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1. Normal growth and development encompasses all of the changes that occur from the moment conception takes place until a child reaches adulthood. For most of pregnancy, an embryo or fetus is unable to survive outside the mother’s body. At birth, infants have many organ systems functioning, such as the cardiovascular, respiratory and digestive systems, but cannot survive on their own. Throughout childhood, enormous physical, emotional, cognitive and behavioural changes occur as babies go from being dependent on their parents for all of their needs to becoming independent adolescents, capable of functioning alone and reproducing themselves. A child’s growth and development can be divided into the following stages: prenatal, infancy, early childhood, middle childhood and adolescence. To support healthy growth and development throughout childhood and in later years, proper nutrition, adequate rest and physical activity are essential. However, among the most important things parents and other caring adults can do as children grow and develop is to provide them with plenty of attention and unconditional support at every stage of their development. Normal growth and development encompasses all of the changes that occur from the moment conception takes place until a child passes through adolescence and reaches adulthood. Throughout this timeframe, vast physical, emotional, cognitive and behavioural changes occur as babies grow and gradually learn to process and interact with their environment. Most children develop at similar stages, reaching similar milestones within a few months of each other. It is normal for healthy children to grow and develop at their own pace. However, parents should notify their child’s physician if a child displays signs of possible developmental delays while growing up. These can include, but are not limited to failure to thrive, not being able to walk by age 18 months or not being able to read by age eight. To promote health and development from the start, pregnant women should receive prenatal care. Research suggests that women who see an obstetrician-gynaecologist (a physician who specializes in the female reproductive system and childbirth) regularly during pregnancy have healthier babies, are less likely to deliver prematurely, and are less likely to have other serious problems related to pregnancy.
Following birth, all the stages of childhood development can be monitored when children receive regular checkups with a physician, preferably a paediatrician. Regular contact with a paediatrician can also help monitor a child’s development and note any problem areas. Children should have regular well-child visits, during which the paediatrician can ask the parents if the child has met certain milestones for each stage of development. To support healthy growth and development throughout childhood proper nutrition, adequate rest and physical activity are essential. Play is another important component of childhood development. It can help spur a child’s emotional, cognitive and social/motor development. Through various play activities, children can learn basic concepts and ideas, communication and socialization techniques, and physical skills.
In addition, among the most important things parents and other caring adults can do as children grow and develop is to provide them with attention and unconditional support at every stage of their development. Each part of a child’s life involves large changes in development. Each stage has particular developmental milestones associated with it. 1. Prenatal development encompasses the 40 weeks of pregnancy. After conception, a zygote forms that rapidly changes into a blastocyte, embryo and finally a fetus. Every week of a woman’s pregnancy, the developing infant undergoes great changes as the body forms and takes shape. During the first three months (trimester) of pregnancy, the most dramatic changes occur. A ball of cells divides into three different types of tissue, which eventually divide to form the different body parts and organ systems. By the end of the first trimester, the fetus has the general appearance of a baby, with head, arms, legs and functioning organ systems. Many problems that eventually become birth defects begin with malformations in the first trimester. For example, neural tube defects occur when the spinal cord fails to close properly. It may cause spina bifida or other more severe birth defects. Some abnormalities that occur are so severe that the pregnancy cannot be sustained and a miscarriage occurs. Other birth defects are the results of genetic defects, such as Down syndrome or muscular dystrophy. The mother’s actions during pregnancy may also affect the fetus, especially if she smokes, drinks alcohol or uses recreational drugs. Some birth defects can be identified and repaired in infancy. During the second and third trimesters of pregnancy, most development is related to growth, weight gain and the outer appearance of the fetus. Some problems during these later parts of pregnancy may result in premature birth. Babies born before full term may be healthy, but may also be at increased risk for problems such as respiratory trouble, cerebral palsy and developmental delays. Even premature infants born with no apparent problems will develop more slowly than their full-term counterparts. When gauging an infant’s milestones, parents should measure from the baby’s actual due date. For example, a child born one month prematurely should not be expected to meet six-month-old milestones until he or she is at least seven months old. The milestones of development during pregnancy are well defined. A woman’s obstetrician can monitor her progress throughout her pregnancy and can usually tell when certain milestones of weight or growth are not being met. Various prenatal tests may identify and rule out certain genetic problems. 2. Infancy development covers the period from birth to 12 months of age. During this stage, a baby will experience rapid changes, including physical growth and brain development. For example, the baby begins to breathe at birth, developing the respiratory system. The cardiac system has functioned during prenatal development, but changes occur in the heart after birth so that blood is oxygenated and transported throughout the body. Other than regular growth, physical changes include the fusing of the bones in the baby’s skull and the eruption of teeth in the first year. An infant’s brain also grows rapidly, as does the neural connections inside the brain. In the first year, infants develop greater acuity in their senses and begin to understand and use methods of communication like crying. From early on they recognize speech, especially their parents, and eventually can understand the meanings of some words, long before they can speak coherently. Babies can speak a few words by their first birthday. They also begin to recognize that things continue to exist even if they are out of sight. Infants also learn about social connections in their first year. They respond to their parents and other caregivers and learn to prefer their presence. They learn to smile, play and interact with others. By about the age of eight months, infants may develop separation anxiety when they are separated from their parents or primary caregivers. In addition to physical development of organs, babies have huge developmental changes in their motor skills, cognitive abilities and psychosocial connections during the first year of life. At birth, an infant has little control over its body parts. By the first birthday, infants can lift and control their heads and move their arms and legs. They can usually coordinate their limbs enough to roll over, crawl and pull themselves up. Some babies can walk at this stage, and those that cannot begin to do so in the next few months. 3. Early childhood development encompasses the period when children are from one to four years old. Huge changes also take place during this stage, as children change from tiny, dependent infants to children who can walk, talk and begin formal learning. Many of the changes associated with this stage involve movement (walking) and communication (talking). Most children learn to walk early in their second year of life. At such a time, greater vigilance is needed to care for them because they have the ability to reach more dangerous objects, but not the understanding to avoid them.
Communication also grows rapidly in early childhood. Children learn to speak in sentences and understand what is being said to them. The vocabulary grows to about 1,500 words by age four, and children learn some complexities of speech, such as the use of pronouns or the past tense. Likewise, they may use their newfound abilities to test their boundaries in the home. Toddlers learn to say “no” and may refuse to obey their parents or caregivers. Temper tantrums may begin during this period. As children grow toward school age, the likelihood of temper tantrums lessens. Children also learn to control their bodies during this stage. Most children begin toilet training somewhere before or near their third birthdays. The range differs for each child, but girls can usually be toilet trained earlier than boys. Almost all children have complete bowel and bladder control by the time they reach school age, although some children may have bedwetting problems. Developmental delays and other problems may become more obvious during early childhood. Learning disabilities may become noticeable if a child does not take an interest in learning and getting ready to read. Other developmental disorders such as Asperger’s syndrome and autism may also become evident if children have problems with communication, social interaction and behaviour. Monitoring a child’s development can help parents identify problems early and begin treating them early. 4.Middle childhood is the developmental period when children are ages five to 10 years old. During these years, children are more independent and physically active than they were during early childhood development. Physical changes mostly relate to growth in height and weight. Loss of primary teeth and the growth of permanent teeth also occur in these years. Formal education begins during these years and cognitive development continues with greater inputs from reading and learning. The fine motor skills improve in most children with a better ability to write. Learning problems that may not have been identified earlier may become more apparent in these middle childhood years. These include dyslexia and attention deficit hyperactivity disorder (ADHD). Muscular strength, eye-hand coordination and stamina continue to progress rapidly, allowing older children the ability to perform more complex tasks, such as riding a bicycle, dancing and playing sports or musical instruments. 5. Adolescence is the last major developmental stage from childhood to adulthood. It ranges from age 11 to 21. It is generally a time of self-discovery in which young people aim to define their place in the world. The first part of adolescence encompasses the physical changes associated with puberty, or sexual maturation. Children’s bodies begin to produce more hormones and physical changes occur. In both boys and girls, more hair grows on the body, including pubic hair, and for boys, hair on the face. For boys, hormonal changes also mean growth of the sexual organs, greater frequency of erections and the ability to ejaculate semen from the penis. For girls, breast tissue grows, the hips widen and the monthly blood loss of menstruation begins. After menstruation begins (menarche), a young woman is physically capable of becoming pregnant. The hormonal changes in both sexes are accompanied by greater sexual interest in other people. Teenagers may begin sexual behaviour during this time, which may expose them to the potential for unwanted pregnancies and sexually transmitted diseases. The physical maturity may not be matched by a similar emotional maturity to handle such changes. Many psychosocial changes are associated with adolescence. Teenagers may feel like they are adults but are not being treated as adults by their parents. Mood swings and emotional outbursts are common. They frequently test parental boundaries with risk-taking behaviours or general insolence. Some teenage rebellion is a normal part of growth. However, behaviours with serious consequences such as use of recreational drugs or alcohol and sexual recklessness can be a cause for concern. The emotional changes may be more serious for some teens, with thoughts of suicide or the potential for depression. Social changes in adolescence include greater activity and influences of peer groups. In later adolescence, most overt physical changes have been completed. Girls typically finish growing by about age 16 and boys by about age 18. Physical changes that occur after this time may be the same as in any adult, related to nutrition and exercise. Good foundations about a healthy diet and regular exercise help teens at this stage to maintain healthy bodies. During adolescent development, children complete puberty and physical growth. They also develop important social, emotional and intellectual skills, while striving towards independence.
You can give your three-year-old whole cow's milk, but remember that the American Academy of Pediatrics recommends that you begin to use low-fat milk once your child is 2 years old, so you might make the switch to low-fat milk if you haven't already. Common nutrition mistakes at this age include allowing your child to drink too much milk or juice so that she isn't hungry for solids, forcing your child to eat when she isn't hungry, or forcing her to eat foods that she doesn't want. At this age your child is becoming more independent and you can expect her to dress herself and button clothes, brush her teeth with help, stack 9 to 10 blocks, draw circles and squares, use scissors, walk up steps by alternating her feet, jump from a step, hop, walk on her toes, pedal a tricycle, play with imaginary friends, have a very large vocabulary and use 3 to 4 word sentences and her speech should be 3/4 understandable. Over the next year her speech will become fully understandable. Your child may now begin to ask "why" questions, tell stories, remember nursery rhymes, appreciate special events, and understand daily routines. Your three-year-old will now begin to play cooperatively with other children in small groups, share her toys and develop friendships. Playtime may include structured games and fantasy activities. Most toddlers take at least one nap (length of naps are usually very variable between different children, but naps are usually 1-1 1/2 hours long) during the day at this age and are able to sleep all night (for about 11 hours). If not, check to make sure that your toddler has a good bedtime routine and has developed the proper sleep associations. Once your child is able to climb out of his crib (and you have already lowered the mattress and removed the bumper pads), it is time to move him into a toddler bed. If your child is three feet tall, you may want to move him to a toddler bed even if he isn't climbing out of his crib yet. The usual age for moving out of a crib is about eighteen months to two years.
What You Need To Know About Your Three-Year-Old • • • •
Continue to use your car seat with harness straps until your toddler is 40 pounds, when she can likely move to a booster seat. Although they may begin to resist it, most 3-year-olds should still take a nap. The first visit to the dentist is usually by age 3 years. At the three-year-old checkup, you can expect a complete physical exam, a review of feeding and sleep schedules, measurement of your child's height, weight and blood pressure. Your child may receive her HepA shots if she hasn't had them already. A screening vision test will also likely be done.
Common Toddler Problems o o o o o o o o
Constipation Food Allergies ADHD in Preschoolers Allergies Asthma Stuttering Croup Knock Knees
Your child's diet should now resemble that of the rest of the families, with 3 meals and 2 snacks each day. You should limit milk and dairy products to about 16 to 24oz each day, and juice to 4 to 6oz each day, and offer a variety of foods to encourage good eating habits later. To prevent feeding problems, teach your child to feed himself as early as possible, provide him with healthy choices and allow experimentation. Mealtimes should be enjoyable and pleasant and not a source of struggle.
Your child may now start to refuse to eat some foods, become a very picky eater or even go on binges where he will only want to eat a certain food. An important way that children learn to be independent is through establishing independence about feeding. Even though your child may not be eating as well rounded a diet as you would like, as long as your child is growing normally and has a normal energy level, there is probably little to worry about. Remember that this is a period in his development where he is not growing very fast and doesn't need a lot of calories. Also, most children do not eat a balanced diet each and every day, but over the course of a week or so, their diet will usually be well balanced. You can consider giving your child a daily vitamin if you think he is not eating well, although most children don't need them. While you should provide three well-balanced meals each day, it is important to keep in mind that most children will only eat one or two full meals each day. If you child has had a good breakfast and lunch, then it is okay that he doesn't want to eat much at dinner. Other ways to prevent feeding problems are to not use food as a bribe or reward for desired behaviors, avoid punishing your child for not eating well, limit mealtime conversation to positive and pleasant topics, avoid discussing or commenting on your child's poor eating habits while at the table, limit eating and drinking to the table or high chair, and limit snacks to two nutritious snacks each day. To avoid having to supplement with fluoride, use fluoridated tap water. If you are using bottled or filtered water only, then your child may need fluoride supplements (check with the manufacturer for your water's fluoride levels). Feeding practices to avoid are continuing to use a bottle, giving large amounts of sweet deserts, soft drinks, fruit-flavored drinks, sugarcoated cereals, chips or candy, as they have little nutritional value. Also avoid giving foods that your child can choke on, such as raw carrots, peanuts, whole grapes, tough meats, popcorn, chewing gum or hard candy.
Accidents are the leading cause of death for children. Most of these deaths could easily be prevented and it is therefore very important to keep your child's safety in mind at all times. Here are some tips to keep your preschooler safe:
Use a toddler/convertible safety seat in the back seat. Continue to use it until your child outgrows it when he is about 40lbs and then use a booster seat until your car's lap and shoulder belts fit correctly (when your child is 80lbs and 8 years old) and never place your child in the front seat of a car with a passenger side airbag. Also be careful if your car has side impact air bags. Make sure that used or hand-me-down equipment, such as car seats, strollers and cribs, etc, haven't been recalled for safety reasons.
Call the manufacturer or the Consumer Product Safety Commission for an up to date list of recalled products.
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Never leave small objects in your child's reach to prevent choking, including coins, toys with small parts (children under age three should not be allowed to play with toys that have parts that are smaller than 1 1/4 inch in diameter and/or 2 1/2 inches long), and rubber or latex balloons. Take the time to look for small items, especially coins, safety pins, tacks, etc in the areas where your children are playing. Correctly use a harness when he is seated in a high chair. Teach pedestrian (crossing streets, etc.) and playground safety (including not playing on trampolines). Teach stranger awareness (review scenarios that predators may use, including offering candy or toys to get in the car, asking to help look for a lost pet, or being told they are picking your child up because you are sick). Avoid exposing your child to too much sun (use sunscreen). Install smoke and carbon monoxide detectors and use flame retardant sleepware. Practice food safety: wash fruits and vegetables, do not eat undercooked meats or poultry or drink unpasteurized milk or juices.
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If you must have a gun in the house keep it and the bullets in a separate locked place. Practice water safety: teach your child to swim, do not let your child play around any water (lake, pool, ocean, etc.) without adult supervision (even if he is a good swimmer), always wear a life preserver or safety vest when on a boat, and childproof the pool by enclosing it in a fence with a self-closing, self-latching door. Be cautious of certain dog breeds (Rottweilers, pit bulls, German Shepards) that account for over fifty percent of fatal dog bites and closely supervise children when in the presence of animals. Clean his teeth with a soft toothbrush with just a pea-sized amount of a fluoride toothpaste (to prevent fluorosis) until he learns to spit out the toothpaste. The first visit to the dentist is usually by age 3 years. Limit television and encourage reading and storytelling. Child Proof the House (Set the temperature of your hot water heater to 120 degrees F, use gates on stairs, covers on electrical outlets and latches on cabinets, keep household cleaners, chemicals and medicines completely out of reach and always store them in their original container and know the Poison Control Center number (1-800-222-1222), do not carry hot liquids or food near your child and do not allow your child near stoves, heaters or other hot appliances (especially curling irons), and when cooking, use the back burners and turn pot handles inward, to prevent drowning, empty all water from bathtubs and pails, keep the door to the bathroom closed and never leave your child alone near any container of water, keep a list of emergency numbers near the phone, and lock rooms that are not child proof).
Common Preschool Problems at Three Years
Common Preschool Problems •
Constipation: a very common and frustrating problem in children. It is usually defined as the passage of hard and painful stools or going four or more days without a bowel movement. Constipation is most commonly caused by a diet that is low in fiber, but can also be caused by drinking too much milk (more than 16 to 24oz/d), not drinking enough water or waiting too long to go to the bathroom. Initial treatment is increasing the amount of fluids he drinks and increasing the amount of fiber and bran in his diet. It is usually also helpful to decrease the amount of constipating foods in his diet, including cow's milk, yogurt, cheese, cooked carrots, and bananas. Stool softeners may be necessary if these steps don't work.
Upper Respiratory Infections: these are very common and include symptoms of a clear or green runny nose and cough and are usually caused by cold viruses. The best treatment is to use salt water nasal drops and a bulb suctioner to keep their nose clear. Call your Pediatrician if your child has high fever, difficulty breathing or is not improving in 7-10 days Vomiting: usually accompanies diarrhea as part of a viral infection. If your child starts vomiting, it is best to give them a break from eating and drinking for an hour or so and then start to give small amounts of Pedialyte (1 teaspoon) every five or ten minutes. Once your child is able to tolerate drinking these small amounts you can increase the Pedialyte to about a tablespoon every five or ten minutes and then larger amounts as tolerated and then change back to his regular formula. Avoid giving just Pedialyte for more than 12 hours. Call your Pediatrician if the vomit has blood in it, if it is dark green, or if your child is showing signs of dehydration (which includes not urinating in 6-8 hours, having a dry mouth and weight loss). Diarrhea: a common problem and is often caused by a viral infection. Call your Pediatrician if the diarrhea has blood or pus in it, if it is not getting better in 1-2 weeks or if you see signs of dehydration (which includes not urinating in 6-8 hours, having a dry mouth and weight loss). You should continue with their regular diet, but may give 1-2 ounces of Pedialyte each time that he has large diarrhea stool to prevent dehydration.
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