Jean Piagets Theory of Development

Talking To Toddlers

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Which stage of development is characterized by infants and toddlers focusing on their eyes, ears, hands, and other senses?

Sensorimotor period from birth to age 2 years

Which stage of development is characterized by children acquiring representational skills in the area of mental imagery and language?

Which stage of development is characterized by children being more logical, flexible, and organized than in early childhood?

Which stage of development is characterized by being able to think logically, theoretically, and abstractly?

Preoperational thought present from age 2 to 7 years

Concrete operational present from age 7 to 12 years

Formal operational from age 12 to adulthood

INFANT MORBIDITY AND MORTALITY

Define premature birth.

What are the potential outcomes of being a premature infant?

In the United States, what percentage of births is premature?

What are the common risk factors associated with premature births?

Less than 34 weeks gestation or birth weight less than 2500 g

Increased infant mortality

Delayed physical and social development

Emotional and behavioral problems

Dyslexia

Child abuse

6% for white women and 13% for African American women (an average of 7.2 per 1000 live births)

Low socioeconomic status Teenage pregnancy Poor maternal nutrition

NEONATAL REFLEXES

What are the six important neonatal reflexes?

Which neonatal reflexes are present at birth?

1. Moro

2. Palmar grasp

3. Rooting

4. Stepping

5. Asymmetric tonic neck

6. Parachute

Moro

Palmar grasp

Rooting

Stepping

What is the Moro/"startle" reflex? What is the palmar grasp? What is the rooting reflex? What is the stepping reflex?

At what age do the Moro, palmar, rooting, and stepping reflexes disappear?

What is the asymmetric tonic neck?

At what age does asymmetric tonic neck appear and then disappear?

What is the parachute reflex?

Head extension causes extremity extension followed by flexion.

If a finger is placed in an infant's palm, it is grasped.

If an object is placed around an infant's mouth, the infant will pursue it.

When held upright and leaning forward, an infant will make walking motions with their legs.

4 to 6 months

While supine, turning of the head causes ipsilateral extremity extension and contralateral flexion.

Present at 2 weeks and disappears by 6 months

While sitting and tilted to one side, an infant extends the ipsilateral arm to support the body.

DEVELOPMENTAL MILESTONES

What are the key categories of development?

What are the developmental milestones at 1 month of age?

What are the developmental milestones at 2 to 3 months of age?

Gross motor Fine/visual motor Language Social

Gross motor: when prone lifts head slightly

Fine/visual: with eyes tracks objects to midline; tight grasp

Language: startles to sound

Social: fixes on face

Gross motor: steadily holds head up; when prone lifts chest up Fine/visual: hands open at rest Language: smiles responsively; coos Social: recognizes parents; reaches for familiar objects or people

What are the developmental milestones at 4 to 5 months of age?

What are the developmental milestones at 6 months of age?

What are the developmental milestones at 9 months of age?

What are the developmental milestones at 12 months of age?

What are the developmental milestones at 15 months of age?

What are the developmental milestones at 18 months of age?

Gross motor: rolls front to back and back to front; sits well supported Fine/visual: grasps with both hands Language: orients to voice

Social: laughs; enjoys observing environment

Gross motor: sits well unsupported; sits upright

Fine/visual: transfers hand to hand; reaches with either hand Language: babbles

Social: recognizes strangers and has stranger anxiety

Gross motor: crawls, pulls to stand

Fine/visual: uses pincer grasp; finger feeds

Language: says "dada/mama"; understands "no"

Social: waves bye-bye; plays pat-a-cake

Gross motor: walks alone Fine/visual: throws, releases objects Language: one to eight words other than "dada/mama"; one-step commands

Social: imitates actions; comes when called; cooperates with dressing

Gross motor: walks backward; creeps upstairs

Fine/visual: builds two-block towers; scribbles; uses a cup Language: uses four to eight words Social: throws temper tantrums Gross motor: runs; kicks a ball Fine/visual: feeds self with utensils

Language: points to body parts when asked; names common objects

Social: plays around but not with other children; start of toilet training

What are the developmental milestones at 21 months of age?

What are the developmental milestones at 24 months of age?

What are the developmental milestones at 30 months of age?

What are the developmental milestones at 3 years of age?

What are the developmental milestones at 4 years of age?

What are the developmental milestones at 5 years of age?

Gross motor: squats and recovers Fine/visual: builds five-block towers Language: two-word combinations Social: toilet training

Gross motor: walks well up and down stairs; jumps

Fine/visual: removes clothing; copies a line

Language: 50-word vocabulary; stranger understands half of speech

Social: follows two-step commands; engages in parallel play

Gross motor: throws ball over hand

Fine/visual: removes clothes; copies lines

Language: appropriate pronoun use Social: knows first and last names

Gross motor: pedals tricycle; goes up and down stairs with alternating feet

Fine/visual: draws a circle; eats with utensils

Language: three-word sentences; uses plurals and past tense; stranger understands three-fourths of speech

Social: group play; shares toys Gross motor: hops and skips Fine/visual: catches ball; dresses alone; copies a cross

Language: knows colors; counts to 10 Social: imaginative play Gross motor: hops and skips Fine/visual: ties shoes Language: prints first name Social: plays cooperative games; understands rules and abides by them

Table 1.1 Developmental Milestones

Gross

Fine/Visual

Motor

Motor

Language

Social

1 month old

When

With eyes

Startles to

Fixes on face

prone lifts

tracks

sound

head

objects to

slightly

midline;

tight grasp

2 to 3 months old

Steadily holds

Hands open

Smiles

Recognizes

head up;

at rest

responsively;

parents;

when prone

coos

reaches for

lifts chest

familiar

up

objects or

people

4 to 5 months old

Rolls front to

Grasps

Orients to

Laughs;

back and

with both

voice

enjoys

back to front;

hands

observing

sits well

environment

supported

6 months old

Sits well

Transfers

Babbles

Recognizes

unsupported;

hand to

strangers

sits upright

hand;

and has

reaches with

stranger

either hand

anxiety

9 months old

Crawls,

Uses pincer

Says

Waves

pulls to

grasp;

"dada/mama"

; bye-bye;

stand

finger

understands

plays

feeds

"no"

pat-a-cake

12 months old

Walks alone

Throws,

One to eight

Imitates

releases

words other

actions;

objects

than "dada/

comes when

mama";

called;

one-step

cooperates

commands

with

dressing

(Continued)

Table 1.1 Developmental Milestones (Continued)

Gross

Fine/Visual

Motor

Motor

Language

Social

15 months old

Walks

Builds two-

Uses four to

Throws

backward;

block

eight words

temper

creeps

towers;

tantrums

upstairs

scribbles;

uses a cup

18 months old

Runs; kicks a

Feeds self

Points to body

Plays around

ball

with

parts when

but not with

utensils

asked; names

other

common

children;

objects

start of

toilet

training

21 months old

Squats

Builds

Two-word

Toilet

and

five-block

combinations

training

recovers

towers

24 months old

Walks well

Removes

50-word

Follows two-

up and

clothing;

vocabulary;

step

down stairs;

copies a

stranger

commands;

jumps

line

understands

engages in

half of speech

parallel

play

30 months old

Throws ball

Removes

Appropriate

Knows first

over hand

clothes;

pronoun use

and last

copies

names

lines

3 years old

Pedals

Draws a

Three-word

Group play;

tricycle;

circle; eats

sentences;

shares toys

goes up

with

uses plurals

and down

utensils

and past

stairs with

tense;

alternating

stranger

feet

understands

three-fourths

of speech

Table 1.1 Developmental Milestones (Continued)

Gross Motor

Fine/Visual Motor

Language

Hops and skips

Catches ball; dresses alone; copies a cross

Knows colors; counts to 10

Imaginative play

5 years old

Hops and skips

Ties shoes

Prints first name

Plays cooperative games; understands rules and abides by them

What is anaclitic depression?

What occurs without proper mothering or attachment?

What occurs during failure to thrive?

Toddlers who are hospitalized are most likely to fear what?

Physical, psychological, and social problems caused by prolonged removal of parental nurturing during ages 6 to 12 months. This is reversed if nurturing is reintroduced.

Failure to thrive

Developmental retardation

Poor health and growth

High death rates, even with adequate physical care

Separation from parents or care providers more than bodily harm or pain

In what age group is elective surgery best tolerated?

By age 3, how does separation from parents or care providers affect children?

How do toddlers understand death?

At what age do children begin to understand the concept of death?

In what age group do children begin to form relationships with other adults?

At what point should adopted children be told that they are adopted?

7 to 11 years

Separation from parents has no long-term negative effects on children. In fact, children at age 3 are able to spend significant portions of the day with other adults.

It is an incomplete understanding of the meaning of death and the child may expect a friend, relative, or pet to come back to life.

At the age of 8 years 7 to 11 years

At the earliest age possible, when they are able to understand language

EARLY ADOLESCENCE (11 TO 14 YEARS)

How is the start of puberty marked?

How is the development through puberty measured?

How many Tanner stages are there?

What are the three categories of measurement?

In girls: the onset of menstruation, beginning at age 11 to 12 years In boys: the first ejaculation, occurring at age 13 to 14 years

By the Tanner stages

There are five Tanner stages.

1. Male genitalia

2. Female breasts

3. Pubic hair

Table 1.2 Tanner Stages of Development

Male Genitalia

Female Breasts

Pubic Hair

Stage I

Childhood-sized

Preadolescent breasts

Absent.

penis, testes, and

with elevation of the

scrotum

papilla only

Stage II

Enlargement of the

Breast buds with

Pubic hair is

testes and scrotum

elevation of breast

sparse and

and papilla

straight with

downy hair on

labia/penis base.

Stage III

Penis enlargement

Breast and areola

Pubic hair is

enlargement with

curled, darker,

ingle contour

and coarse.

Stage IV

Scrotal skin

Areola and papilla

Pubic hair is

darkening and

projection with

adult- type hair

rugations are

separate contour

limited to the

present.

(secondary mound).

genital area.

Stage V

Adult-sized and

Mature breasts

Pubic hair is

-shaped penis,

adult-quantity

testes, and scrotum

and -pattern and

spreads to the

thighs.

CLINICAL VIGNETTES

A worried mother brings her 6-month-old son to your office for a checkup. She states that his highest achieved milestones are: he can recognize strangers, wave bye-bye, use a pincer-grasp, smile responsively, coo, crawl, and pull to stand. In which developmental areas is he behind?

He is delayed in his language skills. By 6 months he should be babbling, and he should have oriented to voice before that. His language skills are that of a 2-3-month-old. His gross motor, fine motor, and social skills are all at a 9-month level.

Your medical school classmate is a braggart; he loves to tell everyone how advanced his 12-month-old daughter is. He claims she can walk backward, uses a cup, builds a two-block tower, uses six different words, and throws the cutest temper tantrums you've ever seen. How far advanced is she in developmental milestones?

She is at a 15-month level in all areas—fine motor, gross motor, language, and social.

A 35-year-old-male patient comes to your office worried that he never finished going through puberty. His pubic hair is sparse, but it is dark and curled. His penis has enlarged, but there is no scrotal darkening or rogations. At what Tanner stage is he?

Tanner stage III

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