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🌱 健康促进 · 第1课，共6课 · 6 min

四个月会翻身，六个月会坐，十二个月会走

Rolls at Four, Sits at Six, Walks at Twelve

👶 一位母亲说她10个月大的孩子“还不会走路”，她很担心。另一位母亲说她10个月大的孩子“还不能独自坐起来”。其中一种情况需要咨询儿科医生。考试希望你能分辨出是哪一种。

👶 A mother says her 10-month-old 'isn't walking yet' and is worried. A different mother says her 10-month-old 'doesn't sit up alone.' One of those is a question for the pediatrician. The exam expects you to know which.

💡 核心要点

微笑2，头部控制3–4，翻身4–6，坐6–8，爬行8–10，钳形抓握9–12，走路12–15。丧失已经获得的技能始终是危险信号。

Smile 2, head 3–4, roll 4–6, sit 6–8, crawl 8–10, pincer 9–12, walk 12–15. Losing a skill already gained is always a red flag.

🧠 为什么重要

发育遵循从头到脚（cephalocaudal）和从中心向外（proximodistal）的方向。大致时间是：2个月时出现社交性微笑；3 to 4个月时能控制头部；4 to 6个月时会翻身（先从俯卧翻到仰卧）；6 to 8个月时能无支撑坐立；6 to 8个月时开始出现陌生人焦虑；8 to 10个月时会爬行；9 to 12个月时出现钳形抓握；9个月左右能拉着站立；12 to 15个月时会走路；12个月左右说出第一批词语，2岁时能说两词短语。出生体重在约6个月时翻倍，在12个月时增至三倍。后囟门在2 to 3个月时闭合，前囟门在12 to 18个月时闭合。第一颗牙齿在6个月左右萌出。尚未到期的技能尚未出现属于正常；里程碑超过预期范围仍未达到，或已获得的技能丧失，则需要随访和发育筛查，而不是“等着看”。

Development proceeds HEAD TO TOE (cephalocaudal) and CENTER OUTWARD (proximodistal). Roughly: SOCIAL SMILE by 2 months; HEAD CONTROL by 3 to 4 months; ROLLS over at 4 to 6 months (front to back first); SITS without support at 6 to 8 months; STRANGER ANXIETY begins 6 to 8 months; CRAWLS at 8 to 10 months; PINCER GRASP by 9 to 12 months; PULLS TO STAND around 9 months; WALKS at 12 to 15 months; first WORDS around 12 months and two-word phrases by 2 years. Birth weight DOUBLES by about 6 months and TRIPLES by 12 months. The posterior fontanel closes by 2 to 3 months and the anterior by 12 to 18 months. The first tooth erupts around 6 months. A skill not yet due is normal; a milestone missed past its expected range, or a loss of skills already gained, needs follow-up and developmental screening rather than 'wait and see'.

🏥 真实场景

🧸 一名7个月大的婴儿被带到诊所。她能向两个方向翻身，能在少量支撑下坐立，会牙牙学语，并在护士靠近时哭泣。每一项发现都符合发育进程，包括哭泣；在这一年龄出现陌生人焦虑是发育表现，不是问题。考试中“令人担忧”的选项会是7个月大仍不能控制头部的婴儿。

🧸 A 7-month-old is brought to the clinic. She rolls both ways, sits with a little support, babbles and cries when the nurse approaches. Every finding is on schedule, including the crying; stranger anxiety at this age is development, not a problem. The exam's 'concerning' option would be a 7-month-old with no head control.

📌 要点总结

  • 从头到脚，从中心向外Head to toe, center outward
  • 体重在6个月时翻倍，在12个月时增至三倍Weight doubles by 6 months, triples by 12
  • 尚未到期：正常；错过或丧失技能：报告并进行筛查Not yet due: normal; missed or lost skills: report for screening

📖 本课术语

钳状抓握 (Pincer grasp): 用拇指和食指捏起一个小物体，预计在9至12个月时出现。

✅ 自我测试

9个月大婴儿的哪项发现应由护士报告以便进一步评估？Which finding in a 9-month-old should the nurse report for further evaluation?
  1. 用耙抓方式抓小物体Uses a raking grasp for small objects
  2. 不能无支撑坐立Cannot sit without support
  3. 陌生人抱起他时哭泣Cries when a stranger picks him up
  4. 还不会走路Is not yet walking

答案: B · 不能无支撑坐立

无支撑坐立预计在6 to 8个月时实现。走路预计在12 to 15个月时实现，因此9个月时还不会走路属于正常，陌生人焦虑和耙抓方式在这一年龄也很典型。

Sitting unsupported is expected by 6 to 8 months. Walking is expected by 12 to 15 months, so not walking at 9 months is normal, and stranger anxiety and a raking grasp are typical at this age.

一名婴儿出生时体重为7 lb（3.2 kg）。12个月时预期体重是多少？An infant weighed 7 lb (3.2 kg) at birth. Which weight at 12 months is expected?
  1. 约10 lbAbout 10 lb
  2. 约21 lbAbout 21 lb
  3. 约14 lbAbout 14 lb
  4. 约30 lbAbout 30 lb

答案: B · 约21 lb

出生体重在一年时增至三倍：7 lb × 3 = 21 lb（约9.5 kg）。约14 lb是出生体重的两倍，预计在约5 to 6个月时达到，而不是12个月。

Birth weight triples by one year: 7 lb × 3 = 21 lb (about 9.5 kg). About 14 lb is double the birth weight, which is expected by about 5 to 6 months, not 12.

前囟门通常在什么年龄闭合？At what age does the anterior fontanel typically close?
  1. 12 to 18个月时By 12 to 18 months
  2. 2 to 3个月大时By 2 to 3 months of age
  3. 6个月大时By 6 months of age
  4. 2 to 3岁时By 2 to 3 years of age

答案: A · 12 to 18个月时

前囟门在12和18个月之间闭合；后囟门在2 to 3个月时闭合。

The anterior fontanel closes between 12 and 18 months; the posterior closes by 2 to 3 months.

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