Toddler: 12-24 months
Preschoolers: 2-5 years old
WHO growth charts should be used to measure weight and length for children less than 24 months
CDC
... [Show More] weight and length charts used for children older than 24 months
Average 24 month weighs 26 lbs, length 33.5 in and HC 18.5 in
Most have no palpable fontanelle by 12 months
Ant fontanelle closes by 18-19 months
3-6 yrs weight gain expectation is 4.5-6.5 lbs/year
3-6 yrs height gain expectation is 2.5-3.5 inches/yr
4 yrs length at birth has doubled
4-5 years old legs grow faster than rest of the body
Use of dominant hand may appear as early as 8-12 months generally emerges 2-4 years old; handedness established at 5yrs
May develop bowel and bladder control by age 3, but many will not. Boys usually take longer than girls to maintain bedtime
bladder control.
Articulation:
-24 months- 25% is understood by a stranger
-24m-36m- 66% is understood by a stranger
-3 years old- 90% should be understood by a stranger
3 and 4-year-old have a normal hesitance or show stuttering, considered abnormal if beyond 5 years of age
Speech problems often can be from lack of stimulation, hearing problems, ear infections, developmental delay. Early detection
important.
Lexicon:
girls typically say their first word between 8-11 months; boys by 14 months
2 year olds: have more than 200 words in their vocabulary
3 years old: 900 words in vocabulary
3-4 yrs old: able to follow simple commands, talks incessantly
4-5 year olds: add at least 50 new words a month; 1500-2100 words in vocabulary (including names, coins, colors, knows days of
the week)
5 year olds: should be able to define certain words with other words (cup: something you drink with)
Syntax:
8 months: develop receptive language- they understand what a word means before they are able to use it themselves
12-28 months: use holophrases (single words) to express whole ideas
18 months: use telegraphic speech (get milk, go bye-bye)
2 years old: short sentences
3 years old: add plurals, 3-4 word sentences
4 years old: past tense
5 years old: syntax is close to adult style, 5-6 word sentences
Peer relationships:
Toddler: parallel play
Preschoolers: more interactive and social, imaginary play
Body image:
Masturbation starts around 3-4 years old
Theories:
Erikson Industry
team sports/cooperation
Master social studies, math and
reading
sense of competence and
accomplishment
Development of a of “superego” or
conscious develops during
preschool age
Inferiority
children must learn that they will not be
able to master every skill they attempt
Criticism detrimental at this age
Piaget Concrete operations
More tolerant and perceptive of
other’s viewpoint
Children are able to use thought
processes to experience events and
actions
Judgments made based on reason
(conceptual)
Ages 2-4-Starting to realize world outside
their own, realizing they can make things
happen (shift from egocentric. Belief in
“magical” power of words.
Ages 4-7- Preoperational intuitive thoughtstarting
to understand time concept but
limited. Example may understand “after
lunch” instead of in 2 hours.
Kohlberg
(moral
development)
Judge an act based on consequences
of reward and punishment
They know the rules and behaviors
expected of this, but do not
understand the reasons behind them
Can accept the concept of treating others as
they would want to be treated.
Judge an act based on intention not just
consequences
Piaget: Preoperational thinking (2-4yrs) - problem solving based on what they see directly
egocentrism - only about them
Centration - Focus only on 1 thing at a time
Animism - things around them are alive
Magical thinking - thoughts are all powerful - their thoughts can cause things to happen
Developmental Assessment:
BP starts at 3 years old or if at high risk
Hearing and Vision at 4-5 years old
Dentist: first tooth eruption or before 12 months; eruption of permanent teeth start at 5 yrs
3 years: Draw circle, cross and vertical/horizontal lines
4-5 years: Trace cross & copy a square, ties shoelaces
5-6 years: Draw a person, copies a diamond and triangle, can print name
2-4 yrs: Animism and magical thinking
Magical thinking continues into 4-7 years
Screening Tools:
Ages and stages Questionnaire: helps with evaluating fine and gross motor development
M-CHAT: evaluates for autism (used for children 16-30 months)
Early language milestone (ELM): brief screening for speech intelligibility (3-4 years old)
Preschool decision: parents should select a preschool with a play based learning curriculum
Immediate referral is required for children who stop eating, demonstrate cruelty to animals or other people, are self- harmful, start
fires, or talk of harming themselves, their peers or others
Children with scores below 85 on intelligence scales predictably have more difficulty in school
Language development is the best indicator of cognitive development, language delays may indicate serious issues that require
developmental and educational intervention
Vision screening 5y, 6y, 8y, 10y, 12y. Referral with acuity less than 20/40 (aap guidelines)
Hearing screening 5y, 6y, 8y, 10y. (aap guidelines)
Immunization:
Hep Bx3: NB, 1-2 mths, 6mths
Hib x4: 1-2 mths, 4 mths, 6 mths, 12-15 mths
Rotavirus x3: 1-2 mths, 4 mths, 6 mths
PCV x4: 1-2 mths, 4 mths, 6 mths, 12-15 mths
DTaP x5: 1-2 mths, 4 mths, 6 mths, 15-18 mths, 4yr
Polio x4: 1-2 mths, 4 mths, 6 mths, 4-6y
MMR x2: 12-15mths, 4yr
Varicella x2: 12-15mths, 4yr
Older child
Tdap x 1: 11-14yr
Meningitis x2: 11yr, 17yr
HPV x2 (6mths apart): 11-13yrs
Hep A x2 (6 mths apart): between 12-23mths, recommended before middle school if not had earlier
Safety
Helmets, seat belts, still keep cleaning supplies out of reach/locked up.
Gross Motor Development
3 years
•Rides a tricycle
•Walks on tiptoes
•Stands on 1 foot for a few seconds
•Broad Jump
4 years
•Catches a ball
•Hops & skips on one foot
•Walks up and down stairs using alternate feet
5 years
•Jumps rope, begins to skate and swim
•Walks backwards heel to toe
•Skips and hops (alternate feet)
Sleep
12 hours at night, no naps but quiet time
Nightmares - During REM sleep, fully awakes, able to be reassured, occurs at end of the night
Night terrors - No during REM, not aware of others, partial arousal, no memory of dream, earlier in the night
Child Aggression: Not necessarily the behavior itself that is the issue but the frequency, severity, timing. Frustration is the biggest
reason they act out. Can also happen if parent is depressed, child is neglected, etc.
School Age Children
Age 5-12 years
Early Childhood (5 to 7 years)
Middle (8 to 10 yrs)
Late (11 to 12 yrs)
Small amount of breast tissue in males normal during puberty-gynecomastia
Encourage sports activities
Growth and Development
Building self-esteem- praise important
Check immunizations at sick visits- no immunizations if fever within past 24 hours
Get them to talk to you during the visit
No shots until age 11 after 4 year old ones
Age 7 cholesterol (guidelines between 7 and 11)
If BMI >95%, obesity panel- A1c
Vision and hearing often done in school
Important to ask about friends and peer groups
Physical development: strength coordination increase, growth spurts occur, cerebral cortex/frontal lobe develop
Motor skills: run, jump, skip, hop, overhand motion, balance coordination improves
Fine motor skills: improve dexterity, use scissors, writing tools, hand-eye coordination improves
Psychosocial development: Erikson. Industry vs Inferiority. Industry: Development of formal skills, extrinsic rewards important
like grades, cooperation, competition and coping leads to sense of accomplishment. Inferiority: ▪Danger during this period,
especially for those with physical and mental limitations
* No child is able to do everything well, and children must learn that they will not be able to master every skill they attempt
Conceptual vs perceptual thinking: based on reason (conceptual) rather than what you see (perceptual). 95210 plan might be
important, encourage reading.
Communication and language development: Improved communication skills, 8-9 year olds can understand jokes, meanings,
stuttering should resolve by school age. 10-12 year olds understand metaphors, ambiguities of language, speech and language
disorders among the most developmental [Show Less]