NURSING CARE DURING POSTPARTUM 3. Smooth-walled for 3-4 weeks, then rugae reappear.

INTRODUCTION A. Ovulation/Menstruation

PHYSICAL CHANGES OF THE POSTPARTUM PERIOD 1. First cycle is usually an ovulatory. If not lactating, menses may resume in 6-
10 weeks, average of 4-6 weeks.
• PUERPERIUM refers to the postpartum period or the 6-week period after
birth. The postpartum period is further defined as that period of time. 2. If lactating, menses less predictable; may resume in 12-24 weeks.
Usually six (6) weeks, in which the mother’s body experiences anatomic
A. Breasts
and physiologic changes that reverse the body’s adaptation to pregnancy
may also be called involution. Begins with the delivery of the placenta and 1. Non-lactating woman
ends when all body systems are returned to, or nearly to their prepregnant
state. May or may not include the return of the ovulatory/menstrual cycle. a. Prolactin levels fall rapidly

• Reproductive System b. May still secrete colostrum for 2-3 days

A. Uterus: rapid reversal in size c. Engorgement of breasts tissue resulting from temporary congestion of
veins and circulation occurs on third day, lasts 24-36 hours, usually
1. Palpated after delivery below the umbilicus, the uterus regresses resolves spontaneously.
approximately (1) one fingerbreadth (1cm) per day until, by the end of the
2nd week postpartum it is a pelvic organ and cannot be palpated through d. Client should wear tight bra to compress ducts and use cold applications to
the abdominal wall. reduce swelling.

1. The endometrial surface is sloughed off as lochia, in three stages: 1. Lactating Woman

a. Lochia Rubra: dark red color, days 1-3 after delivery; consists of blood and a. High level of prolactin immediately after delivery of placenta continued by
cellular debris from deciduas. frequent contact with nursing baby.

b. Lochia serosa: pinkish brown, days 3-10; mostly serum, some blood, tissue, b. Initial secretions of colostrum, with increasing amount of true breast milk
debris. appearing between 48-96 hours

c. Lochia alba: yellowish white, days 10-14; most leukocytes, with deciduas, c. Milk “let-down” reflex caused by oxytocin from posterior pituitary gland
epithelial cells, mucus. released by sucking

A. Cervix: flabby immediately after delivery; closes slowly d. Successful lactation results from complex interaction of infant sucking
reflexes and the maternal production and let down of milk.
1. Admits one fingertip by the end of one week after delivery
• Abdominal Wall/Skin
2. Shapes of external os changed by delivery from round to slit like opening
a. May need 6 weeks to reestablish good muscle tone. This time sexual
A. Vaginal/Perineum intercourse can be resumed.
1. Edematous after delivery. Inspect episiotomy daily for normal healing; b. Stretch marks gradually disappears or fade to silvery appearance.
observe for redness, edema, ecchymosis, discharge approximation
(REEDA), and hematoma.

2. May have small lacerations

• Cardiovascular System/Circulatory System NURSING CARE OF THE NORMAL NEWBORN

a. Normal blood loss in delivery of single infant is from 500 cc up to 1000 cc • ASSESSMENT AND MONITORING
for Caesarean Section and 300 cc to 500 cc in vaginal birth.
• PHYSICAL EXAMINATION
b. Hematocrit usually returns to prepregnancy value within 4-6 weeks.
• DEVELOPMENTAL STAGES FROM BIRTH THROUGH 1 MONTH (Neonate)
c. WBC count increases
A. Weight
d. Increased clotting factors remain for several weeks leaving woman at risk
1. Average between 2750 g and 4000 g (6-9 lb) at term.
for problems with thrombus
2. Under 2750 g (51/2 lb): Small for gestational age (SGA).
• Urinary System
3. Over 4100 g (9lb): large for gestational age (LGA).
a. May have difficulty voiding in immediate postpartum periods as a result of
urethral edema. 4. Initial loss of 5%-10% of body weight normal during first few days; should
be regained in 1-2 weeks.
b. Mark diuresis begins within 12 hours of delivery; increase volume of
urinary of output as well as perspiration loss. B. Length
c. Lactosuria may be seen in nursing mothers. 1. Average 46-55.9 cm (18-22 in)
d. Many women will show slight proteinuria during 1-2 days of involution 2. Under 45.7 cm (18 in); SGA
• Gastrointestinal System 3. Over 55 cm. (22 in): LGA
1. Mother usually hungry after delivery; good appetite is expected. C. Head Circumference
2. May still experience constipation from lack of muscle tone in abdomen and 1. Average circumference 33-35.5 cm (13-14 in); equal to or 2-3 cm slightly
intestinal tract, and perineal soreness. larger than chest; remeasure after several days if significant molding or
caput succedaneum present.
3. Vital Signs Changes
2. Under 31.7 cm. (12 in): Microcephaly/SGA
4. Temperature: may be slightly increased during the first 24 hours after birth
because of dehydration that occurred during labor. If she receives 3. Over 36.8 cm (14 in): Hydrocephaly/ LGA
adequate fluid during the first 24 hours, this temperature elevation will
return to normal. 4. Anencephaly – is a type of birth defect. It occurs when the baby's brain,
skull and scalp do not develop in the womb.
5. Blood pressure: if decreased indicates bleeding; if elevated to 140/90 mm
Hg. Indicates pregnancy induced hypertension, a serious complication of 5. Caput succedaneum- swelling of the soft tissues of the scalp because of
puerperium. pressure from the cervix against presenting part. It disappears in 3-4 days
without intervention.
6. Pulse: is slightly slower than normal due to the increased stroke volume
brought about by the increasing blood volume returning to the heart. As 6. Cephalhematoma- subperiosteal hemorrhage with collection of blood
diuresis diminished blood volume and causes blood volume to fall, the between periosteum and bone; swelling does not cross suture lines.
pulse rate increases, and by the 1st week, it will be normal/
7. Molding- overlapping of skull bones caused by compression during labor 2. Pigmentation increases after birth.
and delivery.
3. Skin may be dry, but term infant has good skin turgor.
8. Examine symmetry of facial movements.
4. Acrocyanosis of hands and feet normal for 24 hours; may develop
D. Fontanels- area where more than 2 skull bones meet; covered with strong “newborn rash” (erythema toxicum neonatorum).
band of connective tissue; called “Soft Spot.”
5. Pallor- may indicate cold, stress, anemia or cardiac failure.
1. Anterior fontanel- diamond shaped; palpable; generally, closes in 12-18
6. Plethora- reddish coloration maybe due to excessive red blood cells from
months.Posterior fontanel- triangular, may obliterated because of
intrauterine intravascular transfusion (twins), cardiac disease or diabetes in
molding; generally, closes in 2-3 months.
mother.
2. Should be flat and open; enlarged or bulging may indicate increased
7. Jaundice- physiologic jaundice due to immaturity of liver is common in
intracranial pressure.
beginning on day 2, peaking at one week and disappearing by 2nd week first
3. Sunken-often indicates dehydration. appears in skin over face or upper body then progresses over larger area;
can also be seen in conjunctiva of the eyes. In physiologic jaundice,
4. Chest Circumference
average increase from 2mg/dl in cord blood to 6mg/dl by 72 hours, not
5. Average is 30-33cm. (12-13 inches) or 1.9 cm (3/4in) less than head. Breast exceeding 12mg/dl. Pathologic jaundice usually appears early, up to 24
enlargement and milky secretion from breasts (witch milk) is a result of hours after birth; represents a process ongoing after birth. Hair-
maternal hormones. distribution term infant will have lanugo (fetal or embryonic hair with
minute shafts and large papillae) over back; most will have disappeared on
E. Abdomen extremities and other areas of the body. Small amount of vernix caseosa
(white, odorless, cheese-like substance on skin, usually found in folds of
1. Shape- cylindrical protrudes slightly, moves synchronously with chest in
axillae, groin) still seen.
respiration.
8. Ecchymosis - may appear over the presenting part in a difficult delivery;
2. Distention may be due to bowel obstruction, organ enlargement or
may also indicate bleeding problem of infection.
infection.
9. Petechiae- pinpoint hemorrhages on skin due to increased intravascular
3. Auscultate abdomen for masses; gap between muscles is common.
pressure, infection, or thrombocytopenia (an abnormally small amount of
Examine umbilical cord-normally contains 2 arteries, 1 vein; single artery
platelets in the circulating blood); regresses within 24-48 hours.
associated with renal and other congenital abnormalities; by 24 hours,
yellowish brown, dries and falls off in about 7-10 days. 10. Hemangiomas- vascular lesions present at birth; some may fade; but other
permanent.
4. Abdominal Girth may be measured if indicated. Consistent placement of
tape measure is important for comparison, identification of abnormalities. 11. Telangiectatic nevi- flat red or purple lesion most often found on back of
Measurement is best done before feeding, as abdomen relaxes after neck, lower occiput, upper eyelid, and bridge of nose; regress by years.
feeding.
12. Milia- enlarged sebaceous glands found on nose, chin, check, forehead,
F. Skin regress in several days to a week or two.
1. Color in Caucasian infants usually pink; varies with other ethnic 13. Mongolian spots- blue pigmentation on lower back, sacrum and buttocks;
backgrounds. common in Blacks, Asian and infants of Southern European heritage;
regress by 4 years of age.
14. Café-au-lait spots- brown macules, usually not significant; large numbers 6. Frenulum linguae- thin ridge of tissue running from base of tongue along
may indicate neurofibromatosis (genetic disorder that causes tumors to undersurface to tip of tongue; formerly believed to cause tongue tie; no
form on nerve tissue. ) treatment necessary.

15. Harlequin color change- when on one side, dependent half turns red, 7. Thrush as white patches indicates candida infection from the mother.
upper half pale; due to gravity and vasomotor instability.
J. Female Genitalia
G. Ears
1. Vernix seen between labia
1. Should be even with canthi of eyes.
2. Blood tinged mucoid vaginal discharged (pseudomenstruation) from high
2. Cartilage should be present and firm. levels of circulating maternal hormones.

3. Lack of cartilage: possible prematurity K. Male Genitalia

4. Low placement: possible kidney disorder or Down’s syndrome. 1. Testes descended or inguinal canal

• 2. Rugae cover scrotum

H. Eyes 3. Meatus at the tip of the penis

1. May be irritated by medication instillation, some edema/discharge 4. Epispadias- misplaced urinary meatus on upper surface of penis
present.
5. Hypospadias- misplaced urinary meatusonunder surface of penis
2. Color is state blue.
6. Anogenital Area (distance (AGD) is the distance from the midpoint of the
3. Strabismus is normal anus to the genitalia, the underside of the scrotum or the vagina. )

4. Wide space between eyes is seen in Fetal Alcohol Syndrome. 7. Inspect anus for patency by inserting the tip of the little gloved finger and
lubricated. Infant should have pass meconium (first stool) for first 24 hours
I. Mouth
after birth, if not, the neonate is suspected of imperforate anus or
1. Examine the size-small mouth found in trisomy 18 & 21; corners of mouth meconium ileus.
turn down (fish mouth) in fetal alcohol syndrome.
L. Legs
2. Examine hard palate for closure
• No click or displacement of head of femur observed when hips flexed and
3. Examine size of tongue in relation to mouth- excessively large tongue abducted.
found in congenital anomalies such as cretinism and trisomy 21.
M. Feet
4. Teeth- predecidous teeth are found rare occasion, if they interfere with
1. Flat
feeding, they may be removed.
2. Soles covered with creases in fully mature infant
5. Epstein’s Pearls- small white nodules found on sides of hard palate (often
mistaken for teeth); regress in a few weeks. N. Muscle Tone

1. Predominantly flexed.
2. Occasional transient tremors of mouth and chin 1. Maternal blood volume (affected by maternal diseases and iron intake)

3. Newborn can turn head from side to side in prone position. 2. Placental function

4. Needs head supported when held erect or lifted. 3. Uterine contractions during labor

O. Reflexes Present at Birth 4. Amount of blood loss associated with delivery

• 5. Placental transfusion at birth -increase in blood volume of 60% if cord is

clamped and cut after pulsation ceases.
1. Rooting, sucking, and swallowing
a. Blood Pressure
2. Tonic neck, “fencing” attitude.
• Normal at birth: BP 70/40 mm Hg-80/46 mm Hg. At; 100/50 mmHg by 10th
3. Grasp newborn fingers curl around anything placed in palm.
day
4. Moro reflex: symmetric and bilateral abduction and extension of arms and
a. Pulse Rate
hands, thumbs and forefinger from a C; also called the” embrace” reflex,
and is initiated with a loud voice. 1. Normal rate 120-160 beats/minute

5. Startle reflex: similar to Moro, but with hands clenched. 2. Persistently under 120 beats/minute: possible heart block.

6. Babinski’s sign: flare of toes when foot stroked from based of heel along 3. Persistently over 160 breaths/minute: possible respiratory distress
lateral edge to great toe. syndrome (RDS)

P. Cry 4. May rise to 180 when the infant is crying or drop to 70 during sleep

1. Loud and vigorous 5. Apical pulse rate is more accurate

2. Heard when infant is hungry, disturbed or uncomfortable. 6. Generally follows pattern similar to that of respiration.

Q. Respiratory Changes a. Blood Coagulation

1. Normal newborn respiratory rate: 80 breaths per minute (for first few
minutes), then 30-60 breaths/minute when respiratory activity is
established.
2. The infant begins life with intense activity; diffuse, purposeless movements
alternate with periods or relative immobility.
3. Respirations are rapid as high as 80 breaths per minute, accompanied by
tachycardia, 140-180 beats per minute.
1. Most newborns have lower level of vitamin K, so they have prolonged
coagulation
• (process where blood changes from liquid to solid) or prothrombin time.
Meaning, the newborn is prone to bleeding tendencies.
1. Vit. K is synthesized through the action of intestinal flora until 24 hours
because newborn’s intestine is still sterile at birth. This flora is necessary
for the formation of certain coagulation factors e.g. 11, V11, 1X, X

R. Circulatory Changes a. Blood Elements

a. Blood volume: 85-110 ml/kg at birth. Factors that influence blood volume 1. Hemoglobin, 16-22 gm
are:
2. Hematocrit, 45%-50%
3. Reticulocytes, 2.5%-6.5% 8. Heat production- by nonshivering thermogenesis elicited by the
sympathetic nervous system’s response to decrease temperatures,
4. Erythrocyte count, 6,000,000/cu.mm. Increased is due to the nature of
activated by adrenalin.
fetal circulation
9. Elevated: possible infection or dehydration
• and sluggish peripheral circulation.
10. Temperature falls with low environmental temperature, late in cold stress,
1. Leukocytes, 15,000-30,000/cu.mm. Increased means stress or trauma to
sepsis, cardiac disease.
the birth, not infection, but may also consider infection with other signs:
pallor, respiratory difficulty and cyanosis (dark bluish or purplish color of • APGAR SCORING
the skin)
1. Developed by Dr. Virginia Apgar to providea valuable index for assessing
2. Indirect bilirubin level at birth, 1-4 mg/100 ml. newborn’s condition at birth.

A. Cardiovascular System 2. Used to evaluate the newborn in five specific categories at 1 and 5 minutes
after birth.
1. Normal newborn heart rate: 120-160 beats/minute
3. The one-minute score reflects transitional values.
2. Rate- ranges between 100-160 beats/minute influenced by behavioral
state, environmental temperature, medication. Take apical pulse for 1 full 4. The composite score at 5 minutes provides the best direction for the
minute. planning of newborn care.

3. Rhythm- common to find periods of deceleration followed by periods of 5. Composite Score Interpretations
acceleration.
6. 0-4: prognosis of newborn is grave.
nd rd th
4. Heart sounds- 2 sound higher in pitch and sharper than first, 3 & 4
7. 5-7: infants need specialized, intensive care
sounds rarely heard; murmurs common.
8. 7 or above: infant should do well in normal newborn nursery.
5. Examine for presence of brachial, radial, pedal and femoral pulses; lack of
femoral pulses indicative of inadequate aortic blood flow.

A. Temperature Regulation

1. At birth, normal newborn temperature is 99 deg. F (37.2 deg. C), then falls
immediately

2. Mechanism not fully developed; heat production is low.

3. Infants respond readily to environmental heat and cold stimuli.

4. There may be heat loss of 2-3-degree C. at birth by evaporation,

convection, conduction and radiation.

5. The infant develops mechanism to counterbalance heat loss.

6. Vasoconstriction- blood directed away from skin surfaces.

7. Insulation- from subcutaneous adipose tissue`

Sign 0 Point 1 Point 2 Points

Heart Rate Absent <100 >100

Respiratory Effort Absent Slow, irregular Good, crying

Muscle Tone Flaccid Some flexion of extremities Active motion

Reflex Irritability No response Grimace Vigorous cry

Color Blue, pale Body pink, extremities blue, acrocyanosis Completely pink
Psychosexual Theory- Sigmund Freud
Sigmund Freud
Sigmund Freud is known as the father of psychoanalysis, a branch of psychology
that focuses on treating mental illness by examining various stages of growth and
types of human behavior. Essentially, the psychoanalytic theory believes that all
humans have unconscious desires, feelings, and memories.
Freud later developed the psychosexual theory of development that includes five
stages of development from his studies.
Freud's psychosexual theory states five stages of human development: oral, anal,
phallic, latency, and genital
Erogenous zones are parts of the body that have especially strong pleasure-giving
qualities at particular stages of development.

Through years of research and studying human development, Freud believed Fixation is the psychoanalytic defense mechanism that occurs when the individual
unwanted behaviors and repressed feelings stem from childhood trauma and remains locked in an earlier developmental stage because needs are under- or
experiences, resulting in the development of a person as they enter adulthood. over-gratified

Psychosocial Developmental Theory- Erik Erikson

Stage Psychosocial Crisis Basic Virtue Age

1. Trust vs. Mistrust Hope 0 - 1½

2. Autonomy vs. Shame Will 1½ - 3

3. Initiative vs. Guilt Purpose 3-5

4. Industry vs. Inferiority Competency 5 - 12

5. Identity vs. Role Confusion Fidelity 12 - 18

6. Intimacy vs. Isolation Love 18 - 40

7. Generativity vs. Stagnation Care 40 - 65

8. Ego Integrity vs. Despair Wisdom 65+

INFANCY AND Toddlerhood

INFANT TODDLER
 INFANCY AND TOODLERHOOD

GROWTH

1-3years of
 The First Year of Life

 Time of rapid growth and

development.
age
 Growth in the first year is extremely
rapid.
 It occurs in spurts, called saltatory
growth.
 INFANCY AND Toddlerhood
WEIGHT
• At 6 months: 2X birth weight.
• At 12 months: 3 X birth weight.
• At 2 years: 4 X birth weight.
• At 3 years: 5 X birth weight.
 Physical growth and development
 A. General growth parameters
 Physical growth and development
 a. Height
 - grows about 3 inches(7.5cm)
per year
 -the average 2-year-old is about
34 inches(86.5cm) tall.
 Height at 2 years is about half the
expected adult height
INFANCY AND Toddlerhood

 b. Weight
 -gains 4-6 lbs(2-2.5kg) per year
 -average 2-year-old weighs 27
lb(122kg).
 -birth weight quadruples by 2 ½
years.
 INFANCY AND Toddlerhood

HEIGHT
 At Birth:
 At birth: 48 – 53 cm
 At one year = 75 cm.
 At two years = 87.5 cm.
 At four years = 100 cm.
 INFANCY AND Toddlerhood

FOOD
 MILK
 Food preferences and patterns
 a.) most toddlers eat the same

 CERELAC
foods as the rest of the family
(12months).

 START
OF SOLID  Food references and patterns
 b.) many toddlers experience
FOODS physiologic anorexia and become
picky eaters, experiencing food
jags, and eating a large amounts
one day and very little the
next(18months).
 INFANCY AND Toddlerhood

PLAY
 . toddlers engage in parallel
• Solitary Play: play, which is play along side,
not with others. Imitation is one
of the most common forms of
play.
When a child plays
alone even when  toys should be safe (still no
detachable and small
with other children parts).
 INFANCY AND Toddlerhood
 Erik Erikson: First Psychosocial
Stage:
Trust vs. Mistrust
 Consistent loving care by a
mothering person is essential to
build a trust relationship.
 Mistrust develops when basic
needs are inconsistently met
 Overview (Erikson)
 1.”Autonomy vs. shame and doubt”
 -psychosocial theme is “to hold on; to let
go.”
 children at this stage are focused on
developing a sense of personal control
over physical skills and a sense of
independence. Success in this stage will
lead to the virtue of will.
 Overview (Erikson)
 1.”Autonomy vs. shame and doubt”
-the toddler can develop a sense of

shame and doubt if parents keep him
dependent in areas where the toddler
can use newly acquired skills or make
the toddler feel inadequate when
attempting these skills.
 INFANCY AND Toddlerhood
Piaget’s Cognitive Stages

Sensorimotor Sensorimotor
Stage (0-2yrs) Stage (0-2yrs)
 INFANCY AND Toddlerhood
Moral development (Kohlberg)

Level1: Level1:
Preconvention Preconvention
al morality (0- al morality (0-
9y) 9y)
 INFANCY AND Toddlerhood
PSYCHOSEXUAL THEORY

Oral Stage
 Overview (Freud)
 1. the Anal stage of
development extends from
age 18 months to 4 years
 2. the erogenous zone consists
of the anus and the buttocks,
and sexual activity centers on
the expulsion and retention of
body waste.
 AGE PHYSICAL AND FINE MOTOR LANGUAGE PERSONAL SOCIAL
GROSS MOTOR

NEWBORN ➢ Largely reflex ➢ Crying ➢ Enjoys watching

the face of the
primary
caregiver
➢ Enjoys listening
to soothing
sounds
 AGE PHYSICAL AND GROSS FINE MOTOR LANGUAGE PERSONAL SOCIAL
MOTOR

1 MONTH ➢ Raises head ➢ Eyes follow object ➢ Makes throaty and ➢ Social smile
slightly from prone to midline gurgling sound ➢ Likes mobile over
(less than 45 ➢ Coos the crib as a toy
degree)
➢ Turns head from
side to side when
prone
➢ Hands fisted and
obligatory nose
breather
➢ Strong suck and
gag reflex
➢ Dance and doll’s
eye reflexes fading
 AGE PHYSICAL AND GROSS FINE MOTOR LANGUAGE PERSONAL SOCIAL
MOTOR
2 MONTHS ➢ Posterior fontanel ➢ Eyes follow object ➢ Laughs ➢ Responsive
closes past midline ➢ Vocalizes to familiar diminishes activity
➢ Head control 45 ➢ Grasps as reflex voice when talked to
degree in prone ➢ Differentiate cries
➢ Hands no longer
fisted
3 MONTHS ➢ Head control 90 ➢ Hands together ➢ Squeals with ➢ Regards hand
degree in prone ➢ Absent grasp reflex pleasure ➢ Respond to voices
➢ Can get hand in ➢ Pulls at blanket and ➢ Coos, babbles, and watches the
mouth clothes chuckles speaker
➢ Vocalizes when
smiling
4 MONTHS ➢ Raises chest with ➢ Begins reaching and ➢ Moves head toward ➢ Plays with rattle in
arm support grasping with palm sounds hand
➢ Moro, tonic neck and ➢ Babbles and gurgles ➢ Needs space to turn
rooting reflexes have when spoken to ➢ Memory span, 5-
disappeared ➢ Laughs out load 7mins
➢ Can breathe when ➢ Makes consonant ➢ Shows excitement
nose is obstructed sounds (n,j,g,p,b) and anticipation
➢ Drooling begins
(preparation for
teething)
➢ Rolls from back to
side
5 MONTHS ➢ Good head control ➢ Reaches and ➢ Turns to sound ➢ Smiles at self in the
➢ Turns from abdomen voluntarily grasps for ➢ Says simple vowel mirror
to the back objects sounds ( goo-goo and
➢ Discover parts of the
gah-gah)
body
 AGE PHYSICAL AND GROSS MOTOR FINE MOTOR LANGUAGE PERSONAL SOCIAL

6 MONTHS ➢ Birth weight doubles ➢ Grasps feet ➢ May say vowel sounds ( ➢Indicates likes and
and no head lag ➢ Holds their bottle ee, ah,ohh,oh-oh) dislikes
➢ Turns both ways ➢ Pulls objects to mouth ➢ Begins to imitate sounds ➢ Enjoys bathtub toys and
➢ Moro reflex is fading ➢ Resecures dropped rubber ring for teething
➢ First tooth erupts (lower objects ➢ Feeds self with crackers
central incisor) ➢ Beginning of object
➢ Chewing and biting permanence
occurs

7 MONTHS ➢
Sits with support ➢ Transfers objects from ➢ Says “ma” when crying ➢ Recognizes familiar faces
➢ Bears some weight on hand to hand ➢ Smiles and talks to self (beginning of stranger
the legs ➢ Uses one hand for in the mirror, and to toys anxiety)
➢ Eruption of upper grasping and holds a ➢ Calls for help ➢ Responds to own name
central incisors cube in each ➢ Plays peek-a -boo
simultaneously ➢ Imitates simple acts and
➢ Rakes at small objects noises
➢ Has taste preference

8 MONTHS ➢ Sits without support ➢ Releases objects at will ➢ Strings together vowels ➢ Close open hand
➢ Bounces ➢ Reaches persistently for and consonants movements
➢ Begins to show regular toys out of reach ➢ Makes consonant ➢ Peak of stranger
patterns of bowel and sounds ( t,d and w) anxiety
bladder elimination ➢ Increasing separation
➢ Parachute reflex anxiety
disappear ➢ Dislikes dressing and
diaper changing
 AGE PHYSICAL AND GROSS FINE MOTOR LANGUAGE PERSONAL SOCIAL
MOTOR

9 MONTHS ➢ Eruption of upper
lateral incisors
➢ Stands while holding
on to furniture
➢ Creeps on hands and
knees (with the belly
off the floor)
➢ Holds bottle ➢ Waves bye bye ➢ Begins to show fear of
➢ Index finger approach ➢ Responds to NO going to bed and
➢ Shouts for attention being left alone
➢ First few words ( dada
and mama ) ( hi, bye
bye, no)

10 MONTHS ➢ Pulls self to standing ➢ Thumb finger grasp ➢ Understands gestures ➢Develops object
position but cannot (crude pincer grasps) ➢ One word other than permanence
maneuver back down dada and mama (hi, ➢ Does nursery games
except by falling bye-bye, no) (pat-a -cake)
➢ Can change from ➢ Cries when scolded
prone to sitting ➢ Imitates facial
position expression

11 MONTHS ➢
Cruise or walks ➢ Neat pincer grasp ➢ Imitates definite ➢ Helps in dressing,
holding on to ➢ Bangs objects speech holding arm or foot
furniture or with both together out
hands held ➢ Places and removes ➢ Rolls ball to another
➢ Eruption of lower objects from on request
lateral incisor ➢ Shakes head for “no”
 AGE PHYSICAL AND GROSS MOTOR FINE MOTOR LANGUAGE PERSONAL SOCIAL

12 MONTHS ➢ Birth weight triples and ➢ Throw toys ➢ Obeys a commands or ➢ Attempts to use a spoon
birth length increases by ➢ Tries to build a tower od requests ➢ Cooperates in dressing
50 percent 2 blocks but fails ➢ Three- five words other ➢ Shows emotions
➢ Stands alone ➢ Can turn pages in a book than “dada” and (jealousy, affection,
➢ Walks with one hand (many at a time) “mama” anger and fear)
held ➢ Comprehends meaning ➢ May develop that the
➢ Attempts their first steps of several words habit of having a
➢ Babinski reflex almost ➢ Recognize objects by security blanket or a
disappears name favorite toy
➢ Can sit down from ➢ Imitates animal sounds
standing position
without help
15 MONTHS ➢ Walks well alone (since ➢ Builds tower of 2 blocks ➢ Expresses self with ➢ Tolerates some
13 months ➢ Drinks from cup but jargon separation from parents
➢ Walks backward rotates spoon ➢ Says 4-6 words (names ➢ Enjoys being read to
➢ Crawls and creeps ➢ Scribbles spontaneously included) ➢ May discard bottle
upstairs with a pencil ➢ Understand simple ➢ Pats and kisses pictures
➢ Kneels without support ➢ Puts pellets into a bottle commands ➢ Imitates housework,
➢ Loses balance when ➢ Holds two cubes in one ➢ Says “no” even in sweeping and washing
walking around corners hand agreement to the ➢ Expresses emotions and
or stopping suddenly request has temper tantrums
➢ Falls when throwing a ➢ May name a familiar ➢ Kisses and hugs parents
ball object (ball) ➢ Indicates some desires
or needs by pointing
 AGE PHYSICAL AND GROSS FINE MOTOR LANGUAGE PERSONAL SOCIAL
MOTOR

18 MONTHS ➢ Anterior fontanel is ➢ Makes a tower 3-4 ➢ 7-20 words ➢ Seeks help when in
closed cubes ➢ Identifies one or trouble
➢ Able to control ➢ Imitatively makes more parts of the ➢ May complain when
sphincters strokes body wet or soiled
(physiological) ➢ Turns 2 or 3 pages at ➢ Indicates needs ➢ Kisses parents with
➢ Seats self in child a time ➢ Names pictures pucker
chair ➢ Uses spoon without ➢ Points to a common ➢ Imitator (domestic
➢ Runs stiffly and rotation object mimicry)
clumsily (often falls) ➢ Evident tempers
➢ Walks upstairs with tantrums
one hand held or ➢ Beginning awareness
holding the rails of ownership
(places both feet into ➢ May develop
one step before dependency on
advancing) transitional objects
➢ Explores drawers and (security blanket)
wastebaskets etc.
➢ Runs and jumps in
place with both feet
➢ Throws balls
overhand without
falling
➢ Pulls and pushes toys
 AGE PHYSICAL AND GROSS FINE MOTOR LANGUAGE PERSONAL SOCIAL
MOTOR
2 YEARS ➢ Adult height = 2 x ➢ Tower of 7 cubes ➢ Vocabulary: ➢ Stage of parallel
height that of 2 (6 at 21 months) approximately 300 play
years old ➢ Aligns 2 or more words ➢ Possesses
➢ Runs well (wide cubes like a train ➢ Combines two or sustained
stance) ➢ Open doors and three words in a attention span
➢ Goes up and down unscrews lids of sentence ➢ Temper tantrums
stairs alone (still jars ➢ Points to decreases
placing both feet ➢ Imitate circular directions ➢ Pulls people to
on the same step stroke and vertical (two or three) show them
before advancing) strokes ➢ Verbalizes needs something
➢ Picks up object ➢ Turns one page at (toileting, food or ➢ Increased
without falling a time drink) independence
➢ Does not lose ➢ Folds paper once ➢ Talks non-stop ➢ Removes
balance when imitatively ➢ Gives first name garments and
kicking ball (refer to self by dresses self in
forward name) simple clothing
➢ Climbs on ➢ Uses pronouns ➢ Often tells
furniture immediate
experiences
➢ Listens to stories
with pictures
 AGE PHYSICAL AND FINE MOTOR LANGUAGE PERSONAL SOCIAL
GROSS MOTOR
2 ½ YEARS ➢ Complete 20 ➢ Builds tower of ➢ Gives first and ➢ Separates more
deciduous teeth 8 cubes last name easily from
(2 ½ - 3 years) ➢ Adds a chimney ➢ Can name one parents
➢ Birth weight to train of cubes color ➢ Active play,
quadrupled ➢ Good hand- ➢ Refers to self plays house
➢ Daytime bowel finger with pronouns (pretend play)
and bladder coordination ➢ Tells age by ➢ Uses spoon with
control ➢ Moves fingers holding up the little spilling
➢ Jumps with both independent of fingers ➢ Helps in simple
feet from a chair each other ➢ Uses plurals house tasks
or step ➢ Draws simple ➢ Follow ➢ Knows own sex
➢ Tiptoes for a few lines for crosses directions (two ➢ May toilet
steps or three) independently
➢ Names one but needs help
picture in wiping
➢ Helps put things
away
 AGE PHYSICAL AND GROSS FINE MOTOR LANGUAGE PERSONAL SOCIAL
MOTOR
3 YEARS ➢ May have achieved ➢ Builds tower of 9 or ➢ Vocabulary: 900 ➢ Puts on shoes
nighttime bowel and 10 cubes words ➢ Feeds self completely
bladder control ➢ Builds bridges with ➢ Primarily “telegraphic ➢ Knows own sex and
➢ Jumps off the bottom 3 cubes speech” of others
step of the stairs ➢ Imitates a cross, ➢ Uses plurals and ➢ May have fears in the
➢ Goes upstairs with copies a circle, and complete sentences dark
alternating steps, identifies what has with 2-4 words ➢ Parallel and
may still go down been drawn ➢ Tells little stories associative play
using both feet on ➢ Cannot draw s stick about experiences ➢ Dry by night
the step figure but makes ➢ Talks nonstop eve if ➢ Washes and dries
➢ Throws balls circle with facial no one is listening hands
➢ Rides tricycle features ➢ Asks many questions ➢ Plays interactive
➢ Stands momentarily ➢ Counts to three or games (simple) but
on one foot more follows own rules
➢ Broad jumps ➢ Repeats 3 numbers or ➢ Begins to share
➢ May try to dance a sentence 6 syllables ➢ Has increased
(inadequate balance) attention span
➢ Egocentric in thought
and behavior
➢ Dresses with
supervision
➢ Separates from
mother more easily
 AGE PHYSICAL AND GROSS FINE MOTOR LANGUAGE PERSONAL SOCIAL
MOTOR
4 YEARS ➢ Birth length is ➢ Uses scissors to ➢ Vocabulary: 1,500 ➢ Dresses without
doubled cut out pictures words supervision
➢ Goes down stairs ➢ Imitates squares, ➢ Uses sentences of ➢ Very independent
with alternate and traces a cross 4-5 words and tends to be
steps and a diamond ➢ Peak of selfish and
➢ Skips and hops on ➢ Copies bridge questioning impatient
one foot from model ➢ Tells “tall tales” ➢ Physically and
➢ Catches ball well ➢ Imitates (exaggerated verbally
➢ Throws ball construction of stories) aggressive
overhand “gate” of 5 cubes ➢ May be mildly ➢ Mood swings
➢ Constantly in ➢ Copies cross and profane (if ➢ Has pride in
motion square mingling with achievements
➢ Climbs well ➢ Draws a man with other children) ➢ Dramatic, enjoys
2 to 4 parts ➢ Comprehensive entertaining
besides head prepositions, and ➢ Associative play
adjectives such as and imaginary
cold. Tired playmates
 AGE PHYSICAL AND GROSS FINE MOTOR LANGUAGE PERSONAL SOCIAL
MOTOR
5 YEARS ➢ Handedness is ➢ Ties shoelaces ➢ Vocabulary: 2,100 ➢ Independent and
established (90% are ➢ Uses scissors, simple words trustworthy
right-handed) tools, and pencils ➢ Counts to ten ➢ Eager to do things
➢ Eruption of well ➢ Prints first name right and to please
permanent teeth ➢ Copies a diamond ➢ Uses sentences of 6-8 ➢ Better manners
may begin and triangle words (all parts of ➢ Total self-care
➢ Heel to toe walk ➢ Adds 7-9 parts to a speech) (occasional
(backward) stick figure ➢ Names coins and 4 supervision)
➢ Skips and hops, ➢ Prints a few letters, colors ➢ Associative play, tries
alternate feet numbers or words ➢ Describes drawing or to follow rules but
➢ Throws (overhand) (name) picture with may cheat in order to
and catches the ball ➢ Names the heavier of comments and avoid losing
reliably 2 weights enumerations ➢ Tells stories
➢ Balances with skates ➢ Knows the names of ➢ Very curious of facts
➢ Jumps from height of days, month, and concerning the world
12 inches and lands time-associated ➢ Enjoys sports,
on toes words cooking and
➢ Able to balance on ➢ Knows articles shopping with parent
alternate feet with ➢ Able to follow three of the same sex
eyes closed commands in a row ➢ Domestic role
playing
➢ Questions the
meaning of words
 AGE PHYSICAL AND GROSS FINE MOTOR LANGUAGE PERSONAL SOCIAL
MOTOR
6 YEARS ➢ Central ➢ Draws a complete ➢ Adds and ➢ Dresses self
mandibular person with subtracts completely
incisors erupt clothing ➢ Distinguishes ➢ Difficulty owning
➢ Loses first teeth ➢ Can write fairly between left and misdeeds
➢ Constant activity well right, and morning ➢ Enjoys oral
➢ More aware of the ➢ Can use a knife and afternoon spelling game
hand as a tool ➢ Will cheat to win
➢ Rough play, very
competitive and
boastful
➢ Imitates adults
➢ Increases
socialization
➢ More independent
➢ Usually jealous of
younger sibling
➢ Likes to be with
children of same
age