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From birth to twelve


From birth to twelve Development in a nutshell Primary prevention principles CACH works from a primary health care framework Accessibility Appropriate technology ... – PowerPoint PPT presentation

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Title: From birth to twelve

From birth to twelve
  • Development in a nutshell

Primary prevention principles
  • CACH works from a primary health care framework
  • Accessibility
  • Appropriate technology
  • Emphasis on health promotion
  • Inter sectoral collaboration
  • Community participation

Prevention levels
  • CACH works predominantly in the area of primary
  • Primary health promoting strategies aimed at
    protection of health and wellbeing and prevention
    of illness (upstream)
  • Secondary strategies taken to recover from
    illness or to prevent further deterioration in
    health (mid stream)
  • Tertiary strategies to help cope with illness,
    disease or disability (down stream)

What are social determinants of health
  • Social determinants of health are the economic
    and social conditions under which people live
    which determine their health.
  • Virtually all major diseases are primarily
    determined by a network of interacting exposures
    that increase or decrease the risk for the

Social determinants of health
  • Social support
  • Addiction
  • Food
  • Transport
  • Unemployment
  • Work
  • Social gradient between groups and within groups
  • Stress
  • Early life
  • Social exclusion

Life course determinants of health
  • Multiple determinants of health have different
    magnitudes of effect at different stages of life
  • Health and disease status is the result of
    cumulative effects of risk factors and
    determinants across the life course and in
    certain circumstances
  • Early experiences effects later health status and
    decline in health status.

Importance of early years brain development
  • Early brain development is one of the most
    important pathways to lifelong learning,
    behavioural competence, positive social
    relationships and health

Developmental concepts
By the 17th week of pregnancy the foetus has 1
billion brain cells proliferating at
50,000/second. The setting down of neuron
connections continues rapidly and by 8 months of
age there are approximately 1,000 trillion
synapses. Pruning of unused connections continues
for most of childhood though the brain retains
flexibility for future learning. The brain works
on a use it or lose it principal
Developmental concepts
Early brain development influences how we are
wired up for life. The influence of stress,
through the release of cortisol on the developing
brain, impacts on childrens self regulation and
effort control. Securely attached infants
produce less cortisol in response to stress than
children who are not having their
emotional needs met.
Science of brain development
  • Brain is immature at birth
  • Brain is changed by experiences
  • Brains of infants, toddlers and preschoolers
    develop best in a nurturing environment
  • Adversity impacts brain development

Strategies to improve school readiness
trajectories (Halfon and McLearn, 2002)
Human Brain Development Language and Cognition
(vision, hearing)
Cognitive Function
C. Nelson, in From Neurons to Neighborhoods, 2000.
How the brain reacts to lack of stimulation
Developmental concepts
  • Early brain development influences how we are
    wired up for life.
  • Infants are not blank slates and passive
  • Parents are their childs first and most
    influential teachers.

Cycle of early life experiences
Developmentally not ready for school
Poor health
Poor educational behavioural attainment at
Low-status, low-control jobs
Increased risk of unemployment social
Growth and development
  • Put simply
  • Growth is an increase in size
  • Development is an increase in
  • complexity

  • What affects growth development
  • Genetics
  • Intrauterine environment
  • Extrauterine environment
  • Basics of life available
  • Stimulation, opportunity and encouragement
  • Health impact of life course and social
    determinants of health.

Capabilities of the newborn- one smart little
  • Visual can focus best at cradling distance,
    likes bright objects, programmed to faces
  • Hearing knows parents voice from utero, stills
    or startles to sound
  • Taste can determine salt and sweet, prefers
    breast over water any day
  • Smells can identify mums breast milk within
  • Touch is comforted by touch, able to feel and
    react to pain.
  • Communicates through cry, has only needs not

Developmental concepts
  • We all develop in the same sequence but the rate
    may vary.
  • Development progresses in a direction of cephlo
    caudal and proximo distal
  • What that means is from top of head down and
    from the middle of the body out.
  • We master simple things first before progressing
    to more complex

Developmental tasksEarly childhood
  • Learning
  • to walk
  • take solid food
  • to talk
  • to control elimination of body waste
  • Achieving physiological stability
  • Slee,P.T Child, Adolescent and Family
    Development(2nd ed)
  • Forming simple concepts regarding social and
    physical reality
  • Learning
  • about sex differences and sexual modesty
  • to relate emotionally to parents, siblings and
  • to distinguish right and wrong and developing a

The challenges0-5 years
  • Attachment bonding
  • Object permanence
  • Stranger anxiety
  • Safety
  • Play
  • Referral who is out there ????

Theoristsbut dont panic
  • Freud - Psychosexual theorist
  • (you know the one who talks about the mouth,
    anus and penis amongst other things)
  • The oral stage 0-1.5 years
  • energy focused on the mouth, gains pleasure from
    mouth and attention is focused on the person
    gratification / help.
  • The anal stage 1.5 -3.5 years
  • energy focused on the anal area, gains pleasure
    from elimination or retention of faeces

Theoristsbut dont panic
  • Freud
  • The phallic stage 3.5 5.5 years
  • energy focused on the genitals, issues become
    orientation to male and female identification
  • The latency stage 5.5 -12 years
  • energy / impulses are relatively dormant,
    focused on learning, mastering skills and
    acquiring new interests.
  • And then comes ADOLESCENCE!

Theoristsbut dont panic
  • Erikson - Psycho social theorist
  • Viewed development as stages where we have to
    meet a crisis/ challenge before moving onto the
    next stage.
  • Infancy Basic trust versus mistrust
  • Through experiencing the world and consistency
    and continuity of care the infant develops a
    sense of trust, providing the foundation for a
    sense of identity
  • 1.5 3.5 years Autonomy versus shame and doubt
  • Through experiencing independence they develop a
    sense of autonomy, if restricted they may feel
    shame or doubt

Theoristsbut dont panic
  • Erikson - Psycho social theorist.
  • 3.5 5.5 years Initiative versus guilt
  • Through increasing independence and physical
    competency they have the opportunity to be
    themselves and develop a concept of who they are,
    if they dont make the separation guilt can arise
  • 5.5 12 years Industry versus inferiority
  • The child aims for productivity and mastery but
    feels inferior if this is not achieved.
  • But over the horizon is adolesence with all its

Theoristsbut dont panic
  • Piaget Cognitive development theorist
  • Piaget identified that children think and
    understand the world differently from adults. He
    was a stage theorist where each level of
    knowledge incorporates and builds onto existing
    patterns of thought and behaviour. Over time
    children modify the way they think to deal with
    new information

Theoristsbut dont panic
  • Piaget Cognitive development theorist
  • The Sensori motor period 0-2 years
  • Infants use their sensory systems and motor
    activity to help acquire knowledge about the
  • This stage has 6 substages covering the period
    from primary reflexes through to representational
  • The Pre operational period 2 -7 years
  • The child develops symbolism, an understanding
    that enables one object or action to represent
    another, the development of language assist them
    to make further sense of their world and interact
    with others.

Theoristsbut dont panic
  • Piaget Cognitive development theorist
  • The Concrete operational period 7 - 11 years
  • The child can apply simple logic to solve
    problems, they begin to understand the
    relationship between things but still cannot
    think in abstract terms
  • The Formal operational period 11 years
  • The child develops abstract reasoning and are
    able to think beyond the present and can
    appreciate possible relations among sets of

Social Behaviour and play
Key stages in social development 0-5 years
  • 0-6 weeks
  • Preference for attending to people
  • Recognition of Mothers voice
  • Intent regard of faces
  • 6-8 weeks
  • Smiling emerges
  • Imitation of facial expressions

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Key stages in social development
  • 3 months
  • Smiling and other facial expressions synchronised
    with those of caregivers
  • 5 months
  • Growing interest in objects
  • Some refusal to look at parents
  • 9 months
  • Using referential gaze to direct parents
    attention to objects

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Key stages in social development
  • 10 months
  • Wary of strangers
  • 1-2 years
  • Reactions to novel situations largely dependent
    on that of caregivers ( social referencing)
  • Development of teasing anticipating parents
    reaction to forbidden actions
  • Protest and tantrums limit testing

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Key stages in social development
  • 2 -3 years
  • Understanding of responsibility leading to
    denial of transgressions
  • Asking what , where questions
  • Captivated by stories focus shifts from actions
    of characters to feelings.
  • 3-4 years
  • Breadth of interest in social world
  • Asking why questions
  • Talk about inner states and rules what is good,
    bad, naughty, allowed etc
  • Able to adopt emotional states within pretend

Key stages in social development
  • 4 -5 years
  • Growing understanding of rules
  • Increasing understanding of the links between
    peoples mental state and actions theory of

Stages in development of friendships
  • 18 months
  • Child shows awareness of another childs distress
  • 20 months
  • Mutual imitation
  • Beginning to cooperate with a sibling / peer in
    order to achieve a goal
  • 2 years
  • Development of preferences for particular
  • Cooperating within a shared play theme eg tea

Stages in development of friendships
  • 2 ½ years
  • Able to adopt complementary roles within play
    scenarios eg mother baby, doctor patient
  • Awareness of what is pretence eg pretending to be
    in pain, a hungry baby
  • 3 years
  • Using references to friendship to include and
    exclude eg Im not your friend today
  • Tendency to label any play companion as a friend
    so can appear fickle
  • Development of fighting friends ie reciprocal
    relationships that include both harmonious play
    and conflict
  • Some children develop imaginary friends

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Stages in development of friendships
  • 4 years
  • Children are clear about who their friends are
    and will differentiate between friends and other
  • Development of sophisticated sharing of a pretend
    world. Play includes sustained adventures, often
    including favourite characters from books or
    films, or everyday events.
  • Fantasy play with strong emotional components
    such as fear, abandonment, bravery
  • Alternative types of reciprocal play include
    sharing physical activities ( chasing, playing
    football, skipping) or shared mischief

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Stages in development of friendships
  • 5 years
  • Increasing understanding of the needs, feelings
    and wishes of friends
  • Bargaining, compromise and reconciliation
  • Able to talk about what makes someone a friend

Middle Childhood
  • Middle childhood is often called a quiet
    period developmentally but theres is still a
    lot happening

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The challenges5-12 years
  • Friendships and growing independence
  • Transition to school
  • Literacy acquisition
  • Safety
  • Obesity epidemic
  • Referral who is out there ????

Developmental tasksMiddle childhood
  • Learning
  • Physical skills necessary for ordinary games
  • To get along with age -mates
  • An appropriate masculine or feminine role
  • Building wholesome attitudes towards themselves
    as they grow
  • Achieving personal independence
  • Developing
  • Fundamental skills in reading, writing and
  • Concepts needed for everyday living
  • A conscience, morality and a scale of values
  • Attitudes towards social groups and institutions
  • Slee,P.T Child, Adolescent and Family
    development(2nd ed)

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7-8 year olds
  • Large muscles in arms and legs are more developed
    than small muscles. Children can bounce a ball
    and run, but it is difficult to do both at the
    same time.
  • There may be quite a difference in the size and
    abilities of children. This will affect the way
    they get along with others, how they feel about
    themselves, and what they do. Seven to
    nine-year-old children are learning to use their
    small muscle skills (printing with a pencil) and
    their large muscle skills (catching a fly ball).
  • Even though children are tired, they may not want
    to rest. You will need to plan time for them to

7-8 year olds
  • Children want to do things by and for themselves,
    yet they need adults who will help when asked or
    when needed.
  • Seven to nine-year-old children of the same age
    and sex help each other
  • have fun and excitement by playing together,
  • learn by watching and talking to each other,
  • in time of trouble by banning together,
  • by giving support in time of stress, and
  • understand how they feel about themselves.

7-8 year olds
  • Children need guidance, rules, and limits.
  • They need help in solving problems.
  • They are beginning to see things from another
    child's point of view, but they still have
    trouble understanding the feelings and needs of
    other people.
  • Many children need help to express their feelings
    in appropriate ways when they are upset or
  • They need more love, attention, and approval from
    parents and you than criticism.

7-8 year olds
  • With an increased ability to remember and pay
    attention, their ability to speak and express
    ideas can grow rapidly.
  • Things tend to be black or white, right or wrong,
    great or disgusting, fun or boring to them. There
    is very little middle ground.
  • They are learning to plan ahead and evaluate what
    they do.

7-8 year olds
  • With increased ability to think and reason, they
    enjoy different types of activities, such as
    clubs, games with rules, and collecting things.
  • When you suggest something, they may say, "That's
    dumb," or, "I don't want to do it.
  • They are still very self-centered although they
    are beginning to think of others.
  • They often say, "That's not fair!" Often, they do
    not accept rules that they did not help make.

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9-11 years olds
  • begins to see parents and authority figures as
    fallible human beings
  • rituals, rules, secret codes, and made-up
    languages are common
  • enjoys being a member of a club
  • increased interest in competitive sports
  • outbursts of anger are less frequent
  • may belittle or defy adult authority

9-11 years olds
  • girls are generally as much as 2 years ahead of
    boys in physical maturity
  • girls may begin to menstruate
  • increases body strength and hand dexterity
  • improves coordination and reaction time

9-11 years olds
  • interested in reading fictional stories,
    magazines, and how-to project books
  • may develop special interest in collections or
  • may be very interested in discussing a future
  • fantasizes and daydreams about the future
  • capable of understanding concepts without having
    direct hands-on experience

Moral development
Piaget Moral development
  • Stage 1
  • Hetronomous morality, moral reasoning or
    morality of constraints up to 7-8 year olds
  • Rules, obligations and commands are external and
    sacred as laid down by adults.
  • A key concept in the childs moral reasoning is
    immanent justice, punishment for the wrong
    doing is inevitable and retributive, any
    behaviour that shows obedience to adults and
    their rules is good and any non conforming act is

Piaget Moral development
  • Stage 2
  • Development of the justice concept from 7-8
    year olds
  • Rules are recognised as essential for regulating
    play and games, learning about the give and take
    of relationships and of the nature of equality.
  • Punishment must be equivalent to the misdeed, if
    a child hits another the victim can hit back just
    as hard.

Piaget Moral development
  • Stage 3
  • Autonomous morality or moral relativism from
    12 -13 year olds
  • Child gives heavy consideration to motives,
    intentions and individual circumstances when
    making moral judgements.

Kohlbergs Moral development theory
  • Level 1 - Pre conventional level
  • egocentric orientation
  • Stage 1 Punishment and obedience orientation
  • Justice is determined by power, status and
    possession and the physical consequences
    determine its right or wrongness. Child will work
    to avoid punishment and defer to power
  • Stage 2 Instrumental relativist orientation
  • Justice is determined by what you can do for me,
    focus is on meeting own needs.

Kohlbergs Moral development theory
  • Level 2 Conventional level social orientation
  • Childs orientation is in terms of loyalty to
    family or peer group, encompassing conformity to
  • Stage 3 interpersonal concordance
  • Justice relates to what an individual family or
    peer group will think and conforming to
  • Stage 4 law and order orientation
  • A law and order or social group norms guides a
    sense of justice, emphasis on maintaining social

Kohlbergs Moral development theory
  • Level 3 - post conventional principles
  • Stage 5 social contract orientation
  • Stage 6 universal ethical principled orientation

  • Work through the following questions and see what
    you know about childrens development in the
    first five years

Gross motor skills
Developmental tasksEarly childhood
  • What age should a baby
  • Hold their head unsupported
  • Find their hands
  • Lift their chest off the floor when on tummy
  • Roll from front to back
  • Find their genitalia and discover.
  • Sit unsupported

Developmental tasks Early childhood
  • What age should a baby
  • Rock on hands and knees
  • Crawl
  • Pull up on furniture
  • Cruise around holding onto something
  • Stand briefly unsupported
  • Take first steps

Developmental tasks Early childhood
  • What age should a toddler/ preschooler
  • Pull along an object while walking
  • Get off chair without turning
  • Climb stairs two feet to step
  • Run carefully
  • Kick a ball by walking into it
  • Ride a tricycle using pedals
  • Jump from bottom step ( both feet together)
  • Climb stairs alternate feet
  • Throw a ball overhand, catch large ball with arms
    out, kick it hard

Developmental tasks Early childhood
  • What age should a preschooler
  • Run turning corners skilfully
  • Climbs everything
  • Run on tiptoe
  • In ball games, throw catch, bounce, kick better
  • Expert tricycle rider
  • Pick up things by bending from waist with
    extended knees
  • Stand on one foot and hop preferred foot
  • Be Active and skilful in climbing, swinging,
    digging, sliding
  • Moves rhythmically to music

Fine motor skills
Developmental tasks Early childhood
  • What age should a baby
  • Close their hands thumb outside
  • Discover their hands finger play
  • Takes everything to their mouth
  • Reach for object with palmar grasp
  • Passes object from hand to hand
  • Pokes at small object with finger
  • Points with finger at distant objects
  • Grasps small objects with inferior pincer grasp
  • Can release toy from grasp if dropped or pressing
    down not able to place down voluntarily

Developmental tasks Early childhood
  • What age should a baby /toddler
  • Point with index finger at objects of interest
  • Drop and throws toys deliberately
  • Pick up small objects with neat pincer tip
    index and thumb
  • Have Precise pincer either hand used
  • Manipulates cubes, can build 2 block tower
  • Grasps crayon, whole hand using palmar grasp
  • Imitates scribble to and fro

Developmental tasks Early childhood
  • What age should a toddler
  • Pick up small objects with delicate pincer
  • Hold pencil in mid or upper shaft in whole hand
    or crude approximation of thumb and fingers
  • Spontaneous scribble and dots to and fro
    sometimes pencils in both hands
  • Can build 3 block tower after demo, sometimes by
    their own
  • Begins to show hand preference

Developmental tasks Early childhood
  • What age should a toddler /Preschooler
  • Pick up small objects with delicate pincer
  • Hold pencil well down shaft using thumb and 2
  • Spontaneous circular scribble and to and fro
    scribble and dots imitates vertical line and
    sometimes V shape
  • Can build 6-7 block tower
  • Mostly uses preferred hand

Developmental tasks Early childhood
  • What age should a Preschooler
  • Can build 7 block tower using preferred hand
  • Holds pencil preferred hand tripod grasp
  • Imitates horizontal line and circle, usually T
    and V
  • Can build 9-10 block tower
  • Can build 3 cube bridge from model using 2 hands
  • Threads large wooden beads onto shoe lace

Developmental tasks Early childhood
  • What age should a Preschooler
  • Can close fist and wiggle thumb in imitation
    right and left
  • Holds pencil near point in preferred hand between
    first two fingers and thumb with good control
  • Copies circle, usually H, T and V
  • Imitates a cross
  • Draws a person with head and 1-2 other parts or
  • Cuts with toy scissors
  • Paints with large brush, lots of colour, covering
    all paper, primitive pictures which they can name

Developmental tasks Early childhood
  • What age should a Preschooler
  • Imitate spreading of hand and bringing thumb into
    opposition with each finger in turn, right and
  • Build a 10 tower and several bridges from
    model, can build 3 steps after demonstration
  • Holds pencil in adult fashion with good control
  • Copies circle, H, T , V, O
  • Draws a person with head, trunk, legs usually
    arms and fingers.
  • Draws a recognisable house on request

Developmental tasks Early childhood
  • What age should a Preschooler
  • Picks up and replaces minute objects
  • Counts fingers on one hand with index finger of
    the other
  • Build a elaborate models when shown, 3 steps
    from 6 cubes and sometimes 4 steps from 10 cubes
  • Draws with pencils and paint brushes
  • Copies square, H, T , V, O, L, A, C, U, Y
  • Writes a few letters spontaneously
  • Draws a recognisable person with head, trunk,
    legs arms and features.
  • Draws a house with door, windows, roof and
  • Colours pictures neatly within outlines
  • Copies triangle

Language and listening skills
Developmental tasks Early childhood
  • What age should a baby
  • Coo, responds to sudden noises
  • Vocalises happily when spoken too, turns towards
    sounds, quietens to sounds out of sight
  • Vocalises tunefully, sing song vowels single /
  • Laughs, chuckles, squeals, turns to source
  • Vocalises as communication, shouts, listens then
    shouts again
  • Babbles tunefully, long repetitive strings
    syllables, dada,mama,agaga
  • Know and responds to own name

Developmental tasks Early childhood
  • What age should a toddler
  • 2 words plus mum and dad, understands no, bye,bye
  • 5words, obeys simple instructions, points to
  • 6- 20 words, chats to themselves
  • Echoes last word/ sentence spoken, Listens and
    responds to spoken communication
  • Attempts to sing

Developmental tasks Early childhood
  • What age should a toddler/ preschooler
  • Two word sentences, uses 50 or more words, begins
    to listen to general conversation, refers to self
    by name
  • Echolalia, asks names for things, carries out
    simple instructions
  • Uses 200 words but pronunciation and sentence
    structure immature
  • Constantly asks what, who
  • May stutter

Developmental tasks Early childhood
  • What age should a preschooler
  • Large vocab intelligible to strangers, talks to
    self in long monologues
  • Asks what, where, who, listens to stories, knows
    several nursery rhymes, able to describe present
    and past activities briefly
  • Speech grammatically correct, may have a few
    mispronunciations, listens too and tells long
    stories, confuses fact and fantasy, enjoys jokes
  • Loves to be read / told stories and act them out
  • Ask meanings of abstract words and uses them,
    define correct nouns by use, enjoys jokes and
  • 5000 word vocab

Developmental milestones
  • http//

Developmental Bingo
  • From cry to 5000 words and beyond
  • From scribble to Picasso
  • From gorgeous slug to junior athlete
  • An amazing journey the first twelve years
    babyhood to adolescence.

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Hilary Giles Workforce Development Child
Adolescent Community Health Child Adolescent
Health Service