Akanksha joshi child health nursing 3rd year

Child health nursing 5th semester

1. GROWTH AND DEVELOPMENT MILESTONES Submitted to- Ms Jaya Sharma Submitted by- Akanksha Joshi (ASST PROFESSOR)

2. Milestones are the accomplishment of different biological functions at an anticipated age, with a margin of few months on either side. The developmental milestones of children include following aspects: Physical development Motor : - Gross - Fine Sensory development Cognitive development Language development Social development

3. From Birth to 1 Year (Infants) Newborn PHYSICAL GROWTH Weight: Average birth weight of newborn is 2.5 kg.It decreases by 10% in first 10 days of life and then increases at the rate of 500-600g per month during first 6 months Length: At birth, the length of newborn is 45-50 cm. It increases approximately 2-2.5 cm per month during first 6 months. Head Circumference: At birth, it is approximately 33-35 cm and increases at the rate of 1.5 cm per month during first 6 months. Chest circumference: It is about 31-33 cm.Pulse rate is 130+20 beats/minute. Respiration is 35 + 10 breaths/minute. Blood pressure is 80/50 + 20/10 mm Hg. Reflexes: The baby has well-developed sucking, rooting, swallowing, and extrusion reflex. Baby also has Moro's, tonic neck, and crossed extensor reflex.

4. Motor development Gross motor -Lies in flexed position with hands clenched .Turns head when in prone position. -Head lags behind when baby is pulled up from supine to sitting position . Fine motor -Grasp reflex is strong. -Baby can grasp an object placed in hand but drops it immediately. Sensory development Protective blinking reflex is present. Indefinite stare at surroundings. Notices faces and bright objects but only if they arein line of vision.

5. Language development ■Startles to loud noises. ■Responds to human voice. ■Makes comfort sounds during feeding. ■Begins to coo. Newborn senses ■Touch ■Vision ■ HearingTaste ■Smell Touch ■ It is the most highly developed sense. ■ It is mostly at lips, tongue, ears, and forehead. ■ The newborn is usually comfortable with touch.

6. Vision ■Pupils react to light ■Bright lights appear to be unpleasant to newborninfant.Follow objects in line of vision. Hearing ■ The newborn infant usually makes some response to sound from birth. ■Ordinary sounds are heard well before 10 days of life. ■The newborn infant responds to sounds with cry or eye movement, cessation of activity, and/or startle reaction Taste ■ Well-developed as bitter and sour fluids are resisted while sweet fluids are accepted. Smell Only evidence in newborn infants search for the nipple, as he smell breast milk

7. 2 Months →Physical development ■Posterior fontanel closes at 6-8 weeks age. ■ Tears start appearing. ■ Drooling begins. ■Obligate (preferential) nose breathers . Motor development ■Gross motor -Less fixed prone position-arms flexed, hip flat, and legs extended. -Lifts head almost to 45° above flat surface when lying prone. ■ Fine motor - Hands may be open. - Holds a rattle when placed in hand. Sensory development ■ Turns head to side when sound occurs at ear level. ■Eyes follow moving objects and persons nearby. ■Visual acuity is hyperoptic. Language development ■ Laughs and squeals. ■Crying becomes differentiated, varying with reason for crying, e.g., hunger, sleep, pain, etc. ■Utters single vowel sounds such as "ah" and "eh“ Social development Smiles to mother/caregiver. ■Knows that cry will bring attention.

8. 3 Months Physical development ■ Flexion posture is reduced. ■ Grasping, crossed extensor and Moro's reflex disappears. ■ Landau reflex appears. Motor development ■ Gross motor -Able to lift head to 90° when in prone position. -Able to hold head erect but head still bobs forward. -Rolls over from back to side. ■ Fine motor -Can grasp a toy but lacks firm hold. -Hands open and closed loosely -Carries objects and hands to mouth at will. Sensory development -Turns head and looks in same direction to locate sound. -Blinks at objects that threaten the eyes -Beginning of ability to coordinate various sensory stimuli.

9. Language development -Cries less -Shows pleasure in making sound -Chuckles and coos. Social development -May laugh loud. -Looks in direction of speaker. 4 Months Physical development -Drooling indicates appearance of saliva. -Tonic neck and rooting reflex disappears. Motor development ■Gross motor -Holds head erect and steady when placed in sitting position -Sits for short time with adequate support. -Lifts head and shoulders at 90° when prone and looks around -Head lag disappears when pulled to sit.

10. Fine motor -Brings hands together in midline and plays with fingers. -Reaches for objects. Sensory development ■Follows objects to 180°. ■Fairly good binocular vision. ■Beginning of hand-eye coordination. Language development ■Utters two syllable vowel sounds. ■ Can vocalize consonants like "m, b, and g". ■ Responds differently to pleasant and angry voice . Social development -Initial social play by smiling

11. 11 Months Physical development ■Sleeps 14-16 hours per day and Motor development Gross motor -Stands erect with minimum support. -Walks holding on to furniture - Pushes toys. - Cruises well. Fine motor -Explore objects carefully. -Removes covers from boxes and takes toys out of box. -Beginning to hold pen and make marks on paper. Sensory development -Can follow rapidly moving objects. Language development -Responds to simple questions. -Understands simple directions. -Imitates specific sounds of others. Social development - Reacts to restriction with frustration. - Enjoy playing with empty dish and spoon after meals.

12. TODDLER (1-3YEARS) Physical development ■Has 16 temporary teeth. ■Weight gain is 1.8-2.7 kg. ■Average weight is 12 kg. ■Height increases about 10-12.5 cm of birth length. ■Pulse rate is 110 +20 beats/minute. ■Respiration is 26-28 breaths/minute. ■ Blood pressure is 100/65 +25/20 mm Hg. Motor development Gross motor -Steady gait. -Walks on heel-toe. -Walks up and down stairs holding wall. Fine motor -Picks up objects from floor. -Can build tower of six to seven cubes. -Imitates vertical line. -Drinks with glass. Language development ■ Enjoys story. ■ Knows at least four body parts.

13. PRE SCHOOLER(3-6 Years) Physical development ■ Weight is about 16 kg. ■Growth is slow. Motor development Gross motor - Catches bounced ball (two out of three tries). - Dresses without supervision. - Walks downstairs using alternate feet. Fine motor -Cuts pictures with scissors. -Copies a square. Cognitive development ■ Highly imaginative. ■ Obeys commands because of parents fear and not because of understanding between right and wrong. Language development Uses sentence of four to six words. ■ Questioning is at peak. Tells exaggerated stories. ■ Knows nursery rhymes and simple songs. Psychosocial development ■ Very independent. ■ Tends to be selfish and impatient.

14. SCHOOLER (6-11 Years ) Physical development ■ Weight is approximately 22-32 kg. ■ Height is approximately 121.5-136.5cm. ■Pulse is 85 ± 10 beats/minute. ■Respiration is 20 ± 3 breaths/minute. ■ Blood pressure is 102/60 ± 16/10 mm Hg. Motor development ■Gross motor -Performs tricks on bicycles. -Races. -Throws a ball skillfully and overhead. ■Fine motor -Uses both hands independently. -Cursive writing improved. Cognitive development ■ Interested in schoolwork. ■ Rebels against authority. Language development ■ Follows suggestions better then commands. ■ Is gregarious.

15. ADOLESCENCE (12-18 Years) ■ Weight Males: Approximately 38-60 kg. Females: Approximately 40-60 kg. ■ Height Males: Approximately 154-172 cm. Females: Approximately 153-167 cm. ■ Pulse: 65 ± 8 beats/minutes. ■ Respiration: 19 ± 3 breaths/minutes. ■ Blood pressure Male: 114/68 ± 10/14 mm Hg. Female: 112/66 ± 10/12 mm Hg. ■ Eruption of second molars. ■ Secondary sex characteristics develop. ❖ Motor development ■ Clumsiness due to rapid physical growth. ■Motor functions comparable to adults. ■Eye-hand coordination like adults. ■ Manual dexterity is attained . ❖ Cognitive development ■ Uses scientific method for problem-solving ■Generates hypotheses. ■ Uses scientific method for problem-solving.

16. ❖ Language development ■ Uses slangs within and outside peer group. ■ Uses distinct meanings for words. ❖ Psychosocial development ■Beginning of development of sense of identity. ■ Has intense loyalty to peer group.