01.03a Developmental Stages and Milestones

Developmental milestones are important to understand because we need to know as we’re assessing a pediatric patient if they’re doing what they should be doing at a given age. Okay, if they’re not doing what they should be doing, is there some sort of developmental or some sort of musculoskeletal issue that we need to address with this patient. So, let’s talk about some of the developmental milestones that you need to know by age.

For infancy, we’re talking 1 - 12 months. Okay, really, these newborn patients, what they should be doing, first of all, they should be growing, okay? That’s the big thing they need to be doing. We need to double their weight by 6 months and triple their weight by 1 year. That’s their birth weight. Okay, so, if they were born at 8 pounds, by 6 months, they should be about 16 pounds. Okay, and then by a year, they should be 24 pounds. Their fontanels should start closing with, their posterior ones, closing by 8 months and their anterior fontanels closing by about 18 months. And by 1 year, they should start having a handful of teeth. Motorwise, they should be able to sit without support by about 6 or 8 months and they should be able to roll completely over by 6 months and stand up by a year. And remember, these are goals, okay, so, if they accomplish some things sooner, that’s great, you know. If they, if it takes them a little bit longer, we need to be assessing the whole picture, okay? Are they sitting up? Are they rolling? Are they having problem standing? You know, and what do we need to look at with these patient? For language development, they need to be crying and smiling and cooing at 3 months. And those need to be appropriate. Okay, they need to be smiling at people and they need to be looking at people and cooing. And they should understand the meaning of ‘no’ by 11 months, and by about a year, they should be able to follow very simple directions. You know, very simple words, very simple directions. Some of the biggest threats to safety for children of this age are suffocation, falls and burns. So, you can educate your parents that, you know, you need to be careful with plastic bags, with toys, they can get things down their throat, they can get lodged in their trachea and you know, they can fall, or they can get burned on stoves and different things, irons and stuffs like that.

For early childhood, let’s talk about early childhood. That’s for ages 1 - 3 years. They should be gaining 4 - 6 pounds a year and they should be growing about an inch or 3 inches a year. Their head circumference is equal to their chest circumference by 1 to 2 years. And motor development, they should be able to build a tower of about 8 blocks high and can copy a circle on paper. So, if you draw a circle down, they should be able to you know, by 3 years, be able to trace that circle and they should be able to start building towers at that age. Language development should be about 300 words by age 2. So, they should be talking a bit more. You know, at age 2, they should be able to say a few words here and there and be able to just you know, understand basic language, okay?

For our little bit older patient, for our preschool patient, okay, this is a patient who’s 3 - 6 years old who’s just getting ready, you know, in preschool, and getting ready to start school. They should be gaining a little bit more weight. They should be getting about 5 pounds per year and they should be growing about 2 - 3 inches per year. Their motor development. They should be getting a little bit more skillful, okay? They should be able to hop on 1 foot, they should be able to draw a person, you know, a little stick figure. They should know where the head goes, where arms go, where feet go, what goes on the face. Are they able to put those things in the right position on the face, the eyes, the nose, ears, all that. They should be able to know really what’s going on with the face. Their vocabulary should be increasing quite a bit with being able to speak about 2,000 words by the age of 5. They should understand fantasy. They should understand, you know, what is fantasy and be able to differentiate that between real life and be able to use fantasy as they tell a story. They should know their name and their address, that’s something that parents should be able to teach them, especially before, just as a safety thing before they start school, they should be able to know, you know, their name, where they live, etc.

And then, the school age child. So, 6 - 12 years old. They’re gonna be gaining quite a bit more weight. They’re gonna be gaining 7 pounds per year and getting quite a bit bigger. Their brain growth is actually compared complete by about 10 years old and they’re gonna be growing a little bit less, you know, their growth is kinda slow at this point, until they get, you know, to adolescence. And they’ll start losing their teeth. Motor development, they should be able to write in cursive and they should be able to ride bikes, and play active games, and run around and do all those things that, you know, you think the child would know developmental delays is doing out, you know, they are playing tag, jumping, hopping, skipping, all that stuff.

So, that’s really kind of growth and development by age. And those are kinda the big points that you need to kinda need to understand and you need to know and really kinda hit on the big points on each of those growth, motor development and language and then think about some of the safety issues with each of these age groups.