| Milestones Newborn (birth to 4 weeks)Communicates through cries, vision 8-12 inches Infant (4week-12 months)1 month-GM: Lifts chin when prone, turns head when supine, largely reflex FM: hands with tight fist, hands to mouth Hearing fully developed, grunts, startle reflex, fixates on faces, recognizes parents voice 2 month GM: Lifts chest & head when prone, turns head when supine. Head bobs if held upright FM: Tracks past midline (by 4 months), makes eye contacts. Opens and closes hands, hold hands together. Coos, alerts to voice and sound. Social smile begins (by 6 months). Recognizes parents face. 4 month GM: Props on wrists when prone. Holds head up, rolls front to back (by 6 months should see). FM: Tracks to 180’, Grasp, shakes rattle, places items in mouth, reaches for objects. Teething starts, “converses” in responsive manner to person/parents. Laughs out loud. Looks around-curious (near and distant vision). Smiles spontaneously. Sees color. 6 month GM: Starts to sit unsupported (by 9 months). Crawls (by 8months). FM: Reaches with one hand and transfers hand to handBabbles, giggles/laughs and listens by nine months, recognizes strangers. 7 months begins to reach out hands in anticipation of being picked up, 8 months should be sitting unassisted, distinguishes different shapes. 9 month GM: Pulls to stand, cruises, crawlsFM: Pincer grasp, bangs blocks together, holds bottleBabbles (‘Da-da, Ma-ma’ by now), imitates sounds (understands 1-3 words), responds to name (by 12 months), waves “bye-bye” , reciprocates gestures (by 12 months), uses sound to get attention, stranger anxiety. Object permanence. Toddler (1 year-3 year) 12 month GM: Stands alone, first step by some, (walks few steps alone by 18 months). FM: primitive marks on paper. Finger feeds. 1 word immature jargon (begins to use 1-2 word jargon through 2cd year), points finger in purposeful direction, pat-a-cake, imitates, follows 1 step commands with gesture 15 month GM: Walks carrying objects, stoops and recovers, climbs on furniture. FM: Scribbles, 3-4 cube tower (up to 2 year), turns pages, uses spoon and cup3-6 words, says ‘No’ correctly, single step commands w/o gestures 18 monthGM: Walks up steps with hand held, runs, throws ball FM: Scribbles, 4 cube tower minimum10-25 words, points to people and at least three body parts when named, combines language with gestures. Helps in house, removes clothing, imaginative play begins 2 year GM: Walks down step uses rail. Throws ball overhead. Kicks ball. Jumps, walks on toes, alternates feet going up stairs FM: Lines cubes up as train, imitates circle and/or line. Turns paper pages in books, 6-8 cubes tower, can turn knobs and open doors. >50 words 50% intelligible, 2 word phrases, pronouns, can recite parts of familiar book, follows series of independent commands, takes off clothing, parallel play. Washes and dries hands, puts on clothing, imitates adult activities. 3-5 year (preschool) GM: Runs, jumps, skips, rides tricycle, stand on one foot, constantly in motion. Throws overhead by 5 years. FM: Can draw intersecting lines (cross, plus sign). School age (5 years-12 years)GM: FM: draws 6 part man (stick figure) beginning at 5 years. Lace shoes. Adolescent (13 years- 18 years)Depending on circumstances stage can be 13-20 years of age. | Immunization Schedule Direct CDC link with catch up schedule included Birth Hepatitis B (HepB) 1st dose Screening- (B.F. Preventive Service link)‘Newborn Screening’ (usually in hospital prior to discharge w/repeat testing in 9 states at 1-2wks)Hearing birth to 1 monthVision screening at visits to 3years**All screening just for start them, make sure to check on follow up screenings using the B.F. (Bright Futures) recommendations. 1month-2monthsHepatitis B (HepB) 2cd dose 2 month-1st dose Rotavirus (RV): RV1 (2-dose series- If any dose in the series is either RotaTeq or unknown, default to 3-dose series.)Diphtheria, tetanus, acellular pertussis (DTaP <7years) Haemophilus influenzae type b (Hib)Pneumococcal conjugate (PCV13)Inactivated poliovirus (IPV <18 yrs) 4 month-2cd dose Rotavirus (RV): RV1 (2-dose series)Diphtheria, tetanus, acellular pertussis (DTaP <7years)Haemophilus influenzae type b (Hib)Pneumococcal conjugate (PCV13)Inactivated poliovirus (IPV <18 yrs) Screening-6mthRisk for Anemia (screen only)TB screen Q6 months until 2yo then annual. Starting 6 months Inactivated poliovirus (IPV <18 yrs), Hepatitis B (HepB) 3rd dose (6-18 months)RV5 (3-dose series)Diphtheria, tetanus, acellular pertussis (DTaP <7years)Haemophilus influenzae type b (Hib) (6-15 months, can give 4th dose at 12 months if 3rd dose given at 6 months). Screening- 9month (B.F. Preventive Service link)Developmental-BehavioralFinger stick Anemia testLead test or screening test 12-18 months Pneumococcal conjugate (PCV13) Measles, mumps, rubella (MMR)Varicella (VAR)Hepatitis A (HepA)-2 dose series Start of annual Influenza (IIV okay at 6 months) or (LAIV okay at 2 years) 1 or 2 doses Screening-Visual screen annually 3-6yo, then8yo,10yo,12yo,15yo,18yoVisual acuity-Preschool age 3-5yo 15 months Diphtheria, tetanus, acellular pertussis (DTaP <7years) Screening- 18month visit (B.F. Preventive Service link)Risk for Anemia (screen only) Screening- 2-2.5yr visit (B.F. Preventive Service link) Developmental-Behavioral Risk for Anemia (screening only from age 2 to age 21).Finger stick Lead test or screening recommended. 11-12 years Tetanus, diphtheria, acellular pertussis (Tdap ≥7 yrs)Human papillomavirus (HPV)Meningococcal (MenACWY-D ≥9 mos, MenACWY-CRM ≥2 mos) Meningococcal B (high risk group)Pneumococcal polysaccharide (High risk group) Screening- Adolescence (B.F. Preventive Service link) Adolescent alcohol and substance use Cervical Dysplasia-The first Pap test approximately 3 years after onset of vaginal intercourse, but no later than age 21. Screening should be done annually with conventional Pap test or liquid-based cytology until age 30. After age 30, Pap tests may be done every 2 to 3 years after 3 normal tests. 16 years Meningococcal (MenACWY-D ≥9 mos, MenACWY-CRM ≥2 mos) 2cd dose Screening for STD- All sexually active women <25 get chlamydia screening and all sexually active youth get gonorrhea and chlamydia testing annually. High risk-include HIV/Syphillis yearly and change chlamydia to 3-6months testing intervals. See bright futures for discussion on high risk groups. **no child should ever have these so if see please suspect child abuse. | Physical Growth & Safety Birth-1 year: Weight gain 7-8 poundsLength 19-21 inchesVital signs- Temp 37.5, P 120-140, R 30-60, BP 80/40 DocumentLength-for-age and Weight-for-ageHead circumference-for-age and Weight-for-length5th to 95th percentile for normal growth and 3rd to 97th for abnormal encounters that specialist use. Link to 5-95th percentile link- Click here Safety-Never leave a child alone on a changing table, bed, or sofa. Children can fall as soon as they can roll over.Use gates on stairways and install window guards on all windows above the first floor as soon as your baby can crawl.Never leave small objects within your baby’s reach.Never carry hot liquids or food, or cook, while holding your child.  8 to 12 months:Keep pins and other sharp objects off the floor and out of your baby’s reach.Install safety plugs in wall sockets.Remove easily overturned lamps and dangling electrical cords.Place soft adhesive bumpers on the corners of sharp-edged furniture.Place a gate across stairways to keep the baby from falling down stairs.Keep medicines and poisons in a locked cabinet. Install child locks on cabinets.Be sure baby furniture and toys are painted with lead-free paint. Buy age-appropriate toys that are too large to swallow.Never leave your baby alone in the bath; keep one hand on the child at all times. 12 to 36 months:Secure doors that lead to stairways, driveways, and storage areas.Never leave a child alone in a bathtub, wading pool, or other body of water.Lock medicines away immediately after use.Lock kerosene, pesticides, and toxic cleaning products in a safe place.Buy age-appropriate toys that are too large to swallow.Don’t leave your child alone around burning fireplaces, heaters, or other hot appliances.Provide constant supervision.Store dangerous tools and gardening equipment in a locked shed or cabinet.Keep matches and cigarette lighters locked up and out of sight. Toddler (1-3 year)Document-Length-for-age and Weight-for-age. Head circumference-for-age and Weight-for-length Stage-Autonomy vs shame Gains 5-6 pounds a year in this stage.Head circumference gains 2cmRound belly Respirations slow slightlyHR 90-110BP 99/64Brain develops to 90% adult sizeBegins to control urine/bowels with increased sphincter control8 new teeth (canines, and molars)5th-95th percentile growth charts link- Click here  Safety-Teach your child the right way to use simple kitchen tools and appliances.Teach bicycle safety rules and traffic dangers.Start swimming lessons. Never leave a child unsupervised around a pool or other body of water, even if the child has had swimming lessons. Preschooler (3-5 year)Stage- Initiative vs GuiltP 85BP 100/60Voiding is frequent (9-10 times daily)Weight slows down to 4.5 pounds a year Height gain of 2-3.5 inchesAll teeth by now5-95th percentile link-Click here School Age (5-12)Stage- Industry vs inferiorityWeight 3+ poundsHeight 1-2 inchesBrain growth by age 10 completePosture more erectP 70-80BP 112/60Secondary sex characteristics developDeciduous teeth lost and permanent erupt5-95th percentile link-Click here Safety- Insist that your child wear a helmet when cycling or other appropriate times. Children should wear helmets and wrist and kneepads while skating and skateboarding.Teach proper use of more complex kitchen appliances.Be sure your child uses well-fitting, well-maintained sports equipment when practicing or playing a game.Teach your child basic first aid and what to do in an emergency.  Adolescent (13 years- 18 years)Stage-Identity vs Roll (13-20 years)Sexual maturity females 12-18Sexual maturity males 14-20Onset puberty followed by cessation of body growthEarly-most girls 1-2 inches taller then boysBoys grow 4-12 inches, gain 15-65 poundsGirls grow 2-8 inches and gain 15-55 poundsP 70RR 20BP 120/70Second set of molars by 13 and wisdom teeth or 3rd molars by 18-21 years of age. 5-95th percentile link-Click here  Tanner stages-Pubic Hair Scale (both males and females)Stage 1: No hair Stage 2: Downy hair Stage 3: Scant terminal hair Stage 4: Terminal hair that fills the entire triangle overlying the pubic region Stage 5: Terminal hair that extends beyond the inguinal crease onto the thigh Female Breast Development Scale Stage 1: No glandular breast tissue palpable Stage 2: Breast bud palpable under areola (1st pubertal sign in females) Stage 3: Breast tissue palpable outside areola; no areolar development Stage 4: Areola elevated above contour of the breast, forming “double scoop” appearance Stage 5: Areolar mound recedes back into single breast contour with areolar hyperpigmentation, papillae development and nipple protrusion Male External Genitalia Scale Stage 1: Testicular volume < 4 ml or long axis < 2.5 cm Stage 2: 4 ml-8 ml (or 2.5-3.3 cm long), 1st pubertal sign in males Stage 3: 9 ml-12 ml (or 3.4-4.0 cm long)Stage 4: 15-20 ml (or 4.1-4.5 cm long)Stage 5: > 20 ml (or > 4.5 cm long) |
Important Links:
Need answer to this question?
Order an original paper Now!
We’re giving you a 15% discount on your first Order.
Discount Code: SKILNEW15
Use the above discount code during checkout
Peds mental health, behavioral solutions
Bright Futures Nutrition and Pocket Guide
Helmet PDF sheets for education
Never enough sleep: a brief history of sleep recommendations for children. Pediatrics, 129(3), 548-556.
COVID-19 Planning Considerations: Guidance for School Re-entry
Guidance on Providing Pediatric Ambulatory Services via Telehealth During COVID-19
CDC: Interim Guidance for Immunization Services During the COVID-19 Pandemic
Patient Vaccine Education Handouts (English & Spanish) COVID-19 not available at this time
- VIS—DTaP (Diphtheria, Tetanus, Pertussis) Vaccine FREE
- VIS—Haemophilus Influenzae type b (Hib) Vaccine FREE
- VIS—Hepatitis A Vaccine FREE
- VIS—Hepatitis B Vaccine FREE
- VIS—HPV (Human Papillomavirus) Vaccine FREE
- VIS—Influenza (Flu) Vaccine (Inactivated or Recombinant) FREE
- VIS—Influenza (Live, Intranasal) Vaccine FREE
- VIS—Meningococcal ACWY Vaccine FREE
- VIS—Meningococcal B Vaccine FREE
- VIS—MMR Vaccine (Measles, Mumps, and Rubella) FREE
- VIS—MMRV (Measles, Mumps, Rubella, and Varicella) Vaccine FREE
- VIS—Pneumococcal Conjugate Vaccine (PCV13) FREE
- VIS—Pneumococcal Polysaccharide Vaccine FREE
- VIS—Polio Vaccine FREE
- VIS—Rotavirus Vaccine FREE
- VIS—Td (Tetanus, Diphtheria) Vaccine FREE
- VIS—Tdap (Tetanus, Diphtheria, and Pertussis) Vaccine FREE
- VIS—Varicella (Chickenpox) Vaccine FREE
- VIS—Your Child’s First Vaccines FREE
United States Preventative Services Task Force (USPSTF) Clinical Guide 2014 to Preventative Services
Free Telehealth articles but need to form an account
Clinical Practice Guidelines, courtesy of the American Telemedicine Association, provide a foundation for the deployment of telehealth services. View guidelines.
Center for Connected Health Policy provides resources on telehealth-related laws, regulations and Medicaid programs.
The National Consortium of Telehealth provides assistance, education, and information on telehealth.
CDC. (2018). Talking with Parents about vaccines for infants. Retrieved from https://www.cdc.gov/vaccines/hcp/conversations/talking-with-parents.html
McKee, C., & Bohannon, K. (2016). Exploring the Reason Behind Parental Refusal of Vaccines. The Journal of Pediatric Pharmacology and Therapeutics, 21(2). doi: 10.5863/1551-6776-21.2.104