Developmental Milestones

INFANTS (0 12 months)
Play: Solitary Play, Non interactive (Begins at 4 months) Best Toys a. Mobiles b. Teethers c. Music Box d. Rattles Fear: Stranger Anxiety Starts at 6 7 months Peaks at 8 months Fades at 9 months NEONATE (0-28 days) Largely Reflexes Complete Head Lag Hands Fisted Cries w/o tears Visual Fixation for human face 1 MONTH Looks at mobile Prefers checker boards with angles than pastels with contours Hang at least 8 inches (20cm) from head 2 MONTHS Holds head up when in prone position Head lag when pulled in a sitting position Cries with tears (+) Social Smile Closure of Posterior Fontanel (2 3 mos) 3 MONTHS Holds head and chest up when in prone Follows objects past midline (+) Hand Regard Palmar Grasp &Tonic Neck reflexes fading Coos, Babbles 4 MONTHS Complete head control when pulled in sitting position SOLITARY PLAY begins Laughs out Loud Recognizes Mother 5 MONTHS Assumes crawling stance Places object in mouth (provide teether) Handles rattle well Moro Reflex disappears Cries when toy is removed Reaches out to be held 6 MONTHS Starts to move from crawling stance Handles bottle well Rolls over Sits with support ERUPTION of 1st Temporary teeth then a tooth every after month (1st two lower central incisors) BEGINNING OF STRANGER ANXIETY Says vowel sounds ah 7 MONTHS Rocks from crawling stance Transfers object from hand to hand and likes object good in size Bites aggressively Cries when mother leaves Resists unwanted food or object 8 MONTHS Sits w/o support PEAK OF STRANGER ANXIETY (+) Pincer Grasp Plantar Grasp and Babinski Reflex disappears to prepare from walking Responds to often used words 9 MONTHS Creeps and Crawls extensively (+) Neat Pincer Grasp STRANGER ANXIETY FADING Combines 2 syllables (Mama, Dada, Yaya)

10 MONTHS Pulls self to stand, holds to furniture Understand the word no and simple commands Responds to own name Plays Peakaboo and Pat a cake 11 MONTHS Stands with assistance Has a favourite toy Has a 3 word vocabulary Explores environment Recognizes object by name 12 MONTHS Stands alone Walks w/ assistance Takes first step Drinks from a cup Cooperates in dressing Likes nursery rhymes Pulls Toy SPECIAL CONCERNS 1. Colic (Kabag) Paroxysmal (sudden) abdominal pain common in < 3 months S/S: a. Loud Crying b. Flushed Face c. Fists clenched d. Tensed Abdomen Causes a. Overfeeding b. Swallowing of too much air c. Tensed mom during breastfeeding d. Milk formula high in carbs Management: a. Burp in the middle / after feeding OR every 1oz of milk formula b. Position upright on moms chest or shoulder OR c. Position on right side lying on moms lap or arm 2. Constipation or Diarrhea Causes: a. Inaccurate mixing of formula b. Milk formula not properly diluted c. Adding too much sugar

d. Introduction of solid foods with too much sweets or fruits 3. Weaning During 6 months Criteria a. Child can approximate lip to cup b. Decreased sucking intensity Management a. Choose a good day or mood for best cooperation b. Dont rush c. Dont set time table d. Reassure child that giving up bottle or breast is not the end of physical contact with mother. 4. Night Bottle Syndrome Propped bottle dangers: a. Tooth Decay or Dental Caries b. Otitis Media c. Aspiration Pneumonia

TODDLER (1 3 y/o; 12 36 months)

Play: Parallel Play (2 toddlers playing separately) Management of Play: Provide similar toy Best Toys: a. Push and Pull b. Building Blocks c. Waddling Duck d. Tricycle e. Pounding Peg f. Erector Set Fear: Separation Anxiety Management of Separation Anxiety: a. Say goodbye firmly b. Dont prolong goodbye c. Say when youre coming back Phases of Separation Anxiety a. Protest crying, screaming, search for parent, rejects stranger b. Despair depressed, uninterested, withdrawn c. Denial or Detachment Uncommon; lengthy separation Forming shallow relationships with others, being self centered, primary importance on material objects Detaches from parents to escape emotional pain of desiring parents presence. Form of resignation, not of contentment 15 MONTHS Walks alone Creeps upstairs Holds spoon well, rotates spoon, uses cup well Scribbles voluntarily with pencil VOCABULARY: 4 6 words Cant throw ball w/o falling Stacks 2 blocks

18 MONTHS Walks well, runs clumsily and falls, jumps in place, sits itself on a chair Walks up and downstairs holding on to person hand or railing No longer rotates spoon Height of possessiveness MINE Temper tantrums more evident VOCABULARY: 7 20 words Names 1 body part BOWEL CONTROL ACHIEVED 24 MONTHS (TERRIBLE TWOS) Walks up and downstairs with 2 feet on one step Runs fairly with wide stance VOCABULARY: 50 200 words Pulls people to show something DAYTIME BLADDER CONTROL Picks up objects without falling Kicks ball forward Builds 6 7 blocks 30 MONTHS Stands on one foot momentarily Jumps down from chair Makes simple lines, can copy a CIRCLE Good finger hand coordination Knows full name and holds up fingers to show age TEMPORARY TEETH COMPLETE (20 deciduous teeth, last to appear is posterior molars) 36 MONTHS (THRUSTING THREE) Walks up and downstairs using alternate foot Buttons and unbuttons shirt Draws a CROSS Builds tower with 9 10 blocks Builds a bridge with 3 blocks Knows full name and sex VOCABULARY: Speaks fluently 300 900 words Learns to share NIGHTIME BLADDER CONTROL ACHIEVED

SPECIAL CHARACTERISTICS OF TODDLER

1. Scaphoid Abdomen Slightly protruberant d/t underdeveloped muscles 2. Negativistic Always says NO Searching for independency or autonomy Mgt: Limit questions; offer options 3. Rigid, Stereotype Way of mastery or to gain mastery

4. Toilet Training Cues: a. Can sit, squat, walk alone b. Can communicate toilet needs c. Can maintain dryness for 2 hours interval VOCABULARY AND MOTOR 1. 2 yrs old 50 to 200 words 2. 3 years old 300 900 words; CROSS 3. 4 years old 1,500 words; SQUARE 4. 5 years old 2,100 words; TRIANGLE 5. 6 years old defines words by their use; recognizes all shapes 6. 7 years old DIAMOND

SPECIAL CONCERNS
1. Temper Tantrums S/S: Shouts, Stomps Feet, Head Bang Reasons a. Inadequate vocabulary to express feelings b. Unrealistic requests of parents c. Difficulty in making decisions and choices Management: Ignore behaviour 2. Dwadling or Ritualistic Wasting a lot of time in accomplishing tasks Reasons a. Asked to do something difficult b. Short time to remain interested in the task Management: ample time for mastery 3. Tooth brushing a. 2 2 = Start of toothbrushing b. 3 yrs Brushes with assistance c. 6 yrs Brushes alone d. 30 months time to bring to the dentist when temporary teeth are complete

PRESCHOOLER (3 6 years old)

Play: Associative or Cooperative Best Toys a. Playhouse b. Modelling Clay c. Finger Painting d. Dolls and Cars e. Doctors Set Fears: a. Body Mutilation or Castration fear b. Thunders and Lightnings c. Ghosts and Witches d. Dark Places Idea about Death: A form of sleep; Reversible SPECIAL CHARACTERISTICS 1. Curious (Why), Creative, Imaginative and Imitative Parents must set good example to avoid role confusion 2. IDENTIFICATION to parents of the same sex and ATTACHMENT to parents of the opposite sex Parental Figure is important for the formation of identification a. Oedipal Complex little boy loves mommy and imitates daddy b. Elektra Complex little girl loves daddy and imitates mommy Regression 1. Bed wetting 2. Thumb Sucking 3. Baby Talk 4. Assumes Fetal Position 4 YEARS (FURIOUS FOUR) Laces shoes but cant tie bow Copies a SQUARE Draws 3 body parts to stick figure Knows 4 BASIC COLORS Cant keep secrets Quarrelsome, Selfish, Impatient Moody 5 YEARS (FRUSTRATING FIVE) Laces shoes and ties bow Copies TRIANGLE Draws 7 9 parts of man Prints few letters, numbers, and words (FIRST NAME) Has Imaginary Playmate Vocabulary: 2,100 words and asks the meaning of those words Keeps secrets

SPECIAL CONCERNS
1. Telling Tall Tales over imagination 2. Imaginary Playmate to release tension and anxiety 3. Magical thinking transductive reasoning (fats means pregnant) 4. Masturbation sign of boredom; accept the child and divert attention by offering a toy 5. Sibling Rivalry common among 4yo; jealousy to newly delivered baby; management is explain the new role

SCHOOL AGE (6 12 years old)

Play: Competitive Fears a. School Phobia b. Displacement from School c. Loss of Privacy d. Death Causes of School Phobia a. Separation Anxiety b. Strict Teacher c. Over dependent Child d. Overprotective Parents e. New activities Management of School Phobia a. Treat underlying Cause b. Orient in the new environment c. Make child secure Idea of Death 7 9 y/o: Permanent Loss of Corporal Life; Irreversible Significant Others a. Teachers b. Peers of same sex Significant Development a. Prone to Greenstick Fractures b. Mature Vision (20/20) What does hospitalization mean for a 9 year old? 1. Exposure to a strange place 2. Separation from family 3. Separation from friends 4. Pain due to surgery Growth Spurt a. Girls: 10 12 yrs old b. Boys: 12 14 yrs old Special Characteristics 1. Industrious 2. Loves to collect objects 3. Sees self in the eyes of teachers and classmates 4. Compares abilities and achievements with peers (MODEST) Peer Group Teaches the ff: 1. To see oneself in the eyes of other 2. To be a leader and follower 3. To be a good sport 4. Group Loyalty 5. Cooperation 6. Responsibility 7. Independences from adults 8. Assertiveness and Yields Behaviour Problems 1. Cant bear to lose they will cheat, lie, and steal Reasons for Cheating Imitating Adult Practicality of situation Reasons for Lying Inability to separate fantasy to reality Failure to come up with expectations Confusion in cognitive and egocentrism Reasons for Stealing Confusion over perceived ownership Peer pressure Getting back; Embarrassing Parents Special Concerns 1. Safety Motor Vehicular Accidents Dorwning Burns 2. Nutrition Fondness of Junk Food Skipping Meals Obesity Interventions 1. Teach nutrient value of food 2. Control sale of junk food 3. Serve packed snacks or lunch 4. Weigh Reduction Program 5. Close weigh monitoring

3. Sex Education Menstruation and reproductive organs development Secondary Sex Characteristics Sexual Maturity Signs of Sexual Maturity (GIRLS) 1. Thelarche 1st sign; increase in breast and genital size (until 18y/o) 2. Widening of hips 3. Appearance of axillary and pubic hair 4. Menarche 1st menstrual period; last sign Signs of Sexual Maturity (BOYS) 1. Increase in the size of penis and testes (1st sign; until 17 yrs old) 2. Adrenarche appearance of axillary and pubic hair 3. Deepening of voice 4. Muscle Development 5. Production of Viable Sperm last sign (nocturnal emission or wet dreams by 17 yrs old) 6 YEARS OLD Boys and girls are of the same height Year of Constant Motion (Clumsiness) TEMPORARY TEETH BEGIN TO FALL; PERMANENT TEETH BEGINS TO APPEAR (1st molars) Recognizes all shapes Begins to Interact with God (1st Communion) Teacher AUTHORITY Figure Nail Biting 7 YEARS OLD Age of Assimilation (ability to incorporate new ideas, thoughts, and experiences to ones thought) QUITTING DOWN PERIOD Tells time Copies a DIAMOND Enjoys teasing and playing alone Differences in sex is seen in Play Strives for perfection

8 YEARS OLD (BEST FRIEND STAGE) EXPANSIVE STAGE Smoother or Graceful movements Loves to collect objects Same sex best friend Whispering and giggling is common 9 YEARS OLD (GANG AGE) Coordination Improves Takes care of body Hero Worship Has secret code Belongs to all boys or all girls group Teacher finds this group difficult to handle Cheating, Lying, and Stealing are common 10 YEARS OLD (COLLECTING AGE) Age of Special Talents Loves competitive games Joins Organizations Writes Legibly Well mannered with adults but critical for them (part of identity formation) Likes to perfect things 11 12 YEARS OLD (PREADOLESCENT) Full of energy and active Shares secrets with friends Secret Language is common Sociable and Cooperative

ADOLESCENCE (12 21 yrs old) Fears: obesity, acne, homosexuality, death, replacement fromfriends Significant Others: Peers of Opposite Sex Significant Development a. Core concern: Change in Image and Acceptance from opposite sex b. Distinct Odor: due to stimulation of Apocrine Personality Traits: 1. Idealistic 2. Rebellious 3. Reformers 4. Conscious in Body Image Special Concerns 1. Motor Vehicular Accidents 2. Masturbation: Causes conflict with Morality 3. Peer Pressure: Smoking, alcoholism, drug addiction, premarital sex 4. Body Image: EATING DISORDERS affects nutritional state a. Anorexia Nervosa b. Bulimia (Binge eating)