Stage of Human Growth and Development

 STAGES OF HUMAN GROWTH AND DEVELOPMENT

•  All children go through a normal sequence of growth but not at the same rate.
•  The rate is also not the same in all areas.
• There is positive correlation between physical growth and mental, emotional, and sexual development. This may not be true in individual children so we should not attempt to force a child into a standard pattern of growth.
•  There are many variations in genetic traits and in the environment to make this possible.
•  The strain upon the child may affect his personality and even his physical health.
•  Adults who have a clear understanding of the stages of growth and development can apply their knowledge when caring for children.
•  The stages are as follows:

1.  From birth to 4 weeks-a neonate or a newborn
2.  From 1 month (4 weeks)- 12 months (1year)- an infant
3.  From 1 year-3 years –a toddler
4.  From 3-5 years- a preschooler
5. From 6-12 years a school child
6.  From 12 -13 years a pubescent.
7.  From 14-21 years – an adolescent

 MILESTONES

•  Milestones are the various skills which the baby and young child learn
•  The development of a child can be assessed from different points of view:

1.  What he can do in the way of moving around and handling things (motor development)
2.  How he talks and makes his wants known (language)
3.  How he fits into his family and community (social behaviour)

 DEFINITION: THE INFANT
An infant is a live born fetus from time of birth through the completion of one year of age

AVERAGE ACHIEVEMENTS OF A ONE MONTH INFANT

•  PHYSICAL

1.  Weight 4.4 + 0.8 kg
2. Gains 150-210 gm/week during the 1st 6 months
3.  Length 53 + 2.5 cm a moth during the first 6 months
4.  Head circumference increases about 1.5cm per month during the first 6 months
5.  Pulse 130 + 20 beats per minute
6.  Respiration 35 + 10 per minute
7.  Blood pressure 80/50 + 20/10 mm/hg
8.  Well developed sucking, rooting, swallowing, extrusion, Moro and asymmetric tonic neck reflex (head turned to one side, one arm and leg extended on the same side, the other arm flexed to the shoulder with the leg on the same side flexed
9.  Dance and dolls eye reflexes fading
10.  Still breathing through the nose

•   MOTOR: means pertaining to action or movement. (from dictionary of nursing, 2002 Toronto)

1.  Lies in flexed position
2.  When prone pelvis is elevated but knees are not beneath abdomen as they were after birth.
3.  Head lags when baby is pulled from a supine to a sitting position
4.  Head sags forward when baby is held in sitting position
5.  May lift head periodically when held over adults shoulders or placed in prone positions
6.  Cervical curve begins to develop as infant learn to hold head erect
7.  Turns head to one side when prone
8.  Makes crawling movements when prone on flat surface
9.  Pushes with the feet against a hard surface to move forward
10.  Holds hand in tight fists
11.  Can grasp an object placed in the hand but drops it immediately (palmar grasp reflex)

•   SENSORY

1.  Startled by sounds (Moro reflex)
2.  Attentive to speech of others
3. Indefinite stare at surrounding
4.  Fixates on objects brought in front of eyes
5.  Notices faces and bright objects which are in line of vision.
6.  Blinks in response to bright light

•   PSYCHO-SOCIAL

1.  Beginning development of sense of trust versus mistrust
2. Totally egocentric (self centered)

•  PSYCHO-SEXUAL

1.  Complete dependence on caregiver usually the mother
2.  Activity diminishes when a human face can be seen
3.  Establishes eye contact
4.  Smiles briefly
5.  Quiets, cuddles and molds when held
6.  Perceives self and parents as one
7.  Oral stage-oral dependence, need for suckling pleasure.

•  SPIRITUAL

1.  Undifferentiated (0-1 year)
2.  Feelings of trust warmth and security forms the foundation for the latter development of faith

•  INTELLECTUAL

1.  Can make association between an act and a sequential response
2.  Cannot distinguish self from environment
3.  Begins to repeat actions of own body voluntarily , hand to mouth movement permits sucking

•  MORAL
•  Pre-conventional morality

1. “The good is what I like and want”.
2.  Language and speech development
3.  Responds to human voices
4.  Opens and closes mouth as adults speak
5.  Utters small throaty sounds
6.  Utters sounds of comfort when feeding
7.  Cries when hungry or uncomfortable
8.  Begins to coo

•  PLAY STIMULATION

1. Hold ,touch, rock infant gently
2. Talk and sing to infant softly
3.  Call him by name at close range
4.  Encourage mutual eye contact
5.  Provide pacifier for sucking pleasure
6. Place large bright pictures on crib or wall
7. Repeat noises made by infant
8. Coo to infant
9. Respond to crying signals
10.  Have ticking clock, radio, television or music nearber
11.  Provide soft toys too large to swallow Swaddle to soothe infant
12. Place infant when awake where house hold activities are in progress.
13. Take child for a walk
14.  Provide periods of affectionate play when infant is alert and responsive

•  PHYSICAL

     1.Posterior fontanel closes at 6-8 weeks of age.

•  MOTOR

1.  Less fixed prone position
2.  No head droop when suspended in prone position
3.  Lifts head almost 450 above a flat surface when lying prone
4.  Holds head erect in midposition
5.  Holds head erect when held upright
6.  Turns from side to back

•  FINE MOTOR

1.  Hands may be open
2.  Holds a rattle briefly when placed in the hand

•   SENSORY

1. Turns head to side when a sound occurs at ear level
2.  When on back follows a dangling object or a moving light beyond the midline of vision
3.  Eyes follow moving person nearby

•  SYCHOSOCIAL

1. Sense of trust
2. Distinguishes mother or primary caregiver from others and is more responsive to that person
3.  Eye to eye contact –orientation, smiling and vocalization are the evidences of attachment between infant and parents especially the mother
4.  Smiles back in response to another’s smile
5.  This is the beginning of social behavior
6.  Has learnt that crying brings attention

•   PSYCHOSEXUAL

1.  Oral stage 0-1 year.

•   SPIRITUAL

1. Undifferentiated (0-1 year).

•   MORAL

1. Pre-conventional morality.

•   RECEPTIVE LANGUAGE

1. Alert expression when listening
2.  Direct definite regard
3.  Soothed by caregivers, mothers voice.

•   EXPRESSIVE LANGUAGE

1.  Cry patterns develops
2. They vary with the reason for crying
3.  For example hunger, sleepiness or pain
4.  The pitch and intensity vary
5.  Responds vocally to caregivers voice -“ah”, “eh”, “uh”
6.  Coos

•  PLAY STIMULATION

1. Offer a rattle
2.  Pull from supine to sitting position
3.  Hold or dangle toy in front of infant to encourage eye movement
4.  Change patterns of objects from bright and shinny to dull and dark for further stimulation
5.  Go outing with the child

 AVERAGE ACHIEVEMENTS OF A THREE MONTHS INFANT

1.  weight 5.7+0.8 killogram
2.  Length 60 + 2 cm Pulse 130 + 20 beats per minute
3.  Respirations 35 + 10 per minute
4.  Blood pressure 80/50 +20/10 mm/hg

•   REFLEXES

1.  Palmar reflex absent
2.  Landau reflex appears

•   MOTOR

1.  Very slight head lag
2.  Sits back rounded, knees flexed when supported in sitting position
3.  Raises chest usually supported on forearms when in prone position
4.  Hold head erect and steady
5.  Hands open or closed loosely
6.  Holds hands in front of face and stares at them
7.  Holds objects put in hand with active grasp
8.  Carries hand or object to mouth at will
9.  Reaches for bright objects

•   SENSORY

1.  Turns hand to locate sound
2.  Turns eyes to objects
3.  Blinks at objects that threaten the eyes

•   PSYCHOSOCIAL

1.  Sense of trust
2.  Smile in response to mothers smile
3.  Stops crying when familiar faces approaches

•   LANGUAGE

1.  Looks in direction of speaker
2.  Cries less.
3.  Shows pleasure in making many sounds
4.  Vocalizes in response to others
5.  May laugh aloud

•  PLAY AND STIMULATION

1.  Provide greater variety of toys
2.  Take on daily outing
3.  Bounce on bed
4.  Play with infant during feeding

AVERAGE ACHIEVEMENTS OF A FOUR MONTHS INFANT

•  PHYSICAL GROWTH

1.  Drools between 3 and four months
2.  This indicates increased production of saliva and as he is unable to swallow it all it runs from mouth.

•   REFLEXES

1.  Tonic neck, Moro, suckling and rooting when awake are absent
2. Extrusion reflex fading.

•   MOTOR GROWTH

1.  Sits with adequate support
2. Enjoys being propped up
3. Holds head erect and steady when placed in sitting position
4.  Lifts head and shoulders at a 900 angle
5.  When on abdomen and looks around
6.  Attempt to roll or actually rolls over from front to back
7.  Sustains small portion of own weight when held in standing position
8.  Activates arms at sight of preferred toy.

•   FINE MOTOR

1. Holds hand predominantly open
2.  Brings hands together in midline
3. Plays with fingers
4.  Grasps object held near hand
5.  Cannot pick object when dropped down
6.  Grasps object with both hands
7.  Attempts to reach objects with hands but overshoots them
8.  Objects are carried to mouth.

•   SENSORY

1.  Follows moving object well with eyes
2.  Even the most difficult types of eye movement are present
3.  Fairly good binocular vision
4.  Looks briefly for toy that disappears
5.  Accommodation begins to develop
6.  Can accommodate to nearby objects
7.  Can focus on small objects
8.  Stares at rattle placed in hand and takes it to the mouth
9.  Recognizes familiar objects such as feeding bottle and toys
10.  Beginning hand- eye coordination
11.  Comforts self by sucking thumb or pacifier

•   PSYCHOSOCIAL
•  Sense of trust

1.  Smiles in response to smiles of others when appear nearby
2. Initiates social play by smiling or vocalizing
3. Shows evidence of wanting social attention and of increasing interest in other family members
4. Shows interest in new stimuli
5. Fusses if left alone or bored thereby demanding attention from others
6. Shows eagerness when feeding bottle (cup and spoon) appears
7. Breathes heavily when excited.

• PSYCHOSEXUAL

1.  Oral stage
2. Spiritual
3. Still undifferentiated.

•  INTELLECTUAL

1. Repeats actions that affect an object to get a response e.g. shaking a rattle
2. Experiments with old or new responses to produce environmental changes or to reach a goal

•  MORAL

1. Preconventional morality.

•  RECEPTIVE LANGUAGE

1.  Responds differently to pleasant or angry noises
2.  Does not cry when scolded.

•  EXPRESSIVE LANGUAGE

1.  Laughs aloud
2.  Vocalizes socially coos and gurgles when spoken to
3. Very talkative to self, people or toys
4. Talking and crying follow each other quickly
5. Can vocalize consonants b,g,h,k,n,p.

 AVERAGE ACHIEVEMENTS OF A FIVE MONTHS INFANT

•  PHYSICAL

1.  At least twice the birth weight
2. Mean age for doubling birth weight is 3.8 months
3.  Physical growth is slowing down
4. Can breathe through mouth when nose is obstructed

•   MOTOR GROWTH

1. Sits with slight support
2. Balances head well when sitting
3. Hold back straight when pulled to a sitting position
4. Pushes whole chest off a flat surface when prone
5. Rolls from back to front
6. Sustains more of own weight when held in standing position
7. Pulls feet up to mouth when supine
8. Uses thumb in partial apposition to fingers more skillfully
9. Tries to obtain objects independently to direct stimulation of palm of the hand
10. Grasps objects with whole hand either right or left
11. Holds one object while looking at another

•  SENSORY

1. Localizes sounds made below the ear
2. Looks a dropped object
3. Inspects objects visually for a lengthening period of time
4.  Can fixate an object more than 3 feet away

•   PSYCHOSOCIAL

1. Sense of trust Smiles at self in mirror

 Begins to discriminate family members from strangers

1.  Accept an object from another person
2. Play enthusiastically, shows displeasure when toy is lost
3.  Plays with own feet

•   PSYCHOSEXUAL

1.  Oral stage.

•   SPIRITUAL

1.  Undifferentiated

•  RECEPTIVE LANGUAGE

1. Responds when own name is called

•   EXPRESSIVE LANGUAGE

1. Squeals when happy or excited
2. Vocalizes displeasure when a desired object is taken away
3.  Consonant sound increase
4. Sounds like vowels appear with consonants such as “goo”
5.  Begin to mimic sounds

•   PLAY STIMULATION

1.  Provide sufficient different objects for play
2.  Provide small objects that are too large to swallow
3.  Make various sounds near ear
4.  Hold infant in standing position and bounce to exercise legs and develop balance.

•  PLAY STIMULATION

1.  Hold, touch and rock infant gently
2.  Smile when talking and singing to infant
3.  Encourage mutual eye contact
4. Laugh when infant laughs
5. Echo sounds that infant makes
6.  Observe subtle clues from infant’s body language and respond to them
7.  Light tickling stimulates laughter
8.  Provide variety of small multitexured (fuzzy, smooth) and colored objects that infant can hold but not swallow
9.  Shake rattle placed in infant’s hand.
10. Offer toys for grasping
11. Move rattles around the infant so that it can be followed visually and grasped
12. This helps develop hand –eye coordination and improve head control
13.  Provide floating toys for bath
14.  Encourage splashing in bath water
15. Help infant sit up with support and roll over
16. Help infant learn balance when sitting by tilting the body from an erect position to one side
17. Hold child in standing position
18. Use infant seat, swing and stroller
19.  Provide safe area for periods of solitary play
20.  Place infant when awake where household activities are in progress.
21.  Include infant in family’s television viewing and activities

 AVERAGE ACHIEVEMENTS OF A SIX MONTHS INFANT


• PHYSICAL

1.  Weight 7.4 + 1 kg.Gains about 340 gm every month
2. Length 65.5 + 3 cm
3. Head circumference 43 cm
4. Pulse 120 + 20 beats /minute
5. Respirations 31+ 9 per minute
6.  Blood pressure 90/60 + 28/10 mm/hg
7. Teething 2lower central incisors erupt-6+ 2 months
8.  Begins to bite and chew

•  MOTOR

1.  Sits alone briefly if placed in a favorable leaning position on hard surface
2.  Holds arm out
3. Back is straight when sitting in high chair
4.  Pulls to a sitting position
5.  Springs up and down when sitting
6. Lifts chest and upper abdomen when prone putting the weight on arms and hands
7. Turns completely over with rest periods during the turn so the infant must be protected from falling
8.  Sustains most of own weight when held in standing position
9. Hitches- that is moving backward when in a sitting position by using the arms and hands
10. Grasp with simultaneous flexion of fingers
11. Begins to use fingers to feed self a cracker
12.  Retains transient hold on two objects one in each hand
13. Drops one object when another is offered
14.  Begins to bang objects that are held (rattles, spoons, toys)
15. Hold own bottle but may prefer for it to be held

•   SENSORY

1. Localizes sound made above the ear
2.  Retrieves a dropped object that can be seen and reached
3.  Enjoys more complex visual stimuli
4.  Moves in order to see an object

•   PSYCHOSOCIAL

1. Sense of trust
2.  Recognizes strangers as different from family members
3.  Begins to extend arms to be picked up
4.  Thrashes arms and legs when frustrated
5.  Imitation of others is beginning
6.  Sticking tongue out
7.  Knows what is liked and disliked.

SUMMARY

•  In order to know if the child is achieving as expected consider the following parameters:
•  Physical growth, Motor, sensory, psychosocial, psychosexual, spiritual and intellectual development and include his/her receptive and expressive language
•  The care giver /parents should be encouraged to provide what the infant needs at a specific age so that growth and development of the child is enhanced