Growth and Development

References

This note is based on a series of five video lectures by Sir V.

Growth and Development is a series of increases in physiologic and functional capacities of an individual. All individuals are born with the capability to grow and develop as this process is innate in each person.

Growth is a quantitative increase in physiologic size (weight, the best indicator of growth), height, and circumferences (head, chest, and abdominal circumferences). This primarily occurs within the first 20 years of life, most rapidly during infancy and during the growth spurt of adolescence.

Development is a qualitative increase in functional capacity occurring throughout life, broadly in terms of speech and language (known words), body language (gesticulation), self-esteem (valuing of the self; see Theories of Growth and Development), motor development (ability to utilize the body e.g. turning over, lifting the head, crawling, standing, etc.), and sensory development (development of the five senses; the first of which present at birth is the tactile sense).

• Learning primarily occurs through the senses at birth; the infant who does not understand language will learn that an object is “hot” and “should not be touched” when they experience pain upon touching a heated kettle.
• While development is continuous and life-long, there are critical periods that appear throughout life that can alter the development of an individual. These are encountered as developmental tasks.

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Principles of G&D

1. G&D is innate. All individuals are capable of experiencing maturation from birth.
2. G&D is predictable. It occurs in a regular, systematic pattern in most individuals.
3. G&D is varied in pacing between individuals. While the pattern of G&D remains consistent, some may experience growth and development at a faster or slower rate than others.
4. G&D is affected and limited by heredity. Those born of taller individuals may grow in size more and in a faster pace, and those born from intelligent parents may excel in academics.
5. G&D is affected by the environment and nutrition. Lifelong or temporary delays or limitations may occur due to a lack of nutrition, exposure to harmful elements, socioeconomic conditions, etc.
6. G&D is limited. The increasing parameters have natural limits after which no further growth or development can continue to occur.
7. Critical moments occur throughout maturation. Growth is most rapid in infancy and during growth spurts in adolescence, and development undergoes various stages from infancy to old age.

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Patterns of G&D

1. Cephalocaudal: G&D occurs in a cephalocaudal pattern even in-utero as exemplified by the head circumference being larger than the body at birth. Another example is how the toddler lifts the head before lifting the torso.
   • The head circumference (HC) is normally bigger than the body (CC/AC) only for the first year of age. Generally, HC>CC/AC in the first year, HC≈CC/AC in the second year, and CC/AC>HC afterwards.
2. Proximodistal: central areas of the body develop before the distal parts, e.g., the arms before the hands, and the hands before the fingers.
3. Gross-Refined: gross movements (grasping things with the hands; palmar grasp) is achieved earlier than refined movements (picking things up with fingers; pincer grasp)
4. Simple-Complex: similar to the previous number, but in relation to the cognitive aspect of a task. For example, a child is able to untie a shoelace before being able to tie a shoelace.
5. General-Specific: in relation to nouns and names, children are able to remember common names (mama, papa) before proper names.

These are other aspects of growth and develop not discussed during the live lectures but are found in the summarized growth and development table by Sir V.

Age	Language (words)	Sleep (Hours)	Discipline Methods
Infant	5 – 10	17–18 hrs. 10–12 hrs. after 8 to 9 months.	Time-out
Toddler	900–1,000	10–12	Redirection, Time-out, Loss of Privileges, Explaining, Reprimanding, Reasoning, Ignore Temper Tantrums
Preschool	2,000–2,100	11–12	Time-out (in play), Allow To Try, Loss of Privileges, Explaining, Reprimanding, Reasoning
Schoolage	50,000	8–12	Consistency
Adolescent	>50,000	8–10	Consistency Allow to establish independence

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Theories of G&D

The following theories are those related to the social, sexual, cognitive, and moral development of an individual. While these are also discussed in the Growth and Development Stages, these are complete explanations of each stage based on our lecture from Psychiatric Nursing on Therapeutic Theories in Psychiatric Nursing Practice

1. Psychosocial Development Theory (Erik Erikson): each stage is discussed in

   Psychosocial Stages of Development (Erikson)

   Also known as the Eight Ages of Man, Erikson devised the various age groups and each one’s developmental tasks or goals and associated virtues.

   Stage	Age	Task	Virtue
   Infancy	0 to 1 1/2	Trust vs. Mistrust	Needs are met: trust develops. Hope and Faith
   Toddler	to 3	Autonomy vs Shame and Doubt	Toilet training is successful: autonomy develops. Will and Determination
   Preschooler	to 6	Initiative vs Guilt	Curiosity is supervised consistently: initiative and conscience develops. Management of conflict and anxiety. Purpose and Courage
   School-Aged	to 12	Industry vs Inferiority	Efforts to learn are supported: industry develops. Competence, confidence, and pleasure in accomplishments
   Adolescence	to 21	Identity vs Role Confusion	Sexual orientation, role performance, body image, and self-concept are well defined: identity develops. Fidelity and Loyalty
   Young Adult	to 35	Intimacy vs Isolation	Relationships are satisfying: intimacy develops. Love
   Adult	to 60	Generativity vs Stagnation	Sense of usefulness to others: generativity develops. Involves establishing the next generation. Care
   Elderly	60+	Integrity vs Despair	Satisfying past recollection: integrity develops. Wisdom

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2. Psychosexual Development Theory (Sigmund Freud): note embedded from psychiatric nursing

   Psychosexual Stages of Development (Freud, S.)

   1. Oral Stage: 1 to 1 ½ years old; regular feeding is very important
      • Erogenous Zone: mouth; tension is relieved by sucking and fixation may be caused by insecurity in parting with the breast or bottle.
      • Satisfaction: sucking, biting, crying; results in development of trust in later years
      • Greatest Need: security
      • Greatest Fear: separation anxiety
   2. Anal Stage: 1 ½ to 3 years old
      • Erogenous Zone: anus
      • Satisfaction: control over defecation and urination; critical period for toilet training.
        • Anal-Retentive Personality: the child “lets go” of control. Results in a stingy, stubborn, compulsive need for orderliness; punctual and respectful to authority. May also include schizoid, schizotypal, and Superego personalities.
        • Anal-Expulsive Personality: the mother “lets go” of control. Results in a messy, careless, disorganized, and prone to emotional outbursts; inconsiderate to others. May include an Id personality.
      • Greatest Need: power and control; development of Ego and Superego occurs due to introduction of the reality principle.
        • Toilet Training can be started once ready; the child should be able to stand alone, walk steadily, keep themselves dry (bladder control) in at least two hour intervals, demonstrate awareness of needing to defecate and void and the use of words and gestures to show it, and are desirous to please the caregivers.
          • Bladder Control: 18 months
          • Daytime Bladder Control: 2 ½ year old
          • Nighttime Bladder Control: 3 year old
   3. Phallic Phase: 3 to 6 years old; the first period of realization of gender. Identification also occurs, where children incorporate the values of their parent of the same sex into their superego.
      • Erogenous Zone: genital; sexual curiosity, consensual validation, castration anxiety/penis envy, oedipal/electra complex.
      • Satisfaction: masturbation; provide privacy but attempt to distract when possible. Fixation results in narcissistic, vain, and proud personalities, fear or incapability in close love, and homosexuality.
   4. Latency Phase: 6 to 12 years old
      • Erogenous Zone: genital, but dormant/inactive.
      • Satisfaction: acquiring knowledge, social skills (peer development), development of competence (in school and activities), character formation, achievements. Fixation results to immature behavior and less competence.
   5. Genital Phase: 12 to 18+ years old
      • Erogenous Zone: genitals
      • Satisfaction: genitals; development of heterosexual relationships. Interest in the welfare of others develops during this stage.

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3. Cognitive Development Theory (Jean Piaget)

   Cognitive Development Theory (Piaget)

   Four stages of cognitive development in understanding the world, as posited by Jean Piaget; organization and adaptation allow us to make sense of the world.

   Stage	Age (years)	World View
   Sensorimotor Stage	0 to 2	The child is only aware of what is in front of them.
   Preoperational Stage	2 to 7	The child is able to think symbolically.
   Concrete Operational Stage	7 to 11	The child is aware of their surroundings, and is less self-centered.
   Formal Operational Stage	11 to 15	The child is able to think in abstract and logical ways.

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Age Group	Stage	Question
Infant	Sensorimotor	N/A
Toddler	Sensorimotor	What	The child is object-oriented.
Preschool	Preoperational	Why	The child is familiar with objects; the next step is to find reason behind everything.
School-age	Concrete Operational	How	The child is able to rationalize, and now focuses on the procedural aspect.
Adolescent	Formal Operational	What-If	What, why, and how become daily aspects of life. The adolescent now focuses on life situations.

4. Moral Development Theory (Lawrence Kohlberg)

Age Group	Stage	S.O.
Infant	Amoral	P.C.G.	The child is unable to discern between right and wrong.
Toddler	Preconventional I	Parents	The child avoids actions that may lead to punishment or disapproval from the parents.
Preschool	Preconventional II	Family, Neighbors	The child prioritizes actions that receive rewards, and avoids actions that receive consequences or disapproval from the parents or siblings.
School-age	Conventional	Peers, Teacher	The child conforms to social standards/norms as presented by their teachers and displayed by their peers.
Adolescent	Postconventional	Peer Group	Morality becomes internally defined in terms of principles and values. However, this may be bent by peer pressure.

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Growth and Development Stages

Infants

Infants are children from 0 to 1 year old. Their mnemonic is GOATS:

1. Grows very fast: an infant doubles their weight by 6 months, triples their weight by 12 months, and quadruples their weight by 2 years.
2. Oral: according to the psychosexual theory, the infant’s needs manifest orally; the mouth is the site of gratification and exploration. If a child’s oral needs are not met, thumb sucking becomes a habit.
3. Amoral: the infant cannot differentiate right from wrong.
4. Trust vs. Mistrust: according to the psychosocial theory, trust is established if needs are consistently met. Otherwise, mistrust remains present.
   • The infant conveys their needs by needs of crying. Crying can signify hunger, discomfort, pain, or even attention-seeking.
   • Mistrust can be identified by stranger anxiety. Normally, it appears around 6 months of age, peaks by 9 months, and fades by 12 months. This is related to the developing object permanence of an infant at around 6 months, as they are able to remember the face of their primary caregiver and differentiate them from other individuals.
5. Solitary, Stranger Anxiety, and Sensory:
   • Solitary refers to the type of play used by an infant.
     • A musical mobile may be used by two months. As, prior to this, the infant is often asleep for brain development.
     • The primary type of toy used for an infant is a rattle, an object that makes sound when shaken. Shaking aids in motor development, and the sound aids in sensory development. This is given by four or five months as the child loses the palmar/grasping reflex.
     • Play should not be too big, too small, and toxic, and not contain detachable parts. Due to them being in the oral stage, infants will almost always place things in their mouth. Moderately sized, colorful (primary colors, red) toys with no detachable parts and no toxic elements are best choices for infants.
   • Stranger Anxiety refers to the fear of individuals besides the primary care giver. This begins by 6 months of age, peaks by 9 months of age, and fades by 12 months of age.
   • Sensory refers to the primary method for learning/cognitive development. This is part of the sensorimotor stage of Jean Piaget’s cognitive development theory that is most predominant in infancy.

Another important milestone of infancy is the readiness for solid foods or complementary feeding. This is signified by three changes:

1. Sits without support. This also coincides with the development of the cardiac sphincter (lower esophageal sphincter) which indicates the stomach’s ability to retain ingested contents.

Age	Motor Milestones
0 mo.	Head is lifted 0° when prone (cause of asphyxia)
1st mo.	Head is lifted 15°
2nd mo.	Head is lifted 30°
3rd mo.	Head is lifted 45°
4th mo.	Head is lifted >45°
6th mo.	Sits with support
8th mo.	Sits without support
9th mo.	Crawling and creeping
10th mo.	Standing with support
11th mo.	Cruising
12th mo.	Walking with support
15th mo.	Walking without support
18th mo.	Running and jumping
2 y.o.	Child climbs stairs one stair at a time
3 y.o.	Child climbs stairs with alternating steps

2. Teething: the growth of the first deciduous teeth from six months of age (start brushing with soft bristled toothbrush) onwards, often completed between 2 ½ – 3 years of age (first dental appointment), which are then replaced by permanent teeth.

Age	Teething
6 mo.	Deciduous Lower Central Incisors (start brushing)
7 mo.	Deciduous Upper Central Incisors
9 mo.	Deciduous Upper Lateral Incisors
10 mo.	Deciduous Lower Lateral Incisors
12 mo.	Deciduous First Molars
18 mo.	Deciduous Canine
2 ½ – 3 y.o.	All 20 deciduous teeth are present (start dental appointments)
6 y.o.	Permanent First Molars
7 y.o.	Permanent Central Incisors
8 y.o.	Permanent Lateral Incisors
9 y.o.	Permanent First Premolars
10 y.o.	Permanent Second Premolars
11 y.o.	Permanent Canines
12 y.o.	Permanent Second Molars
18 y.o.	Permanent Third Molars (Wisdom Teeth) (32 in total, 28 if wisdom teeth are removed)

3. Disappearance of Extrusion Reflex: in conjunction with the development of the cardiac sphincter (lower esophageal sphincter), the extrusion reflex (tongue pushes out solid food placed into the mouth) is lost.

Nutrition in Children

Once ready to feed, the diet progresses in the order of the following:

1. Iron-Fortified Cereals: prevents anemia
2. Vegetables then Fruit: easy to chew, e.g., boiled and mashed

• Potatoes, carrots, chayote (sayote), calabaza (kalabasa), papaya
• Not too many bananas or apples (constipating) or ripe mango (may cause prickly heat)
• Ripe papayas (anti-constipation), pear, peach

3. Meat: chicken and pork are boiled, shredded, then chopped. Fish may be boiled, steamed, and mashed.

• Chicken liver is soft and is good for infants. This may be found in tinola.
• Hard boiled egg yolk without the egg whites (contains albumin; may cause allergy)

Complementary feeding is began by 6 months. Breastfeeding is exclusive until the 6th month but is recommended to continue until 2 years of age. The diet is as stated above.

• Wean the child from breast to bottle by 6 months.
• Wean the child from bottle to cup by 12 months.

	Infant	Toddler	Preschool	Schoolage	Adolescent
Daily Caloric Demand	1,200 or 100–115/kg	1,300–1,400	1,700–1,800	2,100–2,400	2,200–2,700
Remark		Able to feed self		Minimize junk food

Toddler

Toddlers are children from 1 to 3 years old. Their mnemonic is PRAISE for the items listed below, but also because praise is the best form of reward for toddlers. This enforces independence and stimulation of motor development and environmental exploration. All-in-all, this builds autonomy.

1. Parallel, Push-Pull, Parents
   • Parallel: toddlers play alongside other children, but by themselves; parallel. This is because toddlers often become selfish and jealous of others’ toys.
   • Push-pull toys are the toy of choice for children, especially as they are in their sensorimotor (motor) stage.
   • Parents are the significant other of a toddler.
2. Rituals/Routines, Regression, Rivalry
   • Rituals/Routines are useful in caring for a toddler. “Childhood rituals” are those involving objects that serve as ceremonial objects. These are security objects such as blankets, pillows, and plushies that allows the toddler to settle into a sense of safety before sleeping.
     • The parents are responsible for introducing good, healthy rituals once they observe that the toddler has begun using rituals, e.g., a kiss, handwashing, or toothbrushing.
     • Routines are also utilized for toilet training.
   • Regression is the most common coping mechanism used in toddlerhood. It is the devolvement back into previous stages of development— loss of bladder control (enuresis) is a primary form of regression.
   • Rivalry between siblings is very common in toddlers for attention with parents. This is enhanced by the toddler’s selfishness and egocentrism in this stage. When asked to cooperate, they also display negativism.
3. Autonomy vs. Shame and Doubt, Anal
   • Autonomy vs. Shame and Doubt is the psychosocial stage a child encounters in toddlerhood. The parents allow the toddler to explore, provide praise, and provide simple decision-making opportunities. This develops autonomy— independence.
   • Anal is the psychosexual stage a child encounters in toddlerhood. The site of gratification is the anus.
4. Involve the parents in the care of the toddler
5. Separation Anxiety, Sensorimotor, Selfish
   • Separation anxiety: the toddler whose significant others are their parents will only feel secure with the presence of at least one parent in the household. If the parents will leave, the toddler will (1) protest against the parents from leaving, (2) despair as the toddler feels abandoned or threatened by their perceived solitude, (3) denial, and eventual (4) recovery.
6. Environment/Explorer, Elimination, Egocentric
   • Environment/Explorer: the toddler will like to explore the environment at this age, in conjunction with their autonomy. This is a good time to make sure the environment is clear of any potential hazards such as poisonous substances.
   • Elimination: toilet training begins and is completed in toddlerhood. The best indicator for the initiation of toilet training is walking well. This signifies that the anal sphincter is developed well enough for bowel control. Additionally, remaining dry for long periods (holding it in) and identifying wetness (pointing out when the child has voided or defected in their diaper) are positive indicators for toilet training.
     • Bowel training: obtain a potty chair for the child. In line with the rituals and routines, bowel training should be done at the (1) same time every day, with (2) no distractions like food, toys, television, or any playmates.
     • Bladder training: avoid fluids (30 – 60 minutes) and urinate (just before) before going to bed. The child is taught how to use the restroom by themself, first accompanied then slowly alone (accompany to bathroom, then outside the bathroom, then outside the hallway, etc.)

Elimination	Begin	Gain Control
Bowel	1 ½ – 2 y.o.	2 ½ – 3 y.o.
Bladder	2 ½ – 3 y.o.	3 – 5 y.o.

With the development of autonomy, the toddler becomes:

1. Selfish, Egocentric: the child focuses on their self and their needs and wants. Along with this, the toddler is normally jealous.
2. Manipulative: they manipulate for their wants and needs.
3. Frustrated: with (reasonable) non-fulfillment of the toddler’s wants, the toddler becomes frustrated. With the inability to express this frustration, the toddler expresses frustration non-verbally.
   • The primary method of expressing frustration is through temper tantrums. The action to take for temper tantrums is to ignore the behavior while maintaining safety. Reacting to the tantrum may indicate to the toddler that temper tantrums will result in the parents succumbing to their needs or otherwise attract attention, either positive or negative.
4. Negativistic: the toddler will like to say no, and hate being told no.
   • In the context of sharing, the toddler will often say no. The parent should encourage sharing, but not force it. If the toddler does so, praise the behavior.

The theme of toddlers is Holding On and Letting Go: (this wasn’t expanded upon all too much)

1. Holding onto toys and food: toddlers are selfish, and are commonly jealous of others’ toys. This is the reason for parallel play. Each child will have their own toy to play with.
2. Holding onto stool: the toddler begins to hold in their stool, prolonging periods of dryness. This is one of the indicators for beginning toilet training in toddlerhood.

Preschool

Preschoolers are children from 3 to 6 years old. Their mnemonic is MAGIC:

1. Mutilation or castration, a primary fear of preschoolers.
2. Associative Play: the type of play utilized by the preschooler as they undergo their imitative and imaginative phase; role-modeling is exemplified by the child playing “pretend games” through play sets— doll houses, kitchen sets, medical sets, etc. They can also play with puzzle sets.
   • Preschoolers become more comfortable with sharing (expanding significant others)
3. Guilt: the developmental outcome of failure to establish initiative.
4. Initiative, Imitator, Imaginative
   • Initiative: the primary developmental task of a preschooler. The development of trust in infancy, then autonomy in toddlerhood lead to initiative, a sense for doing things proactively. Otherwise, guilt develops. To aid in developing this sense of initiative, the preschooler is supported and allowed to try.
   • Imaginative: the preschooler is highly imaginative, giving rise to their way to play, fears (supernatural), and even the presence of an imaginary friend to fulfill emotional needs.
     • Additionally, the child begins to tell tall tales. The parent should correct these tales in private with the child as this behavior can persist.
5. Curiosity is strong, in conjunction with and as a motivation for developing initiative.

The theme of preschoolers is To Try, To Make, To Play. These are all inclusive of initiative.

1. Remember that preschoolers have the family and neighbors as their significant others. This is why preschoolers are often more comfortable with sharing at this stage, giving way to associative play.
2. The preschool child will want to find meaning behind the things around them— a procedural focus. Their favorite question to use is “Why?”
3. To develop a sense of initiative and confidence, allow the preschool to try. The preschooler will desire to try things, often out of curiosity rather than an actual willingness to perform the activity. For example, a preschooler will want to try sweeping if they observe their parents sweeping, and the parents should support this but remember that this is only an attempt; do not discourage, demean, or shut off the child.
4. The preschooler begins to differentiate sexes in the phallic stage of Sigmund Freud’s psychosexual stages. This gives rise to (a) gender orientation, and (b) curious masturbation.
   • The genitals are one of the primary targets of the child’s fears of castration or mutilation.
   • This also gives rise to the Oedipal (maternal attachment) and Electra (paternal attachment) complexes, where the child is attracted to the parent of the opposite sex. This should equalize or reverse in normal development.
5. The preschooler also develops ideas of today vs. tomorrow, and inside vs. outside.

School-age

School-age children are children from 6 to 12 years old. Their mnemonic is DIMPLE:

1. Death: awareness of the reality of death and mortality causes school-age children to fear death. Additionally, these children also fear intimidating teachers.
2. Industry vs. Inferiority: the school-age child is exposed to the academic system where competition and ranking arise formally and informally. The developmental task is to establish industry (productivity, competence) to find validation from their teachers and to establish an ego as a capable student which if unfulfilled can result in feelings of inferiority. The development of industry is supported by teaching by the parents.
   • Punishment from failure or excessive expectations will also result in failure to develop industry and a strengthened feeling of inferiority.
3. Modesty: the child high values the valuation and recognition of their teacher. Modest behavior (refinement of words, actions), being helpful, and being respectful are the methods by which the student seeks for this validation.
4. Peers: the significant others of the school-age child shifts from their home environment to their school environment— the peers, those of the same age group in the same environment, and their teachers from which they derive their feelings of validation and/or fear.
5. Loss of Self-control: a problem that results from the child’s involvement in competition. This is an important time to strengthen the child’s sense of sportsmanship.
6. Explanation of the Procedure: The school-age child begins to ask the question “How?” and takes pleasure in learning how things are done.

Other concepts related to school-age children is that they:

1. Prefer cooperative games and, secondarily, competitive games.
2. Potentially develop school phobia. For these children, they are slowly desensitized to the school environment by making sure the child attends school every day. Initially, the mother may accompany the child at the back of the class, then seated apart, then from the hallway, etc.
3. May become latchkey children: children who may leave the home and return by themselves, keeping their own keys to their home. This is common in nuclear families where both parents work. This may be a risk factor for exposure to vices and negative behavior.
4. Experience Latency in the psychosexual stages, as they focus on the acquisition of knowledge. This puts their phallic stage on hold which resumes in adolescence when the genital phase appears.

Adolescent

Adolescents are children from 12 to 18 years old. Their mnemonic is PAIRS:

1. Peer group: the adolescent shifts their focus to their peer group, their troupe of main friends. The adolescent may also find their first proper romantic partners.
2. Acceptance of bodily changes: a major prerequisite to the identity of an adolescent.
3. Identity: discussed below ↓
4. Role confusion, Role diffusion, Rejection:
   • Rejection one of the primary fears of adolescents.
5. Separation from peer group: another primary fears of adolescents.

Adolescents undergo the:

1. Identity vs. Role Confusion stage of psychosocial development by Erik Erikson places the adolescent in a period of finding the self and one’s place in their environment and group. Part of this task is to accept the bodily changes that occur in adolescence.
   • An identity crisis is not only about sexuality. It may span to familial roles and career options, etc.
   • If a child takes the role of the father in a household where the father has absconded, role confusion occurs.
   • A child forced into a specific career path, being forced into an identity they do not wish to be in, undergoes role diffusion.
2. Genital stage of psychosexual development by Sigmund Freud. The individual moves from gender orientation in the Phallic stage to sexual orientation. Masturbation moves from curiosity to an actual sexual activity, and sexual activity with others may appear.

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Developmental Milestones

Of particular emphasis:

1. Lifting of head
2. Sitting, crawling, cruising, walking, running
3. Birth weight: doubling, tripling, quadrupling
4. Secondary Sexual Characteristics

Age	Motor Milestones
0 mo.	Head is lifted 0° when prone (cause of asphyxia)
1st mo.	Head is lifted 15°
2nd mo.	Head is lifted 30° Posterior fontanel closes Rolls side to back Social smile appears Follows objects to side
3rd mo.	Head is lifted 45° Hand-to-mouth activities Starts to drool Laughs audibly
4th mo.	Head is lifted >45° With good head control, no head lag Rolls from back to side
5th mo.	Takes objects when presented Raking grasp May start to roll over Begins bowel sounds
6th mo.	Sits with support Doubled birth weight Rolls over completely from supine to prone Teething Stranger anxiety begins
7th mo.	Discovers feet and plays with them
8th mo.	Sits without support Stranger anxiety peaks Follows simple commands
9th mo.	Crawling and creeping Pulls self to sitting position Responds to parental anger Holds bottle with hand to mouth coordination Demonstrates pincer grasp
10th mo.	Standing with support Pulls self to standing position Brings hands together Pincer grasp complete Drinks from cup Vocalizes two words Waves bye
11th mo.	Cruising Stands erect with support
12th mo.	Walking with support Triples birth weight Sits from standing position Eats with fingers Anterior fontanel starts to close With 4 pairs of deciduous teeth Vocalizes 4 to 5 words Knows own name
15th mo.	Walking without support Throws objects Grasps spoon With some degree of sphincter control; may begin toilet training
18th mo.	Running and jumping Anterior fontanel is closed Can walk backwards Climbs stairs and furniture Speaks 10 words; begins short sentences Thumb sucking
2 y.o.	Child climbs stairs one stair at a time Runs well Obeys simple commands Quadruples birth weight
30 mo.	Walks on tiptoe Complete deciduous teeth Daytime Bladder Control
3 y.o.	Child climbs (not descends) stairs with alternating steps Able to stand on one foot Rides a tricycle Draws a person with three parts Undresses without help With imaginary friend Nighttime Bladder Control
4 y.o.	Hops on one foot Climbs and jumps well Climbs and descends stairs without support Attempts to print letters Dresses self with assistance Laces shoes Counts to five Attention span of 20 minutes
5 y.o.	Able to jump rope Skips and hops on alternate feet Balances on one foot with eyes closed Throws and catches a ball Dresses self completely alone Draws a person with six parts Counts to 10 or more Cooperative play Attention span of 30 minutes
6 y.o.	Starts to ride a bicycle Able to tie knots Has complete binocular vision
7 y.o.	Rides bicycle well Engages in team games/sports Develops concept of time Draws person with 16 parts
8 y.o.	Movements become more graceful
9–10 y.o.	Normal 20/20 vision is achieved Better behaved Enjoys team sports Appearance of secondary sexual characteristics
11–12 y.o.	Begins interest in opposite sex, reading romance, mystery, and adventure stories

Dentition

Age	Teething
6 mo.	Deciduous Lower Central Incisors
7 mo.	Deciduous Upper Central Incisors
9 mo.	Deciduous Upper Lateral Incisors
10 mo.	Deciduous Lower Lateral Incisors
12 mo.	Deciduous First Molars
18 mo.	Deciduous Canine
2 1/2 – 3 y.o.	All 20 deciduous teeth are present.
6 y.o.	Permanent First Molars
7 y.o.	Permanent Central Incisors
8 y.o.	Permanent Lateral Incisors
9 y.o.	Permanent First Premolars
10 y.o.	Permanent Second Premolars
11 y.o.	Permanent Canines
12 y.o.	Permanent Second Molars
18 y.o.	Permanent Third Molars (Wisdom Teeth)

Secondary Sexual Characteristics

Female Characteristic	Description
Accelerated Linear Growth	Increase in height (growth spurt, 9–11 y.o.)
Broadening of the Hips	Fermenting body type, varying based on individual
Telarche	Development of the breasts
Adrenarche	Growth of pubic (starts with symphysis pubis) and axillary hair
Menarche	The first occurrence of menstruation
Ovulation	Beginning of cyclic release of an egg cell
Increased Vaginal Secretions	As the reproductive system becomes functional

Male Characteristic	Description
Increase in Weight	Increased body weight
Broadening of the Shoulders	Masculine body type, varying based on individual
Growth of Testes	Enlargement and functionality
Deepening of the Voice
Adrenarche	Growth of pubic (starts with base of the penis), axillary, and facial hair
Penile Growth	Lengthening of the penis
Accelerated Linear Growth	Increase in height (growth spurt, 12–14 y.o.)
Spermatogenesis	Production and release of sperm via ejaculations

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Causes of Injury in Children

Accident	Infant	Toddler	Preschool	Schoolage	Adolescent
Aspiration of Foreign Bodies	⭕	⭕
Falls	⭕	⭕	⭕
Asphyxia	⭕	⭕	⭕
Burns	⭕	⭕	⭕
Drowning	⭕	⭕	⭕	⭕	⭕
Poisoning		⭕	⭕
Fracture				⭕	⭕ (and other sports injuries)
Motor Vehicular Accident		⭕	⭕	⭕	⭕
Substance Abuse					⭕
Firearm Accidents					⭕

• Fractures increase in incidence in school-aged children due to rapid long bone development.

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Summary of G&D

	Infant	Toddler	Preschool	Schoolage	Adolescent
Age	0-1	1-3	3-6	6-12	12-18
Psychosocial	Trust vs. Mistrust	Autonomy vs. Shame and Doubt	Initiative vs. Guilt	Industry vs. Inferiority	Identity vs. Role Confusion
Psychosexual	Oral	Anal	Phallic	Latent	Genital
Cognitive	Sensorimotor	Sensorimotor	Preoperational	Concrete Operational	Formal Operational
Moral	Amoral	Preconventional 1	Preconventional 2	Conventional	Post-conventional
Significant Other	Primary Caregiver	Parents	Family, Neighbor	Peers and Teachers	Peer Group
Fear	Stranger Anxiety	Separation Anxiety	Dark, Ghost, Monsters Mutilation, Castration	Death Failure in school Intimidating Teachers	Loss of Privacy Rejection
Play/Toys	Solitary— Rattle	Parallel— Push-Pull	Associative/ Cooperative— Play Sets	Competitive— sports, group games	Competitive
Type of Question	None	What?	Why?	How?	What If?
Behavioral Indicators	Observer	Explorer Negativistic Selfish Manipulative	Imitator Imaginative	Idealistic Modest Helpful Obedient Respectful	Independent
Common Accidents	Aspiration of foreign bodies Fall Asphyxia Burns Drowning	Same as infant, with the addition of poisoning and motor accidents	Same as toddler, but aspiration and asphyxia are no longer as common.	Drowning Motor Accidents Fractures as there is rapid long bone development	Same as schoolage

• Drowning is a consistent threat to children, especially among Asian people.

Complete G&D Table

This discussion tackles aspects of growth and development in individual sections, but essentially all the information is summarized in a G&D table created by Sir V. here: