Stages of child development
It is one of the most spectacular things to watch your child going
through the early ages and stages of development. Besides, the complete
understanding of stages of child development is the core of better
If you think that your newborn baby doesn’t do much more than eat,
sleep and cry, then you are absolutely wrong. The newborn babies display
some remarkable signs of their unique individualities.
The glimpses of their behaviour may be ephemeral for you at first,
but take time to value those tiny movements accompanied with budding
character and abilities and enjoy the stages of your child’s
Being a proud parent, it one of the greatest and most spectacular
thing to watch your child going through his/her early ages of
With active participation and interaction with your child during the
different stages of development, you can ensure his/her proper
nourishment in all spheres of life inculcating the desired qualities and
values in him/her.
So, as a parent, it is of immense importance that you should have the
proper knowledge and understanding of the different stages of the
development of child.
You should know the average age at which the average child will be
able to carry out all of the skills involved in growing up—everything
from rolling, crawling and, sitting to smiling, talking, and toilet
training. The better understanding of this will help you to assess the
development of your child.
Milestone is a parenting term used as a standard level of achievement
of the average child at the particular stage. However, it is important
to know that although milestones are proven as the great tool to assess
the development of your child, they are not fixed and hard estimates but
only rough ones as children vary in the progress of their development.
They may be early on some and may be late in some other aspects.
1 Month - During first weeks, they can see the objects at the
distance of 12 inches, while at the end of first month; their vision
improves up to 3 feet. They can even recognize certain smells like their
mother’s breast milk.
They can hear the sound and even start recognizing the voices of dear
ones by end of month. At this stage, they are also able to move their
heads. Moreover, you may find yourself enjoying and cherishing her first
smile at this stage!
Early on, they gain a great amount of weight—on average, half an
ounce to 1 ounce a day! The circumference of their heads is also on
Baby’s principal jobs are to eat, sleep, and grow. And due to their
fast growth in the first weeks of life, it requires both a lot of eating
and a lot of sleeping. They urinate 6-10 times a day which is a healthy
sign of proper functioning of their kidneys. However the frequency may
be less in case of breastfed babies.
1 to 3 Months
After one month of initial stage of parenthood, it’s time to enjoy
your baby’s growing personality. Your Baby will start to respond to
sounds in more specific way. You can find her changing facial
expression, cooing and gurgling as a response to the sound heard. You
can even find her to track the objects and her attempts to locate the
She will start raising her head and chest and pushing herself up on
her forearms while lying on stomach. Physical growth continues in the
same fashion. Generally, all babies stared to sleep more at night and
less during the daytime.
3 to 6 Months
This period is quite a fun for all parents as the behaviour of babies
start to become more predictable. Your simple interaction with your baby
will be returned with smiles, hilarity, and the appealing babble. It’s a
time for greater mobility for your child. You will witness the rolling
of your child from front to back and then back to front.
Some more bright babies will start to crawl, or in fact drag
themselves on bellies. Some of them even can sit if propped up.
Generally, the birth weight gets double by the 4th month. Their
movements become more coordinated. They try to explore the objects near
them by their mouths. They often start to actually emulate sounds.
They started linking the sound with specific object, the sound is
associated with. Generally, teeth start making their first appearance.
In a typical pattern of teething, the bottom, center teeth are erupting
first, then the two upper front teeth followed by the two on sides.
6 to 9 Months
This is the time when your baby’s intellectual and physical
activities are on a great increase. Your baby can sit without any
support. Children before age of 9 months can sustain weight on their
legs, and afterwards, some of them even go further to stand while taking
They start to stand and start crawling. You can also notice muscle
and motor development at this stage. Most of them start vocalizing a lot
more babble other than crying.
They are also tending to develop more anxiety towards their
surroundings and strangers. You’ll see the eruption of several teeth
during this time period.
This is the time when your baby will start using a variety of solid
foods, like infant cereal, fruits. Your baby’s interest in play
increases significantly at this age, and you have to be very cautious as
they are prone to minor accidents during this period.
9 to 12 Months
They are entering into their tooddlerhood from infancy and you will
be rewarded by hearing their first words uttered and can watch their
first steps during this time. This period is marked by a growing
curiosity about the people and things all around. Babies between 9 and
12 months display their skill to pick up small objects using their
thumbs and pointer fingers.
They start to improve their ability of communication. Your baby
begins to discover the surroundings—making connections, applying new
skills, and learning how things work together.
It is important to let your baby to play with objects of varying
sizes, shapes, and textures.
12 to 18 Months
This is the toddler stage which includes the first attempt of your
child at independence. Children start categorizing the objects, people
They start walking independently or may even start running. They
begin uttering words like “mama”. They develop finer motor skills. By
the age of one year, most children have tripled their birth weight and
grown about 10 inches. There are series of changes in body proportion.
These changes are aimed at hardening bones, strengthening muscles to
offer more balance on two feet.
Look for your child’s new abilities while choosing toys for him. A
light weight pull toy attached with a string or objects that can be
disengaged and then assembled together or stacked toys are always the
great toys to nourish his activities.
The child can take immense pleasure in reading picture book.
18 to 24 Months
Children start increasing their vocabulary. They develop better sense
of understanding among them. This can be ideal age for their toilet
training. They start to become more aware of peoples different emotions
Your child can be accustomed to brushing his teeth. Their eating
habits are marked by decreased requirement of milk and they can be given
a try to eat independently. Their sleeping behaviour also change to just
a one nap at day time.
At this stage, children still prefer to play alone rather than to
interact with other children, so make sure that you are spending enough
time with your child.
2 to 3 years
Now your child will start displaying new abilities- to perform, to
communicate, and to exert his independence. Children’s different
personalities and skills definitely shine through this stage. He will
start talking in sentences; start to understand common rules and
The motor skills like jumping, climbing, and running really improve
over the year. He can name and categorize different objects and people.
Practice usually results in their newly acquired ability of dressing
The growth rate will slower than previous years characterized by few
physical changes-there will be loss of baby fat to longer limbs giving a
leaner, taller appearance. Let them play games like puzzles and shape
sorters-to refine their motor skills. Don’t forget that children acquire
verbal and motor skills at their own paces.
3 to 4 Years
This is the period when activities and play grow more complex. They
have had enough personal knowledge to master the simple concepts of
They acquire more improvised self help skills like zipping or
buttoning the dress. Their language skills are improved greatly and
entered a new stage of development which is marked by asking numerous
They can now recognize letters, different colours; can draw different
shapes. Between 3 and 4 years of age, the playing habits of children go
through a big transition. They begin to switch from parallel play
towards a much more interactive play with other children.
The interaction with your child forms very important part of the
early stages of development. That’s why it is very essential to have
better understanding of the ages and stages of child development for
Rapunzel syndrome - a new discovery
First case reported in Sri Lanka:
‘A moment’s insight is sometimes worth a life’s experience’ as it was
for Consultant Surgeon, Dr. Gamini Goonetilleke of the Sri
Jayewardenepura General Hospital when he uncovered a very rare condition
of Rapunzel Syndrome in a fourteen-year-old student from the Moneragala
district who was brought to the hospital in a dissipated state recently.
|The hairball moulded in
the stomach of the teenager
||The rare hairball with its
tail like extension
The operation to remove the 700 grams, 75 centimetres ball of hair
which had formed a mold in the shape of the stomach had lasted an hour
and was a ‘pathological museum piece’, Dr. Goonetilleke said.
This case of Rapunzel Syndrome or Trichotillomania (pulling an eating
ones own hair) is yet another first in the annals of medical history in
Sri Lanka and is apparently the 28th to be recorded worldwide.
The very rare condition has been prevalent among children below 14
years of age and is said to be more common among female children, Dr.
‘Trichotillomania has been described by Hallopeau in 1889 as an
obsessive compulsive disorder which causes the irresistible desire to
pull out and eat one’s own hair. But the first case of Trichobezoa, the
term used to describe a collection of hair or hairball in the stomach
has however been reported a century earlier by Baudemont in 1779.
Trichobezoa is a condition which continues usually without symptoms
until the hairball reaches a large size,’ Dr. Goonetilleke explained.
‘When the balls of hair go into the stomach it does not get digested but
gets collected forming a mould taking the shape of the stomach.
This steadily reduces the capacity to retain food thereafter causing
irritation on the surface of the stomach: a commonly known condition of
gastritis. When the stomach is full of this Trichobezoa, its hairball
tail like extension overflows into the duodenum and gradually extends
into the small intestine causing a serious condition. This process was
first described by Vaughan in 1968 and called the Rapunzel Syndrome’.
‘Moreover, since, 3-4 such cases have shown repeated incidences
resulting in repeated operations having to be performed, Dr.
Goonetilleke has recommended that the teenager be given psychological
counselling and support to overcome this psychiatric condition,
Having diagnosed the Rapunzel Syndrome in this case Dr. Goonetilleke
said he had further investigated into the teenager’s tendency and
However, the teenager had promptly denied having eaten her own hair
while her mother too when shown the specimen said she was quite unaware
that her daughter had been accustomed to such an unusual habit.
She had never seen her doing such a thing, she had told Dr.
Goonetilleke. The girl needs psychological counselling to overcome this
situation and that is being looked into’, Dr. Goonetilleke said. The
teenager is the youngest sibling of four.
The Rapunzel Syndrome named after the popular Brothers Grimm
fairy-tale ‘Rapunzel’ was however given a different twist: In this case
Rapunzel’s hair was not lowered to the ground from the prison tower for
her charming young prince to climb up to her window to rescue her but
had been eaten by the fourteen-year-old over at least a year until she
was on the brink of collapse.
The symptoms reported in this teenager’s case were loss of appetite,
nausea and vomiting and bouts of severe abdominal pain causing
intestinal perforation and peritonitis which could have soon led to
‘The condition of the teenager who was treated repeatedly at the
Moneragala Hospital over a considerable period of time for almost a year
was undiagnosed and undetected until she was referred to the Sri
Jayewardenepura General Hospital as the Moneragala hospital lacked CT
The girl was in a severe state of dissipation at the time admission.
Having diagnosed abnormality in the stomach and suspecting that it could
be a growth in the stomach I decided to do an upper gastrointestinal
It was this that helped diagnose this very rare condition of Rapunzel
Syndrome which has been only reported in textbooks with specimens of
Trichobezoa and seen only in pathological museums. Rapunzel Syndrome is
a rare form of Trichobezoa where there is a tail like extension of the
hairball into the intestine’, Dr. Goonetilleke said.
Drs. Sanduni Sirimanne, Suchithra Somaratne, Ridma Jayaratne and
Hilton Navenihiran assisted Dr. Goonetilleke with the surgery.
Obsessive Compulsive Disorder
‘Obsessive Compulsive Disorder (OCD) is a condition in which
individuals experience anxiety related to the possibility of a focused
threat, and work hard to relieve the anxiety by assuring themselves that
the threat will definitely not be realized.
The social isolation, depression and mental preoccupation over loss
of control tend to have far more damaging effects than the (often
slightly noticeable) impact of the hair loss.’ When confronted, it is
common for an individual to deny having the disorder like in this case.
Given the stress, social isolation, and shame that are associated
with trichotillomania, a significant number of individuals with this
disorder also suffer from depression, anxiety, and substance abuse
problems. These difficulties only add to the sufferer’s stress level,
often increasing the urge to pull their hair.