The infant stage of development

The period between the first and third years of life sees the fastest, and perhaps most radical, development that a human being ever experiences. A child at the toddler stage learns to ‘stand on its own two feet’, to speak, and is becoming conscious of its own ‘ego’. Besides the oral satisfaction obtained from nibbling and sucking, which persists from the baby period, the toddler discovers the new satisfaction of excreting and retaining faeces. One of life’s milestones is reached at this stage: toilet training.

Typically, a toddler copes with daily experiences by translating them into fantasy games or games that require role-playing. A two-year-old prefers to act as adults do, but naturally does not always succeed. These first attempts at independence are therefore often frustrating and can lead to tantrums.

The child prefers to have everything to his own liking, and as a result is probably frequently reprimanded. The toddler considers everything as belonging to him (or her) and occasionally the child resembles a hamster that gathers all its things around itself. The toddler needs this exaggerated expression of possessivenes to strengthen his or her ego and self-confidence. The notion of being someone, independent of the mother and father, on the one hand gives the toddler a feeling of power, and on the other insecurity and fear. During this period, the toddler may re-experience early fears of being separated from his or her parents and also become easily, sometimes terrifyingly, scared at the thought of huge, wild animals (usually lurking under the bed) or, for example, thunder. Every period of profound emotional development is invariably accompanied by fears and anxieties, and it is hardly surprising that young children are particularly susceptible.

The infant – Physical development

By the end of the first year an infant, let us again assume that it is a boy, has begun to move about, hold and examine objects, and understand the rudiments of speech. Between the ages of one and three years, even more amazing advances occur. The three-year-old is walking, running and moving with confidence and balance. He talks in complex sentences, listens and understands, manipulates objects with great precision and purpose, and is able to express his imagination and emotions in speech, play and drawings or paintings. Never again will he have to learn skills as complex as those necessary for an upright posture and speech – attributes that might be considered to define a human being – and never will he acquire skills at such an amazing speed. To attain such demanding physical and mental skills, the infant is continuously on the go virtually all the time he is awake.

Growth

Once a child passes his first birthday his weight-gain slows down. On average, children put on about 2.7kg in their second year and 1.5 to 2.0kg in their third. During these two years they grow about 20cm taller. The exact rate of growth varies, because children do not grow steadily from one month to the next. Toddlers do not need to be weighed and measured as frequently as young babies; three-monthly checks are sufficient.

When a child first begins to stand upright, and then to walk, he may look incongruous: his head appears too big for his body and his legs too short and weak. His stomach seems enormous in comparison with his shoulders and chest, and he seems to have flat feet. After the age of 12 months, however, the proportions of the body begin to alter. Growth of the head, for example, slows down. By the end of the second year the circumference of an infant’s head is about four-fifths the size of what it will be when the child is fully grown. During his second year, as the child changes from crawling on all fours to walking on two feet, he slims down and his body becomes more muscular. His legs grow in proportion to the rest of his body. Fatty pads are lost from the soles of the feet and he no longer appears flat-footed. The spine develops a lumbar lordosis causing the bottom to protrude. These features are necessary for the child to begin to walk.

Because of the loss of body fat, many children appear thin and frail at about three years old. This is normal, and in fact healthier for the child than being too plump. By the time he is five years of age or so, muscle development will have increased to replace some of the lost fat, and he will appear sturdier.

Some sort of support – often occurs before the age of 12 months. The next stage, ‘cruising’, using furniture or a rail as support while taking a few steps, usually follows rapidly. Novice cruisers hold on with both hands, experts with one! An adventurous step across a small gap without holding on to anything heralds the start of independent walking. Almost constant attention is needed to protect a newly walking infant from hurting himself. By the age of 14 months most children walk unaided, but some show no inclination to do so at all. Efficient crawlers may be unenthusiastic about getting up on two legs; and even proficient walkers crawl when they want to get somewhere fast. Crawling usually persists as an alternative method of moving about until a child can stand up from a sitting position without holding on to anything – probably not until about 18 months.

At 18 months, most children are able to run stiffly and climb stairs if one of their hands is held and with two feet to each step. At about 20 months the legs are usually strong enough to support the child when he bends over to pick something up. By the time he is two years old, he will have mastered walking, more or less, although he will still fall over frequently and will not yet be a fast or agile runner. He is also unlikely to be able to balance on one leg or have the co-ordination to pedal a tricycle. These skills come during his third year. Falls are still frequent.

Walking

Walking is a milestone in human growth and development. The first stage – standing up with the help of

Co-ordination

Improvements in major motor skills are accompanied by increasing control and co-ordination of small muscles. Most children can hold a small object between thumb and forefinger at the age of 12 months. Greater hand and eye co-ordination becomes apparent at about 15 months, when most children are able to place one cube accurately on top of another. By 20 months, on average, a child can build a tower of four cubes, take off his socks (and sometimes other garments as well), undo zips, and spoon-feed himself without spilling much. By two years of age, finger control is much more accurate, enabling the child to build a tower of six or seven cubes, turn over single pages in a book, turn door knobs, unscrew lids and put on socks and underpants.

Three-year-olds generally have sufficient control over their hands to draw simple shapes more or less accurately. They can copy a circle and draw vertical lines. Horizontal lines cause more difficulty, and the ability to draw them usually comes later.

Playing

Playing is very important for every growing child and is, in essence, a prerequisite for its healthy psychological and physical development. Playing has a completely different meaning for children than it has for adults; it does not mean relaxation or something to do between important matters. For the child, playing is ‘work’.

The word “playing’ suggests to an adult an unimportant activity not to be taken seriously, but we should not forget that to the child every game is a serious matter. Their world of fantasy is not, as is the case for adults, separated from reality. While playing the childl earns to control his body, to co-ordinate his muscles, and to explore his emotions and potential for self-discovery. In this way the child learns to recognize his own abilities, and gradually gains insight into his place in the world.

Now and then the child will need the parents’ help to perform particular tasks; but help should never be forced upon the child, because eventually he must learn everything through his own experience. Another point to remember is that, if it can be avoided, a young child should not be abruptly disturbed when playing with concentration; it is best to announce that it shall soon be time to eat or to go to sleep or whatever, rather than expecting an immediate response. It takes some time for a child to ‘wind down’ after playing and sudden demands to stop only cause irritation.

Sleep

As with younger babies, toddlers’ sleeping patterns differ and can change from time to time. Some sleep for 11 or 12 hours at night and take naps during the day. Some children manage on just one nap of about half an hour; others may need up to two hours of sleep morning and afternoon. The child who needs less sleep than his parents and manages with no daytime naps is rare, but each child is an individual; he will sleep as much or as little as he needs. In their third year children may give up at least one of their naps, although they may occasionally need some sleep during the day when they have been more than usually active. Many three-year-olds abandon naps entirely; a few four-year-olds still need them. There may come a stage when the child is willing to sleep during the day but stays awake later in the evening to compensate; this routine may suit some parents who find that trying to keep their child awake all day merely makes him or her tired and irritable. Small babies spend 40 to 60 per cent of their time asleep in sleep that is characterized by the rapid eye movements indicative of dreaming (REM sleep). This proportion declines to about 25 per cent when a child is two to three years old. The amount of time spent in REM sleep is believed to reflect the development of the nervous system, which is most rapid in the first few months of life.

Teeth

By about its first birthday an infant usually has eight teeth, the incisors. A further eight teeth – the first canines and first molars – usually arrive in the second year, making a total of 16 teeth. The second molars are cut later but are usually present by the age of two and a half years.

The age at which teething starts tends to run in families. There is much variation, but they usually arrive in the same order. Incisors and canines are usually cut without much trouble, but the first and second molars may cause discomfort while they are coming through. A teething gel, available without a prescription from most chemists, an ice cube applied to the gum or simply rubbing the gum may help. Although teething may be uncomfortable, it does not make the child ill. Sometimes a child who is teething may have thin, watery stools, but other symptoms such as high fever or convulsions . which often occur at the same time because the child has reached a stage when he is vulnerable to infections, should not be attributed to teething. These are signs that the child is unwell from another cause.

Once the molars are through, the child should have his teeth cleaned regularly, at least twice a day, to remove food debris from the crevices. It is often thought that cleaning milk teeth is not necessary, because they are not permanent. This is a mistake however, because caries in milk teeth will render the permanent teeth susceptible to caries also. Besides, when a child learns to take care of his teeth very early, he will have grown accustomed to this habit when the permanent teeth come through. By the time the molars are through, the child should already have become used to the feel of a toothbrush in his mouth, although he is not sufficiently skilful – or willing, usually – to clean his teeth properly himself. Whether a child should have his teeth cleaned after every meal is debatable. Forcing him to the bathroom when he wants to go and play may put him off the whole idea of dental hygiene. Instead, it may be better to let him finish some meals with a drink of plain water. This will help clean his teeth. The refined sugar (sucrose) present in sweets is harmful to the teeth and is unnecessary for health. A child should instead be encouraged to enjoy naturally sweet fruit and vegetables. However, even if parents avoid giving their child sweets or biscuits, he is bound to find out about them sooner or later. If he persistently demands them, it is probably best to allow him a few occasionally, perhaps at mealtimes. Again, a glass of water afterwards will help remove the sugar remaining on his teeth or, preferably, you can clean his teeth. Sticky sweets such as toffees, which take a long time to dissolve, are worse for teeth than chocolate, which melts and is swallowed fairly quickly.

Common child disorders

By the time a child has passed his first year he is more susceptible to infections than during the previous twelve months. This increased vulnerability is partly the result – if the baby was breastfed – of being weaned away from the breast and consequently losing the immunity to some forms of infection that was provided by the antibodies in the mother’s milk. Besides the colds that almost all children suffer from at some stage, the two most common disorders that afflict toddlers are otitis media and conjunctivitis. Otitis media is an infection of the middle ear that causes inflammation and a discharge of fluid. Pressure of the fluid on the eardrum may cause it to perforate and may also give the child some degree of pain and temporary deafness. A doctor often prescribes antibiotics to clear up the infection quickly, coupled with ear drops to relieve any pain.

Conjunctivitis is a less serious infection that affects the eye, causing a characteristic redness and irritation. Sometimes producing pus inside the eye sockets. Treatment is with eye drops prescribed by a doctor.