Infant and Pediatric
Growth and Development
Brenda Beckett, PA-C
Objectives
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Normal growth patterns
– Height
– Weight
– Head circumference
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Normal development
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Gross motor
Fine motor
Language
Personal / Social
Cognitive
Anticipatory Guidance
Important to remember
Kids are not little adults!!
 Know milestones (normal)
 Learn to recognize abnormal
 Listen to parents’ concerns
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Role of Pediatric Provider
Relationship with provider can last
many years, multiple children
 Understand family and background
 Communication is key to development
of successful relationship
 Providing educational materials,
anticipatory guidance
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Provider/Parent Relationship
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Frequent visits the first year of life
Identify issues of growth and development
Learn about the family’s cultural and
socioeconomic factors
Focus on areas of concern to the family
Assess importance of factors to family
Personal attention to the individual needs of
the child
Parent’s perspective
Well child visit gives chance to assess
parent’s perspective
 Parents are most important observers
 Understand their perception of child’s
development
 Identify concerns and anxieties
 In this way, provider can attempt to
alleviate concerns
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Physical Exam
Dynamic tool to interact with the child
and the parent
 Can reveal important insights into
development beyond physical signs
 Parents often add important insight
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Anticipatory Guidance and
Education
Impact child’s health and development long
term
 Prepare parents/child for next step in
development
 Discuss important issues including:nutrition,
safety, immunizations, developmental
milestones at each visit
 Provide positive feedback whenever possible
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Hearing
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Hearing screen
– Indirect screen of hearing, production of normal
sounds
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6wks-cooing
3mo-laugh out loud
9mo-echo sound
12-15mo-1st words
Hearing is essential for normal language
development
 Audiometric testing
Schedule for Well Child Visits
Newborn, 2 week, 2 months, 4 months,
6 month, 9 months, 12 months, 15
months, 18 months
 2 years and then yearly
 Notice correlation with immunization
schedule
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Growth
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Length, Weight, Head Circumference
– Measured and plotted on growth curves
– Explain growth curve to parents
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Measure HC until age 2
– Relatively large proportionately at birth
– Slow growth-Craniosynostosis (cranial
sutures have closed too soon)
Development
Parental concerns
 Parental questionnaires
 Observation
 Direct questions
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2 Week WCC
Length, weight and HC
 Alertness, Tone, Head Control
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– Gross motor: Head side to side
– Personal-social: regards face
– Language: alerts to sound
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Any parental concerns?
2 Month WCC
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Development
– Gross motor: moving limbs, lifts shoulders
– Fine motor: Tracks past midline
– Personal-social: Smiles responsively
– Language: Coos/verbalizes
Observe infant during exam
 Observe parents with infant
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4 Month WCC
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Gross Motor
– Roll front to back, lifts up on hands
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Fine Motor
– Reach for object, raking grasp
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Personal/Social
– Develops a social smile
– Regards hand
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Language
– Vocalizing, begins to babble, laugh
6 Month WCC
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Gross motor
– Rolls B-F and F-B, sits alone
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Fine motor
– Transfers objects
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Personal/Social
– Feeds self
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Language
– Babbles
9 Month WCC
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Gross Motor
– Sit without support-crawl, pull to stand, cruise
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Fine Motor
– Pincer grasp
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Personal/Social
– Understand bye-bye, and no-no
– Peek-a-boo
– Stranger anxiety
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Language
– Babbling, 1-2 vocalizations, Mama Dada
nonspecific
Anticipatory Guidance and
Education
Safety-child proofing, water safety,
poison control
 Milestones
 Play games with child
 Introduce cup
 Bite size pieces of food
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12 Month WCC
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Gross Motor
– Walking or close
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Fine Motor
– Puts blocks in cup
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Personal/Social
– Drinks from cup, imitates others
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Speech
– Mama, dada specific, plus 1-3 other words
15 Month WCC
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Gross Motor
– Walks well, walks backwards
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Fine Motor
– Scribbles, stacks two blocks
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Personal/Social
– Uses spoon/fork, helps in house
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Speech
– 3-6 words, follows commands
18 Month WCC
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Gross Motor
– Runs, kicks ball
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Fine Motor
– Stacks four blocks
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Personal/Social
– Removes garment
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Speech
– Says at least 6 words
Toddler 1-2 years
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Social/emotional development
– Behavioral shifts
• Stubborn independence to clinging to parent
• Temper tantrums*/discipline
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Cognitive abilities
– Early language
– Pretend play
– Exploration
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Physical Development
– Walking/running
– Slower growth rate
Temper Tantrums
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How not to fuel frustration, initiate power struggles
and create unnecessary conflict!!
 Think before you speak, be realistic when you make
a rule or promise
 Try not to reinforce negative behaviors, just to quiet
your child
 Talk to your child about how he/she are feeling, and
acknowledge those feelings
 Try to be as consistent as possible
 Use your mistakes to help you for the next
time…there will be a next time
 Praise good behavior...set your child up to be
successful
Preschool 3-5 years
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Social/emotional development
– Toilet training*
– Peer interactions
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Cognitive development
– Speech
– Imagination/fantasy
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Physical development
– Increased coordination
– Steady growth
Toilet Training
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Support, educate and encourage parents
 Developmental process, many steps, before
successful, and setbacks are common
 Is your child ready?
– Clues to readiness: express interest in toilet
training, imitate parents behaviors, communicate
need to “go”, demonstrates some independence
– Initiate the discussion with parents at age 1-2
Toilet Training (cont.)
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Are the parents ready?
– Schedule: Do they have blocks of time to
devote to toilet training?
– Encourage them to resist pressures from
grandparents, friends, daycare providers
– Ask if they have any previous experiences
with toilet training that they would like to
discuss
Important Points to Remember
Do not pressure or punish the child
 Stress the importance of
parent/caregiver cooperation
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Middle Childhood 5-10 years
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Social/emotional
– School
– Peer interactions
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Cognitive development
– Reading, math
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Physical development
– Balance
– Sports
Child Safety and Injury
Prevention
Injuries are the number one cause of
death in children ages 1-21
 Motor vehicle cause the most deaths,
followed by drowning
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Car Seats
Safest place in the back seat, in car
seat. Rear-facing until 12mo & 20 lb
 Car seat/booster must be appropriate
size for child, fit properly in the car, and
be fastened correctly
 Air bags-dangerous for child to be in
front seat, even when the car is parked
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Other safety issues
Bicycles
 Skateboarding/Rollerblading
 Firearms
 Poisoning
 And Many More…
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Role of the pediatric health care
provider
Form relationship with child and the
family
 Take a history that will elicit age
appropriate information
 Assess growth and development
 Examine patient
 Provide anticipatory guidance and
education of patient and family
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