Growth & development file

PEDIATRIC
GROWTH AND DEVELOPMENT
FILE

INDEX
SL.NO CONTENT
1.
2.
3.
4.
5.
6.
7.
INTRODUCTION
 Growth and development-
 GROWTH
 DEVELOPMENT
The Fetal Development
 Fetal Development in the first month
 Two Months
 Three months
 Four months
 Five months
 Six months
 Seven months
 Eight months
 Nine months
 Ten months
Principle of Growth and Development
Factor influencing Growth and Development
Stages of growth and development
Growth and Development Monitoring
Growth and development in infancy (frist year of life)
 1 MONTH BABY
 2 MONTH BABY

8.
9.
10.
11.
 3 MONTH BABY
 4 MONTH BABY
 5 MONTH BABY
 6 MONTH BABY
 7 MONTH BABY
 8 MONTH BABY
 9 MONTH BABY
 10 MONTH BABY
 11 MONTH BABY
 12 MONTH BABY
Growth and development of toddlers-1 yr to 3 years
 15 MONTH BABY
 18 MONTH BABY
 24 MONTH BABY
 30 MONTH BABY
Growth and development of preschoolers
 3 years children
 4 year children
 5 year children
Growth and development of school children-6 to 12 years
 6 to 8 years children
Reference

INTRODUCTION
Growth and development is a process where the person thinks normally, eventually and takes a responsible place in society.
Changes occur is from conception to the adolescence. The period of growth and development extends throughout the life cycle. It
is important for a nurse to understand the early periods as well as the total life cycle of an individual to better understand the
behaviour of parents and others who provide care of the child.
Growth and development-
The process of growth and development starts before the baby born that is from the conception in the mother womb. The period extends
throughout the life cycle.
GROWTH-
It is the process of physical maturation resulting an increase in size of the body and various organs. It occurs by multiplication of cells and an
increase in intracellular substance. it is quantitative changes of the body which can be measured in inches/centimetre/ and pounds/ kilogram. It is
progressive and measurable phenomenon.
DEVELOPMENT
It is the process of functional and physiological maturation of the individual. it is progressive increase in skill and capacity to function. It is
qualitative aspect of maturation and difficult to measure.
Principle of Growth and Development
• Cephalocaudal direction
• Proximodistal direction
• General to Specific

Cephalocaudal direction
• The process of cephalocaudal direction from head down to tail. This means that improvement in
structure and function come first in the head region, then in the trunk, and last in the leg region.
Proximodistal direction
The process in proximodistal from center or midline to periphery direction. development proceeds from
near to far - outward from central axis of the body toward the extremities.
General to Specific
• Children use their cognitive and language skills to reason and solve problems.
• Children at first are able hold the big things by using both arms, In the next part able to hold things in a single hand, then only able to pick
small objects like peas, cereals etc.
• Children when able to hold pencil, first starts draw circles then squares then only letters after that the words.

• Development proceeds from general to specific responses.
Factor influencing Growth and Development
1. Genetic
Certain hereditary factors influences on the body formation. Tall parents have tall offspring. Genetic &
chromosomal disorder also effect on growth & development of a baby. Sometimes it is not possible to
prevent the genetic factors but to take necessary care.
2. Nutritional
Nutritional deficiency considerably retards physical growth. Malnourished mother produce babies
with IUGR. Over nutrition may cause obesity. So to control the nutritional requirements of mother is
necessary to have a health child. This factor is neglected in our country, specially the poor families can
not afford to have a proper nutrition during pregnancy. A balanced diet containing all the basic
food principles such as protein, vitamins, minerals etc. According to the World Health Organization.
Lack of proper nutrition can interfere with the maturation of your child’s brain and body.
3. Socio Economic Condition:
Poor socio-economic condition affects growth & development. Sanitary conditions, various parasitic
morbidity, poor housing, stressful family condition, bad financial situation etc have a serious effect on

Child Growth and Development. Children’s coming from adequate finances are more likely to grow and develop to optimal levels, according to
the Annual Review of Psychology.
4. Environmental & seasonal
Physical, psychological, social, cultural factors & harvest seasons have a positive effect over
growth & development . Urbanization has a positive effect on growth. Geographical
environment has a beneficial effect on Child Growth and Development.
5. Chronic diseases:
Chronic untreated diseases of heart, lungs, liver etc impair growth and development
seriously. Growth Hormone Deficiency, Hypothyroidism, Cushing’s Syndrome etc medical
condition that needs early attention.
6. Emotional & cultural
Trauma from unstable family, insecurity, sibling jealousy & loss of parents has effect on
growth & development.

7. Intrauterine
IUGR & maternal infections & diseases affect on growth & development. Maternal diabetes may
result in macrosomia causing more than normal weight baby.
Growth and Development Monitoring
Assessment of growth
• Assessment of physical growth can be done by anthropometric measurement and the study of velocity of physical growth.
• Measurement of different growth parameters is the importance nursing responsibility in child care.
Weight
• weight is one of the best criteria for assessment of growth and a good indicator of health
and nutritional status of child.
• Among Indian children, weight of the full terms neonate at birth is approximately 2.5 kg to
3.5kg.
• There is about 10% loss of weight first week of life, which regains by 10 days of age.

• Then, weight gain is about 25- 30 gm per day for 1st 3 month and 400gm/ month till one year of age.
• The infants double weight gain their birth weight by 5month of age, trebled by one year, fourth time by two years, five times by three year, six
times by five year, seven times by seven year and ten times by ten year.
• Then weight increases rapidly during puberty followed by weight increase to adult size.
Length and height
• Increase in height indicates skeletal growth. Yearly increments in height gradually diminished from birth to maturity.
• At birth average length of a healthy Indian newborn baby is 50 cm.
• it increases to 60 cm at 3 months, 70 cm of 9 month and 75 cm at one year of age. 25
• In second year, there is 12 cm increase, third year it is 9 cm, fourth year it is 7 cm and in fifth year it is 6 cm.
• so the child double the birth by 4 to 4.5 years of age afterwards there is about 5 cm increase in every year till onset of puberty.

Body Mass index (BMI)
• It is an important criteria which helps to assess the normal growth or its deviations i.e. malnutrition or obesity. Weight in Kg BMI = -------------
------------------- (Height in meter) 2
• BMI remains content up to the age of 5 years. If the BMI is more than 30 kg/m2, it indicates obesity and if it is less then 15Kg/m2 , it indicates
malnutrition.
BMI Categories:- –Underweight = <18.5 –Normal weight = 18.5–24.9 –Overweight = 25–29.9 –Obesity = BMI of 30 or greater 30
Head circumference
• It is related to brain growth and development of intracranial volume. Average head
circumference measured about 35 cm at birth.
• At 3 months it is about 40 cm, at 6 month 43 cm, at one year 45cm, at 2 years 48 cm, at 7 year
50 cm and at 12 years of age it is about 52 cm, almost same a adult.
• If head circumference increase more than 1 cm in two weeks during the first 3 month of age
then hydrocephalus should be suspected.
• Head circumference is measured by ordinal tap, placing it over the occipital protuberance at
the back, above the ear on the side and just over the supraorbital ridges in front measuring the
point of height circumference.

Fontanelle Closure
• At birth, anterior and posterior fontanelle are usually present. Posterior fontanelle closes early few
weeks(6-8week) of age.
• The anterior fontanelle normally closes by 12- 18 months of age. Early closure of fontanelle
indicates craniostenosis due to premature closure of skull sutures.
Chest circumference
• chest circumference or thoracic diameters is an importance parameter of assessment of growth and nutrition
status.
• At birth it is 2-3cm less than head circumference. At 6 to 12 months of age both become equal.
• After first year of age, chest circumference is greater than head circumference by 2.5 cm and by the age of 5
year, it is about 5 cm larger than head circumference.
• Chest circumference is measured by placing the tape measure around the chest at level by placing the tape
measure around the chest at the level of the nipple, in between inspiration and expiration.

Mid Upper Arm Circumference(MUAC)
• This measurement helps to assess the nutritional status of younger children.
• There is growth due to inadequate nutritional, which can be this simple particle and useful
measurement.
• The average MUAC at birth is 11 to 12 cm, at one year of age it is 12 to 16 cm, at 1 to 5 years it
is 16 to 17 cm, at 12 years it is 17 to 18 cm and at 15 years it is 20 to 21cm.
Eruption of teeth
• There is a variation for the time of eruption of teeth. First teeth commonly the lower central incision may appear in 6 to 7 months of age.
• It can be delayed even up to 15 months, which also can be considered within the normal range of time for teething.
• So dentition is not dependable parameters for assessment of growth.
• There are ‘two sets of teeth, temporary teeth bigger in size for two sets of teeth.

Permanent Teeth Eruption Chart

Osseous growth
• Bony growth follows a definite pattern and time schedule from birth to maturation.
• It is calculated by the appearance of ossification center by X – ray study.
• Skeletal maturation or bone growth is an indicator of physiological development and continue up to 25 years of age. 44
Growth monitoring
• Assessment of growth may be done by longitudinal & cross sectional studies. The common parameters used for growth monitoring include,
head circumference, chest circumference, UL/LS ratio. The following are the 3 members used for comparisons:-
• Use of mean/median values.
• Use of percentile
• Use of indices as weight for height & weight for age.
• Common reference values- –WHO reference value – Indian standards
Indian standards- • ICMR under took a national wide cross sectional study during the year 1956- 1965. This tool is widely used in India as the
reference value to assess growth.

Assessment of Development
• Normal development is a complex process & has a multitude of facets. However, it is convenient to understand & assess development under
the following domains.
–Gross motor development
–Fine motor skill development
–Personal & social development

–Language
–Vision & hearing.
Gross motor development
• Motor development progress in an orderly sequence to ultimate attainment of locomotion & more complex motor tasks thereafter. In an infant
it is assessed & observed as follows:-

Fine motor skill development
• Fine motor development upon neural tract maturation. Fine motor development promotes adaptive actives with fine sensorimotor adjustments
and include eye coordination, hand eye coordination, hand to mouth coordination, hand skill as finger thumb apposition, grasping, dressing ect.

Personal & social development
• Personal and social development includes personal reactions to his own social and cultural situations with neuromotor maturity and
environment stimulation. It is related to interpersonal and social skill as social smile, recognition of mother, use of toys.

Assessment of Development
• Healthy development, in all forms, particularly social/emotional, communication, and behavior, should be monitored by parents and physicians
through screenings at each well visit.
• The Denver Developmental screening test
• Denver articulation screening examination (DASE)
• Baroda screening test
• Trivandrum development screening test
• Other test
– Woodside DST
– Cognitive adaptive test
– Early language milestone etc.

The Denver Developmental screening test
• Developmental originally by Franken – burg and dodds(1967), this simple, economic and useful test screens for developmental delays during
infancy and the preschool period.
• On the test, the age division are monthly unit 2 years of age , and half yearly from 2 to 6 years of age.

Baroda Screening test
• It was developed by Dr. Promila phatak with 25 test items primarily for psychological aspects. The test is relevant for age 0 to 30 months.
Gross motor, fine motor and cognitive aspects are evaluated in 10 mints mainly by the psychologist.
Trivandrum development screening test
• It is simplified version of Baroda DST that can be used by the health worker, nurses and pediatricians/ physicians. It has17 test items relevant
for 0 to 2 years of age. The children are evaluated in three domains( gross motor, fine motor and cognitive for 5 minutes only.

Ballard Maturational Assessment
The Ballard Maturational Assessment, Ballard Score, or Ballard Scale is a commonly used technique of gestational age assessment. It
assigns a score to various criteria, the sum of all of which is then extrapolated to the gestational age of the fetus. These criteria are divided into
physical and neurological criteria. This scoring allows for the estimation of age in the range of 26 weeks-44 weeks. The New Ballard Score is an
extension of the above to include extremely pre-term babies i.e. up to 20 weeks.
The scoring relies on the intra-uterine changes that the fetus undergoes during its maturation. Whereas the neurological criteria depend mainly
upon muscle tone, the physical ones rely on anatomical changes. The neonate (less than 37 weeks of age) is in a state of physiological hypotonia.
This tone increases throughout the fetal growth period, meaning a more premature baby would have lesser muscle tone.

FETAL GROWTH AND DEVELOPMENT DURING PREGNANCY
STAGE OF GROWTH AND DEVELOPMENT
PRENATAL PERIOD
 Ovum 0-14 days after conception
 Embryo-14days to 8 weeks
 Fetus-8weeks to birth
POSTNATAL PERIOD
 Neonate-from birth to four weeks of life
 Infancy-frist year of life
 Toddler-one to 3 years
 Preschool child(early childhood)3 to 6 years
 School going child(middle childhood)
 6 to 10 years(girls)
 6 to 12years(boys)
 Adolescent from puberty to adulthood
 Prepubescent(early adolescent/late child hood)
-10 to 12 years (girls)
-12 to 14 years(boys)
 Pubescent(middle adolescent)
-12 to 14 years(girls)
-14 to 16 years (boys)
 Post pubescent(late adolescent)
-14 to 18 years(girls)
-16 to 18 years(boys)

EMBROLOGICAL DEVELOPMENT
ZYGOTE
When a single sperm enter the mother’s egg cell,the resulting cell is called a zygote.the zygote contains all of
the genetic information(DNA) need to become a baby. Half of the genetic formation comes from the
mother’s egg and half from the father’s sperm. The zygote spends the next few days travelling down the
fallopian tube and divides to form a ball of cells.
BLASTOCYST
The zygote continue ti divide,creating an inner group of cells with an outer shell.this stage is called a
blastocyst. The stage is called blastocyst. The inner group cell will become the embryo,while the outer group
of cells will become the membranes,that nourish and protect it.
The blastocyst reaches the womb (uterus) around day 5, and implants into the uterine wall on about day 6.
At this point in the mother’s menstrual cycle,the lining of the uterus has grown and is ready to support a
baby.the blastocyst sticks tightly to the lining,where it receives nourishment via the mother’s blood stream.

EMBRYO
The cells of the embryo now multiply and begin to take on specific functions.this process is called differentiation it leads to the various cell types
that make up a human being (sucuch as blood cells,kidney cells and nerve cells).
There is rapid growth, and the baby’s main external features begin to take form.it is during this critical period (most of the first trimester)that
growing baby is most susceptible to damage.the following can interfere with the baby’s development.
 Alcohol, certain prescription-arid recreational drugs,and other substances that causes birth defects .
 Infection such as rubella or cytomegalovirus.

The Fetal Development
The period of time between conception and birth during which the fetus grows and develops inside the mother’s womb is called gestation.in
humans,the length of pregnancy,or gestiotinal age ,is the time measured from the frist day of women’s last menstrual cycle to the current date.it
is measured in weeks.gestational age also called menstrual age.
If you got pregnancy using infertility treatments called assisted reproductive technology,gestational age determined by adding 2 weeks to the
conptional age.
The following list describes specific changes that occur in the womb.
 Week of pregnancy (gestational age)
Fertilization
When semen is deposited in the vagina,the spermatozoa travel through the cervix and body of the uterus and into the fallopian tubes.fertilization
of the ovum (egg cell)usually takes place in the fallopian tube.many sperm must cooperate to penetrate the thick protective shell-like barrier that
surrounds the ovum.the frist sperm penetrates fully into the egg donates its genetic material(DNA).the egg then polarizes,repelling any additional
sperm.the resulting combination is called zygote,a new and genetically unique human organism.the term conception refers variably to either
fertilization or to formation of the conceptus after uterine implation,and this terminology is controversial.
Implation
Some spotting (also known as implation bleeding)may occur about 10-14 days after conception,you may belive you are starting your period but
generally this bleeding is extremely light and lasts only a dat or so.

Fetal Development in the first month
• At this point the face and the neck are becoming evident
• The heart and blood vessels continue to develop
• By the end of the first month, the embryo is about 1/10 of an inch long. The heart, which is no larger than a poppy seed, has begun
beating

Two Months
• Eyelids and ears are developing
• The tip of the nose is becoming visible.
• The embryo is about half an inch long and has distinct, slightly webbed fingers. Veins are clearly visible. The heart has divided into right
and left chambers

Three Months
• The fetus measures about 2 inches and starts to make its own movements The sex organs of the baby should start to become clear.
Four Months
• The fetus now is about 4.3 to 4.6 inches and weighs about 3.5 ounces. The baby's eyes can blink and the heart and blood vessels are fully
formed. The baby's fingers and toes should have fingerprints. The baby is covered with a layer of thick hair called lanugos

Five Months
• The baby weighs about 10 ounces and is a little over 6 inches long
• A protective coating called vernix caseosa begins to form on baby's skin
Six Months
• Eyebrows and eyelids are visible. the baby's lungs are filled with amniotic fluid, and he has started breathing motions.

Seven Months
• By the end of the seventh month, your baby weighs about 3 1/2 pounds and is about 12 inches long. His body is well-formed. Fingernails
cover his fingertips
Eight Months
• The baby is gaining about half a pound per week, and layers of fat are piling on. He has probably turned head-down in preparation for
birth. He weighs between 4 and 6 pounds

Nine Moths
• Babies differ in size, depending on many factors (such as gender, the number of babies being carried, and size of the parents), so the
baby's overall rate of growth is as important as the actual size. On average, it's about 18.5 inches and weighs close to 6 pounds. The brain
has been developing rapidly. Lungs are nearly fully developed. The head is usually positioned down into the pelvis by now.

DEVELOPMENTAL MILESTONE
NEONATE
NEW BORN
Newborn period encompasses the first four weeks of extra uterine life.it is an important link in the chain of events from conception to
adulthood.a healthy newborn infant born at term, between 38 to 42 weeks,cries immediately after birth, establishes independent rhythmic
respiration,quickly adapts with the extra-uterine environment,having an averages birth weight and no congenital anomalies.

CHARACTERISTICS OF NEWBORN:
PHYSICAL CHARACTERISTICS OF NEWBORN PHYSIOLOGICAL CHARACTERISTICS OF NEWBORN
 Length –at birth the average length of the term infant is 50
cm,with range of 48-53 cm.
 Head circumference-the normal head circumference is usually
varies from 33 to 37 cm, with average of a normal full term
newborn infant is about 2.9kg with a variation of 2.5 to 3.9 kg
or more.
 Chest circumference-the chest circumference is about 3cm less
than head circumference.
 Abdomen is prominent with short neck and large head.
 The skin is pinkish but bluish hands and feet may present for a
short time after birth
 The ear cartilage is firm & fully curved,showing good elastic
recoil
 The eyes are largely covered with eye lids
 The breast nodule is palllpable,measuring above 5mm in
diameter.
 The labia majora covers the labia minora.
 The scrotum shows adequate rugae with deep pigmentation &
palpable testes.
 The ear drum is thick.
 The frontal & sphenoidal sinuses are poorly developed
kidney.liver &sateen may be oalooble.
 The respiratory rate varies between 30-60 breaths per minute at
resting.
 Respiration is usually periodic,shallow but irregular.
 The hert rate varies between 120-160 beats per minute,with an
average of140 beats per minute.
 The healthy neonates cries almost immediately after birth.
 Blood pressure ranges ranges from 60-80 mm ofhg systolic &
diastolic 25-40mmhg average 60/40 mmof hg.
 The normal body temperature is 36.5 c to 37.5 which falls after
birth but become normal within 4 to 8 hours.
 Rooting ,sucking swallowing reflexes are well developed.
 A neonate spends about 80% of time in sleeping about 20 hrs a
day
 Protein and carbohydrate are efficienly digested by the new
born but the fat is not.
 The baby passes urine shortly after birth or within 24 hours.
 The first stool or meconium is usually passed within 24 hours.it
is greenish black colour thick and viscid.it is passed for 3-4
days &3-4 times a day.
 The neonates has blood volume about 80ml/kg of body with
RBS-6-8 million/cmm,HB%-18gm%,WBC-10000-
17000/cmm,plateles 350000/cmm.

Growth and development in infancy (frist year of life)
1 MONTH BABY
Physical or Biological Physical growth and development (motor) Sensory
WEIGHT- 4.4+0.8 kg(10+1.5lb);gains above
680 g (1.5lb) a month during first 6 months,
or 150-210g (5-7 oz)a week.
LENGTH APPROXIMATELY - 53+2.5 cm
(21+ 1 in);increase about 2.5cm(1 in) a month
during first 6 months.
HEAD CIRCUMFERENCE- increase about
1.5 cm (0.5 in) a month during first 6 months
PULS- 130+20
RESPIRATION- 35+10
BLOOD PRESSURE- 80/50+20/10
Reflexes- primitive reflexes govern
movements. Has well devolved sucking,
rooting,swalling,and estrusion(tongue
thrust)reflexes,moro reflex (startle reflex),and
asymmetric tonic neck reflex (head turned to
one side ,one arm extended on the same side,
the other arm flexed to shoulder )(picture no-
1) .
Dance and doll’s eye reflexes fading
physiological immaturity breathes through
nose.
GROSS MOTOR
 LIES IN FLEXED POSITION,WHEN PRONE ,PELVIS
IS ELEVATEDBBUT KNEES ARE NOT BENEATH
ABDOMEN AS THEY WERE AFTRE BIRTH (picture
no-2)
 HEAD LEG WHEN PULLED FROM SUPINE TO A
SITTING POSITION (picture no-3)
 TURNS HEAD TO THE SIDE WHEN PRONE
 MAKE CRAWLING MOVEMENT S WHEN PRONE
ON FLAT SURFACE
 PUSH WITH THE FEET AGAINST A HARD
SURFACE TO MOVE FORWARD
FINE MOTOR
 HOLD HAND TO TIGHT FISTS
 CAN GRASP AN OBJECT PLACED IN THE HAND
(PALMER GRASP REFLEX)BUT DROPS IT
IMMEDIATELY
 Startled by
sounds(moro reflex)
 Attentive to speech
of others
 Notice the faces
especially and bright
objects, but only if
thy are in the vision
(picture no-4)
 Protective blinking
in response to bright
light
 Follows a bright
object to the midline
of vision
If 6 to 8 inches from
eyes

Psychosocial, psychosexual and spiritual
development
Intellectual and moral development Language,
speech
development
Play
stimulation(visual,a
uditory,tactile and
kinetic)
Psychosocial
Beginning development of sense of trust.
Negative counterpart: mistrust
Totally egocentric
Complete dependent on caregivers, usually
mother bonding progresses
Establish eye contact
Smiles briefly
Psychosexual
Oral stage(0-1 year)
Oral-dependent or oral-passive need for
sucking pleasure
Need for sucking pleasure
Spiritual
Undifferentiated (0-1 year)
Feelings of trust,warmth,and security form
the foundation for the later development of
faith.
Intellectual
Sensori motor stage (0-2years)
Substages1(birth to 1 month):infant
uses reflexes to begin to make
associations between an act and a
sequential response
Cannot distinguish self from
environment
Substage 2 primary circular
reaction(1-4 months)
Begins to repeat actions of own body
voluntarily(hand-to mouth movement
permits sucking)
Moral
Preconventional morality stage 0(0-2
years)
The good is what i like and want
Respective language
Respond to human
voice
Expressive language
Opens and closes
mouth as adult speaks
Utters small throaty
sounds
Utters sounds of
comfort when feeding
Cry patterns
developing
Cry when hungry or un
comfortable
begins to coo
Hold, touch, and rock infant
gently
Talk and sing softly to infant
at close range
Encourage mutual eye
contact
Provide pacifier for sucking
pleasure
Place large bright pictures
on crib or wall
Respond to crying signals
Have ticking clock, wind
chimes,radio,television,or
music box near by

Picture no-1 picture no-2 picture no-3
Picture no-4

2 MONTH BABY
Physical or biological Physical growth and development (motor) Sensory
Posterior fontanel closed at 6-8 weeks of age. Gross motor
 Less fixed prone position:arms
flexed,hip flat,legs extended,head in
midposition or side (picture no-5)
 No head droop when suspended in
prone position (picture no-6)
 Less head lag when pulled from a
supine to a sitting position (picture no-
7)
 Lift head almost 45 degrees above a
flat surface when lying prone (picture
no-8)
 Holds head erect in midposition
 Holds head erect when held upright
(picture no-9)
 Turns from side to back
Fine motor
 Hand may be open
 Holds a rattle briefly when placed in
the hand
 Turn head to side when a sound occurs
at ear lrvel
 When on back, follows a dangling
 Object or a moving light beyond the
midline of vision
 Beginning binocular fixation and
convergence to objects near by
 Eyes follow moving person nearby

Psychosocial, psychosexual
,spiritual development
Intellectual, moral
development
Language, speech
development
Play
stimulation(visual,auditory,
tactile, and kinetic)
Psychosocial
 Sense of trust
 Distinguishes mother or
primary care giver from
others and is more
responsive to that
person
 Eye to eye contact ,en
face orientation
,smiling ,and
vocalization are the
evidenced of
attachment between
infant and parents
.especially the mother
smiles back in response
to mother’s smile .this
is the beginning of
Intellectual
Sensor motor stage
Sub stage 2
Primary circular
reaction(1-4 months)
Moral
Preconvention
morality stage 0(0-2
years)
Receptive language
 Alter expression when
listening
 Direct definite regard
 Soothed by
caregiver’s,mother’s
voice
Expressive language
 Cry patterns develop
 Crying becomes
differentiated ,varying
with the reason for
crying ,e.g ,hunger ,
,sleepiness,or pain.
 Pitch and intencity vary
 Responds vocally to
caregiver’s
voice;ah,eh,uh
 Same as 1 month
 Offer a rattle,pull from
supine to sitting position
 Hold or dangle toy in front of
infant to encourage eye
movement
 Change patterens of objects
from bright and shiny to dull
and dark further stimulation
 Place in vertical infant seat
so that environment can be
viewed from a different
angle
 Outings in carriage or car if
not done earlier

social behaviour.
Psychosexual
Oral stage (0-1 year)
Spiritual
(Undifferentiated 0-1
year)
Picture no-5 picture no-6 picture no-7

3 MONTH BABY
PHYSICAL OR BIOLOGICAL Physical growth and development
Motor
Sensory development
WEIGHT-5.7 KG+0.8 kg(12.3+2lb)
LENGTH-60CM+2cm(23.5+1in)
PULSE-130 +20
RESPIRATIONS-35+10
BLOOD PRESSURE -80/50+20/10
REFLEXES-
Grasping (palmer) reflex absent landau reflex
appears; an infant suspended in a horizontal
prone position with the head flexed against the
chest reflexly draws the legs up against the
abdomen.
GROSS MOTOR
 Symmetric posture of head and body
(picture no-10)
 Very slight head lag when pulled from
supine to sitting position
 Sits,back rounded,knees flexed when
supported in sitting position (picture
no-11)
 Raises chest,usually supported on
forearms,when in prone position
(picture no12)
 Holds head erect and steady
FINE MOTOR
 Hands open or closed loosely (picture
no-11)
 Hold hands in front of face and stares
at them
 Hold object put in hand with active
grasp
 Carries hand or object to mouth at
will (picture no-13)
 Reaches for bright objects but
misses them
 Turns head and looks in same
direction to locate sound
 When on back, turns eyes to a
dangling
 Object or a moving light to
marginal field of vision
 Loses interest in objects that are
suddenly removed from the
perceptual field
 Beginning ability to coordinate
various sensory stimuli

Psychosocial,psychosexual.spiritual
development
Intellectual,moral
development
Language,speech
development
Play
stimulation(visual,
auditory, tactile,
and kinetic)
Psychosocial
 Sence of trust
 Recognizes and smiles in response to
care givers’(usually the
mother’s)face
 Stop crying when familiar person
approaches
 Interested in surroundings
Psychosexual
Oral stages(0-1 year)
Spiritual
Undifferentiated(0-1 years)
Intellectual
Sensorimotor stage
Sub stage 2
Primary circular
reaction (1-4
months)
Moral
Preconventional
years)
Receptive language
 Looks in direction of
speaker
Expressive language
 Cries less
 Shows plessure in
making many
sounds
 Vocalizes in
response to others
 Coos and chuckles
 May laugh aloud
 Same to 1to2 months
 Encourage infant to
raise head when in
prone position
 Pull baby to sitting
position,thus
encouraging head
control
 Hold bright toys in
front of infant to
encourage reaching
 Provide greater
variety of toys as
baby shows interest
in playthings

Picture no-12
Picture no-10
Picture no -11
Picture no-13

4. MONTH BANY
Physical or biological Physical growth and development (Motor) Sensory development
Drools between 3 and 4 months of
age,indicating increased production of
saliva.unable to swallow it,therefore, it runs
from mouth.
Reflexes
Tonic neck,moro,sucking,and rooting(when
awake)reflexes absent;extrusion reflex
fading(3-4 months)
GROSS MOTOR
 Symmetric body postures predominate
 Sits with adequate support.Enjoys
being propped up (picture14)
 Holds head erect and steady when
placed in sitting position(picture14)
 Activates arms at sight of proffered toy
 Sustain small portion of own
weightwhen held in standing position.
(picture no-15)
 Lift head and shoulders at a90 degree
angle when on abdomen and looks
around (picture no-17)
FINE MOTOR
 Holds hand predominately open
 Graps object held near hand (picture
no-16)
 Object are carried to mouth
 Fingers are clutches clothing
 Follows moving object with eyes.
Even the most difficult type of eye
movement are present fairly good
binocular vision
 Look briefly for toy that desappear
 Accommodation begins to develop
 Can focus a small object

Psychosocial,psychosexual,spiritu
al development
Intellectual,moral
development
Language, speech
development
Play
stimulation(visual,auditory,tact
ile, and kinetics)
Psychosocial development
 Sence of trust
 Smiles in response to smiles of
other
 Shows eagerness when feeding
bottle appears brreathes heavily
when excited
Psychosexual
 Oral stage(0-1 year)
Spiritual
 Undifferentiated (0-1
years)
Intellectual
 Sensorimotor stage
substage 2:
 Primary circular
reaction(1-4
months)
 Substage 3:
secondary circular
reaction(4-8
months)
 Repeats actions that
affect an object to
get a response
(shakeing a rattle)
Moral
 Pre
conventiona
l morality
stages 0(0-2
year)
Receptive language
 Responds
differently to
pleasant or angry
voice does not cry
when scoled
Expressive language
Laugh aloud vocalize
socially;coos and gurgles when
spoken to very “talkative”to
self,people, or toys
 Can vocalize
consonants;b,g,h,k,n,p
 Hold ,touch ,and rock
infant gently
 Smile when talking and
singing to infants
 Encourage mutual eye
contact
 Laugh when infant laughs
 Echo sound that infants
make
 Shake rattle placed in
infants hand
 Offer toy for grasping
 Hold infant in standing
position

Picture no-14
Picture no-17
Picture no-15
Picture no-16

5th
MONTH BABY
Physical or biological Physical growth and development (Motor ) Sensory development
Weight atnleast twice the birth weight.mean
age for doubling birth weight is 3.8 months
Physical growth slowing down can breathe
through mouth when nose is obstructed
GROSS MOTOR
 Sits with slight support
 Balances head well when sitting
 Holds back straight when pulled to a
sitting position
 Pushes whole chest off a flat surface
when prone
 Rolls from back to front
 Pulls feet up to mouth when suline
(picture no-18)
FINE MOTOR
 Use thumb in partial apposition to
fingers more skilfully
 Tries to obtain objects beyond reach
(picture no-19)
 Grasp objects independently of direct
stimulation of the palm of the hand
 Grasps objects with whole hand, either
right or left
 Hold one object while looking at
another
 Localizes sounds made below the ear
 Look after a dropped object
 Inspects objects visually for
alengthening period of time
 Can fixate on objects more than 3 feet
away

Psychosocial,psychosexual
and spiritual development
Intellectual,moral
development
Language, speech development Play
stimulation(visual,auditory,tactile,
and kinetics)
Psychosocial
 Sense of trust
 Smiles at self in
mirror(picture no-20)
 Begins to discriminate
family members from
strangers
 Accepts an object from
another person play
enthusiastically. shows
displeasure when toy is
lost plays with own feet
Psychosexual
 Oral stage(0-1
year)
Spiritual
 Undifferentiated(0-1
years)
Intellectual
 Sensori motor stage
3:secondary circular
reaction(4-8 month)
Moral
 Preconventional
years)
Receptive language
 Responds when own
name is spoken
Expressive language
 Squeals when happy or
excited
 Desired object is taken
away
 Consonnant sounds increase
sound like vowels appear
with consonants,such as goo
begins to mimic sounds
 Same as 4 months
 Provide sufficient different
objects that are too large to
swallow
 Make various sounds near
ear hold infant in standing
position and bounce to
exercise legs and to devlop
balance

Picture no-18
Picture no-19 Picture no-20

6th
MONTH BABY
Physical or biological Physical growth and development (Motor) Sensory
Weight-7.4 kg + 1 kg (16.5 + 2.5lb); gain
about 340g(0.75lb) a month, or 90-150g(3.5
oz) a week during second 6 months
Length-65.5cm gains about 1.25cm a mongth
during second 6 months
Head circumference - 43 cm(1.7 in).
increases about .5cm(0.25 in) per month
during second 6 month during second 6
months
Pulse-120 +20
Respirations-31 +9
Blood pressure-90/60 +28/10
Teething two lower central incisors erupt(6 +2
months)
Begins to bite and chew
GROSS MOTOR
 Sits alone briefly if placed in a favourable
leaning position on hard surface.hold arms out
 Back is straight when sitting in high
chair(picture no-23)
 Pulls to a sitting position
 Springs up and down when sitting
 Turns completely over, with rest periods during
the turn.infant must be protected from falling
 Lifts chest and upper abdomen when prone
,putting the putting the weight on the arms and
hands.(picture no-21)
FINE MOTOR
 Grasps with simultaneous flexion of fingers:
begins to use fingers to feed self a cracker
 Retains transient hold on two object, one in
each hand(picture no-22)
 Drops one object when another is offered
 Begains to tranfer object from one hand to the
other
 Manipulates small objects
 Begains to bang objects that
areheld(rattles,spoon,toy)
 Holds ownbottle but may prefer for it to be held
 Localizes sounds made above
the ear
 Retrieves a dropped object
that can be seen and reached
 Enjoys more complex visual
stimuli
 Moves in order to see an
object

Psychosocial,psychosexual and
spiritual development
Intellectual,moral development Language, speech development Play
and kinetics
Psychosocial
 SENSE OF TRUST
 RECOGNIZES
PARENTS
 RECOGNIZES
STRANGERS (5TH -6TH
MONTH) AS
DIFFERENT FROM
FAMILY MEMBERS.
 BEGAINS TO EXTEND
ARMS TO BE PICKED
UP THRASHES ARMS
AND LEGS WHEN
FRUSTED
 STICKING TOUNG OUT
 KNOWS WHATNIS
LIKED AND DISLIKED
Psychosexual
 Oral stage(0-1
year)
Spiritual
 Undifferentiated (0-1
years )
Intellectual
 Sensorimotor stage sub
stage 111:
Secondary circular
reaction(4-8
months)beginning of
object performance when
infant briefly searches for
a dropped object
Moral
Preconvention morality
stage 0(0-2 years)
Receptive language
Recognizes familar wards
Expressive language
 Actively vocalizes
pleasure with cooing or
crowing
 Cries easily on slight or
no provocation
(withdrawal of a toy)
 Vocalizes several well
defined syllables
 Shows enjoyment in
hearing own vocalization
talks to image in mirror
may pat image of self if
close to mirror
 Same as 4 and 5 month
 encourage infant to look in
a mirror repeat names of
parts of face such as mouth
nose and eyes
 Make funny faces for infant
to imitate
 Point out people food
objects and repeat their
names
 Talk to infant about own and
surrounding activities
 Provide more complex soft
cuddly toys
 Help infant sit up while
leaning forward for support

Picture no-21 Picture no-22 Picture no-23

7th
MONTH BABY
Physical or biological Physical growth and development (Motor ) Sensory
Reflexes
 Sucking and rooting reflexes
disappear at 7-8 months when asleep
 Parachute reflex appears between 7-9
months
 An infant suspendeed in in a
horizontal prone position and lowered
suddenly will extend the hands
forward to provide protection from
falling. This reflex continues
indefinitely
 Upper central incisors erupt
(7.5+2months)
 Lower lateral incisors erupt
(7_+2months)
 Ultimate colour of this is established
Gross motor
 Sits alone on hard surface leaning
forward on hands (picture no-24)
 Lifts head as if trying to sit up when
supine control of trunk is more
advanced
 Bounces actively when held in
standing positions.
Fine motor
 holds 2 toys at once (picture no-25)
 Approaches toy and grasps it with one
hand
 Imitate simple act of others
 Trance for a toy one hand to
other,there usually successfully
 Hold cup
 Head turns in a curving arch to localize
sounds
 Depth perception beginning to develop
 Fixates on very small objects and
details
 Discrimination between simple
geometric forms begins to develop
 Has preferences in taste for foods

Intellectual,moral development Language, speech
development
Play
and kinetics)
Psychosocial
 Sense of trust
 Shows increasing fear of
strangers(7-8 month)
 Actively clings to a
familiar person when
distressed
 Unhappy when
caregiver,usually mother
disappears
 Responds socially to own
name emotinal instability
psychosexual
 Oral agressiveness is
evidenced by biting and
chewing
 Discovers genitalia
 undifferentiated (0-1
year)
Intellectual
 Sensorimotor stage sub stage
111:
o Secondary circular
reaction(4-8
months)beginning of
object performance
when infant briefly
searches for a
dropped object
moral
Preconvention morality stage 0(0-2
years)
Receptive language
 Recognizes own name
 Respond with gestures
to words such as come.
Expressive language
 Vocalizes eagerness
vocalizes m-m-m when
crying
 Imitates simple noises
and speech sounds
 Make polysyllabic
vowel sounds vocalizes
da- ma-ba
 Same as 4,5 and 6 month
 Place toy under blanket and
encourage infant to find it
 Repeat simple sound :dada-
mama
 Provide objects or food that
can be bitten and chewed
safely

8th
MONTH BABY
Physical or biological Physical growth and development (Motor Sensory
Begining of a in bowel and bladder
elimination
GROSS MOTOR
 Sit alone stedily(picture no-26)
 Pulls self into standing position with
help
 Hand-eye coordation is perfected so
that random reaching and grasping no
longer occur
FINE MOTOR
 Holds 2 objects while looking at a
third
 Persistenly reaches for objects beyond
range of grasp
 Releases objects from hands
voluntarily
 Complete thumb apposition
 Eat finger food ,such as crackers that
can be held in one hand drinks from
cup with assistance(7-9month)(picture
no-27)
 Recognizes familiar words and sounds

Intellectual,moral development Language, speech
development
Play
and kinetics)
Psychosocial
 Sense of truth
 Greets strangers with coy
or bashful
behaviour,turning
away,crying or even
screaming (picture no-28)
 Refuse to play with
stranger anxity, to be
distiguished from
anaclitic
depression,occure
betweenthe 6-8 months
 Affection for or love of
family member
 Emotional instability still
evident
 Dislikes changeing
clothing and diapers
Psychosexual
 Oral stage(0-1
year)
Spiritual
 Undifferentiated (0-1 year
)
Intellectual
 Sensorimotor stage sub
stage 111:
 Secondary circular
reaction(4-8
months)knows that object
are separete from self
searches briefly for
objects seen being placed
elsewhere.the search is
confined to only one
modality
 Action to produce aresult
have been memrized
 Substage iv:
 Cooradation of secondary
schemas(8-12 months)
 Abilities learned earlier
are combined and
extended to deal with
new situations:
Moral
stage 0(0-2 years)
Receptive language
 Stops activity when
own name is spoken
 Being to understand
meaning of no
Expressive language
 Shout for attention
 Limitates sound
sequences continues
syllabus :dada-
mama(non specific
meaning)
 Can vocalizes
consonants:d,t,and w
 Hold,touch,and rock infant
gentry
 Talk and sing to infant in a
sitting position against a wall
and encourage learning away
from the wallto improve balance
 Gently push infant from a sitting
position to improve balance

Picture no-26

9th
MONTH BABY
Reflexes
 Plantar grasp absent
 Teething
 Upper lateral incisor erupt(9
months)
GROSSMOTOR
 Raises to a sitting position alone with
good coordination
 Sits steadily for longer period of time
 Recovers balance when learning
forward,but not sideways
 Crawling may be done as early as the
4th month;the average age is 8-9
months.(picture no-29)
 Creeping-it is a more advanced type of
locomotion than crawling.
 Begining to pull self to standing
position alone while holding on to
furniture.(picture no-30)
FINE MOTOR
 Bangs two objects together
 Pokes objectives with fingers
 Use thumb and index finger in early
pincer grasp
 Has preference for the use of one of
onedominant hand
 Drink from cup with some spilling(0-
12)m0nth
 Attempts to use aspoonbut spills
contents(picture no-31)
 Head turns directly to source of sound
 Increase depth of perception
 Recognizes by looking or moving
towards familiar object when named
 Able to follow objects through transition
from one place to anather

Psychosocial,psychosexual and spiritual
development
Intellectual,moral
development
Language, speech development Play
stimulation(visual,audito
ry,tactile, and kinetics
Psychosocial
 Sense of trust
 Know what no meanswith
adult such as big bye bye
 Dilike haveing face washed
so cover face with arm and
hands
Psychosexual
Spiritual
 Undifferentiated (0-1 years)
Intellectual
 Sensorimotor Substage iv:
Cooradation of secondary
Moral
 Preconvention
morality stage 0(0-
2 years)
 Language.speech
development
Receptive language
 Stop activity in response to no
 Biginning to respond to smile
commands given verbaly
respond to adult anger
Expressive language
 Cries when scoled
 echolalia or correct initative
 Expressssion of sounds made
by other s (9-10 month)
 Says ma-ma-,da –da,as name
of the persons
 schemas(8-12 months)
 Able to follow objects through
transition from one place to
another
 Same as 8 month
 Encorage
exploration of toys
with eyes and
finger s
 Show infant large
picture in books
 Say bye bye with
approprite motion
 Begain to play
peek-a boo

Picture no-29

10th
MONTH
Physical or biological Physical growth and development (Motor ) Sensory
Macula is well developed so that fine visual
discrimination can be made
GROSS MOTOR
 Move from prone to sitting position
 May sit by falling down from standing
position
 Sits steadily for indefinite period of
time
 Make step movement when two hand
are held(picture no-33)
 Creeps well(picture no-32)
 Cruises well (walks sideways while
holding on to a supporting object with
both hands(picture no-34)
FINE MOTOR
 Picks small objects up with index
finger and thumb
 Release an objects after holding it
Bring the hands together
 Marked interest in very small objects
 Search for a lost toy with greater
persistence

Psychosocial,psychosexual and spiritual
development
Intellectual,moral
development
Language, speech
development
Play
stimulation(visual,auditory,tacti
le, and kinetics)
Psychosocial
 Sense of trust
 Express several beginning recognizable
emotions such as
anger,sadness,jealousy,anxity,pleasure,excite
ment,and affection
 Play social game with adults
Psychosexual
 Oral stage(0-1 year)
Spiritual
 Undifferentiated (0-1 years )
Intellectual
Sensorimotor
Substage iv:
 Cooradation
of secondary
schemas(8-12
months)
Moral
Preconvention
morality stage
0(0-2 years)
Receptive language
 Understandsimple
commands:give toy
on arequest that is
accompanied by
gestures
Expressive language
 May speak one
word besides ma-
ma and da-da,such
as no,hi
 Understand
meaning of bye-bye
 Same as 8 to 9 months
 Obtain infants attention
when request are made
and use gesture to indicat
meaning
 Make facial expression
and sound
 Hand for sapport
 Encorage standing and
jumping

11th
MONTH BABY
Physical or biological Physical growth and development (motor )
GROSS MOTOR
 Stand erect with minimal support and
lifts one foot to take a step(picture no-
34)
 Cruises walks holding on to furniture
FINE MOTOR
 Explore toys and other objects more
care fullly
 removes covers from boxes(picture
no-35)
 Takes toy out of box or cup
 Beginning to hold a crayon and make a
mark on paper(picture no-36)

and kinetics)
Psychosocial
 Sense of trust
 Shows pleasure when a
desired act is
accomplished
 Activities are restricted
aserts self among family
Psychosexual
Spiritual
 Undifferentiated (0-1
years )
Intellectual
Sensorimotor Substage
iv:
 Cooradation of secondary
Moral
stage 0(0-2 years)
Receptive language
Responds to smile question:for
example,where is the kitty
pointing and looking toward
object
Expressive language
 Imitates spesific speech
 Sound of others
 Jargon well established
 Same as 8,9,10 months
 Provide opportunities for
placing small objects into
larger objects and for taking
them out again.
 Play simple games such as
rolling a ball to infant.
 Show infant how to throw it
back encourage play with
other persons
 Encourage infant to stand
alone by gradually
decreasing (furniture or
adult’s hands)
 Place infant in a walker and
encourage letting go by
offering a toy to grasp

12th
MONTH BABY
Weaight- 10 +1,5 kg (11 + 3 pounds);has
tripled birth weight
Length –74.5 + 3 cm (29 +1.5 inches);length
has increased 50% from birth
Head circumference 46 cm (18 inches); head
circumference has increased by one third since
birth,brain weight has increased rapidly since
birth,
Anterior fontanel closes between 12 and 18
months
Pulse 115 +20
Respiration 30 +10
Blood pressure 96/66 +30/24
Reflexes
 Babinski reflex disappears landau
reflex disappears between 12-24
months
 Teething has 6-8 teeth
GROSS MOTOR
 Stand alone for variable length of
time(picture no-37)
 Sits down from standing positionalone
 Walk a few step (picture no-38)
FINE MOTOR
 Good pincer grasp
 Enjoys eating with finger (picture no-
39)
 Drinks from acup and eat from a
spoon(picture no-40)
 Listion for recurring sounds
 follows fast moving object with eyes.

and kinetics)
Psychosocial
 Sense of trust theoritically
achived.
 Infant imotion such as
fear ,jealousy,anger,can be
more clealy interpreted
 Attachment developed to
primary care giver
Psychosexual
Spiritual
 Undifferentiated (0-1
years )
Intellectual
Sensorimotor Substage iv:
 Cooradation of secondary
 Problem solving begining
to develop,although the
infant has not learned to
think per se
Moral
stage 0(0-2 years)
Receptive language
Responds to smile question:for
example,where is the kitty
pointing and looking toward
object
Expressive language
 Imitates spesific speech
 Sound of others
 Jargon well established
 Same as 8-9,10 and 11
months
 Provide opportunites for
placeing small
 Play simple games such as
rolling a ball to infant
 Encourage infant to walk
 Improve balance

Picture no-37 Picture no-38 Picture no-39 Picture no-40

Growth and development of toddlers-1 yr to 3 years
15 month baby
Physical and biological Motor and self care sensory
Leg appear bowed Gross motor
 Assume standing position without help
 walk without support at 13 months,wide-based gait (photo no-1)
 kneels without support
 creeps up stairs (photo no-2)
 cannot throw ball without falling
fine motor
 builds a tower of 2-3 cubes (photo no -3)
 open boxes
 pokes finger in hole
 scribbles spontaneously(photo no-4)
 makes line with crayon
self care
feeding skill
 may give up bottle
 hold a cup with all fingers grasped about it.
 Spoon is likely to be turned upside down before reaching mouth(
photo no-5)
Dressing skill
 Stick out arm and leg to help dressing
 Removes socks
Toileting and growing skills
 Indicates when diaper is wet or soiled.
 Sound localization
indicated by head
 Movement in all planes
 Binocular vision fully
developed
 Looks at pictures intently
for prolonged periods of
time(phote no-6)

Psychological,psychosoc
ial,spiritual development
Intecllectual or
cognitive,moral
development
Language and speech
development
Play
stimulation(visual,auditory
,tactile,and kinetic)
PSYCHOSOCIAL
 Sence of autonomy(1-3
years);negative
counterpart:shame and
doubt
 Egocentric
 Separation anxity:coping
 Depend on primary care
giver’s presence but not
tolerate some separation
 Coping decreased in
unfamiliar environment
 Less fearful of strangers
 Hugs and kisses parents
 Very early temper
tantrums
PSYCHOSEXUAL
 Anal stage(1-3 years)
SPIRITUAL
 Intuitive-projective
INTELLECTUAL
OR COGNITIVE
Sensorimotor
Stage
Substage v.tertiary circular reaction
(12-18 months):experiences only
the present
MORAL
Preconventional morality stage 0
(0-2 YEARS).the good is what I
like and want!
RECEPTIVE LANGUAGE
 Comprehends more than
can communicate
 Recognizes names of
various parts of body
 Responds to familiar,
simple commands
EXPRESSIVE LANGUAGE
 Continues use of
expressive jargon
 True words included
with jargon, possibly
with gestures says 2-6
words
 Names familiar pictures
or objects, such as ‘ball’
 Vocalizes wants and
points to desired object
 Shakes head to
communicate ‘no’
 Walking becomes a form of
play carries a toy when
walking balls
 Stuffed animals
 Dolls
 Musical toys
 Picture books
 Stacking discs or blocks

Picture no-1
Picture no-2
Picture no-4
Picture no-3
Picture no-6
Picture no-5

18 months baby
 Anterior fontanel closed
may be closed early as 12
months)
 Abdomen protrudes
 Physiological anorexia due
to to dressed growth and
development
 Has sphincter control
GROSS MOTOR
 Walks with some what wide stance ,but but increasingly more
like adult gait.seldom falls
 Walks sideways and backwards(16.7 months)
 Walk upstairs with one hand held(photo no -7)
 Runs stiffly,often fall
 Seat self in small chair
 Climbs on furniture (phote no-8)
 Get into every thing:explores drawers,closet,and
wastebaskets(phote no -9)
 Pulls and pushes toy(photo no-10
FINE MOTOR
 Builds tower of 3-4 cubes(phote no -11)
 Limitates a vertical stroke with crayon(phote no-12)
 Put block into hole
 Dumps pellet from bottle
SELF-CARE
Feeding skills
 Holds cup with both hands.hands it to caregiver,puts it down,or
droup it on floor(photo no-13)
 Finger feeds proficiently
 Eats with spoon;turns spoon in mouth.
 Spills frequently
 May play with food
 Can see better,thus has
intense
 Interest in pictures
 Identifies various shapes
 Convergence well
established
 Some depth perception

Dressing skills
 Removes simple garments (mittens,shoes)and unzips garments
Toileting and grooming skills
 May complain when wet or soiled or give indication of need to
toilet
 Increased readiness for bowel and bladder control
 Possibly early control of bowel movements
 May smear faeces
Psychological,psychosoci
al,spiritual development
Intecllectual or
cognitive,moral
development
Language and speech
development
Play
stimulation(visual,audito
ry,tactile,and kinetic)
PSYCHOSOCIAL
 Sense of autonomy(1-3
years)
 Egocentric
 Autonomous behaviour
increasing
 Autonomy is tested with
‘no’
 Negativism and dawdling
predominate
 Begins to have temper
tantrums if things go wrong
 Bedtime ritual begin
 Call for primary caregiver
 Thumb sucking may peak
 Kisses parents with pucker
 Awareness of gender
Intecllectual or cognitive
 Sensorimotor stage
 Substagevi:invention of
new means through
mental combinations (18-
24 months)concept of
object permanence fully
developed.
 Beginning sense of time
and anticipation of events
 Beginning traces of
memory
MOTOR
 Preconventional morality
stage 0(0-2 years)
RECEPTIVE LANGUAGE
 Identifies pictures of
familiar
 Objects when named
 Identifies one or more
parts of body when named
EXPRESSIVE LANGUAGE
 Vocabulary
 Speak 10 real words
 Besides jargon
 Name pictures
 Uses words more than
gestures to express desires
 One word used to
communicate
Enjoys solitary play or watching
activities of oters
Has a favourite toy or
transitional(security)object,such
as a blanket
MOTOR PLAY
 Large,hollow wooden
blocks
 Balls
 Pull toys
 Low swing with arma
and back low slide
 Rocking chair or horse
CREATIVE PLAY
 Containers with openings
into which blocks of
different shapes can be

identity begins
PSYCHOSEXUAL
Anal stage(1-3 years)
SPIRITUAL
Intuitive –projective
placed
 Fingerpaints
 Clay
QUIET PLAY
 Sand toys (shovel,pail)
 Stuffed animals and dolls
to darg,sit upon,or hug
DRAMATIC PLAY
 Imitates parental actions
in play

Picture no-31Picture no-7

24 months baby
Weight approximately 11.8-12.7kg(26-
28lb);has gained 1.8-2.7kg(4-6ib)during
second year
Height approximately 82.5-85.0cm(32.5-
34 in);gained 10-12.5 cm(4-5 in)in
second year.
Adult height is about twice height at 2
years of age
Chest circumference exceeds head
circumference
Anterior poster or diameter less than
lateral diameter
Head circumference 49-50 cm (19.6-20
in)
Pulse 110+ 20 (average 100 beats/min)
Respirations 26-28 per min
Blood pressure 99/64 + 26/24
Reflex landau reflex completely
disappeared
Dentition approximately 16
Temporary teeth
Physiological functioning,with the
exception of reproductive and
endocrine,is mature
Abdomen protrudes less than at 18
months
Probably ready for beginning daytime
GROSS MOTOR
More grown up, steady gait
Can walk with heel-toe gait
Walk up and down stairs,both feet on one step at a time,holding
onto a railing or the wall (photo 14)
Pick up object from floor without losing balance (photo 15)
FINE MOTOR
Builds a tower of 6-7 cubes (photo-16)
Imitates a circular stroke
Opens door by turning door knob;may run away(photo-17)
SELF CARE
Feeding skills
Puts spoon into mouth occasionally with one hand,but without
turning it(photo-18)
Play with food
Dressing skills
Pulls on own simple garments-coat,pants,shoes
Removes most of own clothing
Toileting and gromming skills
Verbalizes toilet needs
Usually bowel –trained with occasional accidents
Usually urinates when taken to toilet
May still smear stool
Visual acuity:20/40
Accommodation well developed
Inserts square object into its
appropriate place or hole may
develop esotropia(strabismus)

control of bowel and bladder.
Psychological, psychosocial,
Intellectual or
cognitive,
moral
development
Language
and speech
development
Play
stimulation(visual,auditory,tactile,and
kinetic)
PSYCHOSOCIAL
Sense of autonomy(1-3 years)
Egocentric in both thought and behaviour
Separation anxity from primary care giver is at
height;feares parents leaving
Beginning to show early sign of individuality
and independence from primary caregiver
Thumb sucking decreased
Focuses on own wishes
Violent temper tantrums decreasing
PSYCHOSEXUAL
Anal stage (1-3 years)
SPIRITUAL
Intuitive-projective
Intellectual or
cognitive
Preoperational stage
Preconceptual
phase(2-4 years)
Preoccupation with
symbols in
language,dreams,and
fantasy
Attention span
longer
Memory increases
Imitation becoming
more symbolic
MORAL
Preconventional
morality stage 1
92-3 years)if
punished for doing
it,it’s wrong;if not
punished,it must be
right
RECEPTIVEE
LANGUAGE
Understands
more complex
sentences
Obeys 1
directional
preposition(on or
under)and 2
commands(pick
up your coat and
put it on the
chair)
Enjoy story with
picture
EXPRESSIVE
LANGUAGE
Vocabulary
No longer use of
jargon
Know about 300
words
Identifies
familiar objects
Enjoys parallel play-little social interation with
other children even though their activity is the
same.
Beginning to learn to replace toys in their proper
place
Dawdles frequently
MOTOR PLAY
Pulls wagon
Places beads in box and dumps them
CREATIVE PLAY
Manipulates play materias such as clay and play-
doh
Fingerpaints
Brush paints
Sing song
QUIET PLAY
Enjoys hearing stories illustrated with pictures
Takes favourite toy to bed
DRAMATIC PLAY
Mimics domestic activities of parents(domestic
mimicry)
Enjoys playing with dolls

Picture no-18

30 months baby
Weight gains about 5 kg (11lb) between 1 and
3 years;birth weight quadrupled by 2 and half
years
Height grows about 6-8 cm(2.4-3.2 in)during
third year
Dentition full set of 20 temporary (deciduous)
teeth
Daytime bowel and bladder control possibly
established
GROSS MOTOR
Stand on one foot alone momentarily
(photo 19)
Jumps from step or low chair
Can throw a large ball overhand 4-5
feet(photo 20)
Rides awalker or peadal car (photo 21)
FINE MOTOR
Build tower of 8 cubes (photo 22)
Adds chimney to train of cubes
Makes vertical and horizontal strokes but may
or may not join them to make a cross
SELF CARE
Feeding skills
Self feeding with occasional spilling
Pours from pitcher;often spills
Gets a drink without assistance
Chews with mouth closed
Usually has mastered daytime bladder control
Beginning night-time bladder control
May go to toilet by self (for bowel
movement,26 months,for urination,30
months). Need assistance with wiping(photo
23)
Visual acuty:20/30 convergence smooth
recalls visual images

Psychological,
psychosocial, spiritual
development
Intellectual or
cognitive, moral
development
Language and speech
development
Play
kinetic)
PSYCHOSOCIAL
Sense of autonomy (1-3
years). Theoretically achived
at end of toddler period. If
not, a sense of shame and
doubt predominates
Beginning to learn to cope
with separation anxiety
Reluctant to go to bed
Temper tantrums may or may
not decrease
Imitates sex-role behaviour
of adults
Knows own sex
PSYCHOSEXUAL
Anal stage (1-3 years)
SPIRITUAL
Intuitive-projective
Intellectual or cognitive
Preoperational stage
Preconceptual phase (2-4
years)concept of time
improved but still limited
Begins causal thinking
Problem-solving through
trial and error
RECEPTIVE
LANGUAGE
Identifies five body parts
when named
EXPRESSIVE
LANGUAGE
Vocabulary
Gives full (frist and
last)name if asked
Uses of appropriate pronoun
when referring to self-i
Uses of 4-5 word sentences
Parallel play continues
Helps put things away
Pretends in play
MOTOR PLAY
PUSHES AND STEERS TOYS WELL
LARGE CARS,TRUCKS
CARBOARD BOXES
BLOCK TRAINS THAT INTERLOCK
CREATIVE PLAY
Clay
Finger paints
Large crayons
Large wooden puzzles
Sandbox toys
QUIET PLAY
Uses transitional securityobject(favourite toy or
blanket)for comfort
Toys for water play
DRAMATIC PLAY
Baby doll and doll equipment
Toys for housekeeping (small broom,dust cloth)
Play telephone

Picture no-21

Growth and development of preschoolers
3 years baby
Weight approximately 12.5-16.5 kg(27.5-
36.3ib).has gained 2.27kg during third year
Height approximately 90.5-101.5cm.gained 8
cm in third year
Pulse 105+15 (average 95 beats/minute)
Respiration 25 +5 per min
Blood pressure 100/67 +24/25
GROSSMOTOR
Walks straight line (ph no -1)
Walks on tiptoes (ph no-2)
Walks backward
Kick a ball
Jump from height of several inches
Ride atricycle using padals;turn wide
corners(ph no-3)
FINE MOTOR
Builds a tower of 9-10 blocks(ph no -4)
Copies of circle(ph no-5)
Uses of blunt scissors with one hand to cut (ph
no-6)
Puts beads on string(ph no-7)
SELF CARE
Canput on coat without assistance
Canundress self in most instances
TOIELETING GROOMING
Can pull pants up and dowen
Can go to toilet alone
Brushes teeth with help
Visual acuity:20/20

Psychological,
psychosocial,
spiritual
development
Intellectual or
cognitive, moral
development
Language and speech
development
Play
kinetic)
PSYCHOSOCIAL
Beginning development of
sense of initiative (3-5
years)
Negative counterpart:guilt
Egocentric in thought and
behaviour
Alternates between reality
and imagination
Fear to dark
Knows own sex
PSYCHOSEXUAL
Phallic stage (3-6 years)
SPIRITUAL
Intuitive-projective faith
PREOPERATIONAL
THOUGHT
Sub stage i:preconconceptual
(2-4 years) characterized by
language acquisition
Substage ii:intuitive stage (4-
7years);egocentric
preschooler bases problem
solution on only one aspect
Tries to please and conforms
to requests
Able to follow directional
commands
MORAL
Preconventional morality
stage 1 (2-3 years)
RECEPTIVE LANGUAge
Can obey two prepositional
commands(i.e.on,under)
EXPRESSIVE
LANGUAGE
USES4-WORD
SENTENCES-ASKS
WHY,USES PLURALS
GIVES SEX AND FULL
NAME
Name figures in a picture
Has vocabulary of 800-1000
words
Child shoud be intelligible
90% of time
Likes things that squish,move,talk,make noise
Books about known things crayons,paints
Climbing apparatus transportation
toys:tricycle,wagons,dump trucks,doll carriage
play telephone, busy –box ,music,

Picture no-1
Picture no-4
Picture no-6
Picture no-5
Picture no-7
Picture no-8

4 years baby
Weight approximately 13.5-19.5kg.has gained
2.27kg during the fourth year.
Height approximately 95-109 cm. has
increased 8 cm.has doubled birth length
Pulse 100+10 beats/minute average 92
beats/minute
Blood pressure 100/66+_20 usually dry at
night
GROSS MOTOR
Runs on tiptoes
Balances on one foot 3-5 seconds
Jumps from greater heights (photo 9)
Catch ball with extended arms and with
hands(photo 10)
Hops on preferred foot(photo 11)
Alternates feet when descending stairs (photo
12)
FINE MOTOR
Copies a square(photo 13)
Draws a simple face(photo 14)
Cuts around picture with scissors
SELF CARE
Feeding skills
Manages spoon with little spilling
Eats with fork held in fingers
Dressing skills
Buttons side buttons,small buttons
Can put on socks with help
May bathe self,with assistance washes and
dries hand without supervision
Visual acuity:20/20

Psychological,
development
Intellectual or cognitive,
moral development
Language and speech
development
Play
stimulation(visual,auditor
y,tactile,and kinetic)
PSYCHOSOCIAL
Sense of initiative(3-5 years)
Egocentric-unable to see
others’viewpoints and can’t
understand why others don;t see
child’s tends to be impatient and
selfish
Usually easily separation from
parents
More cooperative in play
PSYCHOSEXUAL
Phallic phase(3-6 years)
SPIRITUAL
Intutive-projective faith
PREOPERATIONAL
THOUGHT
Substage i(2-4 years)
Sub stage ii(4-7 years)
Classifies objects according to
one characteristic not able to
conserve matter continues to
believe thoughts cause events
obeys because parents set
limits,not because of
understanding between right and
wrong highly imaginative
Concept of time improving,
MORAL
Stage 2(4-7 years)you do it for
me,i’ll do it for you
RECEPTIVE LANGUAGE
Understand directives
(on,under,in back,in front)
EXPRESSIVE LANGUAGE
Name one or more colours
correctly
Uses i
Count to 5
Plays cooperatively with others
(photo 15)
Interested in world
Provide hand puppets,doll house
and furniture,costume box,doll.
Blackboard,chalk,paste,paper,sciss
ors,clay,finger paints to stimulate
creativity.

Picture no-11
Picture no-12

5 years baby
Physical or biological Motor and self care sensory
Weight approximately 15.4-21.4kg.has gained
2.27 kg during the fifth year
Height approximately 103-115cm.gained 8cm
in fifth year.
Pulse 95+15(average 90 beats/minute)
Respiration 22+3 per minute
Blood pressure 100/60+14/10
Head size adult size nearly reached
Anticipates immediate toilet needs
GROSS MOTOR
Skips,alternates feet
Jumps rope and jumps over objects (photo 16)
Balance in one foot 8-10 second
Roller skates(photo 17)
FINE MOTOR
Copies a triangle (photo 18)
Crosses vertical lines
Draws a three-part man(photo 20)
SELF CARE
Feeding skills
Selects fork over spoon when
approximately(photo 21)
Dressing skills
May be able to lace shoses(photo 22)
Manages zippers in back
Wipes self independently
Flushes toilet after each use
Bathes self
Combs hair with help
Can blow nose when asked
Visual acuity:20/20

Psychological,
psychosocial,
spiritual
development
Intellectual or
cognitive, moral
development
Language and speech
development
Play
kinetic)
PSYCHOSOCIAL
Sense of initiative(3-5
years)
Continues to be egocentric
Separetes easily from
parents
Independent and trustworthy
Has fantasies and day
dreams
Looks for parental
encouragement and support
Engages in cooperative play
Very industrious
PSYCHOSEXUAL
Phalic stage (3-6 years)
SPIRITUAL
Intuitive-projective faith
PREOPERATIONAL
THOUGHT
Substage ii(4-7 years)
Classifies objects according
to relationship that are similar
accurately describes events
Aware of culture differences
RECEPTIVE
LANGUAGE
Carries out instruction with
three suggested
taste,i.e.wash,dry,sit down
EXPRESSIVE
LANGUAGE
Name primary colours
Asks meaning of words
Counts to 10
Has vocabulary of 2100
words
Plays competitive exercise games loves to
transport things in trucks,car,wagons
Provide:simple games for competitive and team
play(photo 23)
See-saw,jungle gym,sleds,jump rope,and skates
for motor activity paper dolls,books and puzzles
for quiet play

Picture no-16
Picture no-17

Growth and development of school children-6 to 12 years
6 to 8 years children
Weight approximately 17.5-25.5 kg gains 3.8
kg yearly
Height approximately 110-124 cm.gain
1.13cm(2,5in)yearly
Pulse 90+15 beats/minute
Respirations 21+3per minute
Dentition starts to lose temporary
teeth;acquires first permanent molars,medial
incisors,lateral incisors
Tires easily
GROSS MOTOR
Rides bicycle without training wheels
Runs,jumps,climbs,hops(photo 1)
Constantly in motion
Coordination improving(photo2)
FINE MOTOR
Knows right from left hand
Draws a person with 12-16 parts(photo 3)
Has improved eye-hand coordination(photo 4)
SELF CARE
Feeding skills
At 6 years,likes to eat with fingers,stuffs food
into mouth,talkative while eating.
At 7 years,improved table manners,less
talking,may bolt food
Grooming and dressing skills
Self-care managed:has a tendency to dawdle
in bathtub
May need some help with dressing(photo 5)
Can brush and cumb hair
Visual acuity 20/20(adult value)

Psychological,
psychosocial,
Intellectual or
cognitive, moral
development
Language and
speech development
Play
kinetic)
PSYCHOSOCIAL
Beginning of development of
sense of industry (6-
12years)(photo 6)
Negative
counterpart:inferiority
continues to be egocentric
bossy
Has a ‘know it all’attitude
Craves attention
Has good days and bad days
Wants other children to play
with jealous of siblings
Fears injury to body
PSYCHOSEXUAL
Lantency stage(6-12 years)
SPIRITUAL
Mythical-literal faith
PREOPERATIONAL
THOUGHT
Substage ii(4-7 years)
Attention span increasing
Can describe objects and
effect developing
Can see difference more than
similarities
Call tell time knows
date,month,and season
MORAL
Preconventional morality
stage 2(4-7 years)
Conventional morality stage
3(7-9 years)
Am i a good person?
RECEPTIVE
LANGUAGE
Follows series of 3
commands,responds to
praise and recognition
EXPRESSIVE
LANGUAGE
Can repeat sentences of 10-
12 words
Has a vocabulary of 2500
words
Uses all forms of sentence
structure
Knows number
combinations up to 10
Likes rough and tumble play
Loves active play
Prefers group play
Doll ply at a height
Provide:table game,board game for competitive
and team play bicycles,jump ropes punching
bags,roller skates for motor play
Puppets,dolls,paints,crayons,drawing
materials,clay,for creative play
Books,puzzles,records,tapes,collectibles for quit
play

Picture no-4
Picture no-6
Picture no-7

8-10 years children
Weight approximately 22-23kg gained 3.8 kg
yearly
Height approximately 12.5-136.5 cm.gain 1.13
yearly
Pulse 85+10 beats/minute
Respirations 20+3 per minute
GROSS MOTOR
Performs tricks on bicycle;races
Begins toparticipate in organized sports,like
baseball,soccer
Throws a ball skilfully;overhand and under
land
FINE MOTOR
Use both hands independently
Draws a person with 18-20 parts
Has increased smoothness and speed in fine
motor control(photo 8)
Prints fluently;cursive writing improved(photo
9)
SELF CARE
Feeding skills
Handles eating utensils skilfully
Dressing and gromming skills
Dresses self completely;enjoys selecting own
clothes
Unaware of dirty clothes
Needs to be reminded brush teeth
Visual acuity:20/20(adult value)

Psychological,
development
Intellectual or
cognitive, moral
development
Language and speech
development
Play
kinetic)
PSYCHOSOCIAL
Sense of industry (6-12
years) is readay for any thing
Curious about everything
(photo 10)
Concerned about
relationships with other
Becoming peer-oriented
Easy to get along with at
home
Begins hero worship
Relationships with siblings
improved
Aware about appropriate
sexual role
PSYCHOSEXUAL
Latency stage (6-12 years)
SPIRITUAL
CONCREETE
OPERATIONAL
THOUGHT
(7-11 YEARS)
Learns to understand and
use abstract symbols and
carries out mental operations
Shows interest in causal
relationship
Interested in schoolwork
(photo 11)
Memory span increasing
Makes alibis for own faults
MORAL
Conventional morality
Stage 3(7-9 years )
Stage 4(10-12 years)
‘we need law and order’
RECEPTIVE
LANGUAGE
Follows suggestions better
than commands
EXPRESSIVE
LANGUAGE
Is gregarious
Begins to use shorter and
more compact sentences
Prefers companionship in play (photo 12)
Likes to compete
Continues to require supervision in play-fights
may occur
Enjoys dramatic play
Continues collections-hobbies begin to develop
Enjoys making things

10 to 12 years children
Weight
10 years
Approximately 25.5-39.5 kg.gains 3.8 kg
12 yerrs
Boys :30-48 kg
Girls:30-50 kg
Height
10 years
Approximately 131.5-147.5 cm. Gain 3.8 kg
yearly
12 years
Boys :142-158 cm
Girls :144-160 cm
Pulse
10 years
90+20 beats per minute
12 years
Boys :90+20
Girls :85+20
Respirations 19+3 per minute
Blood pressure
10 years 109/58+16/10
12 years 113/59+18/10
Dention acquires cuspids, frist and second
premolars.
Secondary sex charecteristics may begin to
develop
GROSS MOTOR
Enjoy all physical activities (photo 13)
FINE MOTOR
Coordination continues to improve (photo
14.15)
SELF CARE
Feeding skills
Criticizes table manners of parents
Dressing and groming skills
May wear some clothes continually
Leaves clothes where they fall
Enjoys wearing current style of clothes
Needs constant reminding of personal hygiene
(10 years)
Bathes frequently-prefers showers(12 years)
Visual acuity :20/20 (adult value)

Psychological,
development
Intellectual or
cognitive, moral
development
Language and speech
development
Play
kinetic)
PSYCHOSOCIAL
Sense of industry (6-12
years)
Congenial sincere, confident
Has greater self-control
Respects parents and their
role
Has short bursts of anger (10
years)
Able to control anger(12
years)
Knows about sexual
intercourse
PSYCHOSEXUAL
Latency stage (6-12 years)
SPIRITUAL
FORMAL
OPERATIONAL
THOUGHT(11 years to
adulthood)
Develops abstract and
deductive reasoning
Uses problem-solving
method
Can define abstract terms
Collects facts for future use
(photo 16)
Short interest span
MORAL
Conventional morality
Stage 4 (10-12 years)
RECEPTIVE
LANGUAGE
Follows suggestions better
than requests;is obedient
EXPRESSIVE
LANGUAGU
Oral vocabulary of 7200
words,reading vocabulary of
50,000 words
Uses parts of speech
correctly
Able to give precise,
Enjoys riddles
10 years
Enjoy :
Large –muscle activity and outdoor
Activities
Bicycle riding
Reading
Collecting
Construction activities
12 years
Enjoys:
Parties (with supervision)
Athletic sports
Reading mystry and love stories
Talking on telephone
Sex differences noticed in play

Picture no-16

REFERNCE-
 Datta parul ,pediatric nursing 2nd edition ,jaypee brother publishers (p)ltd page no-115,116,127,128
 www.preschool-plan-it.com/developmental-milestones.html
 www.webmd.com › parenting › Guide
 http://www.kamloopschildrenstherapy.org/fine-motor-skills-preschool-milestones
 "Fetal Development Pictures Slideshow: Photos Month-by-Month by WebMD." WebMD - Better Information. Better Health. Luis
Chang, 11 Aug. 2011. Web. 26 Dec. 2011.
 http://www.webmd.com/baby/ss/slideshow-fetal-developme
 "Fetus." Wikipedia, the Free Encyclopedia. 24 Dec. 2011. Web. 24 Dec. 2011. <http://en.wikipedia.org/wiki/Fetus>.

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