Milestone of Development

THE FIRST YEAR

Motor Development

During early childhood, the primitive reflexes are replaced by voluntary motor control, which is under the higher cortical control. Motor development is a cumulative process; higher level skills are dependent on lower level skills.

           In the first two months, an infant’s movements consist largely of uncontrolled writhing with apparently purposeless hand opening and closing. Smiling occurs involuntarily. However, eye gaze, head turning, and sucking are under conscious control.

        At 2 to 6 month old, early reflexes that limited voluntary movement. Infants can begin to examine objects in the midline and manipulate them with both hands. Waning of early grasping reflex allows them to voluntarily hold and release objects. A novel object may elicit purposeful but inefficient reaching. The quality of spontaneous movements also changes, from larger writhing to smaller, circular movements, described as ‘fidgety’. Intentional rolling is made possible by increased control of truncal flexion. Head control improves, allowing infants to gaze across things and begin to take food from a spoon.

            Between 6 to 12 month old, infants gain the ability to sit up unsupported and later pivot while sitting, providing increasing opportunities to manipulate several objects at one time. These explorations are aided by the emergence of pincer grasp. Many infants begin crawling and pulling to stand around 8 months, and walk before 12 months.

Cognitive Development

            Caretaking activities provide visual, tactile, olfactory, and auditory stimuli. All these stimuli play an important part in the development of cognition. Infants can see, hear and smell within days of birth. They are able to perceive objects and events as coherent. These abilities allow them to sort stimuli into meaningful sets. Infants appear to seek stimuli actively as tough satisfying an innate need to make sense of the world.

            At the age 1 month, infants can enjoy conversations. By 5 to 6 weeks, infants begin to smile, at first once or twice in a day, more frequently and to more different stimuli as they get older. In a further week or two, they vocalize their pleasure when spoken to.

            Around 4 month old, infants are described as ‘hatching’ socially, they become interested in a wider world. Infants between 2 to 6 months old also explore their own bodies, staring intently at their hands, vocalizing, etc. These explorations represent early stage in the understanding of cause and effects as infants learn that voluntary muscle movements produce predictable tactile and visual sensation. They also have a role in the emergence of a sense of self.

            At 6 to 12 month old, infants begin to put everything into the mouth, later they are picked up, inspected, passed from hand to hand, and banged dropped, then mouthed. Each action represents a nonverbal idea about what things are for. Anytime after 5 months old, infants may begin to imitate such acts as chewing or protrusion of the tongue. From age 6 month, they begin to show memory of foodstuffs by strong reactions of like and dislike.

The major milestone is the achievement of object constancy (about 9 month), the understanding that objects continue to exist even when not seen. At 4 to 7 month, infants try to look for dropped toy, but quickly give up if it is not seen. With object constancy, infants persist in searching and finding hidden objects.

Emotional and Communication Development

Basic trust develops as infants learn that their urgent needs are met regularly. The consistent availability of a trusted adult creates a condition for secure attachment. The emotional significance of any experience depends on an individual child’s temperament as well as the parents’ responses.

At 2 to 4 month old, infants interact with increasing sophistication and range of emotions. The primary emotions of anger, joy, interest, fear, disgust and surprise appear in appropriate contexts as distinct facial expressions. Face-to-face with a trusted adult, the infant and adult match affective expressions. Such face-to-face behavior reveals the infant’s ability to share emotional states, the first step in the development of communication.

Between 6 to 12 months, infants can recognize parents and strangers, they may cling or cry anxiously when being approached by strangers. Separation often becomes more difficult. At the same time, the demand for autonomy emerges. Infants begin to refuse or consent activities. They may turn away as the spoon approaches when being fed, or may insist on holding it themselves. Self feeding with finger foods may be the only way to get them to eat. Tantrums make their first appearance as the drives for autonomy and mastery come in conflict with parental controls and with infants’ self limited abilities.

The average infants begin to vocalize with vowel sounds, ah, eh, uh, a week or two after beginning to smile in response to parents. In three or four weeks, these vowel sounds are followed by the addition of front consonant (m, p, b) and back consonant (g, k). At 2 to 3 months, he says “gaga.” At 3 months, infants hold long conversation with parents, with increasing tone and pitch. At 4 months, he says “ah goo”, and much vocal play begins, he enjoys the vibration when he razzes. At 6 months, they add many syllables, and by 7 months they begin combining syllables without meaning. Up to this stage, an infant’s vocalization is largely unrelated to his race or hearing.

Infants at 7 month are adept at nonverbal communication, expressing a range of emotions and responding to vocal tone and facial expressions. Around 9 months, infants become aware that emotions can be shared between people. Between 8 to 10 months, babbling takes on a new complexity, with many syllables (ba-da-ma) and inflections that mimic the native language. The first true word, that is a sound used consistently to refer to a specific object or person, appears in concert with the discovery of object constancy.

THE SECOND YEAR

Motor Development

            Most children begin to walk independently near their first birthday, some do not walk until 15 months. After several months of practice, the child is able to stop, pivot, and stoop without toppling over. At the age of 18-24 months, motor development is incremental, with improvement of the balance and agility and the emergence of running and stair climbing.

Cognitive Development

            Object exploration accelerates because reaching, grasping, and releasing are nearly fully mature and walking increases access to interesting things; Toddlers combine objects to create interesting effects such as stacking blocks. Playthings are more intended to be used for their intended purposes (comb for hair, cups for drinking). Imitation of parents and older children is an important mode of learning.

            At approximately 18 months, object permanence is firmly established. Cause and effect are better understood, and they demonstrate the flexibility in problem solving, using sticks to obtain a toy out of reach and figuring how to wind a mechanical toy.

Emotional Development

            Infants developmentally approaching the milestone of their first steps may be irritable. Once they start walking, their predominant mood changes markedly. Toddlers are described ‘intoxicated’ with their new ability and with the power to control the distance between themselves and their parents.

            In many children, the relative independence of the preceding period gives way to increased clinginess around 18 months. This stage, described as rapprochement, may be a reaction to growing awareness of the possibility of separation. Many children use a special blanket or stuffed toy as a transitional object: something that functions as a symbol of the absent parent.

            Self-conscious awareness and internalized standard of evaluation first appear at 18 to 24 months. They begin to reach for their own face, rather than the mirror image, when they see an unusual appearance. They begin to recognize a broken toy and may hand them to parents to fix. When tempted to touch a forbidden object, they may tell themselves “no, no,” evidence of internalization of standards of behavior.

Linguistic Development

            Receptive language proceeds expressive. By the time infants speak their first words, around 12 months, they already responds appropriately to several simple statements such as “no,” “bye-bye,” “give me.” By 15 months, the average child points to major body parts and uses four to six words spontaneously and correctly. Most communications of wants and ideas continues to be nonverbal.

            Labeling objects coincides with the advent of symbolic thought. Children may point at things with index finger and ask their names. After the realization that words can stand for things, a child’s vocabulary grows from 10-15 words at 18 months into 100 or more at 2 years. After acquiring about 50 words, toddlers begin to combine words to make simple sentences. At this stage, toddlers understand two-step commands, such as “give me the ball and then get your shoes.”

PRESCHOOL YEARS

Motor Development

            Most children walk with mature gait and run steadily before the end of their third year. Beyond this basic level, there is wide variation in ability as the range of motor activities expands to include throwing, catching, and kicking ball, climbing, dancing and other complex-pattern behaviors.

            Handedness is usually established by the third year. Variations in fine motor development reflect both individual proclivities and different opportunities for learning.

            Bowel and bladder control emerge during this period. Daytime bladder control typically precedes bowel control and girls precede boys. Bed-wetting is normal up to age 4 in girls and 5 in boys. Many children master toileting with ease, particularly once they are able to verbalize their bodily needs.

Cognitive Development

            The preschool period is characterized by magical thinking, egocentrism, and thinking that is dominated by perception. Magical thinking includes a confusion of coincidence for causality, animism, and unrealistic beliefs about the power of wishes.

            During the preschool period, play is marked by increasing complexity and imagination, from simple scripts replicating common experiences such as shopping (age 2-3 year) to a more extended scenarios involving singular events such as going to the zoo (age 3 or 4 year) to creation of scenario that have only been imagined, such as flying to the moon (age 4 or 5 year). Similar progression in socialization moves from minimal social interaction with peers during play (solo or parallel play, age 1 or 2 year) to cooperative play (age 3 or 4 year) to organized group play with distinct role assignments.

            Moral thinking mirrors and is constrained by a child’s cognitive level. Emphatic responses to others’ distress arise during the second year, but the ability to cognitively consider another child’s point of view remains limited through out the preschool period. Fairness is taken to mean equal treatment regardless of circumstantial differences. Rules tend to be absolute, with guilt assigned for bad outcomes regardless of intentions.

Emotional Development

Emotional challenges facing preschool children include accepting limits while maintaining a sense of self-direction, reigning in aggressive and sexual impulses, and interacting with a widening circle of adults and peers. At age 2 year, behavioral limits are predominantly external; the age 5 years, these controls need to be internalized if the child is to function in a typical classroom.

Children learn what behaviors are acceptable by testing limits. Excessively tight limits can undermine a child’s sense of initiative; whereas the overly loose limits can provoke anxiety in a child who feels no one is in control. Control is the central issue. Inability to control some aspects of the external world often results in a loss of internal control that is a temper tantrum. Tantrums normally appear toward the end of the first year of life, and peak in prevalence between 2 and 4 years.

Preschool children normally experienced complicated feelings toward their parents: intense love and jealousy and resentment and fear that angry feelings might lead to abandonment. The swirl of these emotions, most beyond the child’s ability to express or analyze, often find expression in highly labile moods.

Curiosity about genitals and adult sexual organs is normal. Modesty appears gradually between age 4 and 6 year, with wide variations among cultures and families.

Language Development

            Language development occurs most rapidly between 2 and 5 year of age. Vocabulary increases from 50-100 words to more than 2000. Sentence structures advances from telegraphic phrase to sentences incorporating all the major grammatical components. As a rule of thumb, between age 2 to 5, the number of words in typical sentences equals the child’s age (2 by age of 2, 3 by age of 3, and so on). By 2 ½, most children are using possessives (my ball), questions and negatives. By the 4, they can count to 4.