Developmental Stages - Infant to Adolescent

Infant (Birth through 12 months)

A. Physical Tasks
Birth to 1 month
 no control of muscles of the head
 behavior is reflex controlled
 flexed extremities
 can lift head slightly off bed when prone
 differentiates light and dark at birth
 rapidly develops clarity of vision within 1 foot
 fixates on moving objects
 strabismus due to lack of binocular vision
1 – 4 months
 posterior fontanel closes
 gain head control; balances head in sitting position
 rolls from back to side
 begins voluntary hand-to-mouth activity
 locates sounds by turning head and visually searching
 binocular vision developing; less strabismus
 beginning hand-eye coordination
 prefers human face
 follows objects 180°
5 – 6 months
 Birth weight doubles
 Eruption of teeth begins
- enzyme release with teething causes mild diarrhea
- causes increase saliva and drooling
- slight fever may be associated with teething
 Intentional rolling over
 Supports weight on arms
 Creeping; pushes backward with hands
 Can grasps and let go voluntarily
 Transfers toys from one hand to another
 Sits with support
 Smiles at own mirror image and responds to facial expressions of others
 Sucking needs have decreased and cup weaning can begin; chewing, biting, and taste preferences begin to
develop
7 – 9 months
 Teething continues
 Sits unsupported; goes from prone to sitting upright
 Crawls; may go backwards initially
 Pulls self to standing position
 Develops finger-thumb opposition
 Preference for dominant hand evident
 Can fixate on small objects
10-12 months
 Birth weight tripled
 Creeps with abdomen off floor
 Walks with help
 May attempt to stand alone
 Can sit down from upright position
 Weans from bottle to cup
 Able to discriminate simple geometric form
 Able to follow rapidly moving objects
 Visual acuity 20/50 or better
B. Psychosocial Tasks
Neonatal Period
 Cries to express displeasure
 Smiles indiscriminately
 Receives gratification through sucking
1 – 4 months
 Crying ceases when parent in view
 Coos, babbles, laughs; vocalizes when smiling
 Squeals to show pleasure at 3 months
 Stares at parents’ faces when talking at 1 month
 Smiles socially at 2 months
 Shows excitement when happy at 4 months

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  Demands attention, enjoys social interaction with people at 4 months.
5 – 6 months
 Begins to imitate sounds
 Recognizes parents, stranger anxiety begins to develop
7 – 9 months
 Verbalizes all vowels and most consonants
 Shows increased stranger anxiety and anxiety over separation from parent
 Exhibits aggressiveness by biting at times
 Understands the word “no”
10 – 12 months
 Imitates animal sounds, can say 4-5 words “mama”, “dada”
 Begins to explore surroundings
 Plays peek-a-boo
 Shows emotions such as jealousy, affection, anger and fear
C. Cognitive Tasks
Neonatal period: reflexive behavior only
1 – 4 months
 Recognizes familiar faces
 Is interested in surroundings
 Discovers own body parts
5 – 6 months
 Begins to imitate
 Can find partially hidden objects
7 – 9 months
 Begins to understand object permanence; searches for dropped objects
 Reacts to adult anger; cries when scolded
 Imitates simple acts and noises
 Responds to simple commands
10 – 12 months
 Recognizes objects by name
 Looks at and follows pictures in book
 Shows more goal-directed actions
Nutrition
Birth to 6 months
 Breast milk is a complete and healthful diet
 No solid foods before 5 months; too early exposure may lead to food allergies
 Juices may be introduced at 5-6 months, diluted 1:1 and preferably given by cup
6 – 12 months
 Breast milk or formula continues to be primary source of nutrition
 Introduction of solid foods starts with cereal, which is continued until 18 months
 Introduction of other food is arbitrary; most common sequence is fruits, vegetables and meats
 Introduce one new food a week
 Decrease amount of formula to about 30 oz as foods are added
 Fingers foods such as cheese, meat, carrots can be started
 Chopped table food can be introduced by 12 months
 Weaning from breast or bottle to cup should be gradual during second 6 months
Safety
Birth to 4 months
 Use car seat properly
 Ensure crib mattress fits snugly
 Keep side rails of crib up
 Do not leave infant unattended on bed, couch, table
 Do not tie pacifier on string around infant’s neck; remove bib before sleep
 Remove small objects that infant could choke on
 Check temperature of bath water and warmed formula or food
5 – 7 months
 Restrain in high chair or infant seat
 Do not feed hard candy, nuts, foods with pits
 Inspect toys for small removable parts
 Be sure paint on furniture does not contain lead
8 – 12 months
 Keep crib away from other furniture or windows
 Keep gates across stairways
 Keep safety plugs in electrical outlets
 Remove hanging electrical wires and tablecloths
 Use child protective caps and cabinet locks
 Place cleaning solutions and medications out of reach
 Do not let child use fork to self-feed

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  Do not leave alone in bathtub
Play (Solitary)
Birth to 4 months
 Provide variety of brightly colored objects, different sizes and textures
 Hang mobiles within 8-10 inches of infant’s face
 Expose to various environmental sounds; use rattles, musical toys
5 – 7 months
 Provide brightly colored toys to hold and squeeze
 Allow infant to splash in bath
 Provide crib mirror
8 – 12 months
 Provide toys with movable parts and noisemakers; stack toys, blocks; pots, pans, drums to bang on; walker and
push-pull toys
 Plays games; hide and seek
Fears : Stranger Anxiety
 Separation from parents
 Searches for parents with eyes
 Shows preference for parents
 Develops stranger anxiety around 6 months

Toddler ( 12 months to 3 years)

A. Physical Tasks: this is a period of slow growth
 Primary dentition (20 teeth) complete by 2½ years.
 Develops sphincter control necessary for bowel and bladder control.
 Mobility
- Walks alone by 18 months
- Climbs stairs and furniture by 18 months.
- Runs fairly well by 2 years.
- Jumps from chair or step by 2½ years.
- Balances on one foot momentarily by 2½ years.
- Rides tricycle by 3 years.
B. Psychosocial tasks
 Increases independence; better able to tolerate separation from primary caregiver.
 Less likely to fear strangers.
 Able to help with dressing/undressing at 18 months; dresses self at 24 months.
 May have temper tantrums during this period; should decrease by 2½ years.
 Vocabulary increases from about 10 to 20 words to over 900 words by 3 years.
 Has beginning awareness of ownership (my, mine) at 18 months; shows proper use of pronouns (I, me, you)
by 3 years.
 Moves from hoarding and possessiveness at 18 months to sharing with peers by 3 years.
 Toilet training usually completed by 3 years.
a. 18 months: bowel control
b. 2-3 years: daytime bladder control
c. 3-4 years: nighttime bladder control
C. Cognitive tasks
 Follows simple directions by 2 years.
 Begins to use simple sentences at 18 months to 2 years.
 Can remember and repeat 3 numbers by 3 years.
 Knows own name by 12 months; refers to self, gives first name by 24 months; gives full name by 3 years.
 Able to identify geometric forms by 18 months.
 Achieves object permanence; is aware that objects exists even if not in view.
 Uses “magical” thinking; believes own feelings affect events (e.g. anger causes rain).
 Uses ritualistic behavior; repeats skills to master them and to decrease anxiety.
 May develop dependency on “transitional object” such as blanket or stuffed animal.

Nutrition
 Increased need for calcium, iron, and phosphorous.
 Needs 16-24 oz milk/day.
 Appetite decreases.
 Able to feed self.
 Negativism may interfere with eating.
 Initial dental examination at 3 years.
Safety
 Turn pot handles toward back of stove.
 Teach swimming and water safety; supervise near water.
 Supervise play outdoors.
 Avoid large chunks of meal, particularly hotdogs.
 Do not allow child to walk around objects such as lollipops in mouth.

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  Know how to use ipecac.
 Use car seats properly. Children greater than 9 kg (20 lbs) should be in a forward-facing position in the back
seat of the car.
Play : Parallel Play
 Imitation of adults often part of play.
 Begins imaginative and make-believe play.
 Provide toys appropriate for increased locomotive skills: push toys, rocking horse, riding toys or tricycles;
swings and slide.
 Give toys to provide outlet for aggressive feelings: work bench, toy hammer and nails, drums, pots, pans.
 Provide toys to help develop fine motor skills, problem-solving abilities: puzzles, blocks, finger paints,
crayons.
Fears: Separation Anxiety
 Learning to tolerate and master brief periods of separation is important developmental task.
 Increased understanding of object permanence helps toddler overcome his fear.
 Potential patterns of response to separation
a. Protest: screams and cries when mother leaves; attempts to call her back.
b. Despair: whimpers, clutches traditional object, curls up in bed, decreased activity
c. Denial: resumes normal activity but does not form psychosocial relationships; when
mother returns, child ignores her

Preschooler ( 3 to 5 years)
A. Physical Tasks
 Slower growth continues
 Walks up stairs using alternate feet by 3 years
 Walks down stairs using alternate feet by 4 years
 Rides tricycle by 3 years
 Stands on 1 foot by 3 years
 Hops on 1 foot by 4 years
 Skips and hops on alternate feet by 5 years
 Balances on 1 foot with eyes closed by 5 years
 Throws and catches ball by 5 years
 Jumps off 1 step by 3 years
 Jumps rope by 5 years
 Hand dominance is established by 5 years
 Builds a tower of blocks by 3 years
 Ties shoes by 5 years
 Ability to draw changes over time
- copies circles, may add facial features by 3 years
- copies a square, traces a diamond by 4 years
- copies a diamond and triangle, prints letters and numbers by 5 years
 Handles scissors well by 5 years
B. Psychosocial Tasks
 Becomes independent
- feeds self completely
- dresses self
 Aggressiveness and impatience peak at 4 years
 By 5 years, child is eager to please and manners become more evident
 Gender-specific behavior is evident by 5 years
 Egocentricity changes to awareness of others; rules become important; understands sharing
C. Cognitive Development
 Focuses on one idea at a time; cannot look at entire perspective
 Awareness of racial and sexual differences begins
- manifests sexual curiosity
- sexual education begins
- beginning body awareness
 Has beginning concept of causality
 Understanding of time develops during this period
- learns sequence of daily events
 Has 2000-word vocabulary by 5 years
 Can name 4 or more colors by 5 years
 Is very inquisitive
Nutrition
 May demonstrate strong taste preference
Safety
 Safety is similar to toddler
Play: Associative Play
 Enjoys imitative and dramatic play
- imitates same-sex role functions in play

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 - enjoys dressing up, dollhouses, trucks, cars, telephones, doctor and nurse kits
 Provide toys to encourage fine motor skills: tricycles, sandbox
 Provide toys to encourage fine motor cells, self-expression, and cognitive development: construction set,
blocks, carpentry tools, flash cards, illustrated books, puzzles, paints, crayons, clay, simple sewing kits
 Television can provide a quiet activity
 Imaginary playmates common during this period
Fears
 Fears concerning body integrity are common
 Magical thinking allows children to develop many illogical fears (fear of inanimate objects, the dark, ghosts)

School-age ( 6 to 12 years)
A. Physical Tasks
 Slow growth continues
 Loses first primary teeth at about 6 years
 Bone growth faster than muscle and ligament development
 Vision is completely mature
 Children are very energetic , develop greater strength and stamina
B. Psychosocial tasks
 School occupies half of waking hours
 Morality develops
 Peer relationships
 Enjoys family activities
 Has some ability to evaluate own strengths and weaknesses
 Has increased self-direction
 Is aware of own body; compares self to others; modesty develops
C. Cognitive Development
 Period of industry
- is interested in exploration and adventure
- likes to accomplish or produce
- develops confidence
 Concept of time and space develops
- understands and causality
- masters concept of conservation: permanence of mass and volume; concept of reversibility
 Develops classification skills: understands relational terms; may collect things.
 Masters arithmetic and reading
Nutrition
 “Junk” food may become a problem; excess sugar, starches, fat
 Obesity is a risk in this group age
 Nutrition education should be integrated into school program
Safety
 Incidence of accidents is decreased when compared with younger children
 Motor vehicle accidents most common cause of severe injury and death
 Other common activities associated with injuries include sports (skateboarding, roller skating)
 Education and supervision are key elements in prevention
Play: Cooperative Play
 Team play: games or sports
- help learn value of individual skills and team accomplishments
- help learn nature of competition
 Quiet games and activities: board games, collections, books, television, painting
 Athletic activities: swimming, hiking, bicycling, skating
Fears
 More realistic fears than younger children; include death, disease or bodily injury, punishment; school phobia
may develop, resulting in psychosomatic illness.

Adolescent ( 12 to 18 years)
A. Physical Tasks
 Fast period of growth
 Puberty
- is related to hormonal changes
- results in growth spurt, change in body structure, development of secondary sex characteristics, and
reproductive maturity
 Girls: height increases approximately 3 inches/year; slows at menarche; stops around age 16.
 Boys: growth spurts spurt starts around age 13; height increases 4 inches/year; slows in late teens.
B. Psychosocial Tasks
Early adolescence ( 12-13 years)
 Starts with puberty
 Physical body changes result in altered self-concept
 Tends to compare own body to others

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  Early and late developers have anxiety regarding fear of rejection
 Fantasy life, daydreams, crushes are all normal, help in role play of varying social situations
 Is prone to mood swings
 Needs limits and consistent discipline
Middle adolescence ( 14-16 years)
 Can identify own values
 Can define self (self concept, strengths and weaknesses)
 Partakes in peer group; conforms to values
 Has increased heterosexual interest; communicates with opposite sex; may form “love” relationship
 Sex education continues
Late adolescence ( 17 – 19 years)
 Achieves greater independence
 Chooses a vocation
 Participates in society
 Finds an identity
 Finds a mate
 Develops own morality
 Completes physical and emotional maturity
C. Cognitive Development
 Develops abstract thinking abilities
 Is often unrealistic
 Is capable of scientific reasoning and formal logic
 Enjoys intellectual abilities
 Is able to view problems comprehensively

Nutrition
 Nutritional requirements peak during years of maximum growth: age 10-12 in girls, 2 years later in boys
 Appetite increases
 Inadequate diet can retard growth and delay sexual maturation
 Food intake needs to be balanced with energy expenditure
 Increased needs include calcium for skeletal growth; iron for increased muscle mass and blood cell
development; zinc for development of skeletal and muscle tissue and sexual maturation.
Safety
 Accidents are leading cause of death: motor vehicle accidents, sports injuries, firearms accidents
 Safety measures include education about proper use of equipment and caution concerning risk taking
 Drug and alcohol use may be a serious problem during this period

Activities
 Group activities predominate (sports are important); activities involving opposite sex by middle adolescence
Fears
 Threats to body image: acne, obesity, homosexuality
 Injury or death
 The unknown