Lifespan Development for Allied Health Professionals

Motor development of the 2 to 3-month-old infant should show the ability to raise their head while lying on their stomach and to open and close their hands briefly (CDC, 2023c).

Cognitively, a two-to-three-month-old infant will typically start to be able to follow a moving object with their eyes. They are making sounds other than crying and will also respond to a voice or turn their head toward the direction of a sound. They also start to look at a toy for several seconds (CDC, 2023c).

Social and emotional development wise, an infant 2 to 3 months of age will attempt to mimic facial expressions and begin to smile in response to people. Facial expressions become more numerous and complex. Most babies at this age will look at your face, seem happy to see their parents when they walk up to them, and calm down when spoken to or picked up (CDC, 2023c).

Infant lifting head

Infants in this age group gradually reach milestones like pushing themselves onto elbows and forearms when on their stomach and pushing up onto fully straight arms by six months. They can now sit while leaning on their hands for support and hold their head steady without support. By six months, they can typically roll from their tummy to back (CDC, 2023e).

Infant Pushing Onto Upper Extremities

They learn to explore attractive toys, put them in their mouth for further exploration, and experiment with the properties of the toy by shaking it or hitting it against another toy. They learn to hold toys with two open hands, then a fist, and progress to a precise grasp. As the grasp becomes more mature, the infant progresses from raking small bites of food, such as Cheerios, to holding food in their hands, such as a soft banana.

Regarding communication and social development, 4 to 6-month-old infants will coo, chuckle, and make sounds back when talked to. They will turn, smile, move, or make sounds to keep someone’s attention (CDC, 2023d). By six months, infants like to look at themselves in a mirror, laugh, blow raspberries, and stick their tongues out (CDC, 2023e).

During these months, most children develop a strong attachment to their caregiver. Separation anxiety develops and peaks close to the first birthday. Depending on the opportunity for socialization, children at this age learn to communicate with others. Babies initially learn to communicate their needs, such as hunger, sleep, and discomfort, with sounds, babbling, and then with the first few words. The environment greatly impacts the language development of infants and toddlers. By one year, an infant will usually wave hello and goodbye and can call a parent by simple names such as mama or dada.

Cognitively, the infant will be able to understand the word and meaning of “no” and play simple games (CDC, 2023f). This is an excellent time to enjoy such games as patty cake! Remember, you are your baby’s first teacher, and the child will often begin to mimic what they are seeing. Using positive words and physical affirmations when the infant performs a desired behavior will help reinforce their learning and encourage continued performance. Typically, by now, the infant understands to look for things they have seen you hide and can put large items inside other things, like placing wooden toys into a bucket or toy wagon. They still lack fine motor skills to manipulate smaller objects and toys but may be starting to pick items up between their thumb and index fingers(CDC, 2023f).

Infants playing with toys

Physically, an infant in this age range can start to pull to stand, cruising around furniture while holding on, and may even start walking. As the infant becomes more mobile, proper home childproofing becomes crucial.

There is significant growth and development between one and two years of age. Infants are getting taller, their muscular system is strengthening to support mobility, and cognitively, they are developing rapidly. These are the times when the infants’ unique personalities start to show. Within these years, an infant will progress from pulling themselves to standing to cruising along furniture while holding on, learning to walk without support, and being able to climb onto and off a chair or couch independently (CDC, 2023g). By age two, a toddler can run and kick a ball (CDC, 2023h).

Babies First Steps

Hand motor skills are also rapidly improving, and the toddler will progress from trying to use their fingers to feed themselves (CDC, 2023i) to being able to use a spoon. During this time, toddlers can manipulate switches, knobs, and buttons on toys or activity boards and scribble with a writing device (CDC, 2023h). They understand how to play with toys like cars and trucks and can play with more than one toy at a time (CDC, 2023h).

Language skills expand drastically during these two years. Progressing beyond their first few words, such as mama and dada, the child will start to apply simple words to other objects, such as “Da” for a dog or “Ba” for a bottle, around 15 months (CDC, 2023i). By 18 months to 2 years, they can put three or more words together (CDC, 2023g).

Cognitively and emotionally, the infant of 18 months starts to move away from their parent in a sense of independence but will check to ensure their parent is still nearby (CDC, 2023g). By two, the toddler begins to notice the feelings of others and will express concern if someone else is hurt, sad, or crying (CDC, 2023h).

Children at three years should be physically able to walk unassisted up a flight of stairs one step at a time, pedal a tricycle, throw a ball overhand, and turn a doorknob. They are developing enough fine motor skills to string beads, use a fork, dress with loose clothing, and draw simple shapes like a circle (CDC, 2023j).

The social and emotional development behaviors considered normal for this age group include expressing a wide range of emotions, copying adult behavior, and describing what others are feeling.

The cognitive and language abilities of the 3 to 4-year-old child should include an increasingly sophisticated sense of time, the ability to follow a short series of instructions, speak in short sentences, and be understood most of the time. When asked, they can name familiar objects and friends and state their first names. Asking questions involving who, what, where, and why is typical for this age (CDC, 2023j).

Young Child Riding Tricycle

Preschoolers, 4–5-year-olds, are very active. Motor skills are improving; they can catch a large ball and hold crayons between their fingers and thumb (not just as a fist) (CDC, 2023k). You can encourage your child to develop these fine motor skills by encouraging them to turn pages in a book and play with puzzles. Cognitively, they begin using symbols and improving their memory. They can count to 10 and start to recognize letters. They begin to develop an understanding of time, such as yesterday and day/night, and can start to recognize letters. They have vivid imaginations, which may cause unseen fears. A dress-up box may be helpful in activities such as tea parties and pretending to be someone else, like a teacher or doctor (CDC, 2023k).

Child playing dress-up

In these years, they will also be able to start telling stories with at least two events, sing, dance, and hold a conversation with more than three exchanges (CDC, 2023l). The preschooler is starting to develop independence, which means they may begin to talk back and test the boundaries of behavior (CDC, 2023l).  Try to encourage their independence by taking notice and praise for good behavior. The preschooler is starting to notice and become sensitive to other people’s feelings and will try to comfort others who are sad or hurt (CDC, 2023k).

School-aged children between 6-12 years grow more slowly now until puberty. Cognitively, they are active and eager learners who can understand cause and effect. Building self-esteem is an important task during this period. The school-age child develops a greater sense of self and independence and wants to fit in with his peers. The school-age child is beginning to make lifestyle choices and may act with poor judgment. Peer pressure, alcohol, sex, drugs, and smoking need to be discussed with this age group.

Strong school-aged girl

Approach an infant or toddler calmly, gently, and slowly. Have the caregiver hold the patient during an assessment or treatment if possible. If the child has to lie down, let the parent stay next to the child (Treitz et al., 2018). Try to make the assessment or treatment into a game to reduce fear. Use your imagination and involve the toddler using storybooks, dolls, or puppets. Since infants and toddlers have a short attention span, remember to change activities frequently. Provide reassurance during the assessment or intervention. Praise the child for doing well. Early intervention can be of great benefit to a child who may be slower in their development or those who may be significantly behind their developmental milestones. Physical, occupational, and speech therapy can be influential in improving a child’s motor, cognitive, and language skills.

Speak at the language level the child can understand. Explain what you are doing to and with the child using sensory terms whenever possible. Use games and imagination to gain cooperation. Allow the child to handle the equipment if possible. Enlist the child’s help and allow him to express his feelings. Preschoolers need praise, rewards, and easy-to-understand rules.

Because of developing independent and cognitive understanding, the school-aged child needs to be allowed to help make decisions when feasible and within reasonable bounds. Provide privacy during assessment or treatment and explain all procedures at the child’s level of understanding. Be prepared to listen and be honest. Tell the child how they can be involved or assist in their care, if possible. Reassure the child that their therapy care is not a punishment but something that can help them, is fun, and something to look forward to.

Accidental Injury is the number one cause of death for children in the US, with 1 in 5 child deaths due to injury. Accidental injuries like burns, drowning, poisoning, falls, suffocation, and automobile accidents are prevalent in children; most injuries are preventable (CDC, 2020).

Infants and children are naturally curious, and exploration is part of their growth. They are much more likely to use hand-to-mouth behavior to determine the nature of an object, and they lack the caution of older children. Serious harm and death caused by pediatric exploratory behavior are unusual; however, because of the risks of choking and poisoning, infants and children need to be monitored carefully. Because of their body weight, children are especially vulnerable to the effects of medications and hazardous substances, and even one dose of certain medications can cause serious harm or death in a child.

Physical and Occupational therapists can help educate parents on these safety issues by teaching parents safe handling skills with their child while dressing, changing, or carrying their child. They can work with parents to prevent falls, on home safety considerations such as baby-proofing techniques and safety with bathing to prevent burns and drowning risks. Proper car safety is crucial, and healthcare professionals should teach parents how to get their child into a properly installed car seat safely.

Therapy professionals can play a key role in keeping children safe by helping to improve proper motor and muscular development to improve strength, range of motion, and balance to prevent falls or other musculoskeletal injuries.

The incidence of child abuse is difficult to ascertain, but it is a prevalent social issue that has serious short and long-term consequences. The CDC estimated that 1 in 7 children in any year are abused, and 1750 children died in 2020 of abuse and neglect (CDC, 2022a). In addition, child abuse statistics can be deceiving because a child who is abused would be considered one case, but that child is likely to be abused many times.

Child abuse can be physical, sexual, emotional, psychological, or in the form of neglect. Munchausen syndrome by proxy is another form of child abuse in which the caregiver fabricates illnesses or makes the child sick (Kaneshiro, 2021). The CDC identifies many risk factors for child abuse (CDC, 2022b), including individual characteristics, caregiver and family risk factors, and community risk factors.

There are many characteristic signs, symptoms, and patterns of injury associated with the physical abuse of a child, such as bruises, burns, specific fractures, and head trauma, all of which may be indicators of child abuse (Colbourne, 2020). For screening and detection purposes, clinicians should also keep in mind that the emotional and psychological condition of the child and the history surrounding possible incidents of child abuse are important. When considering the possibility of child abuse, consider these three issues.

1. Child-caregiver interaction: Is the child agitated, fearful, or emotionally or psychologically upset when interacting with the caregiver? What are the caregiver’s attitudes and behaviors towards the child? Are they attentive, concerned, cold, disinterested, and harsh?
2. Frequent or suspicious injuries: Does the caregiver’s story of how and why the injury occurred make sense? Did the caregiver delay getting help for an injured child? Has the child had previous injuries or the same injury before? Are the injuries increasing in frequency and severity? Does the child have an injury or a medical condition that could not happen to a child, like genital trauma, a sexually transmitted disease, or physical trauma that could not happen to a child, given their age, body weight, and level of physical activity? Does the child have bruises or fractures that are days, weeks, or months old, but the caregiver claims that the child was recently injured?
3. General well-being of the child: Is the child well nourished? Do they have frequent illnesses or injuries? Is the child withdrawn, apathetic, or fearful?

Healthcare professionals must report child abuse according to professional ethics codes, the standards of healthcare facilities, and state and local statutes. In the United States, mandatory reporting laws vary by state and will describe what populations are covered and under what situations. Typically, this will include children, the disabled, and the elderly, including neglect and abuse (Thomas & Reeves, 2023). State reporting laws will also indicate which individuals are mandated to report, such as childcare providers, clergy, coaches, counselors, healthcare providers, lay enforcement, and educational staff such as principals and teachers.

The CDC’s publication Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities, 2016, provides guidelines, plans, and resources for preventing child abuse (Fortson et al., 2016). The publication can be accessed using this link. Other information from the CDC on this topic is on their website.

Unintentional injuries continue to be the leading cause of death of adolescents between 15-19 years old, followed by homicide and suicide (CDC, 2023m). Motor vehicle safety needs to be emphasized with this population, with education centering on the importance of safety belt use, the risks of substance abuse while driving, and speed-related risks. Adolescents should not be allowed to drive until they demonstrate the physical and cognitive skills to do so safely (Kaneshiro, 2023).

Sports participation significantly increases in adolescence and can become a large component of a teen’s personal and social identity. With sport comes an increased risk of injury. A teen’s musculoskeletal maturity is often incomplete, so they must be educated about the risk of overuse or overload injury. An adolescent athlete needs to be educated on the importance of a proper warm-up, limiting the number of repetitions (such as for youth baseball pitchers), and should be encouraged to participate in multiple sports. An adolescent should be encouraged not to participate in year-round sports competitions. Youth with early single-sport specialization, before the age of 14, or those with high training volumes have been shown to have an increased history of injury, have sustained a greater total number of injuries, and had a higher incidence of injuries requiring surgery (Ahlquist et al., 2020). Intensity and exercise load must be considered when developing rehabilitation programs for this population. The cumulative amount of time the athlete spends on strength and conditioning, rehabilitation, and practice training sessions should also be considered.

Proper preparticipation examinations should include a general health checkup, a check of organs and systems, a thorough screening of the musculoskeletal system for muscle, bone, and joint health, and neurocognitive baseline testing. Establishing baselines for these systems will ensure that the adolescent is healthy enough to participate in sports and indicate the healing trajectory if an injury occurs, such as a concussion. Proper cardiac screenings should be considered to identify the risk of cardiac events. Adolescents must be informed about the importance of proper techniques and safety equipment. In addition, physicians, athletic trainers, and physical therapists can play a key role in keeping an adolescent healthy.

Major depression in adolescents is a common and serious problem, and it is associated with acute and chronic morbidity and mortality (Zuckerbrot et al., 2018). According to the American Academy of Pediatrics (AAP), approximately 1 in 11 adolescents have had a major depressive event (AAP, 2021). Major depression in adolescents also frequently goes unrecognized, and it is recommended that depression screening start at age 12(Zuckerbrot et al., 2018). The AAP recommends using the Patient Health Questionnaire-2 (PHQ-2), as seen below.

Suicide is the second leading cause of death in 15 to 24-year-olds (AACAP, 2021). Most adolescents who attempt or commit suicide have a serious psychiatric disorder, most commonly depression. Other factors that put adolescents at risk for suicide include but are not limited to, anxiety disorders, emotional problems, a history of physical or sexual trauma, family conflict, feelings of hopelessness, or stressful life events (AACAP, 2021).

Bullying is an unwanted and aggressive behavior among school-aged children involving a power imbalance that may be perceived or real (Stopbullying.gov, 2023a). Examples of bullying include teasing, name-calling, pushing, hitting, or making sexually inappropriate gestures.

Who is at risk?  (Stopbullying.gov, 2023b).

• Children who appear different from their peers
• Those who are perceived as weak, depressed
• Those with low self-esteem
• Those who have a sexual and gender orientation not fitting the ‘traditional norms”
• Those who are overweight or underweight
• Those with visible (or invisible) disability

Signs of Bullying include (Stopbullying.gov, 2023c): 

• Unexplainable injuries
• Destroyed/ damaged books
• Altered eating habits
• Faking illness to skip school
• Declining school grades
• Attempting to harm themselves or talking about suicide

You can find additional information on bullying here.

According to the CDC (2021), school violence is described as violent “acts that disrupt learning and have a negative effect on students, schools, and the broader community.” School violence can include bullying, fighting, weapon use, gang violence, and sexual violence. The Youth Risk Behavior Surveillance, 2019, reported that 7.0% of students had been threatened or injured with a weapon, 8.0% had been in a physical fight, and 9% of high school students had not gone to at least one school day because of safety concerns.

The CDC’s program, STOP SV: A Technical Package to Prevent Sexual Violence, is not designed explicitly for adolescents, but it provides essential information on the topic (Basile, et al. 2016). The STOP SV program can be accessed by using this link.

Compared to other age groups, workplace injuries are more prevalent in the age group than others, as these are the years in which most adults focus on their careers and work toward building their retirement funds. In 2020, the top 3 causes of occupational injuries involving days away from work were the following (NSC, 2021):

1. Exposure to harmful substances or environments
2. Overexertion, bodily reaction (most common site: back injury)
3. Falls, slips, trips

“ Work-related medically consulted injuries totaled 4.26 million in 2021 (NSC, 2021)”.

Allied health professionals often perform ergonomic evaluations at worksites to decrease the risk of workplace-related injuries. A physical therapist may also be contracted to perform “back classes,” during which employees are taught proper lifting techniques and how to use proper body mechanics when performing the tasks related to their job. This can be especially important in repetitive jobs.

Falls in the Elderly

A simple fall can cause serious injury in the older adult, such as breaking a bone, leading to expensive medical costs and the possibility of more serious health problems or long-term disability (NIAb,nd). Falls are a common event in older adults, and it has been estimated that more than one in four people over 65 years fall annually (NIAb,nd). Multiple risk factors contribute to falls in the elderly, including (but not limited to):

• Decreased eyesight, hearing, or reflexes
• Medical conditions like dementia or stroke, diabetes, neuropathy
• Adverse effects of medications
• Orthostatic hypotension
• Age-related loss of muscle mass or problems with balance and gait
• Safety hazards in the home
• History of past falls

A fall risk assessment is recommended for all older adults, at least once a year, and more frequently for at-risk patients. Screening involves questioning about fall history, gait, and balance. A formal fall assessment can be done if the patient or caretaker reports positively to the questions. Several well-validated screening tests for fall assessment include the Timed Get Up and Go, Berg Balance Scale, Falls Efficacy scale, Activity-Specific Balance Confidence scale, Five Times Sit to Stand Test, and the Tinetti Performance Oriented Mobility test. In addition to the performance-based balance assessment tests, additional screening should be performed on strength, range of motion, vision, cognition, and vestibular functions.

Home evaluations can include assessing the presence of stairs in the home, tripping hazards such as throw rugs or electrical cords, poor lighting, and proper footwear. Encourage the use of handrails whenever navigating stairs. Encourage the older adult to keep clutter on the floor to a minimum. Educate the older adult to turn on the lights and avoid walking in dark or dim lighting. Assessing the need for use or compliance with assistive devices, such as canes and walkers, is often necessary to improve safety. Install grab bars where needed, often in the shower or near the toilet. As part of a fall prevention program, an occupational therapist could evaluate and improve an older adult's ability to don and take off clothing.

Finally, assessment of risk-taking behaviors also needs to be evaluated, such as excessive alcohol consumption and adherence to medication schedules and dosages. Physical and occupational therapists are skilled at performing comprehensive evaluations to identify the root causes of falls and address them effectively.

According to the National Council on Aging, older adults are 3.5 times more likely to die in fires than the general population (Crosswhite-Chigbue, 2022). Common causes of fire in the age population result from cooking on the stove or oven, smoking, and using candles. Safety skills in the kitchen can be addressed by occupational therapists.

Elder abuse is a severe and pervasive safety issue for aging adults. According to the National Council on Aging, approximately 1 of every 10 Americans 60 years of age or older have experienced elder abuse, and it has been estimated that only 1 out of 14 cases of elder abuse are reported (NCOA, 2021). Elder abuse has been defined in different ways. Still, it is typically considered intentional actions that either cause harm or a risk of harm done by a caregiver or someone in a position of trust (NCOA, 2021). The types and definitions of elder abuse are (NCOA, 2021).

1. Physical Abuse: Inflicting injury or pain.
2. Sexual Abuse: Nonconsensual touching or sexual activities.
3. Emotional abuse: verbal assaults, threats of abuse, harassment, or intimidation.
4. Confinement: restraining or isolating an older adult other than for medical reasons.
5. Passive Neglect: Failing to provide the necessities of life.
6. Willful deprivation: denying an older adult medication, medical care, shelter, food, a therapeutic device, or other physical assistance and exposing the person to the risk of physical, mental, or emotional harm.
7. Financial Exploitation: Failing to provide the necessities of life.

Signs of elder abuse vary depending on the type of abuse. Some signs to watch out for in older adults include the individual seeming withdrawn, isolated from family or friends, having unexplained bruises, burns/ scars, appearing dehydrated, dirty, or having not received needed medical care, and recent changes in their spending patterns(NIAa, nd). Several professional organizations recommend screening patients for elder abuse; many screening tools are available.