Kids Growth Milestones
Growth Milestones - PRENATAL INTERVIEW
Growth Milestones - PRENATAL INTERVIEW
"Choosing a Doctor"
Choosing a doctor to care for your baby is one of the most important decisions parents make. You and your child will see this physician regularly for up to 18 years. A child's pediatrician does more than just treat illness. He or she will help you develop a comfortable style of parenting which will allow you and your partner to gain confidence in yourselves as parents.
The best time to select your baby's doctor is before the baby is born. You can start by making a "prenatal visit" to interview and get acquainted with a physician. This is usually arranged during the last trimester, although it can be scheduled at anytime during the pregnancy. Many new parents interview three or four doctors before making their decision. Some physicians charge for the "prenatal visit" and others do not. Expect to spend approximately 15 to 20 minutes with the doctor.
We have done many prenatal interviews over our pediatric careers. Many parents come into the office with long lists of questions, usually taken from various parenting books. Others, especially first time parents, are uncertain about what to ask. In the latter situation, the pediatrician will usually ask the parents questions "to get the ball rolling."
Most new parents usually begin the interview by asking practical questions such as how the doctor can be reached? How often are the visits? What are the office hours? Is it office policy to have certain "telephone" hours or can you call with non-emergency questions anytime? How are after-hour problems handled? What insurance does the doctor accept? Who covers for the doctor when he or she is not available?
You can also ask the doctor where he or she went to medical school, did his or her training, is he or she board certified, a member of the American Academy of Pediatrics and what hospitals is he or she affiliated. Parents have frequently ask us what we like most about being a pediatrician and if we have any children of our own.
Concerning medical issues, it is best to be general in your questioning. How do you feel about breast feeding? What formula do you recommend if we cannot breast feed? If we have a boy, how do you feel about circumcision? How do you feel about antibiotics? Alternative medicine? Immunizations? How soon after the baby is born will he or she be examined? When is my first visit in the office with my new baby?
The prenatal visit is not one-sided. It gives the physician a chance to introduce himself or herself, the practice and staff. In addition, the physician may ask the parents-to-be specific questions: How is the pregnancy going? Is mom on any medication? Any problems? Are there any family medical problems or genetic diseases? Any smokers in the house? Who will be home to help mom take care of the baby once they are discharged? Any other children? Have you prepared the other children for the new arrival? Have the parents purchased an approved car seat for the baby?
Expectant parents have a lot on their minds and often the last thing they think about is finding a pediatrician. While there are a number of ways to decide on a doctor for your baby - referrals from your obstetrician, friends, area hospitals and county medical societies - there is nothing like using the prenatal interview to search out the best physician to care for your child.
As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.
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Growth Milestones - 2 Weeks
The following comments are designed to help you enjoy your new baby and develop confidence in yourself as a parent. This information is not intended as a substitute for well-baby visits with your newborn's pediatrician. Remember, no two babies have exactly the same makeup or the same needs. Your baby is an individual with his or her own special growth pattern. Comparing your infant's growth and development with other children is not a good idea and usually causes needless worry. Never hesitate to ask your child's physician for guidance concerning specific problems. This is the reason for regular well-baby checkups!
Parenting and Behavioral
Hold, cuddle, talk to, sing to and rock your baby as much as you can. A lot of your infant's development depends on his or her interaction with you. Every touch stimulates the baby's brain.
Recognize the fact that parents can not always console their baby. Expect this. Of course, always check your baby when he or she seems uncomfortable, to make sure the infant is not too hot, too cold, hungry, wet or needs to burp. Give your child the benefit of the doubt and do not worry about "spoiling."
Try to spend time nurturing your baby when the infant is quiet, happy and alert, instead of waiting for him or her to cry and fuss for attention.
Parents should make sure they get adequate rest. Take the phone off the hook and nap when the baby naps. Encourage dad and other family members to help care for the infant. Keep in contact with friends and relatives. Go for a daily walk with the baby for fresh air.
Stages of Parental Development
Development
Begins to recognize family voices and makes small "throaty" noises.
Recognizes sounds by blinking, crying or showing the startle reflex (arms and legs move away from the body equally).
Blinks at bright light and may begin to follow, but eyes often do not focus together.
Watch for the first smile ... truly a milestone. It is the earliest sign of mental growth ... the first thing your baby can do on his or her own! (Usually not seen until 2-3 months).
Lifts head briefly when lying on his or her stomach.
Feeding
Make feeding a pleasant time for the entire family. Remember, your baby's first love for his or her parents arises from the bonding obtained during feeding time. The affection and touching the baby gets during the feeding period is an important part of the diet.
Babies need only breast milk or iron-fortified formula at this time unless otherwise directed by your baby's doctor.
Your baby's feeding habits will vary from day to day just like you. This is just another way your baby is letting you know he or she is a unique individual.
If prescribed by your child's doctor, remember to give vitamins and/or fluoride.
Call the doctor if you feel the baby is not gaining enough weight.
Do not use a microwave oven to heat formula.
Delay the introduction of solid foods until they are suggested by your infant's doctor.
Do not put your baby to bed with a bottle or prop it in his or her mouth.
Never give an infant honey to prevent infant botulism.
Sleep
Always put your baby to sleep on his or her back.
Infants sleep most of the day but a child's sleep patterns vary from baby to baby. It is not unusual for a baby to have a "fussy" period during the late afternoon or early evening. This is how the infant's immature nervous system handles all of the day's stimuli so ... prepare yourself for it.
Most babies will sleep through the night by 3 months old. "Lucky" parents get a good night sleep sooner. To achieve this, many babies need encouragement. Put the infant to bed when he or she is drowsy, but awake. Avoid rocking your baby to sleep or holding him or her until he or she falls asleep. Your baby needs to learn to fall asleep on his or her own. Try to ignore the baby if he or she is just squirming or whimpering. Your infant may go back to sleep on his or her own!
Reducing the Risk of SIDS
Prevention of Infant Sleep Problems
Immunizations
Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced,it is always best to seek the advice of your child's health care provider concerning the child's vaccine schedule.
Most physicians give the first of three Hepatitis B vaccines at the 2 week or one-month checkup, unless it was given in the hospital.
2001 immunization Schedule
Hepatitis B Vaccine
Newborn Testing
Safety
Always use a rear-facing infant car seat placed in the center of the back seat.
Never leave a baby alone with a young sibling or a pet.
Never leave your baby alone in a tub or on a high place, such as a changing table, bed or sofa.
Set hot water thermostat at less than 120 degrees F.
Insist on a smoke-free environment for your baby. If there is a smoker in the family, do not permit any smoking in the house or in the car.
Make sure smoke detectors are in place and working.
If your home uses gas appliances, install and maintain carbon monoxide detectors.
Avoid sun exposure to baby's tender skin.
Car Seat Selector
Never, ever shake a baby!
Eliminations
Every baby has his or her own unique pattern to the frequency of their bowel movements. Some go after every feeding, some once a day and others every two or three days.
Most babies strain, grunt and fuss even when they have a loose bowel movement.
Stool color and consistency varies from yellow in breast fed babies to brown and green in formula fed babies. Consistency can be anywhere from thin to a thick paste.
What is Constipation and how to treat it
How often does a normal baby have a bowel movement?
Does Iron in Infant Formula Cause Constipation?
When to Call the Doctor
Anything that bothers you is important to your child's pediatrician. That's our job!
Fever (over 100.2 degrees F rectally).
Not gaining weight.
Excessive vomiting, especially if it is forceful and goes across the room.
Uninterested in eating.
Irritability or lethargy.
Unusual skin rashes.
When to call the doctor for
Fever
Vomiting
Coughing
Diarrhea
The information presented in Growth Milestones was obtained with the help of our pediatric experts and with material from The American Academy of Pediatrics' Guidelines for Health Supervision and Bright Futures' Guidelines for Health Supervision of Infants, Children, and Adolescents. Bright Futures is supported by the Maternal and Child Health Bureau, U.S. Department of Health and Human Services
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As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.
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Yes: No:
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Quick reference medical handouts used by Pediatric offices
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Growth Milestones - 2 Months
"The Big Smile"
<http://www.kidsgrowth.com/images/twomonths.jpg> The following comments are designed to help you enjoy your new baby and develop confidence in yourself as a parent. They are not intended as a substitute for well-baby visits by your newborn's pediatrician. Remember no two babies have exactly the same makeup or the same needs. Your baby is an individual with his or her own special growth pattern. Comparing the growth and development of your baby with other children is not a good idea and usually causes needless worry. Never hesitate to ask your child's physician for guidance concerning specific problems. This is the reason for regular well-baby checkups.
Parenting and Behavioral
The next few months are perhaps the easiest age during a baby's life. Your baby still has relative immunity to most infections. He or she is happy to see people, yet does not demand a lot of attention nor can they get up and crawl around to get into things. Your child will become responsive when you talk to him or her and is beginning to blossom into a "real" person.
Continue to hold, cuddle, talk to, sing to and rock your baby as much as you can. Every interaction with your child stimulates brain development.
Encourage your baby to "speak" by talking to him or her during dressing, bathing, feeding, playing, walking and driving. Stimulate your child with age- appropriate toys. Hang a rattle, mobile or some other bright object across the crib so that your infant can begin watching and reaching for it. Parents should continue to make sure they get adequate rest. A lot of moms still need a nap, so take one when baby naps. Go for a daily walk with the baby for fresh air. Mothers should have had their postpartum checkup by now.
The crying Infant
Is it okay to let a
baby cry?
Stages of Parental
Development
In a child's voice
Have Baby, Will
Travel
Raising a Healthy
Baby
Learningames
To Soothe The Cries
of a Colicky Baby
Some Thoughts on
Colic
?Temper Tantrum in
2-month old
Development
Have you noticed that your baby's smile has improved, especially when he or she sees you? Infants at this age begin to show pleasure in their interactions with their parents.
Before long, the neck muscles will begin to develop, allowing your baby to gain more head control. He or she will be able to hold his or her head steady and it will not bob around when you pick up your child. Until this happens, however, be prepared to give your baby extra head support.
Your baby will begin to grasp a rattle or tightly hold on to your finger
Between now and the 4-month checkup, most babies will start to lift their head, neck and upper chest on their forearms, craning their necks like a turtle to see what is going on. They will also straighten out their legs when you let them sit on your lap and try to stand with support. And no, this will not cause them to become bow-legged.
Your baby's brain
development
Milestones in Motor
Development
Unavoidable Injuries
at Birth
Feeding
Ensure that your infant is gaining enough weight.
Discuss with your baby's doctor any problems you are having with breast or bottle feeding. Remember, "spitting up" is common and as long as your baby is thriving, the spitting is a "nuisance" rather than a "problem."
Infant feeding demands will continue to vary from day to day. By 10 weeks of age, some babies are feeding only four to five times a day (breast or bottle) while others require more feeding times. This is normal. Hopefully, the interval between feedings is not at least every three to four hours during the day with lengthened intervals at night. Do not put cereal in a bottle unless instructed to do so by your baby's doctor. The introduction of solid foods depends on the preference of your child's pediatrician.
Remember to give vitamins and/or fluoride if prescribed by your child's doctor.
Do not use a microwave oven to heat formula.
Never put your baby to bed with a bottle or prop it in their mouth.
Between now and the next checkup, many babies begin to drool. This is quite common and does not necessarily indicate early teething. It is probably due to a lot of saliva that the baby has not yet learned to swallow.
When Baby Spits
up frequently
Abnormal stomach
value causes vomiting
ABC's of Infant
Formulas
Collection and Storage
of Breast Milk
Eating right - A Guide
for Breastfeeding Moms
Feeding Suggestions
for the 1st Year
Tables of Normal
Growth
Sleep
Always put your baby to sleep on his or her back. Alternate the end of the crib where you place his or her head so he or she does not always sleep with his or her head on one side.
Begin to establish a bedtime routine and other habits to discourage night awakening.
Infants sleep most of the day but a child's sleep patterns vary from baby to baby. Many babies still have that "fussy" period during the late afternoon or early evening. It is OK for moms and dads to give themselves a break from that time by getting assistance from relatives and friends.
Most babies will sleep through the night by 3 months old. "Lucky" parents get a good nights sleep sooner. To achieve this, many babies need encouragement. Put the infant to bed when they are drowsy but awake. Avoid rocking your baby to sleep or holding him or her until he or she falls asleep. You baby needs to learn to fall asleep on his or her own. Try to ignore the baby is he or she is just squirming or whimpering. Your infant may go back to sleep on his or her own!
Reducing the
Risk of SIDS
Prevention of Infant
Sleep Problems
Night Criers and
Feeders
Night Awakenings from
Holding Until Asleep
Can We Prevent Infants
from Waking up at Night
Is it okay for an infant to
sleep in his car seat?
Is it okay to let a baby
"cry it out" when they
wake up at night?
At this Checkup
An important part of each well-child visit is the evaluation of the baby's growth. In the vast majority of children, growth falls within normal ranges on the standard growth curves for weight, height or head size. The smooth curves of a growth chart might create the impression that a baby grows in a continuous, smooth manner. Instead, growth usually occurs in spurts. Therefore, single growth (height , weight, head size) measurement at any particular month in a child's life is of limited value - more important is the child's rate of growth over time.
The 2-month old will also be checked thoroughly both physically and developmentally.
Growth Charts
Tables of
Normal Growth
Immunizations
Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced, it is always best to seek the advice of your child's health care provider concerning your child's vaccine schedule.
Haemophilus Influenza Type b (Hib) Vaccine #1
Diphtheria, Tetanus, Acellular Pertussis (DTaP) Vaccine #1
Inactivated Poliovirus (IPV) Vaccine #1
Hepatitis B Virus (HBV) Vaccine #2 (To be administered at 2 or 4 months)
Prevnar (Pneumococcal) Vaccine #1
Ask your baby's doctor about possible side effects (fever, irritability, tenderness over the injection site).
2001 Immunization
Schedule
Additional information
on:
HiB Vaccine
DTaP Vaccine
Polio Vaccine
Prevnar
Safety
Continue to use an infant car seat that is properly secured at all times.
Continue to put the baby to sleep on his or her back or side.
Continue to test the water temperature with your wrist to make sure it is not hot before bathing the baby. Never leave the baby alone or with a young sibling or pet.
Do not leave your baby alone in a tub of water or on high places such as changing tables, beds, sofas or chairs.
Always keep one hand on the baby.
Continue to insist that the baby's environment is free of smoke.
Never shake or jiggle the baby's head vigorously.
Never leave the infant alone in the house or car, even for a minute.
Do not place strings or necklaces about a baby's neck or use a sting to attach a pacifier.
Never hold your baby while drinking a hot liquid.
If your home uses gas appliances, install and maintain carbon monoxide detectors.
Never, ever shake
a baby!
Car Seat Selector
Product Recalls
Eliminations
Your baby will have his or her own frequency of bowel movements.
Most babies strain, grunt and fuss when they have bowel movements.This does not mean they are constipated.
What is Constipation
and how to treat it
Does Iron in Infant
Formula Cause
Constipation?
When to Call the Doctor
Anything that bothers you!
Fever.
Not gaining weight.
Excessive vomiting, especially if it is forceful and goes across the room.
Uninterested in eating.
Irritability or lethargy.
Unusual skin rashes.
Your baby seems very stiff or very floppy.
When to call the doctor
for
Fever
Vomiting
Coughing
Diarrhea
The information presented in Growth Milestones was obtained with the help of our pediatric experts and with material from The American Academy of Pediatrics' Guidelines for Health Supervision and Bright Futures' Guidelines for Health Supervision of Infants, Children, and Adolescents. Bright Futures is supported by the Maternal and Child Health Bureau, U.S. Department of Health and Human Services.
<../images/back2.gif>
As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.
| home | contact us | about us |
| parenting & behavioral | child development | growth milestones |
| childhood conditions | seesaw | book reviews |
Copyright © 1999, 2000, 2001, KG Investments, LLC.
Usage Policy and Disclaimer
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Do you believe that picking up a three-month old everytime she cries will spoil her?
Yes: No:
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Quick reference medical handouts used by Pediatric offices
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Growth Milestones - FOUR MONTHS
"Emerging Personality"
The 4-month-old infant is beginning to settle in by establishing regular sleeping and feeding cycles. He or she is also showing endless interest in his or her environment. The following comments are designed to help you and your partner enjoy your 4-month-old while continuing to gain confidence in yourselves as parents. This information is not intended as a substitute for well-baby visits by your newborn's pediatrician. Never hesitate to ask your child's physician for guidance concerning specific problems. This is the reason for regular well-baby checkups.
Parenting and Behavioral
This is an enjoyable time for you and your baby. He or she is more fun and less work. He or she is exploring more and trying to make contact with his or her surroundings.
Continue to hold, cuddle, talk to, sing to and rock your baby as much as you can. Every interaction stimulates brain development. He or she needs an interested audience and a chance to use his or her laughing skills.
Now is the time to think about getting your baby a playpen and some suitable toys to keep him or her entertained.
Read brightly colored books to your baby. Reading is important to succeed as an adult and you can not start early enough.
Since the 4-month-old infant is more active, spitting up is common at this age, so have a good supply of absorbent bibs to protect your baby's skin and clothing from being constantly wet.
If the mother has returned to a second job outside the home, she needs to feel comfortable with the child care arrangements she has made for her baby.
Parents need to keep in contact with friends and family to avoid social isolation.
Development
A baby's development proceeds in a head to foot direction. At this age the typical child can hold his or her head high and raise the body on his or her hands while lying on his or her stomach.
The 4-month-old baby keeps his or her hands open while at rest. He or she will play with his or her hands, bat at mobiles and reach for rattles. Any object he or she holds goes directly into his or her mouth.
Most babies this age will show a clear preference for parents and other caregivers. They will turn toward a sound and recognize their parent's voices. Four-month-old infants babble, smile, laugh and squeal.
The 4-month-old baby also begins to learn cause and effect. He or she shakes a rattle and it makes noise, you wind the mobile and it begins to move.
Feeding
Feeding times may become interesting! Your baby will begin responding to all the sights and sounds of his or her environment. Frequently, the baby may become so interested in his or her world that he or she may refuse to settle down to eat. He or she will take a few swallows of formula or breast milk and then stop to see what is going on in the room.
Most pediatricians start solid foods sometime between ages 4 and 6 months. If your baby sits well when supported, holds his or her head up and seems to be hungry, it may be time to being cereal. Begin with infant rice cereal. Mix a couple of teaspoons with breast milk or formula until it becomes a thin soup. Place the spoon about half way back on the baby's tongue to teach swallowing. As your baby gets the hang of it, increase the thickness and amount of the cereal. If your baby pushes the solid food out of his or her mouth, it does not necessarily mean he or she does not like what your giving him or her. Babies have a tongue reflex that causes them to push anything out of their mouth.
Remember to give vitamins and/or fluoride if prescribed by your child's doctor.
Never put your baby to bed with a bottle or prop it in his or her mouth.
Ask your pediatrician about giving diluted juices.
Between now and the next checkup, many babies begin to drool. This is quite common and does not necessarily indicate early teething. It is probably due to a lot of saliva that the baby has not yet learned to swallow.
At this Checkup
An important part of each well-child visit is the evaluation of the baby's growth. In the vast majority of children, growth falls within normal ranges on the standard growth curves for weight, height or head size. The smooth curves of a growth chart might create the impression that a baby grows in a continuous, smooth manner. Instead, growth usually occurs in spurts. Therefore, single growth (height, weight, head size) measurement at any particular month in a child's life is of limited value - more important is the child's rate of growth over time.
The 4-month old will also be checked thoroughly both physically and developmentally
Sleep
Always put your baby to sleep on his or her back. Alternate the end of the crib where you place his or her head so your baby does not always sleep with his or her head on one side. If you wake up and find your baby has rolled over onto his or her stomach, don't panic. If the child can roll over, he or she is at a reduced risk for SIDS (Sudden Infant Death Syndrome).
Encourage your baby to console himself or herself by putting your child to bed awake. Teach your 4-month-old self-soothing techniques by providing him or her with a transition object, such as a stuffed animal, blanket or favorite toy.
Keep to your establish a bedtime routine and other habits to discourage night awakening.
Immunizations
Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced, it is always best to seek the advice of your child's health care provider concerning your child's vaccine schedule.
Immunizations recommended at this age include:
Haemophilus Influenza Type b (Hib) Vaccine #2
Diphtheria, Tetanus, Acellular Pertussis (DTaP) Vaccine #2
Inactivated Poliovirus (IPV) Vaccine #2
Prevnar (Pneumococcal) Vaccine #2
Hepatitis B Virus (HBV) Vaccine #2 (To be administered at 2 or 4 months)
Ask your baby's doctor about possible side effects (fever, irritability, tenderness over the injection site).
Safety
Now that your baby is more active, parents need to be more careful than ever not to leave the child anyplace from which he of she can fall. Always keep one hand on the baby and never turn your back, for even a second, when you put your infant on a sofa, bed, changing table or any other high place. Your baby demands your full attention.
Continue to use an infant car seat that is properly secured at all times.
If your home uses gas appliances, install and maintain carbon monoxide detectors.
Continue to keep the baby's environment free of smoke. Keep the home and car nonsmoking zones.
Do not drink hot liquids or smoke while holding the baby.
Remember, everything a 4-month holds goes in his or her mouth, so keep toys with small parts out of reach. Warn siblings to keep these objects away from their little baby brother or sister.
Do not use an infant walker at any age. The walkers are dangerous and do not help your baby's motor development.
Eliminations
Your baby will have his or her own frequency of bowel movements.
Most babies strain, grunt and fuss when they have bowel movements.This does not mean they are constipated.
When to Call the Doctor
Anything that bothers you!
Not gaining weight.
Your baby seems stiff or floppy.
Becomes totally uninterested in eating.
Your baby cannot hold a rattle or doesn't babble.
Eyes are crossed most of the time.
You have not seen any developmental changes since the last checkup.
Check your child's progress with our Growth Charts.
The information presented in Growth Milestones was obtained with the help of our pediatric experts and with material from The American Academy of Pediatrics' Guidelines for Health Supervision and Bright Futures' Guidelines for Health Supervision of Infants, Children, and Adolescents. Bright Futures is supported by the Maternal and Child Health Bureau, U.S. Department of Health and Human Services.
<../images/back2.gif>
As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.
Growth Milestones: Six Months
The Social Butterfly
The 6-month-old infant likes to be with people and there is a sudden burst in awareness of his or her surroundings. The baby loves to play face to face with parents and begins to develop a sense of trust and the beginning elements of learning (through games like peekaboo). The following comments are designed to help you and your partner enjoy your 6-month-old while continuing to gain confidence in yourselves as parents. This information is not intended as a substitute for well-baby visits by your newborn's pediatrician. Never hesitate to ask your child's physician for guidance concerning specific problems. This is the reason for regular well-baby checkups.
Parenting and Behavioral
Encourage speech development by talking to your 6-month-old while dressing, bathing, feeding, playing, walking and driving.
Begin playing social games such as pat-a-cake, peek-a-boo, so-big, etc.
Begin to set some limits for future discipline by using distraction, reducing stimulation and establishing routines.
Establish a bedtime routine and other habits to discourage night awakening. Make sure your baby has learned self-soothing techniques by providing your child with the same transitional object, such as a stuffed animal, "special" blanket or favorite toy.
Encourage play with age-appropriate toys. Babies like to bounce, swing, reach for you, pick up and drop objects, and bang things together. Unbreakable household objects such as plastic measuring cups, large wooden spoons, pots, pans and plastic containers make great toys.
Shoes are not necessary at this age except for show and to keep their feet warm.
Development
Begins to speak single (hard) consonants, like "dada" (sorry mom!).
Rolls over both ways (front to back and back to front).
The baby will begin to look for a toy dropped out of sight.
Has no head lag when pulled to a sitting position.
Begins to "tripod" (sits with one hand on the ground for support) and soon will begin to sit without support.
Continues to grasp and mouth objects, but now can transfer small objects from one hand to another.
Six-month-old babies begin to rake at small objects but cannot pick them up yet because their finger coordination is not yet precise enough.
Shows displeasure with loss of a toy.
Is able to recognize each parent and may even begin to show some stranger anxiety.
Makes attempts to feed himself or herself.
Smiles, laughs, squeals and begins to imitate sounds.
Can be content in a playpen for a while playing with one or two toys.
Can bear weight on his or her legs when held in a standing position (no, it will not make him or her bowlegged).
May develop one or more teeth by the 9-month checkup. Don't worry if teething is delayed, as every child has his or her own timetable for teething. The process of getting teeth can be difficult or easy and there is no reason why one baby frets and drools during tooth eruption and another sails through it without a whimper. Ask your baby's doctor what you can do if teething gives your little one a problem.
Feeding
Most babies double their birth weight in the first 5 to 6 months. They will not double their weight in the next six months as growth rate slows a little. Therefore, expect your baby's appetite to diminish a little in the next six months.
Continue to breast feed or use iron-fortified formula for the first year of the infant's life.
Feeding should be on a routine mealtime schedule which hopefully coincides with the family mealtimes.
Continue introducing new solid foods, starting with fruits, yellow vegetables, green vegetables and then meats. Your baby will let you know when and how much he or she wants to eat.
Your baby will begin to show preferences for some food and dislike for others as new solids are introduced.
Now is the time to begin introducing a cup since it is important to eliminate all bottles by the baby's first birthday. The easiest way to do this is by taking advantage of the infant's natural curiosity and desire to imitate adults. Parents should buy two or three brightly colored plastic cups and begin drinking their coffee or tea out of these new cups. Since the child will want the same thing the parents have, start giving your child his or her milk or juice in an identical cup. The child will not be able to hold the cup by himself or herself for some time. An alternate way of introducing the cup is to use one with a top and "feeding spout." While your child will not be using this type of cup when he or she gets older, there is less of a mess when he or she tips it over! Don't lose patience! If your 6-month-old shows little interest, try again in a day or two. Don't worry if it seems your baby is taking less liquid from the cup. This is normal since the growth rate slows down for a while.
Avoid giving foods that can cause choking. The most common foods babies' aspirate are peanuts, popcorn, hot dogs or sausages, carrot sticks, celery sticks, whole grapes, raisins, corn, whole beans, hard candy, large pieces of raw vegetables or fruit and tough meat. Always supervise your baby when he or she is eating and learn the proper emergency procedures for choking.
If there is a strong family history of a food allergy, you might want to limit or avoid highly allergic foods such as eggs, strawberries, chocolate and seafood until your baby is older.
Continue to give the breast-feeding infant supplemental Vitamin D if recommended by your baby's doctor and fluoride supplements if your water supply is not fluoridated.
If your baby is being fed by a care giver, go over the schedule with him or her to make sure he or she is feeding your infant the way you want.
Because your baby is getting ready to cut teeth, he or she may be "gnawing" on everything.
At this Checkup
An important part of each well-child visit is the evaluation of the baby's growth. In the vast majority of children, growth falls within normal ranges on the standard growth curves for weight, height or head size. The smooth curves of a growth chart might create the impression that a baby grows in a continuous, smooth manner. Instead, growth usually occurs in spurts. Therefore, single growth (height, weight, head size) measurement at any particular month in a child's life is of limited value - more important is the child's rate of growth over time.
The 6-month old will also be checked thoroughly both physically and developmentally.
Sleep
Encourage your baby to console himself or herself by putting your child to bed awake.
Some 6-month-old babies decrease the length and/or frequency of naps.
Due to the emergence of stranger anxiety, the 6-month-old baby may show resistance to going to sleep for naps and at night.
Some 6-month-old babies begin night awakenings for short periods of time. Should this happen, check your baby, but keep the visit brief, avoid stimulating your infant and leave the room quickly once you feel everything is OK.
Immunizations
Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced, it is always best to seek the advice of your child's health care provider concerning your child's vaccine schedule.
Haemophilus Influenza Type b (Hib) Vaccine #3
Diphtheria, Tetanus, Acellular Pertussis (DTaP) Vaccine #3
Prevnar (Pneumococcal) Vaccine #3
Ask your baby's doctor about possible side effects (fever, irritability, tenderness over the injection site).
Safety
Your adorable newborn is about to become "mobile" so child-proofing your home should take priority at this age.
Now that your baby is more active, be more careful than ever not to leave him or her anyplace from which he or she can fall. Always keep one hand on your child and never turn your back, for even a second, when you put him or her on a sofa, bed, changing table or any other high place. Your baby always needs your full attention. Never leave your baby alone with a young sibling or pet.
Continue to use an infant car seat that is properly secured at all times.
Avoid using baby walkers. There is considerable risk of major and minor injury and even death from the use of walkers and there is no clear benefit from their use.
If your home uses gas appliances, install and maintain carbon monoxide detectors.
Continue to keep the baby's environment free of smoke. Keep the home and car nonsmoking zones.
Get down on the floor and check for safety hazards at your baby's eye level.
Empty buckets, tubs or small pools immediately after use. Ensure that swimming pools have a four-sided fence with a self-closing, self-latching gate.
Avoid overexposure to the sun.
Do not leave heavy objects or containers of hot liquids on tables with tablecloths that your baby may pull down.
Place plastic plugs in electrical sockets.
Keep toys with small parts or other small or sharp objects out of reach. It is especially important to remind older siblings that they should always play with small objects out of reach of their baby brother or sister.
Keep all poisonous substances, medicines, cleaning agents, health and beauty aids, and paints and paint solvents locked in a safe place out of your baby's sight and reach. Never store poisonous substances in empty jars or soda bottles.
Install safety devices on drawers and cabinets where the infant may play. Install gates at the top and bottom of stairs, and place safety devices on windows.
Lower the crib mattress.
Avoid dangling electrical and drapery cords.
If you have a pet, keep his or her food and dishes out of your baby's reach. Also, never allow your child to approach a dog while the dog is eating.
Use the playpen as an "island of safety."
Learn first aid and infant cardiopulmonary resuscitation (CPR).
Eliminations
Your baby will have his or her own frequency of bowel movements.
Most babies strain, grunt and fuss when they have bowel movements.This does not mean they are constipated.
When to Call the Doctor
Anything that bothers you!
Appears not to be gaining weight.
Your baby shows little interest in social interaction, avoids eye contact, and smiles infrequently.
Your baby seems stiff or floppy.
Your baby's head lags when pulled to a sitting position.
Your baby only uses one hand to reach.
Your baby makes no attempt to roll over.
There is no infant squealing or laughing.
Eyes are crossed most of the time.
You have not seen any developmental changes since the last checkup.
The information presented in Growth Milestones was obtained with the help of our pediatric experts and with material from The American Academy of Pediatrics' Guidelines for Health Supervision and Bright Futures' Guidelines for Health Supervision of Infants, Children, and Adolescents. Bright Futures is supported by the Maternal and Child Health Bureau, U.S. Department of Health and Human Services.
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As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.
Growth Milestones: Nine Months
"The Creepy-Crawler"
The 9-month-old child continues making major gains in development and begins displaying a little independence. The youngster of this age is always on the move and will begin to get opinionated about such things as what foods to eat and when to go to sleep. Occasionally, these opinions turn into protests, so now is the time to begin setting some limits and saying "no." The following comments are designed to help you and your partner enjoy your 9-month-old while continuing to gain confidence in yourselves as parents. The information is not intended as a substitute for well-baby visits by your newborn's pediatrician. Never hesitate to ask your child's physician for guidance concerning specific problems. This is the reason for regular well-baby checkups.
Parenting and Behavioral
Keep up a constant chatter with your 9-month-old child. Talking to your child while dressing, bathing, feeding, playing, walking and driving encourages speech development.
Encourage play with age-appropriate toys. Babies like to bounce, swing, reach for you, pick up and drop objects, and bang things together. Unbreakable household objects such as plastic measuring cups, large wooden spoons, pots, pans and plastic containers make great toys. A foam rubber ball helps the child develop his or her small motor skills.
Provide opportunities for safe exploration.
Begin to set limits by using verbal "no's," distraction, removing the object from the baby's sight or removing the baby from the object. Never use spanking as a form of discipline, even a "little" tap on the hand. If you become angry with your baby, put the child in his or her crib or playpen for one or two minutes. This will allow you to calm down and allows your baby to realize he or she has done something wrong. Consistence of discipline is very important - adhering to the limits you set keeps your child safe.
Shoes are not necessary at this age (except for "show"). They should be used only to protect the feet from sharp objects and the cold.
Stranger anxiety may limit some parent's ability to leave their 9-month-old with grandparents or a baby sitter. It is important for parents to get out from time to time without their little one. You get a breather, and your son or daughter learns that sometimes you do go away, but you always come back.
Development
During this period your baby will probably learn to creep, crawl and otherwise get around the room. He or she may even pull up in the bed or on furniture and begin "cruising" around the room.
Responds to his or her own name.
Understands a few words such as "no-no" and "bye-bye."
Begins developing certain concepts - for example, your child will retrieve a toy after he or she watched you put it under a blanket.
May say "dada" or "mama" but not specifically.
Sits well independently.
Bangs two toys together.
Plays interactive games well such as peek-a-boo and pat-a-cake.
Perhaps the most striking developmental achievement is the use of fingers and thumb to poke, pry, probe and pick up smaller and smaller objects.
Sleeps through the night except for an occasional night wakening.
The 9-month-old has now learned to be "cool" or even a little afraid of certain strangers - even family members he or she does not see very often. The baby of this age also begins to take a dim view of being examined by their doctor.
Often has one or both bottom front teeth.
Illness
Nine months is the age when a child becomes increasing susceptible to infections, probably due to loss of maternal antibodies the youngster received during pregnancy. In addition, everything goes into his or her mouth, including germs!
Do not be discouraged if your child has a cold or two between now and his or her first birthday.
Feeding
Give your baby soft table foods if approved by your doctor to increase the texture and variety of foods in his or her diet. Give your child the opportunity to use his or her newly developed skill of plucking things by offering small bits of soft table foods. (You may need to give your child a bath after every meal!) The 9-month-old is a great imitator. The food on your plate is much more appetizing to him or her, so take advantage of this to introduce new table foods.
Never give a 9-month-old food that may cause choking and aspiration, such as peanuts, popcorn, hot dogs or sausages, carrot or celery sticks, whole grapes, raisins, corn, whole beans, hard candy, large pieces of raw vegetables or fruit, or tough meat.
Always supervise your child while he or she is eating.
Continue teaching the infant how to drink from a cup so he or she is off any bottles by 1 year.
Continue using breast milk or iron-fortified formula for the first year of your infant's life.
Continue giving extra Vitamin D to the breast-feeding infant and supplemental fluoride to all children who are not exposed to fluorinated water.
At this Checkup
An important part of each well-child visit is the evaluation of the baby's growth. In the vast majority of children, growth falls within normal ranges on the standard growth curves for weight, height or head size. The smooth curves of a growth chart might create the impression that a baby grows in a continuous, smooth manner. Instead, growth usually occurs in spurts. Therefore, single growth (height, weight, head size) measurement at any particular month in a child's life is of limited value - more important is the child's rate of growth over time.
The 6-month-old will also be checked thoroughly both physically and developmentally.
Sleep
Encourage your baby to console himself or herself by putting your child to bed awake.
Due to the emergence of stranger anxiety, the 9-month-old baby may show resistance to going to sleep for naps and at night.
Some 9-month-old babies begin night awakenings for short periods of time. Should this happen, check your baby, but keep the visit brief, avoid stimulating your infant, and leave the room quickly once you feel everything is OK. Do not give extra bottles, take the infant into bed with you or rock him or her back to sleep. This will only reinforce the night awakenings and it will become a habit.
Sleep is also occasionally disturbed when the infant pulls up in his or her crib and can not get back down.
Never put the baby to bed with a bottle.
Immunizations
Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced,it is always best to seek the advice of your child's health care provider concerning your child's vaccine schedule.
Many physicians apply a painless skin test for tuberculosis which needs checking by the parents in three days. A positive reaction does not mean the child has tuberculosis - only that he or she has been exposed to the disease.
Ask your baby's doctor about possible side effects (fever, irritability, tenderness over the injection site).
Some physicians at 9 months, others at 12 months, perform a hemoglobin or hematocrit determination to check for anemia ("low blood"). This requires a small poke on the finger to obtain a drop of blood.
Safety
Remember, there is no such thing as a "child proof" cap.
Your adorable newborn is now "mobile" so child-proofing, if not done at 6 months, is a priority. Get down on the floor at your baby's eye level and see what the infant can get in to.
Continue to use a rear facing infant car seat in the back seat.
Do not leave your child alone in a tub of water or on high places such as changing tables, beds, sofas or chairs. Always keep one hand on your baby.
Avoid using baby walkers. There is considerable risk of major and minor injury and even death from the use of walkers. There is no clear benefit from the walker's use.
If your home uses gas appliances, install and maintain carbon monoxide detectors.
Always empty buckets, tubs or small pools immediately after use. Ensure that swimming pools have a four-sided fence with a self-closing, self-latching gate. Swimming pools are deadly to children at this age.
Continue to keep the baby's environment free of smoke. Keep the home and car nonsmoking zones.
Avoid overexposure to the sun. A waterproof sun screen with an SPF more than 15 is OK. Even with sun screen, avoid the hours between 10 a.m. and 3 p.m., when the sun is most dangerous.
Do not leave heavy objects or containers of hot liquids on tables with tablecloths that the baby may pull down.
Place plastic plugs in electrical sockets.
Keep all poisonous substances, medicines, cleaning agents, health and beauty aids, and paints and paint solvents locked in a safe place out of the baby's sight and reach. Never store poisonous substances in empty jars or soda bottles.
Ask your doctor about having some Syrup of Ipecac (to induce vomiting) in the home to be used only after consulting with the poison control center or the baby's physician. Keep the number of the poison control center near the telephone.
Install gates at the top and bottom of stairs, and place safety devices on windows.
Lower the crib mattress.
Learn child cardiopulmonary resuscitation (CPR)
Eliminations
Your baby will have his or her own frequency of bowel movements.
Most babies strain, grunt and fuss when they have bowel movements.This does not mean they are constipated.
When to call the Doctor
Anything that bothers you!
Your baby shows little interest in social interaction, avoids eye contact and smiles infrequently.
Your baby seems stiff or floppy.
Will not bear weight on legs.
No babbling, infant squealing or laughing.
Does not turn when name is called.
Eyes are always crossed.
You have not seen any developmental changes since the last checkup.
The information presented in Growth Milestones was obtained with the help of our pediatric experts and with material from The American Academy of Pediatrics' Guidelines for Health Supervision and Bright Futures' Guidelines for Health Supervision of Infants, Children, and Adolescents. Bright Futures is supported by the Maternal and Child Health Bureau, U.S. Department of Health and Human Services.
<../images/back2.gif>
As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.
Growth Milestones - TWELVE MONTHS
"Happy Birthday"
A year ago, did you wonder if you would ever make it to this day? Well, you have! And along the way you have taken a tiny helpless newborn and watched him or her become a constantly moving and exploring person. Get ready! Your baby is about to enter the toddler stage of child development. Some 1-year-old children are cruising around furniture while others are walking. All 1-year-olds get into everything and become more vocal . . . and more assertive! Your child's world is enlarging, bringing new excitement and new challenges to you as a parent. The following comments are designed to help you and your partner enjoy your 12-month-old son or daughter while continuing to gain confidence in yourselves as parents. They are not intended as a substitute for well-baby visits by your newborn's pediatrician. Never hesitate to ask your child's physician for guidance concerning specific problems. This is the reason for regular well-baby checkups.
Parenting and Behavioral
Because your one-year-old is mobile, whether crawling, cruising, or walking, it is important to begin putting limits on their behavior. They learn by exploration but need safe limits.
Praise the one year old for good behavior.
It is important to teach the child the word "no." Saying "no" in a stern voice with good eye contact is almost always effective in this age group. Some parents have a fear of the word "no." They do not want their child to feel restricted, so they bend the other way and let their youngster run wild without any limits. A child needs guidance for his or her own protection and to learn that others have rights. "No" at the appropriate time is as important for the child's development as is nutrition and love.
Discipline should be consistent to be effective. To discipline a one year old, use distraction, loving restraint, removal of the object from the toddler or the toddler from the object.
Discipline does not mean punishment or spanking. If you become angry with your baby, put your little one in his or her crib or playpen for one or two minutes of "time out." This will allow you to calm down and it also allows your baby to realize that he or she has done something wrong. During "time out" the child should not be able to see you or any other family member.
Encourage play with age-appropriate toys. Children this age love push and pull toys. Develop motor coordination by clapping and dancing to children's music. Encourage your toddler to play alone as well as with playmates, siblings and parents.
Encourage your child to play alone with supervision and with other toddlers.
Remember that aggressive behaviors - hitting and biting - are common at this age. How parents respond to this behavior determines if it will continue.
Despite your child's desire to become independent, you will find the 1- year-old often clinging to a parent more than before. In addition, stranger anxiety may cause some parent's not to be able to leave their child with grandparents or a baby sitter. It is important for parents to get out from time to time without their little one. You get a breather, and your son or daughter learns that sometimes you do go away, but you always come back.
A demon explorer who wants to learn all about the size, shape and movability of everything in sight. Opens cabinets, pulls tablecloths, usually examines an object before putting it into mouth
Development
Pulls to stand, crawls rapidly, seats self on floor , cruises on furniture or walks alone with an unsteady gait.
Plays social games such as pat-a-cake, peek-a-boo and so-big.
Bangs two blocks together.
Has vocabulary of one to three words in addition to "mama" and "dada."
Drinks from a cup - not bottles.
Waves "bye-bye."
Feeds himself or herself
Points with a finger and displays a precise pincher grasp when picking up small objects.
May say one to three meaningful sounds besides using "mama" and "dada" correctly. Shows definite understanding of a few simple words; Loves music, rhythms, and rhymes
Will begin to cooperate a little in getting dressed by holding still.
Illness
The 12-month-old child will continue to experience upper respiratory infections (colds) and might even have an occasional ear infection. Children who are in day care will experience more infections than those who are at home with a parent or grandparent.
Feeding
Your baby's appetite is going to take a nose dive in the next six months. Your child has been experiencing very rapid growth for a while - doubling their birth weight at 5-6 months and tripling it at a year. Now their rate of growth is slower than in the first year and their appetite cuts back. Do not misinterpret this normal decrease in eating as a sign of illness or disease. Never, under any circumstances, force a child to eat. Develop a "take it or leave it" attitude and do not get into the habit of substituting, bribing or begging your child to eat. Your child will determine the amount of food he or she needs. Therefore, never overload the plate. If your son or daughter wants more, he or she may have it. One of our problems as adults is over eating, and many of us learned this in childhood.
Most babies at this age are eating mostly table foods but it is okay if your youngster still prefers "baby food."
Milk intake decreases considerably and your child will either want to feed himself or herself or will still want you to do it.
Give your 12 month old child a spoon to hold and get used to, although most cannot master utensils until 18 months. As much as possible, let your toddler feed himself or herself (most will want to anyway).
Feed your youngster three meals a day eaten with the family, and a midmorning and mid-afternoon snack.
Discuss milk feedings with your doctor. If you are formula feeding, your doctor might suggest weaning to whole milk ( note: some babies have harder bowel movements at first with whole milk) and limit the amount of milk to 24 ounces or less. It is important to eliminate all bottles by one year of age. After one year, the bottle is more of a comfort item and can cause damage to the teeth. If you are breast feeding, discuss with your child's pediatrician your feelings about weaning to a cup.
Avoid foods that can cause choking, such as peanuts, popcorn, hot dogs or sausages, carrot sticks, celery sticks, whole grapes, raisins, corn, whole beans, hard candy, large pieces of raw vegetables or fruit, or tough meat.
Always supervise your child when he or she is eating.
Oral Health
Begin brushing your child's teeth with a tiny, pea-size amount of toothpaste.
To protect the toddler's teeth, do not put him or her to bed with a bottle or prop it in his or her mouth.
Give your child fluoride supplements as recommended by the pediatrician based on the level of fluoride on the level of fluoride in the toddler's drinking water.
Ask your pediatrician when your child should see the dentist for the first time.
Sleep
Encourage your baby to console himself or herself by putting your child to bed awake.
Children this age frequently resist going to sleep because they do not want to be separated from people and their new activities.
Your child may start to give up one of his or her naps, although most 1-year-olds still take two naps.
Some 1-year-old children continue to experience night awakenings for short periods of time. Should this happen, check your baby, but keep the visit brief, avoid stimulating your infant, and leave the room quickly once you feel everything is okay. Do not give extra bottles, take the infant into bed with you, or rock him or her back to sleep. This will only reinforce the night awakenings it will become a habit.
Never put your baby to bed with a bottle.
Immunizations and Medical Tests
Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced,it is always best to seek the advice of your child's health care provider concerning your child's vaccine schedule. It is recommended that the one-year old child receive:
Measles, Mumps, and Rubella (MMR) Vaccine #1 (Can be administered at either 12 or 15 months)
Varicella (chicken pox) vaccine (12 months visit)
Hepatitis B (HepB) #3 may be given at this time if not previously administered.
Prevnar (Pneumococcal) Vaccine #4 (this may also be given at 15 months instead)
Lead screening is done at 12 months of age for children at risk.
Hematocrit or hemoglobin (for anemia) screening if not done at nine months or if needed for WIC (Women-Infants-Children).
Safety
You must take safety to the "next level!" Your adorable newborn is now more "mobile" than ever, so child-proofing, if not done previously, is a priority. Accidents kill more children than all other diseases combined. Get down on the floor at your baby's eye level and see what your toddler can get in to.
Remember, there is no such thing as a "child proof" cap.
Ask your doctor about having some Syrup of Ipecac (to induce vomiting) in the home. This should be used only after consulting with the poison control center or the baby's physician. Keep the number of the poison control center near the telephone.
One year is the minimum age for riding in a forward-facing car seat.
If guns are in the house, safety precautions are crucial.
Do not leave your 1-year-old alone in a tub of water or on high places such as changing tables, beds, sofas or chairs.
Always empty buckets, tubs or small pools immediately after use. Ensure swimming pools have a four-sided fence with a self-closing, self-latching gate. Swimming pools are deadly to children this age.
The cupboard under the kitchen sink is very attractive to a baby of this age, so have a lock put on all doors that have cleansers, detergents, bleaches, furniture polish and insecticides behind them.
As soon as you use medicine of any kind, replace the cap and put the bottle out of reach, preferably locked up. Be particularly vigilant when you have visiting grandparents who are not used to watching the medicines that closely.
Continue to keep the baby's environment free of smoke. Keep the home and car nonsmoking zones.
Avoid using baby walkers. There is considerable risk of major and minor injury and even death from the use of walkers and there is no clear benefit from their use.
Prevent fires and burns by: Turning your water heater down to 120 degrees F (50 degrees C), use the back burners on the stove with the pan handles out of reach, do not cook with your child at your feet, keep all electrical appliances out of the bathroom, keep hot appliances and cords out of reach, place plastic plugs in electrical sockets.check your smoke detectors and replace batters if necessary, and practice a fire escape plan.
If your home uses gas appliances, install and maintain carbon monoxide detectors.
Avoid overexposure to the sun and use sunscreen.
Do not leave heavy objects or containers of hot liquids on tables with tablecloths that the baby may pull down.
Keep all poisonous substances, medicines, cleaning agents, health and beauty aids, and paints and paint solvents locked in a safe place out of your baby's sight and reach. Never store poisonous substances in empty jars or soda bottles.
Install gates at the top and bottom of stairs, and place safety devices on windows. Lower the crib mattress.
Learn child cardiopulmonary resuscitation (CPR).
Check your child's progress with our Growth Charts.
The information presented in Growth Milestones was obtained with the help of our pediatric experts and with material from The American Academy of Pediatrics' Guidelines for Health Supervision and Bright Futures' Guidelines for Health Supervision of Infants, Children, and Adolescents. Bright Futures is supported by the Maternal and Child Health Bureau, U.S. Department of Health and Human Services.
As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.
Growth Milestones - FIFTEEN MONTHS
"Whirlwind of Activity"
It is easy to expect too much of the 15-month-old child. They look so much different from the crawling infant of a few months ago that many parents think their child "is no longer a baby." And while the 15-month-old child is indeed a whirlwind of activity and curiosity, he or she may lack a sense of danger or fear. Your child will try to climb up furniture or put his or her fingers in electrical sockets. Your youngster will touch everything in sight. As a parent, you may not realize what all this means until your child has his or her first temper tantrum, ruins the carpeting or nearly breaks a precious heirloom. Parenting this age is indeed a balancing act, between giving your child freedom to explore while keeping him or her sage. The following comments are designed to help you and your partner enjoy your 15-month-old while continuing to gain confidence in yourselves as parents. This information is not intended as a substitute for well-baby visits by your child's pediatrician. Never hesitate to ask your doctor for guidance concerning specific problems. This is the reason for regular well-baby checkups.
Parenting and Behavioral
Show affection and praise to your toddler for good behavior and accomplishments.
Talk to your child about what he or she is doing and seeing. Singing to your child is another way to encourage vocabulary development.
Use picture books to enrich his or her vocabulary. Reading books to your youngster will help with language development.
It is best to keep rules at a minimum - remove things when possible rather than make issues about them. Long speeches of explanation or argument with a 15-month-old are useless. When something has to be done, do it in a pleasant manner.
Discipline should be consistent, but done in a loving, understanding manner. Use the two "I's" of discipline. Ignore and isolate. Temper tantrums, for example, are best handled by ignoring them. If this is not possible, isolate the child by placing him or her in his or her crib, playpen or room for a "time-out." Never use the two "S's" of discipline -shouting and spanking.
Positive reinforcement should be encouraged for acceptable behavior. Praise the child for good behavior and build up the child's self-esteem and self-confidence.
Your child will begin to experience some frustration. Your youngster will get upset when he or she cannot do something, or when he or she can not do what he or she wants. A child at this age will try crying and screaming to get his or her way, and such protests may become full-blown temper tantrums and breath-holding spells. Trying to reason with or punish your child may actually make the tantrum last longer. It is best to make sure your toddler is in a safe place and then ignore the tantrum You can best do this by not looking directly at her and not speaking to her or about her to others when she can hear what you are saying.
Keep family outings with a 15-month-old short and simple. A child this age has a very short attention span and lengthy activities will cause him or her to become irritable and tired.
The best toys are stuffed animals, dolls, books and small toys that can be pulled and pushed, filled and emptied, opened and closed. Household items such as plastic measuring cups and empty boxes are other toys your 15-month-old will enjoy.
Limit television viewing and do not use the TV as a "baby sitter."
Although hitting and biting are common behaviors at this age, the behavior should never be permitted.
Don't worry if your child becomes curious about body parts. This is normal at this age. It is best to use the correct terms for genitals.
Toddlers may want to imitate what you are doing. Sweeping, dusting, or washing play dishes can be fun for children at this age.
Development
The vocabulary for a 15-month-old is usually three to six words that parents can understand and an entire language that they cannot!
Will be able to point to one or more body parts.
Understands simple commands ("bring me the ball").
Walking has improved and will begin to crawl up stairs.
Can feed himself or herself with the use of his or her fingers.
Drinks only from a cup, but still may need help in holding it.
Recognizes himself or herself in a mirror.
Indicates what they want by pulling, pointing, grunting and other methods of communicating
Finds an object placed out of sight
Points to one or two body parts
Scribbles spontaneously
Oral Health
Brush your toddler's teeth with a small amount of fluoridated toothpaste. The 15-month-old can not clean his or her teeth by alone.
A child this age should be off the bottle and at the very least no bottles to bed. To avoid dental decay, do not give any juice or other sugary substances in bottles. If snacks are given, non-sugary and unsalted foods such as fresh fruits are preferable to candy and chips.
Give your child fluoride supplements as recommended by the physician based on the level of fluoride in the toddler's drinking water.
Discontinue pacifier use except, perhaps, at nap time and bedtime.
Ask your child's doctor when you should make the youngster's first dental appointment.
Feeding
Have your child eat with the family and encourage your child to do most of the feeding, even though he or she will be clumsy with the spoon and cup. Parents should not focus on table manners at this age. They will use their fingers and maybe start using a spoon. This will be messy!!
Make sure food is cut into small pieces so your baby will not choke (the size of a pencil eraser)
Babies still need nutritious snacks like cheese, fruit and vegetables. Some nutritious desserts are baked apples or fresh fruit. Never use food as a reward.
The child's weight may stay the same for several months, so appetite will diminish. All you can expect is one fair meal a day.
Try not to get into the habit of between meal carbohydrates, cookies and sweets, that will take away his or her appetite for more nourishing foods.
If your child still has a bottle, it should be phased out in the next month.
Sleep
The afternoon nap is still required by most toddlers.
Bedtime problems can occur at this age because of the toddler's desire for independence. Try to be consistent and follow routines.
Immunizations
Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced,it is always best to seek the advice of your child's health care provider concerning your child's vaccine schedule.
Normally, no immunizations are given at this checkup unless your child's doctor follows another approved schedule or the child is behind in the immunization schedule.
By this age, most children have received the following immunizations (*depending on the doctor's schedule):
<http://www.kidsgrowth.com/images/check.gif> 3 doses of Hepatitis B vaccine
<http://www.kidsgrowth.com/images/check.gif> 3 or 4 doses of DTaP vaccine *
<http://www.kidsgrowth.com/images/check.gif> 3 or 4 doses of HIB vaccine *
<http://www.kidsgrowth.com/images/check.gif> 1 dose of the MMR vaccine
<http://www.kidsgrowth.com/images/check.gif> 1 dose of the Chickenpox vaccine
<http://www.kidsgrowth.com/images/check.gif> 3-4 doses of the Prevnar vaccine *
<http://www.kidsgrowth.com/images/check.gif> 2-3 doses of the Inactivated Polio Vaccine *
Toilet Training
The development of readiness for toilet training does not appear until somewhere between 18 and 24 months.
Starting toilet training at an early age, even though grandparents will indicate that you were "trained at this age," will only cause the child to rebel and still be in diapers at 3 and 4 years of age.
Wait for the signs of readiness: dry periods for at least two hours, knows the difference between wet and dry, can pull pants up and down, wants to learn, and can signal when he or she is about to have a bowel movement.
Safety
Continue to use a toddler car seat and make sure it is properly secured in the back seat.
Use locked doors or secure gates at stairwells.
Continue to keep the toddler's environment free of smoke.
Avoid foods such as nuts, bacon, popcorn, hot dogs, carrot and celery sticks, whole grapes, tough meat raw vegetables and hard candy which can be aspirated by children. For the same reason, never give a child plastic bags, marbles and balloons.
Keep syrup of ipecac in the home to be used to induce vomiting only after instructions from the child's physician or the poison control center.
Be careful of plastic bags and balloons
Guard against falls. Do not leave a chair in such a position that it enables the child to climb to a dangerously high place
Prevent burns and scalds. Hot water thermostats should be set at 120 degrees so that scalding will not occur if the child turns on the hot water.
Place the child in a safe place such as the playpen during meal preparation. The kitchen is a dangerous place for a child at this time. Keep hot liquids out of reach.
Be careful about ironing. Keep the child away from hot stoves, space heaters, wall heaters and fireplaces.
There is no such thing as a childproof cap. Poisons, medications and toxic household products should either be excluded from the home or kept in a locked cabinet. Do not store lye drain cleaners in the home. Never underestimate the ability of the 15-month-old to climb. Ensure the crib mattress is on the lowest rung.
Guard against electrical injuries from cords and outlets.
Always use sunscreen when the your child goes outside to play. Avoid, when possible, going outside between 10 a.m. and 3 p.m. when the sun's ultraviolet rays are most dangerous.
Never leave the 15-month-old unsupervised in or near a swimming pool, bathtub, bucket of water, ditch, well or bathroom. Knowing how to "swim" at this age does not make a child water-safe.
Choose caregivers carefully and prohibit spanking.
Watch your child carefully around dogs, especially if the dog is unknown or is eating.
Keep your toddler away from moving machinery, lawn mowers, overhead garage doors, driveways and streets.
Hold your child's hand when you are around traffic
Illnesses
The 15-month-old will experience respiratory infections, such as colds, ear infections and sinus infections, especially if he or she is in day care or "preschool." Respiratory infections of this type are a normal part of growing up.
Check your child's progress with our Growth Charts.
The information presented in Growth Milestones was obtained with the help of our pediatric experts and with material from The American Academy of Pediatrics' Guidelines for Health Supervision and Bright Futures' Guidelines for Health Supervision of Infants, Children, and Adolescents. Bright Futures is supported by the Maternal and Child Health Bureau, U.S. Department of Health and Human Services.
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Growth Milestones - EIGHTEEN MONTHS
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"Mr. No!"
Your sweet little baby has grown up into a toddler, entering a world of boundless energy, curiosity, independence and negativism. Having a toddler brings new challenges to you and your partner as parents. The following comments are designed to help you enjoy your 18-month-old son or daughter. This information not intended as a substitute for well-baby visits by your newborn's pediatrician. Never hesitate to ask your child's physician for guidance concerning specific problems. This is the reason for regular well-baby checkups.
Parenting and Behavioral
The 18-month-old child gets around easier and will soon be running. It is easy to except too much of our toddler. He or she looks so different from the crawling baby of a few months ago, and many parents think their youngster is no longer a baby.
Keep rules to a minimum. Long speeches of explanation are completely useless. "Because I said so!" should be enough.
Be firm and consistent, but loving and understanding with discipline. Praise your toddler for his or her good behavior and accomplishments.
Encourage your toddler to make choices whenever possible, but the choices should be limited to those you can live with ("red shirt or green shirt.") Never ask a toddler an open question ("Do you want to take a bath?") unless you are willing to accept the answer.
Use the two "I's" of discipline (ignore or isolate) rather than the two "S's" (shouting or spanking). Keep time-out to no more than two minutes per child's age, and be consistent. When disciplining, try to make a verbal separation between the child and his or her behavior ("I love you, but I do not like it when you touch the VCR." Pick-up your toddler, hold him or her, or remove her from dangerous situations. Reassure the toddler once the negative behavior has stopped.
Provide alternatives. "No, you cannot play with the telephone, but you can play with these blocks."
Avoid power struggles with your toddler. No one wins! The toddler uses a powerful weapon against the parents: the temper tantrum! These occur when the toddler is angry, tired, frustrated, or does not get his or her way. Most of the time, what happens during the tantrum is fairly predictable. Occasionally a child this age my get so angry he or she will hold his or her breath and pass out. Not to worry - once they do, the body's reflexes take over and your child will start breathing again on his or her own. Again, handle temper tantrums with the two I's of discipline - ignore or isolate (time out!).
Reinforce self-care and self-expression. Praise what the child does for himself (putting his hand in a sleeve, putting meat on a fork, washing his hands, etc.) Parents should say "...and you did that all by yourself!" The 18-month old child is highly pleased by parental approval.
Show affection in the family. Be a good role model by using seat belts, avoiding tobacco and showing respect for others. The toddler is a great imitator.
Do not expect the toddler to share toys, wait for his or her food in a restaurant, or be patient while you try on clothes at the store or go food shopping.
Early toilet training does not mean your child is super smart. Pushing the toddler will only make him or her rebel and be in diapers even longer. Signs that a child might be ready are dry for periods of about two hours, knows the difference between wet and dry, can pull his or her pants up and down, wants to learn, and can give a signal when he or she is about to have a bowel movement. If you insist on toilet training when your child is not ready, a battle will develop ... and it is a battle you cannot win! Discuss toilet training with your child's pediatrician to get his or her views.
Remember that aggressive behaviors - hitting and biting - are common at this age. They are, of course, not acceptable behaviors. How parents respond to them determines if the behavior will continue.
Do not discourage your child from using a security object - a stuffed animal, favorite blanket, etc. These are important for a toddler and the child will give it up when he or she is ready. (They usually do not take them to high school!)
Despite your child's desire to become independent, you will find the 18-month-old will still cling to a parent.
Read simple stories to the child regularly, especially at bedtime, to enrich his verbal expression and increase his interest in the spoken language and his listening skills.
Limit television viewing and do not use it as a substitute for interaction with the child. Watch children's programs with the child when possible.
The principal caregiver should be encouraged to arrange time for himself/herself. Raising a toddler can often be demanding.
Praise the child when they are behaving well, and always show affection
Development
Walks fast, walks up stairs with one hand held, kicks a ball.
Uses a vocabulary of four to 10 words and may combine two-word phrases.
Understands simple directions.
Points to some body parts correctly.
Shows affection by kissing parents.
Feeds himself or herself, drinks from a cup adequately and uses a spoon.
Imitates a crayon stroke on paper.
Holds and "loves" a doll or stuffed animal; may use a household-type toy (for example, a toy telephone) appropriately.
Will sit for a short time and look at pictures in a book. Turns single pages in book or magazine
Oral Health
Begin brushing your child's teeth with a tiny, pea-size amount of toothpaste.
To protect your toddler's teeth, do not put him or her to bed with a bottle or prop it in his or her mouth.
Continue to give your child fluoride supplements as recommended by the pediatrician based on the level of fluoride in the toddler's drinking water.
Discontinue pacifier use except, perhaps, at nap time and bedtime.
Ask your child's doctor when you should make the youngster's first dental appointment.
Feeding
Your baby's appetite is going to continue decreasing during the toddler years. Don't make a "big deal" out of it if your child refuses to eat. No one ever starved with a refrigerator full of food. The toddler's caloric needs are down and he or she is trying to show independence. Develop a "take it or leave it" attitude and do not engage in battles over eating. You cannot win, so why fight? Children this age will determine the amount of food they need. Mealtime should not be a battle.
Your toddler probably did not grow much since his or her last checkup. Maybe two inches and a few pounds, but that's all.
Share meals as a family whenever possible. This helps your baby learn Make mealtimes pleasant and encourage conversation. Avoid using snacks between meals because the toddler has "not eaten all day."
The toddler should be drinking only from a cup and using utensils pretty well to feed himself or herself.
Sleep
Encourage your child to console himself or herself by putting them to bed awake.
Prepare strategies to deal with night awakening, night fears, nightmares and night terrors.
Children this age frequently resist going to sleep. They will usually give you a "test" cry to see if you will return. While it is important to let the toddler know you are there, it is also important to let him or her know that the day is over.
Your toddler may start to give up at least one nap. This is sometimes an awkward stage when one nap is not enough and two naps are too many.
Never put your child to bed with a bottle. He or she should be off all bottles at this age!
Immunizations
Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced,it is always best to seek the advice of your child's health care provider concerning your child's vaccine schedule.
Normally, no immunizations are given at this checkup unless your child's doctor follows another approved schedule or the child is behind in the immunization schedule.
By this age, most children have received the following immunizations
<http://www.kidsgrowth.com/images/check.gif> 3 doses of Hepatitis B vaccine
<http://www.kidsgrowth.com/images/check.gif> 4 doses of DTaP vaccine
<http://www.kidsgrowth.com/images/check.gif> 4 doses of HIB vaccine
<http://www.kidsgrowth.com/images/check.gif> 1 dose of the MMR vaccine
<http://www.kidsgrowth.com/images/check.gif> 1 dose of the Chickenpox vaccine
<http://www.kidsgrowth.com/images/check.gif> 4 doses of the Prevnar vaccine
<http://www.kidsgrowth.com/images/check.gif> 3 doses of the Inactivated Polio Vaccine
Toilet Training
Some children show readiness for toilet training between 18 and 24 months. When toddlers report to their parents that they have wet or soiled their diaper, they are beginning to be aware that they prefer dryness. This is a good sign and parents should praise their child. Other signs of readiness include long periods of dryness, ability to pull pants up and down, can signal when he or she is about to have a bowel movement and knows the difference between wet and dry.
Toddlers are naturally curious about the use of the bathroom by other people, so let them watch you or other family members use the toilet.
Starting toilet training before the child is ready will only cause the toddler to rebel and still be in diapers at 3 and 4 years of age. It is important not to put too many demands of a child or shame them during toilet training.
Safety
Use car restraints consistently.
Ensure stair and window safety.
All play outside should be supervised. Toddlers do not understand danger and cannot remember "no."
Knowing how to "swim" does not make a child water-safe at this age. Supervise the toddler constantly whenever he or she is in or around water, buckets, the toilet or the bathtub. Continue to empty buckets, tubs or small pools immediately after use. Ensure that swimming pools have a four-sided fence with a self-closing, self-latching gate.
If your home uses gas appliances, install and maintain carbon monoxide detectors.
Put sun screen on the toddler before going outside to play or swim. Be particularly careful during the hours between 10 a.m. and 3 p.m. when the sun is most dangerous.
Continue to keep your toddler's environment free of smoke. Keep the home and car nonsmoking zones.
Ensure electric wires, outlets and appliances are inaccessible or protected.
Keep medicines, cigarettes, lighters, matches, alcohol, firearms and electrical tools locked up and/or out of the toddler's sight and reach.
Always walk behind your car before you back out the driveway.
Remember, almost anything in your home can be poisonous.
Keep Syrup of Ipecac in the home to be used as directed by the poison control center or the health professional. Keep the number of the poison control center near the telephone.
Do not expect your older children to supervise the toddler (e.g., in the house, apartment, playground, or yard).
Keep the toddler away from moving machinery, lawn mowers, overhead garage doors, driveways and streets.
Ensure that a toddler riding in a seat on an adult's bicycle is wearing a helmet and wear a helmet yourself.
Teach the child to use caution when approaching dogs, especially if the dogs are unknown or eating.
Keep plastic bags and balloons, and small hard objects out of reach. Cut food into small pieces.
Know how to save a choking child.
Store toys in a chest without a dropping lid
Illnesses
Your toddler might have many colds and other respiratory infections during this time. Children who are in day care will experience more infections than those home with a parent or grandparent.
There will be times when you will think you "live" at your pediatricians office, since many viral infections at this age come one after the other.
Check your child's progress with our Growth Charts.
The information presented in Growth Milestones was obtained with the help of our pediatric experts and with material from The American Academy of Pediatrics' Guidelines for Health Supervision and Bright Futures' Guidelines for Health Supervision of Infants, Children, and Adolescents. Bright Futures is supported by the Maternal and Child Health Bureau, U.S. Department of Health and Human Services.
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Growth Milestones - TWO YEARS
"Miss Independent"
By age 2, your child is no longer a baby. He or she can run, has given up drinking from a bottle, and can feed himself or herself pretty well. Every day your 2-year-old says new words and does more things. In spite of these achievements, the two-year-old is still a baby in many ways. The 2-year-old is difficult, if not impossible, to reason with, but still extremely lovable. He or she will assert independence at mealtime, bedtime and during attempts at toilet training. Two-year-olds typically do not know what they want, except they are sure they do not want to do what you want them to do. The 2-year-old will struggle with his or her parents before going into the bathtub, then once in the tub, will struggle with the parents when it's time to get out of the tub. At times, the toddler will be a "handful." Sometimes it is tough to parent a 2-year-old. Yet these years do not have to be "terrible," and can be "terrific." Your child is simply moving from babyhood to childhood. The following comments are designed to help you and your parents enjoy your 2-year-old while continuing to gain confidence in yourselves as parents. This information is not intended as a substitute for well-baby visits by your child's pediatrician. Never hesitate to ask your doctor for guidance concerning specific problems. This is the reason for regular well-baby checkups.
Parenting and Behavioral
Use picture books to enrich your child's vocabulary. Reading books to your child will help with language development.
Arrange times for safe running and exploring outdoors.
Playmates are important, so allow your child to experience playing with peers. This can be accomplished in a preschool, play group or just having another 2-year-olds over for a few hours. Do not expect sharing at this age.
Limit television viewing. Do not use the TV as a baby sitter or as a substitute for interaction with your child. Watch children's programs with the child when possible. Turn the TV off during meals.
Do not worry if your child becomes curious about body parts. This is normal at this age. It is best to use the correct terms for genitals.
Spend time teaching your child how to play. Encourage imaginative play and sharing of toys (but do not be surprised if the 2-year-old does not want to share his or her toys with anyone else).
The 2-year-old may adopt a security object (such as a blanket, favorite stuffed toy, etc.) that he or she keeps with him or her most of the time. This is normal and the youngster will give it up when he or she is ready.
Parents should continue to take some time for themselves. Show affection in the family.
Keep family outings with a 2-year-old short and simple. The child this age has a short attention span and lengthy activities will cause the child to become irritable and tired.
Allow any older siblings to have things he or she does not have to share with the 2-year-old.
Many parents are beginning to plan for another child around this time. If you are, discuss with your pediatrician the best way to discuss the expected baby and the changes that will occur in the family.
Discipline
Discipline is very important at this age. Do not waste your time and breath arguing or reasoning with a 2-year-old. Long speeches of explanation are completely useless. "Because I said so!" should be enough for now, but as they get older more explanations will be needed.
Discipline should be firm and consistent, but loving and understanding. Praise your child for his or her good behavior and accomplishments.
Encourage your 2-year-old to make choices whenever possible, but the choices should be limited to those you can live with ("red shirt or green shirt.") Never ask a 2-year old an open question ("Do you want to take a bath") unless you are willing to accept the answer.
Use the two "I's" of discipline (ignore or isolate) rather than the two "S's" (shouting or spanking). When disciplining, try to make a verbal separation between the child and the behavior ("I love you, but I do not like it when you touch the VCR.")
Provide alternatives. If your 2-year old is playing with something you do not want him or her to have, replace it with another object or toy that your child enjoys. "No, you cannot play with the telephone, but you can play with these blocks." This avoids a fight and does not place children in a situation where they'll say "no."
Avoid power struggles. No one wins! The 2-year-old still uses the temper tantrum as a weapon against parents. These occur when the child is angry, tired, frustrated or does not get his or her way. Again, handle temper tantrums with the two I's of discipline - ignore or isolate (time out!).
Teach. Decide on a few rules (most of which have to do with the child's safety) and enforce them. Use time out immediately when rules are broken by placing the child alone for 2 minutes.
Development
Climbs up steps alone, one step at a time holding the stair rail or the parent's hand.
Jumps off the floor with both feet.
Opens doors.
Kicks a ball.
Can wash and dry hands.
Climbs on furniture.
Uses a spoon and cup well.
Asks frequent questions: "What is that?"
Enjoys imitating adult activities.
Two year olds often go through a short period of mild speech abnormalities (like stuttering).
Selects and uses a toy appropriately (feeds a doll, hammers pegs in a cobbler's bench).
Most 2-year-olds have a vocabulary of 50 or more words, although this number varies with the sex of the child (girls speak more than boys), if the child has older siblings (who will speak for him or her) or if two languages are spoken in the house.
Oral Health
Check with your child's pediatrician concerning when and how often to see the dentist.
The child will imitate a sibling or parent in the use of a toothbrush so take advantage of this to teach brushing. It is OK to use a small amount of fluoridated toothpaste.
Second molars usually appear.
Feeding
The 2-year-old will eat barely enough to keep a bird alive. Appetite is finicky and will vary from meal to meal and day to day. The child is not doing much growing at this stage so he or she does not need much food to survive. Your child will only gain three or four pounds during this year. Do not expect three good meals a day.
Family meals are important so let your 2-year-old eat with you to make him or her feel part of the family. Do not make mealtime a battle over food. Let you child's appetite be your guide and let him or her (within reason) choose what foods to eat. Never use food as a reward (for example, avoid saying "eat your meal and you will get dessert")
The child can name foods and tell parents his or her likes and dislikes.
The 2-year-old frequently wants the same thing day in and day out.
No bottles!
May change to 2% milk if approved by your pediatrician.
Discuss a vitamin/fluoride supplement with your child's doctor. Continue to give fluoride supplementation if the water is lacking in fluoride.
Make sure your child's caregiver is following your feeding instructions.
Sleep
In general, an afternoon nap is still required by most 2-year-olds.
The child should sleep in his or her own bed if feasible. (Discuss the move from a crib to a regular bed with your child's doctor.)
A 2-year-old's bedtime is usually between 7 p.m. and 8 p.m. Certain sleep problems are common during this time, including refusing to go to bed, getting out of bed and wandering around the house at night, and night terrors and nightmares.
"Stalling techniques" are common at bed and nap time, such as "I have to go potty" to "I want a drink of water."
A series of rituals works well to help your 2-year-old go to sleep. This is an excellent time to read a book to your youngster.
Immunizations
Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced,it is always best to seek the advice of your child's health care provider concerning your child's vaccine schedule.
Normally, no immunizations are given at this checkup unless your child is behind in the immunization schedule.
Hepatitis A (HepA) may be administered at this visit for children living in selected states.
Annual flu vaccines may be recommended for children with chronic illnesses like asthma and heart defects. Check with your doctor.
Some physicians at 2 years do a hemoglobin or hematocrit determination to check for anemia ("low blood"). This requires a small poke on the finger to obtain a drop of blood. A urinalysis will also be done if the child is toilet trained.
By this age, most children have received the following immunizations:
<http://www.kidsgrowth.com/images/check.gif> 3 doses of Hepatitis B vaccine
<http://www.kidsgrowth.com/images/check.gif> 4 doses of DTaP vaccine
<http://www.kidsgrowth.com/images/check.gif> 4 doses of HIB vaccine
<http://www.kidsgrowth.com/images/check.gif> 1 dose of the MMR vaccine
<http://www.kidsgrowth.com/images/check.gif> 1 dose of the Chickenpox vaccine
<http://www.kidsgrowth.com/images/check.gif> 4 doses of the Prevnar vaccine
<http://www.kidsgrowth.com/images/check.gif> 3 doses of the Inactivated Polio Vaccine
Toilet Training
The term "toilet training" should be discarded since we do not actually "train" the child. The 2-year-old simply learns to control his or her urine and bowel movements when he or she is developmentally ready, just as the child learned to sit, walk and talk. Regardless of how hard you try, you cannot speed up your child's schedule and teach the youngster before he or she is ready. In fact, by over-training, you may delay the process by making your child tense and nervous, resulting in a rebellion. The last thing parents want to do is to make toilet training become a battle ground. Pick your battles, and this should not be one of them!
If your child has a bowel movement at the same time every day, you may sit him or her on a little potty chair and "catch it." A favorable response from you sends a message to your child. If on the other hand, his or her bowel movement occur at irregular times during the day, watch for a characteristic expression and posture that indicates a bowel movement. When this occurs, pick up your child and put him or her on the potty. If nothing happens in a few minutes, or if your child is alarmed in any way, take him or her off the potty.
Your child's incentive to control bladder and bowel movements is to please you, the person he or she looks to for love. Therefore, praise your child's accomplishments and let him or her know you are pleased. When your child has an "accident," stay calm and don't punish. If you act distressed or angry when the child fails, training may be delayed.
Signs of toilet learning readiness include awakening from a nap with a dry diaper, having bowel movements at the same time each day, being able to say "wee-wee" or "poopee", etc., knowing when he or she has to go, and being able to take off his or her own clothes. Remember, by pushing your child, scolding or being impatient, you will only delay the development of voluntary control, and possibly lay the groundwork for a real "toilet problem" in years to come.
Safety
Continue to use proper car safety restraints in the back seat of every car trip. The greatest risk to your child's health is a motor vehicle accident. Remember, it is impossible for you to protect your child during an accident by just holding him or her.
Always walk behind your car before backing out of the driveway.
Beware of chewing or picking at old painted surfaces.
Keep firearms out of the home or in a locked, out of sight container, unloaded.
Pools must be gated. Knowing how to "swim" does not make a child water- safe at this age. Never leave a child unattended in a bathtub, even for a few seconds. Ensure the child wears a life vest if boating.
Falls from kitchen cabinets and down stairs occur frequently at this age. Never leave a chair in such a position that your child can use it to climb to a dangerously high place.
Be careful of items that can be left at counter level elsewhere, such as knives, scissors, cleaning agents, nail polish remover, household repair items, weed killers, insecticides, gasoline, oil, kerosene, lighter fluid and all medicines. Always keep potentially poisonous things in the items' original containers. Never put poisons in food containers or bottles.
Be careful what you put in the waste basket ... 2-year-olds love to stick there hands in the trash.
There is no such thing as a "child proof cap." Ingestion of toxic substances is common at this age.
Never buy toys or other objects that can cut or be ingested. Suffocation by plastic bags and balloons occurs at this age.
Always supervise when your child is playing near a street. Remember, a child at this age does not understand danger or remember "no"; they cannot count on being aware of the outside hazards.
Be especially careful when using power lawn mowers and other power tools.
Never leave a child unattended in a car or a house.
Keep Syrup of Ipecac in the home to be used only as directed by your child's doctor or the poison control center. Keep the phone number of the poison control center near the telephone.
Test smoke detectors to ensure they are working properly.
If your home uses gas appliances, install and maintain carbon monoxide detectors.
Continue to use a water proof sunscreen on your child before going outside. Avoid the hours between 10 a.m. and 3 p.m., when the sun is the most dangerous.
Illnesses
The 2-year-old may continue to experience respiratory infections, such as colds, ear infections and sinus infections. Respiratory infections of this type are a normal part of growing up.
Check your child's progress with our Growth Charts.
The information presented in Growth Milestones was obtained with the help of our pediatric experts and with material from The American Academy of Pediatrics' Guidelines for Health Supervision and Bright Futures' Guidelines for Health Supervision of Infants, Children, and Adolescents. Bright Futures is supported by the Maternal and Child Health Bureau, U.S. Department of Health and Human Services.
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Growth Milestones - THREE YEARS
"Goodbye Babyhood, Hello Childhood"
While rearing a child at any age is no snap, things should get easier during the third year. Most 3-year-olds can be reasoned with. They will take turns and may even share toys. A child in this age group will help the parents get him or her dressed. Most are toilet trained during the day, although it is common for an occasional "accident" while busy playing. In previous generations, moms and dads learned what to expect of their child from their mother, grandmother or another family member. Today, most families are so scattered that parents do not have this help available. Therefore, do not hesitante to ask any questions you might have about your child's growth and development during the three year checkup. This is the reason for regular well-child exams.
Parenting and Behavioral
The 3-year-old will ask more questions than a district attorney. Nothing is sacred and some questions will throw you for a loop!
Continue reading books to your child.
Arrange times for safe running and exploring outdoors.
Playmates are important. Allow your child to experience interaction with peers. Three-year-olds are usually quite social and enjoy being with other 3-year-olds. This can be accomplished in a preschool, play group or just having another child over for a few hours.
It is normal for children this age to have imaginary friends. Parents can sometimes use the youngster's imaginary "playmate" to their advantage (like getting your 3-year-old to do something you want them to do.)
Limit television viewing. Do not use the TV as a baby sitter or as a substitute for interaction with your child. Watch children's programs with your child when possible.
Do not worry if the child becomes curious about body parts. This is normal at this age. Always use the correct terms for genitals.
Children this age begin to recognize gender differences and will correctly say "I am a girl" or "I am a boy."
Discipline should be firm and consistent, but loving and understanding. Praise your child for his or her good behavior and accomplishments.
Three-year-olds like to do things for themselves.
The 3-year-old does not understand "tongue-in-cheek" comments and can not always tell when a parent is joking. For example, never threaten to leave a child at the store when he or she misbehaves.
Your child may continue to use a security object (such as a blanket, favorite stuffed toy, etc.). This is normal and the youngster will give up the item when he or she is ready.
Keep family outings short and simple. Children have a short attention span at this age and lengthy activities will cause them to become irritable and tired.
The question of preschool usually comes up now. Daycare has already been established for a family when both parents work outside the home. Even for moms who stay at home with their child, preschool a few mornings a week can be helpful. It gives mom a welcome break and provides the child an opportunity to meet new friends.The success or failure of preschool will depend upon the child's maturity and the quality of the preschool. For example, if your child seems anxious and dependent away from home, perhaps he or she is not ready for preschool.
If you are expecting another baby, discuss with your child's physician how to prepare your 3-year-old.
Discipline
Encourage your 3-year-old to make choices whenever possible, but the choices should be limited to those you can live with ("red shirt or green shirt.") Never ask a toddler an open question ("Do you want to take a bath") unless you are willing to accept the answer.
Use the two "I's" of discipline (ignore or isolate) rather than the two "S's" (shouting or spanking). When disciplining, try to separate the child and his or her behavior ("I love you, but I do not like it when you touch the VCR.").
Provide alternatives. "No, you cannot play with the telephone, but you can play with these blocks."
Avoid power struggles. No one wins! The 3-year-old still uses temper tantrums as a weapon. Respond to this behavior with the two I's of discipline - ignore or isolate (time out!).
Discipline should be consistent. Do not make threats that you can not carry out. If you say you are going to do something, do it!
Development
Can name pictures in a book.
Names at least one color.
Knows his or her own name, age and sex.
Begins to use pronouns.
Able to put on his or her own shirt, but will need help with shoes and buttons.
May be able to ride a tricycle.
Can jump in place and stand briefly on one foot.
Can (unfortunately!) open doors.
More than 50 percent of the child's speech is intelligible. There may be temporary episodes of stuttering during this time.
Understands such words as "cold," "tired," "hungry." Comprehends the meaning of "on or under", and "bigger or smaller."
Oral Health
Supervise brushing twice a day with a small amount of fluoridated toothpaste.
Take your 3-year-old to the dentist, if you have not already done so.
Limit juice and sweets.
Continue giving a fluoride supplement if your drinking water is not fluoridated. Some dentists recommend fluoride be continued through age 8; others recommend continuing through age 12 or 16. Check with your pediatrician and dentist.
Stop pacifier use
Feeding
Appetite is perhaps a shade better than it was a few months ago, but it is still not what most parents (or grandparents) think it should be. "My child will not eat," is a familiar complaint heard at the three year checkup. Remember, feeding problems may arise if parents make their child eat more than the child needs to, or shows too much concern in what the youngster eats.
The 3-year-old should pretty much be able to feed himself or herself.
During meal time, the 3-year-old is sometimes very demanding of parent's attention and may also dawdle!
Avoid nuts, hard candy, uncut grapes, hot dogs or raw vegetables. Control sweets and avoid junk food.
Eat dinner together as a family whenever possible.
Begin to teach proper table manners and encourage conversation during family meals.
Turn the TV off during meals.
Make sure your child's caregiver is following your feeding instructions.
Sleep
An afternoon nap is usually still needed by the 3-year-old.
Fears of the dark, thunder, lightning, etc. are quite common at this age.
Maintain a consistent bedtime and bedtime routine. Using a night light, security blanket or toy are all ways to help lessen nighttime fears.
Read to your child when possible before "lights out."
Nightmares can wake a child up from sleep. The nightmares can be triggered by changes or stress. Reassure your child and put him or her back to bed.
Immunizations
Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced,it is always best to seek the advice of your child's health care provider concerning your child's vaccine schedule.
Normally, no immunizations are given at this checkup unless your child is behind in the immunization schedule.
Hepatitis A (HepA) may be administered at this visit for children living in selected states.
Annual flu vaccines may be recommended for children with chronic illnesses like asthma and heart defects. Check with your doctor.
Some physicians at 3years do a hemoglobin or hematocrit determination to check for anemia ("low blood"). This requires a small poke on the finger to obtain a drop of blood. A urinalysis will also be done if the child is toilet trained to check for kidney and bladder problems.
By this age, most children have received the following immunizations:
<http://www.kidsgrowth.com/images/check.gif> 3 doses of Hepatitis B vaccine
<http://www.kidsgrowth.com/images/check.gif> 4 doses of DTaP vaccine
<http://www.kidsgrowth.com/images/check.gif> 4 doses of HIB vaccine
<http://www.kidsgrowth.com/images/check.gif> 1 dose of the MMR vaccine
<http://www.kidsgrowth.com/images/check.gif> 1 dose of the Chickenpox vaccine
<http://www.kidsgrowth.com/images/check.gif> 4 doses of the Prevnar vaccine
<http://www.kidsgrowth.com/images/check.gif> 3 doses of the Inactivated Polio Vaccine
Toilet Training
Many 3-year-olds are trained during the day but still do not stay dry at night. Others are completely trained. Remember, the age a child uses the bathroom by himself or herself varies and it is based only on a child's readiness to be trained and the positive attitude of the parents.
Avoid putting too many demands on the child or shaming him about wearing diapers. Instead, let your child no how proud and happy you are about any potty successes.
Some children may postpone having a bowel movement as a way to manipulate their parents or because they are busy doing something else. Try not to make an issue of this.
Safety
Responsibility for accident prevention will gradually shift to your child as he or she grows older. It is still necessary for parents to keep dangerous and poisonous items out of their 3-year-old's reach and protect him or her from other indoor and outdoor hazards.
Insist that your home and car be smoke free.
Begin to teach your child his or her full name, address and phone number
If bicycling, teach safety rules and insist on helmet use.
Continue to use proper car safety restraints in the back seat of every car trip. A 3-4 year old child (once 40 lbs. or over) is safest using a belt-positioning booster seat. The greatest risk to your child's health continues to be motor vehicle accidents. Remember, it is impossible for you to protect your child during an accident by just holding him or her.
Always walk behind your car before backing out of the driveway.
If your home uses gas appliances, install and maintain carbon monoxide detectors.
The purchase of a trampoline is not recommended because of the risk of serious injury.
Keep firearms out of the home or in a locked, out of sight container, unloaded
Pools must be gated. Knowing how to "swim" does not make a child water- safe at this age. Never leave a child unattended in a bathtub, even for a few seconds. Ensure your child wears a life vest if boating.
Be careful of items that can be left a counter level elsewhere, such as knives, scissors, cleaning agents, nail polish remover, household repair items, weed killers, insecticides, gasoline, oil, kerosene, lighter fluid and all medicines. Always keep potentially poisonous things in the original containers. Never put poisons in food containers or bottles.
There is no such thing as a "child proof cap." Ingestion of toxic substances is common at this age. Keep syrup of Ipecac in the home to be used only as directed by your child's doctor or the poison control center.
Never buy toys or other objects that can cut or ingested. Suffocation by plastic bags and balloons still occurs at this age.
Always supervise when your child is playing near a street. Remember, a 3-year-old child does not understand danger or remembers "no"; your child cannot be counted on to be aware of outside hazards.
Be especially careful when using power lawn mowers and other power tools.
Never leave a child unattended in a car or a house.
Test smoke detectors to ensure they are working properly.
Continue to use a water proof sunscreen on your child before going outside. Avoid the hours between 10 a.m. and 3 p.m. when the sun is the most dangerous.
Advise your 3-year-old to be careful around strange dogs, especially ones that are eating.
Begin to teach your child not to talk to strangers.
Illnesses
Your 3-year-old may continue to experience respiratory infections, such as colds, ear infections and sinus infections. These frequent ailments often become frustrating for parents. Unfortunately, most illnesses are unavoidable, especially if your child is in preschool or has older siblings who bring the colds home from school.
When your child is ill, the pediatrician will determine whether antibiotics are needed. Remember, most illnesses at this age are viral, which means antibiotics will not shorten the course of the illness
Check your child's progress with our Growth Charts.
The information presented in Growth Milestones was obtained with the help of our pediatric experts and with material from The American Academy of Pediatrics' Guidelines for Health Supervision and Bright Futures' Guidelines for Health Supervision of Infants, Children, and Adolescents. Bright Futures is supported by the Maternal and Child Health Bureau, U.S. Department of Health and Human Services.
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As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.
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Growth Milestones - FOUR YEARS
"Growing self-reliance"
Can you believe that four years ago your child was born? Boy, "does time fly when you are having fun." Now you know why your parents used to say that you were growing up too fast. Ties to your apron strings will begin to loosen as the 4-year-old develops more independence and self-confidence. Before you know it, it will be time to start kindergarten. In previous generations, moms and dads learned what to expect of their child from their mother, grandmother or another family member. Today, most families are so scattered that parents do not have this help available. Therefore, do not hesitate to ask any questions you might have about your child's growth and development during the four year checkup. This is the reason for regular well-child exams.
Parenting and Behavioral
Always remember the positive effects of praise.
The 4-year-old will still ask many questions, most of which start with "Why?" Nothing is sacred and some questions will throw you for a loop! Watch what you say around your child ... he or she will repeat everything.
Continue reading books to your child and spending quality time one-on-one.
Arrange times for safe running and exploring outdoors.
The 4-year-old really enjoys playmates. At this stage the toddler will begin to play cooperatively others.
It is normal for children this age to have imaginary friends. Parents can sometimes use the youngster's imaginary "playmate" to their advantage (like getting your 4-year-old to do something you want him or her to do.)
Limit television viewing to one hour per day. Do not use the TV as a baby sitter or it as a substitute for interaction with your child. Watch children's programs with your child when possible.
Do not worry if your child becomes curious about body parts. This is normal at this age. Always use the correct terms for genitals. Modesty and a desire for privacy begin to emerge at this age.
Discipline should be firm and consistent, but loving and understanding. Praise your child for his or her good behavior and accomplishments.
Continue to allow your 4-year-old to make choices whenever possible but the choices should be limited to those you can live with ("red shirt or green shirt"). Never ask a 4-year-old an open question ("Do you want to take a bath") unless you are willing to accept their answer.
Use the two "I's" of discipline (ignore or isolate) rather than the two "S's" (shouting or spanking). When disciplining, try to separate your child and his or her behavior ("I love you, but I do not like it when you touch the VCR.")
Provide your 4-year-old with clearly stated limits along with an explanation of the consequences if rules are broken.
Your child may continue to use a security object (such as a blanket, favorite stuffed toy, night light, etc.). This is normal and your youngster will give up the item when he or she is ready,
If you are expecting another baby, discuss with your child's physician how to prepare your 4-year-old.
Allow your child to participate in setting and cleaning up the table. Always praise him or her for a job well done.
Provide some type of structured learning environment in preparation for kindergarten next year. Examples include preschool, Head Start or Sunday School. Show an interest in your child's preschool activities.
Development
Speech is almost always understandable.
Can usually count from 1 to 10.
Can walk on tiptoes, climb a ladder and ride a tricycle.
May name and match three or four primary colors.
Knows his or her own name.
Correctly uses the pronoun "I."
Children this age recognize gender differences and will correctly say "I am a girl" or "I am a boy."
Can dress and undress with supervision but still has trouble with laces and buttons. They also begin to be selective about what they wear.
Holds and uses a pencil with good control. Can copy a cross, circle and possibly a square.
Can to draw a person with a face, arms and legs.
Engages in conversational "give-and-take."
Can sing a song.
Talks about his or her day's activities and experiences.
Can identify emotions such as sadness, anger, anxiety and fear.
Oral Health
Supervise brushing twice a day with a small amount of fluoridated toothpaste.
Take your 4-year-old to the dentist again this year and schedule re-checks as recommended by the dentist.
If the child sucks his or her fingers or thumb, ask the dentist how to discourage these habits. Stop pacifier use.
Continue giving a fluoride supplement if your drinking water is not fluoridated. Some dentists recommend fluoride be continued through age 8; others recommend continuing through age 12 or 16. Check with your pediatrician and dentist.
Learn how to prevent dental injuries and what to do in case of a dental emergency, especially the loss or fracture of a tooth.
Feeding
The 4-year-old continues in a period of relatively slow growth. Average weight gain per year is only three to four pounds. Therefore, the appetite still is not what most parents (or grandparents) think it should be. Remember, feeding problems may arise if parents make their child eat more than he or she needs to, or show too much concern in what their child eats.
Provide snacks rich in carbohydrates and limit high-fat, low nutrient foods.
The 4-year-old can and usually insists on feeding himself or herself.
Mealtime should be pleasant and food should never be forced. Provide nutritious foods and let your child decide what and how much to eat. Offer small portions with the availability of a second helping.
The 4-year-old will often imitate peers in food likes and dislikes.
Avoid nuts, hard candy, uncut grapes, hot dogs or raw vegetables. Control sweets and avoid junk food.
Eat dinner together as a family whenever possible.
Insist on good table manners and encourage pleasant conversation during meals.
Turn the TV off during meals.
Sleep
An afternoon nap may still be necessary.
Fears of the dark, thunder, lightning, etc. are quite common at this age.
Maintain a consistent bedtime and bedtime routine, using a night light, security blanket or toy are all ways to help lessen nighttime fears.
Nightmares can wake a child up from sleep. They can be triggered by changes or stress. Reassure your child and put him or her back to bed.
Immunizations
Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced,it is always best to seek the advice of your child's health care provider concerning your child's vaccine schedule.
Some physicians will give the child DTaP#5, IPV #4, and MMR#2 at this checkup. Other doctors wait until the five year checkup. Both schedules are acceptable.
Annual flu vaccines may be recommended for children with chronic illnesses like asthma and heart defects. Check with your doctor.
If the child can cooperate or a problem is suspected, vision and hearing will also be checked. The child's blood pressure will be recorded.
Toilet Training
By age 4, 95 percent of children are bowel trained.
By age 4, 90 percent of children are dry in the daytime and 75 percent at night.
Safety
Your child continues to require close supervision. Accidents continue to be the principal cause of death in children in this age group.
Know where your child is at all times. A 4-year-old is too young to be roaming the neighborhood alone.
If your home uses gas appliances, install and maintain carbon monoxide detectors.
The purchase of a trampoline is not recommended because of the risk of serious injury.
Insist that your home and car be smoke free.
Select toys that are safe.
Electrical tools, firearms, matches and poisons should be locked up, out of reach.
The child should not have unsupervised access to, or ride a bike in, the street.
Some 4-year-olds can be taught their full name, address and phone number.
If bicycling, teach safety rules and insist on helmet use.
Continue to use a car seat or booster seat secured properly until the child weighs at least 60 pounds or his or her head is higher than the back of the rear seat. The greatest risk to your child's health continues to be motor vehicle accidents. Remember, it is impossible for you to protect your child during an accident by just holding him or her. Set a good example by always using a seat belt when driving.
Always walk behind your car before backing out of the driveway.
Many 4-year-olds are fairly good "swimmers," but knowing how to "swim" does not make the youngster water safe. Never leave a child unattended in a bathtub, even for a few seconds. Ensure that your child wears a life vest if boating.
There is no such thing as a "child proof cap." Ingestion of toxic substances is common at this age. Keep syrup of Ipecac in the home to be used only as directed by your child's doctor or the poison control center.
Never buy toys or other objects that can cut or ingested. Suffocation by plastic bags and balloons still occurs at this age.
Be especially careful when using power lawn mowers and other power tools.
Test smoke detectors to ensure they are working properly.
Continue to use a water proof sunscreen on your child before he or she goes outside. If possible, avoid the hours between 10 a.m. and 3 p.m. when the sun is the most dangerous.
Advise your 4-year-old to be careful around strange dogs, especially ones that are eating.
Begin to teach your child not to talk to strangers or accept food from strangers.
Teach your child pedestrian safety ("look both ways before crossing the street").
Illnesses
The 4-year-old experiences less respiratory infections, such as colds, ear infections and sinus infections than the previous year. Begin to teach good habits: washing his or her hands after using the toilet, putting his or her hands in front of his or her mouth before coughing or sneezing, and washing his or her hands after coughing or sneezing.
Remember, most illnesses at this age are viral, which means antibiotics will not shorten the course of the illness.
Check your child's progress with our Growth Charts.
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As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.
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Yes: No:
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Quick reference medical handouts used by Pediatric offices
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Growth Milestones - FIVE YEARS
The Five-Year Checkup
"Leaving the Nest"
Your 5-year-old is about to begin "real" school for the first time. Your child changes from a little one, protected by home, to a kindergartner, with the demands of a new school and new expectations. Children this age need approval, praise and encouragement. They want to please and are proud of their work.
School Readiness
Here are some guidelines indicating your child is ready for kindergarten:
He or she plays well with other children and takes turns.
Is able to follow directions.
Can follow simple directions.
Conforms to simple rules regarding behavior.
Feeds and dresses himself or herself (except, perhaps, for tying shoes)
Is able to separate from the parents, after a short transition time, for at least half a day day.
Parenting and Behavioral
Listen to and show respect for your child.
This is an important time to continue reading to your child or read together. Get a library card and use it regularly. Ask the librarian to pick out age appropriate books.
By the end of this year many 5-year-olds can recognize simple words and may even be reading. Praise your child's progress.
Children this age show concern for each other so parents should encourage diversity, respect and tolerance.
The 5-year-old enjoys crafts, coloring and painting. He or she may also begin enjoying simple board games (like "Candyland," etc.).
It is not unusual to have occasional accidents at night and during play. Be understanding and do not make a big deal out of it. However, if it happens frequently, it would be a good idea to discuss the matter with the child's doctor.
Enhance your 5-year-old's experience with trips to parks, libraries, zoos and other points of interest.
Teach your child the difference between right and wrong.
Begin age appropriate chores.
Building self-esteem is very important at this age. Give your child encouragement and praise not only for completing a task but also while working on the task. Avoid physical punishment - it only promotes fear and guilt and teaches the child that violence is acceptable in certain situations.
Always show affection.
Development
Skips, can walk on tiptoes and jumps forward.
Throws a ball overhand.
Washes and dries hands and brushes teeth unassisted.
Can cut and paste.
Can name four or five colors.
Can state his or her age.
Has a vocabulary of six to eight word sentences.
Can tell a simple story.
Can dress and undress without supervision.
Knows his or her own phone number, address and several nursery rhymes.
Can copy a triangle from a picture.
Draws a person with a head, body, arms and legs.
Understands right and wrong, fair and unfair.
Understands games that have rules.
Engages in make-believe and dress-up play, in which your child may assume a specific role( "mommy or daddy").
Oral Health
Encourage teeth brushing twice a day with small amount of fluoride toothpaste.
Continue to give fluoride supplements if not in the water supply.
Continue seeing a dentist at least twice a year.
Consider the use of dental sealants.
Feeding
Appetite is usually much better at 5 as the child begins the second of three growth spurts. Continue to offer your child a selection from the basic food groups.
Make meal time pleasant, turn off the TV and encourage conversation.
Limit carbohydrate snacks like soft drinks, chips, candy and cookies. Instead, encourage healthy snacks, such as fruit and vegetables.
Ensure your child eats a balanced breakfast and a nutritious lunch at school.
Sleep
At this age expect an occasional nightmare or night terror. If the behavior become frequent, speak to your child's doctor about it.
Immunizations
Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced,it is always best to seek the advice of your child's health care provider concerning your child's vaccine schedule.
The following immunizations are given at the five year checkup if not previously given:
Diphtheria, Tetanus, Acellular Pertussis (DTaP) Vaccine #5
Inactivated Polio virus (OPV) Vaccine #4
Measles, Mumps, and Rubella (MMR) #2
Other screening done at this age include vision, hearing, tuberculin test (if indicated) and blood pressure. If there is a family history of elevated cholesterol, some physicians will also obtain a screening blood test.
Safety
Continue to use a seat belt in the back seat of the car at all times.
Teach your 5-year-old how to swim.
Make sure all swimming pools in your area are secure.
Always use sun screen when your child is outside playing or swimming.
Keep your child's environment free of smoke.
Conduct fire drills and make sure all smoke alarms are operating properly
Make sure any guns in the home are locked up and the ammunition is stored separately. A trigger lock is an additional precaution. And make sure these same safety precautions are followed at friends' homes. Never allow your child to handle firearms.
Teach bicycle safety and make sure your child always wears an approved helmet as well as shoes while riding a bicycle.
If your home uses gas appliances, install and maintain carbon monoxide detectors.
The purchase of a trampoline is not recommended because of the risk of serious injury.
Begin to teach your child rules for interacting with strangers, either on the phone or at the door.
Never let your child play unsupervised outside.
Sexuality
Now is the time to begin to teach your child the names of all body parts including genitals. Give your youngster a vocabulary to avoid unwanted touching. If this is a difficult subject for you to discuss, ask the help of your doctor or the child's teacher.
Recognize that a child's sexual curiosity and exploration are normal.
Check your child's progress with our Growth Charts.
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As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.
| home | contact us | about us |
| parenting & behavioral | child development | growth milestones |
| childhood conditions | seesaw | book reviews |
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Do you believe that picking up a three-month old everytime she cries will spoil her?
Yes: No:
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Quick reference medical handouts used by Pediatric offices
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Growth Milestones - 6 Years
""The Big First Grader" "
Your child has changed from a little one, protected by home, to a first-grader who now must meet the demands and competition of school life. A 6-year-old is eager, active and likes to be on the go. A youngster this age is eager to act independently, but he or she is not yet able to consistently make wise decisions. A 6-year-old needs parental approval, understanding, praise and encouragement. When parents or school push too hard or expect too much, the child may become tense and nervous and develop physical symptoms such as stomach-ache, headache, fatigue and irritability.
Possible Questions for Your Child's Doctor
Some of the questions or concerns you may have about your 6-year-old can be raised at this checkup. These might include:
Hyperactivity which interferes with school performance.
Inability to get along with peers or siblings, or lack of friends.
Poor school progress or school avoidance.
Being overweight.
Bed wetting or soiling.
Recurrent nightmares, tics, aggressive behavior, fears.
It is not unusual for a 6-year-old to steal money or enticing objects. Speak to your physician if you are concerned about this.
What is ADD?
Hyperactivity and ADD
Recognizing ADHD
Medical causes of Behavior
Being overweight can damage self-esteem
Encopresis (soiling)
Enuresis(bedwetting)
Simple Tics
Stealing
Parenting and Behavioral
Parenting and Behavioral
Adults play important roles in the life of children at age 6. Children will develop close relationships with teachers. It can be upsetting to a child when adults they love (including teachers) go through difficult times or changes.
Establish rules to be followed at home with respect to: bedtime, TV watching, helping with chores such as setting the table, keeping their room neat.
The TV can become a major pastime for the 6-year-old. Don't let it. Television can be a positive resource if watched in small and controlled doses. Always watch TV with your child and explain the differences between reality and fantasy.
Spend active time with your child on a daily basis if possible. Especially show interest in your child's daily school activities.
At this age, an adult should be present at home (or other arrangements made for adult supervision) when the parents are absent.
Praise and encourage the child's activities. Build the child's self-esteem. Show affection. If there are siblings, promote the individual strengths of each child.
Promote activities outside the home. Remember that the goal of these activities is to have fun and develop oneself to the greatest capacity. Winning and losing should receive limited attention.
Encourage reading. Read to your 6-year-old. Let him or her read to you. Read together. Your example will help reinforce that reading gives pleasure. If you haven't already done so, get a library card and use it.
Development
Can bounce a ball 4-6 times; throws and catches.
Skates.
Can ride a bicycle.
Can tie shoelaces.
Can count up to 100, print first name, print numbers up to 10 and print a few letters.
Knows right from left.
Can draw a person with six body parts.
Begins to learn some specific sports skills like batting a ball or kicking a soccer ball.
Oral Health
Ensure that your child brushes his or her teeth twice a day with a pea-size amount of fluoridated toothpaste. Regularly supervise tooth brushing.
Give your child fluoride supplements as recommended by the your youngster's physician based on the level of fluoride in your drinking water.
Learn how to prevent dental injuries and handle dental emergencies, especially the loss or fracture of a tooth.
Flossing the teeth before bedtime is recommended.
If your child regularly sucks his or her fingers or thumb, begin to intervene gently to encourage discontinuation.
Schedule a dental appointment for your child every six months, unless the dentist determines otherwise based on your child's individual needs/susceptibility to disease.
As the child's permanent molars erupt, ensure that the dentist evaluates them for application of dental sealants.
Nutrition
Your child may develop strong food preferences. A 6-year-old may refuse to eat some foods. This will gradually change as the youngster is exposed to different foods outside your home.
Try not to use food as a reward for good behavior. Praise is better. Ensure that your child eats three regular meals and two nutritious snacks per day.
Make mealtimes pleasant and companionable. Encourage conversation.
Provide nutritious snacks rich in complex carbohydrates. Limit high-fat or low-nutrient foods.
Model and encourage good eating habits.
Serve a variety of healthy foods and avoid excessive junk food, especially those with "empty" calories such as soft drinks, chips, candy and cookies.
Help your child learn to choose appropriate foods, including five servings of fruits and vegetables daily.
Encourage your child to eat a balanced breakfast or ensure that the school provides one.
Ensure that your child eats a nutritious lunch at school, either through the school lunch program or by packing a lunch.
Good table manners take a long time to develop. Model good table manners for your child.
Sleep
Ensure that your 6-year-old child gets adequate sleep. For children 6-10 years of age, the suggested bedtime is 8-9 p.m.
Health Promotion
Be a role model for your child by having a healthy lifestyle.
Encourage regular physical activity.
Limit television watching to an average of one hour per day of appropriate programs. Watch the programs together and discuss them.
Reinforce with your child's personal care and hygiene.
Discourage interest in tobacco products. Parents are very influential in teaching children to avoid tobacco. If a parent smokes, the parent should set a quit date and stop smoking. Modeling nonsmoking is a powerful example with important health consequences. Tell your child that smoking is related to the cause of death for 1 in every 5 people in the U.S.
Immunizations
Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced,it is always best to seek the advice of your child's health care provider concerning your child's vaccine schedule.
Annual flu vaccines for children with chronic illnesses like asthma and heart defects. Check with your doctor.
Vision and hearing, as well as blood and urine, are usually checked at this visit. Other screening done at this age may include a tuberculin test (if indicated) and blood pressure. If there is a family history of elevated cholesterol, some physicians will also obtain a screening blood test.
By this age, most children have received the following immunizations:
<http://www.kidsgrowth.com/images/check.gif> 5 doses of DTaP vaccine
<http://www.kidsgrowth.com/images/check.gif> 4 doses of HIB vaccine
<http://www.kidsgrowth.com/images/check.gif> 1 dose Chickenpox vaccine
<http://www.kidsgrowth.com/images/check.gif> 4 doses of Prevnar vaccine (if born after 1999)
<http://www.kidsgrowth.com/images/check.gif> 3 doses Hepatitis B vaccine
<http://www.kidsgrowth.com/images/check.gif> 2 doses of MMR vaccine
<http://www.kidsgrowth.com/images/check.gif> 4 doses of the Inactivated Polio Vaccine
2001 Immunization
Schedule
Safety
Enforce consistent, explicit and firm rules for safe behavior.
Continue to ensure that he or she wears a seat belt in the car at all times.
Reinforce with your child the safety rules for swimming pools. Teach your child how to swim.
Ensure that swimming pools in the child's community, in your apartment complex or at your home, have a four-sided fence with a self-closing, self-latching gate. Children should be supervised by an adult whenever they are in or near water.
Teach your child how to put on sunscreen before he or she goes outside to play or swim.
Continue to keep your child's environment free of smoke.
Test smoke detectors to ensure they work properly. Change batteries yearly.
Reinforce with your child the safety rules for the home. Conduct fire drills at home. Lock up poisons, matches and electrical tools.
Ensure that guns, if in the home, are locked up and ammunition is stored separately. A trigger lock is an additional important precaution.
Reinforce with your child the safety rules for getting to and from school. Reinforce with your child pedestrian and neighborhood safety skills.
Reinforce with your child the safety rules for bicycles, including use of proper traffic signals. Ensure that he or she always wears a helmet when riding a bicycle.
Reinforce the importance of playground safety.
Ensure that your child is supervised before and after school in a safe environment.
Reinforce with your child the safety rules for interacting with strangers (e.g., answering the telephone or the door, never getting into a stranger's car). Ensure that your child's school curriculum includes information on how to deal with strangers.
Teach him or her about sports safety, including the need to wear protective sports gear such as a mouth guard or a face protector.
Sexuality
Answer questions at a level appropriate to the child's understanding.
Have age-appropriate sexual education books in the home that will answer some questions and encourage your child to ask others.
Check your child's progress with our Growth Charts.
The information presented in Growth Milestones was obtained with the help of our pediatric experts and with material from The American Academy of Pediatrics' Guidelines for Health Supervision and Bright Futures' Guidelines for Health Supervision of Infants, Children, and Adolescents. Bright Futures is supported by the Maternal and Child Health Bureau, U.S. Department of Health and Human Services.
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As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.
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Source : http://www.kidsgrowth.com/stages/guide/index.cfm