developmental milestones and complications

Developmental Stages

Week 7

Christina Sierra



Developmental Management in Pediatric Primary Care

Developmental Management of Infants

Developmental Management of Early Childhood

Developmental Management of School Age Children

Developmental Management of Adolescents


Developmental Management in Pediatric Primary Care

Assessing development

Height weight head circumference

Interviewing parents

Knowing appropriate milestones

Educating families on normal vs abnormal

Educating on developmental expectations

We all grow at different rates so never compare yourself to someone else’s situation, doing so, can only bring disappointment.

– Massy Arias


Growth Chart

In child development nothing is set in stone. There is a grey area in timing.

Development has a variation in time- it maybe a few weeks or months.

Developmental Management of Infants

Birth to one month:

Babies lose 5-8% of body weight in their first few days and then regain within 10-14 days

They should gain about 2 lbs per month

Nutritional needs should meet 110 kcal/kg/day

Sleep about 16 hours

Sucking, rooting, tonic neck, moro, grasp- present and symmetric

Moving hand to mouth, sucking, or grasp clothing- self console

May turn to parents voice

Visual space is about 8 -12 in from face, vision is foggy

Hearing and smell is developed- but especially smell

Four ways of being awake: 1. Drowsy 2. Quiet but alert 3. Crying 4. Alert and active

What does a baby’s cry mean?


Hunger- rhythmic intense

They want to be cuddled-slow, low tone

Pain- high pitch screetchy

Tired- slow rhythmic, intensifies

Cries should be distinctive and vary on needs or feels.

This begins articulation

What does a baby’s cry mean?

Usually colics

Crying for over 30 minutes even after being fed, cleaned, consoled.

High-pitched, shrieking

Abnormal central nervous system

Cornelia de Lange syndrome – like a bleating lamb

Cri-du-chat syndrome- like a cat

Cerebral irritability (i.e. meningitis, hydrocephalus, kernicterus)

Malnutrition especially marasmus






Trauma to the hypopharynx

Vocal cord paralysis




Foreign body

Infection – abscesses, croup, epiglottitis

Laryngeal abnormalities

Oropharynx abnormalities

Tracheal abnormalities


Weak or whimperyMuscle weakness

Muscular dystrophy

Myasthenia gravis


1 month to 3 months

Growth in height is approximately 1.4in per month

Growth in head circumference is approximately 0.8 in

Weight gain is approximately 420 g= about 1 lb a month

Growth spurts are expected and baby will eat more in a quicker time frame

Baby becomes more routined with sleeping, passing stool and eating schedule

Body movement is symmetric

Attempts to grasp objects

Cooing and babbling should be expected

Response to conversations- acknowledgment, turning head, focused with communication with body language

They may show smiles, imitation, tracking objects

By two months you should expect to see:

Social and Emotional

Begins to smile at people

Can briefly calm herself (may bring hands to mouth and suck on hand)

Tries to look at parent


Coos, makes gurgling sounds

Turns head toward sounds Baby raising head and chest when lying on stomach

Cognitive (learning, thinking, problem-solving)

Pays attention to faces

Begins to follow things with eyes and recognize people at a distance

Begins to act bored (cries, fussy) if activity doesn’t change

Movement/Physical Development

Can hold head up and begins to push up when lying on tummy

Makes smoother movements with arms and legs

4 months to 5 months

Sleep approximately 12 hours and through the night

By 5 months baby DOUBLE BIRTH weight

Weight gain, height and head circumference growth slows down

Begin to grab objects, hold bottles

You now see the Landau reflex

Baby rolls

Tummy time is important- they should start to see slight holding of the head while on their belly

Beginning to show signs of progression to sit

You may begin

Landau’s Reflex

Begins at 3-4 months

Seen until 12-24 months

Lay prone supported in air

You want to see the “superman”

Is your baby ready for solids?

At 4 months you can introduce solids such as cereals.

`Can your baby hold his or her head in a steady, upright position?

Can your baby sit with support?

Is your baby mouthing his or her hands or toys?

Is your baby showing a desire for food by leaning forward and opening his or her mouth?

Foods are introduced one at a time for three days straight to assure there are no food allergies

6 months to 8 months

Teething symptoms begin

Crawling begins, infant may stand, scooting, sitting longer

Rake and pincer grasp, transfer ball to ball, reach and grab, pointing, tugging throwing

Led weaning begins at this time

Single sound- oh, ah, da, ba, ma. Cooing and babbling

Imitation of sounds such as coughing

They learn parents tone and can understand no

Social play, separation anxiety

Cause and effect- gravity, peek a boo

9 months to 12 months

Bowel and bladder are more regular

Food preferences with structured meals- breakfast snacks lunch snack dinner

Hold cups and sips

They should put objects in box, stack objects,

Add a Slide Title – 4

Resource through the CDC

Developmental check list


American Academy of Pediatrics, website. Responding to your baby’s cries. Updated November 21, 2015. Accessed November 20, 2018.

Pomeranz AJ, Sabnis S, Busey SL, Kliegman RM. Irritable infant (fussy or excessively crying infant). In: Pomeranz AJ, Sabnis S, Busey SL, Kliegman RM, eds. Pediatric Decision-Making Strategies. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 79.

Illingworth RS. Common Symptoms of Disease in Children. Blackwell Scientific Publications: Oxford. 1988:296.

Jonathan Juett, and Benjamin Kuipers, “Learning to reach by building a representation of peri-personal space,” 2016 IEEE-RAS 16th International Conference on Humanoid Robots (Humanoids), pp. 1141–1148, .

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