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DateLine Sunday, 6 July 2008

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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 parenting.

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 development.

Being a proud parent, it one of the greatest and most spectacular thing to watch your child going through his/her early ages of development.

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.

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Newborn Babies

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 increase.

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.

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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 sound.

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.

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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.

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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 supports.

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.

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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.

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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 and actions.

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.

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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 around them.

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.

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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 mannerism.

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 himself.

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.

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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 life.

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 questions.

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 better parenting.


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. Goonetilleke explained.

‘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, Trichotillomania.

Having diagnosed the Rapunzel Syndrome in this case Dr. Goonetilleke said he had further investigated into the teenager’s tendency and psychological well-being.

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 death.

‘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 scans facilities.

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 endoscopic examination.

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.

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