NEWBORN

&
DEVELOPMENTAL
MILESTONES

Dr. Cecille O. Martinez

 The Skin
The ❑ General inspection of a newborn’s skin includes
color, any birthmarks, and general appearance.
Appearance
A. The Color
of a Newborn ❑ Most term newborns have a ruddier complexion
for their first month than they will have later in
life because of the increased concentration of
red blood cells in their blood vessels and a
decrease in the amount of subcutaneous fat,
which makes blood vessels more visible.

❑ Infants with poor central nervous system control

or respiratory difficulty may appear pale and
cyanotic.
 The Cyanosis.
❑ Generalized mottling of the skin
Appearance (blotchy, red-purplish marbling of the skin)
of a Newborn is a common f inding in newborns.
❑ The lips, hands, and feet are likely to
appear blue from immature peripheral
circulation (termed acrocyanosis).
❑ This can be so prominent in some
newborns that the infant’s hands
appear as if a stricture at the wrist
must be cutting off circulation because
there is usual skin color on one side
and blue on the other.
❑ Acrocyanosis this way is a normal
finding at birth through the first 24 to
48 hours af ter birth.
 The Hyperbilirubinemia
❑ Hyperbilirubinemia is caused by the accumulation of
Appearance e xc e s s b i l i r u b i n i n b l o o d s e r u m .
❑ In the average newborn, the skin and sclera of the

of a Newborn eyes begin to appear noticeably yellow on the

second or third day of life as a result of a
breakdown of fetal red blood cells (called
p hy s i o l o g i c j a u n d i c e ) , h a p p e n i n g b e c a u s e , a s t h e
high red blood cell count built up in utero is being
reduced, heme and globin are released.
❑ There is no set level at which indirect serum
bilirubin requires treatment because other factors,
s u c h a s a g e , m a t u r i t y, a n d b r e a s t fe e d i n g s t a t u s ,
a f fe c t t h i s d e t e r m i n a t i o n .
❑ If the level rises to more than 10 to 12 mg /100 ml,
treatment is usually considered.
❑ Phototherapy (exposure of the infant to light to
initiate maturation of liver enzymes) is common
t h e ra p y
❑ Some infants need continued therapy after discharge
and receive phototherapy at home either by a light-
emitting diode (LED) or f luorescent lights over their
crib or a phototherapy blanket ( Baston, 2012).
 The Pallor
Appearance ❑ Pallor in newborns is potentially serious because
it usually occurs as the result of anemia, which
of a Newborn may be caused by a number of circumstances
such as:

1 . Low iron st ores caused by poor m aternal nutrition

during pregnancy.
2 . Blood incom patibility in which a large num ber of red
blood cells were hemolyzed in utero.
3 . Fetal– m aternal transf usion .
4 . Inadequate f low of blood f rom the cord into the inf ant
before the cord was cut.
5 . Excessive blood loss when the cord was cut.
6 . Internal bleeding.

❑ To de te ct thi s, a ba by w h o a p pea r s p al e s ho uld b e

wa tch e d cl o s e l y f o r s i g n s o f b l o o d i n th e s to o l o r vo m i tu s .
❑ N ew bo rn s id en tif ied a s havi ng a ne mia n ee d the rap y s u ch
a s s u pple me ntal ir on o r a p a cked r ed cell tran s fu sio n to
r e s to r e th e i r b l o o d vo l u me .
 The
Appearance The Harlequin Sign
of a Newborn
❑ Occasionally, because of immature blood
circulation, a newborn who has been lying on
his or her side appears red on the dependent
side of the body and pale on the upper side,
as if a line had been drawn down the center of
the body.
❑ This is a transient phenomenon and, although
startling, is of no clinical significance.
❑ The odd coloring fades immediately if the
infant’s position is changed or the baby kicks
or cries.
 The Mongolian Spots
❑ Mongolian spots are collections of pigment
Appearance cells (melanocytes) that appear as slate-gray
of a Newborn patches across the sacrum or buttocks and
possibly on the arms and legs of newborns.

Lanugo
❑ Lanugo is the fine, downy hair that covers a term
newborn’s shoulders, back, upper arms, and possibly
also the forehead and ears.
❑ Post-term infants (born after more than 42 weeks of
gestation) rarely have lanugo.
❑ Babies born at 37 to 39 weeks, in contrast, have a
generous supply of lanugo.
❑ Following birth, lanugo is rubbed away by the friction
of bedding and clothes against the newborn’s skin.
❑ By 2 weeks of age, it has usually totally disappeared.
 Vernix Caseosa
❑ Vernix caseosa is the white, cream cheese–like
The substance that serves as a skin lubricant in

Appearance utero.
❑ Some of it is invariably noticeable on a term
of a Newborn newborn’s skin, at least in the skin folds, at
bir th.
❑ Nurses should document the color of any vernix
present, because it takes on the color of the
amniotic f luid (yellow vernix implies the
amniotic fluid was stained from excessive
bilirubin or a blood dyscrasia may be present;
green vernix suggests meconium was present in
the amniotic f luid).
❑ Until the f irst bath, when vernix is washed away,
handle newborns with gloves to protect yourself
from exposure to this body f luid.
❑ Never rub it away harshly because newborn skin
is tender and breaks in the skin caused by too
vigorous attempts at removal could open portals
of entr y for bacteria
 Desquamation
❑ Within 24 hours af ter birth, the skin of most
The newborns begins to dry.

Appearance ❑ The dryness is particularly evident on the

palms of the hands and soles of the feet and
of a Newborn results in areas of peeling like those caused
by sunburn.
❑ This is a temporary reaction to suddenly living
in an air-f illed rather than a liquid-f illed
environment and so needs no treatment.
❑ Lotion can be applied to prevent excessive
dryness.
❑ Newborns who are post-term and have
suffered intrauterine malnutrition may have
such extremely dry skin that it has a leathery
appearance and there are actual cracks in the
skin folds.
❑ This should be differentiated from normal
desquamation because it helps to diagnose the
newborn as post-term
 Desquamation
❑ Within 24 hours af ter birth, the skin of most
The newborns begins to dry.

Appearance ❑ The dryness is particularly evident on the

palms of the hands and soles of the feet and
of a Newborn results in areas of peeling like those caused
by sunburn.
❑ This is a temporary reaction to suddenly living
in an air-f illed rather than a liquid-f illed
environment and so needs no treatment.
❑ Lotion can be applied to prevent excessive
dryness.
❑ Newborns who are post-term and have
suffered intrauterine malnutrition may have
such extremely dry skin that it has a leathery
appearance and there are actual cracks in the
skin folds.
❑ This should be differentiated from normal
desquamation because it helps to diagnose the
newborn as post-term
 The
Appearance Milia
❑ Sebaceous glands in a newborn are immature,
of a Newborn so at least one pinpoint white papule (a
plugged or unopened sebaceous gland) is
usually found on a cheek or across the bridge
of the nose of every newborn.
❑ Such lesions, termed milia, disappear by 2 to
4 weeks of age as the sebaceous glands
mature and the plugged ones drain.
❑ Nurses should caution the parents to avoid
scratching or squeezing the papule while they
wait for this to clear to prevent secondary
infection.
 Erythema Toxicum
The ❑ In most term newborns, some degree of a
rash, called erythema toxicum , is present.
Appearance ❑ The rash usually appears in the first to fourth
day of life but may appear as late as 2 weeks
of a Newborn of age.
❑ It begins with small papules, increases in
severity to become erythematous by the
second day, and then disappears by the third
day.
❑ It is sometimes called a flea-bite rash because
the lesions are so minuscule.
❑ It occurs sporadically and unpredictably and
may last hours rather than days.
❑ It is probably caused by the newborn’s
eosinophils reacting to the rough environment
of sheets and clothing rather than a smooth
liquid against the skin.
❑ It requires no treatment.
 Skin Turgor

The ❑ Like adult skin, newborn skin should feel

resilient if the underlying tissue is well
Appearance hydrated.

of a Newborn ❑ Grasp a fold of the skin between your thumb

and f ingers and evaluate if it feels elastic.
❑ When released, the skin should fall back to
form a smooth surface.
❑ If severe dehydration is present, the skin will
not smooth out again but will remain as an
elevated ridge.
❑ Poor turgor is seen in newborns who suffered
malnutrition in utero, who have difficulty
sucking at birth, or who have certain
metabolic disorders such as adrenocortical
insufficiency.
❑ It always needs to be reported as it suggests
extremely poor hydration.

▪ Reflexes are involuntary movements
or actions.
▪ Some movements are spontaneous
and occur as part of the baby's
normal activity.
▪ Others are responses to certain
actions.
▪ Healthcare providers check reflexes
to determine if the brain and
nervous system are working well.
▪ Some reflexes occur only in specific
periods of development.
✓ T h e M o ro ref l ex i s o f te n ca l l e d a
sta r tl e ref l ex .
✓ T h at ’s b e ca u s e i t u s u al ly o c c u rs
wh e n a b a by i s sta r tl e d by a l o u d
s o u n d o r m ove m e nt.
✓ I n re s p o n se to t h e s o u nd , t h e
b a by t h rows b a c k h i s o r h e r
h e a d , ex te n d s o u t h i s o r h e r a r m s
and legs, cries, then pulls the
a r m s a n d l eg s b a c k i n .
✓ A b a by's o wn c r y ca n sta r tl e h i m
o r h e r a n d t r i g ge r t h i s ref l ex .
✓ T h i s ref l ex l a st s u nt i l t h e b a by i s
a b o ut 2 m o nth s o l d .
Suck reflex
▪ Rooting helps the baby get ready
to suck. When the roof of the
baby's mouth is touched, the baby
will start to suck.
▪ This reflex doesn't start until about
the 32nd week of pregnancy and is
not fully developed until about 36
weeks.
▪ Premature babies may have a
weak or immature sucking ability
because of this.
▪ Because babies also have a hand-
to-mouth reflex that goes with
rooting and sucking, they may suck
on their fingers or hands.
Tonic neck reflex
▪ When a baby's head is turned
to one side, the arm on that
side stretches out and the
opposite arm bends up at the
elbow.
▪ This is often called the fencing
position.
▪ This reflex lasts until the baby
is about 5 to 7 months old.
Grasp reflex
Stroking the palm of a baby's hand
causes the baby to close his or her
fingers in a grasp. The grasp reflex
lasts until the baby is about 5 to 6
months old. A similar reflex in the
toes lasts until 9 to 12 months.
Stepping reflex
▪ This reflex is also called the
walking or dance reflex
because a baby appears to
take steps or dance when
held upright with his or her
feet touching a solid
surface.
▪ This reflex lasts about 2
months.
▪ The plantar grasp reflex (Babinski
reflex) is similar to the grasp reflex of
the hand. If you place your thumb
below the toe bed of an infant's foot
and apply pressure, the toes will curl
around your thumb, grasping it (flexion
and adduction).
▪ This reflex is not present in many
newborns.
 Examples of reflexes that last into
adulthood are:
Reflex​ Age When Reflex Age W​hen Reflex
Appears Disappears ✓ Blinking reflex: blinking the eyes when
Stepping Birth 2 months they are touched or when a sudden
bright light appears
Rooting Birth 4 months ✓ Cough reflex: coughing when the airway
is stimulated
Palmar grasp Birth 5–6 months
✓ Gag reflex: gagging when the throat or
Moro reflex Birth 5–7 months back of the mouth is stimulated
✓ Sneeze reflex: sneezing when the nasal
Tonic neck reflex Birth 5–7 months passages are irritated
✓ Yawn reflex: yawning when the body
Plantar grasp Birth 9–12 months
needs more oxygen

Note: A reflex that is still present after the age

when it would normally disappear can be a sign of
brain or nervous system damage.
THE CARE N e w b orn Id e n t i f i ca t i o n a n d Re g i s t rat i o n

OF A
❑ Be ca use new b orn s h ave no way of i de nt ify i n g
t he mse lves , a n im p or t a nt n urs i n g resp o n s i b i l ity is t o

NEWBORN be cer t a i n t hey have a n ide n t if i ca t i on b a n d i n p l ace ,

so me d i cine a dm i n is trat i o n or per for mi n g

AT BIRTH p r o ce d u res ca n b e d o n e s a fe l y.

❑ O ne tra di ti on a l for m of i den tif i ca tio n u sed w ith

new b or ns is a p l as t i c brace let w i th a per m ane n t lo ck
t h a t r e q u i res cu t t i n g t o b e r e m oved .

❑ A n u m ber t ha t corres po nd s t o t he mo t her ’s h os pi t a l

n u m ber ; t he m ot her ’s name ; a n d t he se x , date , an d
t i m e o f t h e i n f a n t ’s b i r t h a r e p r i n t ed o n t h e b a n d .

❑ Af ter ide n t if i ca t i o n b an ds are at ta ch ed , a n i nf a nt ’s

fo o t pr i nt s may be t a ken a n d t hereaf ter kep t w i t h the
b a b y ’s e l e ct ron i c r e co rd fo r p e r m an en t i d e n t i f i ca t i o n
 Newborns are cared for in either a bir thing room
NURSING CARE or a transitional nurser y for optimal safety in the
f irst few hours of life.
OF A
❑ The Initial Feeding
NEWBORN AND
❑ The Baby-Friendly Hospital Initiative (BFHI) is
FAMILY IN THE a global program sponsored by the World
POSTPARTAL Health Organization (WHO) and the United

PERIOD Nations Children’s Fund (UNICEF) to encourage

and recognize hospitals and bir thing centers
that offer an optimal level of care for
breastfeeding.
❑ Af ter a f irst feeding in the bir thing room, both
formula-fed and breastfed infants do best with
an “on-demand” schedule (i.e., are fed when
they are hungry), not at a set 3-hour or 4-hour
inter val.
❑ Many need to be fed as of ten as every 2 hours
in the f irst few days of life.
 ❑ During the f irst few days of life, because they
NURSING CARE are receiving only colostrum and need the
OF A nutrients and f luid obtained by frequent

NEWBORN AND sucking, babies should be fed as of ten as they

seem hungry (e.g., every 2 to 3
FAMILY IN THE hours).Frequent feeding also is advantageous
POSTPARTAL to sustain a milk supply, because the more
PERIOD of ten breasts are emptied, the more eff iciently
they f ill and continue to maintain a good
supply of milk.

❑ It is just as important to help infants break

away from the breast when they are through
feeding . Teach a woman to insert a f inger in
the corner of the infant’s mouth or pull down
the infant’s chin to release suction . Otherwise,
the baby may pull too hard on the nipple,
causing nipple cracking or soreness.
 At the heart of the protocol are four (4) time -bound
interventions:

1) immediate and thorough drying (prevents hypothermia which

Essential is extremely important to newborn survival)

2) early skin -to-skin contact (keeping the mother and baby in

Newborn Care uninterrupted skin -to-skin contact prevents hypothermia,
hypoglycemia and sepsis, increases colonization with protective
bacterial flora and improved breastfeeding initiation and
(ENC) exclusivity) followed by,

3) properly -timed clamping and cutting of the cord after 1 to 3

minutes (properly timed cord clamping and cutting until the
umbilical cord pulsation stops decreases anemia in one out of
every seven term babies and one out of every three preterm
babies. It also prevents brain (intraventricular) hemorrhage in
one of two preterm babies.), and

4) non-separation of the newborn from the mother for early

breastfeeding initiation and rooming -in. (breastfeeding initiation
within the first hour of life prevents an estimated 19.1% of all
neonatal deaths)
 ✓ “The Unang Yakap or Essential Intrapartum Newborn Care
was really conceptualized in order to have early initiation
Essential of breastfeeding.
✓ So how early is early? As early as delivery.
Newborn Care ✓ The newborn is placed strategically on the mother’s
breast so he will be able to feed immediately when he is
(ENC) hungry.
✓ What’s good about Unang Yakap is that it respects the
readiness of the baby to breastfeed as manifested by
feeding cues,”
Additional Information:
✓ E xc l u s i ve b r e a s t f e e d i n g m e a n s t h a t t h e i n f a nt r e c e i v e s o n l y
b r e a s t m i l k . N o o t h e r l i q u i d s o r s o l i d s a r e g i ve n – n o t e ve n wa t e r
– wi t h t h e e xc e p t i o n o f o r a l r e h yd r a t i o n s o l u t i o n , o r d r o p s / s yr u p s
o f vi t a m i n s , m i n e r a l s o r m e d i c i nes .

✓ f o r a b o u t t h e f i r s t 6 m o n t h s wi t h c o n t i n u e d b r e a s t f e e d i n g a l o n g
wi t h i n t r o d u c i n g a p p r o p r i a t e c o m p l e me n t a r y f o o d s f o r 1 ye a r o r
l o n g e r.
 ✓ “The Dietary Guidelines for Americans and the
American Academy of Pediatrics recommend children
Essential be introduced to foods other than breast milk or
infant formula when they are about 6 months old.
Newborn Care ✓ Introducing foods before 4 months old is not
recommended.
(ENC)
✓ Every child is different.

✓ Let the child try one single -ingredient food at a time

at first.

✓ This helps the parent see if the child has any problems
with that food, such as food allergies.

✓ Wait 3 to 5 days between each new food. (Or 4 to 7

days apart) Before the parent know it, the child will be
on his or her way to eating and enjoying lots of new
foods.
 What newborn care practices in the delivery room
should no longer be continued?
Essential T he f ollowing pr actices s hould never be done a nymore t o t he
newbor n:

Newborn Care ❑ Ma nipulation s uc h a s r o utine s uctioning o f s e cretions i f t he ba by

i s c r yi ng a nd br eathing no rmally. D oing s o may c ause t r auma o r
i ntroduce i nf ection.
(ENC)
❑ Putting t he newborn o n a c old o r w et s urf ace.

❑ Wi ping o r r emoval o f v ernix c a seosa i f present

❑ Fo ot pri nting

❑ Bathing e arlier t han 6 ho urs o f l i fe

❑ Unnecessary s eparation o f t he newborn pri marily f or weighing,

a nthropometric measurements, i ntramuscular a dministr ation o f
vi tamin K , Hepatitis B v accine a nd BC G v accine

❑ T r ansferring o f t he newborn t o t he nur sery o r neonatal i ntensive

c a re uni t wi thout a ny i ndication

WEANING THE BABY
FROM FEEDING
W e a n in g i s t h e t i m e w h e n t h e
baby learns to drink from a cup
instead of from a breast or
bottle.
I n f a n t s u s u a ll y s t a y o n f o r m u la
until their first birthday.
Tell parents to give formula in
the cup instead of cow's milk if
they want to wean their child
before one year of age.
▪ T h e a g e o f w e a ni ng i s d i f f e r e nt f o r e a c h b a b y .
▪ M o s t a r e r e a d y t o s t a r t l e a r n i ng t o u s e a c u p b y 6 t o 1 2 m o n t hs
of age.
▪ T h e b a b y s h o u l d b e a b l e t o s i t u p w e l l w i t h o ut s u p p o r t b e f o r e
t h e m o t he r b e g i n w e a n i ng .
▪ T h e y h a v e t o e n c o ur a g e t h e i r b a b y t o g i v e u p t h e b o t t l e w h e n h e
o r s h e s h o w s a n y o f t h e se s i g n s :
1. Shortens his or her breast -feeding time.
2. Is easily distracted when held for a feeding.
3. Wants to hold the bottle alone.
F or B o t t l e - fed C hi ld - I t i s r e commended t hat p ar ent s s h ould w e an
t hei r c hi l dren o f f t he b o t tl e a t 1 5 - 18 m ont hs o f a g e.
B ut I f a b o t t l e i s s t i l l a t t ached t o t he c hi ld a t 3 y e ars o f a g e d uring
n ap ti me o r b e dt i me, i t s h ould c o nt ai n o nl y w a t er t o p r event t he r i sk
o f d ent al c ar i es.
The use of a nighttime bottle can cause tooth decay because the formula
sticks to the teeth and germs grow, causing cavities.
 Burping the Baby

NURSING CARE ❑ S o m e i n f a n t s s e e m t o s w a l l o w l i t t l e a i r w h e n t h e y fe e d ,
whereas others swallow a great deal.
OF A ❑ As a rule, it is helpful to burp newborns after they have
NEWBORN AND e m p t i e d t h e f i r s t b r e a s t ( o r h a l f o f t h e b o t t l e - fe e d i n g
f o r m u l a ) a n d a g a i n a f t e r t h e t o t a l fe e d i n g t o h e l p e v a c u a t e
FAMILY IN THE air from their stomachs.

POSTPARTAL ❑ Placing the baby over one shoulder and gently patting or
s t r o k i n g t h e b a c k i s a t i m e - h o n o r e d p o s i t i o n . H o w e v e r, t h i s
PERIOD position is not always satisfactory for a newborn who has
poor head control because a parent may have difficulty
supporting the baby and patting the back at the same time.

❑ Holding the baby in a sitting position on the lap, then

leaning the child forward against one hand, with the index
finger and thumb supporting the head, is often the best
position to use. This position provides head suppor t and
l e av e s t h e o t h e r h a n d f r e e t o p a t t h e b a b y ’s b a c k

❑ Pa r e n t s u s u a l l y n e e d t o b e s h o w n t h i s m e t h o d b e c a u s e i t
does not seem as natural as placing a baby against the
s h o u l d e r.

❑ Laying the baby prone across the lap is yet another

alternative position.
 Ba t h i n g
NURSING CARE
❑ In mo st h os p i ta l s , newb or n s rece ive a co mplete
OF A s p o n ge b a t h to was h away ver n ix case osa w i th i n an
NEWBORN AND hour after birth.

FAMILY IN THE ❑ Ba b ie s of mo t hers w it h H IV i n fe ct ion s ho u l d have a

t h or o u g h ba th immedi a tel y to de cre ase the
POSTPARTAL p o s s i b i l i t y o f H I V t ra n s m i s si o n .
PERIOD ❑ T hereaf ter, al l b a b ies are sp o n ge ba the d o n ce a day,
a l t h o u g h t he pro ce d ure m ay be l i mi te d t o was hi n g
o n l y t h e ba by ’s f a ce , di a pe r a r e a, a n d s k i n fo l ds .

❑ N ur ses s ho u ld wear g l oves w he n h a n dl i n g newb orns

u n t i l t he f irst b a t h t o avo i d ex po s i ng the ir ha n ds t o
b o d y s e cr eti o n s s u c h a s t h e ve r n i x ca s e o s a .

❑ As a ru le , ba t h i n g s h o u ld pr o ceed fro m t he cle anest

p ar ts of t he b o dy to t he m os t s o i led are as —t h a t i s,
fr o m t he eyes a nd fa ce to t he tr u nk a n d ex trem i ties
and, last, to the diaper area.
NURSING CARE
OF A
Hepatitis B Vaccination
NEWBORN AND
FAMILY IN THE ❑ All newborns born in a hospital, or a birthing
center receive a first vaccination against
POSTPARTAL
hepatitis B within 12 hours af ter birth; a
PERIOD second dose will then be administered at 1
month and a third one at 6 months.

❑ Infants whose mothers are positive for the

hepatitis B surface antigen (HBsAg) also
receive hepatitis B immune globulin (HBIG)
at birth (APA, 2012a).
 Vitamin K Administration
NURSING CARE
OF A ❑ Newborns are at risk for bleeding disorders
during the first week of life because their
NEWBORN AND
gastrointestinal tract is sterile at birth and
FAMILY IN THE
therefore unable to produce vitamin K, a
POSTPARTAL vitamin necessary for blood coagulation .
PERIOD
❑ A single dose of 0.5 to 1.0 mg of vitamin K
administered intramuscularly within the first
hour of life helps prevent such problems.

❑ Vitamin K is also available in an oral form

but is not the preferred form because
newborn absorption may still be immature,
and vomiting can dilute the dose (Ipema,
2012).
 ❑ Swaddling is a traditional practice of wrapping a
baby up gently in a light, breathable blanket to help
Swaddling a them feel calm and sleep. They should only have
baby their body wrapped and not their neck or head.

❑ The idea is that being swaddled will help the baby

feel snug and secure, like how they felt in the womb.

Advantages:
❑ I t p r e ve nt s unne c e s s ar y w a ke -up s c aus e d a b a b y’ s s t ar t l e r e f l e x .
Th i s i s b e c aus e a s w ad d l e d b ab y ’ s ar ms and l e gs w i l l b e c on t a i ne d
a s t he y ’ r e w r ap p e d g e n t l y i n a b l an ke t . Th at me ans t he y w i l l b e
l e s s l i k e l y t o s t a r t l e t h e ms e lv e s a w a k e w i t h t h e i r f l a i l i ng l i m b s .

❑ I t he l p s e l i m i na t e a n x i e t y i n t he b ab y b y i m i t a t i n g m ot he r ’ s
t ouc h, w h i c h he l p s t h e b ab y l e a r n t o s e l f -s o o t h . I t ke e p s t he
m o t h e r ’ s h a n d s o f f t h e b a b y ’ s f a c e a n d h e l p s p r e v e nt s c r a t c hi n .
 ❑ Every infant will have his own pattern of
Newborn elimination, but most newborns will urinate six
to twelve times and have one to six bowel
Elimination movements a day.

❑ Newborns should have at least four wet

diapers a day but may go several days without
a bowel movement.

❑ Newborn’s first bowel movements will be a

substance known as meconium. This thick black
or dark green substance filled their intestines
before birth, and once passed, the stools
turn yellow-green.
 ❑ N e w b o r n ’s s t o o l s v a r y i n c o l o r a n d c o n s i s te n c y d u e t o t h e i r i m m a t u r e
d i g e st i v e sy ste m .

Newborn ❑ I f b r e a s t fe d , t h e i r s to o l s s o o n s h o u l d b e y e l l o w l i q u i d m i xe d w i t h s o m e
particles. Until they start to eat solid foods, the consistency of the stools
m ay ra n g e f ro m v e r y s o f t to l o o s e a n d r u n ny.

Elimination ❑ I f t h e y ' r e f o r m u l a - fe d , t h e i r s t o o l s u s u a l l y w i l l b e ta n o r y e l l o w i n c o l o r.
T h e y w i l l b e f i r m e r t h a n a b r e a s t fe d b a b y ' s , b u t s h o u l d b e n o f i r m e r t h a n
s o f t c l ay.

❑ G r e e n sto o l s a r e n o t u n u s u a l , e i t h e r, a n d t h e y s h o u l d n o t c a u s e a ny a l a r m .

❑ M a ny p a s s a s to o l s o o n a f t e r e a c h fe e d i n g . T h i s i s a r e s u l t o f t h e g a s t r o c o l i c
r e f l ex , w h i c h c a u s e s t h e d i g e s t i v e sy s te m t o b e c o m e a c t i v e w h e n e v e r t h e
sto m a c h i s f i l l e d w i t h fo o d .

❑ B y t h r e e t o s i x w e e k s o f a g e , s o m e b r e a s t fe d b a b i e s h a v e o n l y o n e b o we l
m o v e m e n t a we e k a n d st i l l a r e n o r m a l .

❑ B r e a s t m i l k l e a v e s v e r y l i tt l e s o l i d w a s te t o b e e l i m i n a te d f r o m t h e c h i l d ' s
d i g e s t i v e sy s t e m . T h u s , i n f r e q u e n t s t o o l s a r e n o t a s i g n o f c o n s t i p a t i o n a n d
should not be considered a problem as long as the stools are soft, and the
i n fa n t i s o t h e r w i s e n o r m a l , ga i n i n g we i g h t ste a d i l y, a n d n u rs i n g r e g u l a r l y.

❑ I f t h e b a b y i s f o r m u l a - fe d , t h e y s h o u l d h av e a t l e a s t o n e b o w e l m o v e m e n t a
d a y. I f t h e y h av e fe w e r t h a n t h i s a n d a p p e a r t o b e s t ra i n i n g , t h e y m ay b e
c o n st i p a te d .
Newborn ❑ Cuddling helps the baby develop a secure

Cuddling
attachment to the mother.

❑ The bond developed has effects later in the

child's life in terms of self-confidence, healthy
individuation and exploration, expression of
empathy, social relationships and ability to
cope with life stressors.

❑ By about 4 to 6 months of age, babies

become increasingly social and love to cuddle
and laugh.
Vestibular
•Th e v e st i bu l a r sy st em i s on e o f ou r i n t er n a l s en s es t h a t
c o n t r ols a p e r s o n b a l a n c e a n d m o t i on .
Stimulation •Th i s sy st em h elp s t h e p e r son r e m ai n b a l an c e d, f e el s af e w h en
m ov i n g , co o r di n at e ey e an d h e a d m o v e m en t s, an d c oor di n a t e
both sides of the body.

•T h e v e s t i b u la r s y s t e m b e g i n s t o d e v e l o p i n t h e w o m b .

•O n c e a b a by i s bo r n , i t ’ s s t r en g t h e n e d an d st i m u l at e d t h r ou g h
m o v e m e n t a n d c h a n g e s i n p o s i t i on .

•Th r ou g h ou t b ab y an d t o d d le r h oo d, mov em e n t s li k e b ei n g
r o ck e d , g en t ly s w u n g , r ol li n g , c r aw li n g , w a lk in g , an d r u n n i n g a l l
provide input for a healthy vestibular system.

❑ A n y g en t l e a ct i v i t y t h a t g en t ly an d s af ely r o ck s , r ol l s,
t u m b l es , bou n ce s , sw i n g s an d s pi n s t h e n ew b or n pr ov i d es
t h e m w i t h v e st i bu l ar st i m u l at i on . Th i s s t i m u l at i on o f t h e
balance system is centered in the inner ear.

❑ I t u s e s i n f or m a t i on f r o m f lu i d i n t h e i n n er e a r t o l et t h e
p e r son k n ow t h e ov e r a l l po si t ion o f h er / h i s bo dy , w h e t h er o r
n o t p eo p l e a r e m ov i n g , an d i f t h ey ar e m ov i n g h ow q u i ck ly
a n d i n w h a t d i r e c t i on .
 Sensory ❑ Sensory stimulation is the input and
Stimulation sensation the newborn receive when one
or more of their senses is activated.

❑ This type of stimulation is important

for infant development and can be used to
improve the well-being of
developmentally disabled adults, people
with neurocognitive disorders, and older
adults.
 Sensory stimulation for babies

❑ Because babies learn about the world around them with

Sensory their senses, sensory stimulation is linked to:
Stimulation (Audio • e m o t i o na l d e ve l o p m e nt
& Tactile) • c o g n i t i ve d e ve l o p me nt

• p hy s i c a l d e ve l o p me nt

❑ Repetitive activities that stimulate the senses can help

babies learn and reach developmental milestones .

Examples of sensory stimulation for babies include:

• ra t t l e s

• mobiles

• h e a r i ng l u l l a b i e s

• toys

• p e e k- a - b o o g a m e s

• bath time
 Biological
❑ Biological development is the
progressive changes in size, shape, and

Development function during the life of an organism by

w hich its genetic potentials (genotype) are
translated into functioning mature systems
(phenotype).

❑ In the language of genetics the word genotype is

used to indicate the hereditary instructions
passed on from one generation to another in the
genes, while phenotype is the term given to the
functioning organisms produced by those
instructions .

❑ Biological development, therefore, consists of the

production of phenotypes.
 ➢ Soon after birth, an infant normally loses about
5% to 10% of their birth weight.

➢ B y a b o u t a g e 2 w e e ks , a n i n f a n t s h o u l d s t a r t t o
g a i n w e i g h t a n d g r o w q u i c kl y.

➢ By age 4 to 6 months, an infant's weight should

be double their birth weight.

Child’s ➢ D u r i n g t h e s e c o n d h a l f o f t h e f i r s t ye a r o f l i fe ,
g r o w t h i s n o t a s ra p i d .

➢ B e t w e en a g e s 1 a n d 2 , a t o d d l e r w i l l g a i n o n l y

Weight a b o u t 5 p o u n d s ( 2 . 2 k i l o g ra m s ) .

➢ We i g h t g a i n w i l l r e m a i n a t a b o u t 5 p o u n d s ( 2 . 2
k i l o g ra m s ) p e r ye a r b e t w ee n a g e s 2 t o 5 .

➢ B e t w e en a g e s 2 t o 1 0 ye a r s , a c h i l d w i l l g r o w a t a
steady pace.

➢ A final growth spurt begins at the start of

p u b e r t y, s o m e t i me b e t w ee n a g e s 9 t o 1 5 .
❑ Growth and development milestones help see how the child is
doing compared with other children the same age.
❑ The milestones tell what people should expect from their child in
five areas:
• Physical growth
• Thinking and reasoning (cognitive development)
• Emotional and social development
• Language development
• Sensory and motor development
• If the child is meeting the milestones, his or her development is on track.
• If the child continually misses milestones or reaches a milestone but then loses
that new ability, he or she may need extra help from the doctor or a specialist.
 •G ross m ot or s kills : using la rge groups of m us cles to

Normal sit, st and, w alk,

c ha nging pos i tions
run, etc ., k e e pi ng balance a nd

Development •Fi ne mot or skills : using hands to b e able to eat,

dr aw, dr e s s , pl a y, w r ite, a nd d o m a n y ot he r t hi ngs

•Language skills : speaki ng, using bod y l anguage a nd

gest ur es, c ommunica ting, and under sta nding w hat
Developmental milestones ot he r s s a y

are a set of functional skills •C ognitive s kills : t hinki ng s kills including lea rni ng,
under sta ndi ng, pr oble m -s ol vi ng, re as oni ng, and
or age-specific tasks that
r e m e m be ring
most children can do at a
•Social skills : i nte racti ng w ith ot her s, ha vi ng
certain age range.
r elations hips w ith fa mil y, fri ends, and te ac her s,
c oope r ating a nd r e s ponding t o t h e f e e lings o f ot he r s .
Developmental Movement Milestones
•Makes jerky, quivering arm thrusts
Milestones: •Brings hands within range of eyes and mouth
•Moves head from side to side while lying on stomach
1 Month •Head flops backward if unsupported
•Keeps hands in tight fists
•Strong reflex movements
Visual and Hearing Milestones
•Focuses 8 to 12 inches (20.3 to 30.4 cm) away
•Eyes wander and occasionally cross
•Prefers black-and-white or high-contrast patterns
•Prefers the human face to all other patterns
•Hearing is fully mature
•Recognizes some sounds
•May turn toward familiar sounds and voices
Developmental Smell and Touch Milestones
•Prefers sweet smells
Milestones: •Avoids bitter or acidic smells
•Recognizes the scent of his own mother ’s breastmilk
1 Month •Prefers soft to coarse sensations
•Dislikes rough or abrupt handling

Developmental Health Watch

If, during the second, third, or fourth weeks of the
baby ’s life, she shows any of the following signs
of developmental delay, notify the pediatrician.
•Sucks poorly and feeds slowly
•Doesn’t blink when shown a bright light
•Doesn’t focus and follow a nearby object moving side to side
•Rarely moves arms and legs; seems stiff
•Seems excessively loose in the limbs, or floppy
•Lower jaw trembles constantly, even when not crying or
excited
•Doesn’t respond to loud sounds
 Social and Emotional
Begins to smile at people
Developmental Can briefly calm herself (may bring hands to mouth and suck
on hand)
Milestones: Tries to look at parent

2 Months Language/Communication
Coos, makes gurgling sounds
Turns head toward sounds

Cognitive (learning, thinking, problem -solving)

Milestone Checklists - 2 months

Pays attention to faces
Begins to follow things with eyes and recognize people at a
distance
Begins to act bored (cries, fussy) if activity doesn’t change

Movement/Physical Development
Can hold head up and begins to push up when lying on
tummy
Makes smoother movements with arms and legs
Developmental
Act early by talking to your child’s doctor if your child:
Milestones:
Developmental Health Watch
2 Months •Doesn’t respond to loud sounds

•Doesn’t watch things as they move

•Doesn’t smile at people

•Doesn’t bring hands to mouth

•Can’t hold head up when pushing up when on tummy

 Movement Milestones
•Raises head and chest when lying on stomach
Developmental •Supports upper body with arms when lying on stomach
•Stretches legs out and kicks when lying on stomach or back
Milestones: •Opens and shuts hands
3 Months •Pushes down on legs when feet are placed on a firm surface
•Brings hand to mouth
•Takes swipes at dangling objects with hands
•Grasps and shakes hand toys
Visual and Hearing Milestones
•Watches faces intently
•Follows moving objects
•Recognizes familiar objects and people at a distance
•Starts using hands and eyes in coordination
•Smiles at the sound of your voice
•Begins to babble
•Begins to imitate some sounds
•Turns head toward direction of sound
 Social and Emotional Milestones
Developmental •Begins to develop a social smile
•Enjoys playing with other people and may cry when
Milestones: playing stops
•Becomes more communicative and expressive with
3 Months face and body
•Imitates some movements and facial expressions
D e ve l o p m e nta l H e a l t h Wa tc h
•D o e s n ’t s e e m t o r e s p o n d t o l o u d s o u n d s
•D o e s n ’t n o t i c e h e r h a n d s b y t wo m o n t h s
•D o e s n ’t s m i l e a t t h e s o u n d o f m o t h e r ’s vo i c e b y t wo m o n t h s
•D o e s n ’t fo l l o w m o v i n g o b j e c t s w i t h h e r e ye s b y t wo t o t h r e e m o n t h s
•D o e s n ’t g ra s p a n d h o l d o b j e c t s b y t h r e e m o n t h s
•D o e s n ’t s m i l e a t p e o p l e b y t h r e e m o n t h s
•C a n n o t s u p p o r t h e r h e a d we l l a t t h r e e m o n t h s
•D o e s n ’t r e a c h fo r a n d g ra s p t o ys b y t h re e t o fo u r m o n t h s
•D o e s n ’t b a b b l e b y t h re e t o fo u r m o n t h s
•H a s t r o u b l e m o v i n g o n e o r b o t h e ye s i n a l l d i r e c t i o n s
•C r o s s e s h e r e ye s m o s t o f t h e t i m e ( O c c a s i o n a l c r o s s i n g o f t h e e ye s i s
n o r ma l i n t h e s e f i r s t m o n t h s . )
•D o e s n ’t p ay a t te nt i o n t o n e w fa c e s , o r s e e m s ve r y f r i g hte n ed b y n e w
fa c e s o r s u r ro u n d i n gs
 S o c i a l a n d E m o ti o n al
✓ S m i l es s p o nta neo us ly, e s p e cially at p e o p le
Developmental ✓ L i ke s to p l ay w i th p e o p le a n d m i g ht c r y w h e n p l ay ing sto ps
✓ C o p i e s s o m e m ove m e nts a n d fa ci al exp re ss ions, l i ke s m i l ing or

Milestones: f ro w n i ng
L a n g u age/ C o m m unicatio n
✓ B e g i ns to b a b ble v i d e o i co n
4 Months ✓ B a b bles w i th exp re s sio n a n d co p i e s s o u n d s h e h e a rs
✓ C ri e s i n d i f ferent ways to s h o w h u n ger, p a i n, o r b e i ng ti re d
C o g n i ti ve ( l e arning , th i n k ing , p rob l e m - s olvin g)
✓ L ets yo u k n o w i f h e i s h a p py o r s a d
✓ Re s p o n d s to af fec tio n
✓ Re a c h es fo r toy w i th o n e h a n d
✓ U s e s h a n d s a n d eye s to geth e r, s u c h a s s e e i ng a toy a n d re a c hing
fo r i t
✓ Fo l l o ws m o v i n g th i n g s w i th eye s f ro m s i d e to s i d e
✓ Watc h e s fa c es c l o s ely
✓ Re co g n i zes fa m iliar p e o p l e a n d th i n g s at a d i stance
M o ve m e nt/ Physical D eve l o pm ent
✓ H o l d s h e a d ste a d y, u n s u p po rte d
✓ P u s h es d o w n o n l e g s w h e n fe et a re o n a h a rd s u rfa ce
✓ M ay b e a b l e to ro l l o ve r f ro m tu m my to b a c k
✓ C a n h o l d a toy a n d s h a ke i t a n d sw i n g at d a n gling toys
✓ B ri n g s h a n d s to m o u th
✓ W h e n l y i ng o n sto m a c h , p u s h es u p to e l b o ws
 S o c i a l a n d E m o ti o n al
✓ Kn o ws fa m iliar fa c e s a n d b e g i ns to k n o w i f s o m e o n e i s a
Developmental stra n ge r
✓ L i ke s to p l ay w i th o th e rs , e s p e cially p a re nts
Milestones: ✓ Re s p o n d s to o th e r p e o p l e’s e m o ti o n s a n d o f te n s e e m s h a p py
✓ L i ke s to l o o k at s e l f i n a m i rro r
6 Months L a n g u age/ C o m m unicatio n
✓ Re s p o n d s to s o u n d s by m a k i ng s o u n d s
✓ S tri n g s vo we l s to geth e r w h e n b a b b lin g ( “a h ,” “e h ,” “o h ”) a n d
l i kes ta k i n g tu rn s w i th p a re nt w h i le m a k i ng s o u n d s
✓ Re s p o n d s to o w n n a m e
✓ Ma ke s s o u n d s to s h ow j oy a n d d i s pleas ure
✓ B e g i ns to s ay co n s o n a nt s o u n d s ( j a b bering w i th “m ,” “b ”)
C o g n i ti ve ( l e arning , th i n k ing , p ro b l e m - s o lvin g)
✓ L o o ks a ro u n d at th i n g s n e a rby
✓ B ri n g s th i n g s to m o u th
✓ S h o ws c u ri o s ity a b o u t th i n g s a n d tri e s to get th i n g s th at a re o u t
o f re a c h
✓ B e g i ns to p a s s th i n g s f ro m o n e h a n d to th e o th e r
M o ve m e nt/ Physical D eve l o pm ent
✓ Ro l l s o ve r i n b o th d i re c tio ns ( f ro nt to b a c k , b a c k to f ro nt)
✓ B e g i ns to s i t w i th o u t s u p p o rt
✓ W h e n sta n ding , s u p p o rts we i g ht o n l e g s a n d m i g ht b o u n c e
✓ Ro c ks b a c k a n d forth , s om eti m es craw lin g b a ck ward b efore
m o v i n g fo r wa rd
Developmental
early by talking to your child’s doctor if your child:
Milestones: Act

Developmental Health Watch

6 Months •D o e s n ’t w a t c h t h i n g s a s t h ey m ov e

•D o e s n ’t s m i l e a t p e o p l e

•C a n ’ t h o l d h e a d s t e a d y

•D o e s n ’t c o o o r m a ke s o u n d s

•D o e s n ’t b r i n g t h i n g s t o m o u t h

•D o e s n ’t p u s h d ow n w i t h l e g s w h e n f e e t a re p l a c e d o n a
h a rd s u r f a c e

•H a s t ro u b l e m ov i n g o n e o r b o t h ey e s i n a l l d i re c t i o n s
 Social and Emotional
M a y b e a f ra i d o f s t ra n g e r s
Developmental May be clingy with familiar adults
H a s f a vo r i t e t o y s

Milestones: L a n g u a g e / C o mmu n i ca t i o n
Understands “no”
9 Months M a ke s a l o t o f d i f fer e nt s o u n d s l i ke “ m a m a m a m a” a n d
“ b a b a b a b a b a”
Copies sounds and gestures of others
Uses fingers to point at things

C o g n i t i ve ( l e a r n i ng , t h i n ki n g , p r o b l e m - s o l v i n g )
Wa t c h es t h e p a t h o f s o m e t h i ng a s i t f a l l s
L o o k s f o r t h i n g s s h e s e e s yo u h i d e
Plays peek-a-boo
Pu t s t h i n g s i n h i s m o u t h
M o ve s t h i n g s s m o o t h l y f r o m o n e h a n d t o t h e o t h e r
P i c k s u p t h i n g s l i ke c e r e a l o ’s b e t w ee n t h u m b a n d i n d e x
finger

M o ve m e n t / P hys i c a l D e ve l o p m en t
Stands, holding on
Can get into sitting position
Sits without support
Pu l l s t o s t a n d
C ra w l s
 Note: The pincer grasp is the ability to hold
Developmental something betw een the thumb and first finger. This

Milestones: skill usually develops in babies around 9 to 10 months

old. The pincer grasp is an important fine-motor
9 Months milestone.

Developmental Health Watch

• Doesn’ t bear weight on legs with support
• Doesn’ t sit with help
• Doesn’ t babble (“mama”, “baba”, “dada”)
• Doesn’ t play any games involving back -and-
forth play
• Doesn’ t respond to own name
• Doesn’ t seem to recognize familiar people
• Doesn’ t look where you point
• Doesn’ t transfer toys from one hand to the
other
 Social and Emotional
Is shy or nervous with strangers
Cries when mom or dad leaves

Developmental Has favorite things and people

Shows fear in some situations
Hands you a book when he wants to hear a story
Repeats sounds or actions to get attention
Milestones: Puts out arm or leg to help with dressing
Plays games such as “peek -a-boo” and “pat-a-cake”

1 year Language/Communication
Responds to simple spoken requests
Uses simple gestures, like shaking head “no” or waving “bye -bye”
Makes sounds with changes in tone (sounds more like speech)
Says “mama” and “dada” and exclamations like “uh -oh!”
Tries to say words you say

Cognitive (learning, thinking, problem-solving)

Explores things in different ways, like shaking, banging, throwing
Finds hidden things easily camera
Looks at the right picture or thing when it’s named
Copies gestures camera
Starts to use things correctly; for example, drinks from a cup, brushes
hair
Bangs two things together
Puts things in a container, takes things out of a container
Lets things go without help
Pokes with index (pointer) finger
Follows simple directions like “pick up the toy”

Movement/Physical Development
Gets to a sitting position without help
Pulls up to stand, walks holding on to furniture (“cruising”)
May take a few steps without holding on
May stand alone
Developmental
Milestones: Developmental Health Watch
• Doesn’ t crawl
1 year • Can’ t stand when supported
• Doesn’ t search for things that she sees you
hide
• Doesn’ t say single words like “mama” or
“dada”
• Doesn’ t learn gestures like waving or shaking
head
• Doesn’ t point to things
• Loses skills he once had
Every child grows and develops at an individual
pace. Here’s a quick look at some common
milestones for each age period.
 ❑ During this period of profound grow th and
development, babies grow and change rapidly.

Birth to ❑ Doctors recommend that the mother speak to her

baby a lot during this phase, because hearing
their voice w ill help the baby to develop
18 months communication skills.

Other suggestions include:

• Short periods of tummy time to help strengthen

the baby’s neck and back muscles — but make
sure baby is aw ake and mother is close by for
this playtime.
• Respond right aw ay w hen the baby cries.
• Picking up and comforting a crying baby builds
strong bonds betw een the mother and baby
Development table: Birth to 18 months

12-18
1-3 months 4-6 months 5-9 months 9-12 months
months

Has learned
Recognizes
Shows interest how to use
familiar faces Brings hands
in objects and Watches some basic
up to mouth
human faces things fall things like
Notices music
Cognitive spoons
Passes things
May get bored Looks for
Responds to from one hand
with repeated hidden things Can point to
signs of love to the other
activities named body
and affection
parts
Development table: Birth to 18 months

12-18
1-3 months 4-6 months 5-9 months 9-12 months
months
Responds to
facial May engage in
expressions simple pretend
Tries to look at
Enjoys mirrors games
you or other
Enjoys playing May be clingy
Social and people
with people Knows when a or prefer May have
emotional
stranger is familiar people tantrums
Starts to smile
Responds present
at people
differently to May cry around
different voice strangers
tones
Development table: Birth to 18 months

12-18
1-3 months 4-6 months 5-9 months 9-12 months
months
Responds to
Begins to coo hearing their
and make vowel name
Points Knows how to
sounds
Begins to say several
May add
babble or Knows what words
Becomes calm consonant
Language imitate sounds “no” means
when spoken to sounds to
Says “no”
vowels
Laughs Imitates sounds
Cries differently
and gestures Waves bye-bye
for different May
needs communicate
with gestures
Development table: Birth to 18 months

12-18
1-3 months 4-6 months 5-9 months 9-12 months
months
Turns toward Starts sitting
Sees things and Walks holding
sounds up without
reaches for onto surfaces
support
them
Follows objects Pulls up into
Stands alone
with eyes May bounce standing
Movement/Phy Pushes up with
when held in position
sical arms when on May climb a
Grasps objects standing
tummy step or two
position Crawls
Gradually lifts
Might be able to May drink from
head for longer Rolls in both
roll over a cup
periods directions
 ❑ D u r i n g t h e t o d d l e r ye a r s , c h i l d r e n c o n t i nue t o n e e d l o t s o f

18 s l e e p, g o o d n u t r i t i on , a n d c l o s e , l o v i ng r e l a t i on s hi ps w i t h
p a r e nt s a n d c a r e gi v e r s .

months ❑ D o c t o r s o f f e r a d v i c e f o r c r e a t i ng a s a f e , n u r t ur i n g s p a c e t o
m a x i m i z e t h e c h i l d’s e a r l y g r ow t h a n d d e v e l op m e nt :

to • C r e a t e p r e d i c t a b l e r o u t i n e s a n d r i t u a ls t o k e e p t h e c h i l d
f e e l i ng s e c u r e a n d g r o u nd e d.

2 years •

•
To d d l e r - pr oof t h e h o m e a n d ya r d s o k i d s c a n e x p l or e s a f e l y.
U s e g e n t l e d i s c i p l in e t o g u i de a n d t e a c h c h i l d r e n. Av o i d
h i t t i ng, w hi c h c a n c a u s e l o n g - t e r m p h ys i c a l a n d e m o t i on a l
harm.
• S i n g , t a l k , a n d r e a d t o yo u r t o d d l e r t o b o o s t t h e i r
v o c a b ul a r i e s .
• Wa t c h t h e c h i l d f o r c u e s a b o u t t h e w a r m t h a n d r e l i abi l i t y o f
a l l c a r e gi v e r s .
• M o t he r s s h o u l d t a k e g o o d c a r e o f t h e i r p h ys i c a l a n d
e m o t i on a l a s p e c t s , b e c a u s e t h e i r c h i l d n e e d s t h e m t o b e
h e a l t h y.
Development table: 18 months to 2 years

18 months 24 months
May identify familiar things in picture Builds towers from blocks
books
May follow simple two-part
Knows what common objects do instructions
Cognitive
Scribbles Groups like shapes and
colors together
Follows single-step requests like “Please
stand up” Plays pretend games
Development table: 18 months to 2 years

18 months 24 months

May help with tasks like putting away toys Enjoys play dates

Is proud of what they’ve accomplished Plays beside other children; may

Social and
start playing with them
emotional
Recognizes self in mirror; may make faces
May defy directions like “sit
May explore surroundings if parent stays close by down” or “come back here”
Development table: 18 months to 2 years

18 months 24 months

May ask simple questions

Knows several words
Can name many things
Language Follows simple directions
Uses simple two-word phrases
like “more milk”
Likes hearing short stories or songs
Says the names of familiar people
Development table: 18 months to 2 years

18 months 24 months
Can help in getting dressed
Runs
Begins to run
Jumps up and down
Drinks well from a cup
Stands on tip-toes
Movement
Eats with a spoon
/Physical Can draw lines and round shapes
Can walk while pulling a toy
Throws balls
Dances
May climb stairs using rails to
hold on
Gets seated in a chair
 ❑ D u r i n g t h e se p r e - s c h ool ye a r s , c h i l dr e n g r ow m o r e a n d m o r e
i n d e pe nd e nt a n d c a p a bl e . T h e i r n a t u r a l c u r i os i t y i s l i k e l y t o b e
s t i m ul a t e d b e c a us e t h e i r w o r l d i s e x p a n di ng: n e w f r i e nds , n e w
e x p e r i e nc e s , n e w e n v i r on m e n t s l i k e d a yc a r e o r k i n d e r g a r t e n.

3 to 5
years old ❑ D u r i n g t h i s t i m e o f g r ow t h, i t i s r e c o m m e nd e d t h a t m o t h e r s :

• K e e p r e a d i ng t o t h e i r c h i l d d a i l y.

• S h ow t h e m h ow t o d o s i m p l e c h o r e s a t h o m e .

• B e c l e a r a n d c o n s i s t e n t w i t h t h e i r e x p e c t a t i ons , e x p l a i ni n g
w ha t b e h a v i or s t h e y w a n t f r o m t h e c h i l d.

• S p e a k t o t h e c h i l d i n a g e - a pp r op r i a t e l a n gu a ge .

• H e l p t h e c h i l d p r o b l e m s o l v e w h e n e m o t i ons a r e r u n n i ng h i g h .

• S u p e r v i s e t h e c h i l d i n o u t d oo r p l a y s p a c e s , e s p e c i a ll y a r o u n d
w a t e r a n d p l a y e q u i pm e nt .

• Al l o w t h e c h i l d t o h a v e c h o i c e s a b o u t h ow t o i n t e r a c t w i t h
f a m i l y m e m b e r s a n d s t r a n ge r s .
Development table: 3 – 5 years old

3 years 4 years 5 years

Draws more complex

May be able to count “people”

Can draw stick figures Counts up to 10 things

Can put together a 3-4 part puzzle
May be able to predict Can copy letters,
Can use toys that have moving parts what will happen in a numbers, and simple
like buttons and levers story shapes
Cognitive
Can turn door knobs May play simple board Understands the order of
games simple processes
Can turn book pages
Can name a few colors, Can say name and
numbers, and capital address
letters
Names many colors
Development table: 3 – 5 years old

3 years 4 years 5 years

Is aware of gender
Shows empathy for hurt or crying May play games that
children have roles like “parent”
Likes to play with friends
and “baby”
Offers affection
Sings, dances, and may
Plays with, not just
play acting games
Understands “mine” and “yours” beside, other kids
Social and
emotional Switches between being
May get upset if routines are Talks about their likes
compliant and being
changed and dislikes
defiant
Can get dressed Pretends; may have
Can tell the difference
trouble knowing what’s
between made-up and
Knows how to take turns real and what’s pretend
real
Development table: 3 – 5 years old
3 years
Talks using 2-3 sentences at a time
Has the words to name many things
used daily Speaks in sentences
Language
Can be understood by family
Understands terms like “in,” “on,”
and “under”
4 years 5 years
Can talk about what May tell stories that stay
happens in daycare or at on track
school
Recites nursery rhymes
or sings songs
May recognize or say May be able to name
rhymes letters and numbers
Can say first and last Can answer simple
name questions about stories
Development table: 3 – 5 years old

3 years 4 years 5 years

May be able to
Can hammer a peg into a
somersault
hole
Can walk up and down steps with
one foot on each stair Uses scissors
Walks backwards
Movement/Ph Runs and jumps with ease Hops or stands on one
Climbs stairs confidently
ysical foot for about 10 seconds
Catches a ball
Can hop
Can swing on swingset
Can slide down a slide
Pours liquids with some
Goes to the bathroom in
help
the toilet
 ❑ D ur i ng t he s c hool ye a r s , c hi l dr en ga i n i nde pe ndence a nd
c om pe t ence qui c k ly.
❑ Fr i e nds be c om e m or e i m por t ant a nd i nf luential.
❑ A c hi l d’s s e l f -confidence w ill be a f f ec ted by t he a c a de mic
School-age a nd s oc i al c ha l lenges pr e s e nt ed i n t he s c hool
e nvi r onm e nt.
❑ As k ids mature, the pare nting challenge is t o find a
bala nce be tw e en kee ping the m saf e, enf or cing rules,
Development m ai ntai ning fa mil y c onnecti ons, allow ing t he m to ma ke
s ome de cisions, a nd encour agi ng t he m to accept
i nc r ea sing r e s ponsibility.
❑ D e s pi te t he i r r a pi d gr ow th a nd de ve l opm e nt, t he y s t i ll
ne e d pa r e nts a nd c a r e give r s t o s e t l i m i ts a nd e nc oura ge
he a l thy ha bi ts.

❑ H e r e a r e s om e t hi ngs m ot he r s c a n do t o e ns ur e t ha t t he i r
c hi l d c ont inue s t o be he a l thy:
• M a k e s ur e t he y ge t e nough s l e e p.
• Pr ovi de oppor t unit ies f or r e gul ar e x e r c ise a nd i ndivi dua l
or t e a m s por t s .
• C r e a t e qui e t , pos i tive s pa c e s f or r e a di ng a nd s t udyi ng a t
hom e .
• Li m i t s c r e e n t i me a nd moni t or onl i ne a c t i vi t ies c a r e fully.
• B ui l d a nd m a i nt ain pos i tive f a m i ly t r a ditions.
• Ta l k t o t he i r c hi l dren a bout c ons e nt a nd s e t t ing
bounda rie s w ith t he i r bodi e s.
Development table: school – age years

6-8 years 9-11 years 12-14 years 15-17 years

Develops views and

opinions that may
differ from parents’
ideas
Can use common Internalize work and
Can complete instructions devices, including study habits
Grows awareness
with 3 or more steps phones, tablets, and
that parents aren’t
game stations Can explain their
always correct
Can count backward positions and
Cognitive
Writes stories and choices
Can understand
Knows left and right letters
figurative language
Continues to
Tells time Maintains longer differentiate from
Ability to think
attention span parents
logically is
improving, but
prefrontal cortex is
not yet mature
Development table: school – age years

6-8 years 9-11 years 12-14 years 15-17 years

Cooperates and plays with

others Increased interest in
May have a best
May become more dating and sexuality
friend
May play with kids of independent from
different genders parents Spends more time
Can see from
Social and with friends than
another person’s
emotional Mimics adult behaviors Displays moodiness family
perspective
Feels jealousy Increased need for Growth in ability to
Experiences more
some privacy empathize with
peer pressure
May be modest about others
bodies
Development table: school – age years

6-8 years 9-11 years 12-14 years 15-17 years

Listens for specific reasons (like

pleasure or learning) Can speak, read, listen,
and write fluently and
Forms opinions based on what’s easily
heard
Can use speech that
Can have complex
isn’t literal
Can read books at Can take brief notes conversations
grade level Can speak differently
Can use tone of
Language Follows written instructions in different groups
voice to
Understands speech
communicate
and speaks well Draws logical inferences based Can write persuasively
intentions; i.e.
on reading
sarcasm
Can understand
Can write about a stated main proverbs, figurative
idea language, and
analogies
Can plan and give a speech
Development table: school – age years

6-8 years 9-11 years 12-14 years 15-17 years

Many females
Can jump rope or
will have started
ride a bike
periods
Can draw or paint May experience signs of early
Secondary sex
puberty like breast
characteristics
Can brush teeth, development and facial hair Continues to mature
Movement/P like armpit hair
comb hair, and growth physically,
hysical and voice
complete basic especially boys
changes continue
grooming tasks Increased skill levels in sports
and physical activities
Height or weight
Can practice
may change
physical skills to get
quickly and then
better at them
slow down
 ❑ Age s 11 t hr ough 1 4 a r e of t e n c a l led e a r l y a dol e scence .

❑ The s e ye a r s ar e an exciti ng ti me of va ri ed a nd r apid

c ha nges .

❑ The c hild grow s taller a nd st ronger a nd als o sta rts t o feel

Milestones for a nd t hi nk i n m or e m a t ur e w ays .

Ages 11 to 14 ❑ Pa rents m a y f e el amaz ed as the y w atch t he chil d be gin to

t ur n i nt o a n a dul t .

❑ B ut this c an be a c onf usi ng ti me f or bot h ki ds a nd parents .

B oth m ust get use d to the new person t he chil d is
be c om ing.

Physical development
C hi l dre n i n t hi s a ge gr oup :

• O fte n ha ve a gr ow th s purt , st arti ng at a bout age 11 in gi rls

a nd a bout age 1 3 in bo ys . Thi s ra pid gr ow th usuall y s ta rts
be f or e o r dur i ng pube r t y.

o G ir ls be gi n to d e ve lop breasts a nd start the ir per iods .

Bo ys g r o w f a c i al h a i r. Bo t h b o ys a n d g i r l s g r o w p u b i c h a i r.
o Bo ys m a y la g b ehi nd g irls in he ight du ri ng these years,
b u t t h e y u s u a ll y e n d u p t a l l e r.
 Thi nk i ng a nd r e a s oning ( c ognitive de ve l opm e nt)

C hi l dre n i n t hi s a ge gr oup:
• Typi c a l l y t hi nk i n c onc r et e w ays but a r e gr a dua lly
Milestones for be gi nning t o gr a s p a bs t r act a nd s ymbol i c c onc e pt s.
• B e gi n t o s e e t ha t i s s ues a r e not j us t c l e a r -c ut a nd t ha t
Ages 11 to 14 i nf or m ation c a n be i nt er pr ete d i n di f f er ent w ays .
• Typi c a l l y f oc us on t he pr e s e nt, but a r e s t a r t ing t o
unde r s tand t ha t w hat t he y do now c a n ha ve l ong - ter m
e f f e cts on t he m.
• M a y be s e l f - center ed a nd c a n be i ns e nsitive t o ot he r s.

Em ot i ona l a nd s oc i al de ve l opm e nt

C hi l dre n i n t hi s a ge gr oup:
• B e gi n t o e s t a blish t he i r ow n i de nt ities a nd be c ome mor e
i nde pendent f r om t he i r f a m i lie s.
• M a y f or m s t r ong f r i ends hips a nd pr e f e r t o be w ith t he i r
f r i e nds or on t he i r ow n r a t he r t ha n w ith f a m i ly m e m be r s .
• M a y ha ve pe r i ods w hen t he y a r e s ul len a nd a l oof.
• M a y l ook t o f r i e nds, i ns t ead of pa r e nt s, f or a dvi c e .
 ❑ Ag es 15 to 18 are an exciting time of life . But these
years can be challenging for teens and their parents.

❑ Emotions can change quickl y as teens learn to deal

w ith school, their friends, and adult expectations .

Milestones for ❑ Teen self-esteem is affected b y success in school,

sports, and friendships .
Ages 15 to 18 ❑ Teens tend to compare themsel ves w ith others, and
they might form false ideas about their body image.

❑ The influence of TV, magaz ines, and the Internet can

add to a teen's poor body image.

Physical development
Teens in this age group:

• Usually enter puberty by age 15.

o Most girls have had their first menstrual period by age

15.
o By age 15, girls are near their adult height.
o Boys usually continue to grow taller and gain weight
through their teen years.
 Thinking and reasoning (cognitive development)

Te e n s i n t h i s a g e g r o u p :

• Begin to see issues in shades of gray instead of black and white.

Milestones for • May understand that people can see the same issue in different
w a ys , b u t o f t e n f e e l t h a t t h e i r p e r s o n a l vi e w s a r e t h e o n e s t h a t
are most correct.

Ages 15 to 18 • M a y t h i n k t h e y " k n o w e ve r y t h i n g . "

Emotional and social development

Te e n s i n t h i s a g e g r o u p :

• Tr y t o f i n d t h e i r p l a c e i n t h e w o r l d . T h e y a r e f i g u r i n g o u t " W h o
am I?" and "How do I fit in?"
• M a y h a ve e m o t i o n a l s w i n g s f r o m d a y t o d a y.
• S e e m m a t u r e a t t i m e s , b u t s t i l l h a v e p e r i o d s o f c h i l d i s h b e h a v i o r.
• M a y r e b e l a n d h a v e d i f f i c u l t b e h a v i o r.
• Begin to seek intimate relationships, which become an important
p a r t o f t h e i r i d e n t i t y.

Sensory and motor development

In this age group:

• B o ys c o n t i n u e t o g e t s t r o n g e r a n d m o r e a g i l e e ve n a f t e r p u b e r t y.
• G i r l s t e n d n o t t o g a i n a n y m o r e s t r e n g t h o r a g i l i t y a f t e r p u b e r t y.
❑ Body image is a complex concept that symbolizes the way in
which people perceive themselves and the way they feel and
behave in relation to their own body.
❑ This also includes social and individual dimensions (Aguado,
2004).
❑ In this sense, self-perception of body image is determined by
each person’s physical traits, making up a subjective vision of
one’s own body, parallel to the objective idea that others have
concerning body image (Castañer and Camerino, 2012).
❑ Body image is not constant throughout time, but is rather a dynamic construct
that changes over the different stages of the life cycle (Rodríguez and Alvis, 2015)
and which is built up both historically and culturally (Raich, 2001).
❑ Childhood and pre-adolescence are critical stages in a human being’s
development.
❑ Pre-adolescence in particular is a crucial stage because of the substantial
corporal, cerebral, sexual, emotional and social changes that occur.
❑ In girls, this takes place between 9 and 12 years of age, while in boys it occurs
between 10 and 13 years of age (Mancilla et al., 2012).
❑ People do, however, start to construct their own body image in childhood, to be
precise, the first body image for a child is the image of another’s body (Levin,
2008).
❑ It is in pre-adolescence when human beings are more sensitive to the start of
their dissatisfaction with their own body (De Gracia et al., 2007; Jensen and
Steele, 2009; Schore, 2015; Blakely-McClure and Ostrov, 2016).
❑ This is because one’s own body image is influenced by the subjective evaluations
that one makes, as well as by the social evaluations one receives from others
(Dasgupta, 2013; Preckel et al., 2013).
❑ Body image is an important problem for most pre-
adolescents (Ricciardelli and Yager, 2015).
❑ According to Vaquero et al. (2013), approximately 50% of
children between 7 and 12 years of age wish to be slimmer.
❑ During pre-adolescence, are more sensitive to suffering
from greater dissatisfaction with the physical changes that
occur during their biological development (Meza and
Pompa, 2013), as well as the emotional, cognitive and, in
particular, social changes that bring about an increase in
the preoccupation concerning their physical appearance
(Ramos et al., 2010).
❑ In this sense, body dissatisfaction is an important risk
factor for mental disorders. (Legey et al., 2016).
❑ In so far as an excessive preoccupation and negative
evaluations concerning body image dominate in a person’s
mind, it can give rise to body image or eating disorders (De
Gracia et al., 2007; Trujano et al., 2010; Vaquero et al.,
2013).
❑ Self-esteem — a person's sense of worth — is important for success.
❑ When children feel confident and secure, they're more likely to succeed in school and
achieve personal goals.
❑ As they get older, they learn to confront problems and resist peer pressure.
❑ Self-esteem affects the child in many ways.

❑ For example, self-esteem influences the child's attitude, energy level, their response to
peer pressure; their ability to learn, grow, and be creative; relate to others; make
healthy choices; problem solve; and reach their goals.

❑ It gives the person the courage to try new things. Or make new friends. With self-
esteem, they believe in themself.

❑ They will know that good things can happen when they try.
Kids with self-esteem:

✓ feel liked and accepted

✓ feel confident
✓ feel proud of what they can do
✓ think good things about
themselves
✓ believe in themselves

Kids with low self-esteem:

✓ are self-critical and hard on

themselves
✓ feel they're not as good as
other kids
✓ think of the times they fail
rather than when they succeed
✓ lack confidence
✓ doubt they can do things well
How Self-Esteem Develops
▪ Self-esteem can start as early as babyhood.
▪ It develops slowly over time.
▪ It can start just because a child feels safe,
loved, and accepted.
▪ It can start when a baby gets positive attention
and loving care.
▪ As babies become toddlers and young children,
they're able to do some things all by themselves.
▪ They feel good about themselves when they can
use their new skills.
▪ Their self-esteem grows when parents pay
attention, let a child try, give smiles, and show
they're proud.
❑ As kids grow, self-esteem can grow too.
❑ Any time kids try things, do things, and
learn things can be a chance for self-
esteem to grow.
❑ This can happen when kids:
✓ make progress toward a goal
✓ learn things at school
✓ make friends and get along
✓ learn skills — music, sports, art,
cooking, tech skills
✓ practice favorite activities
✓ help, give, or be kind
✓ get praise for good behaviors
✓ try hard at something
✓ do things they're good at and enjoy
✓ are included by others
✓ feel understood and accepted
✓ get a prize or a good grade they know
they've earned
❑ When kids have self-esteem, they feel
confident, capable, and accepted for who
they are.
How Parents Can Build Self-Esteem
Every child is different. Self-esteem may come easier to
some kids than others. And some kids face things that
can lower their self-esteem. But even if a child's self-
esteem is low, it can be raised.
Here are things parents can do to help kids feel good
about themselves:
✓ Help the child learn to do things. At every age,
there are new things for kids to learn. Even during
babyhood, learning to hold a cup or take first steps
sparks a sense of mastery and delight. As the child
grows, things like learning to dress, read, or ride a
bike are chances for self-esteem to grow.
✓ When teaching kids how to do things, show and
help them at first. Then let them do what they can,
even if they make mistakes. Be sure the child gets a
chance to learn, try, and feel proud. Don't make new
challenges too easy — or too hard.
✓ Praise the child, but do it wisely. Of course, it's
good to praise kids. Parent’s praise is a way to show
that they're proud. But some ways of praising kids
can actually backfire.
❑ Don't overpraise. Praise that doesn't feel earned
doesn't ring true.
❑ For example, telling a child he played a great
game when he knows he didn't feels hollow
and fake. It's better to say, "I know that wasn't
your best game, but we all have off days. I'm
proud of you for not giving up." Add a vote of
confidence: "Tomorrow, you'll be back on your
game.
❑ "Praise effort. Avoid focusing praise only on
results (such as getting an A) or fixed
qualities (such as being smart or athletic).
❑ Instead, offer most of your praise for effort,
progress, and attitude. For example: "You're
working hard on that project," "You're getting
better and better at these spelling tests," or,
"I'm proud of you for practicing piano —
you've really stuck with it." With this kind of
praise, kids put effort into things, work toward
goals, and try. When kids do that, they're
more likely to succeed.
Be a good role model.
❑ When parents put effort into everyday tasks (like
raking the leaves, making a meal, cleaning up the
dishes, or washing the car), they're setting a good
example. The child learns to put effort into doing
homework, cleaning up toys, or making the bed.
❑ Modeling the right attitude counts too. When parents
do tasks cheerfully (or at least without grumbling or
complaining), they teach the child to do the same.
❑ When they avoid rushing through chores and take
pride in a job well done, they teach the child to do
that too.
Ban harsh criticism.
❑ The messages kids hear about themselves from
others easily translate into how they feel about
themselves.
❑ Harsh words ("You're so lazy!") are harmful, not
motivating. When kids hear negative messages
about themselves, it harms their self-esteem.
❑ Correct kids with patience. Parents should focus on
what want them to do next time. When needed,
show them how.
Focus on strengths.
❑ Pay attention to what the child does well and
enjoys.
❑ Make sure the child has chances to develop these
strengths.
❑ Focus more on strengths than weaknesses if the
parent want to help kids feel good about
themselves.
❑ This improves behavior too.
Let kids help and give.
❑ Self-esteem grows when kids get to see that what
they do matters to others.
❑ Kids can help out at home, do a service project at
school, or do a favor for a sibling.
❑ Helping and kind acts build self-esteem and other
good feelings.
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