EMBRYOLOGY INTRODUCTION

Human genetics deal with human variation its nature, extent origin a maintenance, its
distribution in families etc. Human embryology is the study of development of an
individual before birth. Every individual spends first nine months (266 days or 38 week
to be exact) of its life within the womb (uterus) of its mother. During this period, it
develops from a small cell called zygote to an organism having billions of cells.

Numerous tissues and organs are formed and start to function in perfect harmony. The
most spectacular of these changes occur in first two months. We call the developing
individual an “embryo”. From third month until birth, we call it a “foetus”.

DEFINITION

According to Basavanthappa :-

Human embryology is the study of development of an individual before birth.

Embryology is the study of the formation and development of the embryo or foetus
from the movement of its inception up to the time when it is born an infant.

According to Baillier’s

Embryology is the study of the growth and development of the embryo from unicellular
stage until birth.

According to Medical Dictionary

Embryology is the study of growth and development of the embryo and foctus from
fertilization of the ovum until birth.

Fertilization :-

Fertilization takes place in the ampulla (outer third) of uterine tubes. When a sperm
successfully penetrates the membrane surrounding the ovum, both sperm and ovum
are enclosed within the membrane and membrane becomes impenetrable to other
sperm. This is termed the zone reaction.

The second meiotic division of the oocyte is completed and the ovum nucleus becomes
the female pronucdens. The head of sperm enlarges to become male pronucdens and
tail degenerates. The nuclei fuse and chromosomes combine. Restoring the diploid
number conception, the formation of the zygote (the first cell of new individual) has
been achieved. The male and the female pronude unite at the center, with restoration of
diploid number at chromosomes (46) the zygote thus formed, contains both the
paternal and maternal genetic materials.

Sex of the child is determined by the pattern of sex chromosome supplied by the
spermatozoon. It the spermatozoon contain ‘X’ chromosomes, a female embryo (46XX)
formed. If it contains a ‘Y’ chromosome a male embryo (46XY) is formed.
STAGES OF GROWTH AND DEVELOPMENT

Pre-embryonic stage ;-

The fertilized egg travels from the fallopian tube and implants or embedded a itself into
the lining of the uterus. Lasts from 12-14 days after fertilization.

Fertilization to 1 week :-

Appearance

 Fertilization of ovum in distal third of fallopian tube.

 Zygote divided and form morula.
 Early and late blastocyst.
 Implantation begins.

Internal development

No organ differentiation.

Week-2 (Days 8-12)

Appearance

 The implanted embryo is embedded more deeply in the uterine endometrial.

 Amniotic and exocelomic cavities are present.
 Primitive placental circulation begins.
 Extra embryonic mesoblast forms.

Internal Development

 Flat embryonic disk ectoderm and endoderm.

 Primitive placental circulation.

Week 3 (Days 13-19)

Appearance

 This stage referred to as prismatic.

 Chorionic villi branches the primitive streak and notochordal process appear.
 Towards the end of period, the neural plate and groove appear and the neural
folds may be present.
 CR-CH-1.5-3 mm

Internal development

Trilaminar embryo mesoderm develops between ectoderm and endoderm.

 PRIMARY GERM LAYER AND BODY PARTS
Morula Blastocyte (inner cell

ECTODERM ENDODERM MESODERM

• Epidermis, • Dermis • Lining of auditory

Cutaneous gland • Skeleton canal,
• Sweat glands • Cartilage
• Nails, hair , • Tympanic
• Muscles (all type)
• Nervous system,
• Connective tissue membrane
including Cranial
nerve & spinal nerve • Adrenal cortex • Thyroid gland
• Sense organs- • Pleura,
• Pharynx, tonsils
neuroepithelium pericardium
• Optic lens, • Peritoneum • Trachea, bronchi,
epithelium of • Teeth dentine lungs air passages,
Portion of eye
• Heart
• Sensory epithelium alveoli
of ear, • Spleen
• Blood, bone • GI tract
• Pituitary gland,
• Adrenal medulla marrow • Pancreas, liver gall
• Upper pharynx & • Blood lymphatic bladder
nasal passage vessels
• Nasopharynx & • Kidneys, ureters • Urinary bladder
mouth epithelium
• Gonads, uterus • Lining of
• Teeth-enamel,
• Salivary glands alimentary tract
• Mammary gland,
• Urethra
• Lower portion of
anal canal lining
EMBRYONIC STAGE

Being the 3rd week after conception and ends at the end of the & week of gestation.
Major organ system formation and development occur during this period.

The embryo changes from a mass of cells to an organism that looks distinctly human.

Week 3 (Day 20-21)

 The first so mites thickened of mesodermal cells appear and neural folds being to
fuse, later become CNS.
 The head and tail folds are apparent.
 CR- 3 mm

Internal development

 Thyroid begins to develop.

 The two heart tubes into fuse to circulate early blood cells formed in the yolk
sac.
 Lung buds present.
 So mites, form in pairs alongside the neural folds (later become skeleton and
muscles of skeleton)

Week 4 (day 22-28)

Appearance

 Head is right angle to body, embryo is C- shape

 Head 1/3 of body length.
 Optic vesicle and otocyst present.
 Primitive jaw is formed.
 The upper limb buds appear.
 Tail prominent
 CR-4.0 mm
 Weight-0.4 gm.
Internal development

 Initial stage of most organ development.

 Heart begins to beat.
 Aortic arches and major veins developed.
 Right and left primary bronchi form.
 Neural folds fusing.
 Anterior end forms brain posterior end forms spinal cord.
 Esophagi cheal septum divides trachea and esophagus.
 Early beginning of peritoneal and pleural cavities. All 42 so mites are present.

Week 5 (day 29-35)

Appearance

 Primitive umbilical cord developing from body stalk.

 Head much large in proportion to trunk.
 Leus pits and optic cups formed and nasal pits forming.
 Primitive month.
 Facial features closes together.
 Hand plats (paddle shaped)
 Wrist and elbow develop.
 Leg buds (paddle shaped)
 CR and CH -7- 8 mm.
 Weight – 1gm.

Internal development

 Brain differentiated into 5 areas, the spinal nerve sprout.

 The cranial nerve, motor nuclei, sensory and parasympathetic cranial nerve
ganglia being to form.
 Division of cardiac atria occurring.
 Beginning of primitive kidney.
Week 6(Day 36-42)

Appearance

 Upper lip formed.

 Upper and lower jaw recognizable.
 Palate developing.
 Tooth buds forming.
 Ear forming evident.
 Finger rays present.
 The foot plate appears on the lower limb buds.
 Tail still present, but regression evident.
 Placental begins to support maternal placental circulation.
 Weight – 1.5 gm.

Internal Development

 Lung formation beginning due to tracheal bifurcation.

 Liver forming RBCS.
 Some intestines out abdominal cavity :- abdomen too small to hold all intestines.
 Primitive skeleton shape beginning to form.
 Muscle and cartilage formation beginning.

Week 7-8 (day 43- 56)

Appearance

 Presence of beginnings of all essential external structures.

 Recognizable eyes, ears, nose, mouth.
 Eyelids forming.
 The upper limbs being to bend at the elbow.
 Anal membrane perforated.
 External genitalia are sexless but have begun to differentiate.
 To rays apparent.
 The trunk begins to elongate
 Fetal movement begin.
 Umbilical card organized.
Internal Development

 Presence of beginnings of all essential internal structures.

 Optic nerve formed.

 Pericardial and pleural cavities form.

 Valves and septa of heart, and interior vena cava form.
 Heart fairly well developed and beating 40-60 beats a minute.
 Abdominal and thoracic cavities are separated by diaphragm.
 Stomach well developed.
 G I tract rotates midget.
 Urogenital membrane degenerating.
 Urogenital and bladder are separating from rectum.
 Anal cancel developed, urine is first formed and excreted into amniotic fluid .
 Sex gland beginning to differentiated into ovaries or testes.
 Muscle continues to develop.
 Reflex are ready to function.
 Sensory organ development progressing.
FETAL STAGE

This stage begins in the ninth week and ends in the 38 th week of gestation or at the time
of delivery.

Week 9-10 (day 57-70)

Appearance

 Face and month developing.

 Eye lids fuse.
 Palate fusing.
 Tooth enamel beginning to be formed.
 Beginning of nail growth.
 Male and female external genitalia , which develop from analogus structures, still
appear fairly similar,
 Responds to tactile stimulation.

Internal development

 Basic division of brain.

 Erythropoietin in liver but gradually regresses.
 Intestines return to abdomen.
 Bladder sac forms, urine continues to form.
 Testes forming testosterone.
 Bonemarow formation and functioning begins.
Week 12

Appearance

 Skin delicate and pink.

 Human like appearance, but head still large in proportion to body fusion of
palate complete.
 Respiratory motion is visible.
 Distinctive external genitalia present.
 Sucks thumb and begins to shallow.
 Lower trunk moves more freely.

Internal development

 Brain appearance roughly complete.

 Growth hormone produced in pituitary gland.
 Erythropoiess in spleen begins.
 Uterus and testes now specific, uterus is no longer bicorn ate.
 Ossification of upper cervical to lower sacral arches and bodies.

Week 16
Appearance

 Growth appears human.

 Hair begins to grow on body.
 Hard and soft palates differentiated.
 Nipples present.
 Fetus quite active, sucks thumb, upper limb protrudes on stimulation, grasp
reflex.
 Maternal 16-20 weeks mother feels fetal movements.

Internal development

 Cerebral lobes present, rapid growth of neurons.

 Myelinization beginning .
 Heart muscle well developed.
 16-20 wks heart tones of fetus can be heart using fetoscope at 20-160 beats per
minute.
 30% nephrons in kidney mature.
 Bladder has adult form.
 Me conium in intestine (presence of me conium in amniotic fluid indicate fetal
distress) .
 Anal canal open.
 Vagina open.
 Bone ossification evident radiography, ischium is ossified.
 Sense organs differentiated.

Week 20
Appearance

 Vernix caseosa forming and present at birth.

 Eye brow and eye lashes developing.
 Too enamel and dentin continue to form.
 Primitive respiratory rhythms.
 Lower abdomen from umbilicus to pubis increases in length.
 Legs elongate to final proportion with body length.
 Sucking reflex increasingly apparent.
 Maternal stranger and more frequent fetal movement that mother can feel.

Internal development

 Sebaceous glands appear.

 Brain stem and spinal cord hyalinization begins.
 Ossification of sternum.
 Bone marrow is more important in blood formation.
 Storage of iron begins.
 Brown fat forming.

Week 24
Appearance

 Vernix apparent.
 Skin wrinkled and red (blood is visible in capillaries)
 Small amount of subcutaneous fat.
 Structure of eyes complete.
 Respiratory like movements.

Internal Development

 Beginning development of primordial at permanent teeth.

 Alveolar ducts and sacra evident in lungs.
 Alveolar cell begin to make surfactant.
 Testes present at inguinal ring.
 Os pubic ossifies.
 Immunoglobulin level rise to maternal values to protect fetus and neonate from
diseases for which the mother has immunity.
 Survival rate few but fetus is viable.

Week 28
Appearance

 Subcutaneous fat minimal.

 Skin less wrinkled and red.
 Nails more obvious.
 Pupils respond to light.
 Movements not well sustained.

Internal Development

 Cerebral fissure appears.

 Convolutions appear on brain.
 Formation of glial cells and hyalinization of brain capillaries develop around
alveoli.
 Surfactant forming on surface of alveoli, lunge capable of breathing air.
 Testes below inguinal ring.
 Bone marrow is major area information of blood liver decreasing in importance.
 Ossification of astragal us.
 Survival rate 10% with optimal care because gas exchange is possible.

Week 32
Appearance

 Lanugos starting to disappear.

 Skin smooth and pink.
 Subcutaneous fat increasing.
 Papillary light reflex 30 weeks.
 Increased muscle tone in legs and trunk.
 Movements better sustained.
 Responds to sound from outside world.
 Moro’s reflex present 30 weeks delivery position is assumed.

Internal Development

 Lecithin/ sphingomyelin.
 Testes descending to scrotum.
 Ossification of middle and 4th phalanges.
 Survival rate 33% with optimal care.

Week 36
Appearance

 Skin pink.
 Body rounded limbs flexed.
 Lanugos disappearing.
 Fuzzy hair growth.
 Lobes of ear soft, little cartilage.
 Umbilicus near center of body.
 Scrotum small, few rugae.
 Few creases in soles of feet.
 Spontaneous orientation to light.
 Firm grasp.
 Cries when hungry.
 May show greater or less activity because of lightness of uterine space.

Internal Development

 Lecithin/ sphingomyelin (ls) ratio = 2:1 or more.

 Iron storage increased in liver.
 New nephrons no longer form.
 Spinal cord ends at l3 level.
 Testes in inguinal cancel.
 Distal ossification centers of femurs present.
 Survival rate 70- 80% with optimal care.

Week 40
Appearance

 Flexed limbs.
 Muscle tone well developed.
 Skin pink, smooth, plump.
 Vernix caseosa covers skin.
 Lanugo remains on upper part of body and shoulder.
 May have moderate to profuse silky hair.
 Cartilage present in ear and nose.
 Nails extend over ends of fingers and toes.
 Crease cover soles.
 Strong sucking reflex.

Internal Development

 Pulmonary branching 66% complete.

 Myelinization reaches level of hemispheres.
 Testes in rougous scrotum.
 Labia major well develop.
 Bone and skull continue to firm.
 Proximal tibial ossification centers present.
 Continuing to store minerals and fat.
 Absorption of maternal hormones.
 Ready to be born
 Survival rate over 95% with optimal care.

FETAL MATURATION

The stage of the foetus last from nine weeks until the pregnancy ends. The foetus is less
vulnerable to teratogen except for those effecting CNS functioning. Viability refers to the
capability of foetus to survive outside the uterus.

FACTORS INFLUENCING GRAOWTH AND DEVELOPMENT

Growth and development depend on not one but a combination of many factors, all
interdependent. The relatively typical pattern of growth and development is influenced
by heredity and environment. Factors affecting child development–Growth and
development is a complex process that depends on the inherent biological potential as
well as various environmental influences including social, emotional and pathological
factors. Important factors affecting child development are as follows:

I. Intrinsic (Biological) factors affecting child development determine the inherent

pace, pattern and ultimate potential for growth & development, achievable under best
environmental situations and include -

a) Age: General pace of growth is highest in intrauterine life and early infancy,
decelerates gradually with advancing childhood, followed by a second growth- spurt
with onset of puberty.

b) Sex: Boys are usually heavier and taller than girls in early childhood but puberty
begins and completes earlier in girls.

c) Ethnicity: Caucasians and children of developed countries have better growth, due to
inherent potential as well as good environmental factors e.g. good nutrition and less
infections.

d) Hereditary: Children of taller parents are usually tall and vice-versa. Age of menarche
in daughters usually correlates well with that in their mothers.

e) Genetic disorders are associated with inherently altered growth potential e.g. short-
stature in Turner syndrome, achondroplasia etc. and tall-stature in Marfan syndrome
etc.

II. Extrinsic (Organic) factors affecting child development are prime determinants of
growth and development in developing countries, which directly facilitate or limit the
achievement of inherent growth potential. The exact effect of these factors affecting
child development depends on the age, quantum and duration of exposure in relation to
the period of growth. Important organic factors affecting growth/development include -

a) Prenatal factors affecting child development involving maternal health e.g.

maffiutrition, infections and systemic diseases affects growth of offsprings in three
different ways i) during the period of organ differentiation i.e. embryogenesis, leading
to higher risk of abortions or congenital malformations; ii) during late foetal phase of
anatomical and functional maturation, leading to intrauterine growth retardation
(IUGR) or stillbirths, iii) during postnatal life, when maternal ill-health may affect
emotional attention & quality of baby-care during critical phase of growth.

b) Obstetrical or perinatal factors affecting child development: Preterm and/or Low

birth weight (LBW) babies behave differently than term babies during postnatal growth
period while preterm grow faster in late infancy (catch-up growth) than the term
babies, small for gestational age (IUGR) babies are unlikely to show significant catch-up
growth and have limited growth potential throughout the life. Other perinatal events
e.g. asphyxia/injuries, sepsis, kernicterus etc. may also have disastrous effects on
subsequent growth and development.

c) Postnatal factors affecting child development: Postnatal growth is largely governed

by hormonal influences e.g. growth hormone in prepubertal period and sex-steroids
during puberty; apart from adequate supply of substrates e.g. nutrition, oxygen etc. and
freedom from infections.

Malnutrition, chronic infections e.g. tuberculosis and systemic illnesses e.g. asthma,
heart diseases etc. are most important adverse factors influencing postnatal growth and
development. Head injury may lead to mental retardation while growth of a particular
limb may be affected after fractures of long bones. Prolonged steroids/cytotoxic therapy
are important causes of iatrogenic growth suppression.

III) Extrinsic (environmental) factors affecting child development are important

hindrances for normal growth in developing countries, which indirectly affect nutrition,
infection rate and quantum of health care. These include -

a) Socio-economic factors affecting child development: Children of affluent parents have

better growth due to better nutrition and hygienic conditions than those of low
socioeconomic status.

b) Cultural factors affecting child development: Child-rearing practices vary in different

communities, which may significantly impact child’s growth. Routine practice of breast-
feeding is a positive growth-promoting factor, while delayed weaning, food taboos and
unhygienic living conditions are important adverse cultural influences in India.

Heredity

The heredity of a man and women determines that of their children. Embryonic life
begins with the cytoplasm and the nucleus of the fertilized ovum, genetically
determined by both parents. Members of families bear physical resemblances to each
other, and a high degree of correlation of stature with weight among sibling exists.

Sex

Sex is determined at conception. After birth, the male infant is both heavier and longer
than the female infant. Boys maintain their superiority until about 11 years of age. Girls
mature, reach the period of accelerated growth earlier than boys and are taller on the
average. Bone development is more advanced in girls than boys.

Racial and National characteristics

Race:- Distinguishing characteristics called racial or sub racial developed in prehistoric

humans. As to height, tall and short examples exist among all races and sub races.
Among civilized groups intermarriage has produced mixed racial types.

Nationality:-Children whose forebears came from the Scandinavian countries to be

larger and those of Sicilian ancestry to be smaller than the average American.

ENVIRONMENT
External Environment

Cultural Influences: - groups of human beings create their own cultures, whereas each
individual is influenced or shaped by the culture of which he or she is a part. The child is
cared for according to the culturally sanctioned pattern of child rearing. The child is fed
the diet that is dictated, dressed in appropriate clothing, and given health care as
defined by the culture.

Socioeconomic Status of the Family: - The environment of the lower socioeconomic

groups may be less favourable than that of the middle and upper groups. Today,
however public health and health education programs are gradually assisting such
parents to provide better care for their children.

Nutrition: - Nutrition is related to both the quantitative and qualitative supply of food
elements- proteins, fats, carbohydrates, minerals, and vitamins. If these essential
nutrients are received in the balanced amounts necessary to sustain life, to allow for
energy expenditure, and to promote growth and development, a child is well nourished.
The nutritional needs of a child depend on the age, sex, rate of growth, and the level of
activity.

Climate and Season: - Climatic variations influence the infant’s health. summer heat,
however, is important when parents may be unable to provide adequate refrigeration of
food and extermination of files and other insects. Infants in such families are prone to
suffer diarrhoea with subsequent dehydration. The seasons of the year influence growth
rates in height and weight, especially in older children. Weight gains are lowest in
spring and early summer and greatest in late summer and autumn. These differences
are probably due to seasonal variations in the activity levels of children.

Deviations From positive Health: - These may be caused by hereditary or congenital

conditions, illness, or injury and may result in altered levels of growth and
development. Conditions causing shortened stature include various types of Dwarfism,
Turner’s syndrome and XY Turner phenotype (Noonan Syndrome). Conditions causing
increase in height above normal include Marfan syndrome, and Klinefelter syndrome.
Long term or chronic illnesses of any type may have an adverse effect on growth and
development, like cystic fibrosis, inability to digest and absorb food, congenital cardiac
anomalies.

Exercise: - Exercise, by increasing the circulation, promotes physiologic activity and

stimulates muscular development; fresh air and moderate sunshine favor health and
growth.

Ordinal Position in the Family: - The behaviour of parents toward, and their
expectations of each child are different. The first-born child in a family is an only child
receives all the parental attention until the second child is born. The middle child many
times gets less attention from the parents than does the first-born. The middle child is
less achievement- oriented than the first-born and may be aggressive in meeting life
goals. The youngest child in a family tends to be more peer-oriented less intellectually
inclined and less achievement oriented than older siblings. The youngest child receives
a great deal of love and attention and therefore tends to develop a good natured,
friendly, warm personality and high self esteem.
Internal Environment

Intelligence: - Intelligence is correlated to some degree with physical development- ie;

the child of high intelligence is likely to be taller and better developed than is the less
gifted child. Also intelligence influences mental and social development.

Hormonal Influence: - There is evidence that all hormones in the body affect growth in
some manner. Although three hormones – somatotropic hormone, the thyroid hormone,
and the hormones that stimulate the gonads are very important.

Somatotropic hormone or growth hormone : The sources of this is in the

adenohypophysis, the anterior or glandular portion of the hypophysis ceribri. T is
largely utilized during childhood. The growth hormone stimulates skeletal and protein
anabolism through the production of somatomedins or intermediary hormones. An
excess of growth hormone causes gigantism and a lack results in dwarfism.

Thyroid hormones : Thyroxine (T4) and triiodothyronine (T2), thyrotropic hormone

(TH) produced by aderohypophysis stimulates the thyroid gland to release T3 & T4.
These thyroid hormones stimulate general metabolism and are necessary for growth
and development after birth.

Hormones that stimulate the gonads : The adreno corticotropic hormone, produced by
the adenohypophysis stimulates hypothalamus and causes to secrete gonadotropic
hormones. The gonadotropic hormones stimulate the interstitial cells of the testes to
produce testosterone and interstitial cells of the ovaries to produce estrogen.

Other hormone that less directly influence the process of growth and development
include insulin, parathormone, cortisol and calcitonin.

Emotions: - Relationship with significant other persons, mother, father, siblings, peers
and teachers, among others play a vital role in the emotional, social and intellectual
development of the child.

DEVELOPMENTAL MILESTONE

Age Physical Social and Intellectual Language

 Emotional
Development Development Development
Development

Lies in foetal
position with Beginning to
knees tucked develop
up. Unable to concepts e.g.
raise head. becomes
Cries
Head falls aware of
vigorously.
backwards if physical
Bonds with Respond to
pulled to sit. sensations
At Birth mother. Smiles high-pitched
Reacts to such as hunger.
at mother. tones by
sudden sound. Explores using
moving his
Closes eye to his senses.
limbs.
bright light. Make eye
Opens eye contact and cry
when held in to indicate
an upright need.
position.

Pelvis is flat
when lying Takes
down. Lower increasing
back is still interest in his
Attentive to
weak. Back surroundings.
Squeals with sounds made
and neck firm Shows interest
pleasure by your voice.
when held in playthings.
appropriately. Indicates needs
sitting. Grasps Understand
Reacts with with
3 objects placed cause and
pleasure to differentiated
Months in hands. effect e.g. if you
familiar cries. Beginning
Turns head tie one end of a
routines. to vocalise.
round to have ribbon to his
Discriminates Smile in
a look at toe and the
smile. response to
objects. other to a
speech.
Establishes mobile, he will
eye contact. learn to move
the mobile.

6 Can lift head Responds to Finds feet Double syllable

Months and shoulders. different tones interesting. sounds such as
Sits up with of mother. Understand 'mama' and
support. May show objects and 'dada'. Laughs
Enjoys 'stranger know what to in play. Screams
standing and shyness'. expect of them. with
jumping. Takes stuff to Understand annoyance.
Transfers mouth. 'up' and
objects from 'down' and
one hand to make
 the other.
Pulls self up to
sit and sits
erect with appropriate
supports. Rolls gestures, such
over prone to as raising his
supine. Palmer arms to be
grasp of cube. picked.
Well
established
visual sense.

Sits
unsupported.
Grasps with
thumb and
index finger.
Apprehensive
Releases toys Shows interest Babbles
about
by dropping. in picture tunefully.
strangers.
Wiggles and books. Vocalises to
9 Imitates hand-
crawls. Picks Watches attract
Months clapping.
up objects activities of attention. Enjoy
Clings to
with pincer others with communicating
familiar
grasp. Looks interest. with sounds.
adults.
for fallen
objects. Holds
bottle. Is
visually
attentive.

1 Year Stands holding Cooperates Responds to Babbles 2 or 3

furniture. with dressing. simple words
Stands alone Waves instructions. repeatedly.
for a second or goodbye. Uses trial-and- Responds to
two then Understands error to learn simple
collapses with simple about objects. instructions.
a bump. Walks commands. Understands
holding one Demonstrate several words.
hand. Bends affection. Uses jargon.
down and Participate in
picks up nursery
objects. Pulls rhymes.
to stand and
sits
deliberately.
May walk
alone. Holds
spoon. Points
at objects.
 Picks up small
objects.

Can crawl up
stairs
frontwards.
Kneels
unaided. Helps with
Balance is dressing.
Can
poor. Can Indicates
communicate
15 crawl down soiled or wet
Is very curious. needs. Jabbers
Months stairs paints.
freely and
backwards. Emotionally
loudly.
Builds 2 block dependent on
tower. Can familiar adult.
place objects
precisely.
Turns pages of
picture book.

Squats to pick
up toys. Can
walk alone. Plays alone
Drinks near familiar
without adult.
spilling. Picks Demands
up toy without constant
Enjoys simple Uses 'Jargon'.
falling over. mothering.
picture books. Uses many
Shows Drinks from a
Explores intelligible
18 preference for cup with both
environment. words. Repeats
Months one hand. Gets hands. Feeds
Knows the an adult's last
up/down self with a
names of parts word. Jabbering
stairs holding spoon. Attains
of his body. established.
onto rail. bowel control.
Begins to jump Tries to sing.
with both feet. Imitates
Can build a domestic
tower of 3 or 4 activities.
cubes and
throw a ball.

2 Years Can kick large Throws Joins 2-3 Talks to self

ball. Squats tantrum if words in continuously.
with ease. frustrated. Can sentences. Speaks over
Rises without put on shoes. Recognises two hundred
using hands. Completely details in words, and
Builds tower spoon feeds pictures. Uses accumulate
of six cubes. and drinks own name to new words very
Able to run. from cup. Is
 Walks up and
down stairs 2
feet per step.
Builds tower aware of
of 6 cubes. physical
refer to self. rapidly.
Turns picture needs. Dry by
book pages day.
one at a time.

Can jump off

lower steps.
Can pedal and
steer tricycle.
Goes up stairs
1 foot per step
and Plays co- Relates
downstairs 2 operatively . present
feet per step. Undresses activities and
Constantly asks
Copies circle. with past
questions.
Imitates cross assistance. experiences.
Speaks in
3 Years and draws Imaginary Can draw a
sentences.
man on companions. person with a
Talks to himself
request. Tries very head. Can sort
when playing.
Builds tower hard to please. objects into
of 9 cubes. Has Uses spoon simple
good pencil and fork. categories.
control. Can
cut paper with
scissors. Can
thread large
beads on a
string.

4 Years Sits with Argues with Counts up to Many infantile

knees crossed. other children. 20. Asks substitutions in
Ball games Plans games meanings of speech. Uses
skill increases. co-operatively. words. correct
Goes down Dresses and Questioning at grammar most
stairs one foot undresses its height. of the time.
per step. with Draw Enjoy counting
Imitates gate assistance. recognisable up to twenty by
with cubes. Attends to house. repetition.
Copies a cross. own toilet
Can turn sharp needs.
corners when Developing a
running. sense of
Builds a tower humour.
 Wants to be
of 10 cubes.
independent.

Skips. Well
developed ball
skills. Can
walk on along
Chooses own
a thin line.
friends. Fluent speech
Skips on both
Dresses and Writes name. with few
feet and hops.
undresses Draws a infantile
Draws a man
alone. Shows detailed substitutions in
and copies a
caring person. speech. Talks
5 Years triangle. Gives
attitudes Matches most about the past,
age. Can copy
towards colours. present and
an adult's
others. Copes Understands future with a
writing.
well with numbers. good sense of
Colours
personal time.
pictures
needs.
carefully.
Builds steps
with 3-4
cubes.

Learns to skip
Fluent speech.
with rope. Stubborn and Draws with
Can pronounce
Copies a demanding. precision and
majority of the
diamond. Eager for fresh to detail.
sounds of his
6 Years Knows right experiences. Developing
own language.
from left and May be reading skills
Talk fluently
number of quarrelsome well. May write
and with
fingers. Ties with friends. independently.
confidence.
shoe laces.

PHYSICAL OR BIOLOGICAL GROWTH

MEASUREMENT BIRTH INFAN TODDLE PRESCHOO SCHOO ADOLESCEN

S T R L L T
CHILD
HEIGHT 19 – 21 inches 75-80 82.5- 103-115cm Male- Male-163-
(48- cm 85cm 142- 182cm
53centimeters) 158cm Female-156-
Female 170cm
-144-
160cm
WEIGHT 6pounds2ounc 9-11kg 11.8- 15.4- Male- Male-56-
 es - 12.7kg 21.4kg 30- 80kg
9pounds2ounc 48kg Female-48-
es (2812grms- Female 72kg
4173grms) -30-
50kg
HEAD 33-35cm 46cm 49.3- 50-51.5cm 52cm 52cm or
CIRCUMFERENC 50.5cm above
E
CHEST 31-33cm 46cm 50-55cm 56-58cm 58cm Equal to
CIRCUMFERENC or adult size
E above
MID ARM 11-12cm 12- 16-17cm 16-17cm 17- 20cm &
CIRCUMFERENC 16cm 18cm above
E

GROWTH CHART

A growth chart is used by paediatricians and other health care providers to follow a
child's growth over time. Growth charts have been constructed by observing the growth
of large numbers of normal children over time. The height, weight, and head
circumference of a child can be compared to the expected parameters of children of the
same age and sex to determine whether the child is growing appropriately. Growth
charts can also be used to predict the expected adult height and weight of a child
because, in general, children maintain a fairly constant growth curve. When a child
deviates from his or her previously established growth curve, investigation into the
cause is generally warranted. For instance, a decrease in the growth velocity may
indicate the onset of a chronic illness such as inflammatory bowel disease.

Growth charts can also be compiled with a portion of the population deemed to have
been raised in more or less ideal environments, such as nutrition that conforms to
paediatric guidelines, and no maternal smoking. Charts from these sources end up with
slightly taller but thinner averages.

Growth charts are different for boys and girls, due in part to pubertal differences and
disparity in final adult height. In addition, children with diseases such as Down
syndrome and Turner syndrome follow distinct growth curves which deviate
significantly from normal children. As such, growth charts have been created to
describe the expected growth patterns of several genetic diseases.

GROWTH CHART OF BOYS 2-20YEARS OF AGE

GROWTH CHART OF GIRLS 2-20 YEARS OF AGE

DENTITION
CHRONOLOGY OF PRIMARY OR DECIDUOUS TEETH

TEETH ERUPTION SHEDDING

MAXILLARY MANDIBULAR MAXILLARY MANDIBULAR
Central incisor 6-8 month 5-7 month 7-8 year 6-7 year
Lateral incisors 8-11 month 7-10 month 8-9 year 7-8 year
Cuspids 16-20 month 16-20 month 11-12 year 9-11 year
(canines)
First molar 10-16 month 10-16 month 10-11 year 10-12 year
Second molar 20-30 month 20-30 month 10-12 year 11-13 year

CHRONOLOGY OF SECONDARY OR PERMANENT TEETH

TEETH ERUPTION
MAXILLARY MANDIBULAR
Central incisors 7-8 year 6-7 year
Lateral incisors 8-9 year 7-8 year
Cuspids (canines) 11-12 year 9-11 year
First premolars (bicuspids) 10-11 year 10-12 year
Second premolars (bicuspids) 10-12 year 11-13 year
First molar 6-7 year 6-7 year
Second molar 12-13 year 12-13 year
Third molar 17-22 year 17-22 year

IMMUNIZATION

Immunization is the process whereby a person is made immune or resistant to an

infectious disease, typically by the administration of a vaccine. Vaccines stimulate the
body’s own immune system to protect the person against subsequent infection or
disease. Immunization is a proven tool for controlling and eliminating life-threatening
infectious diseases and is estimated to avert over between 2 and 3 million deaths each
year. It is one of the most cost-effective health investments, with proven strategies that
make it accessible to even the most hard-to-reach and vulnerable populations. It has
clearly defined target groups; it can be delivered effectively through outreach activities;
and vaccination does not require any major lifestyle change.

SL
AGE DISEASE VACCINATION
NO.
1 AT BIRTH HEPATITIS B HEP B VACCINE –I
2 AT BIRTH POLIO ORAL PV 0 DOSE
3 BIRTH TO 6 WK TUBERCULOSIS BCG
4 4 -6 WEEKS HEPATITIS B HEP B VACCINE –II
DIPHTHERIA
PERTUSIS DPT-I
5 6 WEEKS
TETANUS OPV –I
POLIO
DIPHTHERIA
PERTUSIS DPT-II
6 10 WK TETANUS OPV-II
POLIO HEP B VACCINE III*
HEPATITIS B
DIPHTHERIA
DPT-III
PERTUSIS
7 14 WEEKS OPV- III
TETANUS
HEP B VACCINE IV*
POLIO
8 24 WEEKS HEPATITIS B HEP B VACCINE III*
POLIO OPV-IV
9 9 -12MTHS
MEASLES MEASLES
MUMPS
10 15-18 MTHS MEASELES MMR*
RUBELLA
DIPHTHERIA
PERTUSIS DPT –BOOSTER I
11 18 MTHS
TETANUS OPV –V
POLIO
12 24 MTHS TYPHOID TYPHOID*
DIPHTHERIA
PERTUSIS DPT BOOSTER – II
13 4-5 YR
TETANUS OPV –VI
POLIO

OTHER AVAILABLE VACCINES

SL
AGE DISEASE VACCINATION
NO.
1 6 WEEKS H influenza B HiB
2 10 WK H influenza B HiB
3 14 WK H influenza B HiB
4 18 MTHS H influenza B HiB
5 24 MTHS HEPATITIS A H A VACCINE-I
6 30 MTHS HEPATITIS A H A VACCINE –II
7 12 MTHS CHICKENPOX VARICELLA VACCINE
8 MENINGOCOCCAL MENINGOCOCCAL
24 MTHS
A&C VACCINE
9 12 MTHS PNEUMOCOCCAL PNEUMOCOCCAL VACCINE
10 12 MTHS INFLUENZA INFLUENZA VACCINE

ON GOING VACCINATIONS

SL
AGE DISEASE VACCINATION
NO.
1 10 YEARS TETANUS TT
2 5 YEARS TYPHOID TYPHOID
3 MENINGOCOCCAL
5 YEARS MENINGOCOCCAL VACCINE
A&C
4 NID’S & SNID’S POLIO ERADICATION PULSE POLIO

REFLEXES
(1) ROOTING:-

Stimulation: - Touching or stroking the cheek near the corner of the mouth.

Response: - Head turns in direction of stimulation so that the neonate can find food.
When the breast touches the cheek, neonate turns toward the nipple.

Disappearance: - 6th week of life when the source of food can be seen. Disappears 3-4
months when awake when asleep 7-8 months.

(2) SUCKING:-

Stimulation: - Touching the lips with the nipple of the breast or bottle or other object.

Response: - Sucking movements that enable the newborn to take in food.

Disappearance: - Begins to diminish at 6 months disappears soon after birth it not

stimulates. If a neonate cannot take oral feedings a pacifier may be need to maintain the
reflex.

(3) SWALLOWING:-

Stimulation: - Accompanies the sucking reflex

Response: - Food reaching the posterior of the mouth is swallowed.

Disappearance: - Doses not disappear.

(4) GANGING:-

Stimulation: - when more is taken into the mouth that can be successfully swallowed.

Response: - Immediate return of undigested food.

Disappearance: - Does not disappear.

(5) SNEEZING AND COUGHING:

Stimulation: - Foreign substance entering the upper or lower airways.

Response: - Clearing of upper air passages by sneezing, the lower air passages by
coughing.

Disappearance: - Does not disappear.

(6) EXTRUSION:-

Stimulation: - Substances placed on anterior position of tongue.

Response: - Extrusion of the substance to prevent swallowing.

Disappearance: - About 4 months.

(7) BLINKING:-
Stimulation: - Exposure of eyes to bright light from a flash light or otoscope or sudden
movement of an object toward eye.

Response: - Protection of the eye by rapid eyelid closure.

Disappearance: - Does not disappear.

(8) DOLL’s EYE:-

Stimulation: - Turn the newborn’s head slowly to the right or left side.

Response: - Normally eyes do not move.

Disappearance: - When fixation develops.

(9) PALMAR GRASP:-

Stimulation: - Object placed in new born’s palm.

Response: - Grasping of object by closing fingers around it.

Disappearance: - 6 weeks to 3 months. Purposeful grasp is evident at 3 months of age.

(10) PLANTAR GRASP:-

Stimulation: - Touching the sole at the foot at the base of the toes.

Response: - Toes grasp around very small object.

Disappearance: - 8 to 9 months in preparation for walking may continue to be present

during sleep.

(11) DANCING (STEP-IN-PLACE):-

Stimulation: - Hold neonate in a vertical position with the feet touching a flat, firm
surface.

Response: - Rapid alternative flexion and extension of the legs as in stepping.

Disappearance: - 3-4 weeks. The neonate soon the reefer can bear some weight on the
legs without stepping.

(12) BABINSKI:-

Stimulation: - Stroking the lateral aspect of the sole of the foot with a relatively sharp
object from the heal up to ward the little toe and across the foot to the big toe.

Response: - Fans the toes (+ve Babinski sign). The adult normally flexes the toes. The
newborns response is due to an immature level of nervous system development.

Disappearance: - 3-4 weeks. 3 months of age; variable.

(13) TONIC NECK (FENCINA POSITION):-

Stimulation: - Turing the head quickly to one side while the infant is supine.

Response: - Arm and leg on the side the head is turned toward extend. Arm and leg on
the opposite side flex. Both hands may make fists.

Disappearance: - 18-20 weeks. Tonic neck reflex is replaced with symmetric positioning
of both sides of the body.

(14) MORO (STARTLE):-

Stimulation: - Startling the infant with a loud voice or apparent loss at support due to a
change in equilibrium. The neonate is hold in a supine position above the table or be.
The Nurse supports the upper back and head with the other. The newborn’s head is
suddenly allowed to drop backward an inch or so.

Response: - Generalized muscular activity symmetric abduction and extension of the

arms and legs with fanning of the fingers. The thumb and index finger on each hand
from a C shape. The extremities then flex and adduct the baby may cry.

Disappearance: - Strong up to 2 months. Disappears by 3-4 months.

NEEDS OF INFANTS
  Love and security
 Infant temperament and the parents
 Dependence progressing to independence
 Discipline leading to self control
 Developing self esteem
 Infant nutrition

NEEDS OF TODDLER

1. Love and security

 Separation anxiety
 Regression
2. Discipline leading to self control
 Setting of limits
 Constructive discipline
 Consistency
 Clarity
 Firmness
 Immediacy
 Encouragement of independence
 Disciplinary action
 Physical punishment
 Explaining or reprimanding
 Taking “time-out”
 Outcomes of discipline
3. Dependence progressing to independence in self care
4. Achieving control of bodily functions
 Meaning of toilet training to the toddler
 Indications of the toddler’s readiness for training
 Physiologic readiness
 Psychologic readiness
 Intellectual readiness
 Process of toilet training
5. Developing self esteem

NEEDS OF PRESCHOOLER
 1. Emotional-social needs
 Love and security
 Guidance
2. Dependence progressing to independence
 Nursery school and kindergarten
 Separation
3. Discipline leading to self control
 Bed time problems-sleep
 Selfishness
 Hurting others
 Destructiveness
4. Developing self esteem
5. Physiologic-biologic needs, control of bodily functions
 Enuresis
 Encopresis

NEEDS OF SCHOOL CHILDREN

Health promotion and anticipatory guidance

 Nutrition
 Eating habits
 School vending machines
 Dental health
 Sleep and rest
 Activities accident prevention
 Sex education
 Prevention of sexual molestation
 Smoking and drugs

BEHAVIOURAL PROBLEMS
Behavioural problems in children are outcome of three factors. Genetic predisposition,
child rearing practices, social and school environment. Child + nature + nurture +society
= behaviour of child. So, we can see that child is no way responsible for his behaviour.
We each have the kind of children we deserve. If there is anything we wish to change in
the child, we should first examine it and see whether it is not something that could
better be changed in ourselves. Someday, may be, there will exist a well-informed, well
considered and yet fervent public conviction that the most deadly of all possible sins is
the mutilation of a child's spirit. A hundred years from now it will not matter what my
bank account was, the sort of house I lived in, or the kind of car I drove...but the world
may be different because I was important in the life of a child.

1. Infantile problems
 Evening colic
 Feeding problems
-Over feeding
-Under feeding
-Excessive spitting
-Rumination
 Stranger anxiety
2. Early childhood problems
 Thumb sucking
 Breath holding spells
 Temper tantrum
 Pica
3. Problems of young child
 Enuresis (bed wetting)
 Stuttering
 Tics
 Nail biting
4. Adolescent behavior problems
 Anorexia nervosa
 Masturbation
 Juvenile delinquency

Approach to a child with behaviour disorder

1. Back ground history

2. Assess severity
3. Identify triggers
4. Increase appropriate behavior
5. Decrease inappropriate behavior
6. Skill development
7. Loving attitude
8. Parent management training

ACCIDENT PREVENTION
Accidental injuries to infants and young children are often serious, but are largely
preventable with appropriate information and safe practices. Young children are
particularly vulnerable to accidents due to their innate desire to explore their world and
the inability to perceive the dangers of their actions. As children learn through
experience, minor injuries are inevitable but providing a safe environment can reduce
the risks, coupled with close supervision and setting the limits of safety. Parents should
remember that they need to maintain a constant balance between overprotecting the
child on one hand and giving him freedom in his process of learning the hazards of his
environment.

What to do to Prevent Accidents in Young Children?

Specific Do's

 Use appropriate barriers for stairs, landings, rooftops and fireplaces. Vertical
banisters for windows are preferable to horizontal ones, as children cannot
climb upon them out of curiosity and risk falling from a height.

 Supervise young children particularly during the use of fireworks, escalators,

kite- flying and swimming.

 Use dummy plugs to cover unused sockets and install safety circuits.
Alternatively place heavy furniture in front of them.

 Keep your cupboards securely locked, as these are one of the favorite places for
young children to hide. Accidental closure can result in choking.

 Always read labels carefully before administering any medication to the child. All
medicines should be kept away from children's reach as even apparently
harmless tablets and syrups such as iron tablets and paracetamol can prove
dangerous as they look attractive and may result in a fatal overdose if taken
accidentally. Discard all old and partially used medications.

 Instruct your children to hold on firmly to swings, slides, and seesaws while
playing.

 Small objects like beans, buttons, beads and safety pins must be kept out of reach
of children particularly below the age of two years.

 Teach your child to look left and right before crossing roads. Preferably, make
your child wear brightly- colored clothes, as it is safer while walking at night.

 Preferably, young children should be made to sit in the backseat of the car. If
they sit in front, the use of seat belts should be mandatory.

Specific Don’ts
  Never leave your infant or young child alone near a bathtub, bucket, hot iron,
teapot in the kitchen, etc.

 Do not allow children to play with plastic bags covering their heads and faces, as
these can cause asphyxiation.

 Do not hold your baby in the lap while drinking anything hot or while cooking.

 Do not allow children to play and run with sharp objects in their mouths.
Accidental falls can result in severe lacerated wounds in the mouth and throat.

 Do not allow children to perform new skills without giving them proper
demonstration and training.

 Anticipating potential dangers and taking simple measures will go a long way
towards preventing suffering and making your home a safe place for your little
ones.

Prevent Accidental Poisoning

• Cleaning detergents, insecticides, pesticides, and herbicides are in safety-latched

cabinets.

• Poisonous plants are kept out of children’s reach.

• Medications and vitamins are in safety-latched or locked cabinets.

• Hobby chemicals, such as paint thinner or film developing products, are locked away.

• Family members are able to recognize poisonous insects, snakes, and wild plants.

• Suspected gas leaks from household appliances are fixed.

• Fuel, such as for oil lamps or portable heaters, is stored out of reach.

• Poison Control Centre hotline number is posted clearly by the phone.

• Vehicles are never left running in an enclosed area.

Fire and Burn Prevention

• Everyone knows how to dial 911.

• Everyone knows the fire escape plan and routes.

• A fire extinguisher is kept in the kitchen, garage, and near a fireplace.

• Smoke detectors are installed throughout the home and batteries are regularly

checked.

• Matches, fire starters, and lighters are out of children’s reach.

• Guards are in place around fireplaces, woodstoves, radiators, or hot pipes.

• Fireplace chimney is professionally cleaned yearly.

• After running 3 minutes, water temperature is 120 degrees or less to prevent

scalding.

• Electrical sockets not in use are plugged.

• If a home space heater must be used, it’s kept from curtains and flammable

materials.

• Trash flammables, such as hair spray or paint cans, are never tossed into a fire.

• Children are always supervised when near burning sticks, leaves, grass, or trash.

Preventing Falls

• Stairways indoors and outdoors have handrails and are clear of toys and tripping
hazards.

• Stairways are gated off for very young children.

• In inclement weather, walkways are kept clear of ice.

• Non-slip throw rugs are used.

Kitchen and Food Safety

• When using a stove, pot handles are turned towards the back of the stove, out of

reach of children. When possible, only back burners are used on the stove.

• Food poisoning is prevented through safe food storage and preparation.

• Appliance cords are kept out of reach.

• Highchairs and children’s eating tables are away from stove or hot appliances.

• Food and drink temperatures are tested before serving to children.

• Hot liquids and foods served at the table are kept out of children’s reach.

• All cabinets and drawers are safety-latched.

• Knives, appliance blades, and sharp cooking utensils are out of children’s reach.

Garage/Shed Storage Safety

• Trash is kept in tightly covered container.

• Automotive, woodworking, garden, or house painting tools are out of children’s reach.

• Keys to any vehicle are stored out of children’s reach.

• Vehicles are always left turned off in the “park” gear.

Transportation Safety

• Adults and children always buckle up and each child is restrained in an age-
appropriate, safety-approved safety seat that has been correctly installed.

• All vehicles have a first aid kit and fire extinguisher on board.

• Children are never, ever left alone in a car, whether it’s running or not.

• Car doors are locked when car is in motion.

• Motorcycle riders and bike riders wear a helmet.

Outdoor Play Safety

• Play space is fenced in or children are continually supervised by an adult.

• When not in use, sandboxes are covered and kiddy pools are drained.

• Swimming pools and garden ponds are fenced off. Swimming children are always
supervised. Toys aren’t left in pools after play to entice children.

• Protective gear, such as helmets or kneepads, is used when riding bikes or scooters.

• Floatation devices are used during boating, or whenever swimming without

supervision.

• All play equipment is assembled correctly, and if applicable, securely anchored.

• There is adequate play space around all equipment, such as swings and slides.

• Climbers have a thick layer of impact absorbing material under fall zones

• Play equipment is free of head, finger, arm, leg, and foot entrapment hazards.

• Children under age 10 never cross the street alone.

Toy Safety
• Toys are painted with non-toxic paint.

• Toys are regularly inspected so broken toys are discarded.

• Wooden toys are kept splinter-free.

• Infants, toddlers, and twos have toys that won’t fit into the mouth to cause choking.

• Removable parts on toys aren’t small enough to fit into preschooler’s nose or ears.

• Only older preschoolers and up use battery-operated toys.

• Storage containers close securely and don’t pose pinching hazards.

Sleeping Area Safety

• Infants are placed on their backs to sleep.

• Children’s sleepwear is fire-retardant.

• Shelving isn’t top-heavy and can’t easily be pulled over onto a child’s body.

• Beds are away from radiators or other hot surfaces.

• Infant and toddler’s crib slats are no more than 23⁄8 inches apart.

• Bed mattress fits sides of crib or bed snugly.

Bathroom Safety

• Razors, razor blades, and sharp objects are out of children’s reach.

• Bottom of tub or shower has rubber stickers or mat to prevent slipping.

• Young children are never left in the tub without adult supervision.

• Potential poisons, such as shampoos, deodorant, cosmetics, are out of children’s reach.

• Hairdryers, curling rods, razors are never left plugged in and are used away from
water.

General Safety Precautions

• First aid kit is fully stocked and regularly replenished.

• Guns are never stored loaded with ammunition. Guns have safety locks that are
conscientiously used. Guns and ammunition are always in a locked cabinet away from
children.

• Small hobby objects, such as sewing buttons, safety pins, glue guns, are out of
children’s reach.

• Indoor and outdoor safety checks are conducted regularly.

• Emergency response plans (fire or tornado) are established and practiced regularly.

• Children under age 12 are never left home alone.

• Plastic bags, curtain cords, and shade pulls are out of children’s reach.

• Windows have screens and locks.

• Purses, brief cases and adult backpacks of family and visitors are out of children’s
reach. (Such items might have cigarette lighters, pocket knives, or other items that are
dangerous if children have access to them.)

PLAY THERAPY
Play is universal for all children. It is work for them and ways of their living. It is
pleasurable and enjoyable aspect of child’s life and essential to promote growth and
development. Play is the activity that has no serious motive and from which there is no
material gain. The distinction between work and play however lies in the mental
attitude.

Importance of Play

Play helps in development of children in various aspects i.e, physical, intellectual,or

educational, emotional, moral and social.

Types of Play

Play is natural and spontaneous. It depends upon age, sex, interest, personality, ability,
cultural pattern and socio-economic status of child’s family.

INFANTS- Usually engage in social affective play, sense-pleasure play and skill play. In
social affective play infants response by smiling, cooing to the interacting adult. In sense
pleasure play, they learn and explore environment through various sensory experience.
They develop skills through imitation.

PRESCHOOL CHILDREN- They enjoy dramatic play through which they identify
themselves with adult and dramatize adult’s behaviour.

SCHOOL CHILDREN- They enjoy competitive sports , games and they develop hobbies
for recreation and diversion.

ADOLESCENTS AND OLDER SCOOL AGE CHILDREN engage in a more sophisticated type
of fantasy activity called day dreaming.

According to Parten and Newhall, play behaviour can be described as-

1. In occupied play behaviour- The child is not involved in play activity but may move
around randomly, crawl under a table, climb on and off a chair or follow another person
or just stand alone with least social involvement.

2. Solitary independent play- Indicates when the child plays independently. Toddlers
and pretoddlers engage in this type of concentrating play with less interaction with
others.

3.Onlooker play- This behaviour found when the child watches others play but does not
become engaged in their play. The child may sit nearby or hear or see what others are
doing or talking as he /she feels interest.

4. Parallel play- Is an independent play activity when the child plays alongside other
children but not with them. Toddlers typically play in this manner.

5. In associative play- Social interactions occur between children. This is common in

preschool age group. They play with same thing and do similar activity.

6. Co-operative play- Behaviour is found in preschool and school children. They engage
in formal game in group like football or dramatic play of life situation.

SELECTION AND CARE OF PLAY MATERIALS

 Selection of play materials and toys depends upon age, abilities, interests, likes and
dislikes, culture, experience, personality and level of intelligence of the child.

The play materials should have the following characteristics-

 Safe, washable, light weight, simple, durable, easy to handle and non-
breakable.
 Realistic, attractive, constructive and offer problem solving opportunities.
 No sharp edges and no small removable parts which may be swallowed or
inhaled.
 Not over stimulating and frustrating.
 No toxic paints, not costly, not inflammable and not excessive noisy.
 Play things with electrical plugs should be avoided, only children over 8 years
of age should be permitted to use them.

Children must be taught the followings-

 Correct use of toys. Parent should explain the directions for use and the caution
labels.
 Safe storing of toys in a space with easy reach and away from busy areas.
 Keeping the playthings in good conditions. Parents should repair or discard
damaged and broken toys.
 Keeping the play materials of older brothers and sisters away from younger
children. The wrong toys for wrong ages can be injurious to children.
 Electronic toys and games can also be shared by the adults in the children’s play
time. Parents may interact and initiate the use with precautions.

SUITABLE PLAY MATERIALS ACCORDING TO AGE

INFANT

4weeks- Bright and moving objects, hanging cradle toys, musical toys,
4months balloons, rattles etc.

4-6months Soft squeeze toys, rattles, toy animals, balloons etc.

7-9months Squeeze and sound toys, blocks, cubes, plastic ring, rattles etc.

10-12months Motion toys, water play, blocks doll, ball, musical toys, picture books
or stiff cards, rocking horse walker, transporting objects, pull and
push toys.
TODDLER Fitting toys, pull-push toys, blocks, vehicles, dolls, ball, pots and pans,
house hold articles, mud or clay, crayons, picture books or cards,
play telephone, doll’s house etc.
PRESCHOOL Puppets, animals, dolls, doll’s house, carpentary tools, large blocks,
CHILDREN paint materials, colored picture books, doctor set toys, hospital
equipments, housekeeping toys, paper modelling clay, cooking
materials, tricycles etc.
SCHOOL-AGE They like games rather than toys. They enjoy games of muscular
CHILDREN activity, running climbing, swinging, etc. They like carpentary tools,
painting materials, chess, chinese-checkers, cards, balls, crafts,
music, puzzles, aquarium, maps, animals to make zoo or pets,
gardening etc.

THERAPEUTIC PLAY
Play can provide a release from stress and tension for individuals of all ages. The sick
child needs play to fill lonely hours and for expressing feeling and aggression through it,
to reduce the trauma caused by hospitalization. Therapeutic play is the specialized play
activities by which a child acts out or expresses his unconscious feelings.

IMPORTANCE OF PLAY FOR HOSPITALIZED CHILDREN

It helps the child-:

1. To enhance coping abilities in hospital environment.

2. To express fear, anxiety, tension, anger, and fantasies.
3. To understand and comprehend the hospital procedures.
4. To communicate with others and to reduce emotional trauma due to hospital
experiences.
5. To continue growth and development in physical, psychological, social, moral
and educational aspects.
6. To get rid of boredom due to prolong illness and to release hostile feelings.

It helps the health team members-:

1. To gain co-operation and trusting relationship of the hospitalized children and

their family members.
2. To diagnose the child’s feeling and behavior and plan for psychological approach
during care.
3. To find out and correct the misconceptions and beliefs regarding hospitalized
care.
4. To reassure the anxious parent and to promote their participation in child care
during illness and wellness.

TYPES OF PLAY FOR HOSPITALIZED CHILDREN

1. Emotional outlet or dramatic play – It is used to express the child’s anxiety, to

solve conflict and as a diagnostic tool to identify child’s concern about the illness
and hospitalization.
2. Instructional play – Instruction is given for therapeutic play to the children
according to their past experiences, coping abilities and psychological status.
3. Physiologic enhancement play – It is used to maintain and improve physical
health and body functions. It can be selected to treat pathological conditions.