Child Growth and Development

Child G & D 1 2006 (1)

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What do you think is the one thing you can count on as children grow and develop? It’s that children will change quickly – almost before your eyes! From birth to age eighteen, a child goes from being a tiny helpless baby to an independent young adult. Each child has to take many steps and learn many new things. Childhood is a busy and exciting time of life!

When you think about child growth and development, there are some important things to remember:

Children grow from the head down (think about how big a baby’s head is compared to the rest of its body. The brain is nearly full grown by age two, but it takes the rest of the body another 18 years!).
Children develop from the head down too (think about a baby again. First, she learns to control her neck. Then, she learns to hold up her head. Slowly, she learns to control the rest of her body.)
There is usually one big milestone that children focus on at a time. You’ll see a baby practice a new skill over and over until they get it right. But, as soon as they have mastered a new skill, they change their focus to learning something new. For example, most babies focus on learning how to walk before they spend too much time on talking.
Even while children focus on one big milestone, they continue to develop emotionally, too.
Children want to learn. They love developing new skills and becoming more independent.

Throughout this inservice, you’ll learn more about the different stages children go through. Remember that you are learning about the average child with no physical or mental disabilities. In reality, each child is an individual, and may go through these stages a little slower or a little faster than average.

Interesting Facts About Children

In the United States

There are 72 million children under the age of 18. Over half of them are teenagers.
By the year 2020, there will be about 78 million American children.
More than 8,000 babies die every year from birth defects.
Every year, 40,000 babies are born with disabilities. Many of these defects could be prevented.
Sudden Infant Death Syndrome is the leading cause of death for infants.
For every 100 children, 18 have problems with their hearing.
At least 13 million children under the age of six are in child care and nearly half of all infants are in child care.
More children die from injuries than from any other cause.
The most common chronic health problem for children is asthma. For every 1000 children, 69 of them will have asthma.
About 80% of all parents report that their children are in very good or excellent health.

Around the World:

40,000 children under the age of five die every day from malnutrition and preventable diseases.
Nearly 100 million school aged children have never been to any kind of school.
Only half the children in developing countries have access to clean drinking water, and even fewer have access to sanitary waste facilities.

All About Children:

Vitamin A is extremely important in preventing illness and disease. It also prevents visual problems.
Iron is another very important mineral for children to consume because it protects not only their bodies, but also their mental abilities.
Breast milk (or formula) is the only type of food and drink needed by babies under the age of six months.
The care and attention that children receive during their first three years of life is extremely important to their development.
Experts say that children develop more secure attachments to their caregivers when their needs are met quickly.

Why Learn About Child Growth and Development?

The children you work with are probably ill or disabled, right? So why do you need to know how the average healthy child grows and develops?

It’s simple. Learning about healthy kids gives you the basic information you need for working with sick kids. The more you know about how a healthy child grows and develops, the more you’ll be able to notice when things aren’t right with your young clients. For example, let’s say you care for a five year old boy. Unless you know that the average five year old boy weighs 41 pounds, you won’t know if your client’s weight is above or below normal.

No matter what illnesses or disabilities your pediatric clients may have, you will be better caregiver if you learn some basic child growth and development.

Infants (Birth to 1 Year)

A baby’s body weight triples in the first year.
A newborn baby is made up of about 70% water (this means they can get dehydrated very easily if they don’t get enough to drink).
Babies tend to breathe quickly since their lungs are small and still developing.
The size of a baby’s stomach increases rapidly in the first few months. But, the digestive system is not fully developed and food goes through it rapidly!
An infant’s immune system is not fully developed, so they need to be protected from contagious diseases.
Infants have a strong sense of taste and smell present at birth (Have you ever seen a newborn’s face scrunch up when something tastes bad?).
Bones and muscles grow very quickly during the first year. All of this growth requires a lot of sleep – at least 12 hours every day.
The sense of touch develops first, then comes hearing and vision.
The brain grows rapidly and infants have all their brain cells by the end of the first year.
Babies communicate with sounds. When they are happy, they might coo, gurgle, and/or smile. When they are afraid, uncomfortable, hungry, or tired, they often cry.
It is very important to know the average size of a normal infant. Obesity, which can begin in infancy, is becoming a big problem in the U.S. Proper nutrition is the best way to keep an infant at a healthy weight.
At six months, the average boy is 27 inches long and weighs 17 pounds. At six months, the average girl is a bit smaller… at 26 inches and 16 pounds.
During his first year, the average baby boy grows by about 10 inches and 14 pounds. The average baby girl grows by about 9 inches and 14 pounds in her first year.

Infant Milestones

A one month old baby likes to suck, stare at movement and light, and be held and rocked.
Three month old babies like to reach and feel with open hands, and stare at their own fists while they wave them.
Six month old babies like to shake, band, and throw things, and chew on things.
At nine months, babies like to pull themselves up, creep along the floor, and play pat-a-cake.
At one year, babies like to use their fingers, mark on paper, and imitate sounds.
One year olds may also try to copy sounds or words they hear.
Most infants learn to lift their heads at one month, smile at two months, laugh at four months, roll over at five months, pick up finger foods at eight months, pull themselves up to stand at ten months, talk a little at twelve months, and walk at twelve to fifteen months.

Two Things to Remember About Infants

During the first year of life, babies are learning to trust. They come to know that the people around them will feed them, change them, and keep them from hurting. Some experts say that if babies are mistreated during infancy, it is difficult for them to learn to trust later in life.
Infants learn about their environment most often by using their senses – and their mouths! For example, Michael, a three month old, loves to watch his arm wave around. But he doesn’t even know it’s part of his body! Michael will learn that this waving arm belongs to him by putting it in his mouth. He’ll taste it, smell it, and feel it, and in time, make the connection that it is his arm. Remember that babies will put almost anything in their mouths in order to learn about it.

Other Key Points About the First Year of Life

Newborns see mostly in black and white. By the time they reach six months of age, their eyes have developed full color vision.
There are many different “styles” of crawling – and all are considered normal. Some babies sit on their bottoms and scoot along the floor. Others crawl backwords instead of forwards. And some babies get where they want to go by rolling on the floor. Remember, too, that not every baby crawls before learning how to walk.
Babies need to be touched. Studies have shown that babies who are touched and held frequently throughout each day fuss less, sleep better, have stronger immune systems and even develop larger brains.
You may think that infants have to eat frequently because their stomachs are so small, but that’s not the real reason. Babies need to eat so often because they are growing so fast… and they need the extra calories to keep up. Just think. To eat as much as an infant does – in comparison to his body weight – you would have to consume four gallons of milk a day!
Normal Vital Signs During Infancy
- A newborn: T: 99.1, P:120, R:35, BP: 110/75
- A one year old: T:99.0, P: 120, R:30, BP: 110/75

Toddlers (1 to 3 Years)

After the first year, the legs grow faster than the rest of the body.
The speed with which muscles grow slows down a bit after the first year (That’s a good thing. We wouldn’t want kids to triple their weight every year. If they did, a 3 year old would weigh about 180 pounds!).
The brain reaches ninety percent of its adult size by the age of two.
Before the age of two, not many toddlers are able to remember experiences. However, this changes during toddler years as they begin to remember things for a short time.
The average three year old sleeps about twelve hours at night and may have given up afternoon naps – although some children keep napping until age five.
Many toddlers are able to see connections between certain events. For example, Maria is a two year old. She knows that every time her mother picks up her purse and car keys, she is leaving the house. Maria begins to cry and throw a tantrum if her mother does not bring her along.
Watch out for the terrible twos!
- Around age two, many toddlers begin to have separation anxiety when they are from their caregivers. This makes it extra hard to control a toddler. They say “no” frequently and may have trouble controlling their emotions and sharing their toys.
The normal vital signs for a two year old are:
- TL 99.0, P:110, R:25, and BP: 110/75.

Two Things to Remember About Toddlers

Psychologists say that toddlers begin to develop a sense of independence and they learn about shame. For example, Susan, at three years old, has learned how to pull on her own pants. She is proud of that independence. Susan has also learned to be ashamed if she takes her pants off in the middle of church service! However, some toddlers are made to feel too much shame, even for normal behavior. Those toddlers often grow up without much self-confidence.
Toddlers like to learn about the world around them by using their muscles. By testing their muscles, toddlers become more independent and more in control of themselves. For example, toddlers take a big step toward independence when they learn bowel and bladder control. Some experts say that toddlers are in the anal stage, since they work so hard to learn when to hold things in and when to let go. If toddlers have problems with their emotional development during this stage, they may try too hard to be perfect – to always be in control – later in life.

Feeding Toddlers

Generally, children have a decreased appetite during the toddler years.
A toddler needs about 1,000 calories a day to meet his needs for growth, energy, and good nutrition.
Toddlers need foods from the same four food groups as adults do, but the serving sizes should be considerably smaller.
A good basic rule for serving sizes for toddlers is one tablespoon of solids or 1/4 cup of liquids for each year of age. So, for example, a serving of milk for a 2-year old would be 1/2 cup, while a serving of cooked carrots for a 3-year-old would be 3 tablespoons.
Because toddlers are so full of energy and curiosity, it’s often difficult to get them to settle down for a good meal.
It can also be difficult to predict a toddler’s eating habits from day to day. One day, little Mary may eat everything in sight, but the next day she may not want to eat much at all. Or, little Jimmy may seem fixated on one particular food for days on end but then suddenly reject that food without warning!

Toddler Milestones

Between the age of one and three, children do a lot of growing. The average boy grows about 7 inches and 10 pounds. The average girl adds about 8 inches and 10 pounds.
An average two year old boy is 34 inches tall and weighs 27 pounds. An average two year old girl is the same height but weighs one pound less.
One year old toddlers should be able to crawl on their stomachs, and pull themselves to stand.
By age two, toddlers should be able to walk without help. They may even begin to run!
Two year olds usually develop their second year molars and have all 20 baby teeth by age three. Teething can be quite painful and may be why many two year olds are so irritable!
At age three, children usually express their emotions and affection for others openly.
Most three year olds are also able to climb, run, and bend over easily.
Toddlers often try to feed themselves. Whether it is neat or not, toddlers feel a sense of accomplishment when they eat without help!
By the age of three, a child has probably engaged in imaginative play, and may even have an imaginary friend!
Through the ages of 1 to 3, toddlers have a LOT of energy. Since they have learned to use their legs, they may try to be completely independent (even if they do need a little help).
Many toddlers begin speaking in complete sentences and have a vocabulary of about 100 words. Adults need to help them practice their language skills by talking to them normally instead of using baby talk.
Toddlers need a good amount of play time to help them expand their vocabulary and develop other skills such as planning, thinking and organizing.

Preschoolers (3 to 6 Years)

As preschoolers, boys and girls grow at nearly the same rate.
Body fat decreases from age 1 to age 7 for both boys and girls (As kids get older, they lose their “baby fat”).
By the age of five, preschoolers are at least half their adult height.
The average five year old boy is between 43 inches tall and weighs 41 pounds. Between the ages of 3 and 6, boys add 8 inches and about 13 pounds.
The average five year old girl is 43 inches tall and weighs 39 pounds. During the preschool years, girls grow 8 inches and gain about 12 pounds.
The normal vital signs for a six year old are:
- T: 98.5, P: 100, R:21, and BP:120/85.
Preschoolers are intensely curious about the world. They ask “why?” frequently. However, they are unable to focus on one thing for very long since their attention span is only about twenty minutes.
Some preschoolers still soothe their fears by dragging around a worn-out teddy bear. Most children learn new ways to comfort themselves by age 5 – and are able to leave the baby blankets and stuffed animals behind.

Preschooler Milestones

Preschoolers are usually able to move in a coordinated way. For example, if they want to take dance lessons, the preschool years would be the earliest they should start.
By age three, preschoolers should be able to answer easy questions with simple answers. At age five, children have a vocabulary of at least 1500 words and speak in 4 to 5 word sentences.
Preschoolers are usually able to wash their own hands. Because they are often outside getting dirty, it is important for them to learn how important it is to wash their hands.
Many preschoolers develop nightmares and night terrors. They may also have difficulty going to bed because they are afraid of the dark or of having another frightening dream.
During the preschool years, children establish whether they are right handed or left handed. Some children will do everything with the same hand; others may write with one hand but throw a ball with the other.
Preschoolers begin to understand the concept of time – although ten minutes may seem like an eternity to them!
Preschoolers work very hard at developing self-control, learning how to delay gratification for short periods of time. However, like people of all ages, preschoolers have a harder time maintaining self-control when they are hungry, tired, or upset.
By age three, most children are toilet trained, although some children catch on earlier and others aren’t ready until age 4.

Temper Tantrums

Unfortunately, temper tantrums don’t disappear once a child gets beyond the “terrible twos.” During the preschool years, many children continue to have an occasional “meltdown.” Fatigue, hunger, and frustration seem to be common causes.

Children at this developmental stage are learning to be independent. They want to make their own choices but can’t cope with the frustration of not getting their own way.

When a preschooler has a tantrum, there are a few strategies that might help, including:

Try distracting the child by suggesting a new activity, making a silly face, or singing a song.
Stay calm. If the adult gets upset too, it will only make things worse.
Consider ignoring a minor tantrum. If the child receives no attention for his behavior, he may calm down fairly quickly.

Two Things to Remember about Preschoolers

Preschoolers learn more about the world through movement. For example, they learn about “going fast” by running and they learn about “up” and “down” by jumping or climbing. By moving their bodies and using their big muscles (arms, legs, shoulders, etc.), they develop many important physical skills and learn more about life.
Preschoolers also learn about right and wrong through movement. For example, when Timmy was two, he used to fall on the floor and have a tantrum if he didn’t get his way. Now, Timmy is five, and he has learned to control his temper – at least some of the time! Timmy also knows that even though he has learned to kick a ball, it would be wrong to kick it through a window! If children do not learn the difference between right and wrong when they are preschoolers, they may have trouble following rules and laws as they get older.
Some psychologists say that preschoolers are in the phallic stage. This means that they are focused on the difference between the sexes. Preschoolers watch people around them to learn what it means to be a boy and what it means to be a girl.

School-Aged Kids (6 to 12 Years)

Girls begin to grow faster than boys during this period.
The average 10 year old boy is 54 inches tall and weighs 62 pounds. Between the ages of 6 and 12, the average boy grows 13 inches taller and adds 42 pounds.
The average 10 year old girl is 55 inches tall and weighs 72 pounds. School-aged girls usually grow 15 inches taller and gain 49 pounds.
Stomach juices become more acidic through early childhood. This means that as children get older that they are better able to digest a variety of foods.
If kids are going to be nearsighted (need glasses for seeing far away), they often start having trouble with their vision at age eight or nine.
These years are most common for children to develop certain disorders – such as conduct disorder or ADHD. These disorders are often not seen until a child enters school, since teachers will inform caregivers of a child’s progress.
It is important for children at this age to interact with other kids. Children learn how to deal with conflict and also how to share and make friends!
Many children this age have developed a sense of humor. They are able to make jokes as well as laugh at them.
The heart rate, or pulse, gets slower throughout childhood and then stabilizes at about 80 beats per minute in adulthood.
The normal vital signs for a ten year old are:
- T:98.1, P:90, R:19, and BP:125/85

Three Things to Remember About School-Aged Kids

School aged kids learn to feel good about themselves as they become more and more independent. They also learn to make more decisions form themselves and to take some risks.
Some experts call this period of childhood the latency stage (Latent means invisible or hidden. In the latency stage, children are focused on developing their minds and emotions – things we can’t see.). During this period, children learn by expanding their creativity at school and at home. They learn how to study and how to work hard for what they want. They read about the world and learn how to write down their own ideas. If children have emotional problems during this stage, they may lack motivation on the job later in life.
This is an important time to enforce rules on children. School aged children are very curious about their surroundings and can easily get in trouble and/or hurt themselves. If rules and values are taught at this age, it will be easier for a child to accept and follow them. Safety is also important to teach children as violence is becoming a greater problem among school aged children.

Adolescents (12 to 18 Years)

Have you ever known an adolescent who wasn’t hungry all the time? This is because nearly every part of the body is growing rapidly during this period.
Body fat increases towards puberty, especially for girls as they develop their “womanly” shape.
Both boys and girls reach their full height before their bodies “fill out.” This is why so many teenagers seem to be all “arms and legs.”
During puberty, boys develop more muscle strength than girls.
At puberty, the sex organs develop and both boys and girls grow more body hair. Girls begin to menstruate.
Many teenagers tend to develop skin problems such as acne.
The average 16 year old boy is 68 inches tall and weighs 137 pounds. From the time he’s 12 until he’s 18, the average boy shoots up 11 inches and gains 63 pounds!
The average 16 year old girl is 64 inches tall and weighs 123 pounds. During adolescence, the average girl grows about 5 inches taller and adds 33 pounds.
Normal vital signs for a sixteen year old:
- T:97.6, P:78, R:17, BP:135/90

Four Things to Remember About Adolescents

Teenagers are busy developing their own identity. They often “try on” different roles to see if they fit. They might grow their hair long and wear baggy clothes for a while. Then, they might decide to cut their hair short and pierce their ears (or other body parts!). Adolescence is a time for learning from different experiences. Teenagers try to put together everything they have learned to help them decide how to become an adult. If teenagers do not have supportive role models in their lives, they may become confused and feel “lost.”
Psychologists say that adolescents are in the genital stage. During this time, they develop their sexual maturity. Both boys and girls are learning to accept their changing bodies and to cope with sexual feelings. If adolescents have problems during this stage, they may have trouble with marriage or sexual intimacy later in life.
Moodiness or depressive attitudes among adolescents should not be considered “normal.” Certain stressors that many adolescents face during their everyday lives can lead to long-term depression and even suicide. It is important for caregivers to express concern for their adolescent in order for them to feel accepted.
Children this age tend to sleep a lot (but for a good reason). Adolescents need a good ten hours of sleep every night in order to remain healthy and restored. It is important for adolescents to get this sleep since it can’t be “made up” for later.

When You Work With Kids, DON’T:

Leave children unattended, even if they are sleeping.
Put a soft pillow in a crib with a small baby.
Discipline children by withholding good, by confining them, or with physical punishment.
Treat all children the same. Remember the different stages of childhood and be supportive of each individual child.
Give non-washable toys to children in diapers. Non-washable toys will collect lots of germs. Ask family members if it’s okay to wash any stuffed animals in the washing machine.
Forget that hard plastic toys can be disinfected in a dishwasher.
Allow a child to each paint that has peeled off the walls. It may contain lead which can cause many mental and physical problems.
Give honey to any baby under one year of age. It can be harmful.
Allow a baby or child to sleep with a bottle. This can harm the teeth.
Let a child get near an open window, especially if it’s above the first floor.
Leave a young child alone in the bath tub filled with water.
Leave small objects – such as coins, hard candies, or small toy parts – near babies or toddlers. They might cause the child to choke.
Forget to watch children carefully at all times. It only takes a moment of looking away for an accident to happen.
Feed an infant or young toddler foods that can easily cause them to choke. For example, avoid giving youngsters peanuts, carrot sticks, hard candy, tough meat, or raisins.
Forget that a child under the age of one should always ride in a backward facing car seat that is securely fastened in the back seat of the car.
Reinforce a youngster’s tendency to get up from a nap earlier than normal. Children need adequate amounts of sleep. Giving a child an extra bottle or comforting them after they have roused from bed could reinforce a bad habit.
Forget to put safety caps on any medications. Also, try to keep these medications out of the reach of children.
Lose your patience when working with children. It can be challenging to care for kids, especially if they are very ill or severely disabled. Let your supervisor know if you are becoming overly stressed.

Safety First!

Did you know that a young child can fall out a window that is open only five inches or drown in less than one inch of water in a matter of seconds?

The world is a dangerous place for children – especially young ones who haven’t learned to avoid unsafe situations. Every day, more than 39, 000 American children are injured seriously enough to require medical treatment. That’s more than 14 million children each year!

As a nursing assistant, you are responsible for the safety of all your clients. However, focusing on safety is even more important when you work with pediatric clients. So, pay close attention to your young clients to keep them out of harm’s way.

When You Work With Kids, DO:

Use safety straps in high chairs, strollers, swings, and infant seats.
Make sure the baby is safe in his crib. Babies have been known to get their heads stuck between the slats of a crib!
Follow physician or nursing orders about how to position a baby for sleeping. If there is no special order, remember that doctors recommend putting babies on their backs to reduce the risk of Sudden Infant Death Syndrome.
Make sure toys are safe – with no sharp edges or strings.
Report poor feedings and/or poor weight gain to your supervisor.
Make sure the child’s environment has enough stimulation. Children need to be able to see, touch, and hear new things.
Make sure a young child’s environment has been childproofed, with no exposed electrical outlets, no sharp objects, no medications or chemicals in reach and no open stairways.
Encourage children to use their minds and their muscles as much as possible!
Be sure to let your supervisor know if you need ideas about handling a child who is kicking, hitting, or biting you.
Use Standard Precautions, especially handwashing. Help children to wash their hands frequently too.
Tell your supervisor if you notice a child with “crossed” eyes or if the child is squinting and complaining of headaches. Also, report it if a child suddenly has trouble hearing you.
Help your young patients take care of their gums and teeth by performing oral care as necessary.
Report any violent behavior that you feel you could be harmful to a child. If you witness any form of child abuse from a caregiver, report it to your supervisor immediately.
Watch for any warning signs that might signal something is wrong with the child. For example, watch for a child who doesn’t respond to his environment, who is often unhappy or tired, or a child who shows no interest in usual activities.
Remember that each child develops at a different speed, but all children need support and encouragement no matter what stage they’re in.

Promoting Healthy Children

Whether your pediatric clients follow “normal” growth and development patterns or have physical or mental challenges, certain key factors help them achieve optimal health, including:

Eating a balanced diet.
Exercising every day.
Getting the right amount of sleep for their age.
Living in a safe environment.
Having some fun every day.
Developing social skills that help them get along with others.
Learning something new every day.
Having access to medical care when needed.

If you keep these factors in mind during your daily work, you’ll go a long way toward helping your young clients live happy and healthy lives.