Growth and Development of Newborns, Infants, and Young Children
GROWTH AND DEVELOPMENT
Key Quote: "Children are not small adults."
Importance emphasized in pediatrics.
CHAPTER 25: NEWBORNS AND INFANTS
OVERVIEW
Newborn: Birth to the first 28 days of life.
Infancy: Birth to 12 months of age.
Growth: Increase in physical size.
Development: Sequential process of gaining various skills and abilities.
PHYSICAL GROWTH
Weight:
Average at birth: 7.5 lbs.
Expected loss: 5-10% in the first week.
Regain birth weight by 7-10 days.
Gains approximately 1 oz or 30g per day.
Double birth weight by 4-5 months, triple by 12 months.
Length:
Average at birth: 50 cm (20 in).
Quicker growth in the first 6 months than the second 6 months.
50% increase in length in the first year.
Head Circumference:
Average at birth: 35 cm (13.5 in).
Increases by 10 cm by 12 months.
More rapid growth in first 6 months.
PHYSIOLOGIC CHANGES
NEUROLOGIC SYSTEM
States of Consciousness:
Deep sleep: Eyes closed, no movement.
Light sleep: Eyes closed, rapid eye movement, irregular body movements.
Drowsiness: Eyes closed or half-lidded.
Quiet alert state: Eyes wide open, body relaxed.
Active alert state: Eyes open, body moving.
Crying: Cries or screams; difficult to get infant’s attention.
Brain Growth:
At 6 months: Weighs ½ of adult brain.
At 12 months: 2.5 times heavier than at birth.
Anterior fontanel closes typically by 12-18 months; can close as early as 9 months.
Reflexes steadily replaced by purposeful movements.
RESPIRATORY SYSTEM
Respiratory Rate:
Newborn: 30-60 breaths/min.
12 months: 20-30 breaths/min.
Rhythm:
Newborn: Irregular with periodic pauses.
12 months: More regular and rhythmic.
Anatomic Differences:
Narrower nasal passages, compliant trachea, shorter bronchi/bronchioles, funnel-shaped larynx, larger tongue, fewer alveoli.
CARDIOVASCULAR SYSTEM
Heart Rate:
Newborn: 120-140 beats/min.
12 months: 100 beats/min.
Blood Pressure:
Newborn: 60/40.
12 months: 100/50.
Thermoregulation:
More difficult in newborns, normalizes by 12 months.
Peripheral capillaries closer to surface.
GASTROINTESTINAL SYSTEM
Teeth Development:
First tooth usually around 6-8 months.
By 12 months: 4-8 teeth present.
Stomach Capacity:
At birth: 0.5-1 oz.
By 12 months: capable of 3 meals plus snacks.
Stool Characteristics:
Meconium: Dark green to black, sticky.
Formula-fed: Peanut butter consistency.
Breastfed: More liquid and “seedy.”
Newborns: 8-10 stools/day.
INTEGUMENTARY SYSTEM
Acrocyanosis:
Blueness of hands and feet in light-skinned infants; blueness in soles of feet and palms in dark-skinned infants.
Mottling:
Pink-white marbling appearance in light-skinned infants; more difficult to distinguish in dark-skinned infants.
GENITOURINARY SYSTEM
Susceptible to dehydration and electrolyte imbalances.
HEMATOPOIETIC SYSTEM
Iron stores derived from mother's iron supply, can become iron deficient between 6-9 months.
IMMUNE SYSTEM
IgG from the placenta provides coverage for antigens for 3-6 months post-birth.
DEVELOPMENTAL THEORIES
Psychosocial Development (Erikson):
Trust vs. Mistrust (Birth to 1 year).
Caregivers respond consistently to needs (feeding, diaper changes, etc.) leading to trust.
Cognitive Development (Piaget):
Sensorimotor (Birth to 2 years).
Uses senses and motor skills to learn about the world.
Includes object permanence and imitation of caregivers.
MOTOR SKILL DEVELOPMENT
Cephalocaudal Development: Head control → rolling over → sitting → crawling → pulling to stand → walking.
Proximodistal Development: Bats with whole hand → grasps with whole hand → grasps with fingers.
SENSORY DEVELOPMENT
Vision: Nearsighted, prefers viewing distance of 20-38 cm (8-15 in), recognizes faces by 1 month, and develops full color and distance vision by 7 months.
Hearing: Intact at birth, recognizes voices by 1 month.
Smell: Differentiates mother's breastmilk from others by day 7; prefers sweet tastes.
Touch: Holds, strokes, rocks, and cuddles influence sensory development.
COMMUNICATION AND LANGUAGE DEVELOPMENT
Crying: Most basic form of communication.
Milestones:
2 months: Coos, reacts to sounds, has different cries.
4-5 months: Laughs, makes vowel sounds.
6 months: Blows raspberries, squeals.
9 months: Babbles, raises arms.
9-12 months: Attaches meaning to words like “mama” and “dada.”
12 months: Babbling with inflection mimicking spoken language.
Importance of talking to infants through reading and storytelling.
SOCIAL AND EMOTIONAL DEVELOPMENT
Stranger Anxiety: Begins around 9 months, causing clinginess and whining.
Separation Anxiety: Develops later and indicates cognitive maturation.
Temperament: Inborn traits influencing interactions with the world.
PROMOTING HEALTHY GROWTH AND DEVELOPMENT
Growth through Play: Critical for learning.
Safety: Emphasis on safety in the home, car, and water.
Nutrition: Importance of a balanced diet.
Sleep: Adequate rest is essential for growth.
Healthy Teeth and Gums: Starting dental hygiene early.
Discipline: Appropriate techniques for development.
COMMON DEVELOPMENTAL CONCERNS
Colic: Excessive crying.
Spitting Up: Normal in infants.
Thumb-sucking and Pacifiers: Manage but don’t prohibit completely.
Teething: Normal developmental phase.
Use of security items: Considerations for emotional support.
CHAPTER 26: TODDLERS
OVERVIEW
Age range: 1-3 years.
Characterized by finer motor skills, continued cognitive growth, and appropriate language skills.
PHYSICAL GROWTH
Slower growth compared to infancy with growth spurts.
Average weight gain: 1.36-2.27 kg (3-5 lbs) per year.
Average height gain: 7.62 cm (3 in) per year.
Anterior fontanel typically closes by 18 months.
Typical Appearance: Rounded abdomen, slight swayback, wide-based stance.
PHYSIOLOGIC CHANGES
NEUROLOGIC SYSTEM
Myelination progresses and is completed by 24 months, leading to improved coordination.
Improved sphincter control indicates readiness for potty-training.
Respiratory System: Increased number of alveoli, larger tongue, and susceptible to ear infections due to eustachian tube's size.
CARDIOVASCULAR SYSTEM
Decrease in heart rate with an increase in blood pressure as the toddler grows.
GASTROINTESTINAL SYSTEM
Bowel control typically achieved by the end of toddlerhood.
GENITOURINARY SYSTEM
Short urethra in males and females, leading to increased susceptibility to UTIs.
MUSCULOSKELETAL SYSTEM
Appearance may include weak abdominal muscles leading to pot-belly and swayback appearance.
DEVELOPMENTAL THEORIES
Psychosocial Development (Erikson): Autonomy vs. Shame and Doubt (1-3 years).
Achieving independence, imitating adults, spontaneous affection, inability to take turns.
Cognitive Development (Piaget): Sensorimotor stage; differentiation from objects, thinking before acting.
MOTOR SKILL DEVELOPMENT
Gross Motor Skills: Rough toddler gait improves over 6 months; includes running, jumping, climbing up stairs.
Fine Motor Skills: Involves holding utensils, puzzle assembly, crafting.
SENSORY DEVELOPMENT
Vision: 20/40 to 20/50 accuracy develops.
Hearing: Matures significantly.
Taste and Touch: Preferences develop for comforting foods; exploring textures.
COMMUNICATION AND LANGUAGE DEVELOPMENT
Receptive Language: Understanding spoken language.
Expressive Language: Communicating desires and feelings.
Echolalia and Telegraphic Speech: Repeating words without understanding; using essential words only.
EMOTIONAL AND SOCIAL DEVELOPMENT
Separation and Individuation: Learning to exert control over their environment; focus on self (egocentrism).
Aggression: Behaviors such as hitting and biting are common with emotional lability.
MORAL AND SPIRITUAL DEVELOPMENT
Beginning to learn right from wrong; decision-making driven more by immediate consequences.
PROMOTING HEALTHY GROWTH AND DEVELOPMENT
Play: Essential for learning and social interaction.
Eating Habits: Promote nutritional balance.
Discipline: Establish boundaries in a caring manner.
Sleep and Rest: Importance of regular sleep structure.
Oral Hygiene: Encouragement for dental care.
COMMON DEVELOPMENTAL CONCERNS
Toilet Teaching: Readiness signs include regular bowel movements and interest in using the toilet.
Negativism: Avoid yes/no questions; provide options.
Temper Tantrums: Techniques to manage frustration and express emotions are crucial.
Thumb Sucking and Pacifiers: Set limits and maintain consistency.
Sibling Rivalry: Involvement in caregiving can help adjustment.
Regression: Backtracking in behavior during stressful times is normal; positive reinforcement is recommended.
CHAPTER 27: PRESCHOOLERS
OVERVIEW
Age range 3-6 years characterized by slower physical growth but substantial psychosocial, cognitive, and language development.
PHYSICAL GROWTH
Growth of 6.35-7.62 cm (2.5-3 in) per year.
Height at ages 3: 94 cm, 4: 102.9 cm, 5: 109.2 cm.
Weight gain of 1.8-2.3 kg (4-5 lbs) per year with loss of baby fat and increase in muscle mass.
SENSORY DEVELOPMENT
Remains intact since birth with enhanced development.
Taste and Vision: Color vision intact, vision needs screenings for impairments.
DEVELOPMENTAL THEORIES
Psychosocial Development (Erikson): Initiative vs. Guilt.
Desire to please, plan activities, feel guilt from wrong choices.
Cognitive Development (Piaget): Preoperational substage, learning through observation with short attention spans.
MORAL AND SPIRITUAL DEVELOPMENT
Kohlberg's Development: Focus on punishment-obedient orientation; good vs. bad judgments often based on consequences.
MOTOR SKILL DEVELOPMENT
Gross Motor Skills: Improved coordination in movement activities; may lead to occasional awkwardness during growth.
Fine Motor Skills: Ability to hold feeding utensils, draw, use scissors.
COMMUNICATION AND LANGUAGE DEVELOPMENT
Critical development period with significant vocabulary expansion from 50-100 words by age 2 to over 2,000 words by age 5.
Fluency: Opportunities for adult language use modeled by parents will benefit language development.
EMOTIONAL AND SOCIAL DEVELOPMENT
Friendships: Begins to form peer relationships and understand emotions.
Temperament: Individual differences influence interactions.
Fears: Common fears include fear of the dark, strangers; importance of offering security and comfort.
PROMOTING HEALTHY GROWTH AND DEVELOPMENT
Play: Encouragement of activities conducive to learning.
Nutritional Needs: Maintaining a balanced diet as children become more selective.
Healthy Teeth and Discipline: Establishing the basis for long-term health and well-being.
COMMON DEVELOPMENTAL CONCERNS
Addressing Topics: Lying and sexual education in age-appropriate ways.
CHAPTER 28: SCHOOL-AGE CHILDREN
OVERVIEW
Ages 6-12 years marked by slower physical growth intertwined with robust social and developmental growth.
Common growth patterns observe 6-7 cm (2-2.5 inches) per year, weight increase of 2-3 kg (4-7 lb) per year.
Gender Differences: Early similarities in size; later school-age years show females surpassing males in size.
PHYSIOLOGIC CHANGES
NEUROLOGIC SYSTEM
Growth in facial bones leads to noticeable changes.
Respiratory System: Fewer respiratory infections and more mature lung function.
CARDIOVASCULAR SYSTEM
Increased blood pressure and overall change in heart rates.
MUSCULOSKELETAL SYSTEM
Increased strength and coordination; muscular changes during hormonal development.
DEVELOPMENTAL THEORIES
Psychosocial Development (Erikson): Industry vs. Inferiority; nurturing self-esteem through successes.
Cognitive Development (Piaget): Concrete operational stage; understanding perspectives, thinking about consequences.
MOTOR SKILL DEVELOPMENT
Enhanced gross motor skills allow participation in various physical activities; continued improvement in fine motor skills.
COMMUNICATION AND LANGUAGE DEVELOPMENT
Growth in reading abilities and understanding of complex grammatical structures.
EMOTIONAL AND SOCIAL DEVELOPMENT
Importance of peer relationships, influences from teachers, and family dynamics play a critical role.
Development of self-esteem and body image relevant to interactions.
PROMOTING HEALTHY GROWTH AND DEVELOPMENT
Emphasis on established safety standards to protect school-age children in various environments.
COMMON DEVELOPMENTAL CONCERNS
Topics including screen time, school refusal, and managing behavioral issues through school-age years.
CHAPTER 29: ADOLESCENTS
OVERVIEW
Age range: 11-20 years characterized by drastic changes in various developmental areas.
Involvement in risk-taking behaviors: e.g., drinking, drug use, sexual activities.
PHYSIOLOGIC CHANGES ASSOCIATED WITH PUBERTY
FEMALES
Increased estrogen leads to breast tissue development, pubic hair growth, and menarche (first menstruation).
MALES
Increased testosterone sparks changes in genitalia, hair growth, and muscular development.
GENERAL CHANGES
Continued brain growth; changes in cardiovascular and respiratory systems, including deepening voice in males.
DEVELOPMENTAL THEORIES
Psychosocial Development (Erikson): Identity vs. Role Confusion; assertive independence leads to boundary testing and body image adjustment.
Cognitive Development (Piaget): Evaluating morals and developing personal moral standards.
MOTOR SKILL DEVELOPMENT
Improvement in endurance; increased fine motor skills and hand-dexterity.
COMMUNICATION AND LANGUAGE DEVELOPMENT
Use of slang complicates communication, increased proficiency akin to adults.
EMOTIONAL AND SOCIAL DEVELOPMENT
Focus on peer importance, relationships with parents, self-concept, and sexual identity defining experiences.
PROMOTING HEALTHY GROWTH AND DEVELOPMENT
Emphasis on safety during emerging independence, especially in areas like sports and potential risk behaviors.
COMMON DEVELOPMENTAL CONCERNS
Substance use and violence require attention for healthy adolescent development.
VACCINES
Comprehensive immunization recommendations listed for children from birth to 6 years and adolescents from ages 7 to 18 years.
Clear guidelines are provided for various vaccines including Hepatitis B, DTaP, IPV, MMR, and HPV, with a reference to managing health risks associated with delays or refusals in vaccinations.