Infant

By
M.Vinolia Rajashree
Msc I year.

INTRODUCTION
Infants are born prepared to learn
and are equipped with remarkable
abilities including memory, social
interaction skills, communication,
and movement. Infancy is a time of
tremendous change and growth both
physically and cognitively.

DEFINITION

INFANCY - From 2 to 4weeks to 1year.
•Physical changes and development are dramatic
changes during infancy.
•It is the period of most rapid growth & development.
•All body system undergo progressive maturation.
•Acquisition of fine and gross motor skills in an orderly
head to toe and center to periphery sequence.

HEIGHT AND LENGTH:
•Height increases 2.5cm[1 inch] a month during
first six months and slows down in second 6
months.
•Average height at 6months is 65cm and 75 cm
at 12 months.
•By 1 year the birth length increases by 50%.

BIOLOGIC GROWTH:
WEIGHT:
•Infant gains 150-210 gm/wt till 5-6 months
&680 gm/month.
•Around 6 month birth weight doubles {average 7.26 kg}
•The weight gain slows during next 6 months.
•After one year of age the birth weight is tripled.
{average 9.75 kg}

HEAD:
•Head growth is rapid during 1st 6 months.
•Head circumference increases approximately
1.5cm/month and 0.5 cm/next 6 month.
•Head circumference is 43 cm at 6 months.
•2/3rd brain growth.
•Closure of cranial sutures occurs.
•Posterior fontanel closing by 6-8 wk[one and half month].
•Anterior fontanel closing by 12-18 month.
[1- one and half year].

CHEST CIRCUMFERENCE:
•Assumes more adult contour with lateral diameter
becoming larger than anterio-posterior diameter.
•By the end of the first year chest circumference is
equal to head circumference.
•Flat chest when compared to neonate.

MATURATION OF SYSTEMS:

 RESPIRATORY SYSTEM
•Resp.rate slows & is relatively stable.
•Resp.movement continue to be abnormal.
•Short length of resp.tract transmits agent from pharynx
to middle ear ie from one portion to other easily.
•The short straight Eustachian tube allows infection
to ascend from pharynx to middle ear.

CARDIOVASCULAR SYSTEM:
•Heart rate slows down.
•Systolic blood pressure during 1st 2 months as a
result of increase ability of left ventricular to pump blood.
• Rhythm is sinus arryhtmia[rate increases with
inspiration and decreases with expiration].
•Diastolic BP decrease during 1st 3 months and
then decrease to the values close to those at birth.

HAEMOPOIETIC SYSTEM:
•Fetal haemoglobin [hgbf] present for 1st 5 month.
•RBC has short life span and shortened number of RBC.
•This result in shortened survival of RBC and
less number of RBC physiological anemia.
•Maternally received iron stores diminishes
after 1st 6 months.

DIGESTIVE SYSTEM:
•Digestive processes are immature at birth
[evident in the appearance of stools].
•Stomach enlarges to accommodate greater volume
of blood.
•By the end of 1 year infant tolerates
3 meals/day and evening bottle.
•May have one or two bowel movements daily.
•Eruption of teeth occurs[5-6 months].
•Maturation of sucking,swallowing and breathing reflexes.

IMMUNE SYSTEM:
•40% adult level IgG are reached by 1 year.
•IgM adult level reached by 9 months.
•Secretory IgA is found in saliva and tears by 2-5 wks.
•IgA in large amounts are found in colostrum.
RENAL SYSTEM:
•Immature renal structure also predispose
dehydration[maturity occur at 2 yrs].
•Ability to concentrate urine not established
and pass lot of urine frequently.
•ACTH produced in limited quantity.

SENSORY SYSTEM:
EAR:
Auditory acuity at adult level.
EYE:
•Visual acuity improves.
•Bimocular fixation of two ocular in one
cerebral picture[begins to develop at 6
months].
•Depth perception [stereopsis] begins to
develop by age 7-9 months.

MOTOR DEVELOPMENT:

1.Gross motor skills
2.Fine motor skills.

Motor development cont….

1.Gross motor skills:
•1 month:Head control.
•2months-45 degree head control.
•3 months-90 degree head control, raises chest.
•4 months –lifts head &shoulders at 90 degree
when on abdomen.
•6 months-head control is well established.
•5-6 months rolls over.
•6-7 month sits with support.
•8months sits without support.
•9 months pulls self to stand.

Gross motor skills cont….
•Creeps-9 month
•Cruising:-10-11 month[where they can walk
by holding onto something].
•Standing with support-10-11 months.
•Stands alone support 11-12 months.
•Walks with someone hands -12 months.


FINE MOTOR;
•1 Month-Eyes to midline.
•3 months-eyes past midline.
•4 months-brings hands together.
•5 months-grasps/reaches objects[purposeful]
•6 months-holds objects in 2 hands.
•7 months- hand to hand transfer.
•9-10 months-pincer grasp-points at objects.
•11 months-bangs objects together.
•12 months-throws toys-attempts 2 tower blocks.

REFLEXES
APPEARING

Landau reflex:
Parachute reflex

Reflexes continued……….

Landau
reflex

Develops by 4 -5
months of age.

Reflexes
continued……….

Parachute
reflex

Appears at 8-9
months

PERSONAL
SOCIAL:
•2 months-social smile.
•5months-smile at self in mirror.
•4 months-play with rattle: enjoys social interaction.
•7months-Feeds self ,recognizes familiar faces.
•8 months –peek –a-boo-:stranger anxiety.
•9 months-waves ‘bye-bye”
•10 months-nursery games.
•11 months-holds arm or foot out for dressing.
•12 months-attempts to use spoon; shows jealousy
and affection.

Theories related to infants growth and
development:
FREUD

ORAL STAGE

ERICKSON

BASIC TRUST VS MIS-TRUST

PIAGET

SENSORIMOTOR STAGE

FOWLER

STAGE 1 PRIMAL FAITH

KOHLBERG

LEVEL-1 PRE-CONVENTIONAL
STAGE

LANGUAGE:

•1 month-throaty gurgling sound.
•2 months-differentiate a cry.
•3 months-squeals.
•4 months-coos &gurgles; moves head to sound.
•5 months-simple vowel sounds.
•7-8 months-“ma” when crying.
•9 months-mama, dada: understands no-no.
•10 months-understands gestures: responds to name.
•12 month-obeys commands; one word
other than mama or dada.

PLAY-SOLITARY PLAY

1 -3 MONTHS
•Balloon mobiles
•Mirror play
•Sluffed animals.
•Rattles being held

4-6 months
•Squeezes toys.
•Busy boxes.

7-9 months
•Block play
•Splashing bath toys.
•Cloth textured toys.
•Large balls

10-12 months
•Large blocks.
•Nesting cups.
•Peek-a- boo.
•Rocking.
•Singing games.
•Picture books
•Squeazing toys
•Pat-a-cake.
•Feet & toes games.
Fingers & hand games

NUTRITION
•Lipase-dec until one yr
•A mylase-dec until 3 months.
•Immature liver-inefficient storage &
formation of nutrients.
•Extrusion reflex-until 4 months
•Calories-100-115 kcal/kg/day.
•0-6 months-breast milk.

NUTRITION cont……..
•6 months-semi solid food.
•Introduce one at a time.
•Start with small quantities.
•Cereals,strained vegetables,meat.
•7-9 months,finger food,fluids.
•10-12 months-3 meals with snacks.
•Water 135-150 ml/kg/day from 6-12 months.

Appearance of teeth
•A child who gets her teeth early is likely to be
advanced in physical maturity.
•65% of teething infants show no symptoms.

Age-Appropriate
Toys;

Birth- 2 months
- moving toys
2-4 months Rattles,cradle
4-6 months Brightly coloured toys[small enough to
grasp,large enough for safety]
6-9 months Large toys with bright colors,
Movable parts and noise makers.
9-12 months Books with large pictures,
Push-pull toys,teddy bears.

NEEDS of
INFANTS

1.Emotional& social needs.:
•Love and security,self esteem,infant
temperament with parents.
•Dependency progressing to independence.
•Discipline leading to self control.
•Developing self esteem.

BIOLOGICAL NEEDS
•Sleeping, walking, feeding,
exercise.
•Daily schedule.
•Routine.
DAILY CARE:
•Bathing
•Diaper care
•Care of teeth
•Dressing
•Sleep-10-12 hrs/day:1 or
more naps by 12 months old.
•Exercise.

1MONTH
Physical/Biological:

Weight-4.4+/-0.8 kg gains above 680 gm & month
during first 6 months/150-210 gms and week.
Length-53+/_2.3 cm increases about 2.5 cm(1 inch)
2 month during first 6 months.
Head circumference-Increases1.5 cm/0.5 inch
.a month during first 6 months.
Pulse- 130+/_20
Respiration-35+/_10.
Blood pressure-80/50+_20

ReflexesPrimitive reflexes sucking,rooting,swallowing
and extrusion well developed.
Mono reflexes, symmetrical tonic neck reflex,
doll and dance eye reflexes fading.
•Physiologic immaturity.
•Breathes through nose.

MOTOR DEVELOPMENT

GROSS MOTOR:

FINE MOTOR:

GROSS MOTOR:
•Lies in flexed position,when prone pelvis
elevated but knees are not beneath
abdomen as they were after birth..

Turns head to
side when prone.

Gross Motor development cont….
•Head sags forward when baby is held in sitting
position,may lift head periodically when held
over adults shoulder/placed in prone position.
•Cervical curve begins to develop as infant
learns to hold head erect.

Gross Motor development cont….
•Makes crawling movements when prone
on flat surface.
•Pushed with the feet against head surface
to move forward.


FINE MOTOR:
•Holds hands in tight fists.
•Can grasp objects placed in
hand

PSYCHOSOCIAL DEVELOPMENT
•Sense of trust.
•Distinguish ‘mother”/primary caregiver from other
•Eye to eye contact,smiling and vocalization are evidenced
of attachments between infant and parents especially mother.
• Smiles back in response ,to another smile.

PSYCHOSEXUAL DEVELOPMENT:
Oral stage(0-1 yr)- Oral development or
Oral passive- need for seeking pleasure.

Spiritual development:
Undifferentiated (0-1 yr)

INTELLECTUAL DEVELOPMENT:
Sensori motor stage(0-2yr)
Substage 1(birth- 1 month):

MORAL DEVELOPMENT:
Pre conventional morality.Stage (0-2 years)-The good is
what i like & want.
LANGUAGE
Receptive language:Responds to human voices.
Expressive language:
• Opens and closes mouth as adult speaks.
•Utters small threaty sounds.
•Cry patterns developing, crisis when hungry/uncomfortable.
•Utters sounds of comfort when feeling.
•Begins to woo.

PLAY STIMULATION:

•Hold,touch & rock infant gently.
•Provide pacifier for sucking pleasure.
•Place cradle gym/crib mobile within infant reach.
•Place large bright pictures on crib /wall.
•Repeat noises made by infants.
•Coo to infants.
•Respond to crying signals.
•Have ticking clock,wind chemis,radio,television
/music box near by.

TWO MONTHS

Physical &Biologic development:
Poserior fontanelle closed at
6-8 weeks of age.

MOTOR DEVELOPMENT
GROSS MOTOR:

FINE MOTOR:

GROSS MOTOR:
•Less fused prone position arms fused,hips,feet,
leg extremities,head in midposition/side.
•Lifts head almost 45* above a flat surface when
lying prone.
•Holds head erect in midline position.
•Holds head erect when held upright.


FINE MOTOR:
•Hands may be open.
•Holds a rattle briefly when placed in hand.

•Turns head to side when a sound occurs at ear level.
•When on back,follows a dangling objects/
moving light beyond the midline of vision.
•Beginning of binocular fixation of convergence
to objects near by.
•Eyes follow moving person
nearby.

•Begins development of sense of trust(-ve),
counterpart,mistrust.
•Complete dependence on care givers,usually mothers.
•Establishes eye contact.
•Smiles briefly.
•Quiets ,cuddles,molds when held.
•Perceives self and parents as one.

Oral stage(0-1 yr)
SPIRITUAL DEVELOPMENT:
Undifferentiated

Sensori motor stage
Substage 2-Primary circular reaction(1-4yr)

Pre-conventional morality(0-2yr)

LANGUAGE
1.Receptive language

2.Expressive language

LANGUAGE CONT…….

•Alert expression when listening.
•Direct definitive regard soothed by caregivers/
mother’s voice.

LANGUAGE CONT…….

•Cry pattern’s develop.
•Crying becomes differentiated, varying with reason for
crying.
Eg: hunger, sleepiness/pain, pitch &intensity vary.

2.Expressive language CONT…
•Offers a rattle. pull from supine to sitting position.
•Hold/dangle toy infant to encourage eye movements.

PLAY STIMULATION
•Same as 1 month.
•Offer a rattle,pull from supine to prone position.
•Hold /dangle toy infant to encourage eye movements.
•Outing in carriage/care if not done earlier.

THREE MONTH
Physical/Biological:
•Weight=5.7+_0.8 kg(12.3+_2 lb)
•Length=60+_2 cm(23.5+_1 cm)
•Pulse=130+_20
•Resp=35+_10
•B.P=80/50+_20/10

REFLEXES:
•Grasping(palmar) reflex absent.
•Landau reflex appears, an infant suspended in a
horizontal prone position with the head fused
against the chest reflexly draws the legs up
against the abdomen.


GROSS MOTOR:
•Symmetric posture of head & body.
•Very slight head lag when pulled from
supine to sitting position.
•Sits back rounded. knees flexed
when supported in sitting position.
•Raises chest, usually supported on fore-arms.
when in prone position.
•Holds head erect & steadily.


FINE MOTOR:
•Hands open or closely loosely.
•Holds objects put in hand with active grasp.
•Carriers hand/objects to mouth at will.
•Reaches for bright objects but misses them.

SENSORY DEVELOPMENT
•T urns head & looks in some direction to local sound.
•Binocular co-ordination when as object is moved from
right to left& creep and down in front of face.
•Blinks at objects that threats the eyes.
•Beginning ability to co-ordinate various sensory stimuli.


•Sense of trust.
•Recognises and smiles in response to care givers face.
•Stops crying when familial persons approaches.
•Interested in surroundings.

LANGUAGE

Language CONT…

Looks in direction of speaker.

Language CONT…
•Cries less
•Shows pleasure in making many sound.
•Vocalize in response to others coos and cheeks.
•May laugh a loud.

PLAY STIMULATION
Same as 1 and 2 month.
•Encourage infant to rise head, when in prone position.
•Pull baby to sitting position,thus encouraging head control.
•Hold bright toys in front of infant to encourage reaching.
•Provide greater variety of toys which are
baby shows interest in play things.

FOUR MONTH
Physical development:
Drools between 3&4 months of
age,indicating increased production of
saliva.Unable to swallow it therefore,it
.
runs from mouth.

REFLEXES:

•Tonic neck,moro,sucking and rooting
(when awake)reflexes absent.
•Extusion reflex fading(0-4 months).

GROSS MOTOR:

•Sits with adequate support.
•Holds head erect and steady when
placed in sitting position.
•Activates at sight of preffered toy.
•Attempts to roll over
from front to back.


FINE MOTOR:
•Holds hand predominately open.
•Grasps objects with both hands.
•Objects are carried to mouth.
•Thumb apposition in grasping
occurs between 3&4 months.

SENSORY DEVELOPMENT
•Fairly good binocular vision.
•Looks briefly for toy that disappears.
•Accomodation begins to develop.
•Recognizes familiar objects,
such as feeding bottle and toys.

•Sense of trust.
•Smiles in response to smiles of others
•Initiates social play by smiling or vocalizing.
•Shows evidence of wanting social attention

•Shows eagerness when feeding bottle
appears.

Oral stage(0-1 yr)

Undifferentiated

Sensori motor stage
Substage 1- Primary circular reaction(1-4months)
Substage –Secondary circular reaction(4-8 months)


LANGUAGE
1.Receptive language :
•Responds differently to pleasant or angry voice.
•Does not cry when scolded.

•laughs aloud.
•Talking and crying follow each other quickly.

PLAY STIMULATION
•Smile when talking & singing to infant.
•Hold infant in standing position.
•Provide safe area for periods of solitary play.
•Include infant in familys television viewing & activities.

FIVE MONTHS
Physical/Biological
•At least twice the birth weight.
Mean age for doubling birth weight is 3.8 months.
•Physical growth slowing down.
•Can breathe through mouth when nose is obstructed.


GROSS MOTOR:
•Sits with slight support.
•Balances head well when sitting.
•Holds back straight when pulled to a sitting position.
•Sustains more of own weight when held in standing position.
•Pulls feet up to mouth when supine.


FINE MOTOR:
•Tries to obtain objects beyond reach.
•Grasps objects independently of
direct stimulation of the palm of the hand.
•Grasps objects with whole hand,either right or left.
•Holds one object while looking at another.

•Localizes sounds made below the ear.
•Looks after a drooped object.
•Inspects objects visually for a lengthening period of time.
•Can fixate on objects more than 3 feet away.
•Visual acuity 20/20.

PSYCHOSOCIAL DEVELOPMENT
•Sense of trust.
•Smiles at self in mirror.
•Accepts an object from another person.
•Plays enthusiastically.Shows displeasure when toy is lost.
•Plays with own feet.

Oral stage(0-1 yr)

Undifferentiated

Sensori motor stage
Substage 3
Substage –Secondary circular reaction(4-8 months)


LANGUAGE
1.Receptive language :
:Responds when own name is spoken.
2.Expressive language:
•Sequeals when happy or excited.
•Vocalizes displeasure when a desired object is taken away.
•Sounds like vowels appear with consonants such as ‘goo”
•Begins to mimic sounds

PLAY STIMULATION
•Same as 4 months.
•Provides sufficient different objects for play.
•Make various sounds near ear.
•Hold infant in standing position and bounce
to exercise legs and to develop balance.

Physical/Biological
•Weight:7.4+_1kg.(16.5+_2.5 lb).;
gains about 340 gm(0.75lb) a month or
90 to 150 gm(3 -5oz) a week during second 6 months.
•Length:65.5 +_3 cm(26+_1 inch);
gains about 1.25 cm (0.5inch )a month
during second 6 months.
•Head circumference:43 cm(17 inch);
Increases about 0.5 cm(0.25inch)
/month during second 6 months.

Physical weight cont…..

•Pulse:120+_20.
•Respirations:31+_9.
•Blood pressure:90/60+_28/10.
•Teething two lower central incisors
erupt(6+_2 months).Begins to
bite and chew.


GROSS MOTOR:
•Sits alone briefly if placed in a favourable
leaning position on hard surface. Holds arms out.
•Back is straight when sitting in high chair.
•Lifts chest and upper abdomen when prone,
putting the weight on the arms and hands.


FINE MOTOR:
•Grasps with simultaneous flexion of fingers.
•Retains transient hold on two objects,one in each hand.
•Manipulates small objects.
•Begins to bang objects that are held(rattles,spoon,toy).
•Holds own bottle but may prefer for it to be held.

•Localizes sounds made above the ear.
•Retrieves a dropped object that can be seen &reached.
•Enjoys more complex visual stimuli.
•Moves in order to seen an object.

•Sense of trust.
•Recognizes parents.
•Recognizes strangers as different from family members.
•Begins to extend arms to be picked up.
•Thrashes arms and legs when frustrated.
•Imitation of others in beginning;Sticking tongue out.
•Knows what is liked and disliked.

Oral stage(0-1 yr)
Undifferentiated

Sensori motor stage
Substage 3-Secondary circular reaction(4-8 months)
Beginning of object permanence when
infant briefly searches for a dropped object.


LANGUAGE
1.Receptive:Recognises familiar words.
2.Expressive :
•Actively vocalizes pleasure with cooing or crowing.
•Cries easily on slight or no pronounciation.
•Vocalizes several well-defined syllables.
•Shows enjoyment in hearing own vocalization.
•‘Talks” to image in mirror.

PLAY STIMULATION
•Same as 4&5 months.
•Encourage infant to look in a mirror .
•Begin to place infant in walker.
•Provide a limited area on the floor where the
infant can move safely, for sitting, crawling, rolling over.

SEVEN MONTHS

Physical/Biological

Reflexes;
•Sucking and rooting reflexes disappear at
7-8 months when asleep.
•Parachute reflex appears between 7-9 months.
As infant suspended in a horizontal prone position
and lowered suddenly will extend the hands forward
to provide protection from falling.
The reflex continues indefinitely.

Physical weight cont…..
TEETHING:
•Upper central incisors erupt(7.5+_2 months).
•Lower lateral incisors erupt(7.5+_2 months).
•Ultimate color of irir is established.

GROSS MOTOR:
•Sits alone on hard surface ,leaning forward on hands.
•Lifts head as if trying to sit up when supine .
•Control of trunk is more advanced.
•Sustains all of weight on feet
when held in standing position.


FINE MOTOR:
•Holds 2 toys at once.
•Approaches a toy and grasps it with one hand.
•Transfer a toy from one hand to the other.
•Imitates simple acts of others.
•Bangs objects that are held.
•Holds cup.

SENSORY DEVELOPMENT

•Head turns in a curving arch to localize sounds.
•Depth perception beginning to develop.
•Fixates on very small objects and details.
•Discrimination between simple geometric
forms begins to develop.
•Has preferences in taste for foods.

•Sense of trust.
•Shows increasing fear of strangers(7-8 months).
•Actively clings to a familiar person when distressed.
•Unhappy when caregiver,usually mother disappears.
•Responds socially to own name.
•Emotional instability-rapidly changes from crying to laughter.
•Closes lips tightly when disliked food is offered.

•PSYCHOSEXUAL DEVELOPMENT:
• Oral stage(0-1 yr)
•Oral aggressiveness is evidenced by
biting and chewing.
•Discovers genitilia.

Undifferentiated

Sensori motor stage
Substage 3-Secondary circular reaction(48 months)


LANGUAGE

1.Receptive:
•Recognises own name.
•Responds with gestures to words such as “come”.

2.Expressive:
•Vocalizes eagerness.
•Vocalizes “m-m-m” when crying.
•Imitates simple noises and speech sounds.
•Vocalizes “da”’ma” “ba”.

PLAY STIMULATION

SAME AS 4,5,6 MONTHS).
•Place toy under and ask infant to find it.
•Repeat simple sounds “dada” “mama”.
•Encourage banging of toys & clapping hands on objects.
•Continue to help infant learn balance.

8 MONTHS
Physical/Biological
Beginning of a pattern in bowel and bladder elimination.
MOTOR DEVELOPMENT
GROSS MOTOR:
FINE MOTOR:

GROSS MOTOR:
•Sits alone steadily.
•Pulls self into standing position with help.
•Hand –eye coordination is perfected so that
random reaching and grasping no longer occur.


FINE MOTOR:
•Holds 2 objects while looking at a third.
•Releases objects from hands voluntarily.
•Complete thumb apposition.
•Pincer grasp beginning to develop.,using the
finger against the lower portion of the thumb.
•Drinks from cup with assistance(7-9 months).

Recognises familiar words and sounds.
PSYCHOSEXUAL DEVELOPMENT:
Oral stage(0-1yr).

Undifferentiated


•Sense of trust.
•Refuses to play with strangers or even accept toys from them.
•Stretches arms to loved family members.
•Emotional instability still evident.
•Dislikes changing clothing and diapers.

INTELLECTUAL:
Sensorimotor stage.
1.Substage 3
2.Substage 4

Intellectual deve. Cont….

Substage 3:
•Secondary circular reaction(4-8 months).
•Knows that objects are separate from self.
•Searches briefly for objects seen being placed
everywhere. The search is confined to only one modality.

Intellectual deve. Cont….

Substage4:
•Coordination of secondary schemas(8-12 months).
•Abilities learned earlier are combined and
extended to deal with new situations.
•Object permanence progresses and is related to the
necessary ability to deal with matters of time and space.
•Perceptions of space become refined between 8-12 months.
•Problem solving beginning to develop.

MORAL DEVELOPMENT:
Preconventional morality.Stage0(0-1yr).

LANGUAGE
1.Receptive :
•Stops activity when own name is spoken.
•Beginning to understand meaning of “no”.
2.Expressive:
•Shouts for attention.
•Imitates sound sequences.
•Continues syllables “da-da”,”ma-ma”

PLAY STIMULATION

•Hold,touch and rock infant gently.
•Talk and sing to infant.
•Place infant in a sitting position against a wall
and encourage learning away from the wall to improve balance
•Gently push infant from a sitting position to improve balance.

9 MONTHS
Physical/Biological

Reflexes:Plantar grasp absent.
Teething’Upper lateral incisors erupt(9+_2 months).

GROSS MOTOR:

•Raises to a sitting alone with good coordination.
•Sits steadily for longer period of time.
•Recovers balance when leaning forward,but not sideways.
•Crawls instead of hitching.
•Creeping:The infant uses both hands and knees in
moving forward.Beginning to pull self to standing
position alone while holding on the furniture.


FINE MOTOR:
•Bang two objects together.
•Pokes objectives with fingers.
•Uses thumb and index finger in early pincer grasp.
•Has preference for the use of one dominant hand.
•Attempts to use a spoon but spills contents.

•Head turns directly to source of sound.
•Increases depth perception.
•Recognizes by looking or moving toward familiar
object when named.
•Able to follow objects through transition from
one place to another.


•Sense of trust.
•Knows what “no” means.
•Beginning to play simple games with adult such
as “so –big”,”bye-bye”.
•Wants to please caregiver, usually mother.
•Beginning fears about being left alone,
as when put into the crib.

Oral stage(0-1 yr)
Undifferentiated.
INTELLECTUAL DEVELOPMENT:
Substage 4;co-ordination of secondary
schemas(8-12 months).Able to follow objects
through transition from one place to another.


LANGUAGE

1.Receptive;
•Stops activity in response to “no’.
•Beginning to respond to simple commands given verbally.
•Responds to adult anger.
2.Expressive;
•Cries when scolded.
•Echolalia or correct imitative of expression of
sounds made by others(9-10 months).
•Association of words with persons or objects.

PLAY STIMULATION

•Encourage exploration of toys with eyes &fingers.
•Show infant large pictures in books.
•Continue to vocalize with infant.
•Provide a large environment in which the
infant can move safely-crawling,creeping.

10 MONTHS
Physical/Biological

Macula is well developed so that fine visual
discriminations can be made.


GROSS MOTOR:

•Moves from prone to sitting position.
•Creeps well.
•Make stepping movements forward when two hands are held.
•Sits steadily for indefinite period of time.
Does not want to lie down unless sleepy.


FINE MOTOR:

•Picks small objects up with index finger & thumb.
•Releases an object after holding it.
•Brings the hands together.

•Marked interest in very small objects.
•Searches for a toy with greater persistence.

•Sense of trust.
•Expresses several beginning recognizable emotions
such as anger,sadness,jealousy,anxiety,pleasure,
excitement and affection.
•Plays social games with adult,such as “pat- a-cake”.
•May object to being away from present.
•Attracts the attention of others by pulling on their clothes.

Oral stage(0-1 yr)
Undifferentiated

INTELLECTUAL :Sensori motor stage
Substage 4;co-ordination of secondary
schemas(8-12 months).


LANGUAGE

1. Receptive; understand simple commands gives a toy
on a request that is accomplished by gestures.
2. Expressive: May speak one word besides ”ma-ma”
such as “no” ,”hi”.
Understand meaning of “bye-bye” pitch variations.

PLAY STIMULATION

Same as 8&9 months.
Obtain infants attention when requests are made
and use gestures to indicate meaning.
Make facial expressions and sounds that infant can imitate.
Provide oppurtunities for holding& releasing objects.
Encourage infant to bounce in a standing position
by holding the hands for support.
Place infant in a jumper seat to encourage standing and jumping

11 MONTHS
MOTOR:
1.Gross motor:
•Stands erect with minimal support and lifts one foot to take a
•Cruises walks holding on furniture.
2.Fine motor:
•Explores toys and other objects more carefully.
•Removes covers from boxes.
•Takes toys out of box or cup.
•Puts toy inside box or cup but may not let go yet.
•Beginning to hold a crayon and make a mark on paper.

Tilt head backward to see upward.

•Sense of trust.
•As how pleasure when a desired act is accomplished.
•Becomes frustrated when activities are restricted.
•Asserts self among family members.
•Seeks approval, avoids disapproval.

LANGUAGE

1.Receptive :Responds to simple questions.
Eg:”Where is the kitty” by pointing and looking
toward object.
2.Expressive:
Imitates specific speech sound of others.
Jargon well established.

PLAY STIMULATION
Same as 8,9,10 months
•Provide oppurtunities for placing small objects into
larger objects and for taking out again.
•Play simple games such as rolling a ball to infant.
•Encourages play with other persons.
•Place infant in a walker & encourage letting
go by offering a toy to grasp.

12 MONTHS
Physical/Biological
•Weight;10+_15 kg(22+_3 pounds) has tripled both weight .
•Length:74+_3cm(29+_1.5 inch);length has
increases by almost 50% form birth.
•Head circumference 46 cm:hc has increased by
one third since birth.
•Head and chest are equal in circumference.
•Anterior fontanelle closes between 12 & 18 months
•Pulse-115+-_20
•Respiration:30+-30
•Blood pressure:96/66+_30/24.

Reflexes:
Babinski reflexes disappears
Landau reflex disappear between 12-24 months.
Lumbar curve develop as walking continues.
Physiologic stability achieved and maintained during first year.


GROSS MOTOR:
Stands alone for variable length of time.
Sits down from standing position alone.
Walks in few steps with help or alone.


FINE MOTOR:
•Good pincer grasp.
•Picks up small bits of food and transfers them to mouth.
•Drinks from a cup and eats from a spoon
but still requires some help.
•Holds crayon adaptively to make a stroke
or a mark on a piece of paper.

•Listens for recurring sounds.
•Full binocular vision is well established.
•Visual acuity:20/100 to 20/50.


•Sense of trust theoretically achieved.
•Infants emotion such as fear, jealousy,
anger, can be more clearly interpreted.
•Attachment developed to primary caregivers.
•Drops objects on purpose to someone can pick them up.
•Cooperates in dressing :puts arms through sleeves.,
feet into shoes. Takes off socks.

LANGUAGE
1.Receptive ;Responds with gestures or actions to move
complex verbal requests,such as “please give it to me”
2.Expressive;
•May speak 2 or more words besides “ma-ma”&”da-da”.
•Understands meaning of many more words
than can be spoken.
•Knows names of increasing number of objects.
•Continues using jargon.
•Indicates “no” by shaking head.
•Vocalization decreases as walking increases.

PLAY STIMULATION
:{SAME AS 8,9,10,11 MONTHS}
•Provide large crayons for drawing.
•Provide stacking discs or blocks.
•Provide push –and –pull toys to encourage walking.
•Encourage infant to walk eventually holding only one hand.
•Provide rough house activity.
•Provide increasing visual,auditory,tactile& kinetic stimulation.

Infant

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