Growth & Devpt - During age 0-2 mo

During age 0-2 mo feeding and sleep-wake cycle develops. Interactions beteween parent and infant helps in cognitive and emotional development.

PHYSICAL DEVELOPMENT.

A newborn's weight may decrease 10% below birthweight in the 1st wk as a result of excretion of excess extravascular fluid and poor intake.
Intake improves as

1.      colostrum is replaced by higher-fat milk,

2.      infants learn to latch on and suck more efficiently

3.      mothers become more comfortable with feeding techniques.

Infants should regain or exceed birthweight by 2 wk of age and grow at 30 g/day during the 1st mo.
Limb movements – writhing body and lower limbs, - purposeless hand opening and closing.
Smiling occurs involuntarily.
eye gaze, head turning, and sucking are voluntary - turning towards the mother's voice

sleep and wakefulness are evenly distributed throughout the 24 hr
If mother is stimulating and talking baby sleeps better. During night baby wakes two or three times to feed; some sleep 6 hr or more.
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 cry up to 3 hr/day, then decreases to 1 hr or less by 3 mo.

COGNITIVE DEVELOPMENT.

1.      visual               ]

2.      tactile              ]

3.      olfactory          ]

4.      auditory           ]           all these stimuli

Play an important part in the development of cognition

Baby can recognize facial expressions (smiles), differentiate - Nipple of mother and bottle.

EMOTIONAL DEVELOPMENT.

Availability of a trusted adult creates feeling of secure attachment. Infants who are picked up and held in response to distress -- cry less at 1 yr and show less aggressive behavior at 2 yr.
Hunger generates tension; - infant cries, the parent arrives gives breast, and the tension decreases. Infants fed "on demand" experience this link between their distress, the arrival of the parent, and the relief from hunger.
Infants given food at the parents' convenience, with neither attention to the infant's hunger cry nor a schedule, may not experience reduction of tension. These infants show increased irritability ,spitting, diarrhea, poor weight gain & later behavioral problems.

Clinical importance

Mild postpartum depression that affects some 50% of mothers ("baby blues"). If sad, anxious feelings persist, the possibility of true postpartum depression is to be considered.

Growth - During age 0-12 years

Weight	Kilograms
At birth	3.25
3-12 mo
1-6 yr	age (yr) × 2 + 8
7-12 yr
Height	Centimeters
At birth	50
At 1 yr	75
2-12 yr	age (yr) × 6 + 77

Developmentt - During age 0-2 months age

Milestone	Average Age of Attainment (mo)	Developmental Implications
1. Gross Motor
Head steady in sitting	2	Allows more visual interaction
2. Fine Motor
Nil
3. Social and Language
Smiles in response to face, voice	1.5	Child more active social participant
4. Cognitive
Stares momentarily at spot where object disappeared (e.g., yarn ball dropped)	2	Lack of object permanence (out of sight, out of mind)

Development at each age

	0 – 4 Weeks
Prone:	Lies in flexed attitude turns head from side to side head lags on ventral suspension
Supine:	Generally flexed
Visual:	Looks st face or light "doll's-eye" movement of eyes on turning of the body
Reflex:	Moro response present stepping and placing reflexes grasp reflex active
Social:	prefers for human face
	At 4 Wk
Prone:	Legs more extended holds chin up turns head head lifted momentarily to plane of body on ventral suspension
Supine:	Tonic neck posture Relaxed head lags on pull to sitting position
Visual:	Watches person follows moving object
Social:	Body movements - in social contact beginning to smile
	At 8 Wk
Prone:	Raises head slightly farther head sustained in plane of body on ventral suspension
Supine:	Tonic neck posture predominates head lags on pull to sitting position
Visual:	Follows moving object 180 degrees
Social:	Smiles on social contact; listens to voice and coos

Growth & Devpt - During age 2-6 mo

voluntary (social) smiles
increasing eye contact
infant's range of motor and social control and cognitive engagement increases

PHYSICAL DEVELOPMENT.

Rate of growth = 20 g/day

Disappearance of the asymmetric tonic neck reflex = infants can begin to examine objects in the midline and handle them with both hands.

Fading of grasp reflex allows baby to hold objects and voluntarily release.

Abnormal or no movements at this age = look for later neurologic abnormalities.

Trunk flexion makes rolling possible. Head control improves
maturation of the visual system allows better vision.
Total sleep requirements = 14 hr/24 hr, with about 9 hr at night - sleeps for a 6hr at a stretch by age 6 mo
sleep electroencephalogram shows - rapid eye movement (REM) and four stages of non-REM sleep.

COGNITIVE DEVELOPMENT.

1.      During feeding become distracted. In the mother's arms, the infant may turn around, looks outward.

2.      explore their own bodies

3.      staring intently at their hands

4.      vocalizing

5.      blowing bubbles

6.      touches own ears, cheeks, and genitals

EMOTIONAL DEVELOPMENT AND COMMUNICATION.

Emotions which appear are

1.      anger              

2.      joy                  

3.      interest                       

4.      fear                 

5.      disgust            

6.      surprise                       
When face to face with a adult, - intensity of smiling, eye widening, and lip puckering rises and falls.
If parent is depressed – baby shows sadness and a loss of energy.

 

IMPLICATIONS FOR PARENTS AND PEDIATRICIANS.

For parents, this is a happy period. They can talk and listen to the child. 4-mo-old is happy and coos. If this does not happen-  causes such as social stress, family dysfunction, parental mental illness, or problems in the infant-parent relationship should be sought.

Development at each age

At 12 Wk
Prone	Lifts head and chest arms extended head above plane of body on ventral suspension
Supine	Tonic neck posture reaches toward and misses objects waves at toy
Sitting	Head lag less on pull to sitting position head control with bobbing motion back rounded
Reflex	Moro response absent
Social	Likes human face listens to music says "aah, ngah"
At 16 Wk
Prone	Lifts head and chest head in line with body legs extended
Supine	Symmetric posture- both hands and legs kept in symmetrical positions hands reach midline reaches and grasps objects and brings them to mouth
Sitting	No head lag on pull to sitting position head steady enjoys sitting with support
Standing	When held erect, pushes with feet
Adaptive	Sees pellet, cannot pick it ( ie- no pincer grasp)
Social	Laughs out loud displeasure if social contact is broken – a person goes away. excited at sight of food

Growth & Devpt - During age 6-12 MO

PHYSICAL DEVELOPMENT.

Growth slows

sit unsupported (about 7 mo) and

to pivot while sitting (around 9-10 mo) – can handle  several objects at a time

pincer grasp (around 9 mo

begin crawling and pulling to stand around 8 mo

walk before their first birthday either independently or in a walker.

Motor development correlate with increasing myelinization and cerebellar growth.

Tooth eruption occurs, usually starting with the mandibular central incisors

Tooth development reflects skeletal maturation and bone age

Cognitive development.

New object is picked up, inspected, passed from hand to hand, dropped, and then mouthed

A major milestone is (about 9 mo) object permanence (constancy), the understanding that objects continue to exist even when not seen.

At 4-7 mo, infants look down for a yarn ball that has been dropped but quickly give up if it is not seen.

With object constancy, infants starts searching, finding objects hidden under a cloth

Emotional development.

Child looks back and forth between a stranger and parent, may cry.

Separations become difficult.

At night begin to awaken cry.

Does not like to be fed, turns face away as the spoon approaches.

Self-feeding with finger =the pincer grasp

Tantrums appears = conflict with parental controls

Communication.

nonverbal communication, responds to vocal tone and facial expressions.

picture books is ideal for verbal language.

Implications for parents and pediatricians.

Teach about  introducing finger foods or drinking from a cup (before first birthday)

Poor weight gain at this age = struggle between an infant and parent during infant's eating.
                                                Development at each age

28 weeks
Prone:	Rolls over Pivots crawls or creep-crawls
Supine:	Lifts head rolls over
Sitting:	Sits briefly, with support of pelvis leans forward on hands back rounded
Standing:	Legs support weight kicks legs actively
Adaptive:	Reaches out for and grasps large object transfers objects from hand to hand grasp uses radial palm Picks at pellet
Language:	Polysyllabic vowel sounds
Social:	Prefers mother enjoys mirror responds to changes of social contact

At 40 Wk
Sitting:	Sits up alone without support back straight
Standing:	Pulls to standing position "cruises" or walks holding on to furniture
Motor:	Creeps or crawls
Adaptive:	Grasps objects with thumb and forefinger pokes at things with forefinger picks up pellet with assisted pincer movement uncovers hidden toy attempts to retrieve dropped object releases object grasped by other person( Voluntary release of grasp)
Language:	Bi syllables (mama, dada)
Social:	Responds when name is called plays peek-a-boo or pat-a-cake waves bye-bye

	At 52 Wk (1 Yr)
Motor:	Walks with one hand held -48 wk Can stand independently Walks
Adaptive:	Picks up pellet with unassisted pincer movement of forefinger and thumb; releases object to other person on request
Language:	A few words besides "mama," "dada" ( 10 words)
Social:	Plays simple ball game Helps in dressing