Growth and Development
The growth and development of your child is something that includes many different milestones. Read about what to expect along the way in the following documents.
Child Safety Seats
General Guidelines
Infants/toddlers
Rear-facing only seats and rear-facing convertible seats
All infants and toddlers should ride in a Rear-Facing Car Seat until they are 2 years of age or until they reach the highest weight or height allowed by their car safety seat’s manufacturer.
Toddler/preschoolers
Convertible seats and forward-facing seats with harness
All children 2 years or older, or those younger than 2 years who have outgrown the rear-facing weight or height limit for their car seat, should use a Forward-Facing Car Seat with a harness for as long as possible, up to the highest weight or height allowed their car seat’s manufacturer.
School-aged children
Booster seats
All children whose weight or height is above the forward-facing limit for their car seat should use a Belt-Positioning Booster Seat until the vehicle seat belt fits properly, typically when they have reached 4 feet 9 inches in height and are between 8 and 12 years of age.
Older children
Seat belts
When children are old enough and large enough to use the vehicle seat belt alone, they should always use Lap and Shoulder Seat Belts for optimal protection. All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.
For updates to this information please go to www.healthchildren.org
Your Newborn Child
YOUR NEWBORN CHILD
Name:_______________________ Date:_______________
Length inches:_________
Weight lbs:____ oz:____
Head Circumference cm:______
NUTRITION
- Feed your child breast milk and/or formula with iron every 2-3 hours.
- Always hold and snuggle your child while feeding; do not prop-up a bottle for your child to take.
- Continue taking your own prenatal vitamin while nursing.
- Solids are not necessary for your child at this time.
- If you are having difficulty with breastfeeding, follow up with a local lactation consultant 875-2662 or contact La Leche League
- International at www.llli.org
SLEEP
- Parental sleep is VERY important. Take shifts. Nap when you can.
- Your infant should sleep on his/her back ONLY as this reduces the risk of sudden infant death syndrome.
- Place your child down for naps and at night, drowsy but awake.
- Make nighttime feedings/diaper changing as subdued as possible to encourage more daytime activity.
PARENTING
- Monitor your child’s umbilical area several times a day and use only warm water if any redness or drainage is noticed. Call your doctor with any questions or concerns.
- It is ok to give your child a lukewarm bath, submerging no higher than shoulder level, 1-3 times a week. Patting dry and applying a fragrance-free, hypoallergenic moisturizing lotion immediately after bathing can help prevent dry skin or worsening the skin condition called eczema. NEVER leave your child unattended near water.
- Learn and respond to your child’s cries (refer to pg 54-55 in your complimentary AAP book).
- Refer to your AAP book on soothing methods.
- Newborns will usually require one extra layer of clothing than an adult would to keep their body temperature up.
- Pacifiers are fine if your child loves to suck. Sucking is a self comforting behavior. Give your baby the pacifier if he/she wants to suck while awake. Offer it to your baby after or between feedings to avoid interference with eating. Avoid giving it to him/her every time he/she cries.
SAFETY
- Check hand-me-down baby gear for recall notices (widely available on the web).
- Never leave your child unattended on elevated surfaces.
- Check the crib and play areas carefully for long cords (strangulation risk).
- Place your child in the crib on his/her back on a firm mattress without fluffy comforters, pillows or stuffed animals.
- Do not use the microwave oven for heating bottles. They heat unevenly and increase the risk of burns.
- Always use a properly fitting car seat. The rear center seat is the safest position for your child. To see if your car seat is installed properly and/or to find a certified passenger safety technician in your area you may call 866-SEATCHECK (866-732-8243) OR visit www.seatcheck.org
- Check your smoke detector and fire extinguishers on a regular basis. Have a family exit plan. Carbon Monoxide detectors are highly recommended in the home.
ACTIVITIES
- Hold, cuddle, touch.
- Sing, talk, play soothing music.
- Watch mobiles; look at high contrast and brightly colored objects with your baby.\
- Take walks outside.
- Tummy time can be started once the umbilical cord has fallen off. This should only be done while your child is awake, alert and fed. Aim for 15-30 minutes a day on the tummy.
GENERAL HEALTH
- Regular vigorous feeding is the most important sign of good health in an infant. If your infant is not feeding well or feeding becomes less vigorous, take his/her rectal temperature and please call the office.
- If your baby has a rectal temperature above 100.4º F, please call the office.
- You may use Mylicon drops for gas.
NEXT VISIT
- Please schedule your child’s next appointment for 2 WEEKS OF AGE.
- Go to your hospital lab for the second genetic screening (PKU) between 10-14 days of life.
- Write down your questions to address with the doctor at your next visit.
Your 2 Month Old Child
YOUR TWO MONTH OLD CHILD
Name:_______________________ Date:_______________
Length inches:_________
Weight lbs:____ oz:____
Head Circumference cm:______
NUTRITION
- Feeding intervals are usually 2-4 hours apart and may be longer at night.
- Breast milk and/or formula with full iron will be good nutrition for your baby.
- To prevent vitamin D deficiency, the American Academy of Pediatrics recommends that all breastfed infants take 1 mL daily of
- Tri-Vi-Sol (available over the counter) unless they are taking at least 16 oz. daily of supplemental formula.
- Solids are not yet needed. Solid food can be introduced at 4-6 months of age.
ELIMINATION
- Stools may become less frequent, sometimes only once per week. If the stools are soft and baby is feeling well, there is no reason to be concerned.
- A boy should have a strong urinary stream.
DEVELOPMENT TWO MONTHS – FOUR MONTHS OLD
- Your baby may grasp a rattle when it is placed in his/her hand.
- Social smiles will be occurring regularly now!!
- A baby this age enjoys people and will coo and babble in “conversation.”
- Your baby will recognize and turn toward your voice.
- Provide “tummy time” when your baby is awake and alert. While on their stomach, babies may push up, roll from side-to-side or even roll over.
- Babies this age can follow objects at least to the midline with their eyes.
- If you have concerns about your baby’s vision or hearing, please let us know.
- Talk with us if you notice that your baby has a strong preference to turn to one side.
SLEEP
- Parental sleep is VERY important. Take shifts and nap when you can.
- Your infant should sleep only on his/her back as this reduces the risk of sudden infant death syndrome.
- To encourage the development of good sleep habits, place your baby in the crib drowsy but awake. This will allow your baby to put him/herself to sleep.
- Keep middle of the night feeding brief and boring to encourage sleep.
- Limit daytime naps to less than three hours.
PARENTING
- Each baby has a unique personality and temperament.
- Sleeping/waking patterns may be emerging; encourage desirable patterns.
- If you haven’t already, start a bedtime routine now. Lay your baby down drowsy but awake. Both you and your baby will benefit if she/he learns to fall asleep without your help. Avoid rocking or feeding your baby to sleep.
- By four months of age, most babies can sleep eight hours without a feeding. When your baby wakes in the middle of the night, let him/her fuss for a few minutes without intervening; he/she may fall back to sleep. If crying persists, try patting or rocking your baby for a few minutes. If none of these methods are effective, feed your baby briefly.
- Take time for yourself and to be alone with other family members.
SAFETY
- Infant seats should NOT be placed on counter or table tops.
- Always use a properly fitting car seat. The rear center seat is the safest position for your child. To see if your car seat is installed properly and/or to find a certified passenger safety technician in your area you may call 866-SEATCHECK (866-732-8243) OR visit www.seatcheck.org
- Check your smoke detector and fire extinguishers on a regular basis. Have a family exit plan: ladders in upstairs bedroom, etc.
- Carbon Monoxide detectors are highly recommended in the home.
- NEVER hold a baby while you are drinking a hot beverage, smoking or cooking over hot surfaces.
- Keep small, sharp objects – as well as plastic bags and balloons – away from your baby.
ACTIVITIES
- Interact with your baby: talk, sing and read aloud.
- Give your baby “tummy time.” At least 30 minutes a day.
- Try mirrors, music and walks outside.
- Now is the time for increased vocalization. Enjoy cooing tone conversations back and forth.
- Babies enjoy toys/objects with varying textures
IMMUNIZATIONS TODAY
- Most babies have no reaction or are somewhat sleepier following their immunization. Your baby may develop a fever and/or be fussy for 24-48 hours. A tender lump at the injection site may occur and persist for a week. Acetaminophen may be given if any of these symptoms are present
- Your child will be receiving Pentacel (DTaP, polio, Haemophilus influenza), Hepatitis B, Prevnar and the oral vaccine Rotarix (optional).
NEXT VISIT
- Please schedule your baby’s 4 MONTH WELL CHILD exam approximately 8 weeks from today as you leave.
- Please bring your yellow immunization card for updating and any questions you may have for the doctor
Acetaminophen (Tylenol)
(80mg/0.8 ml)
6-12 lbs – 0.4 mL (1/2 dropper)
12-18 lbs – 0.8 mL (1 dropper)
18-24lbs – 0.8 + 0.4 mL (1½ dropper)
Over 24 lbs – 0.8 mL x 2 (2 droppers)
Acetaminophen (Tylenol)
(160mg/5 ml)
6-12 lbs – 1.25 mL
12-18 lbs – 2.5 mL
18-24lbs – 3.75 mL
Over 24 lbs – 5 mL
Acetaminophen may be given every 4 hours and not more often than 4 times in 24 hours. PLEASE CHECK THE CONCENTRATION OF THE ACETAMINOPHEN YOU ARE USING; DOSES WILL VARY BASED ON CONCENTRATION. Infant drops are more concentrated than elixir. Please call the office if a fever persists for more than three days or if you have any questions about your child’s illness.
Your 6 Month Old Child
YOUR SIX MONTH OLD CHILD
Name:_______________________ Date:_______________
Length inches:_________
Weight lbs:____ oz:____
Head Circumference cm:______
NUTRITION
- 1 to 3 solid meals a day and between 24-32 ounces of breast milk or formula with iron.
- Continue to commit to feeding your baby healthful foods. Soon your infant will be modeling your eating habits.
- To prevent iron deficiency, breastfed infants should take 1mL daily of Tri-Vi-Sol WITH IRON (available over the counter) unless they are taking at least 24oz of iron-fortified formula or 2 servings of ¼ cup iron-fortified rice cereal daily. If they are taking rice cereal as recommended, breastfed infants still need 0.5 mL daily of Tri-Vi-Sol with iron to prevent vitamin D deficiency unless they are taking at least 16 oz daily of supplemental formula.
- Introduce a cup with water.
- If you want to use juice, think of it as a dessert; water it down. Do not put the juice in the bottle. Limit to 6 oz a day.
- No bottle in bed. Bottles in bed can cause terrible tooth decay.
- Avoid using the bottle as a pacifier.
DENTAL HEALTH
- Fluoride supplement may be needed if your baby does not receive water containing fluoride.
DEVELOPMENT 6-9 MONTHS
- Sits without support. Stands holding on.
- Laughs and babbles\
- Passes things hand to hand to mouth to hand etc.
- May get upset with parents leaving; beginning to differentiate self from others and familiar from unfamiliar.
- If you have any concerns about your baby’s vision or hearing, please let your physician know.
PARENTING
- Separation and stranger anxiety is common during the next several months. Your child may seem like two separate babies. One is outgoing and affectionate; the other is anxious, clingy and frightened by unfamiliar people and objects. You or your parenting styles do not cause these new responses – your child can now differentiate familiar and unfamiliar.
- During the day respond to separation fears with reassuring words and behaviors. At night and naptime your child may find a “transitional object” helpful. This is often a soft toy or blanket held when you are snuggling and taken into the crib to provide reassurance when you are not physically present.
- This is a good time to give up the pacifier and not to use it as a transitional object.
SLEEP
- Continuing a bedtime routine will provide security for your baby at this age.
- Many babies who have previously slept through the night begin to awake again.
- Make your visits prompt and reassuring. It may be helpful to leave the door to your baby’s room open.
SAFETY
- Begin to child-proof the home. Crawl around on your hands and knees. See what is available to a curious person exploring your home at ground level.
- Make one area of your home safe for exploring: free of sharp objects, glass, breakable surfaces, dangling cords, small objects.
- In case of ingestion of poisons, call the Poison Control Center immediately. Post this number near ALL your phones: 800-222-1222
- Install gates. Secure stairway doors, windows and screens.
- Always supervise closely in the tub.
- Check out the crib: move the mattress to the lowest level; remove cushions, stuffed animals and anything that could assist baby in climbing out. Remove mobiles dangling overhead.
- Shoes will be needed when baby begins to walk outside in order to protect feet from cold and cuts. The best shoes are flexible, light weight and have a nonskid sole.
- DO NOT USE WALKERS WITH WHEELS! They are associated with serious injury. Walkers are not helpful in learning to walk. STATIONARY devices such as ExerSaucers or Johnny Jump Up Baby exercisers are generally okay.
- Always use a properly fitting car seat. The rear center seat is the safest position for your child. To see if your car seat is installed properly and/or to find a certified passenger safety technician in your area you may call 866-SEATCHECK (866-732-8243) OR visit www.seatcheck.org
- Check your smoke detector and fire extinguishers on a regular basis. Have a family exit plan: ladders in upstairs bedroom, etc. Carbon
- Monoxide detectors are highly recommended in the home.
ACTIVITIES 6-9 MONTHS
- Babies love noises and are beginning to understand cause and effect. Give measuring cups, pots, pans and wooden spoons to bang.
- Play peek-a-boo, “so big” and other word-with-motion games.
- Talk, talk, talk; narrate your day to your baby.
- Read, read, read, read. Make reading with your child an important part of your family’s day.
IMMUNIZATIONS
- Please tell us if your baby had any reactions to the four month immunizations.
- Most babies have no reaction or are somewhat sleepier following their immunization. Your baby may develop a fever and/or be fussy for 24-48 hours. A tender lump at the injection site may occur and persist for a week. Acetaminophen may be given if any of these symptoms are present.
- Your child will receive some/all of the following vaccines: Pentacel, HepB and Prevnar (pneumoccal conjugate) and may receive flu vaccines if available.
NEXT VISIT
- Please schedule your baby’s NINE MONTH well child exam as you leave today.
Your 15 Month Old Child
YOUR FIFTEEN MONTH OLD CHILD
- Name:_______________________ Date:_______________
- Length inches:_________
- Weight lbs:____ oz:____
- Head Circumference cm:______
NUTRITION
- Enjoy family meals. Model good nutrition. Minimize meal time battles.
- Expect swings in appetite. The amount you child needs decreases as your child’s growth rate decreases.
- If you haven’t started, phase the bottle out now. It becomes more difficult to stop the bottle as your child gets older.
- Offer a wide variety of foods from all the food groups daily.
- If there is a strong family history of food allergies, be cautious when introducing foods containing peanuts, tree nuts and white fish like cod or shellfish.
- Serve small portions and let your child request more if desired.
- Avoid juice; it often sabotages good nutrition and is not an essential part of a healthy diet.
- Offer whole milk with the three main meals. Your child needs 16-24 oz a day.
- Use diet as a way to keep stools soft. Fluids and fiber are important.
HYGIENE
- Continue brushing teeth daily. You don’t need to use toothpaste but you may use a very small amount of toothpaste with fluoride. Give the molar surfaces a good scrub with or without teeth.
- Fluoride supplements may be required if your baby does not receive water containing fluoride.
DEVELOPMENT 15-18 MONTHS
- Shows a preference for one hand.
- Shakes head no (before yes).
- Scribbles and imitates a draw line.
- Participates in parallel play, not ready to share yet.
- Removes articles of clothing.
- Responds to name.
- Shy with strangers. A second wave of separation anxiety may occur.
- Points to objects
- Knows at least one body part.
- Walks well and runs.
- Uses “mama” and “dada” appropriately and has a 4-10 word vocabulary by 18 months old.
- Please let your physician know if you have any concerns about vision or hearing.
PARENTING/SAFETY
- Closely supervise your toddler. Curiosity and energy are not balanced with judgment yet.
- NEVER leave child unattended or with an older child around ANY body of water.
- Keep stairs, windows, stoves, heaters, TV’s and top-heavy furniture secure.
- Never leave child to “play” unattended in a car. When your child is in the car, they should remain in their car seat.
- Always use a properly fitting car seat. The rear center seat is the safest position. Once a child is over 12 months old and 20lbs, they can legally be turned to face forward; however, we and The American Academy of Pediatrics recognize that your child will be 5 times safer in a rear facing position until as old as two years.
- Maintain regular checks on your smoke/carbon monoxide detectors and fire extinguishers. Have a family emergency exit plan.
- Be very clear and consistent about street and parking lot safety—always hold hands or carry.
- Use sunscreen for all outdoor activities.
- Increased curiosity and mobility increase the likelihood of poisoning. Prevention is important, keeping medications and toxic chemicals/cleaners up and locked. In case of ingestion of poisons, call the Poison Control Center immediately. Keep this phone number posted by ALL of your phones: 1-800-222-1222
SLEEP
- May still be transitioning to one nap a day.
- When your child climbs out of the crib, it is time to move mattress to the floor or to a toddler bed.
- ACTIVITIES
- Read, Read, Read. Read at least ten minutes day.
- Point to body parts and name them.
- Push/Pull toys.
- Playdough® or clay.
- Drawing and finger painting
- Name colors and shapes.
- Introduce counting
- Give sequential directions to follow.
IMMUNIZATIONS
- Pentacel (DTaP, HiB, and Polio) – Most babies have no reaction or are somewhat sleepier following their immunization. Your baby may develop a fever and/or be fussy for 24-48 hours. A tender lump at the injection site may occur and persist for a week. Acetaminophen may be given if any of these symptoms are present.
- MMR (Measles, Mumps, Rubella) – no reaction today. Possibly a rash (usually only at the injection site) in two weeks.
NEXT VISIT
- Please schedule your child’s 18 MONTH WELL CHILD EXAM as you leave today.
- Please bring your yellow immunization card for updating.
- Please write down all your questions and concerns to address with the doctor at your next visit
Your 1 Year Old Child
YOUR EIGHTEEN MONTH OLD CHILD
- Name:_______________________ Date:_______________
- Length inches:_________
- Weight lbs:____ oz:____
- Head Circumference cm:______
NUTRITION
- If there is a strong family history of food allergies, be cautious when introducing foods containing peanuts, tree nuts and white fish like cod or shellfish.
- Typically children at this age eat three meals a day with two healthy snacks. Sit down as a family.
- Avoid “choke foods” as described at the nine month well exam, until age three.
- Switch from formula to 2% milk now. Your child needs 16-24oz daily. Milk is part of a food pyramid, not the primary source of calories and nutrients. Serve milk in a cup at meal time.
- Plan to phase the bottle out by 12-18 months old.
- Appetite highs and lows are expected. Your job is to offer healthy foods. Your child’s job is to eat healthy foods when they are hungry.
- Spoon skills are improving; most children master the spoon at twelve months.
- Modeling good nutrition promotes your child’s continued health and helps develop good habits for the future.
HYGIENE
- Brush teeth daily. Use fluoride-free toothpaste. Only after you child is able to spit can they use toothpaste.
- Do not give your child a bottle in the crib. Bottles in bed can cause terrible tooth decay.
- If constipation becomes a problem, offer water or diluted apricot, pear or prune juice.
SUPPLEMENTS
Fluoride supplement may be needed if your baby does not receive water containing fluoride.
DEVELOPMENT 12-15 MONTHS
- Shows preference for one hand.
- Shakes head no (before yes).
- Participates in parallel play, not ready to share.
- Removes articles of clothing.
- Responds to name.
- Points at objects.
- Makes eye contact with you for reassurance.
- Walks well. Starting to run.
- Has a 4-word vocabulary by 15 months.
- If you have concerns about hearing or vision, please let your physician know.
PARENTING
- Respond in a positive way to your child’s good behavior.
- Be very consistent and clear. Keep “rules” to a minimum.
- Temper tantrums and negativism are a normal part of this stage of development. Stay calm, don’t overreact. Try to understand what your child is asking, respond clearly, suggest an alternative and then allow him/her to handle the tantrum on his/her own. Tell him/her you’ll be there when he/she is finished with the tantrum.
- Respect your toddler. Ask if he/she is finished eating prior to taking him/her out of the high chair. Give warning when the scene is about to change. Help him/her communicate and cooperate by giving him/her the opportunity. Narrate your day; talk about what you are doing and seeing.
- Comprehension and receptive language are ahead of expressive language.
- Provide freedom to explore safely.
- Maintain your bedtime ritual. Children may begin to transition into one mid-day nap. This may cause upset until a new schedule is established.
SAFETY
- Curiosity and energy are not balanced by judgment at this age. You MUST closely supervise your toddler.
- Never leave your toddler unattended or supervised by an older child around water, pools or bathtub.
- Be very clear about street and parking lot safety — always hold hands or carry.
- Secure stairs, windows, stoves, heaters, TV’s and furniture.
- Never allow a child to “play” unaccompanied in a car.
- Always use a properly fitting car seat. The rear center seat is the safest position. Once a child is over 12 months old and 20lbs, they can legally be turned to face forward however, we, and The American Academy of Pediatrics recognize that your child will be 5 times safer in a rear facing position until as old as two years.
- Check your smoke detectors and fire extinguishers on a regular basis. Have a family exit plan: ladders in upstairs bedroom, etc. Carbon Monoxide detectors are highly recommended in the home.
- DO NOT USE WALKERS WITH WHEELS! They are associated with serious injury. Walkers are not helpful in learning to walk. STATIONARY devices such as Exer-saucers or Johnny Jump-Up Baby exercisers are generally okay.
- Curiosity and mobility increase the likelihood of poisoning. Prevention is important, keeping medications and toxic chemicals/cleaners up high and locked. IN CASE OF INGESTION OF POISONS, CALL THE POISON CONTROL CENTER IMMEDIATELY. KEEP THEIR NUMBER BY ALL OF YOUR PHONES: 800-222-1222.
ACTIVITIES
- Read, read, read; read at least ten minutes a day.
- Point to body parts and name them.
- Roll a ball back and forth or play other “give and take” games.
- Push/pull toys
- Playdough® or clay.
- Introduce counting.
- Put toys or objects in and out of containers.
- Give sequential directions to follow.
IMMUNIZATIONS
- Varicella (Chicken Pox) – no reaction today. Possibly a rash (usually only at the injection site) in two weeks.
- Prevnar (pneumococcal Conjugate)
- Most babies have no reaction or are somewhat sleepier following their immunization. Your baby may develop a fever and/or be fussy for 24-48 hours. A tender lump at the injection site may occur and persist for a week. Acetaminophen may be given if any of these symptoms are present.
Your 3 Year Old Child
YOUR THREE YEAR OLD CHILD
- Name:_______________________ Date:_______________
- Length inches:_________
- Weight lbs:____ oz:____
- BP________/________
NUTRITION
- Balance food groups, encourage and praise when trying new things.
- Eat together as a family. Model healthy eating and exercise habits.
DENTAL HYGIENE
- If you haven’t already, begin regular dental visits. Please ask your physician if you need a recommendation for a dentist.
- If your child drinks non-fluorinated water, ask your physician about fluoride supplements.
DEVELOPMENT
- Jumps, alternates feet when ascending stairs, dresses self, speech is mostly intelligible to strangers.
SLEEP
Napping often stops now.
GUIDANCE/SAFETY
- Safety: Keep knives out of reach.
- If there are guns in the home, lock them and store ammunition separately under separate lock. Talk to your children about gun safety.
- Begin stranger training. Teach your child not to accept food, rides or help from people you do not know. Begin teaching phone numbers and parents’ names. Identify the helping and “safe” strangers when you are out in the community.
- Continue using a car seat until 40lbs OR 4 years old; then switch to a belt positioning booster seat.
- Consider a playgroup or preschool.
- Explain and discuss feelings and consequences. Be respectful; allow decision making.
- Make sure your child ALWAYS wears a helmet when biking or scooting. Encourage safety equipment appropriate for each activity.
- Be deliberate about TV, video and computer use. Discuss and limit it.
- Look for opportunities for your 3 year old to help out around the house.
- Teach/review with your child about your home emergency response plan, meeting location and how to get out.
- Regularly check your smoke/carbon monoxide detectors and fire extinguishers.
Keep the POISON CONTROL CENTER’s phone number near ALL of your phones: 800-222-1222.
IMMUNIZATIONS
Unless you are behind, no scheduled immunizations.
Your 5 Year Old Child
YOUR FIVE YEAR OLD CHILD
- Name:_______________________ Date:_______________
- Length inches:_________
- Weight lbs:____ oz:____
- BP________/________
NUTRITION
- Continue education regarding good nutritional balance and variety. Continue to introduce small amounts of a variety of food.
- Eat together as a family. Continue to model good nutrition and exercise habits.
DENTAL CARE
- Continue taking your child to the dentist every six months. We can recommend a dentist if you don’t already have one.
- Ask about fluoride supplements if your child drinks non-fluorinated water.
DEVELOPMENT
- Skipping, walking, on tiptoes, broad jumps and active games are popular between 5-6 years old.
- Dresses and undresses without supervision.
- Identifies coins and names four or five colors; can tell own age.
- Knows most of the alphabet and begins counting; defines at least one word (ball, shoe, etc.).
- Enjoys singing, music, drawing, and possibly writing; copies triangle from illustration.
- Draws a person with head, body, arms and legs.
- Curiosity about sexuality.
ACTIVITIES
- Promote interactions with other children.
- Demonstrate interest in kindergarten.
- Setup and clean up table.
- Clean own room (rudimentary efforts).
- Help with household tasks.
- Gardening!
- Music – interactive.
- Read minimum of 20 minutes a day.
ANTICIPATORY GUIDANCE
- Safety: Teach your child about water and bicycle safety. Now is a great time for swimming lessons. Continue to be consistent with helmet and safety equipment use. Continue to model and reinforce seatbelt use.
- Discuss gun safety and carefully lock up firearms, matches and poisons.
- Stranger awareness: Identify the safe and helping strangers when you are out in the community. Discuss touching that is appropriate and inappropriate. Identify people they can talk to if they feel uncomfortable about how someone touched them. Teach your child not to accept food, rides or “help” from strangers.
- Home and fire safety: Teach our child to dial “9-1-1” and give your address in an emergency situation. Emphasize that this is not a game.
- Parenting: Discuss both your child’s feelings and your feelings. Review the best/worst thing about your day and your child’s day. Carefully listen to the answer. Make and plan “dates” with your child. Child-directed play continues to be very important.
- Your child can make his/her own lunch with your supervision and help.
- Be very deliberate about TV, video and computer. Discuss it and limit it.
- Read, read, read. School readiness—discuss this with your child’s preschool teacher, if you have one. Can your child function well alone, within a group, and express ideas clearly?
- Your child should know his/her own phone number.
SAFETY
- Continue using a booster seat. Most children still do not fit properly in regular seat belts by this age. Generally they are not ready to come out of the booster seat until 8 years old or 80 lbs.
- To see if your child is ready, try these tests:
- Does your child sit all the way back against the auto seat?
- Do your child’s knees bend comfortably at the edge of the auto seat?
- Does the lap belt fit snugly across the top of the thighs?
- Does the shoulder belt come across the center of the shoulder and chest?
- Can the child sit like this the whole trip?
- If you answer “NO” to any of these questions, your child needs to ride in a booster seat.
- Always call the Poison Control Center for any poison ingestion. Keep this number near ALL of your phones: 800-222-1222
Your 10 Year Old Child
YOUR TEN YEAR OLD CHILD
- Name:_______________________ Date:_______________
- Length inches:_________
- Weight lbs:____ oz:____
- BP________/________
- Hearing: _______Vision: R: ___/___ L: ___/___
NUTRITION
- Reinforce the value of a healthy diet. Eat together as a family whenever possible.
- Review iron, calcium and vitamin D sources in the diet.
DENTAL CARE
- Continue taking your child to the dentist every six months.
SUPPLEMENTS
- Vitamins are not needed if the diet is balanced. Ask about fluoride supplements.
HYGIENE
- Acne and body odor may appear. Daily showers and deodorant may be appropriate. When acne first appears, washing with soap and rinsing well twice a day is very helpful. There are many other helpful treatments available now. Please ask if you are interested.
- Use sunscreen.
DEVELOPMENT
- Tells time, reads for pleasure, tells jokes, appreciates own talents.
- School and peer relationships gain importance.
- Encourage daily exercise, exercise together or get involved in sports.
PARENTING
- Discuss puberty, read books together, attend a class together.
- Enjoy physical activity together.
- Stay in touch with teachers.
- Discuss and limit TV, computer and video game time to less than two hours a day.
- Discuss current events; share your family values about drug use, sex, alcohol and smoking.
SAFETY
- Reinforce consistent helmet and seatbelt use.
- Discuss gun safety. Do the homes your child spends time in have guns? If so, are they locked safely with ammunition locked in a separate place?
- Model consistent use of seat belts, not using a cell phone while driving and other safe behaviors.
IMMUNIZATIONS
Is your child up to date with MMR, Varicella, Hepatitis B & Hepatitis A?
Your Premature Child
YOUR PREMATURE CHILD
Name:_______________________ Date:_______________
Length inches:_________
Weight lbs:____ oz:____
Head Circumference cm:______
NUTRITION
- Feed your child breast milk and/or formula with iron every 2-3 hours.
- Always hold and snuggle your child while feeding; do not prop-up a bottle for your child to take.
- Continue taking your own prenatal vitamin while nursing.
- Solids are not necessary for your child at this time.
- If you are having difficulty with breastfeeding, follow up with a local lactation consultant 875-2662 or contact La Leche League
- International at www.llli.org
SLEEP
- Parental sleep is VERY important. Take shifts. Nap when you can.
- Your infant should sleep on his/her back ONLY as this reduces the risk of sudden infant death syndrome.
- Place your child down for naps and at night, drowsy but awake.
- Make nighttime feedings/diaper changing as subdued as possible to encourage more daytime activity.
PARENTING
- Monitor your child’s umbilical area several times a day and use only warm water if any redness or drainage is noticed. Call your doctor with any questions or concerns.
- It is ok to give your child a lukewarm bath, submerging no higher than shoulder level, 1-3 times a week. Patting dry and applying a fragrance-free, hypoallergenic moisturizing lotion immediately after bathing can help prevent dry skin or worsening the skin condition called eczema. NEVER leave your child unattended near water.
- Learn and respond to your child’s cries.
- Refer to your AAP book on soothing methods.
- Newborns will usually require one extra layer of clothing than an adult would to keep their body temperature up.
- Pacifiers are fine if your child loves to suck. Sucking is a self comforting behavior. Give your baby the pacifier if he/she wants to suck while awake. Offer it to your baby after or between feedings to avoid interference with eating. Avoid giving it to him/her every time he/she cries.
SAFETY
- Check hand-me-down baby gear for recall notices (widely available on the web).
- Never leave your child unattended on elevated surfaces.
- Check the crib and play areas carefully for long cords (strangulation risk).
- Place your child in the crib on his/her back on a firm mattress without fluffy comforters, pillows or stuffed animals.
- Do not use the microwave oven for heating bottles. They heat unevenly and increase the risk of burns.
- Always use a properly fitting car seat. The rear center seat is the safest position for your child. To see if your car seat is installed properly and/or to find a certified passenger safety technician in your area you may call 866-SEATCHECK (866-732-8243) OR visit www.seatcheck.org
- Check your smoke detector and fire extinguishers on a regular basis. Have a family exit plan. Carbon Monoxide detectors are highly recommended in the home.
ACTIVITIES
- Hold, cuddle, touch.
- Sing, talk, play soothing music.
- Watch mobiles; look at high contrast and brightly colored objects with your baby.
- Take walks outside.
- Tummy time can be started once the umbilical cord has fallen off. This should only be done while your child is awake, alert and fed. Aim for 15-30 minutes a day on the tummy.
GENERAL HEALTH
- Regular vigorous feeding is the most important sign of good health in an infant. If your infant is not feeding well or feeding becomes less vigorous, take his/her rectal temperature and please call the office.
- If your baby has a rectal temperature above 100.4º F, please call the office.
- You may use Mylicon drops for gas.
NEXT VISIT
- Please schedule your child’s next appointment BEFORE you leave today.
- Go to your hospital lab for the second genetic screening (PKU) between 10-14 days of life.
- Write down your questions to address with the doctor at your next visit.
Your 2 Week Old Child
YOUR TWO WEEK OLD CHILD
Name:_______________________ Date:_______________
Length inches:_________
Weight lbs:____ oz:____
Head Circumference cm:______
Nutrition
- Continue to feed your baby breast mild and/or formula with full iron. Continue prenatal vitamins while nursing.
- To prevent vitamin D deficiency, the American Academy of Pediatrics recommends that all breastfed infants begin 1 mL daily of Tri-Vi-Sol (available over the counter at your local pharmacy) by age 2 moths unless they are taking at least 16 oz. daily of supplemental formula.
- Solids are usually not necessary for your baby at this time.
Development
- Raises head when lying on stomach
- Fixes and follows with eyes
- Early smiling
Sleep
- Parental sleep is VERY important. Take shifts. Nap when you can.
- Your infant should sleep only on his/her back as this reduces the risk of sudden infant death syndrome.
- To encourage the development of good sleep habits, place your baby in the crib drowsy but awake. This will allow your baby to put him/herself to sleep.
- Keep middle of the night feeding brief and boring to encourage sleep.
- Limit naps during the day to 3 hours or less to encourage a longer stretch at night.
Parenting
- Your child is probably becoming more fussy. Be patient; fussiness usually declines after 6-8 weeks of age.
- After 1 1/2 -2 hours awake, most babies at this age are tired (fussy) and ready for a nap.
- Place your child down for naps and at night, drowsy but awake. This will prevent hours of frustration later. It is fine if he/she cries for a few minutes while trying to get to sleep.
- Pacifiers are fine if you baby loves to suck. Sucking is a self comforting behavior. Give your baby a pacifier if she/he wants to suck while awake. Avoid giving it to her/him every time she/he cries.
Activities
- Hold, cuddle, touch.
- Sing, talk, play music.
- Watch mobiles; look at high contrast and brightly colored objects with your baby.
- Take walks outside.
Safety
- Check hand-me-down baby gear for re-call notices (widely available on the web).
- Monitor your child closely while in the bath. A towel or washcloth on the bottom of the tub may help prevent sliding.
- Some babies may start scooting/rolling – never leave them unattended on surfaces above the floor.
- Check the crib and play areas carefully for long cords (strangulation risk).
- Continue placing your baby on the back to sleep on a firm surface without fluffy comforters or pillows in the crib.
- Do not use a microwave oven for heating bottles. They heat unevenly and increase the risk of burns.
Always use a properly fitting car seat. The rear center seat is the safest position for your child. To see if your car seat is installed properly and/or to find a certified passenger safety technician in your area you may call 866-SEATCHECK (866-732-8243) OR visit www.seatcheck.org
- Check your smoke detector and fire extinguishers on a regular basis. Have a family exit plan: ladders in upstairs bedroom, etc.
- Carbon Monoxide detectors are highly recommended in the home.
- General Health
- Regular vigorous feeding is the most important sign of good health in an infant. If your infant is not feeding well or feeding becomes less vigorous, take his/her rectal temperature and please call the office.
- If your baby has a rectal temperature above 100.4º F, please call the office.
Next Visit
- Please schedule your baby’s 2 month old well child exam for when your child is approximately 8 weeks old as you leave today.
- Your baby will be offered first-time immunizations at the next visit.
HAVE FUN!!
Your 4 Month Old Child
YOUR FOUR MONTH OLD CHILD
Name:_______________________ Date:_______________
Length inches:_________
Weight lbs:____ oz:____
Head Circumference cm:______
NUTRITION
- To prevent iron deficiency and vitamin D deficiency, breastfed infants should take 1mL daily of Tri-Vi-Sol WITH IRON (available over the counter) unless they are taking at least 24 oz of iron-fortified formula.
- Babies are usually ready for solids around 4-6 months of age. Readiness is indicated by an increase in the quantity or frequency of feedings, an increased interest in your food, or an increase in night waking. Commit to good nutrition for the entire family.
- Initial solid feedings are a developmental experience. They do not replace a bottle or breast-feeding. Solids will gradually become nutritionally significant.
- START WITH PLAIN RICE CEREAL with iron. Mix cereal with formula, breast milk or water.
- Use a spoon. Do not add cereal to a bottle unless instructed by your physician.
- Start once a day.
- Let you baby determine the amount. Please stop when your baby turns away or “zips the lips” together.
- INTRODUCE VEGETABLES, MEATS AND FRUIT when the art of swallowing has been mastered.
- Leave 3-5 days in between the introduction of new, single ingredient, pureed fruits and vegetables. If your baby is intolerant to a certain food, you may notice an increase in fussiness, gas, rash, spitting-up or diarrhea. Allergies are rare
- Finger foods are usually introduced between 6-9 months.
NUTRITION-LOOKING AHEAD
- 6 MONTHS: solids 1-3 times a day, 24-32oz of breast milk or formula with iron, introduction of a cup.
- If you choose to use juice (at 6 months), think of it as a dessert; not as an essential part of a child’s diet. Put juice in a cup only, rather than a bottle, because it is bad for teeth and encourages bottle use. Remember: no bottle in the crib or bed.
- Water will be introduced at 6 months old. Limit juice to 4-6 oz. per day.
DEVELOPMENT 4-6 MONTHS
- Sits steadily if supported, no head lag when pulled to sit, supports weight on legs.
- Grasps and reaches for objects and explores the object with the mouth.
- Smiles, coos, giggles, squeals and initiates interactions; RECOGNIZES PARENTS!
- If you have any concerns about your baby’s vision or hearing, please let your physician know.
SLEEP
- Place in crib awake; establish a bedtime routine which everyone enjoys.
- At four months of age your child is hopefully sleeping through the night. If your child falls asleep independently at the beginning of the night, it will be easier for your baby to go back to sleep in the middle of the night without your help.
- Some babies have transitional objects (comfort objects) as early as four months.
- Your infant should sleep only on his/her back as this reduces the risk of sudden infant death syndrome.
PARENTING
- Have you gone out on a date since becoming parents? Start a babysitter list and sitter information sheet to leave with caregivers.
- Eruption of teeth can begin anytime from 4-12 months. Keep teeth clean with a wash cloth after meals. To soothe discomfort, try a cold,wet cloth or teethers for your baby to chew. Acetaminophen can be used if your baby seems particularly uncomfortable.
SAFETY
- Keep powders, lotions and pins away from baby. Check toys carefully for breakage, sharp and small parts.
- Avoid direct sunlight; sunburns happen easily.
DO NOT USE WALKERS WITH WHEELS! They are associated with serious injury. Walkers are not helpful in learning to walk. Stationary devices such as ExerSaucers or Johnny Jump Up baby exercisers are generally okay.
Always use a properly fitting car seat. The rear center seat is the safest position for your child. To see if your car seat is installed properly and/or to find a certified passenger safety technician in your area you may call 866-SEATCHECK (866-732-8243) OR visit www.seatcheck.org
Check your smoke detector and fire extinguishers on a regular basis. Have a family exit plan: ladders in upstairs bedroom, etc. Carbon
Monoxide detectors are highly recommended in the home.
ACTIVITIES
- Give baby toys and textures to grab.
- Once your baby can easily put toys to the mouth, substitute chew toys for the pacifier.
- Encourage time on the tummy. Aim for 1 hour a day.
- Unbreakable mirrors can be fun for your baby.
IMMUNIZATIONS TODAY
- Please tell us if your baby had any reactions to the two month immunizations.
- Most babies have no reaction or are somewhat sleepier following their immunization. Your baby may develop a fever and/or be fussy for
- 24-48 hours. A tender lump at the injection site may occur and persist for a week. Acetaminophen may be given if any of these symptoms are present. Refer to dosage chart below.
- Your child will be receiving Pentacel, Prevnar, Rotarix and HepB (if not given at birth).
NEXT VISIT
Please schedule your baby’s 6 MONTH WELL CHILD exam as you leave today. Make sure your child is at least 6 months old and that it has been at least 8 weeks from today for immunization purposes.
Acetaminophen (Tylenol)
(80mg/0.8 ml)
6-12 lbs – 0.4 mL (1/2 dropper)
12-18 lbs – 0.8 mL (1 dropper)
18-24lbs – 0.8 + 0.4 mL (1½ dropper)
Over 24 lbs – 0.8 mL x 2 (2 droppers)
Acetaminophen (Tylenol)
(160mg/5 ml)
6-12 lbs – 1.25 mL
12-18 lbs – 2.5 mL
18-24lbs – 3.75 mL
Over 24 lbs – 5 mL
Acetaminophen may be given every 4 hours and not more often than 4 times in 24 hours. PLEASE CHECK THE CONCENTRATION OF THE ACETAMINOPHEN YOU ARE USING; DOSES WILL VARY BASED ON CONCENTRATION. Infant drops are more concentrated than elixir. Please call the office if a fever persists for more than three days or if you have any questions about your child’s illness.
Your 9 Month Old Child
YOUR NINE MONTH OLD CHILD
- Name:_______________________ Date:_______________
- Length inches:_________
- Weight lbs:____ oz:____
- Head Circumference cm:______
NUTRITION
- Three meals a day with two healthy snacks.
- To prevent iron deficiency, breastfed infants should take 1mL daily of Tri-Vi-Sol WITH IRON (over the counter) unless they are taking at least 24oz of iron-fortified formula or 2 servings of ¼ cup iron-fortified rice cereal daily. If they are taking rice cereal as recommended, breastfed infants still need 0.5mL daily of Tri-Vi-Sol with iron to prevent vitamin D deficiency unless they are taking at least 16oz daily of supplemental formula.
- If you are nursing, breast feed after rather than before meals.
- Introduce finger foods; encourage family meals by pulling the high chair right up to the table.
- Present small amounts of finger food at a time.
- Encourage cup use. Remember: no bottles in bed.
- FINGER FOOD (small pieces of food easily mashed between your fingers) – steamed chopped vegetables, ripe thinly sliced fruits, grated or cottage cheese, chopped/shredded meat, rice, pasta, toast with cream cheese, melted cheese, iron-fortified cereals.
- AVOID FOODS THAT PRESENT CHOKING HAZARD UNTIL AT LEAST 3 YEARS OLD: e.g. raw apple, raw carrot, raw celery, nuts, hotdogs, grapes, popcorn, raisins, hard candy, gum and marshmallows.
- Wait until you child is a year old to introduce acidic and potentially irritating foods such as citrus. If there is a strong family history of food allergies, be cautious when introducing foods containing peanuts, tree nuts and white fish like cod or shellfish.
NUTRITION – LOOKING AHEAD
12 MONTHS: solids at three meals a day and two snacks, roughly 16 oz of breast milk or formula. At 12 months, you can substitute whole milk for formula. Continue whole milk until two years old to ensure adequate fat intake for your child’s developing brain. Introduce whole milk in a cup with meals.
DENTAL HEALTH:
After meals, brush your child’s teeth while she/he sits in the high chair. When they are comfortable with the bristles let your child have a turn after you.
DEVELOPMENT 9-12 MONTHS
- Sits well with good head control.
- Pulls to stand and may walk holding on to furniture.
- Feeds finger food to self.
- Assumes hand/knee position and may be crawling.
- Hunts for a hidden toy.
- Mimics sounds: mama, dada, uh-oh.
- Imitates your use of objects such as the telephone, hairbrush or sponge.
- Waves, plays peek-a-boo, finds or looks for hidden objects.
- Bangs two cubes together.
- Responds to “no” but may not actually know what it means.
- If you have concerns about vision or hearing, please let your physician know.
SLEEP/PARENTING
- Your child may begin to resist going to bed as separation anxiety intensifies. This is very normal. Continue your reassuring night routine. If/when night waking recurs; respond much as you did when you were initially teaching your baby to sleep through the night. Make a brief, reassuring visit but let him/her stay in the crib; if visiting makes matters worse, consider not visiting. Teach him/her that this is the way all nights will be.
- Many children have chosen a transitional object (favorite blanket, stuffed animal etc.).
- During the next few months, your child will want to touch, taste and play with everything that is within reach. Curiosity is vital to development. Your job is to allow him/her to explore safely. Distraction is usually a successful way to deal with undesirable behavior at this age.
SAFETY
- Now is the time for parents to discuss what is and is not important, what is and is not off limits.
- Consistent messages are very important. The message must be simple, clear, and supported with action if needed. For example, if an object is potentially a real danger, say “no,” take the off-limit object away and provide a safe substitute. Show your child what to do rather than just focusing on what not to do.
- Your child has a short memory; do not expect learning to occur after one or two incidents.
- Increased mobility creates a bigger challenge for you to make the world a safe place for your child. THOROUGHLY CHILD-PROOF YOUR HOME. Protect from falls – secure gates, doors, windows and screens. Keep sharp objects away – knives, razor blades, plastic wrap boxes etc. Secure heavy objects — furniture, lamps, potted plants, TV’s, etc.
- Improved fine motor abilities give children access to previously unavailable dangers such as small disc batteries, magnets, plant parts and other items that represent a choking hazard.
- Always use a properly fitting car seat. The rear center seat is the safest position for your child. To see if your car seat is installed properly and/or to find a certified passenger safety technician in your area you may call 866-SEATCHECK (866-732-8243) OR visit www.seatcheck.org
- Once a child is over 12 months old and 20lbs, they can legally be turned to face forward; however we, and The American Academy of Pediatrics, recognize that your child will be 5 times safer in a rear facing position until as old as two years.
- Check your smoke detectors and fire extinguishers on a regular basis. Have a family exit plan: ladders in upstairs bedroom, etc. Carbon Monoxide detectors are highly recommended in the home.
- DO NOT USE WALKERS WITH WHEELS! They are associated with serious injury. Walkers are not helpful in learning to walk. STATIONARY devices such as Exersaucers or Johnny Jump Up Baby exercisers are generally okay.
- Poisoning of infants and children is common. In case of ingestion of poisons, call the Poison Control Center immediately. Keep this number by ALL your phones: 800-222-1222.
ACTIVITIES
- Talk and read and talk and read some more! Identify body parts, label simple objects consistently.
- Now is a great time for hide and find games. Try in-and-out-of-container games.
IMMUNIZATIONS
- No scheduled immunizations today.
- Catch-up on any missed immunizations.
NEXT VISIT
- Please schedule your child’s TWELVE MONTH WELL CHILD exam as you leave today. Make sure this is scheduled ON or AFTER the first birthday for immunizations purposes.
Your 18 Month Old Child
YOUR EIGHTEEN MONTH OLD CHILD
- Name:_______________________ Date:_______________
- Length inches:_________
- Weight lbs:____ oz:____
- Head Circumference cm:______
NUTRITION
- Enjoy family meals. Model good nutrition. Minimize meal time battles.
- Expect swings in appetite. The amount of food your child needs decreases as your child’s growth rate decreases.
- Use diet as a way to keep stools soft. Fluids and fiber are important.
- Your child should be taking drinks from a cup only. Continue phasing out the bottle if your child hasn’t completely given it up yet.
- Offer a wide variety of foods from all the food groups daily.
- If there is a strong family history of food allergies, be cautious when introducing foods containing peanuts, tree nuts and white fish like cod or shellfish.
- Serve small portions and let your child request more if desired.
- Avoid juice; it often sabotages good nutrition and is not an essential part of a healthy diet.
- Offer whole milk with the three main meals. Your child needs 16-24 oz a day.
DENTAL HYGIENE
- Continue brushing teeth daily with a pea sized amount of toothpaste with fluoride or without toothpaste. Give the molar surfaces a good scrub with or without teeth.
- Fluoride supplements may be required if your baby does not receive water containing fluoride.
DEVELOPMENT 18-24 MONTHS
- Walks up steps holding on.
- Kicks and throws a ball.
- Enjoys large muscle activity.
- Sits in chair and feeds self with spoon.
- Draws “pictures.”
- 4-10 word vocabulary progressing to using two words together at two years. Speech may not be clear.
- Uses “no” and “mine” to assert independence.
- Hits and bites; especially if excited, frustrated or having difficulty communicating.
- Enjoys books page-by-page and pointing to pictures.
- Recognizes names of people, objects and body parts.
- May sort shapes and colors
- Please let your physician know if you have any concerns about vision or hearing.
SLEEP
- Usually taking one nap.
- When your child climbs out of the crib, it is time to move to the mattress to the floor or a toddler bed.
PARENTING
- Exploring the boundaries established by your rules and your child’s physical and developmental limits will occupy much of his/her time over the next few years. You are very important in showing him/her what is O.K. and what is not. He/she will check in with you frequently for reassurance, guidance, and security.
- Your child is self-centered at this age. It is developmentally difficult to share. Minimize the frustration when your child is playing with friends by having reasonable expectations. Offer toys that come as multiples (blocks, balls, etc.).
- Acknowledge new skills and independence. Praise whenever possible.
- If your child does something that hurts another person, hurts property, or is harmful to themselves, a firm verbal reprimand, brief and clear, or “time out” is appropriate. Having a lot of “time in” – gentle, nonverbal, physical contact is very reassuring to your child.
- Model a calm communication style.
- There are many approaches to discipline. Now is a great time to talk to all your children’s caregivers and agree on consistent guidelines.
- Always use a properly fitting car seat. The rear center seat is the safest position. Once a child is over 12 months old and 20lbs, they can legally be turned to face forward; however we, and The American Academy of Pediatrics, recognize that your child will be 5 times safer in a rear facing position until as old as two years.
- Be very clear and consistent about street and parking lot safety—always hold hands or carry.
- Use sunscreen for all outdoor activities.
- Maintain regular checks on your smoke/carbon monoxide detectors and fire extinguishers. Have a family emergency exit plan.
ACTIVITIES
- Books, puzzles, building blocks, stacking toys, and stringing large beads.
- Somersaults, climbing, and dancing to music.
- Drawing/finger painting, Playdough® and clay, tracing your hand.
- Encourage children to put away toys as part of the playing. Start this habit early ☺
- Discuss limits on TV, video, and computer.
- Continue counting and alphabet introduction.
SAFETY
- Never leave your child unsupervised. Curiosity is increasing rapidly but judgment lags behind. Be especially careful with curling irons, hot ovens and stove tops, knives and other areas where unsupervised experimenting might be harmful.
- Teach animal safety.
- Use sunscreen for all outdoor activities and be aware of water safety.
- When in the car, your child should always remain in the car seat.
- This is a peak age for poisoning. Check your home carefully. Keep the Poison Control Center’s phone number near ALL of your phones 800-222-1222.
IMMUNIZATIONS
- Hepatitis A – Most babies have no reaction or are somewhat sleepier following their immunization. Your baby may develop a fever and/or be fussy for 24-48 hours. A tender lump at the injection site may occur and persist for a week. Acetaminophen may be given if any of these symptoms are present.
NEXT VISIT
- Please make an appointment for when your child is TWO YEARS old.
- Please bring your yellow immunization card for updating.
- Please write down all your questions and concerns to address with the doctor at your next visit
Your 2 Year Old Child
YOUR TWO YEAR OLD CHILD
- Name:_______________________ Date:_______________
- Length inches:_________
- Weight lbs:____ oz:____
- Head Circumference cm:______
NUTRITION
- Continue to offer non-fat milk with every meal.
- If your child does not drink fluorinated water, ask about fluoride supplements.
- Avoid juice except for dessert.
- Vitamins are not necessary if your child has a balanced diet.
- Appetite improves over this next year. Continue to be aware of choking foods.
- Avoid control struggles over food.
- Eat together as a family
- Model good nutrition
- Use diet as a way to keep stools soft. If constipation becomes a problem, offer water or diluted apricot, pear or prune juice.
HYGIENE
- Continue brushing teeth daily with a pea sized amount of toothpaste with fluoride
- Avoid giving milk for at least 30 minutes before bedtime. The sugars in milk can cause horrible tooth decay. Now is the time to discontinue the bottle entirely if you haven’t already done so.
DEVELOPMENT TWO-THREE YEARS
- Climbs well, walks up and down stairs alternating feet, kicks ball and runs easily.
- Draws vertical, horizontal and circular strokes with a pencil.
- Has a vocabulary of 50 words, using 2-3 word sentences, pronouns (I, me, you, we). Stuttering is common. Understands on, in, and under. Refers to self by name.
- Imitation and active imagination.
- Curiosity about body parts.
- Learning to dress self.
- Washes and dries hands; loves water play.
- Please let your physician know if you have any concerns about hearing and vision.
PARENTING
- Try to set up a routine pattern for the day. Your child is more likely to be hungry at mealtimes, tired at nap time, happier and under better control though the day. It will provide a sense of control by “knowing” what comes next.
- Give your child undivided attention at times. Get down on the floor and have “child directed play time.” Take time to do some things slowly, at a child’s pace.
- Do not phrase things in a question when they are not questions. “Do you want to go to bed now?”, “Can I check your ears now?” This gives the impression there is a choice involved when there is not.
- Give advance notice when you need your child to change his/her activity.
- Imaginary playmates may join your household. Dreams may intensify as imagination develops.
- Frustration, anger and temper tantrums are inevitable. Allow your toddler to express emotions but help her/him channel them away from overly aggressive behavior. Limit setting and consistency are important.
- Continue clear, consistent messages regarding appropriate and inappropriate behaviors.
- Follow your established bedtime ritual. Move to a regular bed by 3-4 years. Use a mattress on the floor or “toddler bed” when your child is able to climb out of the crib before 3-4 years.
- Show affection and celebrate accomplishments.
- Facilitate independence, when appropriate encourage the “me do it,” and teach how to put on clothes step-by-step. Put “difficult” clothes out of reach. Place step stools at the sinks and in the kitchen. Put hooks for coats at the two year height and place non-breakable dishes and cups in accessible drawer.
- Be deliberate about TV, video and computer time. Discuss it and limit it.
- Begin teaching your child your family’s emergency exit plan.
TOILET TRAINING
- Watch for signs of readiness which would include: waking up dry in the morning or from naps, awareness prior to urinating and stooling, interest in toilet activity.
- Get a potty chair (floor level) and a foot stool for comfortable seating on the toilet.
- Talk about toilet activity.
- When your child looks interested, or is squirming, or wakes up dry, enthusiastically say “Let us see if pee or poo comes out,” and proceed to the toilet. If there is resistance, slow down. If there is any success or interest, commend and praise our child.
ACTIVITIES
- Play outside, gardening with supervision.
- Read picture books, play with puppets or dress up clothes and props.
- Coloring/finger painting, Playdough®/clay, musical instruments and listening to music.
- Bake cookies, rip salad greens to make dinner.
SAFETY
- Teach respect for animals, especially if the animal is eating or playing with their own toys.
- Hold hands while crossing the street and in parking lots.
- Teach caution and respect for water and cars.
- When tricycle riding (or any other sport activity) begins, always use a helmet and other appropriate safety equipment.
- Always apply sunscreen before all outdoor activities.
- Continue using a car seat with harness until 4 years or 40 lbs, then switch to a booster seat.
- Your child should never be alone in the car or in the house.
- Regularly check your smoke/carbon monoxide detectors and fire extinguishers. Frequently review your emergency family exit plan.
- Poisoning remains high at this age. Keep the Poison Control Center’s phone number near ALL of your phones. 800-222-1222
IMMUNIZATIONS
Hepatitis A #2 and catch-up immunizations. Most children have no reaction or are somewhat sleepier following their immunization. Your child may develop a fever and/or be fussy for 24-48 hours. A tender lump at the injection site may occur and persist for a weeks. Acetaminophen may be given if any of these symptoms are present.
Your 4 Year Old Child
YOUR FOUR YEAR OLD CHILD
- Name:_______________________ Date:_______________
- Length inches:_________
- Weight lbs:____ oz:____
- BP________/________
NUTRITION
- Educate regarding eating a balanced diet and reasons for it.
- Eat together as a family. Model good nutrition and exercise habits.
DEVELOPMENT
- Knows colors, dresses self, climbs well, draws and knows some letters.
- Is familiar with using scissors.
- Able to clearly communicate with adults other than parents.
DENTAL CARE
- Continue taking your child to the dentist every six months. We can recommend a dentist if you don’t already have one.
- Ask about fluoride supplements if your child drinks non-fluorinated water.
SLEEP
- Bedtime rituals.
- Read, read, read and read some more!
PARENTING/SAFETY
- Safety – teach water safety; consider swimming lessons. Use bike helmets and other safety equipment appropriate for the activity.
- Parenting – model behavior and control temper; be consistent. Use logical consequences for behaviors. Discuss what they should be with your child and why. Have conversations involving why, when and how.
- Give your child simple jobs around the house (which you do not have to redo).
- Talk to your child about gun safety. If there are guns in the house, lock them and store ammunition separately under a separate lock.
- Continue stranger training. Teach your child not to accept food, rides, or help from people you do not know. Teach your address and phone numbers. Identify the “helping strangers” when you are out in the community. Let your child know that only people who are helping to keep them clean and healthy should be touching their bottom.
- Be deliberate about TV, video and computer use. Discuss and limit it.
- Activities/Development – Card games, cut, paste, and paint. Get outside! Join play/activity groups.
- When your child is over 4 years OR 40 lbs., you may switch from a car seat with harness to a belt-positioning booster seat.
- Regularly check your smoke/carbon monoxide detectors and fire extinguishers.
- Frequently review your family emergency plan.
- Always call the Poison Control Center immediately for ingestion of poisons. Keep this number near ALL your phones: 800-222-1222
IMMUNIZATIONS
- Catch-up immunizations if required.
NEXT VISIT
- Your next appointment will be at FIVE YEARS of age
- Please bring your yellow immunization card for updating.
- Please write down all your questions and concerns to address with the doctor at your next visit
Your 6-9 Year Old Child
YOUR SIX-NINE YEAR OLD CHILD
- Name:_______________________ Date:_______________
- Length inches:_________
- Weight lbs:____ oz:____
- BP________/________
NUTRITION
- Balance diet. Limit junk food. Avoid eating in front of the TV/computer.
- Eat together as a family whenever possible. Continue to model good nutrition and exercise habits.
DENTAL CARE
Continue taking your child to the dentist every six months. Ask me about fluoride supplements if your child drinks non-fluorinated water.
SCHOOL
- Keep in touch with your child’s teacher.
- Help your child organize. Set up a clear spot for your child’s school things.
PARENTING
- Encourage physical exercise and outdoor activities. Model the behaviors for your child. Self esteem is largely a reflection of parental love and acceptance at this age.
- Discuss current events, advertising, books, and share your family values with your child. Ask what she/he thinks and feels about things. Openly discuss the hazards of smoking, drug use, and alcohol.
- Lock all guns and reinforce gun safety. Keep all ammunition locked away separately from guns.
- Continue to teach and reinforce personal safety and stranger training.
- Be very deliberate about TV, video and computers. Discuss it and limit it.
- Teach your child about water and bicycle safety. Now is a great time for swimming lessons. Continue to be consistent with helmet use. Continue to model and reinforce seatbelt use.
- Continue using booster seat until your child fits properly in regular seat belts. Generally they are not ready to come out of the booster seat until 8 years old or 80 lbs. To see if your child is ready, try these tests:
- Does the child sit all the way back against the auto seat?
- Do the child’s knees bend comfortably at the edge of the auto seat?
- Does the lap belt fit snugly across the top of the thighs?
- Does the shoulder belt come across the center of the shoulder and chest?
- Can the child sit like this the whole trip?
If you answer “no” to any of these questions, your child needs to ride in a booster seat. For further information call 1(800) BUCK-L-UP.
SAFETY
Keep Poison Center phone number available – (800) 222-1222.
Your Teen
YOUR TEEN
- Name:_______________________ Date:_______________
- Length inches:_________
- Weight lbs:____ oz:____
- BP________/________
- Hearing: _______Vision: R: ___/___ L: ___/___
PHYSICIAN RELATIONSHIP
- The physicians in this office are here to help you be as healthy as you can be. We encourage your parents to express concerns they have about your health, yet as you grow up our primary relationship is with you. We encourage confidential interviews.
- Your health is our primary concern. We encourage you to talk to your parents about your health. However, if you are capable of making sound decisions about your health, Colorado State Law allows you to seek medical care for the following conditions, even without the consent of your parents: Birth control and pregnancy related care, mental health conditions (such as depression) and alcohol, and drug problems if over age 14, and sexually transmitted diseases including HIV/AIDS testing, if over age 14
- The records and information about these conditions in general are private and require your consent before they can be released to anyone else. This means that no one except your doctors and nurses (not even your parents) can access the parts of your records about the above conditions without your permission. There are exceptions when yours or someone else’s health and well-being are in immediate danger. Please feel free to discuss with your doctor any questions you have regarding privacy of the information you provide during the appointment.
NUTRITION
Are you comfortable with your nutrition and your weight? Your body and nutritional needs are changing; to stay healthy, eat a balanced diet with an emphasis on grains, fruits and vegetables. Limit fat and cholesterol. Include foods rich in calcium and iron. Drink plenty of water. Maintain caloric balance with exercise and activity. Please ask questions about your nutrition or weight.
SUPPLEMENTS
We advise a multivitamin if you are choosing a vegetarian diet.
HYGIENE
You are responsible for your own hygiene. Daily dental flossing and brushing with toothpaste is advised with dental visits every six months. If acne is a problem for you, please discuss it with us, there are many good treatments for acne. Use sunscreen.
SPORTS
Regular physical activity is a key component of good health. A good goal is 30-60 minutes per day. Find an activity you enjoy alone, or with friends, or with a team. Limit TV to <2 hrs/day. Drink caffeine free fluid to maintain hydration with athletics. Please discuss sports supplements and medications with us before using them.
RELATIONSHIP WITH PARENTS
Your parents’ role in your life is changing. Now your parents are helping you make wise decisions, not making the decisions for you. Discuss current events, drugs, alcohol and sex with your parents. Encourage your parents to share their views about sex, the emotional and physical consequences with you. Who are your social supports? Who do you talk with when something is bothering you? Who do you feel accepts you as you are?
SCHOOL
You are responsible for your schoolwork now. Set goals for yourself. Ask for help: that is why you have teachers. Get to know one teacher reasonably well and help that teacher to know you well. School success and school enjoyment go hand in hand. Find something you enjoy learning about.
SAFETY
Risk taking is a normal adolescent behavior. Risks come in all shapes and sizes. When you consider taking a risk pause to consider the possible consequences of your choice and your behavior; Are you willing to take responsibility and accept the consequences? Discuss safety issues as a family. Helmets and seatbelts can prevent many injuries and deaths. Encourage your friends to use them too.
IMMUNIZATIONS
We will check to be sure you are up to date on Td (tetanus, diphtheria), MMR, Meningococcus (if you are in a dorm at college), Hep B, Hep A and Varicella.
NEXT VISIT
Ask us anything about your health at your next annual visit.