The main goal of pediatric care is to describe normal growth, development and behavior of each child and to observe how biologic and social relationships interact within the family and also the larger society over time.
Understanding normal patterns of a child specific physical growth and cognitive, motor, emotional development, provide early diagnosis of many diseases and protection as primary care
and give a chance to enhance behavioral change to create a seated identity.
Effective pediatricians also recognize how this patterns work with families and children to bring happy, healthy behaviors.
1.Fetal growth and development:
The most rapid development occurs inside the womb
-from a tiny cluster of cells to a bouncing baby.
Pregnancy is a period of psychologic preparation for the demands of parenting.
It’s hard because of that women may experience ambivalence,
even if the pregnancy was planned.
So, please try to forget everything except only how valuable, happy course to welcome a neonate.
Fetus development is very important because of potential effects that have consequences for unborn child.
Sometimes this brings extra stress to mothers what to do and what don’t during pregnancy…
Mother-child relationship starts before birth.
Many decisions have to be made by parents in anticipation of the birth of their child.
Bonding is very important for baby’s cognitive and emotional development.
Even infant has a role in mother-baby attachment, as being healthy…
2. The Newborn:
The newborn period begins at birth and includes the 1st mo of life. Parenting a newborn infant requires dedication because a newborn’s needs are urgent, continuous, and often unclear.
The average term newborn weighs approximately 3.4 kg (7½ lb); boys are slightly heavier than girls are. The average length and head circumference are about 50 cm (20 in) and 35 cm (14 in), respectively, in term infants.
A baby drops 5 to 10 percent of his total body weight in his first few days of life and regains this weight by the end of the first 2 weeks. After this period of time, he should start to gain weight and grow quickly.
3. The first year
A.Age 0-2 Months
Physical Development
Infants regain or exceed birthweight by 2 wk of age and should grow at approximately 30 g (1 oz)/day during the 1st mo.
Limb movements consist largely of uncontrolled writhing, with apparently purposeless opening and closing of the hands.
Smiling occurs involuntarily.
Eye gaze, head turning, and sucking are under better control and thus can be used to demonstrate infant perception and cognition.
An infant’s preferential turning toward the mother’s voice is evidence of recognition memory.
Cognitive Development
Infants appear to seek stimuli actively, as though satisfying an innate need to make sense of the world.
Infants can recognize facial expressions (smiles) even when they appear on different faces.
Infants at 2 mo of age can discriminate rhythmic patterns in native vs non-native language.
Emotional Development
The infant is dependent on a trusted adult to meet the infant’s urgent needs. The first of Erikson’s psychosocial stages is basic baby-mother bonding.
Crying occurs in response to stimuli that may be obvious (a soiled diaper), but are often obscure.
Crying normally peaks at about 6 wk of age, when healthy infants may cry up to 3 hr/day, then decreases to 1 hr or less by 3 mo.
Differing feeding schedules produce differing reactions. Hunger generates increasing tension
Implications for Parents
Success or failure in establishing feeding and sleep cycles, infant issues (colic) occur during this period. When everything go well parents sense a complete bonding.
Mild postpartum depression that affects many mothers passes. Only 10% of postpartum women progress to depression.
The pediatrician may be the first professional to asist the depressed mother.
B.Age 2-6 Months
At about 2 mo, voluntary (social) smiles and increasing eye contact makes a change on parent-child relationship by a sense of being loved reciprocally.
infant’s range of motor and social control, cognitive development increases resulting in strong mutual attachment and enjoyment.
Physical Development
Between 3 and 4 mo of age, the rate of growth slows to approximately 20 g/day By 4 mo, birth weight is doubled.
Infants can begin to examine objects in the midline and manipulate them with both hands voluntarily.
With increasing control of movements the quality of spontaneous movements also changes. Infants can hold their heads steady.
Visual system maturates, they can gaze at things. They can begin taking food from a spoon.
In this period, infants achieve regular sleep-wake cycles.
Cognitive Development
At 4 mo of age, infants become interested in a wider world. During feeding, infants no longer focus exclusively on the mother, may turn around in the mother’s arms, preferring to face outward.
Infants learn voluntary muscle movements and explore their own bodies.
They also have a a sense of self, separate from the mother. The sound, smell, and feel of the mother sometimes appear promptly in response to crying, but sometimes do not. This is the first stage of personality development.
Emotional Development and Communication
The primary emotions of anger, joy, interest, fear, disgust, and surprise appear as distinct facial expressions.
Initiating games (facial imitation, singing, hand games) increases social development.
Such face-to-face behavior reveals the infant’s ability and is the first step in the development of communication.
Implications for Parents
Most parents excitedly report that they can hold conversations with their infants, taking turns vocalizing and listening.
Parents can be reassured that responding to an infant’s emotional needs cannot spoil him or her.
C.Age 6-12 Months
6-12 mo old infants develop will and intentions, characteristics, show advances in cognitive understanding and communication, achieve new skills
Physical Development
By the 1st birthday, birthweight has tripled, length has increased by 50%, and head circumference has increased by 10 cm.
They achieve the ability to sit unsupported (6-7 mo) and to pivot while sitting (around 9-10 mo)
Many infants begin crawling and pulling to stand around 8 mo.
Some walk by 1 yr.
Tooth eruption occurs
Cognitive Development
The 6 mo old infant discovers his hands. At first, everything goes into the mouth. In time, novel objects are picked up, inspected, passed from hand to hand, banged, dropped, and then mouthed. Each action represents a nonverbal idea about what things are for. The complexity of an infant’s play, how many different schemata are brought to bear, is a useful index of cognitive development at this age.
A major milestone is the achievement at about 9 mo of object permanence (constancy), the understanding that objects continue to exist, even when not seen.
Emotional Development
Infants demonstrate stranger anxiety.
Infants who have been sleeping through the night for months begin to awaken regularly and cry.
Use of the 2-spoon method of feeding (1 for the child and 1 for the parent), finger foods, and a high chair with a tray table can avert potential problems.
Communication
Infants at 7 mo of age are adept at nonverbal communication.
Around 9 mo of age, infants become aware that emotions can be shared between people; they show their happy feelings.
Between 8 and 10 mo of age, babbling takes on a new complexity, with many syllables (“ba-da-ma”) and inflections that mimic the native language.
Picture books now provide an ideal context for verbal language acquisition.
Implications for Parents
With the developmental reorganization that occurs around 9 mo of age, previously resolved issues of feeding and sleeping re-emerge.
Parents should be encouraged to plan ahead for necessary, and inevitable, separations
Infants’ wariness of strangers often makes the 9 mo examination difficult,
The second year
The child’s sense of self and others are shaped in the 2nd yr of life.
The ability to walk allows separation and newly found independence.
At approximately 18 mo of age, emergence of symbolic thought and language causes a reorganization of behavior.
D.Age 12-18 Months
Physical Development
Although slower than in the 1st yr, considerable brain growth occurs in the 2nd yr;
Most children begin to walk independently near their 1st birthday; some do not walk until 15 mo of age
Early walking is not associated with advanced development in other domains.
Cognitive Development
Exploration of the environment increases
Playthings are also more likely to be used for their intended purposes (combs for hair, cups for drinking).
Imitation of parents and older children is an important mode of learning. Make-believe (symbolic) play centers on the child’s own body (pretending to drink from an empty cup)
Emotional Development
First steps may be irritable, once they start walking, their mood changes markedly. A securely attached child will use the parent as a secure base from which to explore independently. Proud of her or his accomplishments, the child illustrates Erikson’s stage of autonomy and separation
Linguistic Development
around 12 mo of age, they already respond appropriately to several simple statements, such as “no,” “bye-bye,” and “give me.”
By 15 mo, the average child points to major body parts and uses 4-6 words spontaneously and correctly.
Implications for Parents
Parents who cannot recall any other milestone tend to remember when their child began to walk
The conflicts between independence and security manifest in issues of discipline, temper tantrums, toilet training, and changing feeding behaviors
E.Age 18-24 Months
Physical Development
Height and weight increase at a steady rate during this year, with a gain of 5 in and 5 lb. By 24 mo, children are about ½ of their ultimate adult height
Cognitive Development
At approximately 18 mo of age, several cognitive changes come together to mark the conclusion of the sensory-motor period. These can be observed during self-initiated play.
Symbolic transformations in play are no longer tied to the toddler’s own body, so that a doll can be “fed” from an empty plate.
Emotional Development
Many parents report that they cannot go anywhere without having a small child attached to them.
This stage, described as “rapprochement,” may be a reaction to growing awareness of the possibility of separation
Despite the attachment to the parent, the child’s use of “no” is a way of declaring independence.
Linguistic Development
the most dramatic developments in this period are linguistic.
a child’s vocabulary balloons from 10-15 words at 18 mo to between 50 and 100 at 2 yr
After acquiring a vocabulary of about 50 words, toddlers begin to combine them to make simple sentences,
At this stage, toddlers understand 2-step commands,
Implications for Parents
words become increasingly important for behavior control as well as cognition
Language development is facilitated when parents and caregivers use clear, simple sentences; ask questions; and respond to children’s incomplete sentences and gestural communication with the appropriate words.
The preschool years
The critical milestones for children ages 2 to 5 yr are the emergence of language
Preschool children know that they can do more than ever before, but they also are increasingly cognizant of the constraints imposed on them by the adult world and their own limited abilities.
Physical Development
Increases of ~2 kg (4-5 lb) in weight and 7-8 cm (2-3 in) in height per yr are expected. Birthweight quadruples by 2½ yr of age. An average 4 yr old weighs 40 lb and is 40 in tall.