Chapter 7: Physical Development in Early Childhood

Table 7.3 – Fine Motor Milestones[13]

Typical Age	What Most Children Do by This Age
3 years	Copies a circle with pencil or crayon Turns book pages one at a time Builds towers of more than 6 blocks Screws and unscrews jar lids or turns door handle
4 years	Pours, cuts with supervision, and mashes own food Draws a person with 2 to 4 body parts Uses scissors Starts to copy some capital letters
5 years	Can draw a person with at least 6 body parts Can print some letters or numbers Copies a triangle and other geometric shapes Uses a fork and spoon and sometimes a table knife

Activities to Support Fine Motor Skills

Here are some fun activities that will help children continue to refine their fine motor abilities. Fine motor skills are slower to develop than gross motor skills, so it is important to have age appropriate expectations and play-based activities for children.

• Pouring water into a container
• Drawing and coloring
• Using scissors
• Finger painting
• Fingerplays and songs (such as the Itsy, Bitsy Spider)
• Play dough
• Lacing and beading
• Practicing with large tweezers, tongs, and eye droppers

Sleep and Early Childhood

Along with food and water, sleep is one of the human body’s most important physiological needs—we cannot live without it. Extended sleeplessness (i.e., lack of sleep for longer than a few days) has severe psychological and physical effects. Research on rats has found that a week of no sleep leads to loss of immune function, and two weeks of no sleep leads to death.

Recently, neuroscientists have learned that at least one vital function of sleep is related to learning and memory. New findings suggest that sleep plays a critical role in flagging and storing important memories, both intellectual and physical, and perhaps in making subtle connections that were invisible during waking hours.[15]

How Much Sleep Do We Need?

The amount of sleep an individual needs varies depending on multiple factors including age, physical condition, psychological condition, and energy exertion. Just like any other human characteristic, the amount of sleep people need to function best differs among individuals, even those of the same age and gender.

Though there is no magic sleep number, there are general rules for how much sleep certain age groups need. For instance, children need more sleep per day in order to develop and function properly: up to 18 hours for newborn babies, with a declining rate as a child ages. A newborn baby spends almost 9 hours a day in REM sleep. By the age of five, only slightly over two hours is spent in REM. Studies show that young children need about 10 to 11 hours of sleep, adolescents need between 8.5 and 9.25, and adults generally need between 7 and 9 hours.

Sleepwalking (Somnambulism)

Sleepwalking (sometimes called sleepwalking disorder, somnambulism, or noctambulation) causes a person to get up and walk during the early hours of sleep. The person may sit up and look awake (though they’re actually asleep), get up and walk around, move items, or dress or undress themselves. They will have a blank stare and still be able to perform complex tasks. Some individuals also talk while in their sleep, saying meaningless words and even having arguments with people who are not there. A person who sleepwalks will be confused upon waking up and may also experience anxiety and fatigue.

Sleepwalking can be dangerous—people have been known to seriously hurt themselves during sleepwalking episodes. It is most common in children, but it also occurs occasionally in adults. For adults, alcohol, sedatives, medications, medical conditions and mental disorders are all associated with sleepwalking.

Sleep Terrors and Nightmare Disorder

Sleep terrors are characterized by a sudden arousal from deep sleep with a scream or cry, accompanied by some behavioral manifestations of intense fear. Sleep terrors typically occur in the first few hours of sleep, during stage 3 NREM sleep. Night terrors tend to happen during periods of arousal from delta sleep (i.e., slow-wave sleep). They are worse than nightmares, causing significant disorientation, panic, and anxiety. They can last up to 10 minutes, and the person may be screaming and difficult to wake. In some cases, sleep terrors continue into adulthood.

Distinct from sleep terrors is nightmare disorder. Also known as “dream anxiety disorder,” nightmare disorder is characterized by frequent nightmares. The nightmares, which often portray the individual in a situation that jeopardizes their life or personal safety, usually occur during the second half of the sleeping process, called the REM stage. Though many people experience nightmares, those with nightmare disorder experience them more frequently.[17]

Toilet Training

Toilet training typically occurs after the second birthday. Some children show interest by age 2, but others may not be ready until months later. The average age for girls to be toilet trained is 29 months and for boys it is 31 months, and 98% of children are trained by 36 months (Boyse & Fitzgerald, 2010). The child’s age is not as important as his/her physical and emotional readiness. If started too early, it might take longer to train a child.

According to The Mayo Clinic (2016b) the following questions can help parents (or ECE teachers) determine if a child is ready for toilet training:

• Does the child seem interested in the potty chair or toilet, or in wearing underwear?
• Can the child understand and follow basic directions?
• Does the child tell you through words, facial expressions or posture when he or she needs to go?
• Does the child stay dry for periods of two hours or longer during the day?
• Does the child complain about wet or dirty diapers?
• Can the child pull down his or her pants and pull them up again?
• Can the child sit on and rise from a potty chair?

If a child resists being trained or it is not successful after a few weeks, it is best to take a break and try again when they show more significant interest in the process. Most children master daytime bladder control first, typically within two to three months of consistent toilet training. However, nap and nighttime training might take months or even years.

Elimination Disorders

Some children experience elimination disorders including:

• enuresis – the repeated voiding of urine into bed or clothes (involuntary or intentional) after age 5
• encopresis – the repeated passage of feces into inappropriate places (involuntary or intentional).

The prevalence of enuresis is 5%-10% for 5 year-olds, 3%-5% for 10 year-olds and approximately 1% for those 15 years of age or older. Around 1% of 5 year- olds have encopresis, and it is more common in males than females. These are diagnosed by a medical professional and may require treatment.[19]

Sexual Development in Early Childhood

Self-stimulation is common in early childhood for both boys and girls. Curiosity about the body and about others’ bodies is a natural part of early childhood as well. Consider this example. A girl asks her mother: “So it’s okay to see a boy’s privates as long as it’s the boy’s mother or a doctor?” The mother hesitates a bit and then responds, “Yes. I think that’s alright.” “Hmmm,” the girl begins, “When I grow up, I want to be a doctor!” While this subject can feel uncomfortable to deal with, caregivers can teach children to be safe and know what is appropriate without frightening them or causing shame.

As children grow, they are more likely to show their genitals to siblings or peers, and to take off their clothes and touch each other (Okami et al., 1997). Masturbation is common for both boys and girls. Boys are often shown by other boys how to masturbate. But girls tend to find out accidentally. And boys masturbate more often and touch themselves more openly than do girls (Schwartz, 1999).

Caregivers should respond to this without undue alarm and without making the child feel guilty about their bodies. Instead, messages about what is going on and the appropriate time and place for such activities help the child learn what is appropriate.[20]

Health in Early Childhood

While preschoolers are becoming more and more independent, they depend on their caregivers to keep protecting and promoting their health. [21]

Childhood Obesity

Childhood obesity is a complex health issue. It occurs when a child is well above the normal or healthy weight for his or her age and height. Childhood obesity is a serious problem in the United States putting children at risk for poor health. In 2015-2016, 13.9% of 2- to 5-year-olds were obese.

Where people live can affect their ability to make healthy choices. Obesity disproportionally affects children from low-income families.

Causes of Obesity

The causes of excess weight gain in young people are similar to those in adults, including factors such as a person’s behavior and genetics. Behaviors that influence excess weight gain include:

• eating high calorie, low-nutrient foods
• not getting enough physical exercise
• sedentary activities (such as watching television or other screen devices)
• medication use
• sleep routines

Consequences of Obesity

The consequences of childhood obesity are both immediate and long term. It can affect physical as well as social and emotional well-being.

• More Immediate Health Risks
  • High blood pressure and high cholesterol, which are risk factors for cardiovascular disease (CVD).
  • Increased risk of impaired glucose tolerance, insulin resistance, and type 2 diabetes.
  • Breathing problems, such as asthma and sleep apnea.
  • Joint problems and musculoskeletal discomfort.
  • Fatty liver disease, gallstones, and gastro-esophageal reflux (i.e., heartburn).
• Childhood obesity is also related to
  • Psychological problems such as anxiety and depression.
  • Low self-esteem and lower self-reported quality of life.
  • Social problems such as bullying and stigma.
• Future Health Risks
  • Children who have obesity are more likely to become adults with obesity.11 Adult obesity is associated with increased risk of a number of serious health conditions including heart disease, type 2 diabetes, and cancer.
  • If children have obesity, their obesity and disease risk factors in adulthood are likely to be more severe.[23]

Food Allergies

A food allergy occurs when the body has a specific and reproducible immune response to certain foods. The body’s immune response can be severe and life threatening, such as anaphylaxis. Although the immune system normally protects people from germs, in people with food allergies, the immune system mistakenly responds to food as if it were harmful.

Eight foods or food groups account for 90% of serious allergic reactions in the United States: milk, eggs, fish, crustacean shellfish, wheat, soy, peanuts, and tree nuts.

The symptoms and severity of allergic reactions to food can be different between individuals, and can also be different for one person over time. Anaphylaxis is a sudden and severe allergic reaction that may cause death.4Not all allergic reactions will develop into anaphylaxis.

• Children with food allergies are two to four times more likely to have asthma or other allergic conditions than those without food allergies.
• The prevalence of food allergies among children increased 18% during 1997-2007, and allergic reactions to foods have become the most common cause of anaphylaxis in community health settings.
• Although difficult to measure, research suggests that approximately 4% of children and adolescents are affected by food allergies.

The CDC recommends that as part of maintaining a healthy and safe environment for children, caregivers should:

• Be aware of any food allergies.
• Educate other children and all adults that care for a child with food allergies.
• Ensure the daily management of food allergies.
• Prepare for food allergy emergencies.[24]

Oral Health

Tooth decay (cavities) is one of the most common chronic conditions of childhood in the United States. Untreated tooth decay can cause pain and infections that may lead to problems with eating, speaking, playing, and learning. The good news is that tooth decay is preventable.

Fluoride varnish, a high concentration fluoride coating that is painted on teeth, can prevent about one-third (33%) of decay in the primary (baby) teeth. Children living in communities with fluoridated tap water have fewer decayed teeth than children who live in areas where their tap water is not fluoridated. Similarly, children who brush daily with fluoride toothpaste will have less tooth decay.

Applying dental sealants to the chewing surfaces of the back teeth is another way to prevent tooth decay. Studies in children show that sealants reduce decay in the permanent molars by 81% for 2 years after they are placed on the tooth and continue to be effective for 4 years after placement.[25]

The first visit to the dentist should happen after the first tooth erupts. After that, children should be seeing the dentist every six months.[26]

Protection from Illness

Two important ways to help protect children from illness are immunization and handwashing.

Immunizations

While vaccines begin in infancy, it is important for children to receive additional doses of vaccines to keep them protected. These boosters, given between ages 4 and 6, are doses of the vaccines they received earlier in life to help them maintain the best protection against vaccine-preventable diseases.

Many states require children to be fully vaccinated (unless they have a medical reason to be exempt) before they can enroll in licensed child care or public school. If vaccinations were missed, a health care provider can help the child’s caregivers to create a catch up schedule to ensure the child correctly “catches up” with the recommended childhood vaccination schedule.[29]

Handwashing

Handwashing is one of the best ways to prevent the spread of illness. It’s important for children (and adults) to wash their hands often, especially when they are likely to get and spread germs, including:

• Before, during, and after preparing food.
• Before eating food.
• After blowing nose, coughing, or sneezing.
• After using the toilet.
• After touching an animal, animal feed, or animal waste.
• After touching garbage.

It’s important for children to learn how to properly wash their hands. When washing hands children (and adults) should follow these five steps every time.

1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
2. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.
3. Scrub your hands for at least 20 seconds. Need a timer? Hum or sing the Happy Birthday song or ABCs from beginning to end twice.
4. Rinse your hands well under clean, running water.
5. Dry your hands using a clean towel or air dry them.[30]

Caregivers can help keep children healthy by:

• Teaching them good handwashing techniques.
• Reminding their kids to wash their hands.
• Washing their own hands with the children.[32]

Safety

Child injuries are preventable, yet more than 9,000 children (from 0-19 years) died from injuries in the US in 2009. Car crashes, suffocation, drowning, poisoning, fires, and falls are some of the most common ways children are hurt or killed. The number of children dying from injury dropped nearly 30% over the last decade. However, injury is still the number 1 cause of death among children.[33]

Children during early childhood are more at risk for certain injuries. Using data from 2000-2006, the CDC determined that:

• Drowning was the leading cause of injury death between 1 and 4 years of age.
• Falls were the leading cause of nonfatal injury for all age groups less than 15.
• For children ages 0 to 9, the next two leading causes were being struck by or against an object and animal bites or insect stings.
• Rates for fires or burns, and drowning were highest for children 4 years and younger.[34]

Here is a table summarizing some tips from the CDC to protect children from these injuries: