Infancy & Early Childhood Development Vocabulary (3)

Normal Language & Speech Development (Early Childhood)

• Age 1 yr

  • Language

  • Says 2–3 meaningful words

  • Imitates animal sounds

  • Speech

  • Omits most final & some initial consonants

  • Substitutes easy consonants (m, w, p, b, k, g, n, t, d, h)

  • Peak of unintelligible jargon ≈ 18 mo

  • Intelligibility: ≤ 25\% to unfamiliar listener

• Age 2 yr

  • Language

  • Uses 2–3-word phrases in context

  • Vocabulary ≈ 300 words; uses “I,” “me,” “you”

  • Speech

  • Uses consonants m, w, p, b, k, g, n, t, d, h with vowels— inconsistent & heavily substituted

  • Omits most final consonants; articulation lags behind vocabulary

  • Intelligibility: ≈ 65\% in context

• Age 3 yr

  • Language

  • Says 4–5-word sentences

  • Vocabulary ≈ 900 words

  • Begins using who, what, where; adds plurals, pronouns, prepositions

  • Speech

  • Masters b, t, d, k, g; r & l may remain unclear

  • Repetitions & hesitations common

  • Intelligibility: 70–80\% clear

• Age 4–5 yr

  • Language

  • Vocabulary 1500–2100 words

  • Correctly uses most grammatical forms (e.g., past tense with “yesterday”)

  • Speaks in complete sentences; comprehends if, because, why

  • Speech

  • Masters f & v; may distort r, l, s, z, sh, ch, y, th

  • Little/no omission of initial or final consonants

  • Intelligibility: speech totally intelligible though still imperfect

• Age 6–7 yr

  • Language: vocabulary ≈ 3000 words

  • Speech

  • Masters r, l, th; may still distort s, z, sh, ch, j until 7–8 yr

  • Speech totally intelligible

Physical Growth & Vital Signs (Infancy)

• Weight

  • Maintains ample subcutaneous fat in first 8 mo (insulation & energy reserve)

  • After 8 mo weight gain becomes predominantly bone & muscle

• Length/Height

  • Increases ≈ 1 inch (2.54\,\text{cm}) / month for first 6 mo

  • By 12 mo, length ↑ ≈ 50\% of birth length → typical 30 in (75 cm)

• Vital signs

  • Apical HR at 2 mo ≈ 120\,\text{beats\/min} (count full minute; note rhythm/volume)

  • Respirations decline with age; resting RR at 12 mo ≈ 30\,\text{breaths\/min}

  • BP rises gradually to ≈ 90\/60\,\text{mm Hg} by 12 mo

Dentition & Oral Health

• Teething begins 5–6 mo

  • Prodromal signs (3–4 wk prior): irritability, swollen red gums, drooling, stool changes

• Primary dentition schedule (Box 24.7)

  • 6 mo: lower central incisors

  • 7 mo: upper central incisors

  • 9 mo: upper lateral incisors

  • 11 mo: lower lateral incisors

  • 12 mo: 6–8 teeth total

  • 24 mo: ≈16 teeth

  • 30 mo: full set 20 deciduous teeth

• Care

  • Offer sips of water; wipe & massage gums

  • First dental visit when first tooth erupts or by 1st birthday

  • Begin tooth-brushing with eruption; use fluoride toothpaste if water non-fluoridated

  • Prevent bottle-mouth syndrome – only water in night bottle; never prop bottles; hold infant during feeds

Cognitive & Psychosocial Development

• Erikson: Basic Trust vs Mistrust

  • Responsive care → trust; unmet needs → mistrust & dissatisfaction

• Piaget: Sensorimotor Stage (0–24 mo)

  • Knowledge via sensory impressions & motor acts

  • Builds schemas, assimilates & accommodates new information

  • 1–4 mo: tracks objects with eyes & ears

  • 4–8 mo: begins recognition & imitation; improved reaching & grasping; binocular vision matures

  • By 8 mo: develops separation anxiety; shyness & stranger fear emerge

  • By 9 mo: alarmed by strangers

Nutrition Guidelines (Birth-12 mo)

• Breast milk or iron-fortified formula sole nutrition until ≈6 mo

  • AAP: exclusive breast-feeding first 6 mo; continue through 12 mo or longer while adding solids

• Feeding pattern

  • On-demand; may be every 2 hr early on

  • Initial breast-feeds: 10–15 min/side → adjust per infant cues

  • Adequacy indicators

  • ≥ 4–6 wet diapers/day by day 4

  • ≥ 2–3 seedy stools/day (breast-fed)

  • Signs under-feeding: fussiness, poor wt gain, skin wrinkling

  • Signs over-feeding: post-feed vomiting, frequent watery stools

• Iron

  • Full-term stores last 5–6 mo → afterward supply via supplements or foods

• Foods to avoid < 6 mo: citrus, egg whites, wheat flour (high allergenicity)

Introducing Solid Foods

1. Wait until developmental readiness (head control, decreased tongue thrust, interest)

2. Offer one new food at a time; wait several days to observe for allergy

3. Sequence: iron-fortified cereals → fruits/vegetables → meats

4. Do not mix foods initially; foster taste recognition

5. Supervise at all times; high-risk choking foods: popcorn, grapes, raisins, hot dogs, chicken nuggets

6. No additional water first 4 mo; excess → water intoxication, hyponatremia

7. By 8–9 mo: mashed/junior foods; introduce finger foods for self-feeding

8. Begin gradual weaning ≈ 9 mo using training cup (replace one bottle at a time)

9. Family nutrition modeling: limit sodium, fat, sugar; emphasize fresh produce, lean protein, whole grains

Sleep Patterns & SIDS Prevention

• Sleep

  • Newborns sleep ≈ 18\/24 hr in short naps

  • By 3 mo: clearer nap/wake pattern

  • By 12 mo: ≈ 12 hr nocturnal sleep + one daytime nap

  • Persistent crying during usual sleep → assess for discomfort/illness

• Sudden Infant Death Syndrome (SIDS)

  • Peak incidence 2–3 mo

  • Prevention (“Back to Sleep”):

  1. Supine sleep position

  2. Smoke-free environment (during & after pregnancy)

  3. Firm mattress; no soft bedding/pillows

  4. Good ventilation & comfortable room temp

  5. Breast-feed

  6. Regular pediatric visits & immunizations

  7. Pacifier during sleep

  8. No bed wedges

Motor Development Milestones

• Head control

  • 2 mo: lifts head in prone

  • 4 mo: holds head 90^{\circ} in prone

  • 6 mo: balances head well

• Sitting

  • 7 mo: sits without support

• Locomotion

  • 7 mo: may crawl (abdomen on floor)

  • 9 mo: creeps (hands & knees)

  • 8–15 mo: pulls to stand, cruises, walks with support → independent steps (often first deliberate step ≈ 10 mo)

• Encourage natural progression; avoid premature propping or forced walking

Play & Stimulation

• Type: Sensorimotor / Solitary play (plays alone)

• Early toys: turning mobiles, mirrors, brightly colored shapes, varied textures

• As grasp improves: rattles, soft blocks, chewable shapes

• Late infancy: stacking toys, simple puzzles, nesting cups, musical toys

• Provide safe open space for kicking, rolling, crawling; guard against injury

Safety & Accident Prevention

Accidents = leading cause of injury/death in infancy & early childhood.

• General Rules

  • Never leave infant unattended on elevated surface, high chair, stroller, walker, bath, etc.

  • Keep crib sides up; mattress at lowest level; cribs must meet US CPSC spacing standards

  • Secure stairways & windows; install guards/gates

  • Remove plastic bags, long strings; use one-piece pacifiers

  • Cover electrical outlets; tuck away cords

  • No balloons, small detachable toy parts, hard candies, nuts, popcorn

  • Lock medicines, cleaning agents, plants, rat poison away; have poison-control number visible

  • Test formula/food temperature; turn pot handles inward; remove stove knobs within child’s reach

  • No hot drinks while holding infant; flame-retardant sleepwear; smoke-free zone

  • Use safety seats/restraints every vehicle trip; rear-facing until guidelines met

  • Teach early about strangers, private body parts, calling 9-1-1, street safety (as development permits)

Developmental Tasks of Infancy (Box 24.8)

• Establishes trusting, meaningful caregiver relationships

• Recognizes & attaches to primary caregiver

• Learns object recognition & cause–effect through exploration

• Begins communication: vocalization, non-verbal cues, imitation

• Develops muscle control, eye–hand coordination, object manipulation

• Gains mobility: crawling → creeping → cruising → walking

• Establishes routines: eating, sleeping, elimination

• Initiates independence: self-feeding, undressing, expressing needs

Toddler Period (1–3 Years)

Physical Characteristics

• Growth rate slows yet follows cephalocaudal & proximodistal patterns

• Shift from infant chubbiness to more elongated, upright stance

  • Early toddler: top-heavy; exaggerated lumbar lordosis & protruding abdomen (“potbelly”)

  • By late toddlerhood: extremity growth catches up; appearance proportionate (Fig 24.5)

• All 20 deciduous teeth present by 2.5 yr → begin routine dental exams & daily brushing

Vital Signs

• Pulse: 90–120\,\text{beats\/min}

• Respiration: 20–30\,\text{breaths\/min}

• BP: 80–100\/64\,\text{mm Hg} (systolic/diastolic)

• Temperature: 98–99^{\circ}\text{F} ( 36.6–37.2^{\circ}\text{C} )

Neuromuscular & Gross-Motor Skills

• 12–15 mo: walks independently

• 2 yr: climbs stairs with assistance; runs more confidently

• 3 yr: hops; broader running, climbing, jumping repertoire

Ongoing Safety Needs

• Continue and expand infant safety measures: cabinet locks, stair gates, helmet use, street & water safety, supervised play with pets, avoidance of choking hazards