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Age 1 MO

Physical Wt - Gain 150-210 g (5-7 oz) weekly for first 6 mo. Ht - Gain of 2.5 cm (1 inch) monthly for first 6 mo. Head circincreases by 1.5cm (0.6 inch) monthly for first 6 mo Primitive reflexes present & strong Dolls eye reflex & dance reflex fading Obligatory nose breathing (most infants)

Gross motor Assumes flexed position with pelvis high but knees not under abd when prone (at birth, knees flexed under abd) Can turn head from side to side when prone; lifts head momentarily from bed Has marked head lag, esp when pulled from lying to sitting position Holds head momentarily parallel & in midline when suspended in prone position Assumes asymmetric tonic neck reflex position when supine When held in standing pos, is limp at knees & hips In sitting pos, has uniformly rounded back, absence of head control

Fine motor Hands predominantly closed Grasp reflex strong Clenches hand on contact with rattle

Sensory Able to fixate on moving object in range of 45 when held at distance of 20-25 cm (8-10 in) Visual acuity approaches 20/100* Follows light to midline Quiets when hears voice

Vocalization Cries to express displeasure Makes small, throaty sounds Makes comfort sounds during feeding

Social/Cog Is in sensorimotor phase, stage 1, use of reflexes (birth1mo); & stage 2, primary circular reactions (1-4 mo) Watches parents face intently as she/he talks to infant

2 MO

Posterior fontanel closed Crawling reflex appears

Assumes less flexed pos when prone Hands often hips flat, legs extended, arms open flexed, head to side Grasp reflex Less head lag when pulled to sitting fading pos Can maintain head in same plane as rest of body when held in ventral suspension When prone, can lift head almost 45 off table When held in sitting pos, can hold head up, but bends forward Assumes asymmetric tonic neck reflex pos intermittently

Binocular fixation & convergence to near objects beginning When supine, follows dangling toy from side to point beyond midline Visually searches to locate sounds Turns head to side when sound is made at level of ear

Vocalizes, distinct from crying Crying becomes differentiated Coos Vocalizes to familiar voice

Demonstrates social smile in response to various stimuli

Milestones that represent essential integrative aspect of development that lay the foundation for the achievement of more advanced skills. *Degree of visual acuity varies according to vision measurement procedure used.

Age

Physical
Primitive reflexes fading

Gross motor
Able to hold head more erect when sitting, but still bobs forward Slight head lag when pulled to sitting pos Assumes symmetric body pos Able to raise head & shoulders from prone pos to 45-90 angle from table; bears wt on forearms When held in standing pos, able to bear slight fraction of wt on legs

Fine motor
Actively holds rattle but will not reach for it Grasp reflex absent Hands kept loosely open Clutches own hand; pulls at blankets & clothes

Sensory
Follows objects to periphery (180 ) Locates sound by turning head to side & looking in same direction Begins to have ability to coordinate stimuli from various sense organs

Vocalization
Squeals aloud to show pleasure Coos, babbles, chuckles Vocalizes when smiling Talks a great deal when spoken to Less crying when awake

Social/Cog
Displays considerable interest in surroundings Ceases crying when parent enters room Can recognize familiar faces & objects, such as feeding bottle Shows awareness of strange situations

3 MO

4 MO

Drooling begins Moro, tonic neck, & rooting reflexes disappeared

Has almost no head lag when pulled to sitting pos Balances head well in sitting pos Roles from back to side Back less rounded, curved only in lumbar area Able to sit erect if propped up Able to raise head & chest off surface to angle of 90 Assumes predominant symmetric pos

Inspects & plays with hands; pulls clothing or blanket over face in play Tries to reach objects w/hand but overshoots Grasps objects w/both hands Plays with rattle placed in hand, shakes it but cannot pick up if drop Can carry objects in mouth

Able to accommodate to near objects Binocular vision fairly well established Can focus on a 1.25cm (0.5in) block Beginning eye-hand coordination

Makes consonant sounds n, k, g, p, b Laughs aloud Vocalization changes according to mood

In stage 3, secondary circular reactions Demands attention by fussing; becomes bored if left alone Enjoys social interaction Anticipates feeding when sees bottle or mother if BFing Shows excitement with whole body, squeals, breaths heavily Shows interest in strange stimuli Begins to show memory

5 MO

Beginning signs of tooth eruption Birth weight doubles

Turns from back to abdomen No head lag Holds head erect when sitting Able to sit longer when back is supported Back straight Symmetric pos with arms ext when prone When supine, puts feet in mouth

Grasps objects voluntarily Uses palmar grasp, bidextrous approach Plays with toes Takes objects directly to mouth Holds one cube while regarding a 2nd one

Visually pursues dropped object Is able to sustain visual inspection of object Can localize sounds made below ear

Squeals Makes cooing vowel sounds interspersed with consonant sounds (e.g., ah-goo)

Smiles at mirror image Pats bottle or breast with both hands More enthusiastically playful, but may have rapid mood swings Is able to discriminate strangers from family Vocalizes displeasure when object is taken away Discovers parts of body

Age

Physical
Growth rate begin to decline Wt gain 90-150g (35oz) weekly for next 6 mo Ht gain 1.25cm (0.5in) monthly for next 6 mo May begin teething with eruption of 2 lower central incisors May chew & bite Eruption of upper central incisors Parachute reflex appears

Gross motor
When prone, can lift chest & upper abd of surface, bearing Wt on hands When about to be pulled to sitting pos, lifts head Sits in high chair with back straight Rolls from back to abdomen When held in standing pos, bears almost all weight Hand regard absent When supine, spontaneously lifts head off surface Sits, leaning forward on both hands When prone, bears wt on 1 hand Sits erect momentarily Bears full wt on feet When held in standing pos, bounces actively

Fine motor
Resecures a dropped object Drops 1 cube when another is given Grasps & manipulates small objects Holds bottle Grasps feet & pulls to mouth

Sensory
Adjusts posture to see object Prefers more complex visual stimuli Can localize sounds made above ear Will turn head to side, then look up or down

Vocalization
Begins to imitate sounds Babbling resembles one-syllable utterances ma, mu, da, di, hi Vocalizes to toys, mirror image Takes pleasure in hearing own sounds (self-reinforcement) Produces vowel sounds & chained syllables baba, dada, kaka Vocalizes 4 distinct vowel sounds Talks when others are talking

Social/Cog
Recognizes parents, begins to fear strangers Holds arms out to be picked up Has definite likes & dislikes Begins to imitate (cough, protrusion of tongue) Excites on hearing footsteps Laughs when head is hidden in towel Briefly searches for dropped object (object permanence beginning) Freq mood swings from crying to laughing w/little or no provocation

6 MO

7 MO

Transfers objects from one hand to other Has unidextrous approach & grasp Holds 2 cubes more than momentarily Bangs cubes on table Rakes at small object

Can fixate on very small objects Responds to own name Localizes sound by turning head in curving arch Beginning awareness of depth & space Has taste preferences

Increasing fear of strangers; shows signs of fretfulness when parent disappears


Imitates simple acts & noises Tries to attract attention by coughing or snorting Plays peak-a-boo Demos dislike of food by keeping lips closed Exhibits oral aggressiveness in biting & mouthing Demos expectation in response to repetition of stimuli Exhibits increasing anxiety over loss of parent, particularly mother, & fear of strangers Responds to no Dislikes dressing, diaper change

8 MO

Begins to show regular patterns in B/B elimination

Sits steadily unsupported


Readily bears wt on legs when supported; may stand holding onto furniture Adjusts posture to reach obj

Has beginning pincer grasp using index, 4th, & 5th fingers against lower part of thumb Releases obj at will Rings bell purposely Retains 2 cubes while regarding 3rd cube Secures obj by pulling on string Reaches for toys out of reach

Makes consonant sounds t, d, w Listens selectively to familiar words Utterances signal emphasis & emotion Combines syllables, such as dada, but does not ascribe meaning Localizes sounds by turning head diagonally & directly toward sound Depth perception increasing Responds to simple verbal commands Comprehends no-no

9 MO

Eruption of upper lateral incisor may begin

Creeps on hands & knees Sits steadily on floor for prolonged time (10 min) Recovers balance when leaning forward but cannot do so when leaning sideways

Uses thumb & index finger in crude pincer grasp


Preference for use of dominant hand now evident Grasps 3rd cube Compares 2 cubes by bringing them together

Parent (mother) is increasingly important Shows increasing interest in pleasing parent Begins to show fears of going to bed & being left alone Puts arms in front of face to avoid having it washed

Pulls self to standing pos & stands holding onto furniture

Age

Physical
Labyrinth righting reflex strongest when infant in prone/supine pos; is able to raise head

Gross motor
Can change from prone to sitting position Stands while holding onto furniture, sits by falling down Recovers balance easily while sitting While standing, lifts 1 foot to take step

Fine motor
Crude release of an object beginning Grasps bell by handle

Sensory

Vocal
Says dada, mama with meaning Comprehends bye-bye May say 1 word (hi, bye, no)

Social/Cog
Inhibits behavior to verbal command of no-no or own name Imitates facial expressions; waves bye-bye Extends toy to another person but will not release it Develops object permanence Repeats actions that attract attention & cause laughter Pulls clothes of another to attract attention Plays interactive games such as pat-a-cake Reacts to adult anger; cries when scolded Demos independence in dressing, feeding, locomotive skills, & testing of parents Looks at & follows pic in book

10 MO

11 MO

Eruption of lower lateral incisor may begin

When sitting, picots to reach toward back to pick up an object Cruises or walks holding onto furniture or w/both hands held

Explores objects more thoroughly Has neat pincer grasp Drops obj deliberately for it to be picked up Puts 1 obj after another into container (sequential play) Able to manipulate obj to remove it from tight-fitting enclosure

Imitates definite speech sounds

Experiences joy & satisfaction when task is mastered Reacts to restrictions with frustration Rolls ball to another on request Anticipates body gestures when familiar nursery rhyme or story is being told (holds toes & feet in response to this little piggy went to market) Plays games up-down, so big, peek-a-boo Shakes head for no

12 MO

Birth wt tripled Birth length by 50% Head and chest circ equal (head circ 46cm [18in])

Walks with 1 hand held Cruises well May attempt to stand alone momentarily; may attempt 1st step alone Can sit down from standing pos w/o help

Releases cube in cup Attempts to build 2 block tower but fails Tries to insert pellet into narrow-necked bottle but fails Can turn pages in book, many at a time

Discriminates simple geometric forms Amblyopia may dev w/lack of binocularity Can follow rapidly moving object Controls & adjusts response to sound; listens for sound to recur

Says 3-5 words besides dada, mama Comprehends meaning of several words (comp always precedes verbaliz) Recognizes objects by name Imitates animal sounds Understands simple verbal commands (give it to me, show me your eyes)

Shows emotions such as jealousy, affection (may give hug/kiss on request), anger, fear Enjoys familiar surroundings & explores away from parent Fearful in strange situation; clings to parent May dev habit of security blanket/toy determination to practice locomotor skills Searches for obj even if it hasnt been hidden, but only searches where last seen

Hockenberry, M., & Wilson, D. (2011). Wong's nursing care of infants and children. (9th ed.). St Louis MO: Mosby.

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