Motor development infants

Growth and Development ofGrowth and Development of
ChildrenChildren
Adele Piliterri, Child Health Nursing, Lippincott

Growth and DevelopmentGrowth and Development
of Childrenof Children
PreparedPrepared
ByBy
Dr: Magda Abd El AzizDr: Magda Abd El Aziz

General ObjectiveGeneral Objective::
By the end of this lecture, the student will be ableBy the end of this lecture, the student will be able
to discuss growth and development of children.to discuss growth and development of children.

Specific Objectives:Specific Objectives:
By the end of this lecture, the student will be able to:By the end of this lecture, the student will be able to:
• Identify the importance of growth and development.Identify the importance of growth and development.
• Define growth and development.Define growth and development.
• Mention the principles of growth and development.Mention the principles of growth and 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 size of theGrowth refers to an increase in physical size of the
whole body or any of its partswhole body or any of its parts..
It is simply a quantitative change in the childIt is simply a quantitative change in the child’’ss
bodybody..
It can be measured in Kg, pounds, meters, inches,It can be measured in Kg, pounds, meters, inches,
…….. etc.. etc

Child Growth (Image: WHOChild Growth (Image: WHO((

Changes in bodily proportions with ageChanges in bodily proportions with age..

DevelopmentDevelopment
• Development refers to a progressive increase inDevelopment refers to a progressive increase in
skill and capacity of function.skill and capacity of function.
• It is a qualitative change in the childIt is a qualitative change in the child’’ss
functioning.functioning.
• It can be measured through observation.It can be measured through observation.

By understanding what to expect during each stage of developmentBy understanding what to expect during each stage of development,,
parents can easily capture the teachable moments in everyday life toparents can easily capture the teachable moments in everyday life to
enhance their child's language development, intellectual growth, socialenhance their child's language development, intellectual growth, social
development and motor skillsdevelopment and motor skills..

MaturationMaturation
• Increase in childIncrease in child’’s competence and adaptability.s competence and adaptability.
• It is describing the qualitative change in aIt is describing the qualitative change in a
structure.structure.
• The level of maturation depends on childThe level of maturation depends on child’’ss
heredity.heredity.

Importance of Growth and Development for Nurses:Importance of Growth and Development for Nurses:
• Knowing what to expect of a particular child at anyKnowing what to expect of a particular child at any
given age.given age.
• Gaining better understanding of the reasons behindGaining better understanding of the reasons behind
illnesses.illnesses.
• Helping in formulating the plan of care.Helping in formulating the plan of care.
• Helping in parentsHelping in parents’’ education in order to achieveeducation in order to achieve
optimal growth & development at each stage.optimal growth & development at each stage.

Principles of Growth & DevelopmentPrinciples of Growth & Development
• Continuous processContinuous process
• Predictable SequencePredictable Sequence
• DonDon’’t progress at the same rate (↑ periods of GR in early childhood andt progress at the same rate (↑ periods of GR in early childhood and
adolescents & ↓ periods of GR in middle childhood)adolescents & ↓ periods of GR in middle 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 development.Each stage of G&D is affected by the preceding types of development.

Principles of Growth & DevelopmentPrinciples of Growth & Development
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 to the- Proximodistal (center of the body to the
peripheral)peripheral)
- General to specific- General to specific

Growth PatternsGrowth Patterns
The childThe child’’s pattern of growth is in a head-to-toes pattern of growth is in a head-to-toe
direction, ordirection, or cephalocaudalcephalocaudal, and in an inward, and in an inward
to outward pattern calledto outward pattern called proximodistalproximodistal..

Factors affecting growth and development:Factors affecting growth and development:
• HereditaryHereditary
• Environmental factorsEnvironmental factors
Pre-natal environmentPre-natal environment
1-Factors related to mothers during pregnancy1-Factors related to mothers during pregnancy::
- 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
- childchild’’s nutritions nutrition
- climate and season- climate and season
- childchild’’s ordinal position in the familys ordinal position in the family
- Number of siblings in the family- Number of siblings in the family
- Family structure (single parent or extended family- Family structure (single parent or extended family …… ))

Internal environmentInternal environment
• ChildChild’’s intelligences intelligence
• Hormonal influencesHormonal influences
• EmotionsEmotions

Types of growth and developmentTypes of growth and development
Types of growth:Types of growth:
- Physical growth (Ht, Wt, head & chest circumference)- Physical growth (Ht, Wt, head & chest 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
• PrenatalPrenatal
- Embryonic (conception- 8 w)- Embryonic (conception- 8 w)
- Fetal stage (8-40 or 42 w)- Fetal stage (8-40 or 42 w)
• InfancyInfancy
- NeonateNeonate
- Birth to end of 1 monthBirth to end of 1 month
- InfancyInfancy
- 1 month to end of 1 year1 month to end of 1 year
• 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 approximately 1813 years to approximately 18
yearsyears

11--Newborn stageNewborn stage
Newborn stage is the first 4 weeks orNewborn stage is the first 4 weeks or
first month of life. It is a transitionalfirst month of life. It is a transitional
period from intrauterine life to extraperiod from intrauterine life to extra
uterine environmentuterine environment..

Normal Newborn InfantNormal Newborn Infant
Physical growthPhysical growth
- Weight = 2.700- Weight = 2.700 –– 4 kg4 kg
- Wt loss 5% -10% by 3-4 days after birth- Wt loss 5% -10% by 3-4 days after birth
- Wt gain by 10- Wt gain by 10thth
days of lifedays of life
- Gain- Gain ¾¾ kg by the end of the 1kg by the end of the 1stst
monthmonth

Weight:Weight:
They loose 5 % to 10 % of weight by 3-4 daysThey loose 5 % to 10 % of weight by 3-4 days
after birth as result of :after birth as result of :
 Withdrawal of hormones from mother.Withdrawal of hormones from mother.
 Loss of excessive extra cellular fluid.Loss of excessive extra cellular fluid.
 Passage of meconium (feces) and urine.Passage of meconium (feces) and urine.
 Limited food intake.Limited food intake.

HeightHeight
• Boys average Ht = 50 cmBoys average Ht = 50 cm
• Girls average Ht = 49 cmGirls average Ht = 49 cm
• Normal range for both (47.5- 53.75 cm)Normal range for both (47.5- 53.75 cm)
Head circumferenceHead circumference
33-35 cm33-35 cm
Head isHead is ¼¼ total body lengthtotal body length
Skull has 2 fontanels (anterior & posterior)Skull has 2 fontanels (anterior & posterior)

Anterior fontanelAnterior fontanel
• Diamond in shapeDiamond in shape
• The junction of the sagittal, corneal and frontalThe junction of the sagittal, corneal and frontal
sutures forms itsutures forms it
• Between 2 frontal & 2 parietal bonesBetween 2 frontal & 2 parietal bones
• 3-4 cm in length and 2-3 cm width3-4 cm in length and 2-3 cm width
• It closes at 12-18 months of ageIt closes at 12-18 months of age

Posterior fontanelPosterior fontanel
• TriangularTriangular
• Located between occipital & 2 parietal bonesLocated between occipital & 2 parietal bones
• Closes by the end of the 1Closes by the end of the 1stst
month of agemonth of age

Chest circumferenceChest circumference
It is 30.5 to 33cm (usually 2It is 30.5 to 33cm (usually 2––3cm less than3cm less than
head circumference).head circumference).

Physiological growthPhysiological growth
• Vital signsVital signs
-- Temperature (36.3 to37.2Temperature (36.3 to37.2°°C ).C ).
- Pulse ( 120 to 160 b/min ).- Pulse ( 120 to 160 b/min ).
- Respiration ( 35 to 50C/min) .- Respiration ( 35 to 50C/min) .

Simulation for vital signsSimulation for vital signs

APGAR scoring chartAPGAR scoring chart

• 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 lightPupils react to light
• Bright lights appear to be unpleasant toBright lights appear to be unpleasant to
newborn infant.newborn infant.
• Follow objects in line of visionFollow objects in line of vision

HearingHearing
• The newborn infant usually makes someThe newborn infant usually makes some
response to sound from birth.response to sound from birth.
• Ordinary sounds are heard well before 10 daysOrdinary sounds are heard well before 10 days
of life.of life.
• The newborn infant responds to sounds withThe newborn infant responds to sounds with
either cry or eye movement, cessation of activityeither cry or eye movement, cessation of activity
and / or startle reaction.and / or startle reaction.

TasteTaste
Well developed as bitter and sour fluids areWell developed as bitter and sour fluids are
resisted while sweet fluids are accepted.resisted while sweet fluids are accepted.
SmellSmell
Only evidence in newborn infantOnly evidence in newborn infant’’s search for thes search for the
nipple, as he smell breast milk.nipple, as he smell breast milk.

Normal Newborn InfantNormal Newborn Infant

Gross Motor DevelopmentGross Motor Development
Motor development:Motor development:
The newborn's movement are random,The newborn's movement are random,
diffuse and uncoordinated. Reflexes carrydiffuse and uncoordinated. Reflexes carry
out bodily functions and responses toout bodily functions and responses to
external stimuli.external stimuli.

Fine motor developmentFine motor development
• Holds hand in fistHolds hand in fist
• When crying, he draws arms and legs to bodyWhen crying, he draws arms and legs to body

ReflexesReflexes
• SwallowingSwallowing
• GaggingGagging
• SuckingSucking
• GraspGrasp
• Tonic-neckTonic-neck

One month-ReflexesOne month-Reflexes

Cognitive developmentCognitive development
The cognitive development of newbornThe cognitive development of newborn
infant is difficult to understand orinfant is difficult to understand or
observe it.observe it.

Emotional developmentEmotional development
The newborn infant expresses hisThe newborn infant expresses his
emotion just through cry for hunger,emotion just through cry for hunger,
pain or discomfort sensationpain or discomfort sensation

Social developmentSocial development

Sitting UpSitting Up
Age 2 months
Age 8 months

AmbulationAmbulation
13 month old
Nine to 12-months

Fine Motor DevelopmentFine Motor Development
in infancyin infancy
6-month-old
12-month-old

Definition of normal infantDefinition of normal infant:-:-
It is the period which starts at the end ofIt is the period which starts at the end of
the first month up to the end of thethe first month up to the end of the
first year of age. Infant's growth andfirst year of age. Infant's growth and
development during this perioddevelopment during this period areare
rapidrapid..

Physical growth of normal infantPhysical growth of normal infant
Weight : the infant gains :Weight : the infant gains :
- Birth to 4 months → ¾ kg /month- Birth to 4 months → ¾ kg /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 monthsThe infant will double his birth wt by 4-5 months
and triple it by 10-12 months of ageand triple it by 10-12 months of age

Calculating infantCalculating infant’’s weights weight
Infants from 3 to 12 monthsInfants from 3 to 12 months
Weight = Age in months + 9Weight = Age in months + 9
22
Wt of 7 months old infant = 7+9 = 16 = 8 kgWt of 7 months old infant = 7+9 = 16 = 8 kg
2 22 2

HeightHeight
• Length increases about 3 cm /month during theLength increases about 3 cm /month during the
11stst
3 months of age,3 months of age,
• then it increases 2 cm /month at age of 4-6then it increases 2 cm /month at age of 4-6
months,months,
• Then, at 7Then, at 7 –– 12 months, it increases 112 months, it increases 1 ½½ cm percm per
monthmonth

Head circumferenceHead circumference
• It increases about 2 cm /month during the 1It increases about 2 cm /month during the 1stst
33
months,months,
• Then,Then, ½½ cm/month during the 2cm/month during the 2ndnd
9 months of9 months of
age.age.
• Posterior fontanel closes by 6-8 w of age.Posterior fontanel closes by 6-8 w of age.
• Anterior fontanel closes by 12-18 months of age.Anterior fontanel closes by 12-18 months of age.

Chest circumferenceChest circumference
By the end of the 1By the end of the 1stst
year, it will be equal to headyear, it will be equal to head
circumference.circumference.
Physiological growth of infants:-Physiological growth of infants:-
Pulse 110-150 b/minPulse 110-150 b/min
Resp 35 ± 10 c/minResp 35 ± 10 c/min
Breath through nose.Breath through nose.
Blood pressure 80/50 ± 20/10 mmHgBlood pressure 80/50 ± 20/10 mmHg

DentitionDentition::
Eruption of teeth starts by 5Eruption of teeth starts by 5––6 months of6 months of
age. It is called "Milky teeth" orage. It is called "Milky teeth" or
"Deciduous teeth" or "Temporary teeth"."Deciduous teeth" or "Temporary teeth".

Average age for teeth eruptionAverage age for teeth eruption::
• Lower central incisorsLower central incisors
• Upper central incisorsUpper central incisors
• Upper lateral incisorsUpper lateral incisors
• Lower lateral incisorsLower lateral incisors
• Lower first molarsLower first molars
• Upper first molarsUpper first molars
• Lower cuspidsLower cuspids
• Upper cuspidsUpper cuspids
• Lower 2nd molarsLower 2nd molars
• Upper 2nd molarsUpper 2nd molars
• Erupt at 6 monthsErupt at 6 months
• Erupt at 7.5 monthsErupt at 7.5 months
• Erupt at 20monthsErupt 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 handHold object put in hand

Head ControlHead Control
Newborn Age 6 months

At 4 months, the infant canAt 4 months, the infant can::
• 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 sittingHold head erect and steady while in sitting
position.position.
• Bring hands together in midline and plays withBring hands together in midline and plays with
fingers.fingers.
• Grasp objects with both hands.Grasp objects with both hands.

At 5 months,At 5 months, the infant canthe infant can::
• 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. or Lt.).Grasp objects with whole hand (Rt. or Lt.).
• Hold one object while looking at anotherHold one object while looking at another

• Sit alone briefly.Sit alone briefly.
• Turn completely over ( abdomen to abdomen ).Turn completely over ( abdomen to abdomen ).
• Lift chest and upper abdomen when prone.Lift chest and upper abdomen when prone.
• Hold own bottle.Hold own bottle.

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

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

• Rise to sitting position alone.Rise to sitting position alone.
• CrawlCrawl (i.e., pull body while in prone position).(i.e., pull body while in prone position).
• Hold one bottle with good hand-mouthHold one bottle with good hand-mouth
coordinationcoordination

• 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 can:At 11 months , the infant can:
• WalkWalk holding on furniture.holding on furniture.
• StandStand erect with minimal supporterect with minimal support

At 12 months , the infant canAt 12 months , the infant can::
• Stand-aloneStand-alone for variable length of time.for variable length of time.
• Site down from standingSite down from standing position alone.position alone.
• Walk in few stepsWalk in few steps with help or alone (hands heldwith help or alone (hands held
at shoulder height for balance).at shoulder height for balance).
• Pick up small bits of food and transfers them toPick up small bits of food and transfers them to
his mouthhis mouth

Ambulation(motor growthAmbulation(motor growth((
• 9 month old: crawl9 month old: crawl
• 10 month old: creep10 month old: creep
• 1 year: stand independently from a crawl &1 year: stand independently from a crawl &
creep positioncreep 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 rapidlyHis emotions are instable, where it is rapidly
changes from crying to laughter.changes from crying to laughter.
• His affection for or love family membersHis affection for or love family members
appears.appears.
• By 10 monthsBy 10 months, he expresses several beginning, he expresses several beginning
recognizable emotions, such as anger, sadness,recognizable emotions, such as anger, sadness,
pleasure, jealousy, anxiety and affection.pleasure, jealousy, anxiety and affection.
• By 12 monthsBy 12 months of age, these emotions are clearlyof age, these emotions are clearly
distinguishable.distinguishable.

• HeHe learnslearns that crying brings attention.that crying brings attention.
• The infantThe infant smiles in response to smile of otherssmiles in response to smile of others..
• The infant showsThe infant shows fear of strangerfear of stranger (stranger anxiety).(stranger anxiety).
• He responds socially to his name.He responds socially to his name.
• According toAccording to Erikson, the infant developsErikson, the infant develops
sense of trustsense of trust.. Through the infant's interaction withThrough the infant's interaction with
caregiver (mainly the mother), especially during feeding,caregiver (mainly the mother), especially during feeding,
he learns to trust others through the relief of basiche learns to trust others through the relief of basic
needs.needs.

As an infant's vision develops, he or she may seemAs an infant's vision develops, he or she may seem
preoccupied with watching surrounding objects and peoplepreoccupied with watching surrounding objects 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 sounds8-9 months babbles: mama/dada as sounds
• 10-12 months:10-12 months: ““mama/dada specificmama/dada specific
• 18-20 months: 20 to 30 words18-20 months: 20 to 30 words –– 50% understood by50% understood by
strangersstrangers
• 22-24 months: two word sentences, >50 words, 75%22-24 months: two word sentences, >50 words, 75%
understood by strangersunderstood by strangers
• 30-36 months: almost all speech understood by30-36 months: almost all speech understood by
strangersstrangers

HearingHearing
• BAER hearing test done at birthBAER hearing test done at birth
• Ability to hear correlates with ability enunciate wordsAbility to hear correlates with ability enunciate words
properlyproperly
• Always ask about history of otitis mediaAlways ask about history of otitis media –– ear aidingear aiding
devices.devices.
• Early referral to MD to assess for possible fluid in earsEarly referral to MD to assess for possible fluid in ears
(effusion)(effusion)
• Repeat hearing screening testRepeat hearing screening test
• Speech therapist as neededSpeech therapist as needed

Red Flags in infant developmentRed Flags in infant development
• Unable to sit alone by age 9 monthsUnable to sit alone by age 9 months
• Unable to transfer objects from hand to hand byUnable to transfer objects from hand to hand by
age 1 yearage 1 year
• Abnormal pincer grip or grasp by age 15 monthsAbnormal pincer grip or grasp by age 15 months
• Unable to walk alone by 18 monthsUnable to walk alone by 18 months
• Failure to speak recognizable words by 2 years.Failure to speak recognizable words by 2 years.

Vision in toddler ageVision in toddler age

ToddlerToddler
Safety becomes a problem as
the toddler becomes more
mobile.
Pilliterri, Lippincott

Normal toddlerNormal toddler::
Toddler stage is between 1 to 3Toddler stage is between 1 to 3
years of age. During this period,years of age. During this period,
growthgrowth slowsslows considerablyconsiderably..

WeightWeight::
The toddler's average weight gain is 1.8 to 2.7The toddler's average weight gain is 1.8 to 2.7
kg/yearkg/year..
Formula to calculate normal weight of childrenFormula to calculate normal weight of children
over 1 year of age isover 1 year of age is
Age in years X 2+8 =Age in years X 2+8 = …….. kg.. kg..
e.g., The weight of a child aging 4 yearse.g., The weight of a child aging 4 years
==44X 2 + 8 = 16 kgX 2 + 8 = 16 kg

HeightHeight::
• During 1During 1––2 years, the child's height2 years, the child's height
increases by 1cm/month.increases by 1cm/month.
• The toddler's height increases about 10The toddler's height increases about 10
to 12.5cm/year.to 12.5cm/year.

Formula to calculate normal heightFormula to calculate normal height
Age in years X 5 + 80 = cm.Age in years X 5 + 80 = cm.
e.g., the length of 2 years old childe.g., the length of 2 years old child
= 2 X 5 + 80 = 90cm= 2 X 5 + 80 = 90cm

Head and chest circumferenceHead and chest circumference::
• The head increases 10 cm only from the age of 1The head increases 10 cm only from the age of 1
year to adult age.year to adult age.
• During toddler years, chest circumferenceDuring toddler years, chest circumference
continues to increase in size and exceeds headcontinues to increase in size and exceeds head
circumference.circumference.

TeethingTeething::
• By 2 years of age, the toddler has 16By 2 years of age, the toddler has 16
temporary teeth.temporary teeth.
• By the age of 30 months (2.5 years),By the age of 30 months (2.5 years),
the toddler has 20 teeththe toddler has 20 teeth

Physiological growthPhysiological growth::
Pulse:Pulse: 8080––130130 beats/min (averagebeats/min (average
110/min110/min(.(.
Respiration:Respiration: 2020––30C/min30C/min..
Bowel and bladder controlBowel and bladder control::
Daytime control of bladder and bowelDaytime control of bladder and bowel
control by 24control by 24––30 months30 months..

Fine Motor - toddlerFine Motor - toddler
• 1 year old: transfer objects from hand to hand1 year old: transfer objects from hand to hand
• 2 year old: can hold a crayon and color vertical2 year old: can hold a crayon and color vertical
strokesstrokes
• 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 cross3 year old: copy a circle and a cross –– buildbuild
using small blocksusing 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 around it.Hold a cup with all fingers grasped 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 with twoGo up and down stairs alone with two
feet on each step.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 held inDrink well from a small glass held in
one hand.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, one footWalk up and downstairs, one foot
on a step.on a step.
• Drink without assistance.Drink without assistance.

Issues in parentingIssues in parenting –– toddlertoddler
(emotional development(emotional development((
• Stranger anxietyStranger anxiety –– should dissipate by age 2should dissipate by age 2 ½½ toto
3 years3 years
• Temper tantrums: occur weekly in 50 to 80% ofTemper tantrums: occur weekly in 50 to 80% of
childrenchildren –– peak incidence 18 monthspeak incidence 18 months –– mostmost
disappear by age 3disappear by age 3
• Sibling rivalry: aggressive behavior towards newSibling rivalry: aggressive behavior towards new
infant: peak between 1 to 2 years but may beinfant: peak between 1 to 2 years but may be
prolonged indefinitelyprolonged indefinitely
• Thumb suckingThumb sucking
• Toilet TrainingToilet Training

Cognitive developmentCognitive development::
• Up to 2 years,Up to 2 years, the toddler uses his sensesthe toddler uses his senses
and motor development to different selfand motor development to different self
from objects.from objects.
• The toddler from 2 to 3 years will beThe toddler from 2 to 3 years will be inin
thethe pre-conceptual phase ofpre-conceptual phase of
cognitivecognitive developmentdevelopment (2-4 years),(2-4 years),
where he is still egocentric and can not takewhere he is still egocentric and can not take
the point of view of other peoplethe point of view of other people..

Social developmentSocial development::
• The toddler is very social being but stillThe 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 toAccording to Erikson,Erikson,
• The development of autonomy during thisThe development of autonomy during this
period is centered around toddlers increasingperiod is centered around toddlers increasing
abilities to control their bodies, themselves andabilities to control their bodies, themselves and
their environmenttheir environment i.e., "I can do it myself".i.e., "I can do it myself".

Preschool stagePreschool stage
Definition:-Definition:-
It is the stage where child is 3 to 6It is the stage where child is 3 to 6
years of age. The growth duringyears of age. The growth during
this period is relativelythis period is relatively slowslow..

Physical growth:-Physical growth:-
Weight:Weight: The preschooler gainsThe preschooler gains
approximately 1.8kg/year.approximately 1.8kg/year.
Height:Height: He doubles birth length byHe doubles birth length by
44––5 years of age.5 years of age.

Physiological growthPhysiological growth
• Pulse:Pulse: 8080––120 beat/min.120 beat/min.
(average 100/min).(average 100/min).
• Respiration:Respiration: 2020––30C/min.30C/min.
• Blood Pressure:Blood Pressure:
100/67100/67++24/25.24/25.

Fine MotorFine Motor –– Older ToddlerOlder Toddler
• 3 year old: copy a circle and a cross3 year old: copy a circle and a cross –– build usingbuild using
small blockssmall blocks
• 4 year old: use scissors, color within the borders4 year old: use scissors, color within the borders
• 5 year old: write some letters and draw a person5 year old: write some letters and draw a person
with body partswith body parts

Fine motor and cognitive abilitiesFine motor and cognitive abilities
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 himselfHave child draw picture of himself

Cognitive developmentCognitive development
Preschooler up to 4 years of age is inPreschooler up to 4 years of age is in
thethe pre-conceptual phasepre-conceptual phase. He. He
begins to bebegins to be able to give reasonsable to give reasons
for his belief and actions, but notfor his belief and actions, but not
true cause-effect relationship.true cause-effect relationship.

Emotional Development ofEmotional Development of
PreschoolerPreschooler
• Fears theFears the darkdark
• Tends to beTends to be impatient and selfishimpatient and selfish
• ExpressesExpresses agressionagression throughthrough
physical and verbal behaviours.physical and verbal behaviours.
• Shows signs ofShows signs of jealousy of siblings.jealousy of siblings.

Social development in preschoolersSocial development in preschoolers
• 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

According toAccording to Erikson theoryErikson theory::
• The preschooler is in the stage whereThe preschooler is in the stage where
hehe develops a sense of initiativedevelops a sense of initiative,,
Where he wants to learn what to doWhere he wants to learn what to do
for himself, learn about the world Andfor himself, learn about the world And
other people.other people.

Red flags: preschoolRed flags: preschool
• Inability to perform self-care tasks, handInability to perform self-care tasks, hand
washing simple dressing, daytime toiletingwashing simple dressing, daytime toileting
• Lack of socializationLack of socialization
• Unable to play with other childrenUnable to play with other children
• Unable to follow directions during examUnable to follow directions during exam

Normal school-age childNormal school-age child::
 School-age period is between theSchool-age period is between the
age of 6 to 12 years. The child'sage of 6 to 12 years. The child's
growth and development isgrowth and development is
characterized by gradual growth.characterized by gradual growth.

Weight:Weight:
• SchoolSchool––age child gains aboutage child gains about 3.8kg/year.3.8kg/year.
• Boys tend to gain slightly more weightBoys tend to gain slightly more weight
throughthrough 12 years.12 years.
• Weight Formula for 7 - 12 yrsWeight Formula for 7 - 12 yrs
== (age in yrs x 7 )(age in yrs x 7 )–– 55
22

HeightHeight::
• The child gains about 5cm/year.The child gains about 5cm/year.
• Body proportion during this period: BothBody proportion during this period: Both
boys and girlsboys and girls are long-leggedare long-legged..
Dentition:Dentition:
• Permanent teethPermanent teeth erupt during school-ageerupt during school-age
period,period, starting from 6 yearsstarting from 6 years, usually in, usually in
the same order in which primary teeth arethe same order in which primary teeth are
lost.lost.
• The child acquires permanent molars,The child acquires permanent molars,
medial and lateral incisors.medial and lateral incisors.

• Pulse:Pulse: 9090++15 beats/min15 beats/min
(75 to 105).(75 to 105).
• Respiration:Respiration: 2121++3C/min3C/min
(18(18––24).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: modelsBuilding: models –– logoslogos
• SewingSewing
• Musical instrumentMusical instrument
• PaintingPainting
• Typing skillsTyping skills
• Technology: computersTechnology: computers

Motor developmentMotor development
At 6At 6––8 years,8 years, the schoolthe school––age child:age child:
• RidesRides a bicyclea bicycle..
• Runs Jumps, climbs and hops.Runs Jumps, climbs and hops.
• Has improved eye-hand coordination.Has improved eye-hand coordination.
• Prints word andPrints word and learn cursivelearn cursive
writingwriting..
• Can brush and comb hair.Can brush and comb hair.

• 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, knife)Handles eating utensils (spoon, fork, knife)
skillfully.skillfully.
• Enjoy all physical activities.Enjoy all physical activities.
• Continues to improve his motor coordination.Continues to improve his motor coordination.

School Age: gross motorSchool Age: gross motor
• 8 to 10 years:8 to 10 years: team sportsteam sports
• Age ten:Age ten: match sportmatch sport to theto the
physical and emotionalphysical and emotional
developmentdevelopment

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 difficulties,By parent report: any learning difficulties,
attention problems, homeworkattention problems, homework
• Parental expectationsParental expectations

School Age: cognitive developmentSchool Age: cognitive development
At 7-11 yearsAt 7-11 years,, the child now isthe child now is in thein the
concrete operational stage of cognitiveconcrete operational stage of cognitive
development.development. He is able to function on aHe is able to function on a
higher level in his mental ability.higher level in his mental ability.
Greater ability to concentrate and participateGreater ability to concentrate and participate
in self-initiating quiet activities that challengein self-initiating quiet activities that challenge
cognitive skills,cognitive skills, such assuch as reading, playingreading, playing
computer and board games.computer and board games.

Emotional developmentEmotional development
The schoolThe school––age child:age child:
• FearsFears injury to bodyinjury to body and fear ofand fear of dark.dark.
• JealousJealous of siblings (especially 6of siblings (especially 6––8 years old8 years old
child).child).
• CuriousCurious about everything.about everything.
• HasHas short bursts of anger by age of 10 yearsshort bursts of anger by age of 10 years
but able to control anger by 12 years.but able to control anger by 12 years.

The schoolThe school––age child is :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 selfHas greater self––control, confident, sincere.control, confident, 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 friendsLack of friends
• Social isolationSocial isolation
• Aggressive behavior: fights, fire setting,Aggressive behavior: fights, fire setting,
animal abuseanimal abuse

1313to 18 Year Oldto 18 Year Old

Adolescent ageAdolescent age
• Physical growthPhysical growth
• Physiological growthPhysiological growth
• Secondary sex characteristicsSecondary sex characteristics
• Cognitive developmentCognitive development
• Emotional developmentEmotional development
• Social developmentSocial development

Definition of adolescentDefinition of adolescent::
Adolescence is a transition period fromAdolescence is a transition period from
childhood to adulthoodchildhood to adulthood. Its is based on. Its is based on
childhood experiences andchildhood experiences and
accomplishments.accomplishments.
It begins with the appearance of secondaryIt begins with the appearance of secondary
sex characteristics and ends when somaticsex characteristics and ends when somatic
growth is completed and the individual isgrowth is completed and the individual is
psychological mature.psychological mature.

Physical growthPhysical growth::
Weight:Weight:
• GrowthGrowth spurtspurt begins earlier in girls (10begins earlier in girls (10––14 years, while14 years, while
it is 12it is 12––16 in boys).16 in boys).
• Males gains 7 to 30kg, while female gains 7 to 25kg.Males gains 7 to 30kg, while female gains 7 to 25kg.
Height:Height:
• By the age of 13,By the age of 13, the adolescent triples his birth lengththe adolescent triples his birth length..
• Males gains 10 to 30cm in height.Males gains 10 to 30cm in height.
• Females gains less height than males as they gain 5 toFemales gains less height than males as they gain 5 to
20cm.20cm.
• Growth in height ceases at 16 or 17 years in femalesGrowth in height ceases at 16 or 17 years in females
and 18 to 20in malesand 18 to 20in males

Pulse:Pulse: Reaches adult value 60Reaches adult value 60––80 beats/min.80 beats/min.
Respiration:Respiration: 1616––20C/minute.20C/minute.
NB:NB: The sebaceous glands of face, neck andThe sebaceous glands of face, neck and
chest become more active. When theirchest become more active. When their
secretion accumulates under the skin insecretion accumulates under the skin in
face,face, acne will appearacne will appear..

Appearance of secondary sex characteristicsAppearance of secondary sex characteristics
1- Secondary sex characteristics in girls:1- Secondary sex characteristics in girls:
• Increase in transverse diameter of the pelvis.Increase in transverse diameter of the 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 calledMenstruation (first menstruation is called
menarche, which occurs between 12 to 13menarche, which occurs between 12 to 13
years).years).

2- Secondary sex characteristics in boys:2- Secondary sex 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 chest hair.Growth of pubic, axillary, facial and chest hair.
• Change in voice.Change in voice.
• Rapid growth of shoulder breadth.Rapid growth of shoulder breadth.
• Production of spermatozoa (which is sign ofProduction of spermatozoa (which is sign of
puberty).puberty).

AdolescentAdolescent
• As teenagers gain independence they begin toAs teenagers gain independence they begin to
challenge valueschallenge values
• Critical of adult authorityCritical of adult authority
• Relies on peer relationshipRelies on peer relationship
• Mood swings especially in early adolescentsMood swings especially in early adolescents

Cognitive development:Cognitive development:
Through formal operational thinking, adolescent can deal with aThrough formal operational thinking, adolescent can deal with a
problem.problem.
Emotional development:Emotional development:
This period is accompanied usually by changes in emotional control.This period is accompanied usually by changes in emotional control.
Adolescent exhibits alternating and recurrent episodes ofAdolescent exhibits alternating and recurrent episodes of
disturbed behavior with periods of quite one. He may becomedisturbed behavior with periods of quite one. He may become
hostile or ready to fight, complain or resist every thing.hostile or ready to fight, complain or resist every thing.
Social development:Social development:
He needs to know "who he is" in relation to family and society, i.e.,He needs to know "who he is" in relation to family and society, i.e.,
he develops a sense of identity. If the adolescent is unable tohe develops a sense of identity. If the adolescent is unable to
formulate a satisfactory identity from the multi-identifications,formulate a satisfactory identity from the multi-identifications,
sense of self-confusion will be developed according tosense of self-confusion will be developed according 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 problemsAdolescent behavioral problems
• AnorexiaAnorexia
• Attention deficitAttention deficit
• Anger issuesAnger issues
• SuicideSuicide

Adolescent TeachingAdolescent Teaching
• RelationshipsRelationships
• SexualitySexuality –– STDSTD’’s / AIDSs / AIDS
• Substance use and abuseSubstance use and abuse
• Gang activityGang activity
• DrivingDriving
• Access to weaponsAccess 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 stageSchool-age stage 
Adolescence stageAdolescence stage 
Oral-sensory stageOral-sensory stage
Anal stageAnal stage
Genital stageGenital stage
Latency StageLatency Stage
Pubertal stagePubertal stage

Piaget theoryPiaget theory
(cognitive development(cognitive development
Up to2 yearsUp to2 years  sensori -motorsensori -motor
2-32-3yearsyears  pre-conceptualpre-conceptual
phasephase..
Up to 4yearsUp to 4years  pre-conceptualpre-conceptual
phasephase..
7-127-12yearsyears  concrete-concrete-
operationaloperational..
12-1512-15yearsyears  preoperationalpreoperational
formal operationsformal operations
1515years - through lifeyears - through life 
formal operationsformal operations

Erikson theoryErikson theory
(psychosocial development(psychosocial development((
Trust versus mistrustTrust versus mistrust..
Autonomy and self esteemAutonomy and self esteem
versus shame and doubtversus shame and doubt..
Initiative versus guiltInitiative versus guilt..
Industry versus inferiorityIndustry versus inferiority..
Identity and intimacyIdentity and intimacy
versus role confusionversus role confusion..

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

Motor development infants

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