Growth and development
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📚 Child Growth & Development — Study Notes
Sources: The Harriet Lane Handbook (23rd ed.), Kaplan & Sadock's Synopsis of Psychiatry, Textbook of Family Medicine 9e
1. OVERVIEW OF DEVELOPMENTAL DOMAINS
Development is assessed across four domains — milestone acquisition occurs in a specific, ordered, sequential manner:
| Domain | What It Covers |
|---|---|
| Social/Emotional | Attachment, relationships, self-regulation |
| Language/Communication | Receptive and expressive language |
| Cognitive | Learning, thinking, problem-solving |
| Movement/Physical | Gross motor and fine motor skills |
2. DEVELOPMENTAL MILESTONES (CDC / Harriet Lane)
🍼 2 Months
| Domain | Milestone |
|---|---|
| Social | Calms when spoken to/picked up; smiles when you talk to her |
| Language | Makes sounds other than crying; reacts to loud sounds |
| Cognitive | Watches you move; looks at a toy for several seconds |
| Motor | Holds head up on tummy; moves all limbs; opens hands briefly |
🍼 4 Months
| Domain | Milestone |
|---|---|
| Social | Smiles spontaneously to get attention; chuckles |
| Language | Cooing ("ooo," "aahh"); takes turns making sounds |
| Cognitive | Opens mouth at sight of breast/bottle; watches own hands |
| Motor | Holds head steady; holds a toy placed in hand; pushes up on elbows when prone |
🍼 6 Months
| Domain | Milestone |
|---|---|
| Social | Knows familiar people; laughs; looks at self in mirror |
| Language | Blows "raspberries"; squealing noises; takes turns vocalizing |
| Cognitive | Puts things in mouth to explore; reaches for toys |
| Motor | Rolls tummy to back; pushes up on straight arms; leans on hands when sitting |
🍼 9 Months
| Domain | Milestone |
|---|---|
| Social | Stranger anxiety; shows multiple facial expressions |
| Language | Makes different sounds ("mamama," "bababa") |
| Cognitive | Looks for hidden objects; bangs two things together |
| Motor | Gets to sitting position alone; pulls to stand; pincer grasp emerging |
🍼 12 Months
| Domain | Milestone |
|---|---|
| Social | Plays games (peekaboo); hands objects to others |
| Language | "Mama/dada" with meaning; says 1–2 words besides mama/dada |
| Cognitive | Puts objects in a container; shakes/bangs to make sounds |
| Motor | Pulls to stand; cruises along furniture; may take a step |
🚼 15 Months
| Domain | Milestone |
|---|---|
| Language | Says 3 words besides mama/dada; points to ask for something |
| Cognitive | Tries to use things correctly (spoon, phone) |
| Motor | Walks alone; climbs on/off couch with help |
🚼 18 Months
| Domain | Milestone |
|---|---|
| Social | Moves away from caregiver knowing she's there |
| Language | Uses ≥3 words; names pictures in books |
| Cognitive | Knows use of objects; points to one body part |
| Motor | Walks up stairs holding railing; uses spoon |
🚼 2 Years
| Domain | Milestone |
|---|---|
| Social | Points to show things; plays alongside other children |
| Language | Uses 2-word phrases; points to things in books |
| Cognitive | Holds something in one hand while doing another task |
| Motor | Kicks a ball; runs; goes up/down stairs |
🧒 3 Years
| Domain | Milestone |
|---|---|
| Social | Calms down within 10 minutes of you leaving; notices other children |
| Language | Asks "who," "what," "where" questions; 3-word sentences |
| Cognitive | Draws circle; avoids hot things and edges |
| Motor | Strings items together; rides a tricycle |
🧒 4 Years
| Domain | Milestone |
|---|---|
| Social | Pretends to be something else; comforts others; avoids danger |
| Language | Says sentences with 4+ words; answers "why" questions |
| Cognitive | Names a few colors/numbers; draws a person with 3 body parts |
| Motor | Catches a ball; serves self food/pours water |
🧒 5 Years
| Domain | Milestone |
|---|---|
| Social | Follows rules in games; sings/dances/acts; does simple chores |
| Language | Tells a story with ≥2 events; 3+ back-and-forth conversation exchanges |
| Cognitive | Counts to 10; names letters; pays attention 5–10 min; writes some letters |
| Motor | Hops on one foot; buttons some buttons |
3. PRIMITIVE REFLEXES
Present at birth; disappear with normal maturation:
| Reflex | Description | Disappears |
|---|---|---|
| Rooting | Lip puckering to perioral stimulation | ~4 months |
| Grasp | Fingers close around object placed in palm | ~4 months |
| Moro (Startle) | Arms abduct/extend when head allowed to fall back | ~4 months |
| Tonic neck | "Fencer" posture — arm extends on side head turns to | ~4 months |
| Babinski | Toes spread when sole stroked | ~12 months |
| Sucking/Swallowing | Persist — functional for feeding | Persists |
4. LANGUAGE DEVELOPMENT
| Age | Comprehension | Expression |
|---|---|---|
| 0–6 mo | Startle to sound; recognizes voice | Cries, coos, babbles |
| 7–11 mo | Understands "no"; looks at pictures | Jargon; gestures; "uh-oh" |
| 12–13 mo | Understands body parts/common objects | 1 word (mean 11 mo); ~20 words by 18 mo |
| 12–24 mo | Follows simple directions; understands pronouns | 2-word phrases; echoes; ~25% intelligible |
| 2–3 yr | Follows 2-step commands | 3-word sentences; asks questions |
| 4–5 yr | Follows complex sentences | Sentences of 4–6 words; 75–100% intelligible |
5. DEVELOPMENTAL THEORIES
A. Piaget's Cognitive Stages
| Stage | Age | Key Features |
|---|---|---|
| Sensorimotor | 0–2 yr | Learns through sensory experience; object permanence at ~8 mo |
| Preoperational | 2–7 yr | Symbolic/language thinking; egocentric; magical thinking; animism |
| Concrete Operational | 7–11 yr | Conservation; logical thinking; classification; reversibility |
| Formal Operational | 11+ yr | Abstract reasoning; hypothetical-deductive thinking |
B. Erikson's Psychosocial Stages
| Stage | Age | Virtue | Psychopathology if Fails |
|---|---|---|---|
| Trust vs. Mistrust | Birth–~18 mo | Hope | Psychosis, depression, addiction |
| Autonomy vs. Shame/Doubt | ~18 mo–3 yr | Will | OCD, paranoia, impulsivity |
| Initiative vs. Guilt | ~3–5 yr | Purpose | Phobias, conversion disorder |
| Industry vs. Inferiority | ~5–13 yr | Competence | Creative inhibition, inertia |
| Identity vs. Role Confusion | ~13–20 yr | Fidelity | Delinquency, borderline features |
| Intimacy vs. Isolation | ~20s | Love | Schizoid personality |
| Generativity vs. Stagnation | ~40s | Care | Midlife crisis |
| Integrity vs. Despair | ~60s+ | Wisdom | Extreme alienation, despair |
Key point (Erikson): Trust in infancy depends not on "absolute quantities of food or demonstrations of love, but on the quality of the maternal relationship."
C. Freud's Psychosexual Stages (Summary)
| Stage | Age | Focus |
|---|---|---|
| Oral | 0–1 yr | Feeding, sucking |
| Anal | 1–3 yr | Toilet training, control |
| Phallic (Oedipal) | 3–6 yr | Genitals, same-sex identification |
| Latency | 6–12 yr | Peer relationships, skill building |
| Genital | Puberty+ | Mature sexuality |
6. EMOTIONAL DEVELOPMENT
| Age | Key Developments |
|---|---|
| 0–2 mo | Love (touch-evoked), fear (loud noise), rage; social smile begins |
| 3–4 mo | Laughter; more emotion control; anger expressed |
| 7–12 mo | Stranger anxiety; separation anxiety; transitional objects useful |
| 1–2 yr | Shame, pride, envy, embarrassment appear; empathy emerging |
| 2–5 yr | Complex emotions (jealousy, guilt, love); conscience forming |
| 5–12 yr | Stable emotions; empathy/compassion well developed by age 9–10 |
7. SOCIAL & PLAY DEVELOPMENT
| Age | Type of Play |
|---|---|
| Infant–2 yr | Solitary play — independent play |
| 2–3 yr | Parallel play — alongside another child, no interaction |
| 3+ yr | Associative play — interacts but no organized goal |
| 4+ yr | Cooperative play — organized goals, rules, roles |
8. DEVELOPMENTAL SCREENING
Per AAP Guidelines:
- Developmental surveillance at every well child visit
- Formal standardized screening at: 9, 18, and 30 months (or 24 months if 30-month visit unavailable)
- Address any parental concern immediately
Key Red Flags (Prompt Referral)
| Age | Red Flag |
|---|---|
| 2 mo | No social smile |
| 6 mo | Not turning toward sounds |
| 9 mo | No babbling or back-and-forth vocalizing |
| 12 mo | No gesturing (waving, pointing) |
| 16 mo | No single words |
| 24 mo | No 2-word phrases |
| Any age | Loss of previously acquired skills (always a red flag) |
9. TEMPERAMENT (Thomas & Chess)
Three broad profiles based on nine characteristics (activity, rhythmicity, approach/withdrawal, adaptability, intensity, mood, attention span, distractibility, sensory threshold):
| Profile | Prevalence | Description |
|---|---|---|
| Easy | 40% | Regular biologic functions; positive, adaptable; mild/moderate mood |
| Difficult | 10% | Irregular; negative withdrawal to new stimuli; slow to adapt; intense |
| Slow-to-warm-up | 15% | Mild reactions; slow to adapt; gradual acceptance of new stimuli |
Goodness of fit — match between child's temperament and parental expectations is a key concept in behavioral guidance.
10. AGE-APPROPRIATE BEHAVIORAL ISSUES
| Age | Issue | Guidance |
|---|---|---|
| 1–3 mo | Colic | Peaks at 6 wk, resolves by 3–4 mo; avoid overstimulation; swaddle, white noise |
| 3–4 mo | Trained night feeding | Avoid reinforcing; consistent bedtime routine |
| 9–24 mo | Stranger/separation anxiety | Transitional object; routine; normalizes by 2 yr |
| 12–36 mo | Temper tantrums | Ignore safely; consistent limits |
| 2–3 yr | Toilet training | Daytime dryness by ~2.5 yr; nighttime by ~4 yr |
| Preschool | Sibling rivalry | Avoid favoritism; acknowledge feelings |
| School-age | School refusal | Often related to separation anxiety; early intervention |
Quick Memory Aids
- "No 2-word phrases by 2 → refer" — key language red flag
- GROSS motor rule of 4s: 4 mo holds head; 4–6 mo rolls; 6–8 mo sits; 9–12 mo stands/cruises; 12–15 mo walks alone
- Piaget SPFC: Sensorimotor → Preoperational → Concrete → Formal
- Erikson's childhood triad: Trust → Autonomy → Initiative → Industry
- Object permanence: ~8 months (Piaget sensorimotor stage)
- Stranger anxiety peaks: ~9 months
- Parallel play: ~2–3 years; cooperative play by ~4 years
— The Harriet Lane Handbook (23rd ed.), Kaplan & Sadock's Synopsis of Psychiatry, Textbook of Family Medicine 9e
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