Developmental milestones record

Developmental milestones are behaviours or physical skills seen in infants and children as they grow
and develop. Rolling over, crawling, walking, and talking are all considered milestones. The milestones are
different for each age range.

There is a normal range in which a child may reach each milestone. For example, walking may begin
as early as 8 months in some children. Others walk as late as 18 months and it is still considered normal.

One of the reasons for well-child visits to the health care provider in the early years is to follow your
child's development. Most parents also watch for different milestones. Talk to your child's provider if you have
concerns about your child's development.

SOURCE: (https://medlineplus.gov/ency/article/002002.htm)

Closely watching a "checklist" or calendar of developmental milestones may trouble parents if their
child is not developing normally. At the same time, milestones can help to identify a child who needs a more
detailed check-up. Research has shown that the sooner the developmental services are started, the better the
outcome. Examples of developmental services include: speech therapy, physical therapy, and developmental
preschool.

Below is a general list of some of the things you might see children doing at different ages. These are
NOT precise guidelines. There are many different normal paces and patterns of development.

As your child continues to grow, you will notice new and exciting abilities that your child develops. While
children may progress at different rates and have diverse interests, the following are some of the common
milestones children may reach in this age group:

6- to 7-year-olds:

 Enjoys many activities and stays busy

 Likes to paint and draw
 May lose first tooth
 Vision is as sharp as an adult's vision
 Practices skills in order to become better
 Jumps rope
 Rides a bike

8- to 9-year-olds:

 More graceful with movements and abilities

 Jumps, skips, and chases
 Dresses and grooms self completely
 Can use tools (i.e., hammer, screwdriver)

10- to 12-year-olds:

 Remainder of adult teeth will develop

 Likes to sew and paint

What does my child understand?

 As children enter into school-age, their abilities and understanding of concepts and the world around
them continue to grow. While children may progress at different rates, the following are some of the common
milestones children may reach in this age group:

6- to 7-year-olds:

 Understands concept of numbers

 Knows daytime and night time
 Knows right and left hands
 Can copy complex shapes, such as a diamond
 Can tell time
 Can understand commands with three separate instructions
 Can explain objects and their use
 Can repeat three numbers backwards
 Can read age-appropriate books and/or materials

8- to 9-year-olds:

 Can count backwards

 Knows the date
 Reads more and enjoys reading
 Understands fractions
 Understands concept of space
 Draws and paints
 Can name months and days of week, in order
 Enjoys collecting objects

10- to 12-year-olds:

 Writes stories
 Likes to write letters
 Reads well
 Enjoys using the telephone

How does my child interact with others?

A very important part of growing up is the ability to interact and socialize with others. During the school-
age years, parents will see a transition in their child as he or she moves from playing alone to having multiple
friends and social groups. While friendships become more important, the child is still fond of his or her parents
and likes being part of a family. While every child is unique and will develop different personalities, the
following are some of the common behavioural traits that may be present in your child:

6- to 7-year-olds:

 Cooperates and shares

 Jealous of others and siblings
 Likes to copy adults
 Likes to play alone, but friends are becoming important
 Plays with friends of the same gender
 May have occasional temper tantrums
 Modest about body
  Likes to play board games

8- to 9-year-olds:

 Likes competition and games

 Starts to mix friends and play with children of the opposite gender
 Modest about body
 Enjoys clubs and groups, such as Boy Scouts or Girl Scouts
 Becoming interested in boy-girl relationships, but does not admit it

10- to 12-year-olds:

 Friends are very important; may have a best friend

 Increased interest in the opposite gender
 Likes and respects parents
 Enjoys talking to others

How to help increase your school-aged child's social ability

Consider the following as ways to foster your school-aged child's social abilities:

Set and provide appropriate limits, guidelines, and expectations and consistently enforce using
appropriate consequences.

 Model appropriate behaviour.

 Offer compliments for your child being cooperative and for any personal achievements.
 Help your child choose activities that are appropriate for your child's abilities.
 Encourage your child to talk with you and be open with his or her feelings.
 Encourage your child to read and read with your child.
 Encourage your child to get involved with hobbies and other activities.
 Encourage physical activity.
 Encourage self-discipline; expect your child to follow rules that are set.
 Teach your child to respect and listen to authority figures.
 Encourage your child to talk about peer pressure and help set guidelines to deal with peer pressure.
 Spend uninterrupted time together—giving full attention to your child.
 Limit television, video, and computer time.

SOURCE: (https://www.stanfordchildrens.org/en/topic/default?id=the-growing-child-school-age-6-to-12-years-
90-P02278)

Developmental Milestones

Middle childhood brings many changes in a child’s life. By this time, children can dress themselves,
catch a ball more easily using only their hands, and tie their shoes. Having independence from family becomes
more important now. Events such as starting school bring children this age into regular contact with the larger
world. Friendships become more and more important. Physical, social, and mental skills develop quickly at this
time. This is a critical time for children to develop confidence in all areas of life, such as through friends,
schoolwork, and sports.

 Here is some information on how children develop during middle childhood:

 Emotional/Social Changes
 Children in this age group might:
  Show more independence from parents and family.
 Start to think about the future.
 Understand more about his or her place in the world.
 Pay more attention to friendships and teamwork.
 Want to be liked and accepted by friends.
 Thinking and Learning
 Children in this age group might:
 Show rapid development of mental skills.
 Learn better ways to describe experiences and talk about thoughts and feelings.
 Have less focus on one’s self and more concern for others.
 Positive Parenting Tips
 Following are some things you, as a parent, can do to help your child during this time:
 Show affection for your child. Recognize her accomplishments.
 Help your child develop a sense of responsibility—ask him to help with household tasks, such as
setting the table.
 Talk with your child about school, friends, and things she looks forward to in the future.
 Talk with your child about respecting others. Encourage him to help people in need.
 Help your child set her own achievable goals—she’ll learn to take pride in herself and rely less on
approval or reward from others.
 Help your child learn patience by letting others go first or by finishing a task before going out to play.
Encourage him to think about possible consequences before acting.
 Make clear rules and stick to them, such as how long your child can watch TV or when she has to go to
bed. Be clear about what behaviour is okay and what is not okay.
 Do fun things together as a family, such as playing games, reading, and going to events in your
community.
 Get involved with your child’s school. Meet the teachers and staff and get to understand their learning
goals and how you and the school can work together to help your child do well.
 Continue reading to your child. As your child learns to read, take turns reading to each other.
 Use discipline to guide and protect your child, rather than punishment to make him feel bad about
himself. Follow up any discussion about what not to do with a discussion of what to do instead.
 Praise your child for good behaviour. It’s best to focus praise more on what your child does (“you
worked hard to figure this out”) than on traits she can’t change (“you are smart”).
 Support your child in taking on new challenges. Encourage her to solve problems, such as a
disagreement with another child, on her own.
 Encourage your child to join school and community groups, such as a team sports, or to take
advantage of volunteer opportunities.

Positive Parenting Tip Sheet

Middle Childhood (6-8 years of age) Cdc-pdf [PDF – 762K]

Child Safety First

More physical ability and more independence can put children at risk for injuries from falls and other
accidents. Motor vehicle crashes are the most common cause of death from unintentional injury among
children this age.

 Protect your child properly in the car. For detailed information, visit the American Academy of
Paediatrics’ Car Seats: Information for Families External.
 Teach your child to watch out for traffic and how to be safe when walking to school, riding a bike, and
playing outside.
  Make sure your child understands water safety, and always supervise her when she’s swimming or
playing near water.
 Supervise your child when he’s engaged in risky activities, such as climbing.
 Talk with your child about how to ask for help when she needs it.
 Keep potentially harmful household products, tools, equipment, and firearms out of your child’s reach.
 Healthy Bodies
 Parents can help make schools healthier. Work with your child’s school to limit access to foods and
drinks with added sugar, solid fat, and salt that can be purchased outside the school lunch program.
 Make sure your child has 1 hour or more of physical activity each day.
 Limit screen time for your child to no more than 1 to 2 hours per day of quality programming, at home,
school, or afterschool care.
 Practice healthy eating habits and physical activity early. Encourage active play, and be a role model by
eating healthy at family mealtimes and having an active lifestyle.
 Make sure your child gets the recommended amount of sleep each night: For school-age children 6-12
years, 9–12 hours per 24 hours (including naps)

SOURCE: (https://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/middle.html)

PHYSICAL DEVELOPMENT

School-age children most often have smooth and strong motor skills. However, their coordination
(especially eye-hand), endurance, balance, and physical abilities vary.

Fine motor skills may also vary widely. These skills can affect a child's ability to write neatly, dress
appropriately, and perform certain chores, such as making beds or doing dishes.

There will be big differences in height, weight, and build among children of this age range. It is
important to remember that genetic background, as well as nutrition and exercise, may affect a child's growth.

A sense of body image begins developing around age 6. Sedentary habits in school-age children are
linked to a risk for obesity and heart disease in adults. Children in this age group should get 1 hour of physical
activity per day.

There can also be a big difference in the age at which children begin to develop secondary sexual
characteristics. For girls, secondary sex characteristics include:

Breast development
Underarm and pubic hair growth

For boys, they include:

Growth of underarm, chest, and pubic hair

Growth of testicles and penis

SOURCE: (https://www.mountsinai.org/health-library/special-topic/school-age-children-development)

FEARS
Older kids fear real-life dangers. When kids are 7 or older, monsters under the bed can't scare them (much)
because they know they're not real. At this age, some kids begin to fear things that could happen in real life.
They may have a fear that a "bad guy" is in the house. They may feel afraid about natural disasters they hear
about. They may fear getting hurt or that a loved one could die. Schoolage kids may also feel anxious about
schoolwork, grades, or fitting in with friends.
Preteens and teens may have social fears. They might feel anxious about how they look or whether they will
fit in. They may feel anxious or afraid before they give a report in class, start a new school, take a big exam, or
play in a big game.

SOURCE: (https://kidshealth.org/en/parents/anxiety.html)

Understanding Childhood Fears and Anxieties

My child seems to be afraid of a lot of things. Should I be worried?

From time to time, every child experiences fear. As youngsters explore the world around them, having
new experiences and confronting new challenges, anxieties are almost an unavoidable part of growing up.

Fears are Common:

According to one study, 43% of children between ages 6 and 12 had many fears and concerns. A fear
of darkness, particularly being left alone in the dark, is one of the most common fears in this age group. So is a
fear of animals, such as large barking dogs. Some children are afraid of fires, high places or thunderstorms.
Others, conscious of news reports on TV and in the newspapers, are concerned about burglars, kidnappers or
nuclear war. If there has been a recent serious illness or death in the family, they may become anxious about
the health of those around them.

In middle childhood, fears wax and wane. Most are mild, but even when they intensify, they generally
subside on their own after a while.

About Phobias:

Sometimes fears can become so extreme, persistent and focused that they develop into phobias.
Phobias – which are strong and irrational fears – can become persistent and debilitating, significantly
influencing and interfering with a child's usual daily activities. For instance, a 6-year-old's phobia about dogs
might make him so panicky that he refuses to go outdoors at all because there could be a dog there. A 10-
year-old child might become so terrified about news reports of a serial killer that he insists on sleeping with his
parents at night.

Some children in this age group develop phobias about the people they meet in their everyday lives.
This severe shyness can keep them from making friends at school and relating to most adults, especially
strangers. They might consciously avoid social situations like birthday parties or Scout meetings, and they
often find it difficult to converse comfortably with anyone except their immediate family.

Separation anxiety is also common in this age group. Sometimes this fear can intensify when the family
moves to a new neighborhood or children are placed in a childcare setting where they feel uncomfortable.
These youngsters might become afraid of going to summer camp or even attending school. Their phobias can
cause physical symptoms like headaches or stomach pains and eventually lead the children to withdraw into
their own world, becoming clinically depressed.
 At about age 6 or 7, as children develop an understanding about death, another fear can arise. With the
recognition that death will eventually affect everyone, and that it is permanent and irreversible, the normal
worry about the possible death of family members – or even their own death – can intensify. In some cases,
this preoccupation with death can become disabling.

Treating Fears & Phobias:

Fortunately, most phobias are quite treatable. In general, they are not a sign of serious mental illness
requiring many months or years of therapy. However, if your child's anxieties persist and interfere with her
enjoyment of day-to-day life, she might benefit from some professional help from a psychiatrist or psychologist
who specializes in treating phobias.

As part of the treatment plan for phobias, many therapists suggest exposing your child to the source of
her anxiety in small, nonthreatening doses. Under a therapist's guidance a child who is afraid of dogs might
begin by talking about this fear and by looking at photographs or a videotape of dogs. Next, she might observe
a live dog from behind the safety of a window. Then, with a parent or a therapist at her side, she might spend a
few minutes in the same room with a friendly, gentle puppy. Eventually she will find himself able to pet the dog,
then expose herself to situations with larger, unfamiliar dogs.

This gradual process is called desensitization, meaning that your child will become a little less sensitive
to the source of her fear each time she confronts it. Ultimately, the child will no longer feel the need to avoid
the situation that has been the basis of her phobia. While this process sounds like common sense and easy to
carry out, it should be done only under the supervision of a professional.

Sometimes psychotherapy can also help children become more self-assured and less fearful. Breathing
and relaxation exercises can assist youngsters in stressful circumstances too.

Occasionally, your doctor may recommend medications as a component of the treatment program,
although never as the sole therapeutic tool. These drugs may include antidepressants, which are designed to
ease the anxiety and panic that often underlie these problems.

What Parents Can Do:

Here are some suggestions that many parents find useful for their children with fears and phobias.

Talk with your child about his anxieties, and be sympathetic. Explain to him that many children have
fears, but with your support he can learn to put them behind him.

Do not belittle or ridicule your child's fears, particularly in front of his peers.

Do not try to coerce your youngster into being brave. It will take time for him to confront and gradually
overcome his anxieties. You can, however, encourage (but not force) him to progressively come face-to-face
with whatever he fears.

Since fears are a normal part of life and often are a response to a real or at least perceived threat in the
child's environment, parents should be reassuring and supportive. Talking with their children, parents should
acknowledge, though not increase or reinforce, their children's concerns. Point out what is already being done
to protect the child, and involve the child in identifying additional steps that could be taken. Such simple,
sensitive and straightforward parenting can resolve or at least manage most childhood fears. When realistic
reassurances are not successful, the child's fear may be a phobia.

SOURCE: (https://www.healthychildren.org/English/health-issues/conditions/emotional-
problems/Pages/Understanding-Childhood-Fears-and-Anxieties.aspx)
5-6 years.

• Being separated from you.

Here’s why: At this age, children might show a strong reaction to being separated from one or either or
their parents. This comes as they start to see outside of themselves and realise that bad things can happen to
the people they love. They might want to avoid school or sleepovers so they can be with you and know that
you’re safe and sound.

• Ghosts, monsters and witches – and anything else that bumps around in their wonderfully vivid
imaginations. This can also show itself as a fear of the dark – because we all know the spooky things
love it there.

Here’s why: Their imaginations are still hard at work so anything they can bring to life in there will be
fuel for fear.

• The dark, noises, being on their own at night, getting lost, getting sick.

Here’s why: As well as being scared of things that take up precious real estate in their heads, they
might also become scared of things could actually happen. These are the sorts of things that might unsettle all
of us from time to time.

• Nightmares and bad dreams.

Here’s why: Because of the blurred line between fantasy and reality, bad dreams can feel very real
and are likely to peak at this age.

• Fire, wind, thunder, lightning – anything that seems to come from nowhere.

Here’s why: They are still trying to grasp cause and effect and their minds are curious and
powerful. They might scare themselves trying to explain where scary things come from. Lightning might mean
the sky is about to catch fire.

Thunder – who knows – but anything that loud surely doesn’t come in ‘cute’ or ‘chocolate coated’.

7-11 years.

• Monsters, witches, ghosts, shadows on the wall at night.

Here’s why: Though their thinking is more concrete, children at this age will still have a very vivid
imagination.

• Being at home alone.

Here’s why: They’re still learning to trust the world and their capacity to cope with small periods of time
on their own, without you. Staying at home alone might be exciting, scary or both – then there’s that
imagination of theirs that might still ambush them at times.

• Something happening to themselves or the people (or pets) they care about.

Here’s why: They start to understand that death affects everyone at some point and that it’s
permanent. They might start to worry about something happening to themselves or the people (or pets) they
care about.
• Being rejected, not liked, or judged badly by their peers (buckle up – this one might stay a while).

Here’s why: This can show up at any age but it might ramp up or towards the end of these years. This is
because they will start to have an increased dependence on their friendships as they gear up for adolescence.

SOURCE: (https://www.heysigmund.com/age-by-age-guide-to-fears/)

THE SCHOOL AGE CHILD KATHRYN KUSHTO-REESE, MS.RN.

2. Growth and Development • Spans age 6-12 years • Begins with shedding of first deciduous tooth ends with puberty
and final permanent teeth. • Height and weight, slower but steady pace • Caloric needs decrease • Organ growth slows

3. GROWTH AND DEVELOPMENT• Body systems mature• Average school age child grows• 5 cm or 2”/year and 2-3 kg or
4-6 lbs/year• Prepubescence occurs 2 years• before Puberty• Puberty (avg age)• Girls 12, Boys 14

4. Nutrition• Caloric needs diminish• Need well balanced diet• Food preferences set• Pattern based largely upon
family’s• “Junk food” / Peer influenceTEACHING/PREVENTION• Nutrition education/ School Nurse• Oral health (
dentition, cavities) http://www.youtube.com/watch?v=08HVcfx Rg-k&feature=related

5. OBESITY RISK FACTORS1. Genetic factors/predisposition2. Dietary intake3. Physical activity4. Family Patterns/habits5.
Sedentary life style

6. Obesity Trends* Among U.S. Adults BRFSS, 1990, 1999, 2008 (*BMI 30, or about 30 lbs. overweight for 5’4” person)
1990 1999 2008No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

7. Prevalence of Obesity* Among U.S. Children and Adolescents (Aged 2 –19 Years) National Health and Nutrition
Examination Surveys*Sex-and age-specific BMI > 95th percentile based on the CDC growth charts.

8. View and reflecthttp://www.youtube.com/watch?v=6nM6NDe3hQM&feature=related What do you think?

9. CostIn 2000, obesity-related health care costs totaled anestimated $117 billion.From 1979-1981 to 1997-1999, annual
hospital costs relatedto obesity in children and adolescents increased, from $35million to $127 million.

10. OBESITY PREVENTION1. Diet Nutrition/School based programs limit sugared/sweetened drinks eliminate foods of
low nutritional value2. Change old habits: food as a reward, children forced to eat all of meal3. Water freely available4.
Increase physical activity: limit, screen time, required # minutes spent in physical activity5. Policy and environmental
changes

11. Implications for Nursinghttp://www.youtube.com/watch?v=BXvDI3Lh9xQ&feature=fvw

12. Major TheoristsDevelopmental Tasks/Milestones for this period ● Erickson (Psychosocial development) ● Piaget (
Cognitive development) ● Kohlberg ( Moral development)

13. Erikson – Industry vs. Inferiority• Goal is to achieve a sense of competence• Intrinsic motivation increases with
competence in mastering new skills• Children with mental/physical limitations at risk

14. Piaget – Concrete Operations• 7-11 years progress from what they see(perceptual thinking) to what they
reason(conceptual thinking)• Decrease in egocentricity• Reversibility• Conservation of matter• Classification of objects

15. Kohlberg –Moral development• Young children 6-7: rewards and punishment guide their actions • Older school age
children 9 + Rules of conduct are seen more as mutual agreements based upon cooperation and mutual respect for
others• Spiritual Development become important
16. Gross motor skills/ Fine Motor SkillsGross Motor: Fine MotorBike riding WritingJumping rope MusicalSwimming
InstrumentsBall game skills Constructing models 17

17. Language• Diction is adult, clear.• Opposites.• Word definitions.• Building vocabulary.• Can learn grammar, parts of
speech, rules and exceptions to rules 18

18. Social Development • Explore environment beyond family • Parent’s influence still primary • Peer approval • Same
sex friendships • Question parent’s values • Formalized groups or “Clubs” • Bullying, Gang Violence ● Follow rules, judge
those who do not

19. Play/Peers• Cooperative Play/ Team Play• Sports, Debate Team, Spelling Bee• Importance of group goals• Dividing
tasks• Nature of Competition• Stimulation of cognitive growth• Complex board games, computer games and reading for
pleasure

20. Play and Peers

21. Self Concept/Body Image • Self esteem often based upon grades, teacher comments, peer approval etc.. • Small
successes- increase child’s self- image. • Sexuality- Ideal time for formal sex education

22. School Age Child’sConcept of Illness • Perceive illness as having an external cause • May view pain and illness as
punishment for wrong doing • Fear bodily harm, pain, and death

23. Reaction To Hospitalization • Fear loss of control, abandonment, injury and death. • Fear procedures, pain, and
outcomes, as opposed to the preschooler’s fear of equipment and surroundings.

24. Pre-admission Preparation • School Age- ideal age for advanced preparation • Tours • Classes • Booklets •
Discussion with honest answers

25. Interventions To Promote Coping• Encourage questions /discussion• Use diagrams, models, and equipment to
supplement explanations• Encourage participation in care• Encourage parent involvement/stay

26. Interventions To Promote Coping• Use books, games, role play to work through feelings and to prepare child for
procedures.• Promote contact with family, friends school

27. HOSPITALIZED CHILD

28. Pain Assessment• Subjective “self report” is best1. Assess using Pain scale Faces 0-52. Visual analog Pain Scale 0-10•
Behavioral scales and observations important for child with cognitive impairment

. Faces Scale

Visual Analog Pain Scale

Pain ManagementPCA ( patient controlled analgesia) pump Basal/Bolus rates• Oral pain meds Opioids/NSAID’s•
Comfort/Diversional measures ( computer, video games, game boy) etc….

Special Problems• Limit Setting – Discipline • Withholding privileges • Contracting • Problem solving with child•
Dishonest Behavior • Lying • Stealing • Cheating

Special Problems• Stress – Over programming • “ Hurried Child” ( Elkind) • “ Latch Key” Children• Fears/Worries –
school/peers/family • Violence • Failing feeling “stupid” • Not being accepted by peers • Changes in family structure •
Too many adult responsibilities • http://www.guardian.co.uk/society/video/2009/feb/18/worried -smoking-children
 Anticipatory Guidance • Injury Prevention/Safety • Health Care Visits • Stress Reduction • Nutrition • Rest
/Activity/Exercise • Communicable Diseases • Substance Abuse Education • Developmental changes