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Infant and early childhood development

By megaplexit Sep 30, 2013 3993 Words
1. General infant development
a. Infant period
i. Neonate/newborn: 28 days of life
ii. Infant: 1 month-1 year
b. Physical changes
i. Greatest period of physical development
ii. Birthweight
1. Avg 7.5-8 lbs
2. Doubles at 6 months
3. Triples at 1 year
4. Growth variations= genetics, nutrition, activity, disease iii. Height
1. 19-21 in
2. Increases 10-12 inch by 1st year
3. Half adult height by 2 years
iv. Head circumference
1. 13-14 inch
2. Fontanels: openings in the baby skull (allows skull to expand) a. Posterior closure at 3 months
b. Anterior closure at 18 months
v. Brain/nervous system
1. Midbrain/medulla: vital functions (HR, RR, sleep/wake, elimination) 2. Cortex: perception, thinking, language, body movement
3. Synaptogenesis: synapses form
a. Brain weight triples by 2 years/quadruples by 4 years
b. Top heavy
4. Pruning: getting rid of extra synapses
a. Greatest plasticity (doesn't get hurt as easily)
b. Vulnerable to deficits w/o stimulation (getting rid of synapses that they need) 5. Myelinization
a. Cephalocaudal/proximodistal development (head to limbs/inside to outside) b. Reticular formation (attention/focus) incomplete until 20s vi. Reflexes
1. Adaptive= survival (sucking)
2. Primitive
a. Immature neuro system
b. Disappear 6-12 months
c. Normal
i. Moro (startle)
ii. Rooting/sucking
iii. Palmer/plantar grasp plantar magnet: baby grabs anything that touches hand/foot iv. Babinski (splaying toes)
v. Tonic neck (fencing): turn head they straighten that arm and bend other arm up vi. Stepping/crawling: hold baby over ground= “step”
vii. Behavioral states
1. 5 sleep/wake cycles--> deep sleep, light sleep, drowsiness, quiet alert (most productive for mom and baby), alert, fussing 2. Repeats every 2 hours
3. Circadian rhythms: begin about 8 weeks
4. 6 months= sleep 14 hours (more regular/predictable)
viii. Gross/fine motor development
1. Bones
a. Ossify from prenatal--> puberty
b. Density required for weight bearing/motor activity
2. Muscles
a. Higher fat to muscle ratio at birth
b. Fat ratio declines by age 1
3. Gross motor: head control, rolling, sitting, crawling, walking 4. Fine motor: use of hands/fingers
ix. Motor developmental milestones
1. Gross motor
a. 1 month= stepping reflex, lifts head/lacks head control and support b. 2-3 month= head control
c. 4-6 month= rolls over, sit supported, head erect, creeps (army crawl--> precrawl) d. 7-9 month= sit unsupported, crawls
e. 10-12 month= pulls up, walks grasping furniture (alone)
2. Fine motor
a. 1 month= grasps object in hand
b. 2-3 month= swipes object in sight
c. 4-6 month= reaches, grasps
d. 7-9 month= hand to hand transfer
e. 10-12 month= hand preference, grasp spoon in palm, poor aim hand to mouth c. Sensory skills
i. Vision
1. Acuity
a. 20/200 at birth
b. 20/20 at 2
2. Sees color at birth--> less complicated pattern is seen better 3. Tracking objects
a. Birth-6 weeks= 8-10 inch
b. Tracks across room by 6-10 weeks
ii. Hearing
1. Better than vision
2. Startle to loud noise
3. Turn/search for sound
a. Get better at locating w/ age
b. 18 months= have adult ability
4. Recognize mother's voice
iii. Smelling--> recognize mother's scent
iv. Taste
1. Distinguish sweet, sour, bitter
2. Salt is first taste in utero
3. Sweet is in breastmilk
v. Touch
1. Best developed sense at birth
2. Touching reflexes sensitive to touch and massage
d. Perceptual skills
i. Development
1. Preference technique: look at 2 pics and see which one infant stares at longer 2. Habituation: show same thing to infant several times--> more times you show infant the less excited they get 3. Dishabituation: show a new toy that's similar to habituation toy--> get excited again 4. Operant conditioning: infant associates toy/noise with something ii. Looking

1. Depth
a. NB scans edges
i. Sees outline of faces
ii. Can't discriminate mom when head is wrapped in scarf
b. 3 months= perceives depth
2. Complex patterns
a. Prefer complex pattern
b. Color contrast
c. Discriminate mom's face
iii. Listening
1. 1 month= syllable sounds
2. 6 month= 2 syllable words/all sound contrasts of language--> under this is best time to learn language (parent needs to interact w/ infant and say these words) 3. Perceive different voices
4. Ability decreases over time
iv. Intermodal
1. Integrate info from senses
2. 1-6 months
3. Combined audio-visual stimuli
4. Combined rhythm and movement
5. Important in learning
v. Parent/nurse role
1. Talk, sing, read
2. Label tings
3. Model good speech (enunciate and visualize mouth)
4. Emphasize conversation not direction
5. Give opportunity to talk
6. Listen to them/ask questions
e. Health and wellness
i. Mortality
1. Death of infant in 1st year of life
2. US= 7/1000 births
3. Causes
a. Congenital anomalies--> poor prenatal care
b. Low birth weight (prematurity)
c. SIDS (leading cause b/w 1 month-1 year of life)
d. Effect of maternal and cord/placental complications
e. Accidents
ii. SIDS
1. Sudden death in apparently healthy infant
2. Causation theories
a. Viral infection
b. Apnea
c. Sleeping on stomach
d. Smoking
e. Slow neuro myelination
3. Parent education
a. Back to sleep
b. No smoking in pregnancy/baby's house
iii. Shaken baby syndrome
1. Shaking causes brain damage and retinal hemorrhages
2. Causes
a. History of abuse in family
b. High parental expectations
c. Lack of parental support/parental education
d. Crying/fussy baby; unclear infant cues; prematurity
3. Parent education
iv. Health care--> routine medical check ups
v. Nutrition
1. Breastfeeding
a. Immunologic
b. Enhances GI function
c. Ideal composition
d. Protects against illness
e. Enhances jaw development
f. Convenient, less money, ideal T, sterile
g. Psychological benefit
h. Involution enhanced and weight
i. Best for prematurity babies
2. Formula feeding
a. Designed to resemble breast milk
b. Eat less frequently
c. Sleep through night earlier= more sleep for parents
d. Anyone can feed
e. Use Fe fortified formula until 1 year
f. Dad can help
3. Recommendations
a. Formula/breast feeding for 1 year
b. No cow's milk until a year
c. Use whole milk for at least 3 year then 2%
d. Solids begin 4-6 month
e. Start 1 food at a time and feed for 2-3 days to detect allergies f. Don't give nuts until 2 years
g. No honey until 1 year
4. Malnutrition
a. Impairs brain/nervous system/growth
b. Ca deficiency--> impairs bone growth
c. Micronutrient deficiency--> may lead to language and social delays d. Anemia: Fe deficiency--> not as much O source (growth of organs is slower) e. Marasmus: calorie and protein deficiency (may cause permanent neuro damage) f. Kwashiorkor: protein deficiency (may cause permanent neuro damage) vi. Immunizations

1. HepB: hep B
2. DTaP: diphtheria, tetanus, pertussis
3. Hib: haemophilus influenza B
4. PCV: pneumococcal disease
5. Polio: polio
6. RV: rota virus
7. Influenza: flu
8. MMR: measles, mumps, rubella
9. Varicella: chickenpox
10. HepA: hep A
vii. Immunization ages
1. Birth--> HepB
2. 2 months--> HepB, Dtap, PCV, Hib, Polio, RV
3. 4 months--> Dtap, PCV, Hib, Polio, RV
4. 6 months--> HepB, Dtap, PCV, Hib, Polio, RV
5. 12 months--> MMR, PCV, Hib, Varicella, HepA
6. 15 months--> Dtap
2. Cognitive infant development
a. Cognitive changes
i. Piaget
1. Cognitive theory
a. General
i. Sensorimotor phase (birth-18 months)
ii. Infant understands world through senses and motor actions iii. Infant uses simple symbols, words and pretend plan near the end of this period b. Vocabulary
i. Assimilation: process of fusing incoming information to existing schemes to make sense of experiences ii. Accommodation: changing a scheme to incorporate new information iii. Sensorimotor intelligence: refinement of innate schemes by experiences of senses/motor actions c. Stages

i. 1 (0-1 month)
1. Immediate present
2. Reflexes
3. No remembrance/planning
ii. 2 (1-4 months)
1. Coordination of looking, listening, reaching and sucking
2. Primary circular reactions (simple repetitive actions)
iii. 3 (4-8 months)
1. Simple links b/w stimuli and responses
2. Secondary circular reaction (repetition of action to trigger reaction outside body) iv. 4 (8-12months)
1. Understanding casual connections
2. Means-end behavior (plan to achieve goal)
v. 5 (12-18 months)
1. Environmental exploration more focused
2. Experimental quality
3. Tertiary circular reactions (variations of previous actions) vi. 6 (18-24 months)
1. Manipulate symbols
2. Generate solutions by thinking, not trial and error
3. Sophisticated means end behavior
2. Object permanence
a. Realization that objects still exist when hidden from sight b. Stages
i. 2 months= only rudimentary expectation (surprise when object disappears) ii. 6-8 months= looking for missing object for brief amount of time iii. 8-12 months= reaching/searching for hidden toy
3. Imitation
a. 2 months= can imitate actions they could see themselves make b. 8-12 months= can imitate other people's facial expressions c. 1 year= imitation of any action that wasn't in child's repertoire d. 18 months= deferred imitation: child's imitation of some action at a later time 4. Challenges

a. Piaget underestimated cognitive capacity of infants
b. May have wrongly equated infant's lack of physical ability w/ lack of cognitive understanding c. Object permanence studies incorporating computer technology suggests development happens a lot earlier than predicted ii. Object permanence research

1. Spelke's study of object permanence--> babies have some built in assumptions of object connections 2. Baillargeon
a. Knowledge of objects isn't built in but learning is innate b. Babies as young as 4 months show clear signs of object permanence 3. Recent theories--> object permanence is more of a process of elaboration/development than that of discovery b. Learning, categorizing and memory

i. Classical conditioning
1. Learning of emotional responses as early as 1st week of life 2. Stimulus response connection
ii. Operant conditioning--> both sucking responses and head turning have been increased using reinforcement iii. Modeling
1. Observers
2. Actors
iv. Schematic learning
1. 7 month olds= superordinate (high level) categories
2. 12 month olds= high level/basic level categories
3. 2 year olds= hierarchal categorization
v. Memory
1. 1 months= 1 day
2. 3 months= 1 week
3. 6 months= 2 weeks or longer
4. Early memories are highly specific--> remember only if exactly same context c. Language
i. Infant directed speech (IDM): baby sounds
1. Motherese: “mommy talk”
2. Parentese: “daddy talk”
ii. Repetition
iii. Expansion/recasting: repeat child sentence to be grammatically correct iv. Reinforcement
1. Reading
2. Talking
v. Milestones
1. 2-3 months= cooing, responds to talking w/ smiling and cooing 2. 20 weeks= vowel/consonant sounds w/ cooing
3. 6 months= babbles/uses phonemes of all languages
4. 8-9 months= phonemes, rhythms, intonation of home language, receptive vocabulary of 20-30 words 5. 12 months= expressive language/says single words
6. 12-18 months= uses word gesture combinations
7. 18-20 months= uses 2 word sentences/has expressive vocabulary of 100-200 words vi. Word recognition
1. Syllable stress--> 7 months= discriminate b/w stressed and unstressed sounds 2. Receptive language--> 9-10 months= recognize spoken words vii. 1st words
1. Expressive language--> 12-13 months= recognize/respond to meaningful words 2. Holophrases--> 12-18 months= gestures/single words
3. Naming explosion--> 16-24 months= rapid vocab growth
viii. 1st sentences
1. Telegraphic speech
a. Simple 2 word sentences
b. Include noun, verb, adjective
2. Inflections
a. Grammatical markers
b. Plurals, tense
ix. Differences in language development
1. Rate
a. Early vs. late use of words and sentences
b. Catch up by age 6
2. Style
a. Expressive
b. Referential
3. Culture
a. Same development stages
b. Sentence structure, inflections different
d. Intelligence
i. Denver II screening (1 month-6 years)
1. Personal-social
2. Fine motor-adaptive
3. Gross motor
4. Language
ii. Bayley scale of infant development (for premature babies) 1. Sensory skills
2. Motor skills
3. Social and personality infant development
a. Theories
i. Psychoanalytic perspectives--> greatest risk/ability to be attached (leads to attachment formation later in life) 1. Freud
a. Infant needs to get needs met
b. Infant needs to start to be independent (weaned) at the end of this stage 2. Erikson--> infant needs to be secure in attachment
ii. Ethological perspectives (bowlby attachment theory)
1. Attachment: emotional bond where a person's sense of security is bound up in relationship (child can use mom as safe base) 2. 1st 2 years constitute a sensitive period for attachment in human infants 3. Crucial elements to secure attachment

4. Securely attached infants have secure relationships, better social skills, positive self-image and more empathy to others 5. Phases
a. Birth-3 months
i. Non-focused orienting and signaling
ii. Crying, smiling, eye contact to draw attention
b. 3-6 months
i. Focus on 1+ figures (person who gave them the most attention) ii. Directed signals to few people; less responsive to unfamiliar c. 6-24 months
i. Secure base behavior
ii. Proximity seeking to safe person (usually mom/dad)
d. 24+ months
i. Internal model
ii. Relates actions to effect on bond w/ caregiver
b. Attachment
i. Behaviors
1. Stranger anxiety
a. Fear of strangers
b. 6-8 months of age
c. Behaviors= clinging/looking away from strangers
2. Separation anxiety
a. 8/9 months-18/24 months
b. Desire proximity to primary caregiver
c. Cry/protest when separated
d. Prolonged separation can have adverse effects
3. Synchrony: mutual intertwined pattern of parent child behavior a. Responsiveness b/w parent/child
b. Associated w/ higher intelligence and larger vocab by 3 years 4. Social referencing: child uses facial expression/reaction of mother for what to do in novel situations ii. Variations
1. Secure
a. Explores/separates
b. Seeks parents for safe base
2. Insecure/avoidant
a. Mother rejects/withdraws/avoids
b. Avoids contact
c. Shows no preference
3. Insecure/ambivalent
a. Mother is inconsistent
b. Little exploration
c. Greatly upset on separation/not reassured upon mom's return 4. Insecure/disorganized
a. Parent abusive
b. Confused
c. Moves toward mom yet looks away
iii. Caregiver characteristics/attachment
1. Emotional responsiveness
a. Emotional availability
b. Contingent responsiveness
2. Marital status
a. Married vs. single
i. Kids in married households usually better than in single
ii. Usually depends on who has more resources/time
b. Mother's age--> older= better attachment
3. Mental health (depression)--> isn't a secure attachment= bad iv. Secure attachment effects
1. More sociable
2. More positive in relationships w/ friends
3. Less clinging/dependent on teachers
4. Less aggressive/disruptive
5. More emotionally mature
6. Continues into adolescence
a. More likely to be leaders
b. Have higher self esteem
c. Personality, temperament and self-concept
i. No agreement on temperament today
ii. Origin= nature vs. nurture theory
1. Heredity
2. Long term stability
3. Neurological processes
4. Environment
a. Goodness of fit
b. Gender--> girls are better for social situations
iii. Thomas and Chess
1. Easy child (40%)
a. Comfortable exploring/new situations
b. Not fussy
c. Stable routines
2. Difficult child (10%)
a. More irritable
b. Not comforted easily
c. Don't keep solid routines
3. Slow to warm up child (15%)
a. Don't have a lot of reactions
b. Don't have solid routine
iv. 5 key dimensions of temperament
1. Activity level
2. Approach, sociability, positive emotion
3. Inhibition/anxiety
4. Negative emotionality/irritability/anger
5. Effortful control/task persistence
d. Self-concept
i. Subjective self: I exist
ii. Objective self
1. Qualities= gender, name, size
2. Mine
iii. Emotional self: distinguishing b/w emotions/perception of other emotions e. Effects of non-parental care
i. Over ½ of all 2 year olds are cared for by family members/daycare centers ii. Increased number of working mothers
iii. Research is mixed
iv. Effects
1. Social
a. Some studies show no differences in attachments
b. Infants in non-parental care may be less securely attached c. Children in >20 hrs/week in non-parental care
i. Social problems
ii. More aggressiveness toward peers
iii. Disobedience toward teachers
2. Physical
a. Obesity issues
b. Slower attachment of motor skills
3. Cognitive
a. High quality day care may increase cognition
b. Math/reading scores
i. Increase with poor families
ii. Decrease w/ resourceful families
v. Goal is to make sure non-parental care fits needs/personality of child 4. Early childhood I
a. Defined
i. Toddler (1-2 years)
ii. Preschooler (3-6 years)
b. Physical changes
i. Growth
1. Toddler
a. Weight gain slows
i. 4-6 lbs/year
ii. 2 year weight average= 26-28 lbs
b. Height
i. 3.5-5 inch/year
ii. 9-12 cm/year
iii. 2 year height avg= 34-35 inch
iv. 1/2 adult height= 2 years
c. Head circumference
i. 19-19.5 inch
ii. 18 months= anterior fontanels closed
d. Cardiovascular--> HR (80-100 bmp)
e. GI
i. Stomach enlarges (still small)
ii. Saliva glands mature
iii. Like finger foods
f. Pulmonary--> RR (18-28)
g. Renal
i. Kidney ureters short and straight
ii. 500-600 mL urine/day
iii. Readiness for toilet training/daytime control
2. Preschooler
a. Weight gain slows
i. 3.5 lbs/year
ii. 4 year weight avg= 35 lbs
b. Height
i. 1.5-3 inch/year
ii. 4-6 cm/year
iii. 4 year height avg= 39 inch
c. Cardiovascular
i. HR 70-100 bpm
ii. Heart quadruples in size
d. GI
i. Stomach capacity still small
ii. Best stage to instill healthy nutrition habits
e. Pulmonary--> RR (18-28)
f. Renal
i. Kidney growth
ii. 600-750 mL urine/day
iii. Toilet training day/night control
iv. Frequent accidents
c. Motor development
i. Toddler
1. Fine motor
a. Primitive reflex extinction before voluntary behaviors
b. Proximal to distal
c. Ulnar to radial
d. Pronation to supination
e. Grasp before release
f. Milestones
i. 12 months= pincer grasp
ii. 18 months
1. 4 block tower
2. Drinks from cup
3. Takes off socks
iii. 24 months
1. 7 block tower
2. Scribbles
3. Turns door knob/unbutton
4. Turns pages of book
5. Unscrews lid on jar
2. Gross motor
a. Skills built on neuromuscular tone/development
b. Reflexive to voluntary
c. More efficient behavior requires less energy to encourage development (walk instead of crawl) d. Milestones
i. 12 months
1. Walks w/ 1 hand held
2. Stands alone briefly
ii. 18 months
1. Walks alone
2. Climbs
iii. 24 months
1. Runs
2. Kicks ball
3. Stairs (2 footed)
ii. Preschooler
1. Fine motor
a. 3 year old
i. Brushes teeth (not well)
ii. Tower of 10 cubes
iii. Snips w/ scissors
b. 4 year old
i. Dresses self
ii. Cuts curves w/ scissors
iii. Copies squares/crosses
iv. Strings small beads
c. 5 year old
i. Bathes self
ii. Cuts simple shapes
iii. Pours from pitcher
iv. Grasps pencil properly/print name
2. Gross motor
a. 3 year old
i. Broad jump
ii. Balance on 1 foot
iii. Stairs/alternating feet
b. 4 year old
i. Pedals tricycle
ii. Hops on 1 foot
iii. Catches large ball
c. 5 year old
i. Walks narrow line
ii. Balance on 1 foot longer
iii. Skips alternate feet
d. Brain development
i. Lateralization
1. Corpus callosum growth
2. Connection b/w hemispheres
3. Experience can shape pace
4. Sides of brain
a. Left
i. Language
ii. Logic
iii. Analysis
iv. Math
b. Right
i. Intuition
ii. Creativity
iii. Art/music
iv. Spatial
ii. Reticular formation
1. Hippocampus
2. Concentration/memory
iii. Handedness (genetics)
e. Nutrition/health-care
i. Eating patterns
1. Food aversions
2. Appear to eat less
3. Eating habits for future
ii. Illness/accidents
1. Respiratory and GI viruses
2. Falls, cuts, poisoning, drowning
f. Health promotion/maintenance
i. Physical, psychological, sexual, neglect
ii. Education for parents/caregivers
iii. ID of families at risk
g. Cognitive changes
i. Piaget
1. Preoperational thought (18 months-6 years)
a. Symbolic thinking but lacking in logic
b. Trial and error learning (ritualism/routines important)
c. Centration: can only focus on one thing at a time
d. Egocentrism: can only see from their point of view (frustration trying to communicate) 2. Animism: belief that inanimate objects are alive
3. Irreversibility: inability to mentally reverse actions/ideas 4. Conservation: lacks ability to understand matter changes in form w/o changes in quantity 5. Theory of mind
a. Explain other's beliefs, desires and behavior
b. Develops b/w 4-5 years
c. False belief principle
d. Influences
i. Performance on piaget's tasks
ii. Pretend play
iii. Language skills/emotions
ii. Vygotsky
1. Zone of proximal development
a. Distance b/w actual and potential learning
b. Learning is a process of assisted discovery
c. Learning happens upon scaffolding and modeling
2. Learning is requisite to development--> learning/development isn't equal or parallel iii. Alternative theories
1. Metamemory
a. Knowledge about/control of memory processes
b. 2-6 year old have poor strategies for memory
2. Metacognition
a. Knowledge about/control of thought processes
b. Enables child to generate strategies to solve problems
c. 2-6 year olds lack development of metacognition
h. Language development
i. Toddler
1. Receptive language
a. 12-18 months= follows 1 step commands, enjoys stories, points to familiar body parts b. 18-24 months= follows 2 step commands, enjoys stories, recognizes pronouns 2. Expressive language
a. 12-18 months= names pictures, imitates animal sounds, uses vowels b. 18-24 months= names body parts, names self, vocab explosion begins 3. Requirements for language
a. Oral motor ability
b. Intact hearing
c. Psychosocial stimulation
d. Cognitive ability developing
4. 600 words
ii. Preschooler
1. Receptive language
a. Listens to adult conversation
b. Understands prepositions (under, behind, in front)
c. Recognizes colors/understands numbers
2. Expressive language
a. Joins in songs/rhymes, tells simple stories
b. Asks how and why (lots of questions)
c. Knows 1st/last name and age
d. Understands cold, tired, hungry
3. 15,000 words
4. 10 new words/day
5. Grammar and vocab explosion
6. Tenses and inflections (overregulation)
iii. Fast mapping (3-->6)
1. Grouping objects in classes
2. Linking new words to real world referents
3. Hypothesizing meanings of new words w. associated class
iv. Phonological awareness
1. Learning that sounds are associated w/ letters
2. Leads to faster learning to read
3. Learned through rhymes, games and inventive spelling
5. Early childhood II
a. Social and personality development
i. Freud
1. Anal stage
a. Toilet training struggles
b. Control over bodily functions
c. May fear loss of body w/ toilet flushing
2. Phallic stage
a. Oedipus or electra complex--> desires opposite sex parent b. Task= identify w/ same sex parent
c. Developing gender identity and gender stability
i. Labels sex differences by 2-3
ii. May explore body (masturbation normal)
d. Sex types behavior develops
ii. Erikson
1. Toddler (autonomy vs. shame and doubt)--> centered around toddler's new mobility and desire for autonomy 2. Preschooler (initiative vs. guilt)
a. Ushered in by new cognitive skills
b. Developing conscience dictates boundaries
c. Understanding right and wrong/sense of guilt
iii. Kohlberg--> moral development
1. Toddler
a. Amoral at this stage
b. Follows commands
2. Preschooler
a. Pre-conventional stage of morality
b. Follows commands consistently
c. Awareness of moral emotions (guilt, shame)
d. Works to maintain approval of adults
e. Concept of “good” girl or boy
f. Night terrors
iv. Fowler--> spiritual development
1. Stage 1= intuitive- projective (toddler, preschooler)
2. Imitate religious activities, assimilate values/beliefs/moral codes from attitudes of parents b. Social interaction
i. Play= works of children
1. Social skills are learned through play
2. Solitary play/onlooker play (any age)
3. Parallel play: playing side by side w/ different toys (14-18 months) 4. Associative play (18 months- 3 years)
a. Short social interactions w/ other child
b. Imitate the other, put down toy to pursue other child's play 5. Cooperative play (3 years+)
a. Play together w/ same activity
b. May assign roles
ii. Toddler
1. Always exploring (safety issues)
2. Short attention span
3. Temper tantrums and negativism
a. No's and terrible 2s
b. Biting, kicking, hitting, frustration
4. Hard to share
5. Parallel--> associative play
6. Egocentric: respond to other's stress w/ distress of self 7. Love, warmth, comforting, play and consistency are important to development 8. Natural consequence discipline
9. Aggressive discipline leads to aggressive behavior
iii. Preschooler
1. Attention increasing
2. Negativism and temper tantrums resolving w/ beginnings of reasoning ability at 4-6 years 3. Learns to share
4. Learns cooperative and pretend play
5. Beginning empathy
6. Regression w/ illness or new development
7. Natural consequences--> discipline w/ loving, warmth and consistency iv. Communicating w/ toddlers
1. Give 2 alternative choices if possible (toothpaste)
2. Avoid choices if nonexistent
3. Simple terminology/clear and short instructions
4. Avoid telling too much about steps of procedures
5. Avoid telling too far in advance (don't understand time)
6. Perform treatment in treatment room away from “safe” room 7. Allow to cry and provide comfort
8. Use bandage to cover injured part
c. Anticipatory guidance
i. Safety: injury prevention
1. Poisoning
2. Motor vehicle accidents
3. Water/drowning
4. Falls
5. Burns
6. Abuse
7. Choking/aspiration
8. Electrocution
ii. Things to do
1. Monitor play
2. Lock/raise poisons and dangerous items
3. No dangling cords
4. Handles on stove pots to rear
5. Safety devices on outlets
6. Car seat until 4 years/40 lbs (rear of car)
7. Street and pedestrian safety
8. Teach brushing teeth
9. Screen for abuse (educate parents)
iii. Toilet training guidance
1. Readiness
a. Stands/walks well
b. Pulls pants up/down
c. Recognizes need to eliminate
d. Able to hold elimination
2. Training
a. Readiness at 2-3
b. Prefer small potty seat
c. Try at regular intervals
d. Reward/praise success
e. Wait a few weeks in uncooperative/ill
f. Avoid negativity or punishment for accidents
g. May fear flushing (loss of body parts)
iv. Immunizations
d. Developmental delay assessment
i. Developmental screening for early intervention
1. Use of tools to detect developmental problems
2. Early intervention leads to better deviated outcomes
3. Screening tools assess for normal developmental milestones in a range of normal time 4. Early language milestone test
5. Stanford binet intelligence test
6. DDST II (screening tool)
a. Personal/social
b. Fine motor-adaptive
c. Gross motor
d. Language
ii. Red flags
1. 3
a. Unintelligible speech
b. Doesn't know 2-3 prepositions
c. Unable to calm self
d. Problems w/ toilet training
e. Not able to dress self
f. Doesn't understand taking turns
g. Unable to give full name/match 2 colors
2. 4
a. Withdrawn/acting out
b. Unable to play games/follow rules
c. Cruelty to animals
d. Interest in starting fires
e. Severe shyness/persistent fears
f. Inability to separate from other
g. Limited vocabulary/unclear speech
h. Lack of self-care
i. Unable to copy square/unbutton clothes
j. Unable to balance on 1 foot
3. 5
a. Continued night terrors
b. Hair pulling (own hair)
c. Difficulty w/ friends
d. Cruelty to animals/friends/bullying
e. Prolonged fighting, hitting
f. Withdrawal, sadness, extreme rituals
g. Speech not 100% understandable
h. Unable to copy triangle/draw person w/ 1 body part
i. Difficulty hopping/jumping

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