Hesperian Health Guides

Growth and development at different ages

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HealthWiki > Helping Children Live with HIV > Chapter 3: How young children develop > Growth and development at different ages


Everything children need to grow and develop usually can be found in daily life in the family and community. When children do not develop well and need extra help, family members and others in the child’s community can often provide it. The earlier you notice and help with any physical or learning problems a child has, the more likely she is to do well.

Watch for problems with a child’s growth and development in any area — the child’s body, mind, language, or relationships. Children show different signs they are having problems, depending on how old they are.

A child from birth to 1 year old

Babies learn about the world through their senses. They respond to faces, voices, and bright colors. They discover their hands and feet, smile, start to understand and say a few words, sit up, crawl, stand, and start to explore and play with objects. For the first year of a baby’s life, parents and other main caregivers provide all the child’s basic physical and emotional needs.

What the baby needs:

  • Regular feeding and other physical care, including any needed medicines, and lots of physical affection. Being held helps a baby feel secure.
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  • Talking, stories, singing, and eye contact with the mother or other main caregiver.
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  • Close, responsive attention of a caregiver. This helps a child develop trust.
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  • Physical protection and safe areas to explore, with things to look at, touch, hear, and play with.
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How HIV may harm a baby’s growth and learning from birth to 1 year old

Babies with HIV, or in a family where others have HIV, often show signs of problems during their first year.

3 women holding babies, while a woman is thinking
Hector is 3 months older than Marcos. But he cannot sit on his own. And he does not reach for things.

A baby with HIV infection needs more food than other babies to grow, so malnutrition is very common. Signs include a baby being smaller, weaker, sicker, and slower to talk and understand. Other signs of slow development could be a baby not knowing how to roll over or crawl, not being able to sit, or not being able to hold or pass things from hand to hand. Most healthy babies can do these things by the time they are 1 year old.

a mother speaking while holding a crying baby whilea child is thinking
Why won’t he ever stop crying!
He never wants to play.

Untreated HIV infection can make babies so ill that they die before age 1, usually from illnesses such as pneumonia, diarrhea, malaria, or TB.

When weak and sickly, babies are more fussy and difficult to care for. Caregivers may, over time, feed them less, communicate with them less, and play with them less than the babies need to develop well. This can also happen if the baby’s mother or father is very ill or has died from HIV or another illness.

A child who is treated with impatience or left alone learns not to expect kindness from people. He may develop more slowly and tend to keep to himself or lash out at others.

a child running and speaking

Giving sickly babies more food and caring attention at any point, and starting them on HIV medicines if needed, will help them catch up to others their age. See Chapter 9 and Chapter 10 for what babies need to eat to be healthy, and How to prevent HIV after the birth and Chapter 11: ART: Medicines for HIV for when and how to give children HIV medicines.

Paying close attention to and playing with babies can help caregivers too. When a baby responds to attention, the caregiver feels how much she matters to the baby. Small ways of showing love for and interest in each other are good for both baby and caregiver. See Chapter 4: Communicating with children.

A child from 1 to 3 years old

This is when children learn to walk and run, understand and speak words, communicate ideas, and feed themselves. Many children are toilet-trained by age 3. They become more independent and thrive on interaction, but prefer familiar people. They like to help, can solve simple problems, enjoy learning new skills, and show pride in what they can do. Everything they try helps them learn and bit by bit develop more skills. They get upset if they cannot do things. Children this age do not yet understand time well, or concepts like life or death.

What the child needs:

  • Enough healthy food to keep growing well, and medicines or other needed health care.
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  • Encouragement, praise, and chances to play, learn, and develop some independence.
an older child talking to a younger child
One more step Tomas, you can do it!
  • People who both listen and talk to him.
a man speaking to a wet child
That must have been scary! What happened?
I fell in the water.
  • Protection from environmental dangers. Air or water pollution or poisons in paint or pesticides can cause permanent harm to young children.
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How HIV may harm a child’s growth and learning from 1 to 3 years old

Malnutrition is still a great danger for children this age. Many families affected by HIV simply do not have enough food. This is most dangerous for very young children, and communities need to find ways to help these families.

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When families have many children or an overburdened caregiver, children may not be fed individually. This can lead to accidents and wasted food or to older children taking all the food. Also, when children stop breastfeeding and begin eating solid foods, care is needed to ensure children eat enough. See What to feed babies for some ways to do this.

Malnutrition or illness can make any child smaller, weaker, uncomfortable, and less active. Children may not walk or run as well as other children their age, may not talk as well, and still may not eat or drink by themselves. These children are less able to explore and learn.

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When a 2- or 3-year-old child feels loved and secure, he feels more able to explore and try new things, which helps him learn. A child who feels less secure, perhaps because his mother died, will often be less open and curious, and less active in trying to do things. His learning will be slower than other children’s.

Children with HIV who do not receive treatment with ART often die before they reach 3 years of age. With ART and enough food, a child can live, grow, and develop well, even with HIV. See Chapter 11 for more about ART.

Children of this age grow and develop well when people in their families love and watch over them, give them safe things to touch and play with, keep them away from danger, help them get well when they are ill, answer their questions, and praise their efforts to do new things. In many families affected by HIV, no one has the time or energy to do all that for small children. Children kept inside because caregivers are not well enough or do not want to go out, or fear for their safety, or want them to stay clean, and so forth may not have enough opportunities or places to play, and so their learning will be less.

A child from 3 to 5 years old

Children who are 3 to 5 years old need a lot of attention. They tend to talk a lot, ask many questions because of how much they still need to learn, and have more abilities, though they still need help with many tasks. They like to play with friends, can learn to share, feel angry or guilty if they think they have failed, and become competitive, especially with their brothers, sisters, and playmates. They also become more adventurous and copy adults more. Children at this age are curious about the world outside their home.

Continuing to talk with them and showing them how to do things helps them learn about the world around them.

What the child needs:

  • Opportunities to do many different kinds of activities, including lots of physical play.
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  • Help learning language, through talking, singing, riddles, stories, and being read to.
man talking to a child
Then the man said, that’s my cow there…
  • Chances to explore, solve problems, and make choices.
woman talking to a child while collecting eggs
See how many eggs you can find.
  • Recognition when she tries new things or does something well.
woman talking to a child while washing clothes
Good, Sisi!


And of course, enough healthy food and needed medicines to keep growing well.

How HIV may harm a child’s growth and learning from 3 to 5 years old

A child between 3 and 5 years old is still in danger from malnutrition, whether he has HIV himself or his family has less to feed him because of HIV. Childhood illnesses are very dangerous at this age, especially for children with HIV.

man talking to a child while walking out a door

I will see you tonight. Stay here, and do not get into trouble.

HIV in a family may also mean that caregivers are very busy, ill, grieving, or absent, and therefore unable to give children the guidance, stimulation, and protection they need in order to learn and grow well.

If someone in the family is sick, a child this age often wants to know why. Caregivers may not know how to explain illness, healing, or death, and their relationship with the child may become less trusting.

Also, many children this age fear they are the cause of any bad thing that happens. If a caregiver is uncomfortable or unwilling to talk about illness or a death in the family, the child will guess at a cause, usually incorrectly, and may carry burdens of fear and guilt.

older child talking to a younger child

Did you wet your pants?

When emotionally upsetting things happen to 3 to 5 year old children, such as the death of a loved one or the loss of their home, they may slip “backward” in their development, losing abilities they had learned, such as toilet training. With time and support, children will act their age again.

Signs of learning problems during this age include:

  • difficulties with walking, running, or talking.
  • not understanding or being unable to do something other children the same age can do easily.
  • lack of interest in or engagement with life around them, just staring.

A child from 5 to 8 years old

As they grow older, children show more interest in the world and in people, words, numbers, and ideas. They know more about who they are in relation to others. They are more able to use words to talk about their feelings. They become more physically confident, start to take more responsibility, and they play with others and build trust with friends. They can learn about rules and understand how rules are important in games as well as in daily life, and often have strong feelings about right and wrong ways to act. They begin to have questions about God or morality.

What the child needs:

  • Experiences that help him keep developing his language, thinking, and physical skills.
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  • Help understanding what the rules are in different situations and how to follow them.

 a man in a sports uniform talking to a group of children

When I blow the whistle, everyone must stop.
  • People who will listen to her questions and try to answer them, and who will talk to her about ideas and feelings.

a father and child talking while the mother sits nearby nursing a baby

When will the baby be able to play with me?
Soon, Rani. She will smile for you and play I-can-see-you before long.
  • Opportunities to learn cooperation and self-control, to take responsibility, and to complete tasks.
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How HIV may harm a child’s growth and learning from 5 to 8 years old

Children this age are stronger, but malnutrition and illness can still harm them and interfere with their development. Disabilities from HIV infection may mean they have problems walking, hearing and speaking, or thinking.

A child older than 5 is more able to understand HIV and why people take medicine. He often has more questions and worries about these things than a younger child. These children need to know the truth about HIV, and when caregivers are too uncomfortable or unable to discuss their concerns, or believe children do not need to know, their learning suffers. Worry and guilt weigh heavily on children this age. See Chapter 5 for how to talk about HIV.

a child at a well thinking, while his mother talks to another woman

Will they let me use the pump today?

Between ages 5 and 8, children are very social and need playmates, places to play and explore, and ways to participate in family and community life. Because of HIV, others in the community may avoid a child or his whole family because they wrongly fear he will spread HIV. Or a child may lose his parents and have to move away from the friends and places he knows, and into a family that does not accept him completely.

A child affected by HIV may be so ill or tired, or so sad, upset, or withdrawn, that he lacks the energy to play, and when he does have energy, other children may not want to play with him. Having fewer friends or other relationships weakens a child’s confidence, and gives him fewer ways to learn about the world and develop new skills.

a woman talking to a child while she slaps her

You stupid girl, why did I ever accept you!

HIV often results in families lacking money to send children to school. For children age 5 to 8, school is very important for their learning and relationships.

Caregivers who are dealing with too much work, illness, death, and worry, or who lack a loving relationship with the child, may respond to her needs, crying, or mistakes with impatience or anger, rather than understanding and guidance.

Older children

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Children from about age 8 to 11 and older want to succeed at tasks and please adults and friends. They usually have more chores and regular responsibilities, including caring for younger children in the family. Providing this care without the support of parents is much harder for them. And the care those younger children get may not be as good.

Older children are in a time of intense social learning, especially in school. Their developing sense of self-worth can make them feel rejection deeply. The stigma of HIV, illness, or poverty can be very painful and cause a lot of shame.

These older children are beginning to make closer bonds with people outside the family, such as teachers and friends. Support from mentors such as these can be very helpful, and feeling valued by a widening circle of adults helps build a child’s confidence. Older children still need reassurance and guidance and still need to act and play like the children they are. Girls need to be able to stay in school — it is common to see girls this age burdened with too much work and childcare, especially in families affected by HIV.

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As young boys and girls grow into adults, they are working out their personal identity: “Who am I?” “What makes me the same as others or different?” They can be very emotional, especially as they feel the changes of puberty (maturing physically and having more sexual feelings). They can be very self-conscious and worry about the opinions of friends and peers.

Older boys and girls need to know that it is OK to make mistakes, learn from them, and be forgiven. They need guidance to understand how risky activities are harmful. They also need to develop hope for their futures, so they can make good decisions about avoiding risks. And while they often want and need boundaries or rules, they will also question and rebel against them. This is normal.

A girl may look like a woman but still be a child in many ways. These years are when girls most feel the need for support and encouragement. Boys also need support and guidance — and to be taught to respect girls, especially if we want to prevent the spread of HIV.



This page was updated:27 Nov 2019