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GROWTH AND DEVELOPMENT DURING INFANCY
GROWTH - denotes an increased physical size or a quantitative change.
DEVELOPMENT - indicates an increase in skill or the ability to function or a qualitative
change.
NEWBORN PERIOD
Observation of any asymmetric movement or altered muscle tone and function
may indicate a significant central nervous system abnormality or a nerve palsy resulting
from the delivery and requires further evaluation. Primitive neonatal reflexes are unique
in the newborn period and can further elucidate or eliminate concerns over asymmetric
function. The most important reflexes to assess during the newborn period are as
follows:
The Blink Reflex > to protect the eye from any object coming.
The Rooting Reflex > using hand stroke to find the nipple at feeding time.
The Sucking Reflex > when lips touched, make baby sucking motion
The Swallowing Reflex > gag, cough, sneeze to maintain clear airway.
The Palmar Grasp Reflex > grasp an object in their palm by quickly closing them.
The Babinski Reflex > newborn’s foot stroke “J” heel upward.
The Moro Reflex - or (startle) > stimulates the action of trying to ward of the attacker
and then covering up to protect the baby.
The Plantar Grasp Reflex > the based of the toes , the toes grasp like the finger.
1 MONTH OLD
PHYSICAL
● Weight gain of 150 to 210 g (5 to 7 oz) weekly for first 6 months ● Height gain of 2.5 cm (1 inch) monthly for first 6 months ● Head circumference increases by 1.5 cm (0.5 inch) monthly for first 6 months ● Primitive reflexes present and strong ● Doll's eye reflex and dance reflex fading ● Obligatory nose breathing (most infants) GROSS MOTOR ● Assumes flexed position with pelvis high but knees not under abdomen when prone ● Can turn head from side to side when prone; lifts head momentarily from bed ● Has marked head lag, especially when pulled from lying to sitting position ● Holds head momentarily parallel and in midline when suspended in prone position ● Assumes asymmetric tonic neck flex position when supine ● When held in standing position, body is limp at knees and hips ● In sitting position, back is uniformly rounded, with absence of head control FINE MOTOR ● Hands predominantly closed ● Grasp reflex strong ● Hand clenched on contact with rattle FINE MOTOR ● Hands predominantly closed ● Grasp reflex strong ● Hand clenches on contact with rattle SENSORY ● Able to fixate on moving object in range of 45 degrees when held at a distance of 20 to 25 cm ( 8 to 10 inches) ● Visual acuity approaches 20/ ● Follows light to midline ● Quiets when hear a voice VOCALIZATION ● Cries to express displeasure ● Makes small, throaty sounds ● Makes comfort sounds during feeding SOCIALIZATION AND COGNITION ● Is in sensorimotor phase—stage I, use of reflexes (birth to 1 month old), and stage II, primary circular reactions (1 to 4 months old) ● Watches parent's face intently as she or he talks to infant
2 MONTHS OLD PHYSICAL
● Posterior fontanel closed ● Crawling reflex disappears GROSS MOTOR
VOCALIZATION
● Squeals aloud to show pleasure ● Coos, babbles, chuckles ● Vocalizes when smiling “Talks” a great deal when spoken to ● Less crying during periods of wakefulness SOCIALIZATION AND COGNITION ● Displays considerable interest in surroundings ● Ceases crying when parent enters room ● Can recognize familiar faces and objects, such as feeding bottle ● Shows awareness of strange situations
4 MONTHS OLD PHYSICAL
● Drooling begins ● Moro, tonic neck, and rooting reflexes have disappeared GROSS MOTOR ● Has almost no head lag when pulled to sitting position ● Balances head well in sitting position ● Back less rounded, curved only in lumbar area ● Able to sit erect if propped up Able to raise head and chest off surface to angle of 90 degrees Assumes predominant symmetric position ● Rolls from back to side FINE MOTOR ● Inspects and plays with hands; pulls clothing or blanket over face in play ● Tries to reach objects with hand but overshoots ● Grasps object with both hands ● Plays with rattle placed in hand and shakes it but cannot pick it up if dropped ● Can carry objects to mouth SENSORY ● Able to accommodate to near objects ● Binocular vision fairly well established ● Can focus on a 1.25-cm (0.5- inch) block ● Beginning eye–hand coordination V OCALIZATIONS ● Makes consonant sounds n, k, g, p, b ● Laughs aloud • Vocalization changes according to mood SOCIALIZATION AND COGNITION ● Is in stage III, secondary circular reactions ● Demands attention by fussing; becomes bored if left alone ● Enjoys social interaction with people ● Anticipates feeding when sees bottle or mother if breastfeeding ● Shows excitement with whole body, squeals, breathes heavily ● Shows interest in strange stimuli ● Begins to show memory
5 MONTHS OLD PHYSICAL
● Beginning signs of tooth eruption ● Birth weight doubles GROSS MOTOR ● No head lag when pulled to sitting position ● When sitting, able to hold head erect and steady ● Able to sit for longer periods when back is well supported ● Back straight ● When prone, assumes symmetric positioning with arms extended ● Can turn over from abdomen to back ● When supine, puts feet to mouth FINE MOTOR ● Able to grasp objects voluntarily ● Uses palmar grasp, bi-dextrous approach Plays with toes ● Takes objects directly to mouth ● Holds one cube while regarding a second on SENSORY ● Visually pursues a dropped object ● Is able to sustain visual inspection of an object ● Can localize sounds made below ear VOCALIZATION ● Squeals ● Makes cooing vowel sounds interspersed with consonant sounds (e.g., ah-goo SOCIALIZATION AND COGNITION ● Smiles at mirror image ● Pats bottle or breast with both hands ● More enthusiastically playful but may have rapid mood swings ● Is able to discriminate strangers from family ● Vocalizes displeasure when object is taken away ● Discovers parts of body
6 MONTHS OLD PHYSICAL
● Growth rate may begin to decline ● Weight gain of 90 to 150 g (3 to 5 oz) weekly for next 6 months ● Height gain of 1.25 cm (0.5 inch) monthly for next 6 months ● Teething may begin with eruption of two lower central incisors ● Chewing and biting occur GROSS MOTOR ● When prone, can lift chest and upper abdomen off surface, bearing weight on hands ● When about to be pulled to a sitting position, lifts head ● Sits in high chair with back straight
● Transfers objects from one hand to the other ● Has uni-dextrous approach and grasp ● Holds two cubes more than momentarily ● Bangs cubes on table Rakes at a small object SENSORY ● Can fixate on very small objects ● Responds to own name ● Localizes sound by turning head in a curving arch ● Beginning awareness of depth and space ● Has taste preferences VOCALIZATION ● Produces vowel sounds and chained syllables—baba, dada, kaka ● Vocalizes four distinct vowel sounds ● “Talks” when others are talking SOCIALIZATION AND COGNITION ● Increasing fear of strangers; shows signs of fretfulness when parent disappears ● Imitates simple acts and noises ● Tries to attract attention by coughing or snorting ● Plays peek-a-boo ● Demonstrates dislike of food by keeping lips closed ● Exhibits oral aggressiveness in biting and mouthing ● Demonstrates expectation in response to repetition of stimuli
8 MONTHS OLD PHYSICAL
● Begins to show regular patterns in bladder and bowel elimination Parachute reflex appears GROSS MOTOR ● Begins to show regular patterns in bladder and bowel elimination ● Parachute reflex appears FINE MOTOR ● Has beginning pincer grasp using index, fourth, and fifth fingers against lower part of thumb Releases objects at will ● Rings bell purposely ● Retains two cubes while regarding third cube ● Secures an object by pulling on a string ● Reaches persistently for toys out of reach VOCALIZATION ● Makes consonant sounds t, d, w Listens selectively to familiar words ● Utterances signal emphasis and emotion ● Combines syllables, such as dada, but does not ascribe meaning to them SOCIALIZATION AND COGNITION ● Increasing anxiety over loss of parent, particularly mother, and fear of strangers ● Responds to word “no” ● Dislikes dressing, diaper change
9 MONTHS OLD PHYSICAL
● Eruption of upper lateral incisor may begin GROSS MOTOR ● Creeps on hands and knees ● Sits steadily on floor for prolonged time (10 minutes) ● Recovers balance when leaning forward but cannot do so when leaning sideways ● Pulls self to standing position and stands holding on to furniture FINE MOTOR ● Uses thumb and index finger in crude pincer grasp ● Preference for use of dominant hand now evident ● Grasps third cube ● Compares two cubes by bringing the SENSORY ● Localizes sounds by turning head diagonally and directly toward sound ● Depth perception increasing VOCALIZATION ● Responds to simple verbal commands ● Comprehends “no-no” SOCIALIZATION AND COGNITION ● Parent (mother) is increasingly important for own sake ● Shows increasing interest in pleasing parent ● Begins to show fears of going to bed and being left alone ● Puts arms in front of face to avoid having it washed
10 MONTHS OLD
● PHYSICAL
Labyrinth-righting reflex is strongest when infant is in prone or supine position; is able to raise head GROSS MOTOR ● Can change from prone to sitting position ● Stands while holding on to furniture; sits by falling down ● Recovers balance easily while sitting ● While standing, lifts one foot to take a step FINE MOTOR ● Crude release of an object beginning ● Grasps bell by handle VOCALIZATION ● Says “dada,” “mama” with meaning Comprehends “byebye” ● May say one word (e.g., “hi,” “bye,” “no”) SOCIALIZATION AND COGNITION ● Inhibits behavior to verbal command of “nono” or own name Imitates facial expressions; waves bye bye ● Extends toy to another person but will not release it
● Lumbar curve develops; lordosis evident during walking GROSS MOTOR ● Walks with one hand held ● Cruises well ● May attempt to stand alone momentarily; may attempt first step alone ● Can sit down from standing position without help FINE MOTOR ● Releases cube in cup ● Attempts to build two block tower but fails ● Tries to insert a pellet into a narrow-necked bottle but fails ● Can turn pages in a book, many at a time SENSORY ● Discriminates simple geometric forms (e.g., circle) ● Amblyopia may develop with lack of binocularity ● Can follow rapidly moving object ● Controls and adjusts response to sound; listens for sound to recur VOCALIZATION ● Says three to five words besides “dada,” “mama” ● Comprehends meaning of several words (comprehension always precedes verbalization) Recognizes objects by name Imitates animal sounds ● Understands simple verbal commands (e.g., “Give it to me,” “Show me your eyes”) SOCIALIZATION AND COGNITION ● Shows emotions, such as jealousy, affection (may hug or kiss on request), anger, fear ● Enjoys familiar surroundings and explores away from parent Is fearful in strange situation; clings to parent ● May develop habit of “security blanket” or favorite toy ● Has increasing determination to practice locomotor skills ● Searches for an object even if it has not been hidden but searches only where object was last seen
