1. Discuss the physical development for the age groups infant through adolescent.
2. Identify progression in growth and development for each age group.
3. Discuss the safety considerations and interventions needed by the various age groups.
4. Identify any special considerations for each age group listed.
5. List some of the educational needs of each age group.

AGE BIRTH TO 4 WEEKS                                                      

• PHYSICAL DEVELOPMENT
  • WEIGHT: Gains 5-7 ounces (0.14 - 0.19kg) per week during first month.
  • HEIGHT: Grows approximately 1 in. (2.5cm) during first month.
  • HEAD CIRCUMFERENCE: 13 - 14½ in. (33-37cm): generally ¾ inch larger than chest.
  • FONTANEL: Soft and flat.
  • FEEDING PATTERN: Breast: every 2 -3 hrs. Bottle: 3 - 4 ounces every 3 - 4 hours. (120cc/kg/24hrs.) STOOLS: 2 - 6 per day. Bottle fed: yellow & soft. Breast fed: yellow, soft, runny, seedy.
  • ABDOMEN: Soft and flat.
  • URINE: Voids at least six times per day.
  • COLOR: Lips, palms of hands, and soles of feet pink.
  • SKIN: Generally clear without rash. Milia (minute profuse yellow-white papules) frequently found on face. Mongolian spots common, especially in presacral area, on Black, Oriental, and East Indian infants.
  • SLEEP: Most of the time between feedings. Sleeps 3 - 4 hrs. at night.
  • CORD: Umbilicus clean, non-irritated. Cord should dry and fall off during first or second week of life.
  • EYES: Free of drainage or irritation.
  • MOUTH: Clean; may have nipple blister on lip.
  • PERINEUM: Non-irritated.
  • CIRCUMCISION SITE: clean, non- irritated.
• MOTOR CONTROL
  • Shows "Stepping Reflex" (alternate lifting of feet when held upright with feet kicking surface).
  • Shows palmar grasp and plantar grasp.
  • Shows "Placing Reflex" (infant lifts foot & places it back down when stimulated on dorsum of foot).
  • Shows "Startle Reflex - Moro Reflex" (generalized activity in response to stimulation).
  • Shows "Rooting Reflex" (head turns toward anything which touches cheek).
  • Shows strong suck and gag reflex (after first week of life).
  • Makes crawling movements when prone on a flat surface. Pushes with toes and holds hands in fists.
  • Lifts head intermittently, though unsteady, when in prone position.
  • Turns head to side when prone.
  • Stares at surroundings.
  • Notices faces and bright objects, but only if in line of vision.
• COMMUNICATION/PLAY/ SOCIALIZATION
  • Utters throaty noises, smacks lips.
  • Smiles randomly: reduces activity in response to sounds.
  • Cry is strong and lusty when hungry or uncomfortable.
  • Music (music boxes, soft radio music, singing).
  • Rocking.
  • Baby enjoys being held, cuddled, touched, talked to and smiled at.
  • Shows subtle cues of recognition of parents.
• SAFETY CONSIDERATIONS/ INTERVENTIONS                                    
• Requires car seat for safe travel in automobile (until weight reaches 40 pounds).
• Educate parents about management of airway obstruction.
• Involve parents in procedures.
• Keep parent in infant's line of vision.
• Limit number of strangers caring for infant.
• Give familiar objects to the infant.
• Cuddle and hug the infant.
• Use distractions (pacifier, bottle, etc.).
• Keep crib siderails up at all times.
• Make sure toys do not have removable parts & check for safety approval.
• Have bulb syringe available in case there is a need for suctioning.
• Ask parents about immunization history.
• Encourage parents to assist in care.
• If teaching procedures, provide opportunities for parent/caregiver to return demonstrate.
• Allow time for parent/caregiver to ask questions.
• Assess for & provide support in managing pain. Use oral route if possible.

• PHYSICAL DEVELOPMENT
  • WEIGHT: Gains 5 - 7 ounces (0.14 - 0.19kg) per week during second month.
  • HEIGHT: Grows approximately 1 inch (2.54cm) during the second month.
  • HEAD CIRCUMFERENCE: 13 ½ - 15 ½ inches (34.2 - 39.4cm). FONTANEL: Soft and flat.
  • FEEDING PATTERN: Breast: every 2 - 4 hours. Bottle: 3 - 4 ounces every 3 - 4 hrs. (120 cc/kg/day).
  • STOOLS: 2 - 6 per day. Bottle fed: yellow & soft. Breast fed: yellow, soft, runny, seedy.
  • ABDOMEN: Soft and flat.
  • URINE: Voids at least 6 times per day.
  • COLOR: Lips, palms of hands, and soles of feet pink.
  • SKIN: Clear without rash. Milia clearing.
  • SLEEP: Increasing periods of wakefulness without crying. Sleeps for 4 - 10 hour intervals at night with frequent naps during day.
• MOTOR CONTROL
  • Moro and rooting reflexes and plantar and palmar grasp persist. Stepping and placing reflexes fade.
  • Kicks vigorously. Energetic arm movements.
  • Vigorous head turning.
  • Head does not droop when held prone.
  • When lying prone, infant lifts head so forehead makes 45 degree angle with floor.
  • Head control still absent. When held in sitting position, infant holds head erect, but head bobs.
  • Hands not clenched; often held open.
  • Hand often goes to mouth.
  • When lying supine, likely to turn head to one side.
  • Displays "Larval Reach" (coordinate but incomplete motions of arms and hands in response to sight of objects moving nearby).
• COMMUNICATION/PLAY/ SOCIALIZATION
  • Vocalizes with small throaty sounds. Gurgles in response to human voice.
  • Regards face intently: decreases activity to look at face.
  • Cries as means to obtain social stimulation: has special cry for hunger, pain, etc.
  • Movement of eyes, respiratory rate and activity level change with new sounds.
  • Begins to smile at 6-8 weeks, in response to environment stimulation or human face.
  • Begins to follow objects (follows for 180 degrees, beginning at 90 degrees from midline).
  • Produces short vowel sounds, sometimes repeats the same syllable or sound while vocalizing.
  • Baby responds to and enjoys:
    • - mobiles with large and bright colored objects
    • - human faces
    • - being held, rocked, cuddled
• SAFETY CONSIDERATIONS/ INTERVENTIONS                                   
• Requires car seat for safe travel in automobile (until weight reaches 40 lbs).
• Educate parents about management of airway obstruction.
• Involve parents in procedures.
• Keep parent in infant's line of vision.
• Limit number of strangers caring for infant.
• Give familiar objects to the infant.
• Cuddle and hug the infant.
• Use distractions (pacifier, bottle, etc.).
• Keep crib siderails up at all times.
• Make sure toys do not have removable parts & check for safety approval.
• Have bulb syringe available in case there is a need for suctioning.
• Ask parents about immunization history.
• Encourage parents to assist in care.
• If teaching procedures, provide opportunities for parent/caregiver to return demonstrate.
• Allow time for parent/caregiver to ask questions.
• Assess for & provide support in managing pain. Use oral route if possible.

• PHYSICAL DEVELOPMENT
  • WEIGHT: Gains 5 - 7 ounces (0.14 - 0.19kg) per week during the 2nd & 3rd month.
  • HEIGHT: Grows approximately 1 in. (2.5cm) during 2nd & 3rd month.
  • HEAD CIRCUMFERENCE: 14 ¾ - 17 inches (37.5 - 43.1cm).
  • FONTANEL: Posterior fontanel closes.
  • FEEDING PATTERN: Breast: every 2 hrs. Bottle: 3 - 4 ounces every 3 - 4 hours (120cc/kg/day).
  • STOOLS: 2 - 6 per day. Bottle fed: yellow & soft. Breast fed: yellow, soft, runny, seedy.
  • ABDOMEN: Soft and flat.
  • URINE: Voids at least 6 times per day.
  • COLOR: Lips, palms of hands, and soles of feet pink.
  • SKIN: Clear without rash.
  • SLEEP: May give up night feedings; naps morning and afternoon; is awake longer periods of time.
  • IMMUNIZATIONS: Diphtheria/ tetanus, pertussis (DPT) and oral polio vaccine (OPV), usually recommended at 2 months & 4 months of age.
• MOTOR CONTROL
  • Shows "Tonic Neck Reflex" (head turned to one side, arm on same side extended, and opposite arm reflexed to shoulder).
  • Moro reflex fades.
  • Rhythmic suckle feeding pattern apparent; strong gag reflex.
  • Turns from side to side.
  • Holds head erect and steady.
  • Raises chest, usually supported on forearm.
  • Holds objects for brief period.
  • Follows a moving light or object with his/her eyes.
  • Holds hands in front: plays with fingers.
• COMMUNICATION/PLAY/ SOCIALIZATION
  • Smiles in response to another's smile (especially parent).
  • Responds differently to familiar voices: angry vs. friendly tones.
  • Babbles; playful repetition of some sounds.
  • Responds to selected sounds by stopping activity and listening.
  • Looks around in search of speaker: watches speaker's face or mouth.
  • Uses sucking to soothe self.
  • Shows awareness of own sounds; takes turns when vocalizing between infant and caregiver.
  • New activities that baby responds to and enjoys:
  • - increased contact with family members
  • - rattles easily grasped objects
  • - free motor play
• SAFETY CONSIDERATIONS/ INTERVENTIONS
• Requires car seat for safe travel in automobile (until weight reaches 40 lbs).
• Instruct parents not to leave infant unattended on a flat surface without siderails.
• Educate parents about management of airway obstruction.
• Involve parents in procedures.
• Keep parent in infant's line of vision.
• Limit number of strangers caring for infant.
• Give familiar objects to the infant.
• Cuddle and hug the infant.
• Use distractions (pacifier, bottle, etc.).
• Keep crib siderails up at all times.
• Make sure toys do not have removable parts & check for safety approval.
• Have bulb syringe available in case there is a need for suctioning.
• Ask parents about immunization history.
• Encourage parents to assist in care.
• If teaching procedures, provide opportunities for parent/caregiver to return demonstrate.
• Allow time for parent/caregiver to ask questions.
• Assess for & provide support in managing pain. Use oral route if possible.

• PHYSICAL DEVELOPMENT
  • WEIGHT: Doubles birth weight. Gains 5 - 7 ounces (0.14 - 0.19kg) per week during the 4th & 5th month.
  • HEIGHT: Grows approximately 1 inch (2.5cm) during the 4th & 5th month.
  • HEAD CIRCUMFERENCE: 15¾ - 18¼ inches (40.3 - 46.4cm).
  • FEEDING PATTERN: Breast: every 2 - 4 hrs. Bottle: 4 - 6 ounces four times a day (100cc/kg/day).
  • STOOLS: 1 - 4 per day. Bottle fed: yellow & soft. Breast fed: yellow, soft, runny, seedy.
  • URINE: Voids 4 - 6 times per day.
  • COLOR: Lips, palms of hands, and soles of feet pink.
  • SKIN: Clear without rash.
  • SLEEP: Should sleep 10 - 12 hours at night with naps in morning and afternoon.
  • DENTAL: Drooling common, beginning at 3 - 4 months of age. Tooth eruption may begin.
  • IMMUNIZATIONS: DPT recommended at 4 & 6 months of age. OPV recommended at 6 months of age.
• MOTOR CONTROL
  • Rooting and tonic neck reflexes fade. Palmar grasp fades. Gag reflex less strong.
  • Holds head steady when in sitting position.
  • Shows no head lag when pulled to sitting position.
  • Lifts head and shoulders at 90 degree angle when prone and looks around.
  • Can turn from back to side, begins to roll over.
  • Sits with support: enjoys being propped up.
  • Uses thumb in partial opposition to fingers more skillfully: grasps with whole hand.
  • Reaches for objects effectively.
  • Transfers objects from hand to hand.
  • Turns and manipulates objects.
• COMMUNICATION/PLAY/ SOCIALIZATION
  • Recognizes familiar objects and voices.
  • Begins to listen selectively to familiar words, such as "mama" and "doggie," that are accompanied by consistent information.
  • Laughs aloud.
  • May vocalize to interrupt another's conversation.
  • Vocalizes eagerness for spoon.
  • Babbles, coos, and gurgles when talked to.
  • Enjoys having people around and enjoys being talked to.
  • Turns to source of sound.
  • Baby responds to and enjoys:
  • - increased contact with family members
  • - free motor play
  • - mirror play
  • - soft, large toys
  • - plastic rings, blocks, keys
  • - aprons, pots, pans
  • - banging toys
• SAFETY CONSIDERATIONS/ INTERVENTIONS
• May roll off of bed or furniture.
• May put small or sharp objects in mouth.
• Requires car seat for safe travel in automobile (until weight reaches 40 lbs).
• Time to "baby - proof" the environment:
• -electrical safety
• -poison control
• -eliminating hazardous objects from infant's reach
• -stair guard
• Involve parents in procedures.
• Keep parent in infant's line of vision.
• Limit number of strangers caring for infant.
• Give familiar objects to the infant.
• Cuddle and hug the infant.
• Use distractions (pacifier, bottle, etc.).
• Keep crib side rails up at all times.
• Make sure toys do not have removable parts & check for safety approval.
• Have bulb syringe available in case there is a need for suctioning.
• Ask parents about immunization history.
• Encourage parents to assist in care.
• If teaching procedures, provide opportunities for parent/caregiver to return demonstrate.
• Allow time for parent/caregiver to ask questions.
• Assess for & provide support in managing pain. Use oral route if possible.

• PHYSICAL DEVELOPMENT
  • WEIGHT: Gains 3 - 5 ounces (0.08 - 0.14kg) per week during the 6th & 7th month.
  • HEIGHT: Grows approximately ½ inch (1.25cm) per month.
  • HEAD CIRCUMFERENCE: 16¼ - 18½ inches (41.3-47cm).
  • FEEDING PATTERN: Breast: every 4 - 6 hrs. Bottle: 6 - 8 ounces four times per day. May drink from cup with assistance. May begin solids and finger foods.
  • STOOLS: Soft, formed. Color and consistency varies with intake. 1 - 2 times per day.
  • URINE: Voids 4 - 6 times per day.
  • COLOR: Lips, palms of hands, and soles of feet pink.
  • SKIN: Clear without rash.
  • SLEEP: Sleeps 10 - 12 hours at night. Generally naps morning and afternoon.
  • DENTAL: First tooth eruptions common.
  • IMMUNIZATIONS: DPT recommended at 6 months of age.
• MOTOR CONTROL                                                                   
  • Sits alone steadily.
  • Bears weight when standing.
  • Plays with feet.
  • May pull self to sitting position.
  • Bangs with object held in hand.
  • May begin crawling or creeping.
  • Chews with munching pattern.
  • Rooting reflex gone.
• COMMUNICATION/PLAY/ SOCIALIZATION
  • Vocalizes attitudes.
  • Babbles.
  • Demonstrates excitement.
  • Vocalizes syllable sounds (e.g., Ba, Ma, Da).
  • Cries on provocation.
  • If child makes sound and adult imitates, child will imitate adult.
  • Imitates some gestures.
  • Responds to own name by vocalizing or ceasing activity.
  • Begins to turn head to side on hearing sounds.
  • Attends to sights and sounds in environment.
  • May begin imitating acts, such as pat - a - cake and sound sequences such as "oh - oh."
  • Begins to show fear and separation anxiety.
  • Begins to show physical demonstration of frustrations.
• SAFETY CONSIDERATIONS/ INTERVENTIONS
• May put small or sharp objects in mouth.
• May explore environment without apparent fear.
• Requires car seat for safe travel in automobile (until weight reaches 40 lbs).
• Time to "baby - proof" the environment:
• - electrical safety
• - poison control
• - eliminating hazardous objects from infant's reach
• - stair guard
• Involve parents in procedures.
• Keep parent in infant's line of vision.
• Limit number of strangers caring for infant.
• Give familiar objects to the infant.
• Cuddle and hug the infant.
• Use distractions (pacifier, bottle, etc.).
• Keep crib siderails up at all times.
• Make sure toys do not have removable parts & check for safety approval.
• Have bulb syringe available in case there is a need for suctioning.
• Ask parents about immunization history.
• Encourage parents to assist in care.
• If teaching procedures, provide opportunities for parent/caregiver to return demonstrate.
• Allow time for parent/caregiver to ask questions.
• Assess for & provide support in managing pain. Use oral route if possible.

AGE 9 to 12 MONTHS                                              

• PHYSICAL DEVELOPMENT
  • WEIGHT: Triples birth weight.
  • HEIGHT: Approximately 29 in. (74cm). Grows approximately 1.2 inch (2.8cm) per month.
  • HEAD CIRCUMFERENCE: Equal to chest circumference.
  • FEEDING PATTERN: Breast: every 4 - 6 hrs. Bottle: 6 - 8 ounces four times per day. Uses cup and spoon with some spilling. Lips close around spoon. Tongue may be under rim of cup when drinking. Takes 3 meals per day plus snacks. May begin weaning from breast or bottle.
  • STOOLS: Soft, formed. Color and consistency varies with intake. 1 - 2 times per day. URINE: Voids 4 - 6 times per day.
  • COLOR: Lips, palms of hands, and soles of feet pink.
  • SKIN: Clear without rash.
  • SLEEP: Sleeps 10 - 12 hours at night. May need only one nap.
  • DENTAL: May have several teeth. May get first molar.
  • IMMUNIZATIONS: Tuberculosis skin test recommended. Physician may recommend Hemophilus Influenza B (HIB) vaccine.
• MOTOR CONTROL
  • Crawls.
    
  • Creeps.
• Pulls self upright in crib.
• Stands with support or alone.
• Plantar grasp fades.
• Uses index finger and thumb to hold objects.
• Good hand/mouth coordination.
• Bangs two objects together.
• Cruises (walks sideways holding onto crib or furniture).
• May walk alone.
• Has poor sense of balance.
• Sits down from standing position.
• Has midline skills (e.g., pat - a - cake).

• COMMUNICATION/PLAY/ SOCIALIZATION
  • Imitates sounds introduced by others.
  • Says "Mama" & "Dada" nonspecifically.
  • Responds to own name.
  • Imitates gestures and facial expressions. Smiles at image in mirror.
  • Plays "peek - a boo."
  • Shakes head for "no."
  • Initiates communication by reaching out arms to be picked up.
  • Responds to verbal request for activity such as "Open your mouth."
  • Stops activity in response to "No."
  • "Jabbers" expressively, talking to toys or people throughout the day, using long verbal patterns.
  • Recognizes the meaning of "no - no."
  • Speech development may slow temporarily when walking begins.
  • Shows emotion such as jealousy, affection, anger.
  • Follows simple directions (e.g., "Give it to me," "come here") given with gestures.
  • Begins to recognize own body parts.
  • Shows fear of strange voices.
• SAFETY CONSIDERATIONS/ INTERVENTIONS                                  
• Puts small or sharp objects in mouth.
• Falls easily.
• Cannot differentiate harmful substance.
• Requires car seat for safe travel in automobile (until weight reaches 40 lbs).
• "Baby - proof" the environment:
• Baby especially enjoys opening cupboards and drawers.
• Insure that grandparents and other caregivers take steps to make environment safe.
• Involve parents in procedures.
• Keep parent in infant's line of vision.
• Limit number of strangers caring for infant.
• Give familiar objects to the infant
• Cuddle and hug the infant.
• Use distractions (pacifier, bottle, etc.).
• Keep crib siderails up at all times.
• Make sure toys do not have removable parts & check for safety approval.
• Have bulb syringe available in case there is a need for suctioning.
• Ask parents about immunization history.
• Encourage parents to assist in care.
• If teaching procedures, provide opportunities for parent/caregiver to return demonstrate.
• Allow time for parent/caregiver to ask questions.
• Assess for & provide support in managing pain. Use oral route if possible.

AGE 12 to 15 MONTHS

• PHYSICAL DEVELOPMENT
  • WEIGHT: Gains approximately ½ pound (0.2kg) per month.
  • HEIGHT: Grows approximately 1½ inches to 2 inches (3.8 - 5.1cm) during these months.
  • HEAD CIRCUMFERENCE: 17½ - 19¾ inches (44.5 - 50.2cm).
  • FONTANEL: Anterior fontanel may close between 12 - 24 months.
  • FEEDING PATTERN: Eats three meals per day plus snacks. Drinks well from a cup. Uses a spoon without difficulty. May begin to tolerate cow's milk.
  • STOOLS: Soft, formed. Color varies with intake. 1 - 2 times per day.
  • URINE: Voids 4 - 6 times per day.
  • SKIN: Clear without rash.
  • SLEEP: Sleeps 10 - 12 hours at night. Generally takes one nap. May have night fears.
  • DENTAL: First molars likely to erupt.
  • IMMUNIZATIONS: Measles/mumps/rubella (MMR) vaccine recommended at 15 months.
• MOTOR CONTROL
• Walks alone.
• May walk sideways and backward.
• Creeps upstairs.
• Builds a tower of two or more blocks.
• Throws a ball.
• Child responds to and enjoys:
• - contact with family members
• - being the center of attention
• - brightly colored objects
• - busy boxes, toys requiring manipulation
• - music and rhythm
• - outdoor activity
• - opening and closing cupboards and drawers and exploring contents
• - security objects
• - water play
• - looking at pictures and turning pages of books

• COMMUNICATION/PLAY/ SOCIALIZATION
  • Knows 2 - 3 words.
  • "Jabbers" expressively.
  • Recognizes the meaning of "no - no."
  • Often points to desired objects to communicate wants.
  • Responds to "What's this?" by naming simple object or by "jabbering."
  • Responds to simple commands such as "Give me ______."
  • Has increased periods of play activity.
  • Demonstrates object permanence (looks for object lost out of sight).
  • Concerned only with self.
  • Shows emotions such as jealousy, affection, anger.
  • Shows physical expression of frustration.
  • May indicate when diaper is wet.
  • Imitates simple acts.
  • Understands arrival signals (e.g., knock, doorbell).
  • Understands names of toys or people.
• SAFETY CONSIDERATIONS/ INTERVENTIONS
  • Puts small or sharp objects in mouth.
  • Explores environment without apparent fear.
  • Falls easily.
  • Cannot differentiate harmful substances.
  • Requires car seat for safe travel in automobile (until weight reaches 40 lbs).
  • "Baby - proof" the environment if not already done.
  • Use firm, direct approach.
  • Use distraction techniques.
  • Give one direction at a time.
  • Prepare child shortly before a procedure.
  • Allow choices when possible.
  • Emphasize those aspects that require the child's cooperation.
  • Provide favorite, age - specific food.
  • Allow for rest period after eating based on home routines to the degree possible.
  • Skills may regress due to illness/ hospitalization.
  • Emphasize the importance of parent staying with child at night.
  • Follow home routines if possible. Set limits.
  • Give permission to express feelings.
  • Maintain safety at all times.

AGE 15 to 18 MONTHS                                                            

• PHYSICAL DEVELOPMENT
  • WEIGHT: Gains approximately 1 - 2 pounds (.02 - .09kg) per month during these months.
  • FEEDING PATTERN: Eats three meals per day plus snacks. Drinks from a cup. Continues to spill from a spoon.
  • STOOLS: Soft, formed. Color varies with intake. 1 - 2 times per day.
  • URINE: Voids 4 - 6 times per day.
  • SKIN: Clear without rash.
  • SLEEP: Sleeps 10 - 12 hours at night. May need only one nap. May resist sleep.
  • DENTAL: Continue teething. Thumb and finger sucking common.
  • IMMUNIZATIONS: DTP & OPV recommended once during these months.
• MOTOR CONTROL
  • Sense of balance is improved.
  • May begin running.
  • Climbs stairs with help.
  • Stoops to pick up toys.
  • Builds a tower with three or more blocks.
  • Pulls toys.
• COMMUNICATION/PLAY/ SOCIALIZATION
• Knows 3 - 20 words.
• Uses Jargon.
• Shakes or nods head to yes or no questions.
• Recognizes pictures when named.
• Comprehends up to 50 words.
• Begins repeating words overheard in conversation.
• The child responds to and enjoys:
• - solitary play
• - watching others play
• - running - water play
• - riding toys
• - outdoor activities
• - throwing
• - scribbling
• - looking at books
• - repetitive songs and toys
• - pull and push toys
• - shifts attention from one thing to another
• - responds to simple commands without gesture attached

• SAFETY CONSIDERATIONS/ INTERVENTIONS
  • Puts small or sharp objects in mouth.
  • Explores environment without apparent fear.
  • Cannot differentiate actions that are dangerous.
  • Requires car seat for safe travel in automobile (until weight reaches 40 lbs).
  • Use firm, direct approach.
  • Use distraction techniques.
  • Give one direction at a time.
  • Prepare child shortly before a procedure.
  • Allow choices when possible.
  • Emphasize those aspects that require the child's cooperation.
  • Provide favorite, age - specific food.
  • Allow for rest period after eating based on home routines to the degree possible.
  • Skills may regress due to illness/ hospitalization.
  • Emphasize the importance of parent staying with child at night.
  • Follow home routines if possible. Set limits.
  • Give permission to express feelings.
  • Maintain safety at all times.

• PHYSICAL DEVELOPMENT
  • WEIGHT: Gains approximately ½ pound (.02kg) per month.
  • HEIGHT: Grows approximately 1½ inches to 2 inches (3.8 - 5.1cm) during these months.
  • FEEDING PATTERN: Eats three meals per day plus snacks. Drinks well from a cup. Uses a spoon without difficulty.
  • STOOLS: Soft, formed. Color varies with intake. 1 - 2 times per day.
  • URINE: Voids 4 - 6 times per day.
  • SKIN: Clear without rash.
  • SLEEP: Sleeps 10 - 12 hours at night. May need only one nap. May have night fears.
  • DENTAL: Has approximately 16 teeth. Secondary molars may erupt.
• MOTOR CONTROL
• Walks up and down stairs; begins to alternate feet.
• Runs. Kicks a ball.
• Builds a tower of eight blocks or more.
• Scribbles.
• Jumps in place and from low objects.
• Controlled bite on hard cookie.
• Child responds to and enjoys:
• - parallel play
• - toys that make noise, riding toys
• - listening to stories and looking at books
• - repetitive songs and poems
• - water play; sand box play
• - large puzzles
• - pouring from one container to another
• - climbing and jumping outdoor activities

• COMMUNICATION/PLAY/ SOCIALIZATION
  • Talks in 2 word combinations (builds vocabulary to 300 words).
  • Speech very imitative.
  • Points correctly to parts of body (names 4 by age 2).
  • Responds to "where" questions by pointing.
  • Uses pronouns "mine" or "me."
  • Verbalizes needs.
  • Demonstrates understanding of personal pronouns such as "me," "her," "you."
  • Carries out two directions with an object.
  • Uses Jargon and true words to tell about experience.
  • Obeys simple commands.
  • Fears parents leaving.
  • Has strong sense of "mine."
  • Has a favorite toy or object for bed. Has many demands before bed.
  • Behaves as if other children were physical objects. May hug or push them.
  • May become less compliant; may tantrum.
  • Helps with dressing.
  • Does not readily ask for help.
• SAFETY CONSIDERATIONS/ INTERVENTIONS
  • Puts objects in mouth.
  • Explores environment without apparent fear.
  • Cannot differentiate actions that are dangerous.
  • Requires car seat for safe travel in automobile (until weight reaches 40 lbs).
  • Use firm, direct approach.
  • Use distraction techniques.
  • Give one direction at a time.
  • Prepare child shortly before a procedure.
  • Allow choices when possible.
  • Emphasize those aspects that require the child's cooperation.
  • Provide favorite, age - specific food.
  • Allow for rest period after eating based on home routines to the degree possible.
  • Skills may regress due to illness/ hospitalization.
  • Emphasize the importance of parent staying with child at night.
  • Follow home routines if possible. Set limits.
  • Give permission to express feelings.
  • Maintain safety at all times.

• PHYSICAL DEVELOPMENT
  • WEIGHT: Gains approximately 3 - 5 pounds (1.4 - 2.3kg) per year.
  • HEIGHT: Grows approximately 2 to 2½ inches (5.1 - 6.4cm) per year.
  • FEEDING PATTERN: Eats three meals per day plus snacks. Uses a fork.
  • STOOLS: Soft, formed. Color varies with intake. 1 - 2 times per day.
  • URINE: Voids 4 - 6 times per day.
  • SLEEP: Sleeps 10 - 12 hours at night. May wet bed. May have night fears. May resist naptime.
  • DENTAL: Has full set of 20 teeth.
• MOTOR CONTROL
• Jumps in place and from low objects.
• Walks on tiptoes.
• Stands on one foot.
• Throws objects overhead.
• Uses scissors.
• Learning to copy a circle, square, and cross.
• Tries to draw a human body.
• Strings beads.
• Pours liquid from a pitcher.
• Puts on shoes; attempts to tie shoelaces.
• Limited understanding of time.
• Begins asking about sex differences (age 4).
• Child responds to and enjoys:
• - playing with peers
• - imitative play
• - having stories read
• - riding toys and tricycles
• - showing off accomplishments
• - making up stories and relaying fantasies
• - outdoor activities; water play
• - building with blocks
• - coloring, cutting
• - scribbling, painting and finger painting

• COMMUNICATION/PLAY/ SOCIALIZATION
  • 2 - 3 years: Speech 50% intelligible.
  • Talks in 3 - 4 word combinations.
  • Uses plural and pronouns.
  • Builds vocabulary to 900 words.
  • Follows 2-step command.
  • Identifies "big" and "little."
  • Answers "where" questions.
  • Regularly relates experiences from recent past.
  • Understands long and some complex sentences.
  • Understands prepositions such as "on" and "under." 3 - 4 years:
  • Speech 75% intelligible.
  • Talks in 4 - 6 word sentences.
  • Knows first and last name
  • Begins to tell stories about pictures.
  • Can answer "how much?" and "how many?"
  • Understands "on," "under," "in front," and "in back."
  • Uses past tense.
  • Identifies people in picture.
  • Can answer more abstract questions.
  • Comprehends physical needs like sleepy, hungry.
  • Uses play to learn, express self and work out fears.
  • Temper tantrums and negative behavior may continue; should decrease by age 4.
  • Has routine behaviors established.
• SAFETY CONSIDERATIONS/ INTERVENTIONS
  • Puts objects in mouth.
  • Explores environment without apparent fear.
  • Cannot differentiate actions that are dangerous.
  • Requires car seat for safe travel in automobile (until weight reaches 40 lbs).
  • Explain procedures, unfamiliar objects.
  • Demonstrate use of equipment.
  • Encourage child to verbalize.
  • Use doll/puppets for explanations when performing procedure.
  • Involve the child whenever possible.
  • Maintain safety at all times.
  • Provide rest periods.
  • Assess and manage pain:
  • Offer distractions, e.g., count to 20. Allow to chose the site for injection. Offer a badge of courage (stickers, etc.).
  • Focus on one thing at a time.
  • Give permission to express feelings.
  • Praise for good behavior.
  • Limit movement restrictions.

• PHYSICAL DEVELOPMENT
  • WEIGHT: Gains approximately 3 - 5 pounds (1.4 - 2.3kg) per year.
  • HEIGHT: Grows approximately 1½ to 2½ inches (3.8 - 6.4cm) per year.
  • BLOOD PRESSURE: 80/120 50/80
  • FEEDING PATTERN: Eats three meals per day plus snacks. Uses eating utensils.
  • SLEEP: Sleeps 11 - 12 hours at night. May no longer need a nap. May still have night fears.
  • IMMUNIZATIONS: DTP and OPV recommended during this time.
• MOTOR CONTROL
  • AGE 4:
  • Jumps and climbs well.
  • Can go up and down stairs without using the railing.
  • Throws a ball overhead.
  • Uses scissors to cut out pictures.
  • Copies a circle, square and cross.
  • AGE 5:
  • Skips on alternate feet.
  • Can walk on heels or toes.
  • Can hop well.
  • Can form some letters correctly.
  • Draws a recognizable picture.
  • Catches a bounced ball.
• Self Help:
  • Can fasten buttons on front of clothes.
  • Dresses with minimal supervision.
  • Can brush own teeth.
• COMMUNICATION/PLAY/ SOCIALIZATION
• AGE 4:
• Vocabulary of 1500 words or more.
• Speech 90 - 100% intelligible.
• Can name colors.
• Can name three objects in succession.
• Picks longest of three lines.
• Can count to 5; is learning number concept.
• Comprehends opposites.
• Comprehends "cold," "tired," "hungry."
• Comprehends simple explanations.
• AGE 5:
• Vocabulary of approximately 2100 words.
• Repeats sentences of ten syllables or more.
• Very talkative.
• Asks meaning of words.
• Knows days of week.
• Counts ten objects.
• Can follow three directions given in succession.
• Begins to know the names of coins.
• Communicates in connected sentences that are appropriately sequenced.
• Uses play to learn, express self, and work out fears.
• Plays with peers.
• Enjoys outdoor activities.
• Plays simple board games.
• Marches/sings. Enjoys rhymes/riddles.
• Pretends.
• Increasing independence & beginning to assert self, likes to boast & tattle.
• Masters new tasks & acquires new skills.
• Behavior is modified by rewards & punishments.

• SAFETY CONSIDERATIONS/ INTERVENTIONS
  • Has difficulty differentiating reality from fantasy.
  • Begins differentiating actions that are dangerous.
  • Seat belt use required for safe travel in car.
  • Explain procedures, unfamiliar objects.
  • Demonstrate use of equipment.
  • Encourage child to verbalize.
  • Use doll/puppets for explanations when performing procedure.
  • Involve the child whenever possible.
  • Maintain safety at all times.
  • Provide rest periods.
  • Assess and manage pain:
  • Offer distractions, e.g., count to 20. Allow to chose the site for injection. Offer a badge of courage (stickers, etc).
  • Focus on one thing at a time.
  • Give permission to express feelings.
  • Praise for good behavior.
  • Limit movement restrictions.

• PHYSICAL DEVELOPMENT
  • WEIGHT: Gains approximately 3 - 5 pounds (1.4 - 2.3kg) per year.
  • HEIGHT: Grows approximately 1½ to 2½ inches (3.8 - 6.4cm) per year.
  • BLOOD PRESSURE: 120/80-80/50
  • FEEDING PATTERN: Eats three meals per day plus snacks.
  • SLEEP: Sleeps 10 - 12 hours at night. May still have night fears.
  • DENTAL: Loss of "baby" teeth and eruption of permanent teeth begins.
  • GENERAL HEALTH: Exposure to contagious disease increases.
• MOTOR CONTROL
  • Balance improves.
  • Climbs, skips, hops and gallops well.
  • Appears to be in constant motion.
  • May jump rope.
  • Learning to skate.
  • May be able to ride a bicycle.
  • Can throw and catch.
  • Can hammer and build simple structure.
• SELF HELP:
  • Self help skills increase but still dawdles.
  • May learn to tie shoes.
• COMMUNICATION/PLAY/ SOCIALIZATION
• Uses language correctly, has command of nearly every sentence structure.
• Begins reading and writing, adding and subtracting.
• Has some concept of abstract words, defines words.
• Understands "when" questions, time concepts.
• Tells time by hour. Gives address.
• Can make up simple stories.
• Organizes the content of a message prior to its delivery, expresses self fluently.
• Tells jokes and riddles.
• Is a cooperative member of the family.
• Attention span is lengthening.
• Has increased interest in God and religion.
• Has personified concept of death.
• Child enjoys:
• - playing with peers of same age
• - outdoor activities, competitive games
• - playing board games, songs, rhymes and riddles
• - imitative play, devising new games with new rules
• - arts and crafts, books and stories

• SAFETY CONSIDERATIONS/ INTERVENTIONS
  • Experiments with independence.
  • Differentiates actions that are dangerous.
  • Easily distracted.
  • Drawn to potentially dangerous situations.
  • Seat belt use required for safe travel in car.
  • Explain procedures in advance using correct terminology.
  • Explain equipment.
  • Allow child to have some control.
  • Provide privacy.
  • Assess and manage pain:
  • May understand use of PCA. Parent controlled use of analgesia may be appropriate if unable to understand PCA. Medicate to prevent pain, e.g., around - the - clock.
  • Assess response after & prior to next dose.
  • Promote independence.
  • Continue school.
  • Clearly define & reinforce behavior limits.
  • Use visual aids; be concrete and specific.
  • Relate to child's abilities.
  • Major fear is loss of control.

• PHYSICAL DEVELOPMENT
  • WEIGHT: Gains approximately 3 - 5 pounds (1.4 - 2.3kg) per year.
  • HEIGHT: Grows approximately 1½ to 2½ inches (3.8 - 6.4cm) per year.
  • FEEDING PATTERN: Eats three meals per day plus snacks.
  • SLEEP: Sleeps 8 - 12 hours at night.
  • DENTAL: Loss of "baby" teeth and eruption of permanent teeth continues.
• MOTOR CONTROL
  • Movements are smoother, more graceful and perfected.
  • Increased capabilities in gross and fine motor control.
• SELF HELP:
• Independent in personal hygiene.
• Accepts responsibility for care of pets.
• Child enjoys:
• -playing with peers of same age
• -outdoor activities, competitive games
• -playing board games, books and magazines
• -arts and crafts, solitary activities, collections
• -staying overnight at friend's house
• -takes part in family group discussions
• -able to verbalize feelings
• -searches for independence
• -seeks out heroes and role models
• -increased need for privacy
• -may worry and exhibit nervous behaviors
• COMMUNICATION/PLAY/ SOCIALIZATION
  • Increases reading skills.
  • Begins cursive writing.
  • Begins multiplying and dividing.
  • Can name from memory similarities and differences between objects.
  • Tells time correctly.
  • Participates fully in conversations with adults, introduces topics, stays on topics, can close conversations.
  • Asks for clarification to "repair" conversation.
  • May be interested in mastery of a particular sport or skill.
  • Begins separation from family.
  • Learns by doing.
  • Understands past, present, future.
  • Understands death as permanent, biological and universal.
  • Becomes extremely critical of parents.
  • May be independent, disobedient and defiant, rejects discipline.
  • May glorify another family.
  • Strives to be more grown-up.
• SAFETY CONSIDERATIONS/ INTERVENTIONS
  • Experiments with independence.
  • Differentiates actions that are dangerous.
  • Needs to be reminded of dangerous situations.
  • Seat belt use required for safe travel in car.
  • Explain procedures in advance using correct terminology.
  • Explain equipment
  • Allow child to have some control. Provide privacy.
  • Assess and manage pain:
  • May understand use of PCA. Parent controlled use of analgesia may be appropriate if unable to understand PCA. Medicate to prevent pain, e.g., around - the - clock.
  • Assess response after & prior to next dose.
  • Promote independence.
  • Continue school.
  • Clearly define & reinforce behavior limits.
  • Use visual aids; be concrete and specific.
  • Relate to child's abilities.
  • Major fear is loss of control.

• PHYSICAL DEVELOPMENT
  • HEIGHT & WEIGHT: Wide variations expected. Female growth spurt usually begins during these years. Female gains approximately 20 - 25 lbs. (9.1 - 11.4kg) and grows approximately 5 - 6 inches (12.7 - 15.2cm). Male gains approximately 15 - 20 lbs. (6.8 - 9.1kg) and grows 4½ - 5 inches (11.4 - 12.7cm).
  • SEXUAL DEVELOPMENT: Girls may experience menarche (average age 10 - 16). Muscle strength increases dramatically, especially in boys.
  • BLOOD PRESSURE: 126/84-106/64
  • EATING HABITS: Appetite increases dramatically relative to rapid growth.
  • SLEEP: Sleep needs vary from individual to individual. 8 - 12 hrs. per day are generally sufficient.
  • DENTAL: Loss of "baby" teeth continues, with eruption of permanent teeth.
  • MOTOR CONTROL Physical skills and capabilities continue to develop. Movements less coordinated with rapid growth spurt.
• SELF HELP:
  • Takes responsibility for jobs around the house.
  • Searches for independence but continues to be dependent on others at times.
  • Competitive sports and outdoor activities.
  • Solitary activities.
  • Arts and crafts.
  • Diaries and journals.
  • Radios, music, stereos.
  • Board games.
  • Books and magazines.
  • Cognitive development: -concrete thinkers -live in "here & now," unable to apply general principles from one experience to another situation
• COMMUNICATION/PLAY/ SOCIALIZATION                              
  • Very verbal.
  • Can verbalize feelings, but tends to be private about them.
  • Communication is topic oriented and in sequence.
  • Understands humor.
  • Demonstrates preferences for particular skill or sports.
  • Child enjoys:
    • -interacting with peers of both sexes -staying overnight away from home
    • -experimenting with appearance and clothing
    • -may take part in family discussions
    • -separation from family increases
    • -easily influenced by activities of peer group
    • -appearance becomes more important, emulates teenage dress & slang -need for privacy continues -tends to be self-conscious
    • -creative use of free time
    • -becoming more self-directed in learning -may worry & exhibit nervous behavior -wakening interest in world beyond home and community
    • -can be assisted to make logical decisions
    • -more realistic choice of heroes and role models
• SAFETY CONSIDERATIONS/ INTERVENTIONS
  • Pressure from peers may encourage the child to act against own better judgment without consideration of the consequences.
  • Seat belt use required for safe travel in car.
  • Explain procedures in advance using correct terminology.
  • Explain equipment. Allow child to have some control.
  • Provide privacy.
  • Assess and manage pain: May understand use of PCA. Parent controlled use of analgesia may be appropriate if unable to understand PCA. Medicate to prevent pain, e.g., around - the - clock.
  • Assess response after & prior to next dose.
  • Promote independence.
  • Continue school.
  • Clearly define & reinforce behavior limits.
  • Use visual aids; be concrete and specific.
  • Relate to child's abilities.
  • Major fear is loss of control.

• PHYSICAL DEVELOPMENT
• HEIGHT & WEIGHT: Wide variations expected. Muscle strength increases. Male growth spurt usually begins during these years. Female growth spurt usually ends during these years. Female grows approximately 4 - 4½ inches (10.2 - 11.4cm) and gains 25 - 30 lbs. (11.4 - 13.6kg). Male grows approximately 7 - 8 inches (17.8 - 30.3cm) and gains 35 - 40 lbs. (6.8 - 9.1kg).
• SEXUAL DEVELOPMENT: Onset of puberty for males usually occurs during these years. Onset of menstruation usually occurs before or during the 16^th year.
• EATING HABITS: Appetite varies dramatically relative to rate of growth. Likely to follow fads.
• SLEEP: Sleep needs vary from individual to individual. May require more sleep during rapid growth. 8 - 12 hrs. per day are generally sufficient.
• DENTAL: Loss of "baby" teeth with eruption of permanent teeth completed. Possible third molar ("wisdom teeth") eruption.
• IMMUNIZATION: Adult tetanus/ diphtheria vaccine recommended at age 14 - 16 and every ten years thereafter through adulthood.

• COMMUNICATION/PLAY/SOCIALIZATION
• Gives evidence to support a claim.
• Able to interpret social class and emotional state of the gender from verbal and non-verbal cues.
• Able to analyze arguments in relationship to the source.
• Able to gain/maintain the attention of others in socially acceptable ways.
• Interested in peers of both sexes.
• Beginning interest in dating and "going steady."
• Peer group extremely influential in decision making.
• Intense concern over physical appearance.
• Uses peers as role models, along with older teens & carefully selected adults.
• Able to identify feelings of self & others; considers own feelings to be unique.
• Need for privacy continues, especially with those not in peer group.
• May share intimacies with selected peers.
• Beginning to think realistically about economic career.
• Extremely idealistic.
• Aware of events in nation and world.
• Able to consider potential alternatives to situations not yet experienced.
• Talking and socializing with peers in person or on the telephone.
• Sports events and extra-curricular activities.
• Crafts and projects.
• Reading teen, fashion, sports and automobile magazines.
• Shopping, "hanging out."
• Being mobile via skateboards, roller skates, bicycles, dirt bikes or cars of older peers.
• Experimenting with appearance.
• Music and dancing.
• Video games, movies and television.

• SELF HELP:
• Interested in making independent decisions.
• Beginning responsibility for odd jobs outside of the home to earn money.
• COGNITIVE DEVELOPMENT:
• Reasons through trial and error.
• Has difficulty understanding long-term consequences of their behavior.
• Application of theories and abstract ideas to themselves is difficult.

• SAFETY CONSIDERATIONS/ INTERVENTIONS
  • Pressure from peers may encourage the young teen to act against better judgment, disregarding the consequences.
  • May feel pressure to become sexually active.
  • May be encouraged to use cigarettes, alcohol or drugs.
  • Seat belt use required for safe travel in car.
  • Supplement explanations with rationale.
  • Encourage questions regarding fears.
  • Provide privacy.
  • Involve in planning & decision making.
  • Allow adolescent to maintain control.
  • Provide essential teaching based on how individual learns best.
  • Provide information on pain control methods, assessment scale, schedule for pain management, need to ask for pain medication as soon as pain begins, need to provide information on degree of pain relief, types of pain medication & methods for pain reduction.
  • Do not talk about the individual in front of the individual.
  • Present explanations in a logical manner, use visual aids, provide other materials for review.

• PHYSICAL DEVELOPMENT
  • HEIGHT&WEIGHT: Male and female reach near adult proportions. Muscle strength increases. Female shows little change in height & weight. Male grows approximately 2½ in. (6.4cm) & gains 20 - 35 lbs. (9.1 - 15.9kg) during these years.
  • SEXUAL DEVELOPMENT: Onset of menstruation for females usually occurs before or during the 16^th year.
  • BLOOD PRESSURE: 135/85-105/65
  • EATING HABITS: Appetite varies dramatically relative to rapid rate of growth and activity. Likely to follow food fads. Likely to express concern about weight and eat accordingly.
  • SKIN: May have problems with acne.
  • SLEEP: Sleep needs vary from individual to individual. May require more sleep during rapid growth. 8-12 hours per day is generally sufficient. May enjoy keeping late hours and "sleeping in."
  • DENTAL: Likely third molar eruption ("wisdom teeth").

• COMMUNICATION/PLAY/SOCIALIZATION
  • Primarily present oriented.
  • Decisions continue to be influenced by peers and significant adults, though becoming increasingly independent.
  • Concerned with choices of careers and life-style.
  • May question authority figures and seek ways to change an objectionable situation.
  • Very aware of physical appearance, highly influenced by peer group, concerned with body image.
  • Need for privacy continues.
  • Able to identify feelings, better able to identify commonalties between own feelings and feelings of others.
  • Altruistic attitude toward societal events; developing a value system.
  • Formulates sex role identity.
  • Seeks relationships with members of the opposite sex.
  • Experiences mood changes and unpredictable reactions; ambivalence is common.
  • Experimenting with "adult" behavior.
  • Older adolescents may enjoy:
    • - getting together with peers, "hanging out"
    • - sports events, magazines
    • - reading books and magazines
    • - shopping
    • - driving cars and motorcycles
    • - "suping up" cars
    • - music and dancing
    • - dating
    • - pursuing hobbies
• SELF HELP:
  • Able to enter work force.
• Increased mobility and independence.
• SAFETY CONSIDERATION/INTERVENTIONS                                    
  • May be overly daring with groups of peers.
• May feel pressure to become sexually active.
• May be encouraged to try smoking, alcohol, drugs.
• Seat belt use required for safe travel in car.
• Accurate birth control and STD information.
• Supplement explanations with rationale.
• Encourage questions regarding fears.
• Provide privacy.
• Involve in planning and decision making.
• Allow adolescent to maintain control.
• Provide essential teaching based on how individual learns best.
• Provide information on pain control methods, assessment scale, schedule for pain management, need to ask for pain medication as soon as pain begins, need to provide information on degree of pain relief, types of pain medication & method for pain reduction.
• Do not talk about the individual in front of the individual.
• Present explanations in a logical manner, use visual aids, provide other materials for review.