AGE AND PHYSICAL CHARACTERISTICS |
BEHAVIOR PATTERNS |
NURSING CONSIDERATIONS |
Birth-4 Weeks (1 Month)
Significant neurologic disorganization.
Strong Moro reflex.
Sleep cycle disorganized.
GI system too immature for solid foods.
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Motor development
Momentary visual fixation on objects and adult face.
Eyes follow bright moving objects.
Lies awake on back.
Immediately drops objects placed in hands.
Responds to sounds of bell and other similar noises.
Keeps hands fisted.
Socialization and vocalization
Cognitive and emotional development
Reflexive.
External stimuli are meaningless.
Responses are generally limited to tension states or discomfort.
Gains satisfaction from feeding and being held, rocked, fondled, and cuddled.
Has an intense need for sucking pleasure.
Quiets when picked up.
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Play stimulation
Use human face—smile and talk.
Dangle bright moving object (eg, mobile) in field of vision.
Hold, touch, caress, fondle, kiss.
Rock, pat, change position.
Play soft music or have infant listen to ticking clock, sing.
Talk to infant, call by name.
Parental guidance
Begin to expose infant to different household sounds.
Change crib location in room.
Use brightly colored clothing and linens.
Put infant to sleep on back until old enough to roll.
Keep infant nearby.
Play with infant when awake.
Hold during feeding.
 NURSING ALERT Educate par ents about infant sleep stages and putting infant to sleep on back.
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4-8 Weeks (2 Months)
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Motor development
Reflexive behavior is slowly being replaced by voluntary movements.
Turns from side to back.
Begins to lift head momentarily from prone position.
Shows eye coordination to light and objects.
If bell is sounded nearby, infant will stop activity and listen.
Eyes follow better, both vertically and horizontally. Focuses well.
Socialization and vocalization
Begins vocalization—coos, especially to a voice.
Crying becomes differentiated.
Visually looks for sounds.
May squeal with delight when stimulated by touching, talking, or singing.
Begins to smile socially.
Eyes follow person or object more intently.
Cognitive and emotional development
Recognizes familiar face.
Becomes more aware and interested in environment.
Anticipates being fed when in feeding position.
Enjoys sucking—puts hand in mouth.
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Play stimulation
Arrange mobile over crib so infant’s movement will set it in motion.
Hang wind chimes near infant.
Hang brightly colored pictures on wall. Use cradle gym and infant seat.
Use rattles.
Hold infant and walk around room.
Allow freedom of kicking with clothes off.
Parental guidance
Talk to infant and smile; get excited when infant coos.
Place infant seat on a secure surface (eg, floor, center of a table—never near edge of table) near mother’s activities.
Put infant in prone position in bed or on floor.
Expose infant to different textures.
Exercise infant’s arms and legs.
Sing to infant.
Provide tactile experience during bathing, diapering, and feeding.
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8-12 Weeks (2-3 Months)
Landau reflex appears at 3-4 months.
Positive support reflex disappears.
Posterior fontanelle closes.
Increase in body fluids— real tears appear, drooling and GI juices increase.
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Motor development
When prone, will rest on forearms and keep head in midline—makes crawling movements with legs, arches back, and holds head high; may get chest off surface.
Indicates preference for prone or supine.
Discovers hands—bats objects with hands.
Holds objects in hands and brings to mouth.
Has fairly good head control.
Socialization and vocalization
Smiles more readily, babbles, and coos.
Stops crying when mother enters room or when caressed.
Enjoys playing during feeding.
Stays awake longer without crying.
Turns head to follow familiar person.
Cognitive and emotional development
Shows active interest in environment.
Recognizes familiar faces and objects.
Focuses and follows objects.
Shows repetitiveness in play activity.
Is aware of strange situations.
Derives pleasure from sucking—purposefully gets hand to mouth.
Begins to establish routine preceding sleep.
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Play stimulation
Encourage socialization, smiling, and laughing.
Place on mat on floor.
Continue to introduce new sounds.
Parental guidance
Take outdoors with proper clothing (similar warmth as that of adults), hat, and PABA-free sunscreen.
Bounce on bed.
Play with infant during feeding.
Rattles can be used effectively for visual following and for hand play.
Encourage older siblings to “make faces,” sing, and talk to infant.
 NURSING ALERT Children of all ages should avoid intense sun exposure, particularly during the middle of the day. PABA-free sunscreen with a sun protection factor of at least 15 should be used on children of all ages, particularly if sun exposure is longer than 30 minutes.
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12-16 Weeks (3-4 Months)
Moro reflex fades.
Stepping reflex disappears.
Rooting reflex disappears.
By 4-5 months infant’s weight approximately doubles birth weight.
Average weekly weight gain, 4-7 ounces (113.5-198.5 g).
Average monthly height gain, 1 inch (2.5 cm).
Pulse rate slows to 100-140 beats/minute.
Respirations, 20-40 breaths/minute.
Grasp becomes voluntary.
Sucking becomes voluntary.
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Motor development
Eyes focus on small objects, may pick a dangling ring.
Holds head up (when being pulled to sitting position).
Becomes more interested in environment.
Hand comes to meet rattle.
Listens—turns head to familiar sound. Sits with minimal support.
Intentional rolling over, back to side.
Reaches for offered objects.
Grasps objects with both hands and everything goes into mouth.
Socialization and vocalization
Laughs and chuckles socially.
Demands social attention by fussing.
Recognizes mother.
Begins to respond to “No, no.”
Enjoys being propped in sitting position.
Cognitive and emotional development
Actively interested in environment.
Enjoys attention; becomes bored when alone for long periods.
Recognizes bottle.
More interested in mother.
Indicates increasing trust and security.
Sleeps through night; has defined nap time.
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Play stimulation
Encourage mirror play.
Provide soft squeeze toys in vivid colors of varying textures.
Allow infant to splash in bath.
Infant still enjoys holding and playing with rattles.
Enjoys old-fashioned clothespins and playing pat-a-cake and peek-a-boo.
Parental guidance
Be certain button eyes on toys and other small objects cannot be pulled off.
Hold rattle and let infant reach and grasp it.
When infant is in high chair, strap in.
Move mobile out of reach—infant may grab it and cause injury.
Repeat child’s sounds.
Talk in varying degrees of loudness.
Begin looking at and naming pictures in book.
Begin roughhousing play by both parents.
Give space in playpen or on sheet on floor to practice rolling over.
Place on abdomen for part of playtime.
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16-26 Weeks (4-7 Months)
By 5-6 months, tonic neck reflex disappears.
By 6-7 months, palmar grasp disappears.
Two central lower incisors erupt.
Spine “C-shaped”—lacks lordotic and lumbar curves.
Eustachian tube short and horizontal, which may be a factor in ear infections. GI system mature enough for solid foods.
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Motor development
Shows momentary sitting with hand support.
Bounces and bears some weight when held in standing position.
Transfers and mouths objects in one hand.
Discovers feet.
Bangs objects together.
Rolls over well.
May begin some form of mobility.
Socialization and vocalization
Discriminates between strangers and familiar people.
Crows and squeals.
Starts to say “Ma,” “Da.”
Play is self-contained.
Laughs out loud.
Makes “talking” sounds in response to others’ talking.
Cognitive and emotional development
Secures objects by pulling on string.
Searches for lost objects that are out of sight.
Inspects objects; localizes sounds.
Likes to sit in high chair.
Drops and picks up objects.
Displays exploratory behavior with food.
Exhibits beginning fear of strangers.
Becomes fretful when mother leaves.
Shows much mouthing and biting.
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Play stimulation
Enjoys social games, hide-and-seek with adult, toys, and large blocks.
Likes to bang objects.
Plays in bounce chair and walker.
Enjoys large nesting toys (round rather than square).
Likes to drop and retrieve things.
Likes metal cups, wooden spoons, and things to bang with.
Loves crumpled paper.
Enjoys squeeze toys in bath.
Likes peek-a-boo, bye-bye, and pat-a-cake.
Parental guidance
Will play as long as you can.
Tie toys to chair with short string.
Let play with extra spoon at feeding.
Give soft finger foods.
Because infant puts everything in mouth, use safety precautions.
Keep small items away from infant; could choke on them.
Show excitement at achievements.
Supply safe kitchen items for toys.
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26-40 Weeks (7-10 Months)
By 7-9 months, develops eye-to-eye contact while talking; engages in social games.
Four upper incisors erupt around 7-9 months.
By 9-12 months, plantar reflex disappears.
By 9-12 months, neckrighting reflex disappears.
6-12 months
Average weekly weight gain, 3-5 ounces (85-141.7 g).
Average monthly height gain, ½ inch (1.25 cm).
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Motor development
Sits without support.
Recovers balance.
Manipulates objects with hands.
Unwraps objects.
Creeps.
Pulls self upright at crib rails.
Uses index finger and thumb to hold objects.
Rings a bell.
Can feed self a cracker and can hold a bottle. Chewing reflex develops.
Can control lips around cup.
Does not like supine position.
Can hold index finger and thumb in opposition.
Socialization and vocalization
Claps hands on request.
Responds to own name.
Is very aware of social environment.
Imitates gestures, facial expressions, and sounds.
Smiles at image in mirror.
Offers toy to adult, but does not release it.
Begins to test parental reaction during feeding and at bedtime.
Will entertain self for long periods.
Begins fear of strangers, 8 ½-10 months.
Cognitive and emotional development
Begins to imitate.
Shows more interest in picture books.
Enjoys achievements.
Has strong urge toward independence— locomotion, feeding, dressing.
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Play stimulation
Encourage use of motion toys—rocking horse and stroller.
Water play.
Imitate animal sounds.
Allow exploration outdoors.
Provide for learning by imitation.
Offer new objects (blocks).
Child likes freedom of creeping and walking, but closeness of family is important.
Good toys: plastic milk carton; bean bag for tossing; fabric books; things to move around, fill up, empty out; pile-up and knock-down toys.
Parental guidance
Protect from dangerous objects—cover electrical outlets, block stairs, remove breakable objects from tables.
Have child with family at mealtime.
Offer cup.
Talk and sing to infant.
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10-12 Months (1 Year)
Develops lordotic and lumbar curves to make walking possible.
Weight should approximately triple birth weight.
Two lower lateral incisors appear.
Four first molars appear by 14 months.
Child development theories
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Motor development
Cruises around furniture.
Beginning to stand alone and toddle.
Turns pages in book.
Tries tossing object.
Shows hand dominance.
Navigates stairs; climbs on chairs.
Builds a tower of two blocks.
Puts balls in box.
May use spoon.
Can release objects at will.
Has regular bowel movements.
Socialization and vocalization
Uses jargon.
Points to indicate wants.
Loves give-and-take game.
Responds to music.
Enjoys being center of attention and will repeat laughed-at activities.
Cognitive and emotional development
Shows fear, anger, affection, jealousy, anxiety, and sympathy.
Experiments to reach new goals.
Displays intense determination to remove barriers to action.
Begins to develop concepts of space, time, and causality.
Has increased attention span.
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Play stimulation
Ball play.
Cloth doll.
Motion objects and toys.
Transporting objects.
Name and point to body parts.
“Put-in” and “take-out” toys.
Sand box with spoons and other simple objects.
Blocks.
Music.
Parental guidance
Allow self-directed play rather than adultdirected play.
Continue to expose to foods of different texture, taste, smell, and substance.
Offer cup.
Show affection and encourage child to return affection.
Safety teaching: Child gets into everything within reach. Place medications in safe, locked place. Create a safe environment for child. Use stair guards, faucet protectors, and drawer locks. Have Poison Control Center phone number readily available.
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12-18 Months
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