Well Child Check 1-4

Developmental milestones record – 12 months

The typical 12-month-old child will demonstrate certain physical and mental skills. These skills are called developmental milestones.

Information

All children develop a little differently. If you are concerned about your child's development, talk to your child's health care provider.

PHYSICAL AND MOTOR SKILLS

A 12-month-old child is expected to:

• Be 3 times the birth weight


• Grow to a height of 50% over birth length


• Have a head circumference equal to that of the chest


• Have one to eight teeth


• Stands by his or herself


• Walk alone or when holding one hand


• Sit down without help


• Bang two blocks together


• Turn through the pages of a book by flipping many pages at a time


• Picks up a small object using the tip of the thumb and index finger


• Sleep 8 - 10 hours a night and take one to two naps

SENSORY AND COGNITIVE DEVELOPMENT

The typical 12-month-old:

• Begins pretend play (such as pretending to drink from a cup)


• Follows a fast moving object


• Responds to his or her name


• Can say momma, papa, and at least one or two other words


• Understands simple commands


• Tries to imitate animal sounds


• Connects names with objects


• Understands that objects continue to exist, even when they are not seen (object constancy)


• Participated in getting dressed (raises arms)


• Plays simple back and forth games (ball game)


• Points to objects with index finger


• Waves bye


• May develop attachment to a toy or object


• Experiences separation anxiety and may cling to parents


• May make brief journeys away from parents to explore in familiar settings

PLAY

You can help your 12-month-old develop skills through play:

• Provide picture books


• Provide different stimuli, such as going to the mall or zoo


• Play ball


• Build vocabulary by reading and naming people and objects in the environment


• Teach hot and cold through play


• Provide large toys that can be pushed to encourage walking


• Sing songs


• Have a play date with a child of a similar age


• Avoid television time until age 2


• A transitional object may help with separation anxiety

Developmental milestones record - 18 months

Skills and growth milestones of 18-month-old children describes the physical and mental development that is expected for this age.

Information

All children develop a little differently. If you are concerned about your child's development, talk to your child's health care provider.

PHYSICAL AND MOTOR SKILL MARKERS

The typical 18 month old:

• Has a closed soft spot on the front of the head (anterior fontanel)


• Is growing at a slower rate and has less of an appetite compared to months before


• Is able to control the muscles used to urinate and have bowel movements (sphincter muscles), but may not be ready to use the toilet


• Runs stiffly and falls often


• Is able to get onto small chairs without help


• Walks up stairs while holding on with one hand


• Can build a tower of two to four blocks


• Can use a spoon and cup with help to feed himself


• Imitates scribbling


• Can turn two or three pages of a book at a time

SENSORY AND COGNITIVE MARKERS

The typical 18 month old:

• Shows affection


• Has separation anxiety


• Listens to a story or looks at pictures


• Can say 10 or more words when asked


• Kisses parents with lips puckered


• Identifies one or more parts of the body


• Understands and is able to point to and identify common objects


• Often imitates


• Is able to take off some clothing items, such as gloves, hats, and socks


• Begins to feel a sense of ownership, identifying people and objects by saying "my"

PLAY RECOMMENDATIONS

• Encourage and provide the necessary space for physical activity


• Provide safe copies of adult tools and equipment for the child to play with


• Allow the child to help around the house and participate in the family's daily responsibilities


• Encourage play that involves building and creativity


• Read to the child


• Encourage play dates with children of the same age


• Avoid television time before age 2


• Play simple games together, such as puzzles and shape sorting


• A transitional object may help separation anxiety

Developmental milestones record - 2 years

Physical and motor skill markers:

• Able to turn a door knob


• Can browse through a book one page at a time


• Can build a tower of 6 to 7 cubes


• Can kick a ball without losing balance


• Can pick up objects while standing, without losing balance (often occurs by 15 months, and would be cause for concern if you don't see it by 2 years)


• Can run with better coordination, although the stance may still be wide


• May be ready for toilet training


• Should have the first 16 teeth (the actual number of teeth can vary widely)


• At 24 months, they are about half their final adult height

Sensory and cognitive markers:

• Able to put on simple clothes without help (often better at removing clothes than putting them on)


• Able to communicate needs such as thirst, hunger, need to use the restroom


• Can organize phrases of 2 - 3 words


• Understand 2-step command ("give me the ball and then get your shoes")


• Increased attention span


• Vision fully developed


• Vocabulary has increased to about 50 - 300 words (healthy children's vocabulary can vary widely)

Play recommendations:

• Allow the child to help around the house and participate in the daily family responsibilities.


• Encourage and provide the necessary space for physical activity.


• Encourage play that involves building and creativity.


• Provide safe copies of adult tools and equipment. Many children like to mimic activities such as cutting the grass or sweeping the floor.


• Read to the child.


• Try to avoid watching television at this age (recommendation of the American Academy of Pediatrics).


• Control both the content and quantity of television viewing. Limit television viewing to fewer than 3 hours per day, and preferably 1 hour or less. Avoid programming with violent content. Redirect the child to reading or play activities.


• Control the type of games played

Developmental milestones record - 3 years

This article describes the skills and growth markers relevant to 3-year-olds.

Information

These milestones are typical of children in the third year of life. Always keep in mind that some variation is normal. If you have questions about your child's development, contact your health care provider.

Physical and motor milestones for a typical 3-year-old may include:

• Gains about 4 - 5 pounds


• Grows about 2 - 3 inches


• Are about half their adult height


• Has improved balance


• Has improved vision (20/30)


• Has all 20 primary teeth


• Needs 11 - 13 hours of sleep a day


• May have daytime control over bowel and bladder functions (may have nighttime control as well)


• Can briefly balance and hop on one foot


• May walk up the stairs with alternating feet (without holding the rail)


• Can construct a block tower of more than nine cubes


• Can easily place small objects in a small opening


• Can copy a circle


• Can pedal a tricycle

Sensory, cognitive, and social milestones include:

• Has a vocabulary of many hundreds of words


• Composes sentences of three words


• Counts three objects


• Uses plurals and pronouns (he/she)


• Frequently asks questions


• Can dress self, only requiring assistance with laces, buttons, and other fasteners in awkward places


• Has longer attention span


• Feeds self without difficulty


• Acts out social encounters through play activities


• Has some decrease in separation anxiety for short periods of time


• Fears imaginary things


• Knows own name, age, and gender (boy/girl)


• Starts to share


• Has some cooperative play (building tower of blocks together)

At age 3, almost all of a child's speech should be understandable.

Temper tantrums are common at this age. Children who have tantrums that regularly last for more than 15 minutes or that occur more than three times a day should be seen by a health care provider.

Recommendations for parents regarding appropriate play at this age:

• Provide a safe play environment and constant supervision.


• Provide the necessary space for physical activity.


• Help your child participate in -- and learn the rules of -- sporting activities.


• Monitor both the time and content of television viewing.


• Visit local areas of interest.


• Encourage your child to help with small household chores, such as helping set the table or picking up toys.


• Encourage play with other children to help develop social skills.


• Encourage creative play.


• Read together.


• Encourage your child to learn by answering questions.


• Provide activities related to your child's particular interests.


• Encourage your child to use words to express feelings (rather than acting out).


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Developmental milestones record - 4 years

There are skills and growth markers expected in a typical 4-year-old child. These milestones are physical and mental developments considered normal for this age group.

Information

All children develop a little differently. If you are concerned about your child's development, talk to your child's health care provider.

PHYSICAL AND MOTOR

During the fourth year, a child typically:

• Gains weight at the rate of about 6 grams per day


• The average 4 year old weighs 40 lbs and is 40 inches tall


• Vision is 20/20


• Sleeps 11 to 13 hours, usually without a nap


• Grows to a height that is double the length at birth


• Shows improved balance


• Hops on one foot without losing balance


• Throws a ball overhand with coordination


• Can cut out a picture using scissors


• May still wet the bed (normal)

SENSORY AND COGNITIVE

The typical 4-year-old:

• Has a vocabulary of more than 1,000 words


• Easily puts together sentences of four or five words


• Can use the past tense


• Can count to four


• Will ask the most questions of any age


• May use words that aren't fully understood


• May begin using vulgar words


• Learns and sings simple songs


• Tries to be very independent


• May show increased aggressive behavior


• Talks about personal family matters to others


• Commonly has imaginary playmates


• Has an increased understanding of time


• Is able to tell the difference between two objects based on things like size and weight


• Lacks moral concepts of right and wrong


• Rebels if too much is expected of him or her

PLAY

As the parent of a 4-year-old, you should:

• Encourage and provide space for physical activity


• Show the child how to participate in, and follow the rules of sporting activities


• Encourage play and sharing with other children


• Encourage creative play


• Teach children to do small chores, such as setting the table


• Read together


• Limit television watching to 2 hours a day of quality programs


• Expose the child to different stimuli by visiting local areas of interest