Age Specific Competency Criteria/Guidelines
Age-specific competencies and skills

What are typical milestones, or skills, children learn at different ages?

Preschool Education

Your Baby at 1 Week Your Baby at 2 Weeks Baby Month 1 Baby Month 2 Baby Month 3 Baby Month 4 Baby Month 5 Baby Month 6 Baby Month 7 Baby Month 8 Baby Month 9 Baby Month 10 Baby Month 11 Baby Month 12 Skills You Can Expect Kids to Learn by Age 1 Toddler Month 13 Toddler Month 14 Toddler Month 15 Toddler Month 16 Toddler Month 17 Toddler Month 18 Toddler Month 19 Toddler Month 20 Toddler Month 21 Toddler Month 22 Toddler Month 23 Toddler Month 24 Newborn to 1 Month Physical Development : •Ability to make visual distinction •Recognition of speech, sound, and smell •Ability to move their head •Increase in weight and size of the baby •Begin to smile •May cry frequently to express itself •Will want to eat every three to four hours •Will sleep for almost two-thirds of the entire day Emotional Development : Most babies tend to have a sense of generalized tension because of a general feeling of helplessness. They also display signs of distress and delight. Social Development : Babies who are not even a month old tend to display asocial tendencies. 1 - 3 Months Physical Development : •Tend to respond more distinctly to sound and respond in return •Ability to change facial expressions, coo, and gurgle •Require less support to head than before because of gain in head control •Signs of being able to move •Better reflexes and movement to grasp objects •Increase in sleeping periods Emotional Development : This is the age where the baby starts responding to affection and will show signs of enjoying cuddling. Social Development : You will notice that your baby now starts responding to smiles and will fixate on faces. This is the beginning of his social development. 3 - 6 Months Physical Development : •Greater mobility; ability to roll and crawl by dragging themselves on their bellies •Playing with their fingers and toes •Sitting up with minimal support or while leaning on their hands in tripod position •The weight of the baby should be double of what it was when born •Crying outbursts are restricted to specific reasons •Better coordination and motor skills •Ability to make and enjoy sounds •The number of feeding sessions will reduce •Sleeping pattern becomes more predictable •Fascinated by simple games Emotional Development : At this age, most babies start displaying a certain level of attachment to their mothers and look for them. Social Development : It is at this age that kids start recognizing their mother, expect to be dressed and bathed, and also expect to play simple games with their parents. 6 - 9 Months Physical Development : •Ability to sit unassisted •Trying to stand •Most babies start crawling or at least try to crawl by this time •Ability to make different consonant sounds •Better control over actions •Teething may start during this time •Start getting used to solid foods Emotional Development : There is lessening of the out-of-sight, out-of-mind phenomenon as they start looking for things that they have an attachment to. Social Development : It is at this stage that many parents notice stranger anxiety in their kids. It is possible that they will fear strangers and may throw crying fits around them. 9 - 12 Months Physical Development : •Ability to sit on their own without help •Making attempts to stand by holding on to things •Ability to utter their first words •Ability to communicate effectively to get their point across •Better coordination and grasping abilities Emotional Development : Most babies tend to display fear when they are separated from their mothers. They get anxious and may even throw tantrums. Social Development : Most babies of this age group are responsive to their names and also recognize their reflection. They also may be able to follow instructions. 12 - 18 Months Physical Development : •Ability to walk without any assistance or with limited help •A couple of additions to the vocabulary excluding names for parents •Better motor skills and fine coordination Emotional Development : The increased emotional dependence continues but the fear is lessened and a little more trust is established. Social Development : Babies this age tend to be extremely curious and start to explore their surroundings. It is important that in this stage parents keep a close eye on the baby. 18 - 24 Months Physical Development : •Increase in vocabulary and an ability to understand things better •Walking up the staircase with a little assistance •Better motor skills and better coordination •Better bowel and bladder control •Proper sleep pattern Emotional Development : Many toddlers of this age tend to throw temper tantrums if they do not get what they want. They also become more aware of other people's emotions, reflecting them in some situations Social Development : Anxiety around other toddlers may be a common social behavioral pattern. They may also show anxiety when they think that unpleasant situations are going to occur. 2 - 3 Years Physical Development : •Ability to talk in complete sentences •Ability to understand and follow rules •Motor skills become more confident and they tend to walk, jump, and climb with ease •Ability to dress themselves •Ability to name and categorize things Emotional Development : Some children of this age group tend to show negative and violent tendencies. They may throw temper tantrums. They are also capable of identifying different emotions from facial expressions and respond to them. Social Development : Many kids show a tendency to copy their parents. They also have a stubborn necessity to follow routine without any disturbance whatsoever. 3 Years and Above Physical Development : •Self-reliant and an ability to help themselves with minimal assistance •Efficient vocabulary and an ability to made oneself understood with great ease •Able recognition of color, shapes, and sizes •Ability to draw circles and shapes of different kind •Decides to toilet train Emotional Development : Children of this age often are capable of showing affection and do so with much ease. They also are capable of feeling emotions such as guilt and pride. Social Development : Most kids start school at this age and tend to make friends easily. They tend to be cooperative and will like to share things. They also tend to take on roles performed by same-sex parent. Skills You Can Expect Kids to Learn by Age 2 How old are you? What is expected of you?

Toddler Month 13 Toddler Month 14 Toddler Month 15 Toddler Month 16 Toddler Month 17 Toddler Month 18 Toddler Month 19 Toddler Month 20 Toddler Month 21 Toddler Month 22 Toddler Month 23 Toddler Month 24 Skills You Can Expect Kids to Learn by Age 2

Skills You Can Expect Kids to Learn by Age 3

Age 3 Age 4 Age 5 Age 6 Age 7 Age 8 Age 9 Age 10 Age 11 Age 12 Age 13-18

Infancy (Birth to 1 Year) Toddler (1 – 3 Years) Preschool (3-5 Years) Middle Childhood (6 – 12 Years) Adolescence (13 – 17 Years)

Young Adulthood (18 – 40 Years) Middle Adulthood (40 – 64 Years) Late Adulthood (65 Years and older)

Child Development milestones

Assessment of growth, development and maturation focuses on four major areas: physical, cognitive, social and emotional capabilities. Physical capabilities include gross and fine motor skills as well as strength, stamina, fatigue and pain. Cognitive capabilities include thought, perception, understanding and reasoning. Social capabilities are reflected by relationships established with family, friends, and others. Emotional capabilities reflect one’s awareness and ability to apply feelings to people and situations. This review will describe the major growth and development characteristics and milestones for children and adults. This is only a guide and is in no way to be used to interpret what all people are like or should be like. Remember people are individuals! As medical professionals, we are expected to adapt our exam and assessments to the developmental level of the individual. Each section will describe various nursing considerations to keep in mind when dealing with each developmental level. INFANT: BIRTH TO ONE YEAR NEONATE: Birth to 1 month Physical Development Has Strong Reflexes: a. Automatic Grasp Reflex- Infant’s fingers curve around finger placed in infant’s palm/ b. Sucking Reflex- Neonate sucks on object placed in mouth. c. Rooting Reflex- when cheek is brushed, neonate turns head toward stimulus and attempts to grasp with mouth. d. Moro (Startle) Reflex- Generalized Activity in response to stimulation. e. Babinski Reflex- when stroking outer sole of foot upward from heel to across ball of foot causes toes to hyperextend. Normal Vital Signs: Pulse = 150 (+/- 20), Respirations = 35 (+/- 5). Neonate has poor temperature regulation. Gains about 6 ounces per week. Grows approximately one inch during the first month. Fontanels are soft and flat. Umbilical cord should dry and fall off during the first or second week of life. Is unable to support the weight of his/her head. Psychosocial Development Responds to environment through visual, auditory, tactile and taste senses. Is totally dependent upon caregiver. Perceives self and parent as one. Responds to human voices and faces. Cries when uncomfortable, sleepy or hungry. Soft music and bright colored mobiles provide pleasant stimulation for neonate. Nursing Considerations Physical assessment should include temperature, pulse (counted for one full minute), respirations (also counted for one full minute), weight, head and chest circumference, length and assessment of fontanels. Perform the most uncomfortable or intrusive procedures last. First Hepatitis B Vaccination should be initiated by the age of two months. Hold and cuddle during feeding. Maintain feeding schedule. Check for soiling of diapers. Always transfer neonate via crib, stretcher, or stroller. Keep warm. Place infant in supine position for sleeping (“Back to Sleep”). When keeping track of Intake and Output, weigh diapers for an accurate output. One cc of urine weighs about one gram. Two to Three Months Physical Development Posterior fontanel closes around the second month. Head circumference increases by approximately 1.5 cm per month for the first six months. Startle, sucking and rooting reflexes begin to at around three months. Normally, infant should gain about one ounce during the first six months of life. Normal vital signs: Pulse = 130 (+/- 20), Respirations = 35 (+/- 10), Blood Pressure = 80/45 (+/- 20/10) Can strike at a toy but cannot grasp it. Able to hold head up when supported in the sitting position, but it will bob forward. Rolls over. Around the third month, will purposefully put hand into mouth. Will make crawling movements when in prone position. Can push chest up with forearms. Will visually pursue sounds by turning head. Psychosocial Development Laughs out loud, coos, blows bubbles and squeals. Crying becomes differentiated. Smiles at primary caregiver’s face. Responds pleasurably to gentle touch and motion. Enjoys simple toys, such as a rattle, music box, or brightly colored mobile. Nursing Considerations Physical assessment should include vital signs, weight, head and chest circumference, length, assessment of fontanels and reflexes and immunization status. DPT, Polio and Hib (H. Influenzae type B) immunizations are initiated at 2 months. Second Hepatitis B vaccination is should be administered one month after first dose was given, usually at two to three months of age. Perform most uncomfortable and intrusive procedures last. Take precautions to prevent falls and rolling off surfaces. Keep side rails up on crib at all times. Transport using crib, stretcher, or stroller. Provide play stimulation. Hold and cuddle for feeding. “Back to Sleep.” Four to Five months Physical Development Holds head steady in a sitting position. Supports part of weight with legs when held in a standing position. Reaches out with hands. Brings hands together, plays with them, and puts them into mouth. Can grasp objects with both hands. Drooling begins at four months. At five months, birth weight should be doubled. Can transfer objects from one hand to the other. Rolls back to side. Can balance head well. Normal vital signs: Pulse = 130 (+/- 20), Respirations = 35(+/- 10), Blood Pressure = 80/45 (+/- 20/10). Psychosocial Development Begins to discriminate family members from strangers. Laughs out loud. Initiates social play. Sleeps longer periods at night. May have one or two naps during the day. At five months, will babble vowels such as “goo”. Enjoys hearing self make vocal sounds and splashing in water. Imitates others. Searches for objects at point of disappearance. Nursing Considerations Physical assessment should include vital signs, weight, head and chest circumference, length, assessment of fontanels, and immunization status. The second Polio, DPT and Hib are given at four months. Perform the most uncomfortable or intrusive procedures last. Protect from fall injury. Assess environment for safety hazards. Provide variety of small, multi-textured and colored objects that can be held, BUT not swallowed. Use floating toys for the bath. Mobiles are entertainment for the crib. Talk, play, smile, and laugh with infant. Hold and cuddle. May introduce solid foods. Introduce one new food at a time, allowing a week before introducing the next new food to assess for food allergies. Introduce in this order: cereals, fruits, vegetables, then meats. “Back to Sleep.” Six to Eight Months Physical Development Brings objects to mouth at will. Bangs objects on table. Drops toy from hand to reach for another when it is offered. Lower incisors may begin to erupt. Upper central incisors may begin to erupt at around seven months. Drools constantly. Can sit alone. Begins to show food likes and dislikes. Can drink from a cup. Sucking and rooting reflexes disappear. At eight months, can eat finger foods, such crackers, cookies and bread. Crawls forward and backward. Weight gain is approximately half an ounce daily from six to twelve months. Normal vital signs: Pulse = 120 (+/- 20), Respirations = 30 (+/- 10), Blood Pressure = 90/60 (+/- 20/10) Psychosocial Development Begins to recognize the meaning of certain words and vocal tones. Begins to demonstrate fear of strangers. Enjoys looking at self in mirror. Imitates simple acts of others. Recognizes own name. Vocalizing “da”, “ma”, “ba”. Holds arms out when wants to be picked up. Nursing Considerations Use drinking cup designed not to spill (“sippy cup”) Provide sound making toys and larger toys with moving parts, such as set of measuring spoons, bowls and pots. Provide large, safe area for crawling, such as a playpen. Provide stimulation with simple games such as clapping hands, placing toy under blanket. Read, talk and sing to infant while holding. “Back to Sleep”. Third DPT and Hib immunization is at six months. Third Hepatitis B vaccination is also given four months after first dose, usually in this time frame. Nine to Ten Months Physical Development Hand and eye coordination perfected. Picks up small objects with pincer grasp. Pulls self to standing position. Able to step sideways while holding on to furniture. Normal Vital Signs: Pulse = 120 (+/- 20), Respirations = 35 (+/- 10), Blood Pressure 90/60 (+/- 20/10). Psychosocial Development Says first words, such as “dada” and “mama”. Waves bye-bye. Enjoys playing games like “peek-a-boo” and “pat-a-cake”. Cries when scolded. Repeats activities that attract attention. Nursing Considerations Remove all objects small enough to be swallowed or aspirated from play areas. Provide safe play area keeping objects above infant’s reach. Provide walker for infant to push self around in. Expect some discomfort, drooling, and low-grade fever with teething. Refrain from giving bedtime bottle that contains sugar-containing fluid. Counsel parents to minimize sweets in baby’s diet and avoid adding salt. “Back to Sleep”. Eleven to Twelve Months Physical Development Holds cup alone. Scribble with crayon. Has tripled birth weight by twelfth month. Bowel movements are decreased to one or two per day. At eleven months may begin to stand alone for variable amount of time and begin to walk alone at twelve months. Cooperates with dressing. Takes toys out of box and puts them back into box. Grows about one half inch per month. Anterior fontanel closes between twelve and eighteen months. Babinski reflex disappears at twelfth month. Head and chest are equal in circumference. Normal Vital Signs: Pulse = 120 (+/- 20), Respirations = 25 (+/- 5), Blood Pressure = 90/60 (+/- 20/20). Psychosocial Development Understands simple, short commands. Expresses frustration when restricted. Tantrums may begin. Enjoys simple games. Resists going to bed. Able to form two or three word sentences. Recognizes objects by name. Nursing Considerations Set Limits. Maintain a regular bedtime schedule that parents have established at home. Provide toys which allow placing objects into a large container and taking them out again, such as large stacking blocks. Push and pull toys encourage walking. Play simple games such as rolling balls. Provide hazard-free play area. Begin weaning from bottle. PEDIATRIC: ONE TO TWELVE YEARS Toddler: One to Three Years Old Physical Development At one and a half years old, develops sphincter control. First upper and lower molars appear around fifteen months. At age two, the toddler has about sixteen teeth. Can crawl, run, jump, step backward and sideways. Can climb stairs alone. At two and a half years old, the child’s weight is approximately four times birth weight. Height increases by about four to five inches per year. Learns to ride tricycle. Indicates when diaper needs to be changed. Attempts to spoon-feed self. By age three feeds self completely. Normal Vital signs: Pulse = 110 (+/- 20), Respirations = 25 (+/- m5), Blood Pressure = 99/60 (+/- 20/20). Psychosocial Development Less fearful of strangers. Hugs and kisses parents. Begins to imitate parents doing household chores. By age three, can use a noun, verb and object in a three-word sentence. Has a vocabulary of over 300 words. Knows his/her own name. Shows pride in independence. Uses “no” frequently. Tamper tantrums are less by age three. Likes to do things without help. May begin to play with genitals as a process of self-exploration. At age two, treats other children as objects and cannot share possessions. By age three, is just beginning to understand taking turns and sharing. Begins learning simple rules. Nursing Considerations Provide toys like stuffed animals, dolls, musical toys, picture books, stacking blocks, balls, low slide, toy telephone, hammer and pegboard, pulling and pushing toys. Begin toilet training between eighteen and twenty-four months old. Teach how to brush teeth. Encourage parents to make first visit to the dentist. Use repetition to enhance memory and understanding. Don’t expect child to understand sharing. Toddlers may be examined or have procedure done while sitting in parent’s lap. Safety considerations include keeping crib rails up and use of canopy cribs. Immunizations during this time period include MMR (Measles, Mumps, Rubella) at fifteen months, fourth DPT and third Polio vaccine at eighteen months. The fourth and final Hib vaccine is given between twelve and fifteen months of age. A Varicella immunization is also recommended at twelve to fifteen months of age. Preschool: Three to Five years Old Physical Development Birth length doubles by age four. Nighttime bowel and bladder control should be achieved by age three or four. Performs simple self-care skills independently. Moves with speed and agility. Can lace shoes and jump rope. By age five, can use pencil and scissors well. Normal Vital Signs: Pulse = 92 (+/- 5), Respirations = 25 (+/- 5), Blood Pressure = 99/60 (+/- 10/10). Psychosocial Development Can count to five. Knows primary colors. Understands concept of time in terms of morning, nights, later and so on. Believes that whatever moves is alive, such as car, hospital equipment. Thinking is concrete. Enjoys helping with simple chores around the house. Unable to comprehend the whole picture yet. Focuses on concrete details. Becomes concerned about even the smallest injury. Egocentric in thoughts and behavior. Engages in parallel play. Enjoys dolls, large puzzles, taking toys apart, finger paints, hand puppets, large crayons, play-doh, and moving toys, like pulling wagon. Nursing Considerations Limited ability to judge distances and own strength predisposes him/her to accidents. Preoperative teaching has little meaning, but post-operative reteaching is meaningful and helpful. Band-Aid small scratches and injection sites. Intrusive procedures, such as throat swabs, rectal temperatures, blood drawing and IV starts are distressing and should be done in a treatment room. Preschool children are more cooperative during physical examinations when they are allowed to actively participate, such as holding the equipment, examining you as you examine them. Provide simple explanations about the procedure. Fifth DTP, fourth Polio and second MMR are given prior to entry into school. Middle Childhood: Six to Twelve Years Physical Development Greater muscle strength and coordination is gained. The child works and plays hard but tires easily. Able to complete more complex self-care skills. Starts to lose temporary teeth; acquires first permanent teeth between six and eight years of age. Growth spurt occurs between ten and eleven years with slow increase in height and rapid increase in weight. Normal Vital Signs: Pulse = 80 (+/ 20), Respirations = 21 (+/- 5), Blood Pressure = 103/60 (+/- 20/20). Psychosocial Development Six to Eight Years of Age: Understands and uses classification systems. Enjoys collecting favorite things. Learns to get along with peers. Chooses best friends, usually of same sex. Will accept responsibility for routine household tasks with occasional reminders. Likes to participate in family decision-making. Likes rough and tumble play. Insists on being first in everything. Craves attention. Eight to Ten Years of Age: Curious about everything. Becoming peer-oriented. Begins hero worship. Ashamed of failures. Interested in schoolwork. Prefers companionship in play. May fight. Enjoys making things. Can consider alternative solutions to simple problems. Likes to belong to clubs. Fears the dark. Ten to Eleven Years of Age: May leave clothes where they fall. Prefers showers instead of baths. Needs constant reminder of personal hygiene. Preoccupied with right and wrong. Respects parents and their role. Has short outbursts of anger. Nursing Considerations v Six to Ten Years Old: Enjoys table games, board games, jump rope, punching bags, roller skates, musical instruments, puppets, dolls, painting, coloring, magic tricks, dancing, puzzles, records, tapes, competition games, crafts, athletic sports, collecting things. Ten to Eleven Years Old: Enjoys parties, talking on the phone, solitary play, reading mystery and love stories, going to the movies. School-age children often enjoy actively participating in their examination and care. Allow them choices within acceptable limits. Provide simple explanations. Remember that they are modest and proud. Respect their modesty and keep them covered and screened when possible. Do not embarrass them – especially in front of other children. School-aged children are well coordinated and more safety-conscious. Usually may ambulate freely. Keep bed in low position and side rails down during day unless otherwise ordered. ADOLESCENCE: THIRTEEN TO SEVENTEEN YEARS v Physical Development A growth spurt takes place between ten and sixteen years old. Girls retain more subcutaneous fat than boys do. Muscle development is greater in boys than in girls. In females, breast development begins followed by the growth or pubic hair and axillary hair. The average onset of menarche is thirteen. Acne vulgaris may occur due to increased secretion of androgens. v In males, pubic hair growth occurs around age thirteen. The penis, scrotum, and testes become larger. The voice begins to deepen as the larynx and vocal cords increase in size and strength. Normal Vital Signs: Pulse = 80 (+/- 20), Respirations = 20 (+/- 4), Blood Pressure = 120/78 (+/- 20/10). Psychosocial Development May have employment outside the home. Becomes independent and self-directed in schedules and homework. Begins to explore career options. Searches for new beliefs, resolves inconsistencies of old beliefs and begins to form a personal philosophy of life. Frequent mood swings. Sexual curiosity and fantasy are at a peak. Dating may be a major activity. May be sexually active. Engages in organized competitive sports. Uses slang within and outside peer group. Peer-oriented. Begins to sever ties with parents. Has fewer but closer friends. Enjoys shopping, driving cars, riding motorcycles, reading books, and magazines, “hanging out” with peers. Meal skipping is common. Snacking becomes a part of eating pattern. Fast-food consumption is popular. May experiment with smoking, alcohol, and drugs. Nursing Considerations Adolescents consider themselves adults. Physical assessments are the same as for an adult. Adolescents may become extremely self-conscious and embarrassed. Provide privacy. Drape parts not being examined. Adolescents need adequate explanations. Allow involvement in decisions about care. Teach adolescent girls about self-breast examination. ADULT: EIGHTEEN TO SIXTY- FOUR YEARS Young Adulthood: 18 to 40 Years Physical Development Has achieved full physical maturity by age 20. Psychosocial Development Interests broaden into community and world affairs. Chooses, prepares for and practices a career. Becomes independent of parents. Adjusts to marriage or other intimate love relationship. Childbearing and child rearing are major concerns of those who have children. Is continually adjusting to stress and satisfaction of work, spouse, parents, and children. Establishes a personal set of values and formulates a meaningful philosophy of life. Need for ability to cope with change. Period of reaching psychosocial maturity. Understanding level of maturity will enhance appropriate plan of care. Consider the following criteria: 1. Determination of independence 2. Ability to apply knowledge and experience. 3. Ability to communicate experiences to others. 4. Sensitivity to others. 5. Ability to deal constructively with frustration. 6. Ability to maintain self-control. 7. Willingness to assume responsibility. Nursing Considerations Hospitalization may pose a serious stress on the family, especially if the ill person provides the major source of income for the family. Illness of a family member necessitates role changes at home, which may also be an additional stressor. Involve in planning own care. Keep informed of treatment plan along with reason for interventions. Middle Adulthood: 40 to 64 Years Physical Development A decrease in bone density and mass causes a decrease in height as the individual gets older. Muscle tone decreases, causing the person to appear “flabbier”. Visual acuity often diminishes, necessitating eyeglasses. Adjustment to menopause. Psychosocial Development Learns and adjusts to role as grandparents. Maintains contact with extended family. Reaches and maintains a satisfactory performance in career. Develops adult leisure time activities. Readies self both financially and psychologically for retirement. First awareness that one is becoming “old”. Nursing Considerations Same as for Young Adulthood. GERIATRIC: 65 YEARS AND UP (Late Adulthood) Physical Development Vulnerability to disease increases due to general dimunition of function. Ability to maintain homeostasis decreases. The rate of cellular reproduction declines. Integumentary changes include wrinkling, sagging, growths, and discolorations, loss of hair for men and growth of hair on women’s faces, drying and thinning of hair. Musculoskeletal changes include decrease in bone mass, loss of elasticity in joints, degeneration of cartilage and connective tissue and gradual decrease in muscle mass. Pulmonary alterations include decreases in breathing capacity, residual lung volume, and total lung capacity. Metabolic rate declines. Changes in digestive system include slowed peristalsis, periodontal disease (which is preventable!), and decrease in secretion of digestive juices. Cardiovascular changes include narrowing or loss of elasticity of blood vessels. Renal atrophy predisposes to urinary tract infection and diminished renal function. There is decreased hormone secretion. Sexual function declines due to tissue changes that reduce the flexibility of the vagina and the firmness of the penis. There is LITTLE change in IQ. Skills and abilities tend to become obsolete from disuse rather than from deterioration of mental capacity. Memory losses affect more recent events, whereas events of long ago are remembered. Psychosocial Development Retirement introduces many changes in schedule, reduced income, and leisure time activities. There may be a change in living facilities, such as moving from a home to a congregate living facility. A warmer climate is often sought. Individual has often experienced the death of close family members or friends and may reflect on his/her own death. Often has developed close religious ties. Nursing Considerations Feelings of worth, pride, and usefulness need to be maintained. Suggest volunteer work to meet these goals. Suggest natural seasoning for foods such as lemon or onion as sense of taste and smell decline. Encourage intake of high fiber diet and at least two to three liters of fluid to prevent constipation. Acidic fluids will help maintain acid urine, thus reducing the risk of urinary tract infection. Yearly dental check-up should be recommended. A regular exercise program is useful, such as walking or bicycling. Protect from hazards as agility and balance decline with aging. Medications often require smaller doses due to degenerative changes in body functions. What to Expect Children who are 8 to 18 months old often can: • Drink from a cup, pick up finger food, and begin to use a spoon • Help undress and dress, put foot in shoe and arm in sleeve • Point to body parts • Have strong feelings and begin saying “no” • Reach for/point to choices • Feel a sense of security with routines and expectations (e.g., at bedtime) • Imitate sounds and movement • Understand more than they can say Children who are 18 to 36 months old often can do all of the above and: • Wash hands with help • Drink from a straw • Put clothes in the hamper when asked • Feed self with spoon • Push and pull toys; fill and dump containers • Learn to use the toilet • Bend over without falling • Imitate simple actions • Become easily frustrated • Enjoy trying to do tasks on their own (note that this is why tasks may now take more time to complete) • Pouring, washing, dressing • Enjoy playing dress-up • Become fascinated with water and sand play • Begin learning simple clear rules Children who are 3 often can: • Help with brushing teeth • Understand “now,” “soon,” and “later” • Put dirty clothes in the hamper independently • Get shoes from the closet • Put on shoes without ties • Enjoy singing easy songs • Listen more attentively • At times, prefer one parent over the other • Enjoy playing house • Imitate • Match like objects • Put non-breakable dishes in the sink • Put trash in the trash can • Wash body with help • Wash and dry hands, though they may need some help reaching Children who are 4 often can: • Use a spoon, fork, and dinner knife • Dress without help, except with fasteners/buttons • Learn new words quickly • Recognize stop signs and their own name in print • Follow two-step directions that are unrelated • Understand simple clear rules • Share and begin taking turns • Wash self in the bathtub • Brush teeth independently • Wash and dry hands Children who are 5 often can: • Follow established rules and routines (e.g., wash hands before eating, put dirty clothes in the hamper, brush teeth before going to bed) • Independently initiate a simple routine (e.g., dress and undress, brush teeth, wash hands, eat dinner sitting at the table, take bath with adult watching) • Understand beginning, middle, and end • Begin to understand others’ feelings • Be independent with most self-care skills Sometimes, children with disabilities may need special assistance to become more independent in doing daily routines. You might want to do the following: • Expect your child to do only part of the routine, while you assist with the part that is difficult • Provide help to your child so that he/she can complete the task • Provide instructions in a different format, by modeling and/or using a picture or gesture so that your child understands what to do • Allow extra time to complete the task Teaching Your Child to Independently Complete Daily Routines Young children like to feel independent, but sometimes they need a parent’s encouragement to feel that they are capable and that adults believe that they “can” do it. Teaching independence with self-help skills like hand washing, brushing teeth, and dressing/undressing is an important step in development that can be achieved when children are taught how to do each step in each routine. Initially, it takes an adult’s focused attention to teach children how to do these skills. Once the child learns how to do a skill independently, the adult can fade out of the routine completely. When teaching your child independence in self help routines (brushing teeth, hand washing, getting dressed/undressed), try these simple, yet effective, tips: 1. Begin by getting down on your child’s eye level and gaining his attention. (i.e., touch your child gently, make eye contact, physically guide, or jointly look at the same object). 2. Break down the routine into simple steps and state each step one at a time with positive and clearly stated directions. Sometimes we make the mistake of telling children what not to do or what they did wrong, such as, “Stop splashing in the water.” However, it’s more effective and clear to say, “All done washing, now it’s time to turn off the water.” 3. To clarify steps even further, you could take a photo of each step in the routine and post it where the routine takes place. For instance, with hand washing, you could post photos above the sink. As you state one step at a time, show your child the photograph to illustrate what needs to be done. 4. When teaching your child to do each step, model (i.e., demonstrate) how to do each step. After your child begins to learn the steps, you can take turns showing each other “how” to do the routine. Be prepared to provide your child with reminders about what to do. As a child first learns a skill, it’s common to forget a step and need assistance. You can simply model and say, “Look, do this,” and show how to do the step that is causing difficulty. If needed, you can gently physically guide your child in how to do the step so that he/she can feel successful. 5. For activities that might be difficult or not preferred, state the direction in a “first/then” phrase. For instance, “First wash hands, and then we can eat snack”; or “First brush your teeth, and then I can give you a minty fresh kiss”; or “First get dressed, and then you can choose milk or juice with breakfast.” 6. Offering children a “choice” during routines increases the likelihood that they will do the activity. With brushing teeth, you could say, “Do you want to use the mint toothpaste or the bubble gum toothpaste?” 7. It is very important that you encourage all attempts when your child is first learning how to do a routine. If you discourage or reprimand your child because it was not done quite right, his/her attempts at trying might stop. It’s important to let your child know you understand his/her feelings and then assist your child so that he/she feels successful. For example, “I know it’s hard to brush your teeth. Let me help. (Singing while you help brush) Brush, brush, brush your teeth; brush the front and back . . brush, brush, brush your teeth, attack the germs right back.” Remember that young children need a lot of practice—and your support—before they are able to do new skills independently. 8. Encourage your child as each routine is completed and celebrate when the task is done. Why Do Children Sometimes Become Challenging When Learning to Do Self-Help Skills on Their Own? As children grow, they are learning all kinds of new skills that will help them become more and more independent. A child might be using challenging behavior to communicate a variety of messages. For example, your child might need help with a task, and crying results in your providing that help. Or a child might have a tantrum to communicate that the task is too difficult. Other children might have challenging behavior because they don’t want to leave a preferred activity (e.g., playing with toys) to do something that is less interesting (e.g., taking a bath). If you think you know the “message” of your child’s challenging behavior, a good strategy is to validate what the behavior seems to be saying. For example, you might say, “You are telling me that you don’t want to stop playing for your bath. But it’s time to be all done and get in the tub.” What Can You Do When Children Refuse to Independently Do Daily Routines? Remember, preschoolers are moving from the toddler stage, where much was done for them, to a new stage where they are becoming independent little people. Your child might need a bit of help or extra cueing when learning new skills that will build his/her ability to be more independent around everyday routines. Think about what your child needs and help him/her be successful…success builds independence! For instance, your child: • Might want your attention because inappropriate behavior got attention in the past. Your child might refuse to listen or cooperate to gain your attention because this has worked before. – Remember to ignore the challenging behavior and teach calmly and clearly while guiding him/her through the task. – Praise every little attempt to do any step. Attention to your child’s use of a new skill will strengthen that skill. • Might not understand what you are trying to get him/her to do. – Restate your expectation in positive terms and show him/her how, with either photo cues and/or modeling. • Could need a warning a few minutes prior to the routine. – Let him/her know there are only a few more minutes of “play time” and then it’s time to ____ (i.e., wash hands, eat dinner, undress/dress, brush teeth, etc.). • Might not have heard what you asked him/her to do. – Gain attention and calmly and clearly restate the direction. – Try pairing the verbal direction with a gesture or model. • Might feel rushed and confused. – As children learn new tasks, we need to slow down the routine and expect that it might take extra time to complete. – If you are feeling frustrated with your child and think your child is reacting to your frustration, you might take a few deep breaths to feel calmer. First, take a deep breath in through your nose and out through your mouth several times, and then proceed with clearly stating your expectation to your child. • Might find the routine too difficult and need some modeling or partial help. – First, model how to do the first step and then say, “Now you show me.” Show one step at a time, allowing time for your child to process the information and imitate what you did before moving to the next step. – If needed, assist your child by gently guiding him/her through the steps. – Praise every attempt. • Might need encouragement and to be validated. – You could say, “I see you are sad. This is hard. You can do it. Let me show you how.” It is important to try to understand your child’s point of view and feelings. This will help you respond with the most appropriate cue. Encouragement and supporting your child’s attempts will build confidence. Age-specific competencies and skills