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Updated: Feb 2 2023

Normal Development Landmarks

(0-3 mos)
0-1 mo moro grasp and reflex, visual tracking
  • crying
2 mos holds head up, swipes at objects 
  • cooing
social smile
INFANT (3-12 mos) 3 mos lifting head and chest, moro reflex disappears    
4 mos

rolls from prone to supine,grasps objects



  • orients to voice
  • colic resolves in most babies by this age


6 mos   sits upright
  • babbles
stranger anxiety
9 mos crawls, pull-to-stand, pincer grasp, eats with fingers
  • mama-dada (nonspecific)
waves bye-bye, responds to name

(12-24 mos)

12 mos stands
  • mama-dada (specific)  
picture book
15 mos walks, uses cup
  • several words
temper tantrums
18 mos walks up stairs, throws ball
  • names objects
toilet-training begins 
24 mos runs
  • 2-word sentences, several hundred word vocabulary
follows 2-step commands  
(3-6 years)
36 mos rides tricycle (3yrs), eats with utensils


  • 3-word sentences
  • Clinical correlate
    • selective mutism  
      • selectively mute in specific settings 



knows first and last name

average age of potty training 

(6-11 years)
development of conscience (super-ego), has same-sex friends
(Girls-11yrs, Boys-13 yrs)
abstract reasoning, the formation of personality, may have friends of opposite sex
  • Feeding patterns
    • From birth to six months of age, breastfeeding has preferred the source of nutrition
    • All breastfed infants should be supplemented with vitamin D
    • Preterm breastfed infants should be additionally supplemented with iron
    • Solid foods introduced at six months of age
    • Cow's milk introduced at 12 months of age
  • Cyclic vomiting syndrome - an idiopathic disorder in 4-7 yr old children
    • repeated, stereotypical bouts of acute vomiting accompanied by severe nausea, lethargy, and possibly fever, pallor, diarrhea, headache, and/or photophobia with a return to normal health between episodes 
    • diagnosis of exclusion
    • supportive therapy for management; amitryptiline may be useful in the prevention
    • children outgrow by teenage years
  • Physical activity
    • should be encouraged at a young age to develop habits
    • children should engage in activities they enjoy with structured time allocated
      • weight lifting is appropriate in young children with proper form and instruction 
Breath-Holding Spells
  • Introduction
    • breath-holding spells may be
      • cyanotic or pallid
  • Epidemiology
    • incidence
      • 4.6%
    • age
      • can occur between 6 months to 6 years of age
        • most cases occur before 18 months of age
  • Prognosis
    • usually resolves by school age
    • iron supplementation may reduce the breath-holding spell frequency in
      • patients who are anemic or iron-deficient
Breath-Holding Spells
Trigger Clinical Features Treatment
  • Cyanotic (~80% of cases)
  • Emotional insults such as
    • pain
    • anger
    • frustration
  • Typically the patient vigorously cries, which is followed by
    • forced expiration and breath-holding resulting in
      • cyanosis
        • patients often collapse and lose consciousness and can become limp
  • May be associated with
    • generalized clonic jerks
    • opisthotonos
    • bradycardia
  • Education and reassurance
  • Pallid (~20% of cases)
  • The patient may become quiet, which is followed by
    • breath-holding in the expiratory phase that results in
      • pallor
      • brief loss of consciousness
      • loss of muscle tone
      • diaphoretic
  • There is cardiac bradycardia
  • Tonic rigidity may be seen


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