Slide1: Miracles and Challenges: Early Childhood Development Birth To 5 Years Kathleen C. Schlenz, MS, OTR/L, BCP
Slide2: Goals of this presentation 1. Outline major developmental milestones for children birth to five in 4 areas:
Gross Motor
Fine Motor
Cognitive
Social / Emotional Skills.
2. Review “red flags” for developmental challenges
3. Discuss good parenting skills that support a child development.
First 6 Months of Life: Key Developmental Tasks : First 6 Months of Life: Key Developmental Tasks To learn to trust and begin establishing secure attachments to people, especially mother.
To learn how to get most important needs met.
To establish eye coordination, gain control of large muscles and distinguish sounds.
Slide4: Rolls over front to back and back to front
Sits with support, then independently
Reaches with one hand
Transfers object from hand to hand
Uses raking grasp 6 Months GrossMotor / Fine Motor
6 Months Cognitive: 6 Months Cognitive Finds partially hidden object
Explores with hands and mouth
Struggles to get objects that are out of reach
Explores and experiments with objects by looking, swatting, mouthing
Begins to imitate actions and movements
6 Months Social/Emotional: 6 Months Social/Emotional Enjoys social play
Interested in mirror images
Responds to expressions of emotion by others
Smiles and laughs
Slide7: 6 Months Good Parenting Skills Responsive, nurturing care is key to helping the child establish “basic trust.”
State/arousal regulation is assisted by adequate parental responsiveness.
Most parents benefit from good publications on development and the internet can be a source as well.
Predictable parenting, including stimulation, is essential: talking to the child (“motherese”; mirroring), engaging in reciprocal play, providing opportunity for practice of emerging developmental skills.
Safety is key: attend to all recommendations.
If by around age six months a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. : If by around age six months a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. Indicators of possible developmental delays:
Does not respond to sound (startle or turn head in response to loud sound) or light (reflexive widening or blinking)
Does not calm when held, spoken to, soothed
Not rolling over or readying to sit (sitting when propped)
Not making cooing noises or playing with sounds
Warning Signs
Slide9: Indicators of possible developmental delays (six months):
Does not recognize or prefer familiar individuals (caregivers) over strangers
Not exploring hands, feet, objects, especially with mouth
Not reaching for or swatting at hanging objects
Not beginning to grasp objects placed in or near hand
Feeding / weight gain difficulties
Seems very tight in trunk, arms, or legs (straight or stiff) or has a rag doll-like appearance (floppy) Warning Signs (continued)
1 Year-old: Key Developmental Tasks : 1 Year-old: Key Developmental Tasks To continue learning to trust parents and other caregivers.
To feel secure in the world.
To move the body independently.
To learn ways other than crying to get
adults to meet needs.
To adjust to short periods away from caregiver.
To develop eye/hand coordination.
1 Year Gross Motor Skills: Crawls forward on belly
Assumes seated position unaided
Gets up on all fours
Creeps on hands and knees
Transitions into several positions: sitting, all-fours, prone (on stomach)
Pulls self to stand
Walks holding on to furniture (cruises)
Stands momentarily without support
May walk two or three steps without support 1 Year Gross Motor Skills
1 Year Fine Motor Skills: Bangs two cubes together
Puts objects into container
Takes objects out of container
Lets objects go voluntarily
Pokes with index finger
Tries to imitate scribbling
Uses pincer grasp 1 Year Fine Motor Skills
1 Year Cognitive: Experiments with objects in more complicated ways (shaking, banging, throwing, dropping)
Finds hidden objects easily
Looks for object or person when mentioned or named
Imitates gestures (wave bye)
Uses objects by function (puts cup to mouth, brushes hair, puts phone to ear) 1 Year Cognitive
1 Year Social/Emotional: Shy or anxious with strangers
Cries when parent leaves
Enjoys imitating people in play
Shows preference for certain people and toys
Tests parental responses to behavior
Fearful of novelty, loud noises
Prefers parent and/or regular caregiver over others
Repeats sounds or gestures for attention
Extends arm or leg to help when being dressed
Finger-feeds self 1 Year Social/Emotional
Slide15: 1 Year Good Parenting Attend to safety, especially in the early months of crawling, walking and climbing.
Model language and provide loads of stimulation.
Use affect (emotion) words to label the child’s state/arousal.
Use/teach distraction to cope with being upset.
Provide clear behavioral limits with concise explanations.
Promote good sleep habits.
Establish good nutrition early; now is a good time to introduce balance, moderation and pacing.
Allow and encourage practice of new skills (e.g., motor and language) and reward them.
If by around age one year a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. : If by around age one year a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. Indicators of possible developmental delays:
Not smiling, laughing
Does not imitate sounds/words
Not using jargon (baby talk: tone of voice like adult speech but may have few real words)
Not gesturing (e.g, pointing) with intent to communicate
Not establishing eye gaze with loved ones Warning Signs
Slide17: Indicators of possible developmental delay (one year):
Not responding to simple questions/commands (no! up?)
Not sitting alone, creeping, readying to walk (walking may take place anywhere from 9-14 months)
Does not respond to name being called
Seems detached or apathetic, very difficult to console
Does not protest when trusted caregiver leaves and/or not bothered by presence of strangers
Little interest in new toys, unfamiliar or unusual objects
Not finger feeding or difficulty with table foods
Despite praise, does not repeat actions that please caregivers e.g., clap hands Warning Signs (continued)
Key Developmental Tasks for Toddlers: Key Developmental Tasks for Toddlers To become a distinct person with a positive emerging self image.
To explore an ever-widening world by improving the ability to talk, walk, use fine motor skills and coordination.
To demonstrate increased memory for objects and events.
To develop the beginnings of self control.
Two Years Gross Motor Skills: Walks smoothly, turning corners
Begins to run
Stands on tiptoes
Kicks a ball
Pulls toys while walking
Carries large toy or several toys while walking
Climbs onto and down from furniture unassisted
Walks up and down stairs with support (hand rail) Two Years Gross Motor Skills
Two Years Fine Motor Skills: Turns over containers to pour out contents
Builds tower of four blocks or more
Might use one hand more frequently than the other
Scribbles spontaneously Two Years Fine Motor Skills
Two Years Cognitive: Finds hidden objects
Begins to sort by shape, color
Begins multi-step make-believe play (cooking, feeding baby)
Groups objects by function
Varies imitation from model
Begins to think before acting
Completes simple inset puzzles Two Years Cognitive
Two Years Social/Emotional: Imitates behavior, especially of adults and older children
Increasingly aware of self as separate from others
Enthused by company of other children
Demonstrates increasing independence
Begins to show defiant behavior (no!)
Episodes of separation anxiety wax and wane, overall diminishing Two Years Social/Emotional
Slide23: Two Years Good Parenting Play! Remember (learn) how to pretend and encourage it.
Gentle, firm, predictable limits are essential, particularly around safety.
Promote affective regulation by soothing, using language of affect. Model and teach appropriate behaviors.
Expect testing of limits -- use “if-then” reasoning and apply this to your response.
Establish/maintain household routines (bathing, bedtime, meals). Talk about them.
Extend learning with books, stimulating toys, community encounters (park, library, walks, water/sand play).
Expect irregularities of mood and appetite; respond accordingly.
If by around age two years a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. : If by around age two years a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. Indicators of possible developmental delay:
Not putting 2-3 words together in meaningful, spontaneous sentences (not just repeating others)
Not pointing to objects or persons named
Frustrated when others cannot understand the child’s attempts to communicate
Not making eye contact with others; seems uninterested in others
Doesn’t respond when name is called Warning Signs
Slide25: Indicators of possible developmental delay (age two):
Not engaging socially, i.e., shifting gaze back and forth between an adult and a toy while talking about the top
Not sorting objects or using them by function
Seems withdrawn, uninterested, “in his own world”
Difficulty manipulating objects such as large puzzle pieces, tower of blocks
Not walking smoothly and rounding corners with ease
Seems aggressive, difficult, often frustrated, angry, rageful, fearful
Sleep disturbances or night terrors (should sleep through the night) Warning Signs (continued)
Key Developmental Tasks in the preschool years: Key Developmental Tasks in the preschool years Preschoolers
Are learning, learning, learning…
to control bodily functions, feelings, and behavior...to speak more clearly... about safety...about where to go for comfort...and about how to play with others.
Have established a sense of self as an individual with skills, likes and dislikes.
Can separate thinking from feeling by making conscious choices, accepting limits and finding solutions to simple problems.
Can usually distinguish fantasy from reality.
Are comfortable with body parts and gender identity.
Three Years Fine Motor Skills: Three Years Fine Motor Skills Makes vertical, horizontal, and circular strokes with pencil/crayon
Turns book pages one at a time
Builds a tower of more than six blocks
Holds a pencil in writing position
Screws and unscrews jar lids, nuts and bolts
Turns rotating handles
Three Years Cognitive: Three Years Cognitive Makes mechanical toys work
Matches an object in his hand or room to a picture in a book
Plays make-believe with dolls, animals, and people
Sorts objects by shape and color
Matches like objects
Completes puzzles with three or four pieces
Understands concept “two”
Three Years Social/Emotional: Three Years Social/Emotional Imitates adults and playmates
Spontaneously shows affection for familiar playmate
Can take turns in games
Understands concepts mine, yours and his/hers
Expresses affection openly
Expresses a wide range of emotions
Separates easily from parents
Objects to major changes in routine
Slide30: Three Years Good Parenting Step up expectations for behavior and accommodation to routine. Praise and value independence.
Promote pro-social behavior by close monitoring of encounters with other children.
Examine cultural-familial rules for affect, behavior. Understand your values and articulate them.
Begin using “consequential” (if-then) discipline: withhold privilege for misbehavior. Keep intervention brief & concise.
Extend learning by reading, watching TV together, puzzles, outdoor play, computer.
Teach good coping skills by labeling frustration and encouraging perseverance.
If by around age three years a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. : If by around age three years a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. Indicators of possible developmental delay:
Not speaking in full, fairly elaborate sentences
Not pronouncing consonant sounds (b, t, d, g) or blending sounds well (tr, cl); deleting parts of words
Stranger cannot understand child’s speech in context (the listener knows the topic)
Does not understands and use pronouns (ours, yours, mine) articles (a, an, the), prepositions (over, under) readily
Warning Signs
Slide32: Indicators of possible developmental delay (age three):
Play does not include fantasy, roles, scripts
Does not walk, climb, run, jump well
Cannot pedal a bike or tricycle (with practice)
Not matching/sorting by two attributes (size, color)
Odd pencil/crayon grasp or cannot draw simple figures
Not expressing or regulating emotion well (overly angry, sad, aggressive)
Apathetic, disinterested, or destructive
Overly preoccupied with certain topics, ideas, or age-inappropriate material Warning Signs
Slide33: Hops and stands on one foot up to 5 seconds
Goes up and down stairs without support
Kicks ball forward and throws it overhand
Catches bounced ball
Moves forward and backward with agility Four Years Gross Motor Skills
Slide34: Copies squares and other shapes
Draws a person with two to four body parts
Uses scissors
Begins to copy capital letters Four Years Fine Motor Skills
Slide35: Correctly names colors
Counts and may know numbers
Says first and last name
Approaches problems from a single point of view
Develops a clearer sense of time
Follows three-part commands
Recalls parts of a story
Understands same/different
Engages in fantasy play with roles and scripts Four Years Cognitive
Slide36: Interested in new experiences
Cooperates with other children
Role plays (mom, dad, teacher)
Increasingly inventive in fantasy and role play
Dresses and undresses
Negotiates solutions to conflicts
More independent
Imagines that unfamiliar images are monsters
Views self as a whole person involving body, mind, and feelings
Difficulty distinguishing fantasy and reality at times Four Years Social/Emotional
Slide37: Four Years Good Parenting Encourage the inquisitive mind of the three-year-old: read, travel, visit museums, etc.
Teach preschool skills in a fun, appealing way.
Have explicit behavioral expectations (In our family, we talk about mad feelings…) and enforce them reasonably. Set up clear responsibilities and consequences for meeting them.
Keep behavioral expectations in line with development. Expect less when your child is upset, but push for more.
Promote healthy sleep and eating habits.
Teach empathy.
Respond to fears with understanding, but don’t encourage avoidant behavior.
If by around age four years a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. : If by around age four years a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. Indicators of possible developmental delay:
Does not say first and last name
Speech is not understandable to strangers (should be mostly comprehensible even out of context)
Not engaging in elaborate fantasy play with multiple characters and changing roles
Not telling stories, either original or repeated (fairy tale, video tape)
Not counting, learning alphabet, or identifying colors with exposure or instruction
Warning Signs
Slide39: Indicators of possible developmental delay (age four):
Not dressing self; Not potty trained for day time
Play does not include fantasy, roles, scripts
Not matching/sorting by two attributes (size, color)
Odd pencil/crayon grasp or cannot draw simple figures
Not drawing basic shapes or form recognizable as a human figure
Not expressing or regulating emotion well (overly angry, sad, aggressive)
Apathetic, disinterested, or destructive
Overly preoccupied with certain topics, ideas, or age-inappropriate material Warning Signs (continued)
Slide40: Indicators of possible developmental delays (age four):
Does not walk, climb, run, jump well
Cannot pedal a bike or tricycle (with practice)
Movement is awkward, extremely clumsy, many falls; cannot negotiate climbing toys
Not yet kicking and throwing ball with practice
Extremely upset by changes in routine
Seems very fearful, angry, preoccupied
Aggressive, rageful or vengeful
Engages in repetitive or unusual behaviors
Does not seek approval, affection, contact Warning Signs (continued)
Slide41: Stands on one foot for ten seconds or longer
Hops, somersaults
Swings, climbs
Learning to skip Five Years Gross Motor Skills
Slide42: Copies triangles and other geometric shapes
Draws person with body
Prints some letters, name
Dresses and undresses self
Uses fork, spoon, and (sometimes) a table knife
Toilets independently Five Years Fine Motor Skills
Slide43: Counts ten or more objects
Correctly names most colors
Better understands time
Sequences well (understands cause and effect)
Knows about things used in the home/community (money, food, vehicles, appliances)
May have rigid, all-or-nothing view of things Five Years Cognitive
Slide44: Wants to please friends
Wants to be like peers
More likely to agree to rules
Likes to sing, dance, and act
Shows more independence; may visit a neighbor by self
Aware of gender
Able to distinguish reality from fantasy
Sometimes demanding, sometimes eager Five Years Social/Emotional
Slide45: Five Years Good Parenting Expect the five-year-old to test limits and explore: provide guidelines for safety.
Prepare for kindergarten.
Involve the child in decisions that impact her; allow choices appropriate to capacity.
Help the child understand complicated emotions (guilt, embarrassment, ambivalence).
Help the child understand his reaction to upsetting situations. Distinguish thoughts, feelings, behaviors.
Parental coaching about emotion is correlated with children’s social competence by age 5. Girls are particularly vulnerable to “guidance.”
If by around age five years a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. : If by around age five years a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. Indicators of possible developmental delay:
Exposed to but not acquiring basic preschool skills (colors, counting, recognizing letters, writing letters)
Not aware or able to maintain basic safety rules (danger of stove, traffic, etc.)
Not making friends despite exposure to other children; disliked or feared by peers
Having difficulty expressing self (stuttering, hard to understand, can’t find the right word) Warning Signs
Slide47: Indicators of possible developmental delay (age 5):
Not telling stories with clear beginning, middle, end
Not using full sentences, asking/answering all wh questions (who, what, when, where, how, why)
Does not give full name, address, town when asked (assumes an adult has attempted to teach this)
Not competently feeding self with utensils
Unable to toilet independently and without reminders, both day and night
Not able to hop, somersault, stand on one foot, run, climb, and jump ably
Extreme moodiness, anger, sadness
Destructive, preoccupied or obsessed with certain ideas or actions Warning Signs
Slide48: Miracles and Challenges: Supporting Early Childhood Development Thank you to Anne Farrell, PhD and the
Westchester Institute for Human Development, New York
for their contribution to this training.