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Pediatric Developmental Stages Age Infancy: 0 12 months Milestones

1st month: Turn head side-to-side when prone 2nd month: Vocalizations; Social smile 3rd month: Cooing; babbling; chuckling; localization of sound

Jerry Goure Physical Cephalocaudal and proximodistal development patterns. Respiratory rate slows somewhat Short straight eustacian tubes Heart rate slows somewhat Sinus arrhythmia is common HgbF present for first 5 months; may physiologic anemia Immature digestive processes, esp liver Maternal IgG for 1st 3 months efficient thermoregulation Total body fluid 75% at birth; excess ECF, predisposes to dehydration Renal immaturity Depth perception at ~ 79 months Psychosocial (Erikson) Trust vs Mistrust: Trust established by meeting physical and emotional needs. physical comfort & security Mistrust established by a failure to meet basic needs. Failure to learn delayed gratification 1st 3 4 months: Little tolerance for frustration or delayed gratification Narcissistic Intellectual (Piaget) Sensorimotor: Separation of self from environment Object permanence Symbols Reflexive (birth 1 month): Sucking, Rooting, Grasping, Crying Primary Circular Reactions (1 4 months): Deliberate sucking & grasping. Recognition of stimulus/response. Moral (Kohlberg) No moral development stage.

4th month: Grasping; Laughing; Head balance; Almost no head lag; Rolls from back to side
5th month: Voluntary palmar grasp; Turns prone to supine

6th month: Teething (lower central incisors); Imitation of sounds; Single syllables; Object permanence beginning

7th month: Upper central incisors; Sits with hand sup- port; Transfer objects between hands; Vowels & chained syllables (baba); Stranger fear 8th month: Sits unsupported; Responds to no 9th month: Pulls to standing; Crude pincer grasp 10th month: Dada or Mama with meaning; Object permanence 11th month: Walks with furniture or 2-hand support 12th month: Birth weight x3, length x2; Walks with 1hand support; Brief stand alone; 35 words

Secondary Circular Reactions (4 8 months): Repetition of primary actions; ie grasping shaking, banging, nd 2 Oral/Social Stage: pulling Grasping, reflexive Causality, time, intention, separasocial tion Biting Coordination of Secondary Schemas & Application to New Situations: Transitional exploration of environment

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Pediatric Developmental Stages Age Milestones Physical Weight gain slows; gain of 1.8 2.7 kg/year. Birth weight x4 at ~2.5 years Height slows; about adult-height at 2 years Step-like growth curve growth spurts Chest circumference exceeds head circumference. Retains pot-belly and bowed legs. More efficient defense mechanisms (skin & blood, esp phagocytosis) volume of respiratory tract. Otitis media, tonsillitis & URIs are common. Psychosocial (Erikson) Autonomy vs Shame & Doubt: Conflict of exerting autonomy and relinquishing dependence. Doubt regarding potential capacity to control one's actions Shame over urge to revolt against others' will and fear one will exceed capacity for manipulating the environment Negativism: no and me do Ritualism: need to maintain sameness & reliability. Ability to tolerate delayed gratification Use of transitional objects. Parallel play Push-pull toys, straddle trucks or cycles, small gyms & slides, balls of various sizes, rocking horses. Finger paints, thick crayons, chalk, blackboard, paper, simple puzzles, interlocking blocks. Talking dolls/animals, toy telephones, educational children's TV. Tactile: water toys, sandbox, finger paints, soap bubbles, clay. Intellectual (Piaget) Sensorimotor, Tertiary Circular Reactions (13 18 months): Awareness of causal relationships Does not transfer to new situations Awareness of spatial relationships Shapes & sizes, ex. nesting boxes object permanence: awareness of existence of objects behind doors, in drawers, under tables Sensorimotor, Invention of New Means Through Mental Combinations (19 24 months): object permanence: will actively search for an object in several hiding places Domestic mimicry Sex-role behavior & gender identity Limited sense of time; exaggerated Language comprehension > production (~300 words) Preoperational Phase, Preconceptual (2 4 years): Inability to logically manipulate objects in relation to each other. Egocentric thought Transductive reasoning: particular to particular Global organization: changing a part changes the whole Centration: focus on one aspect, ex a food's color Animism Irreversibility: of actions Magical thinking: thoughts are allpowerful Inability to conserve, ie understand size/shape/volume/length mass Concern over why and how of things, but understanding is crude. Toddlerhood: 15 months: 1 3 years Self-feeds; Drinks from covered cup; Crudely manages spoon; Assists dressing; Pulls off shoes & socks Drops pellet into narrownecked bottle 18 months: Removes gloves per self; May unzip Throws ball overhand without losing balance

Jerry Goure Moral (Kohlberg) Preconventional / Premoral: Punishment & obedience orientation (2 4 years): Action is good or bad depending on whether it results in reward or punishment, regardless of the meaning of the act.

24 months: Manages spoon well Removes most clothing per self; Puts on socks, shoes, pants (sans regard for front or back) Toilet training (no universal age) nighttime likely much later use potty chair 5-10 minute practice sessions with parent present 36 months: May use fork Draws a circle

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Pediatric Developmental Stages Age Early Childhood: 3 6 years Milestones 3 years: Walking, climbing & jumping well-established Rides tricycle, walks on tiptoe, balances on one foot for a few seconds, broad jumps 4 years: Skips, hops on one foot, catches ball reliably 5 years: Skips on alternate feet, jumps rope, begins to skate & swim

Jerry Goure Physical Weight ~2.3 kg/year Height 6.75 7.5 cm/year, primarily in legs Slender, sturdy, graceful, agile & posturally erect Psychosocial (Erikson) Initiative vs Guilt: Initiative accomplishment of & satisfaction with activities. Guilt not behaving appropriately or having inappropriate thoughts (ex wishing parent dead) Beginning of development of conscience.

Intellectual (Piaget) Preoperational Phase: Preconceptual (2 4 years): See Toddlerhood.

Moral (Kohlberg) Preconventional / Premoral:

Punishment & obedience orientation (2 4 Intuitive Thought (4 7 years): years) Language is egocentric, ie little ex Action is good or planation of thoughts bad depending on Play is a way of understanding, whether it results in adjusting to & working out life's reward or punishexperiences. ment, regardless of Often used without complete comAssociative play the meaning of the prehension of words, esp. right vs Physical activites act. left, causality, & time. Manipulative, constructive, cre Incomplete understanding of time Nave instrumental oriative, & educational toys Explain things in relationships to entation (4 7 years) Construction sets, large events, ex Your mother will visit Actions directed toblocks, alphabet or number after you finish lunch. ward satisfying flash cards, paints, crayons, Magical thinking persists needs of self & less simple tools, musical toys, frequently of othillustrated books, large Why? questions ers. puzzles, clay. Concrete sense of Imitative, imaginative, dramatic Basic sex education find out what child knows & justice. play thinks, avoid unasked-for info Reciprocity with no Dolls, housekeeping toys, be honest thought of loyalty farm animals & equipment, or gratitude. trains, trucks, cars, planes, Fears doctor & nurse kits. Stuttering Avoid gender stereotyping. Aggression Imaginary playmates Mutual play between child and Sleep problems parents

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Pediatric Developmental Stages Age Middle Child- hood: 6 12 years

Jerry Goure Physical Psychosocial (Erikson) Intellectual (Piaget) Moral (Kohlberg) Conventional Level: Good-boy / Nice-girl Orientation: Understand rules & expectations. Guided by reward & punishment. Religious concepts in concrete terms. Law & Order Orientation: Judgement partially based on intention & context of situation. Accept concept of treat others as they would like to be treated. Concrete Operations: Ability to see things from others' points of view. Judgements based on reasoning (conceptual thinking) Mastery of symbols. Use of past experiences to interpret present situations. Mastery of conservation at 57 years. Conservation of mass, then weight, then volume. Reversibility of numbers in basic math problems. Classification skills: Logical grouping according to attributes. Enjoyment in collections, ex stickers, stamps, shells, dolls, cars, etc. Bullying May classify friends Targets often deviate from group Understanding of relational connorms, fear school, suffer depression & cepts, ex bigger / smaller, darker / low self-esteem. paler, heavier / lighter, etc. Chronic bullies continue behavior into Learn time-telling, history, geoadulthood graphy. Reading, valuable tool. Games with fixed, unvarying rules; ritual chants Team play encourages group goals and competition. Complex card, board or computer games with fanatic adherence to rules.

Slow & steady Industry vs Inferiority: ~5 cm/year, 3060 cm total Industry development of skills, particip 23 kg/year, total nearly 2x ation in socially useful work. Slimmer, longer legs, varying body pro Desire to carry tasks to completion. portion, lower center of gravity. Independent exploration & manipula Easier climbing, bicycle riding, etc. tion of environment. % muscle tissue, though muscles are Interaction with peers; value of workstill functionally immature vs adolescent ing with others. head circumference, waist circumfer Peer approval is a strong motivator. ence & leg length relative to standing Formal peer groups height rigid rules & standards of behavior Loss of all deciduous teeth exclusivity predominantly same-sex in later Mature GI system school years Bladder capacity: girls > boys can become gangs Steady of heart & respiratory rates, of Inferiority physical or mental limitaBP. tions More competent immue system, but also Inability to master skills, esp. when remore exposure in school. wards are based on mastery.

Preadolescence / Prepubescence (~ 912 years):


Rapid height & weight , especially for girls. Highly variable between sexes & between members of same sex.

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Pediatric Developmental Stages Age Adolescence: 12 18 years Physical Growth spurt; 2436 months; highly variable onset, duration & extent Extremities & neck hip & chest breadth shoulder width trunk length & chest depth Boys begin 10.516 years, gain 1030 cm & 730 kg, cease at 1820 years. Girls begin 9.514.5 years, gain 520 cm & 725 kg, cease 22.5 years after menarche. Puberty in Boys Testicular enlargement; thinning, reddening, loosening of scrotum Growth of hair on pubic area, axilla, upper lip, face and elsewhere on body Facial hair ~2 years after pubic hair First ejaculation Rapid height in larynx and voice; usually takes place along with growth of penis Nocturnal emissions Abrupt deceleration of linear growth Puberty in Girls Breast (thelarche) Rapid height & weight Growth of pubic hair (adrenarche) Appearance of axillary hair Menstruation (menarche); usually begins ~2 years after first signs of puberty Abrupt deceleration of linear growth Pubertal delay: Boys: testicular enlargement or scrotal by 13.514, or incomplete genital growth 4 years after testicles begin to enlarge. Girls: breast development by 13, or menarche within 4 years of breast development. lean (steady) & nonlean (less orderly) body mass Sebaceous glands become active, esp. on genitals, face, neck, shoulders, upper back & chest Apocrine sweat glands activate odor Psychosocial (Erikson) Identity & Repudiation vs Identity Confusion: Sex-roles, including sexual activity & homosexuality Highly emotional Intellectual (Piaget) Formal Operations: Abstract thinking Thoughts about the future Influenced by logical principles. Scientific reasoning & formal Group identity vs alienation: logic. Provides frame of refer Can detect logical (in)conence for self-assertion. sistency Personal identity vs role diffu- > 2 variables simultaneously, sion: ex the relationship between May be influenced by sigspeed, distance & time when nificant others with persistplanning a trip. ent demands. Understand cultural relativism May be negative if society provides a negative label, ex juvenile delinquent or failure

Jerry Goure Moral (Kohlberg) Postconventional / Principled Level: Social-contract Orientation: Should be based on an internalized set of moral principles. Rights & standards agreed upon by the community. Universal Ethical Principle Orientation: Abstract principles of justice & human rights, respecting the dignity of people as individuals. Few people may reach this stage.

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