P OLÍTICAS DE SEGURIDAD

Each of these domains has a line of development or sequences of changes until maximal skills are achieved.

Gross motor Fine motor Social Emotional Language Cognition

Other skills that are important in the older child and which profoundly affecting learning are the ability to pay attention and to concentrate.

Development;

Has a constant pattern Begins in utero

Should be considered longitudinally relating what has happened to what lies ahead Varies in rate between children

There is inter-relatedness in the acquisition of the different skills with deficiencies in one area affecting development of another area. For example hearing deficits have profound effect on development of language, as well as socio and behavioral skills.

0-2 months

The first year is a period of rapid physical growth and maturation and acquisition of numerous competencies. Growth takes place in spurts that qualitatively change the child’s behaviour

Behavioural goals

In the first 2 months of life the main behavioural goals are to establish;

effective feeding,

a predictive pattern of sleeping and waking and

social interaction that becomes the basis for future social and cognitive development.

65 Physical growth and Motor Development

In the 1st week there is a 10% drop in weight which is regained or exceeded by end of second week. During this period the average weight gain 30g/day. The infant’s movements in the first 2 months are largely uncontrolled except for the eye gaze, head turning and sucking. Smiling occurs involuntarily. Babies cry in response to stimuli such as wet diaper, hunger, and over-heating. Crying peaks at 6 weeks of life with at least 3hrs/day, and then declines to 1hr/day. Neurological development contributes to the longer blocks of sleeping time. Learning also contributes to sleeping habits with babies shifting to night time breastfeeding if the mother is away at work during the day.

Cognitive development

Babies receive visual, tactile, olfactory and auditory stimulus. Infants habituate to the familiar and pay less and less attention to a stimulus that is presented repeatedly. In the first 2 months babies can differentiate among similar patterns and colours and consonants. They respond to facial expressions even when they appear on different faces. They are also able to match abstract properties of stimuli, for instance they can tell difference between sound from movement of lips or from a video-tape

Emotional development

The key task in emotional development is to develop basic trust. Key to this goal is consistent availability of a trusted adult. Babies who are consistently picked and held in response to distress cry less at one year and have less aggressive behaviour at 2 years. Feeding plays a key role in emotional development. On-demand fed babies link distress with arrival of mother and relief from distress. Babies fed on fixed schedule usually adapt. Babies with unstable biologic rhythms and who are fed on a fixed schedule experience periods of un-relived hunger or unwanted feedings. Similarly babies fed at parents convenience with complete disregard of baby’s need do not experience feeding as the favourable reduction of tension. Babies who have a mismatch between feeding and hunger have increased physiologic instability manifesting as diarrhoea, spitting, poor weight gain) as well as later behavioural problems

Success in establishing feeding and sleep cycles increases the parents’ sense of efficacy independent of child’s temperament. Normally anxiety and ambivalence experienced by the mother/parents in the first few days after the birth of their baby settle down as baby develops regular rhythms. Mothers with post-partum depression or blues may have a harder time making the adjustment and need specific support.

2-6 months

During the period of 2-6 months the voluntary (social) smile and increased eye-to-eye contact emerges. Parents experience a heightened sense of being loved. At 3-4 months weight gain slows down to 20g/day.

Motor and Physical development

Early reflexes that limit movement recede. There is loss of asymmetrical tonic neck reflex which means that infants can roll over and also begin to examine objects in the mid-line and manipulate them with both hands. Waning of grasp reflexes means that the child can hold an object voluntarily and also let go. A novel object may elicit purposeful but inefficient reaching. Babies have increased control of truncal flexion

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which then makes intentional rolling possible. Head control allows the baby to gaze across things and not just up and down. The baby also learns to take food from a spoon. Maturation of visual system allows much greater depth and field of site.

Sleep requirements are 14-16 hours with 9-10 hours concentrated in the night and up to 70% of the infants sleep 6-8 hours on a stretch. The sleep cycle is short 50-60 minutes compared to the adult 90 min. in adults and therefore babies wake up frequently in the night.

Cognitive development

The period of 4-6 months is characterized by increased awareness of the environment.

The baby no longer focused on the mother only but becomes distracted in her arms.

Infant build a sense of self – when he wiggles the toes, he can see and feel the sensation and do it deliberately. Infants explore their bodies, staring intently at their fingers, toes, vocalizing, touching the different body parts. The baby learns what is self and that he has control over it and what is non self which he has no control, for example smell and touch by mother.

Emotional development

Primary emotions of anger, joy, interest, fear, disgust, and surprise appear in the appropriate context as distinct facial expressions. Face to face expression matches that of the trusted adult, for example a mother and baby smiling to each other. If intensity of stimulation builds the baby turns away. If the mother turns away the baby leans forward and tries to stimulate mother’s attention. Infants of depressed mothers behave differently. They spend less time on co-ordinated behaviour and make little effort to connect and co-ordinate with the parent. The baby shows sadness and loss of energy a parent continues to be unavailable. Babies’ ability to share the emotional state of their parents is the first step in development of communication

The 3-6 months period in a child’s life is exciting and interactive. Some parents may interpret the increasing outward look by the infant as rejection. In the paediatric consult, the session is happy. If the paediatric visit is not joyful and relaxed, causes of social stress and family dysfunction, parental illness or problems of infant parent-relationship should be sought.

6-12 months

Key themes during this period are;

Increased mobility and exploration of the inanimate world, Advances in cognitive understanding and competences New tensions around themes of separation

Infant develops will and intention Motor development

Physical growth slows down. Motor achievements co-respond to increasing myelination and cerebella growth. Approximately half of the babies are able to sit unsupported by 7months, pivot while sitting by 9-10months, pincer grasp by 9 months, crawling and pulling to a stand at 8 months and walking at 1 year. The increased ambulation increases child’s exploratory range, creates new physical dangers and provides new

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learning experiences. Tooth development starts usually with mandibular incisors and to some extent correspond to skeletal growth.

Cognitive development

Initially everything goes to the mouth. Later novel things are inspected, passed from hand to hand, banged, dropped, and then mouthed. The pleasure and persistence with which children pursue these activities points towards intrinsic drive or masterly motivation. Masterly behaviour occurs when children feel secure and children with less secure attachments demonstrate limited experimentation behaviour. Object constancy is a major cognitive milestone achieved at around 9 months. The child now understands that an object exists even when it cannot be seen. Once this is achieved an infant will persist in finding objects hidden under a cloth or behind the examiner.

Emotional development

Development of object constancy corresponds to social and communication changes.

Babies begin to differentiate familiar and strange faces and may cling and cry.

Separation becomes more difficult. Babies may wake up more often to check parents are still there. There is emerging autonomy – infant no longer consents to be fed and turns away as the spoon approaches or insists on holding it himself. Self-feeding with finger foods – practice newly acquired fine motor skill (pincer skills) and maybe the only way to get the child to feed. Tantrums emerge. The drive for autonomy and masterly conflict with parental control and infants still limited abilities.

Communication

7-month old babies are adept at non-verbal communication showing a range of emotions and by nine months realizes that emotions can be shared between two people. As an example, an eight month old baby will show his parents his toys happily.

In a clinic setting, a eight month old baby will start crying because she or he has heard another baby cry. By eight to nine months, babbling increases in complexity with multiple syllables (ba-da-ma) and inflection that mimic the native language. This is followed by emergence of true words - sound used consistently to refer to a specific subject.

Feeding and sleeping problems re-emerge. Poor weight gain may reflect the struggle between the infant and the parent over control of the infant’s feeding. Discussions with parents may help to pre-empt these difficulties. 9-month examination of the child is difficult because of the babies’ wariness of strangers. Time taken in talking to the mother and playing with the child will ease these tensions.

12-18 months Motor development

Further slow down in growth, accompanied by declining appetite. The baby fat burned up with increased mobility. The child has an exaggerated lumbar lordosis makes the abdomen protrude. Brain growth continues with myelinization throughout the 2nd year.

Most children walk by one year with highly active fearless infants walking earlier than the more timid ones. Initially the toddler has a wide base gait, knees bent and arms flexed at elbow and entire torso rotates with each step. Several months later centre of

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gravity shifts back and torso remains more stable, knees extend and arms swing on the side. The child is then able to stop, pivot and stoop without toppling over.

Cognitive development

This stage is characterized by accelerated object exploration and the skills of reaching, grasping and releasing are almost mature. The toddler combines objects in novel ways to create interesting effects. Toys like stacking blocks are very popular and well liked by babies in this age group. Playthings are used for intended purpose e.g. combs for hair, cups for drinking. There is imitation of adult (parents and other siblings) and make believe play

Emotional development

Before walking the toddler’s predominant mood is irritability. Once they walk they become intoxicated with their new ability to control the distance between themselves and their parents. Toddlers orbit round their parents moving away looking back for re-assurance and then moving further before coming back for re-re-assurance. In unfamiliar ground the timid child remains close to the parent while in more familiar surrounding the baby may orbit out. Ability to use the parent as the secure position for exploration depends on the degree of attachment relationship. In a strange room, when the parent leaves most children stop playing, cry and try and follow. When the parent returns, the secured attached child instantly goes to the parent to be picked and comforted and then returns to play. Children with ambivalent attachments go to their parents and then resist being comforted and may hit at their parents in anger. Avoidant children may not protest when the parent leaves and may turn away when they return. Insecure response patterns represent strategies that infants develop to cope with punitive or unresponsive parenting style and may predict long-term emotional problems. Role of infant temperament in response to separation is still controversial.

Language development

Receptive language precedes expressive language. By 15 months use 4-6 words spontaneously, and points to different body parts. They enjoy polysyllabic jargoning and do not mind that others do not understand.

Parents often look forward to the milestone of walking. However the ability to wander off means there is a need for increased supervision. At this stage children are at increased risk of injuries. During a health visit an infants who become anxious in their parents arms and turn to strangers are worrisome and further history and assessment is required to determine the caring practices. This maybe a sign of neglect or inconsistent care practices

18-24 months Motor development

Children develop improved balance and agility. They are now able to run and climb a staircase. Height and weight increase at a steady rate and head growth slows down.

Cognitive development

Age 18 months marks the end of sensory-motor stage. Object permanence is fully established and cause and effect are better understood. The toddler begins to

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demonstrate flexibility in problem solving, and for instance may use a stick to reach a toy that is out of reach. Symbolic play is now not tied to the toddlers’ body, for example a toy can be fed. Cognitive changes have significant effect on emotional and linguistic development.

Emotional development

There is increased clinginess as the child becomes more aware of separation.

Separation at bed-time difficult and many children use special blanket or toy as a transition object, which maybe representing the absent parent. Transition objects remain until symbolic language develops. Self conscious awareness develops and an example is when looking at a mirror the child will reach for their own face and not at the mirror. The child will recognize that toys are broken and may ask parents to fix them.

When tempted to touch a forbidden object they themselves say no- no-no showing that they are internalizing standards of behaviour.

Linguistic development

Children continue to develop symbolic language. The vocabulary increases from 10-15 words at 18 months to > 100 words at 2 years as children realize that words stand for things. Once they have 50 words they are able to combine words to make simple sentences. At 2 years able to follow a two step command e.g. ‘put on your shoes and then kick the ball’. Emergence of verbal language skills marks the end of the sensorimotor period. The child learns to use symbols to express ideas and solve problems and this diminishes the need for cognition based on sensation and motor manipulation.

Physical limits on child’s exploration become limited with the child’s increased mobility.

For example the child is able to climb out of his cot. There is now increased need for behaviour control that is based on language. Children with delayed language acquisition have greater behavioural problems. Language development is facilitated when parents and other care givers use clear, simple sentences, ask questions and respond to children’s incomplete sentence and gestures with the correct words.

Regular looking at picture books with a parent provides ideal setting for language development.

Age 2-5 years