></ul><ul><li>② Stunt ( short body length) – 2 SD ( <3 rd </li></ul><ul><li>percentage) </li></ul><ul><li>⑶ Deviation of HC </li></ul><ul><li>① Over HC + 2 SD (> 97%) </li></ul><ul><li>② Small HC - 2 SD (< 3%) </li></ul>
  105. 117. <ul><li>DISTURBANCE OF PSYCHOLOGICAL BEHAVIOR </li></ul><ul><li>1. BEHAVIOR PROBLEM OF CHILDHOOD </li></ul><ul><li>(1)BREATH HOLDING </li></ul><ul><li>an abnormal behavior of apnea. </li></ul><ul><li>most in 6 ~ 18 mo, disappear before 5 yr old </li></ul><ul><li>occur in emotion change sharply </li></ul><ul><li>(2)BITING THUMB </li></ul><ul><li>physiologic habit in yong infants, disappear with age, if continue to older children </li></ul><ul><li>psychological disturbance </li></ul>
  106. 118. <ul><li>(3)ENURESIS </li></ul><ul><li>urinary incontinence after 5 yr old </li></ul><ul><li>primary enuresis : retardation of the control ability of urination, no organ diseases, most for night time wetting </li></ul><ul><li>secondary enuresis : secondary to urinary tract diseases, diabetes millitus, neurologic abnormalities. </li></ul>
  107. 119. <ul><li>(4) DEFIANCE, TEMPER TANTRUMS </li></ul><ul><li>mainly 18mo ~ 3yr children </li></ul><ul><li>⑸ LYING </li></ul><ul><li>⑹ SLEEP DISORDERS </li></ul>
  108. 120. <ul><li>2. LEARNING DISABILITY </li></ul><ul><li>● a special development disability. </li></ul><ul><li>● obvious difficulty in acquiring and applying the listen, speak, read, write, count, inference. </li></ul>
  109. 121. <ul><li>  3. LANQUAGE AND SPEECH DELEY </li></ul><ul><li>● In normal or disorder children </li></ul><ul><li>● Language screening for 1.5~2.0 yr old </li></ul><ul><li>help early diagnosis, treatment, improve prognosis </li></ul><ul><li>● Language expression delay: </li></ul><ul><li>2 yr old can’t say word </li></ul><ul><li>3 yr old can’t say simple sentence </li></ul>
  110. 122. <ul><li>4. MENTAL RETAARDATION </li></ul><ul><li>● A symptom of know and unknown disorders </li></ul><ul><li>● Factor(s) interfere the normal development of brain->abnormal function of adoption </li></ul><ul><li>● IQ-2 SD with deficit of adoption </li></ul><ul><li>IQ-1.01~2.0 SD ? </li></ul><ul><li>IQ-2.01~3.0 SD mild </li></ul><ul><li>IQ-3.01~4.0 SD severe </li></ul><ul><li>IQ-5.01~ very severe </li></ul>
  111. 123. Conclusion 1 <ul><li>AGE PERIOD </li></ul><ul><li>1. FETAL PERIOD </li></ul><ul><li>2. NEONATAL PERIOD </li></ul><ul><li>3. INFANCY </li></ul><ul><li>4. TODDLER'S AGE </li></ul><ul><li>5. PRESCHOOL AGE </li></ul><ul><li>6. SCHOOL AGE </li></ul><ul><li>7. ADOLESCENCE </li></ul>
  112. 124. Conclusion 2 <ul><li>  T he regularity of development </li></ul><ul><li>⑴ Development is a continuous course but the speed of development varies in different stage. </li></ul><ul><li>⑵ Unbalance development of different organs or systems: </li></ul><ul><li>⑶ General regularity of development </li></ul><ul><li>⑷ individual difference of development </li></ul>
  113. 125. General regularity of development <ul><li>from upper to lower: </li></ul><ul><li>from proximal to distant: </li></ul><ul><li>from gross to fine: </li></ul><ul><li>from simple to complex: </li></ul><ul><li>from junior to senior </li></ul>
  114. 126. Conclusion 3 <ul><li>PHYSICAL GROWTH </li></ul><ul><li>body weight </li></ul><ul><li>body height </li></ul><ul><li>head circumference </li></ul><ul><li>anterior fontanel </li></ul><ul><li>teeth </li></ul>
  115. 127. BODY WEIGHT <ul><li>at birth, 3 kg (2.5 ~ 4kg); 1yr old 9 kg, 2yr old 12 kg; 2 ~ 12yr old 2 kg/yr </li></ul><ul><li>1 ~ 6 mo: Wt (kg) = Wt at birth + mo×0.7(kg) </li></ul><ul><li>7 ~ 12 mo: Wt (kg) = 6(kg) + mo×0.25(kg) </li></ul><ul><li>2 ~ 12 yr: Wt (kg) = Age×2(kg) + 7(8)(kg) </li></ul>
  116. 128. body height (standing height) <ul><li>● Height 50 cm at birth; </li></ul><ul><li><6 mo 2.5 cm/mo, >6 m 1.5 cm/mo) , </li></ul><ul><li>75 cm at 1yr old; </li></ul><ul><li>85 cm at 2 yr old; </li></ul><ul><li>after 2 yr old, 5 ~ 7cm / yr; </li></ul>
  117. 129. HEAD CIRCUMFERENCE <ul><li>34 cm at birth, </li></ul><ul><li>44 cm in 6 mo, </li></ul><ul><li>46 cm in 1 yr old, </li></ul><ul><li>48 cm in 2 yr old, </li></ul><ul><li>50 cm in 5 yr old. </li></ul>
  118. 130. Anterior fontanel <ul><li>Length 1.5 ~ 2 cm at birth, increase gradually, after 6 mo, decrease with ossification gradually, closed 12 ~ 18 mo. </li></ul>
  119. 131. TEETH <ul><li>● Two sets of teeth: deciduous teeth (20), </li></ul><ul><li>permanent teeth (32) </li></ul><ul><li>● Eruption of deciduous teeth: appear at 4 ~ 10 mo, complete before 2.5 yr old </li></ul>
  120. 132. Conclusion 4 <ul><li>Neurodevelopment & sychodevelopment </li></ul><ul><li>1.Sense </li></ul><ul><li>2.Motor </li></ul><ul><li>3. Language </li></ul><ul><li>4. Psychological activity </li></ul>
  121. 133. Behavioral and psychological development Age Motor Language Social development 1 month Hands fisted clench on contact Turning head to sound Stares indefinitely at surroundings, regards observer’s face 3 month Neck holding, Grasping things Cooing Recognized mother, eyes follow slowly the moving object 6 month Sitting without support, reaching things Monosyllables (ma’ba’) Smiles at mirror image, transfer toy from one hand to the another 9 month Standing with support, holding things Saying bisyllables (mama, dada) Waves hands to show good-bye, spontaneously rings bell
  122. 134. Behavioral and psychological development Age Motor Language Social development 1 year Standing without support Two words with meaning, giving toy on request Plays a simple ball game, cooperates in dressing 2 year Walking upstairs, turning pages of books Using pronouns, simple sentence Verbalizes toilet needs consistently 3 year Riding tricycle, holding crayons with fingers Using plurals, telling a story Feeds self well, knows a few rhymes or songs 5 year Jumping freely, tying shoelaces Knowing 4 colors, commenting on pictures Dresses and undresses without assistance, asks meaning of words