Developmental milestone | CHAPTER 2 | Pediatric Nursing

Developmental milestone | CHAPTER 2 | Pediatric Nursing

Developmental milestone – Health of the children has been considered as the vital importance to all societies because children are the basic resource for the future of humankind. Nursing care of children is concerned for both the health of the children and for the illnesses that affect their growth and development. The increasing complexity of medical and nursing science has created a need for special area of child care, i.e. pediatric nursing.

Pediatric nursing is the specialized area of nursing practice concerning the care of children during wellness and illness. It includes preventive, promotive, curative and rehabilitative care of children. It emphasizes on all round development of body, mind and spirit of the growing individual. Thus, pediatric nursing involves in giving assistance, care and support to the growing and developing children to achieve their individual potential for functioning with fullest capacity.

Developmental milestone

 

Developmental milestone | CHAPTER 2 | Pediatric Nursing

Definition of Developmental Milestone:

Developmental milestones are behaviors or physical skills seen in infants and children as they grow and develop. Rolling over, crawling, walking, and talking are all considered as developmental milestones.

Or

These are the parameters of different age of children, which gives an idea about the average estimate of the time when the child can be expected to have certain skills.

Or

Developmental milestones are a set of functional skills or age-specific tasks that most children can do at a certain age range.

 

AgeMotorSpeechVision and hearingSocial
1-1.5 monthsWhen held upright, holds head erect and steady.Cooes and babbles at parents and people they knowFocuses on parents.
  • Loves looking at new faces
  • Starts to smile at parents
  • Startled by sudden noises
1.6-2 monthsWhen prone, lifts self by arms; rolls from side to back.Vocalizes
Cooes (makes vowel-like noises) or babbles		Focuses on objects as well as adults
  • Loves looking at new faces
  • Smiles at parent
  • Starting to smile
2.1 – 4.5 months
  • Rolls from tummy to side
  • Rests on elbows, lifts head 90 degrees
  • Sits propped up with hands, head steady for short time
  • “Changes sounds while verbalizing. “”eee-ahhh””
  • Verbalizes to engage someone in interaction
  • Blows bubbles, plays with tongue
  • Deep belly laughs”
  • Hand regard: following the hand with the eyes
  • Color vision adult-like.
Serves to practice emerging visual skills. Also observed in blind children.
3 months
  • Prone: head held up for prolonged periods
  • No grasp reflex
Makes vowel noises
  • Follows dangling toy from side to side
  • Turns head around to sound.
  • Sensitivity to binocular cues emerges.
Squeals with delight appropriately

Discriminates smile. Smiles often

Laughs at simple things.

Reaches out for objects.

5 months
  • Holds head steady
  • Goes for objects and gets them
  • Objects taken to mouth
Enjoys vocal play
  • Noticing colors
  • Adjusts hand shape to shape of toy before picking up
6 months
  • Transfers objects from one hand to the other
  • Pulls self up to sit and sits erect with supports
  • Rolls over prone to supine
  • Palmar grasp of cube hand to hand eye coordination
  • Double syllable sounds such as ‘mumum’ and ‘dada”
  • babbles (consonant- vowel combinations)
  • Localizes sound 45 cm lateral to either ear
  • Visual acuity adult-like (20/20)
  • Sensitivity to pictorial depth cues (those used by artists to indicate depth) emerges
9 – 10 months
  • Wiggles and crawls
  • Sits unsupported
  • Picks up objects with pincer grasp
Babbles tunefullyLooks for toys droppedApprehensive about strangers
1 year
  • Stands holding furniture
  • Stands alone for a second or two, then collapses with a bump
Babbles 2 or 3 words repeatedlyDrops toys, and watches where they go
  • Cooperates with dressing
  • Waves goodbye
  • Understands simple commands
18 months
  • Can walk alone
  • Picks up toy without falling over
  • Gets up/down stairs holding onto rail
  • Begins to jump with both feet.
  • Can build a tower of 3 or 4 cubes and throw a ball
  • Supinate grasping position usually seen as first grasping position utilized.
Jargon’. Many intelligible wordsBe able to recognize their favorite songs, and will try to join in.
  • Demands constant mothering
  • Drinks from a cup with both hands
  • Feeds self with a spoon
  • Most children with autism are diagnosed at this age
2 years
  • Able to run
  • Walks up and down stairs 2 feet per step
  • Builds tower of 6 cubes
Joins 2-3 words in sentences
  • Parallel play
  • Dry by day

 

Developmental Milestones of a Child at Birth:

 

Gross motora) Prone: Lies in flexed attitude, turns head from side to side, head lags on ventral suspensionb)

b) Supine: generally flexed and a little stiff

c) Reflex: All the reflexes are active eg moro reflex, grasp reflex etc.

Visual:May fix face or light in line of vision.
Social:Visual preference for human face.
Hearing:Startled by sudden noises, stiffens, quivers, blinks, screw up eyes.

 

Developmental Milestones of A Child Al 1-1.5 Months:

 

Gross motor:
  • When check touched at corner of mouth turns to same side in attempt to suck finger
  • In ventral suspension, head in line with body and hips semi- extended
  • Held standing oh hard surface, presses down feet, straightens body and usually makes a forward reflex walking movement.
Fine motor:
  • May retain object for a few moments
Cognitive function:
  • Watches the human face when she talks to him.
Vision:
  • Turns head and eyes towards diffuse light source
  • Watches mother nearby face when she feeds or talks to him with increasingly alert facial expression (from about three weeks)
Hearing:
  • Startled by sudden noises and may cry
Speech:
  • Small throaty sounds
Social behavior
  • Sleeps most of the time when not being fed or handled-
  • Responsive vocalizations at about five to six weeks.
  • Social smile (4-6 weeks)

 

Developmental Milestones of a Child at 3 Months:

 

Gross motor:When pulled to sit little or no head lag.
In ventral suspension, head held well above line of body; hips and shoulders extended
Fine motor:Watches movements of own hands before face and engages in finger play.
Holds rattle for few moments when placed in hand, may move towards face.
Cognitive function:Smiles when spoken to but vocalizes with pleasure.
Inspects own hand.
Vision:Can follow moving object one side to another side (180 degree)
Hearing:Definite quieting of smiling to sound of mother’s voice before she touches him.
May turn eyes and or head towards sound source (try to explore).
Speech:Coos and vocalizes reciprocally
Whimpers, squalls, chuckles, gurgles at back of throat.
Social Behavior:Fixes eyes unblinkingly on mothers face when feeding.
Beginning to react to familiar situations, showing by smiles coos and excited movements when the baby recognizes preparation for baths etc,
Emotion:Can show behavioral expression according to specific emotion

 

Developmental Milestones of a Child at 6 Months:

 

Gross motor
  • Sits with support
  • May sit alone momentarily.
  • Can roll over front to back and (usually) back to front.
  • Placed in prone, lifts head and chest well up supporting himself on flattened palms and extended arms.
Fine motor:
  • Uses whole hand to palmar grasp and passes toy from one hand to another
Cognitive function:
  • Laughs when head is hidden in towel in peek-a-boo game.
  • Wave the rattle purposefully
  • When the drops the rattle he tries to recover it.
Vision:
  • Hen toys fall from hand within visual field watches up to resting place.
Hearing:
  • Turns immediately to mother’s voice across room.
    Responds to baby hearing tests at 1.5 feet on ear level right and left by correct visual localization but may show slightly brisker response on one side.-
Speech
  • Vocalizes tunefully to self and others using sing song.
  • Vowel sounds or single and double syllables e.g: ma, baba, (vowel and consonant).
Social behavior
  • Takes everything to mouth
  • Still friendly with strangers (Definitely reserved with strangers from about seven months)
  • Shows anger at specific activity (e.g. if toy is taken away)

 

Developmental milestone | CHAPTER 2 | Pediatric Nursing

 

Developmental Milestones of a Child at 9 Months:

 

Gross motor
  • Sit alone.
  • Can lean forward to pick up a toy without losing balance.
  • Attempts to crawl: sometimes succeeds
  • Pull to stand holding on to support for a few moments.
Fine motor:
  • Picks up small sweet between finger and thumb and with inferior pincer grasp
Cognitive function:
  • Play peek a boo
  • Responds to own name
Vision:
  • Pokes at small sweet with index finger.
  • Looks in correct direction for falling and fallen toys.
Hearing:
  • Hearing test at three feet from ear above and below ear level but not in mid line.
Speech
  • Babbles loudly and tunefully in long repetitive strings of syllable (e.g. dad dad, mam- mam, ada ba, agaga)
  • Understands no-no and bye-bye.
Social Behavior and self- help/autonomy motion
  • Feeds biscuit/bread.
  • Holds bites and chews a biscuit and feed by himself
  • Plays peek a boo and imitates hand clapping

 

Developmental Milestones of a Child at 12 Months:

 

Gross motorCan rise to sitting position from lying down
Crawl on hands and knees
Pulls standing and lets himself down again holding onto furniture
Fine motorsHolds, bites, and chews a cracker.
Grasps string with thumb and forefinger.
Beats two spoons together.
Begins to use index finger to point and poke.
Cognitive function:Recognizes voices of favorite people.
Responds to verbal request such as “Wave bye-bye.
Vision:Drops and throws toys forward deliberately and watch them fall to ground

Recognizes pictures and objects

 

Developmental Milestones of a Child at 15 Months;

 

Gross motor
  • Walks alone usually with uneven steps, feet wide apart, arms slightly flexed and held above head or at shoulder level for balance.
Fine motor
  • Builds tower of 2″cubes.
  • Scribbles spontaneously or by imitation.
  • Holds cup.
  • Puts raisin or pellet in bottle.
  • Turns book pages, 2-3 at a time.
  • Holds spoon
Cognitive function:
  • Chews most foods well.
  • Opens closed doors.
  • Holds cup and drinks with some spilling.
  • Imitates housework.
  • Brings familiar object upon request.
Speech:
  • Vocalizes “no.”
  • Has vocabulary of 10-15 words.
  • Fluently uses jargon.
  • Points and vocalizes to indicate wants.
Vision:
  • 100s and 1000s used for near vision
Hearing:
  • Distraction test to specific frequencies used.
Social behavior:
  • Begins to distinguish “you” and “me.”
  • Imitates adult activities.
  • Interested in strangers, but wary.
  • Does not respond well to sharp discipline.
  • Does not respond to verbal persuasion and scolding.
  • Expressed autonomy through defiance.
  • Plays alone or beside other children.
  • Strongly claims “mine.”
  • Follows simple requests.

 

(Ref: Module on Early Childhood Development/Hand book)

 

Gross motor
  • Runs stiffly.
  • Pushes and pulls large objects.
  • Carries large teddy bear while walking.
  • Comes downstairs on bottom or abdomen.
  • Seats self in small chair
Fine Motor
  • Builds tower of 4-6 cubes.
  • Tries to fold paper imitatively.
  • Wiggles thumb.
  • Places rings on spindle toy.
  • Turns pages singly.
  • Turns knobs (television).
Cognitive function
  • Points to pictures in books.
  • Points to one body part on request.
  • Understands “yours” versus “mine.”
  • Uses the words “me” and “mine.”
  • Enjoys simple stories.
Vision:Enjoys picture books recognizing fine details in favorite picture.
Speech
  • Has vocabulary of 20 words mostly nouns.
Hearing
  • Play audiometry in free field possible.
Social behavior:
  • Moves about house without constant supervision.
  • Plays primarily alongside children but not with them.
  • Has temper tantrums in situations of frustration.
  • Is conscious of family as a group.
  • Enjoys role playing.
  • Mimics real-life situations during play..
  • Claims and defends ownership of own things.
  • Begins to call self by name.
  • Discriminates between edible and inedible substances

 

(Ref by: Module on Early Childhood Development/Hand book)

 

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Developmental Milestones of a Child at 3 Years:

Gross motor:
  • Walks alone upstairs with alternating feet and downstairs two feet to a step
  • Can stand and walk on tiptoe
  • Stands momentarily on one foot when shown
Fine motor:
  • Holds pencil with thumb and forefingers.
  • Zips and unzips.
  • Builds tower of 6-8 cubes.
  • Learning to use buttons, zippers, and buckles..
  • Pulls on socks.
  • Pulls on pants or shorts.
  • Drinks from cup without spilling.
  • Helps put things away.
  • Toilet training in progress.
Cognitive function
  • Understands and asks for “another.”
  • Points to 4 body parts.
Speech:
  • Often calls self by first name.
  • Speaks 50 or more words.
  • Has vocabulary of 300 words.
  • Uses phrases and 3- to 4-word sentences.
Vision:
  • 2 or 3 primary colors
  • May know names of colors
Social behavior:
  • Initiates own play activities.
  • Want routines “just so.”
  • Does not like change in routine.
  • Cannot wait or delay gratification.
  • Does not share.
  • Knows identity in terms of sex and place in the family.
  • Observes other children at play and Joins in for a few minutes.

 

(Ref by: Module on Early Childhood Development/Hand book)

Developmental Milestones of a Child at 4 Years:

 

Gross Motor:Runs smoothly, varying speeds.
Hops on one fool (4-9 times).
Balances on one foot (8-10 seconds).
Bounces ball with beginning control.
Throws ball overhand.
Fine motor:Copies cross and square.
Attempts to cut on straight line.
Has established hand dominance.
“Writes” on page at random.
May try to print own name.
Draws person arms and legs directly from head
Cognitive function:Understands opposite analogies.
Follows 3-stage commands.
Listens eagerly to stories.
Follows directions with prepositions (e.g., “above,” “under”).
Loves silly songs, names.
Increasing use of imagination.
Enjoys dress-up play.
Is interested in time concepts (e.g.. yesterday, hour, minute).
Identifies several capabilities.
Rote counts to 10.
Counts 4 items. –
Categorizes animals, food, toys.
Matches geometric forms.
Identifies missing part.
Expressive LanguageUses all parts of speech correctly.
Has vocabulary of 2,000- plus words.
Uses color names.
Defines words in terms of use (e.g., car, pencil).
Asks many questions (e.g., why, what, how).
Has 100% production and use of consonants.
Corrects own errors in pronunciation of new words.
Social behavior:Has sense of humor and self-laughing.
Is dogmatic and dramatic.
Shows urge to conform/ please is diminished.
May have control issues.
May be physically aggressive.
Is self-sufficient in own home.
Has nightmares.
May argue, boast, and make alibis.
Calls attention to own performance.
Bosses and criticizes others.
Rarely sleeps at nap time.
Separates from mother easily.
Often has “special” friend.
Prefers peers to adults.
Washes face, brushes teeth, and dresses self.
Uses bathroom unassisted

 

(Ref: Module on Early Childhood Development/Hand book)

 

Developmental milestone | CHAPTER 2 | Pediatric Nursing

 

Developmental Milestones of a Child at 5 Years:

Gross MotorBalances on one foot.
Skips smoothly.
Uses roller skates.
Rides bicycle with training wheels.
Balances on tiptoes.
Fine Motor“Handedness firmly established.
Colors within lines.
Cuts on line.
Copies circle, square, and triangle.”
Is not adept at pasting or gluing.
Draws within small areas..
Ties knot in string after demonstration.
Language development:Receptive Language
Listens briefly to what others say.
Understands 6,000 words.
Categories words.
Guesses object by attribute or use of clues (e.g., “What bounces?”)
Points to first and last in a line-up.
Expressive Language
Has vocabulary of 2,500-plus words.
Repeats days of the week by rote.
Defines words and asks for word meanings.
Acts out stories.
Gives rhyming word after example.
CognitiveIs often ready to enter kindergarten.
Appreciates past present, and future.
Can count 6 objects when asked, “How many?”
Begins to enjoy humorous stories and slapstick humor.
States address, age, name, and ages of siblings.
Acts out stories.
Learns left from right.
Matches 10-12 colors.
Predicts what will happen next.
School MilestonesPrints first name and simple words,
Writing is mostly capital letters.
Frequently copies left to right.
Reversals are common (c.g., writes b as d).
Reads letters in sequence.
Recognizes first name.
Recognizes several or all numerals on clock, phone, calendar.
Counts and points to 13 objects.
Writes 1-10 poorly-many reversals.
Adds and subtracts using 5 fingers.
Is capable of self-criticism.
Social development:Enjoys small group cooperative play often noisy.
Listens and participates in 20-minute group activity
Knows when certain events occur.
Accepts adult help and supervision.
Is serious, businesslike, and self-assured.
Wants to help and please adults.
Enjoys competitive exercise games.
Fears parental loss, thunder, and scary animals
More conscious of body, wants.
Respects peers and their property.

 

(Ref by: Module on Early Childhood Development/Hand book)

Danger Signs of Development;

By looking some of the signs at appropriate age one can assume that the child is not developing properly. These signs if present indicate developmental delay and requires immediate assessment and intervention with appropriate management preferably in a child development centre.

AgeDanger sign/Warning sign
By the age of one month
  • Poor suckling at the breast or refusing to suckle.
  • Little movement of arms and legs.
  • Little or no reaction to loud sounds or bright lights.
  • Crying for long periods for no apparent reason.
  • Vomiting and diarrhea, which can lead to dehydration
By the age of six months
  • Constant moving of the head (this might indicate an ear infection, also indicate deafness, blindness, mental retardation).
  • Little or no response to sounds familiar faces or the breast.
  • Refusing the breast or other food.
  • Absence of neck control, persistence of premature reflex
By the age of 12 months
  • Does not make sounds in response to others.
  • Does not look at objects that move.
  • Listless and does not respond to the care giver.
  • Has no appetite or refuses food.
By the age of two years
  • Lack of response to others.
  • Difficulty keeping balance while walking.
  • Injuries and unexplained changes in behavior. (Especially if the child has been cared for by others)
  • Lack of appetite.
By the age of three years
  • Loss of interest in playing.
  • Frequent falling.
  • Difficulty manipulating small objects.
  • Failure to understand simple messages.
  • Inability to speak using several words.
  • Little or no interest in food.
By the age of five years
  • Observe the roles children take in play. If the child is fearful, angry or ‘violent, these may be signs of emotional problems or abuse.

 

Assessment of Growth of a Child:

Height
  • At birth-50 cm
  • 1 year – 75 cm
  • 2 years-80 cm
  • 3 years increase 5 cm/year
WeightBirth weight: 2.5-4.0 kg

  • First 3 months: 30 g
  • 3-6 months: 20 g (birth weight doubles by 5-6 months of age)
  • 6-9 months: 15 g
  • 9-12 months: 12 g (birth weight triples by first birthday)
  • 1-3years: 8 g (around 3 kg/year). Birth weight quadruples by 2 years of age.
  • 4-6years: 6 g (around 2 kg/year); this rate of gain continues till the onset of puberty
Occiputo-frontal circumference
  • At birth-35 cm
  • Occiputo-frontal circumference
  • 1 year – 45 cm
  • 2 years-48 cm
Mid arm circumference
  • Normal> 13.5 cm
  • Borderline PEM-12.5-13.5 cm
  • Malnourished-< 12.5 cm

 

Definition of Child:

According to UN convention on the rights of children defines “all human offspring aged 0 to 18 years are children”.

Or

A child is a human being between the stages of birth and puberty. The legal definition of child generally refers to a minor, otherwise known as a person younger than the age of majority

Definition of Early Childhood:

According to UNESCO: Early childhood, defined as the period from birth to eight years old, is a time of remarkable growth with brain development at its peak. During this stage, children are highly influenced by the environment and the people that surround them.

Early Childhood Development:

According to WHO (World Health Organization): Early childhood development (ECD) encompasses physical, socio emotional, cognitive and motor development between 0-8 years of age.

Or

The development process that a child goes through the period from conception to age 8 years is termed as ‘Early childhood Development. This period is most vulnerable time to subsequent growth, development and ultimate productivity.

 

Developmental milestone | CHAPTER 2 | Pediatric Nursing

 

(Ref by-en.unesco.org www.who.int)

Factors Influencing Early Childhood Development:

Improper Speech and Language DevelopmentThere are several factors that can have a direct effect on a child’s speech and language development, it include-

  • Lack of stimulation,
  • Delayed motor skills,
  • Inadequate awareness of communication, reduced
  • hearing,
Parental Interactions
Parental interactions with children can have a largely positive or negative effect on child development. Parents who spend time playing and teaching their kids through reading and by performing various types of hands-on games and activities can have a positive impact on their child’s development.
Learning Environment
Children who are surrounded, both at home and at school/daycare facilities, by a strong learning environment that is both informative and supportive may improve their development
HealthProper nutrition can have a direct impact on a child’s development both physically and psychologically,
Social Interaction
Research has shown that social isolation or lack of socialization can lead to early childhood development issues, such as speech problems or an inability to socialize with others in a civilized way.
Others1 . Poverty
2.  Some population groups face considerable inability to access services related to:

  • Language barriers,
  • Transportation issues,
  • Availability of programs and services,
  • Cost

3. There is lack of coordination of services.
4. There are not enough human resources allocated to programs and services for early child development.

 

Importance of Early Childhood Development:

Evidence tells us that a person’s life successes, health and emotional wellbeing have their roots in early childhood. We know that if we get it right in the early years, we can expect to see children thrive throughout school and their adult lives.

Both nature and nurture (genes and environment) influence children’s development. The quality of a child’s earliest environments and the availability of appropriate experiences at the right stages of development are crucial determinants of the way each child’s brain architecture develops.

Caring and supportive environments that promote optimal early childhood development greatly increase children’s chances of a successful transition to school. This, in turn, promotes children’s chances of achieving better learning outcomes while at school and better education, employment and health after they have finished school.

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