Growth is a qualitative increase in size, while Development is a quantitative increase in size.
- The best index of growth is weight. In an average infant, the expected weight at six months of age is double their birthweight, and at twelve months of age is triple their birthweight. At two years old, the toddler will have quadrupled their birthweight.
- Height also increases at a rate of 1 inch every month for the first six months of life, then 1.5 inches until the twelfth month.
- The most rapid period of growth occurs during infancy and adolescence. The slowest is during the school-age period. This is a core competency of nursing, and covers all stages of life from conception to death.
Pediatric Age Groups
- Neonates: first 28 days of life
- Infants: first year of life
- Toddlers: 1 to 3 years old
- Preschoolers: 4 to 6 years old
- School-aged: 7 to 12 years old
- Adolescents: 13 to 18 years old
Developmental Milestones and Theories
Each age group will have its own distinct set of expected behaviors and level of functioning. These are described broadly in traits and especially through the psychosocial, psychosexual, cognitive, and moral developmental theories.
- Psychosocial Development Theory: a theory devised by Erik Erikson describing the developmental milestones of various age groups, detailing the achievement or the potential consequence of failing to meet the developmental needs. For example, “Trust vs. Mistrust” details the development of trust of infants if their needs are consistently and adequately met by the primary caregiver, while developing mistrusting behavior otherwise.
- Psychosexual Development Theory: a theory devised by Sigmund Freud describing the area of gratification of different age groups, describing the development and personality and sexuality. It explores the shifting erogenous zones and how, if gratification is not met, fixations may occur in later life. A common example of this is the lack of oral gratification in infancy, which has been theorized to predispose the individual to nail-biting, thumb-sucking, and even smoking.
- Cognitive Development Theory: a theory devised by Jean Piaget describing the way children and adults acquire/develop cognition. For example, the first stage of this theory is the sensorimotor stage, indicating that infants spend their time developing motor skills and learn how to perceive and interact with objects, leading to the development of object permanence.
- Moral Development Theory: a theory devised by Lawrence Kohlberg describing the level and bases of morality between the age groups, with bases such as having no morality (infants), punishments or rewards, the parents’ reactions, rules and regulations, up until a period where morals and values are based on the individual’s self-formed ethical principles.
Infancy
Infants are observers. With a lack of motor control and ability, they spend their time sleeping and observing things.
- The toys of infants are focused on the senses, with musical mobiles and colorful rattles as the preferred type of toy. Infants play alone— they engage in solitary play.
- Infants, once they develop object permanence, will exhibit stranger anxiety. This is a fear of unfamiliar individuals. This begins by six months of age, peaks at nine months of age, and wanes by twelve months of age as they transition into toddlerhood.
- The sensorimotor stage of cognitive development is predominantly sensory in this stage.
| Dev’t Theory | Stage/Phase | Description |
|---|---|---|
| Psychosocial | Trust vs. Mistrust | |
| Psychosexual | Oral | |
| Cognitive | Sensorimotor | |
| Moral | Amoral |
Aspiration Risk
Infants are very susceptible to aspiration of foreign bodies. This is among the most common causes for injury or death to infants, especially with the oral phase of psychosexual development. Infants will bring most objects they can grab to their mouth and suck on it. Avoid giving infants small toys or toys with small, detachable pieces, and food that are round and similar to the size of the airway.
Toddler
Toddlers are negativistic and egocentric. They frequently use “No” as a means of exercising their autonomy, and focus on their own needs.
- The toys of toddlers are focused on motor development, frequently taking the form of “Push and Pull” toys, which engage the body, particularly the lower body. When playing, they engage in parallel play where they play alone but in the presence of other children.
- Toddlers experience separation anxiety when parents are away.
| Dev’t Theory | Stage/Phase | Description |
|---|---|---|
| Psychosocial | Autonomy vs. Shame and Doubt | |
| Psychosexual | Anal | |
| Cognitive | Sensorimotor/Pre-operational | |
| Moral | Pre-conventional |
Tackling Negativism
To avoid situations where the child says no to something, the caregiver can present options that both achieve the desired outcome. This allows the toddler to exercise autonomy and a sense of choice while also eliminating the overt option of rejection. Besides for avoiding negativism, allowing the toddler to make simple decisions also goes a long way in developing a sense of autonomy.
It is during toddlerhood that toilet training may begin. The following are the basic criteria indicating the readiness for toilet training:
- Able to stay dry for 2 hours.
- Wakes up dry from naps.
- Able to sit, squat, and walk.
- Able to remove clothing.
- Recognizes the urges of defecation and urination.
- Expresses willingness to please parents.
- Able to stay on the toilet for 5 to 10 minutes without getting distracted, getting fussy, or desiring to leave.
Preschool-age
Preschoolers are magical thinkers— they are highly imaginative. They may talk to inanimate objects, conjure imaginary friends, and fears imaginary entities.
- Preschoolers engage in associative play, playing with others and in “pretend” situations. The type of toy being used by preschoolers may involve play sets such as kitchen sets or doctor sets.
- Preschoolers fear pain and body mutilation as they become aware of their respective genitals— the phallic stage of psychosexual development. Similarly, masturbation and self-gratifying behaviors may begin as a means of exploration, rather than as a means of satisfaction.
| Dev’t Theory | Stage/Phase | Description |
|---|---|---|
| Psychosocial | Initiative vs. Guilt | |
| Psychosexual | Phallic | |
| Cognitive | Pre-operational | |
| Moral | Pre-conventional | These children base morality on rewards. They perform “good” acts because they believe it results in good favor, praise, and reward. |
Oedipus and Electra Complexes by Sigmund Freud
The Oedipus (son-to-mother) and Electra (daughter-to-father) complexes are a phenomenon where children attach to their parent of the opposite sex, and perceive the other parent as a competitor for attention.
School-age
School-aged children focus on becoming industrious, with even sexual thoughts (from the phallic phase) being channeled into more culturally accepted forms of activity (latent phase). The child begins to develop perspicacity, and therefore expands their focus from the self to others— egocentrism wanes.
- School-aged children take part in collaborative or even competitive games. This may take the form of indoor games and team games.
- With latency, the children form groups and bonds with same-sex peers.
- Awareness of death as a permanent process is formed, and the child begins to fear death. An orientation towards industry, often in school, also creates fear of displacement or being “behind” in school, and fear of bad favor with their teachers.
| Dev’t Theory | Stage/Phase | Description |
|---|---|---|
| Psychosocial | Industry vs. Inferiority | |
| Psychosexual | Latent | |
| Cognitive | Concrete Operational | |
| Moral | Conventional II | These children follow the Good Boy/Nice Girl orientation, and attempt to live up to what is expected of them. |
Concept of Reversibility by Jean Piaget
It is during this stage that children develop the concept of reversibility. This concept is a display of developing abstract thought and understanding physical transformation and translation. The concept of reversibility is the mental process of reversing an action, process, or operation. A common examples of this is understanding that an amount of fluid, when transferred from a short, wide basin to a tall, thin cylinder does not change in volume and that the amounts are “the same”. In a preschooler, often the child points toward the tall container as having “more”. This is a pretty fun phenomenon to observe. This popular video shows an actual display of this behavior from a 4 1/2 year old child.
Adolescence
Adolescents highly value their body image and peer acceptance. It is in this stage that identity is formed. Aspirations for career goals begin to form.
- Adolescents partake in outdoors competitive games in solo and team sports.
| Dev’t Theory | Stage/Phase | Description |
|---|---|---|
| Psychosocial | Identity vs. Role Confusion | |
| Psychosexual | Genital | The adolescent gains gratification of their own body. Sexual practices are done no longer simply for curiosity but also for satisfaction. This also contributes to sexual relationships with others. This also coincides with the onset of puberty. |
| Cognitive | Formal Operational | Abstraction is achieved, with adolescents being able to solve problems by thinking about them both concretely and abstractly. |
| Moral | Post-conventional | The adolescent may begin to base their decisions on a set of self-formed principles and ethics— their conscience. Their morality is no longer based entirely on societal norms, laws, and expectations. |