Infant Health, Care, and Safety

Antibiotics are powerful drugs used to treat certain illnesses. However, antibiotics do not cure everything, and unnecessary antibiotics can even be harmful.

There are two main types of germs that cause most infections. These are viruses and bacteria.

Viruses cause:

• All colds and flu
• Most coughs
• Most sore throats

Antibiotics cannot kill viruses.

Bacteria cause:

• Most ear infections
• Some sinus infections
• Strep throat
• Urinary tract infections

Antibiotics do kill specific bacteria.

Some viruses cause symptoms that resemble bacterial infections, and some bacteria can cause symptoms that resemble viral infections. Your child's physician can determine what type of illness your child has and recommend the proper type of treatment.

What are resistant bacteria?

Each time you take an antibiotic, bacteria are killed. Sometimes, bacteria may be resistant or become resistant. Resistant bacteria do not respond to the antibiotics and continue to cause infection. A common misconception is that a person's body becomes resistant to specific drugs. However, it is the bacteria, not people, that become resistant to the drugs.

Each time you take or give your child an antibiotic unnecessarily or improperly, you increase the chance of developing drug-resistant bacteria. Therefore, it is critically important to take antibiotics only when necessary. Because of these resistant bacteria, some diseases that used to be easy to treat are now becoming nearly impossible to treat.

Bacteria can develop resistance to certain medications.

• Drug resistance happens when bacteria develop ways to survive the use of medications meant to kill or weaken them
• If a germ becomes resistant to many drugs, treating the infections can become difficult or even impossible
• Someone with an infection that is resistant to a certain medication can pass that resistant infection to another person. In this way, a hard-to-treat illness can be spread from person to person. In some cases, the illness can lead to serious disability or even death.

When are antibiotics needed?

This complicated question, which should be answered by your child's physician, depends on the specific diagnosis. For example, there are several types of ear infections - most need antibiotics, but some do not. Most cases of sore throat are caused by viruses. One kind, strep throat, diagnosed by a laboratory test, requires antibiotics.

Viral infections can sometimes lead to bacterial infections. However, treating viral infections with antibiotics in order to prevent bacterial infections is not recommended.

• Remember that antibiotics do not work against colds and flu, and that unnecessary antibiotics can be harmful
• Consult your child's pediatrician about antibiotics and find out about the differences between viruses and bacteria, and when antibiotics should and should not be used
• If your child does receive an antibiotic, be sure to give it exactly as prescribed to decrease the development of resistant bacteria
• Antibiotic resistance is particularly dangerous for children, but it can occur in adults, as well

Remember that taking antibiotics appropriately and making sure your child receives the proper immunizations will help prevent having to take more dangerous and more costly medications. Consult your child's physician for more information.

Circumcision is a surgical procedure to remove the skin covering the end of the penis, called the foreskin. In many cultures, circumcision is a religious rite or a ceremonial tradition. It is most common in Jewish and Islamic faiths. In the United States, newborn circumcision is an elective procedure. The National Center for Health Statistics estimates that about 56 percent of newborn boys undergo circumcision. However, this number varies among socioeconomic, racial, and ethnic groups.

How is circumcision performed?

Circumcision is usually performed by the obstetrician in the hospital. When it is done for religious reasons, other persons may do the surgery as part of a ceremony after the baby is discharged from the hospital.

Circumcision is performed only on healthy babies. Because the procedure is painful, the AAP recommends using some type of local anesthesia for newborn circumcision. Several types of anesthesia are available, including a numbing cream or injecting small amounts of anesthetic around the penis. Although there are risks with any anesthesia, these are generally considered very safe.

There are several ways to perform a circumcision. Some methods use a temporary clamp device while others use a plastic bell that stays on the penis for a certain length of time. Each method requires separating the foreskin from the head of the penis, cutting a small slit in the foreskin, and placing the clamp on the foreskin. The clamp is left in place for a few minutes to stop the bleeding. The foreskin can then be cut and removed.

How to provide care after a circumcision

Circumcisions performed by a qualified physician rarely have complications. Problems that occur are usually not serious. The most common complications are bleeding and infection. Proper care after circumcision helps reduce the chances of problems.

Your baby's physician will give you specific instructions on the care of the circumcision. It is important that you keep the area clean. After the procedure:

• There may be a gauze dressing with petroleum jelly or an antibiotic cream. This may be removed at the first diaper change. Your baby's physician may recommend applying a new dressing
• The head of the penis may be very raw and red looking
• There may be a small amount of blood at first or yellow-colored drainage later. These are part of normal healing
• Your baby may have some discomfort with diaper changes the first few days
• Keep the penis clean with soap and water
• Circumcisions usually heal within one to two weeks

Your baby may be fussy after circumcision. Cuddling him close and breastfeeding can help comfort him. Most boys do not require special care of the penis after the circumcision is healed.

How to provide care to the uncircumcised penis

A newborn boy normally has foreskin tightly fitted over the head of the penis. As long as the baby is able to pass urine through the opening, this is not a problem. It is not necessary to clean inside the foreskin, only the outside, as part of a normal bath.

As the baby grows, the foreskin becomes looser and is able to be retracted (moved back). This may take many weeks or months. Do not retract the foreskin on your baby boy. Your baby's physician will check this as part of your baby's checkups and will show you how to retract the foreskin. This allows cleansing of the area. As a boy grows, he should be taught how to retract the foreskin and clean himself. The foreskin should never be retracted forcibly. Do not allow the foreskin to stay retracted for long periods, as this may shut off the blood supply, causing pain and possible injury.

In some children, the foreskin cannot be retracted, causing a condition called phimosis. This condition may require circumcision later in childhood.

Most pediatric dentists will agree that regular dental care should begin by 1 year of age, with a dental check-up at least twice each consecutive year for most children. Some children may need more frequent evaluations and care. In accordance with this recommendation, the American Academy of Pediatric Dentistry has provided the following dental checklist for infants and toddlers:

Birth to 6 months of age

• Clean the infant's mouth with gauze after feedings and at bedtime
• Consult your child's pediatrician regarding fluoride supplements
• Regulate feeding habits (bottle-feeding and breastfeeding)

Six to 12 months of age

• During this time, the first tooth should appear. Consult a pediatric dentist for an examination
• Brush teeth after each feeding and at bedtime with a small, soft-bristled brush
• As the child begins to walk, stay alert for potential dental and/or facial injuries

Twelve to 24 months of age

• Follow the schedule of dental examinations and cleanings, as recommended by your child's pediatric dentist. Generally, dental examinations and cleanings are recommended every 6 months for children and adults.
• As your child learns to rinse his/her mouth, and as most primary (baby) teeth have erupted by this age, brushing with a pea-sized portion of fluoridated toothpaste becomes appropriate, in most cases. However, it is advised to consult your child's pediatric dentist regarding the appropriate time for your toddler to begin using toothpaste.

Facts about deciduous (primary or baby) teeth

• Proper care of a child's deciduous teeth (also known as "baby" or primary teeth) is very important, as these teeth hold space for the future eruption of permanent teeth
• If a baby tooth decays or is removed too early, the space necessary for the permanent teeth is lost and can only be regained through orthodontic treatment
• Infected baby teeth can cause the permanent teeth to develop improperly, resulting in stains, pits, and weaker teeth
• Most children begin losing their baby teeth around the ages of 5 or 6, with usually the front teeth first. They continue to lose baby teeth until the age of 12 or 13, when all of the permanent teeth finally come through, except for the third molars (wisdom teeth).

Diet and dental care for children

The American Academy of Pediatric Dentistry recommends the following to ensure your child eats correctly to maintain a healthy body and teeth:

• Ask your child's pediatric dentist to help you assess your child's diet
• Shop smart. Do not routinely stock your pantry with sugary or starchy snacks
• Buy "fun foods" just for special times
• Limit the number of snacks and choose nutritious snacks
• Provide a balanced diet and save foods with sugar or starch for mealtimes
• Do not put your young child to bed with a bottle of milk, formula, or juice
• If your child chews gum or sips soda, choose those without sugar

What is orthodontics?

Orthodontics is the dental specialty that focuses on the development, prevention, and correction of irregularities of the teeth, bite, and jaws. Orthodontists also have specialized training in facial abnormalities and disorders of the jaw. A parent may consult an orthodontist after receiving a referral from their child's general dentist. However, the American Dental Association recommends that every child receive an orthodontic evaluation by the age of 7.

Why choose orthodontic treatment?

Any orthodontic problem may be classified as a malocclusion, or "bad bite." The following problems may be helped or minimized with proper orthodontic treatment:

• Misaligned, crooked, or crowded teeth
• Missing teeth
• Extra teeth
• An overbite
• An underbite
• Misaligned or incorrect jaw position
• A disorder of the jaw joint

At what age do braces become appropriate?

In most cases, the ideal age for braces and other orthodontic treatments is between 10 and 14 years of age. Moving and correcting the alignment of the teeth follows the same biological and physical process regardless of age. However, an adult mouth must overcome already-positioned facial bones and jaw structure. Thus, overcoming most types of malocclusions may require more than one type of orthodontic treatment for adults and can sometimes involve jaw surgery.

What are the different types of braces available?

Braces, also called fixed orthodontic appliances, generally come in three varieties:

• Brackets, metal or plastic, clear or tooth-colored, that are bonded to teeth
• Lingual-type brackets that attach to the back of teeth, hidden from view
• Bands that cover most of the teeth with metal bands that wrap around the teeth

All three types use wires to move the teeth to the desired position.

Oral healthcare and braces

The following recommendations will help to eliminate or reduce any oral health problems while your child's teeth are in braces:

• Make certain that your child is brushing his/her teeth carefully after every meal with fluoride toothpaste and a soft-bristled toothbrush, as food becomes easily lodged in the braces
• Make certain that your child is flossing daily between the teeth and the braces
• Maintain every six month cleanings by your child's dentist or orthodontist, or as recommended
• Limit your child's sugar and starch intake, as debris left behind from these types of foods may turn into damaging acids, which may be harmful to teeth and gums and promote plaque formation
• Avoid hard and/or sticky snacks that may be difficult to remove from the orthodontic equipment in your child's mouth. This includes foods such as popcorn, hard or chewy candy, caramel, and/or nuts.

While every child is different, most children need to be given consistent, clear rules and expectations about behavior. The following are some general principles about discipline:

• Discipline needs to begin as soon as the child is mobile, pulling up, and crawling
• Young infants rely on their parents to provide a safe environment
• Discipline should be age-focused and should teach age-appropriate behaviors
• Try to recognize and praise your child when he/she is being good
• Be a good role model for your child
• After the discipline occurs, hug your child. Make sure the child knows it is the behavior you are not happy with, not the child. Physical punishment is not needed or appropriate.
• Rewards for good behavior should be immediate

Decrease unwanted behavior

It is important to remember not to reward a child or give positive reinforcement for bad behavior. For example, if a child is having a temper tantrum, giving him/her a cookie to be quiet is rewarding the child for the bad behavior. In order to help decrease the chance of bad behavior, consider the following:

• Do not reinforce the behavior; simply ignore the child
• The behavior may have to result in an unpleasant consequence, such as punishment
• Active punishment has two forms, including the following:
  • Denying the child privileges or desired activities, such as decreasing TV time or no dessert
  • Undesirable or uncomfortable activities can be required of the child, such as doing chores or having a "time-out"

• The behavior can result in natural consequences. For example, a child who will not eat may go to bed hungry.

• It is generally accepted that spanking and other forms of physical punishment are not helpful. These types of discipline teach the child aggressive behaviors and poor conflict management.

Methods of discipline

Discipline methods often depend on the age of the child, and how much the child understands his/her behavior. The following are some suggestions for discipline techniques for each age group:

• Infants and toddlers:
  • Safety is the main concern
  • Infants will respond to a loud, firm voice saying "no"
  • Provide a safe environment that decreases the chances of things being broken by the child
  • After saying "no," direct your child to an acceptable behavior, such as a toy
  • Do not reward bad behavior. Ignore temper tantrums, but confront other problems, such as biting or hitting.
  • Praise and reward good behavior
• Preschoolers:
  • Preschoolers need clear and consistent rules
  • This age group needs time to prepare for the next activity. Give your child a warning before it is time to stop playing
  • Preschoolers need lots of explanation as to why things are being done
  • Use a time-out for bad behavior
  • Use praise for good behavior
• School-aged children. School-aged children need the above rules and guidelines, plus the following:
  • Give your child choices
  • Give your child chances to help solve problems together regarding their behavior
  • Give your child chances to explain their side and opinion, and opportunities to express their feelings and concerns

• Adolescents:
  • This age group needs patient and understanding parents as they test all limits
  • Adolescents need to be told the long-term outcomes of bad behaviors
  • Adolescents need to be involved with limit-setting, based on their maturity

What is normal sleep?

The normal amount of sleep varies depending on the age of your child:

• Newborns to 3 months
  • Average nighttime sleep: 8 to 9 hours (waking through the night to feed)
  • Average daytime sleep: 8 hours

• 6 to 12 months
  • Average nighttime sleep: 10 to 12 hours (usually sleeps through the night)
  • Average daytime sleep: 5 hours
• 2 years
  • Average nighttime sleep: 10 to 12 hours
  • Average daytime sleep: 4 hours (fewer naps after 12 months of age)
• 3 years
  • Average nighttime sleep: 10 hours
  • Average daytime sleep: 1 hour
• 4 to 6 years
  • Average nighttime sleep: 10 hours
  • Average daytime sleep: Usually no nap

Helpful tips for healthy sleep habits

The following are some helpful tips for establishing good sleep habits for your child:

• Newborns do not have a set night/day schedule for the first several weeks of life. It is best for a newborn not to sleep longer than five hours at a time in the first five to six weeks, as their small bodies need frequent feedings.
• Older babies and children should have a nap time and bedtime schedule
• Start a quiet time, such as listening to quiet music or reading a book, 20 to 30 minutes before bedtime. TV should not be a part of the quiet time.
• After quiet time, follow a bedtime routine such as a diaper change, going to the bathroom, brushing teeth, etc
• Set a time limit for quiet time and the routine, so it does not drag on, and your child knows what to expect before bedtime
• Say goodnight, turn off the light, and leave the room
• Security objects, such as a special blanket or stuffed animal, can be part of the bedtime routine
• It is important for children to be put to bed awake so they learn to fall asleep themselves
• Babies should not be put to bed with a bottle. It causes problems with tooth decay and ear infections.

Helpful tips for children with poor sleep habits

Children can easily fall into bedtime habits that are not always healthy habits. The following suggestions can help when a child does not want to go to bed or is having trouble staying in bed:

• If your child cries, speak calmly and reassure him/her, "You are fine. It is time to go to sleep." Then leave the room.
• Do not give a bottle or pick up your child
• Stretch out the time between trips to the room if your child continues. Do not do anything but talk calmly and leave.
• Your child will calm down and go to sleep if you stick to this routine. It may take several nights for your child to get used to the new plan.
• If your child is used to getting a large amount of milk right at bedtime, start to cut down the amount of milk in the bottle by one-half to 1 ounce each night until the bottle is empty, and then take it away completely
• Sometimes, children get out of their routine of sleeping at night because of an illness or travel. Quickly return to good sleep habits when things are back to normal.

Sometimes, older children go through a stage or a period of time when they revert back to bad sleep habits or develop new problems in going to sleep. The following are some tips to help parents with older children who have problems going to bed:

• If your child gets out of bed, take him/her back to bed with a warning that the door will be shut (not locked) for 1 or 2 minutes if he/she gets out of bed
• If your child stays in bed, the door stays open. If your child gets out of bed, the door is closed for 2 minutes. Your child can understand that he/she has control of keeping the door open by staying in bed.
• If your child gets out again, shut the door for 3 to 5 minutes (no more than 5 minutes)
• Be consistent. Put your child back in bed each time he/she gets out of bed.
• When your child stays in bed, open the door and give your child praise (i.e., "You are doing a great job of staying in bed. Goodnight.")
• Your child can be rewarded for staying in bed by earning a star on a calendar for staying in bed all night. You can give a special prize for a certain number of stars earned.

Hearing develops early in fetal development and is fully functioning at birth. While children respond differently at different stages of growth and development, hearing problems may be suspected in children who are not responding to sounds or who are not developing their language skills appropriately. The following are some age-related guidelines that may help to decide if your child is experiencing hearing problems.

It is important to remember that not every child is the same, and children reach milestones at different ages. Consult your child's physician if you are suspicious that your child is not hearing appropriately. The National Institute on Deafness and Other Communication Disorders (NIDCD) and other experts list the age-appropriate hearing milestones below for babies and toddlers:

Milestones related to hearing

• Birth to 3 months
  • Reacts to loud sounds with startle reflex
  • Is soothed and quieted by soft sounds
  • Turns head to you when you speak
  • Is awakened by loud voices and sounds
  • Smiles in response to voices when spoken to
  • Seems to know your voice and quiets down if crying
• 3 to 6 months
  • Looks or turns toward a new sound
  • Responds to "no" and changes in tone of voice
  • Imitates his/her own voice
  • Enjoys rattles and other toys that make sounds
  • Begins to repeat sounds (such as ooh, aah, and ba-ba), becomes scared by a loud voice or noise
• 6 to 10 months
  • Responds to his/her own name, telephone ringing, someone's voice, even when not loud
  • Knows words for common things (cup, shoe) and sayings ("bye-bye")
  • Makes babbling sounds, even when alone
  • Starts to respond to requests such as "come here"
  • Looks at things or pictures when someone talks about them
• 10 to 15 months
  • Plays with own voice, enjoying the sound and feel of it
  • Points to or looks at familiar objects or people when asked to do so
  • Imitates simple words and sounds; may use a few single words meaningfully
  • Enjoys games like peek-a-boo and pat-a-cake
  • Follows one-step commands when shown by a gesture
• 15 to 18 months
  • Follows simple directions, such as "give me the ball," without being shown
  • Uses words he/she has learned often
  • Uses two to three-word sentences to talk about and ask for things
  • Knows 10 to 20 words
  • Points to some body parts when asked
• 18 to 24 months
  • Understands simple "yes-no" questions (Are you hungry?)
  • Understands simple phrases ("in the cup," and "on the table")
  • Enjoys being read to
  • Points to pictures when asked
• 24 to 36 months
  • Understands "not now" and "no more"
  • Chooses things by size (big, little)
  • Follows two-step commands, such as "get your shoes and come here"
  • Understands many action words (run, jump)

Lying and stealing are common, but inappropriate, behaviors in school-aged children. While some severe forms of these behaviors can indicate a more serious psychological problem, most of the time, it is simply a common behavior that will be outgrown. Lying and stealing are more common in boys than girls, and occur most often in children aged 5 to 8 years.

Handling the situation when your child is lying

When confronted with a child who is lying, it is important to first remember the child's age and developmental stage. Children under the age of 3 do not lie on purpose. This age group does not understand what they are saying and instead are just experimenting with language and new found facts about the world. They might also lie to avoid punishment because they understand the consequences but have an undeveloped moral code.

Children from the ages of 3 to 7 often have problems separating the real world from fantasy. They might have imaginary playmates at this age and enjoy fairy tales and make-believe play. The lies told by this age group are mostly tales that they have made up, not intentional lies. By the age of 6 or 7, however, children understand what lying is, but will continue to cheat if able.

Children from the ages of 6 to 12 understand what lying is and the moral wrongness of this behavior. However, children may continue to lie in order to test adult rules and limits. The child may admit to telling a lie, but usually he/she has many reasons for having done so. Rules are very important at this age, so cheating becomes less important.

Other factors that may cause a child to lie

• Children may lie if their parents' expectations of them are too high
• Children may lie about their grades if parents assume that they are doing better in school than they really are
• If a child is asked why he/she did some bad behavior, the child may lie because he/she is unable to explain the actions
• Children who are not disciplined on a consistent basis may lie
• Children who do not receive praise and reward may lie to get this attention

When does lying become a concern?

There are multiple situations that may cause concern. If any of these apply to your child, it is important to consult your child's physician:

• A child who is lying and at the same time having other behavioral problems, such as setting things on fire, being mean to animals, having sleep problems, or is very hyperactive, may have more psychological problems
• Children who do not have many friends or do not want to play in groups may have poor self-esteem and be depressed
• Children lie in order to get something from someone else and do not show any signs of regret

Handling the situation when your child is stealing

Stealing often causes more concern to parents because it may happen outside the home and may affect other people. During the school years, stealing may be a sign of a problem, but it may also be a result of peer pressure and the need for the child to fit in. It is important to look at the whole situation.

Children under the age of 3 take things because they do not fully understand the difference between what is "mine" and what is not. They then may become possessive of their things and protect them. They do not steal with bad intentions.

Children between the ages of 3 and 7 begin to respect things that belong to others. However, this age group will trade property without regard to value if something else is wanted. The respect for property continues in the school-aged child.

By the time the child is 9, the child should respect the possessions of others and understand that stealing is wrong. Children in this age group may continue to steal because of several factors, including the following:

• They may feel peer pressure and the need to fit in
• They may have low self-esteem
• They may not have any friends and are trying to "buy" their friends
• They may try to become good at stealing to feel proud of something they have done if they do not receive positive feedback from their parents

When does stealing become a concern?

There are multiple situations that may cause concern. If any of these apply to your child, it is important to consult your child's physician:

• An older child who steals and does not feel bad about it
• A child who constantly steals
• If other behavioral problems also exist in the child

Children older than the age of 3 should be confronted with any lying or stealing, but it is important to remember that most of these behaviors are part of growing up and do not represent severe problems. Each child is unique, and your child's physician should be involved with any concerns.

What are nightmares?

Nightmares are scary dreams that awaken children and make them afraid to go back to sleep. Nightmares may happen for no known reason, but sometimes occur when your child has seen or heard things that upset him/her. These can be things that actually happen or are make-believe. Occasional bad dreams are normal at all ages after about 6 months of age. Nightmares often relate to developmental stages of a child: toddlers may dream about separation from their parents; preschoolers may dream about monsters or the dark; school-aged children may dream about death or real dangers. Nightmares usually happen during the last third of sleep, during REM (dream time) sleep.

How to help a child with nightmares

• Comfort, reassure, and cuddle your child
• Help your child talk about the bad dreams during the day
• Protect your child from seeing or hearing frightening movies and television shows
• Leave the bedroom door open (never close the door on a fearful child)
• Provide a "security blanket," or a toy for comfort
• Let your child go back to sleep in his/her own bed
• Do not spend a lot of time searching for "the monster"
• During the bedtime routine, before your child goes to sleep, talk about happy or fun things
• Read some stories to your child about getting over nighttime fears

When to call your child's physician

Consult your child's physician if you notice any of the following:

• The nightmares become worse or happen more often
• The fear interferes with daytime activities
• You have other concerns or questions about your child's nightmares

What are night terrors?

A night terror is a partial waking from sleep with behaviors such as screaming, kicking, panic, sleepwalking, thrashing, or mumbling. Night terrors usually occur within two hours of the time a child goes to sleep. They are harmless, and each episode will end in deep sleep. They are considered normal until age 6.

The following are common characteristics of a night terror:

• Your child is frightened but cannot be awakened or comforted
• Your child's eyes are wide open, but he/she does not know that you are there
• Your child may think objects or persons in the room are scary
• The episode lasts from 10 to 30 minutes
• Your child often does not remember the episode in the morning

How to help a child during a night terror

• Try to help your child return to normal sleep. You will not be able to awaken your child, so do not try. Turn on the lights so that your child is less confused by shadows. Make soothing comments. Hold your child if it seems to help him/her feel better. Shaking or shouting at your child may cause the child to become more upset.
• Protect your child against injury. During a night terror, a child can fall down a stairway, run into a wall, or break a window. Try to gently direct your child back to bed.
• Prepare babysitters for these episodes. Explain to people who care for your child what a night terror is and what to do if one happens.
• Try to prevent night terrors. A night terror can be triggered if your child becomes overly tired. Be sure your child goes to bed at a regular time, and early enough to give him/her enough sleep. Younger children may need to return to a daily nap.
• For several nights, note how many minutes it is from the time your child falls asleep until the start of the night terror. Begin to awaken your child every 15 minutes before the expected time of the night terror. Keep your child fully awake and out of bed for 5 minutes. Continue waking your child like this for seven consecutive nights. If the night terrors return when you stop waking your child, repeat as needed.

When to call your child's physician

While night terrors are not harmful, they can resemble other conditions or lead to problems for the child. Consult your child's physician if you notice any of the following:

• The child has drooling, jerking, or stiffening
• Terrors happen after the seven nights of waking
• Terrors last longer than 30 minutes
• Your child does something dangerous during an episode
• Terrors are happening during the second half of the night, your child has daytime fears
• You feel family stress may be a factor
• You have other questions or concerns about your child's night terrors

The ability to hear is essential for proper speech and language development. Hearing problems may be suspected in children who are not responding to sounds or who are not developing their language skills appropriately. The following are some age-related guidelines that may help to decide if your child is experiencing hearing problems.

It is important to remember that not every child is the same, and children reach milestones at different ages. Consult your child's physician if you are suspicious that your child is not developing speech and language skills correctly. The National Institute on Deafness and Other Communication Disorders (NIDCD) and other experts list the age-appropriate speech and language milestones below for babies and young children:

Milestones related to speech and language

• Birth to 5 months
  • Coos
  • Vocalizes pleasure and displeasure sounds (laughs, giggles, cries, or fusses)
  • Makes noise when talked to
• 6 to 11 months
  • Understands "no-no" babbles (says "ba-ba-ba")
  • Says ma-ma or da-da without meaning
  • Tries to communicate by actions or gestures
  • Tries to repeat your sounds
  • Says first word
• 12 to 17 months
  • Answers simple questions nonverbally
  • Says two to three words to label a person or object (pronunciation may not be clear)
  • Tries to imitate simple words
  • Vocabulary of four to six words
• 18 to 23 months
  • Correctly pronounces most vowels and n,m,p,h, especially in the beginning of syllables and short words - also begins to use other speech sounds
  • Vocabulary of 50 words, pronunciation is often unclear
  • Asks for common foods by name
  • Makes animal sounds such as "moo"
  • Starting to combine words such as "more milk"
  • Begins to use pronouns such as "mine"
  • Uses two-word phrases
• 2 to 3 years
  • Knows some spatial concepts such as "in" and "on"
  • Knows pronouns such as "you," "me," and "her"
  • Knows descriptive words such as "big" and "happy"
  • Vocabulary of 250 to 900 words
  • Uses three-word sentences
  • Speech is becoming more accurate, but may still leave off ending sounds - strangers may not be able to understand much of what is said
  • Answers simple questions
  • Begins to use more pronouns such as "you" and "I"
  • Uses question inflection to ask for something, such as "My ball?"
  • Begins to use plurals such as "shoes" or "socks" and regular past tense verbs such as "jumped"
• 3 to 4 years
  • Group objects such as foods, clothes, etc.
  • Identifies colors
  • Uses most speech sounds but may distort some of the more difficult sounds, such as l, r, s, sh, ch, y, v, z, th - these sounds may not be fully mastered until age 7 or 8
  • Uses consonants in the beginning, middle, and ends of words - some of the more difficult consonants may be distorted, but attempts to say them
  • Strangers are able to understand much of what is said
  • Able to describe the use of objects such as "fork," "car," etc.
  • Has fun with language - enjoys poems and recognizes language absurdities such as, "Is that an elephant on your head?"
  • Expresses ideas and feelings rather than just talking about the world around him/her
  • Uses verbs that end in "-ing," such as "walking" and "talking"
  • Answers simple questions such as "What do you do when you are hungry?"
  • Repeats sentences
• 4 to 5 years
  • Understands spatial concepts such as "behind," "next to"
  • Understands complex questions
  • Speech is understandable, but makes mistakes pronouncing long, difficult, or complex words such as "hippopotamus"
  • Vocabulary of about 1,500 words
  • Uses some irregular past-tense verbs such as "ran" and "fell"
  • Describes how to do things such as painting a picture
  • Defines words
  • Lists items that belong in a category, such as animals, vehicles, etc.
  • Answers "why" questions
• 5 years
  • Understands more than 2,000 words
  • Understands time sequences (what happened first, second, third, etc.)
  • Carries out a series of three directions
  • Understands rhyming
  • Engages in conversation
  • Sentences can be eight or more words in length
  • Uses compound and complex sentences
  • Describes objects
  • Uses imagination to create stories

As children grow and develop, they can be easily influenced by what they see and hear, especially television. While television programs can be educational, many children watch too much television. TV programs can show children violent behavior that you do not want them to imitate, or that can cause fear. TV may also show children poor eating habits through commercials for high-calorie, low-nutrient foods. Too much TV watching can also take away time from reading, studying, learning activities, play, and/or exercise. Television can also show alcohol and/or drug use, smoking, and sexual behavior before a child is emotionally ready to understand these issues and practice good decision-making.

Parents can help decrease the harmful effects of watching television by screening the type of programming and limiting the amount of time a child watches television. The following are suggestions for helping set good television viewing habits:

• Choose programs for your child to watch. Always plan what your child will see on TV. Do not turn on the TV randomly. Give choices between two programs you think are appropriate for your child.
• Limit TV viewing to 1 or 2 hours a day for children older than 2 years of age. The American Academy of Pediatrics recommends that children younger than 2 years old should not watch TV at all.
• Turn to educational shows from the local Public Broadcasting Station (PBS), or from programming such as Discovery Channel, Learning Channel, or History Channel
• Watch TV with your child. Talk about what happened on the show. Talk about what was good or what was bad about the program. Talk about the difference between reality and make-believe.
• Turn the TV off if the program is something you believe your child should not see
• Do not assume all cartoons are acceptable and appropriate, as many cartoons contain violence
• Many daytime programs (such as soap operas and talk shows) are not appropriate for children.
• Be a good example to your child by not watching too much television yourself. Be involved in other activities, especially reading. Read to your child.
• Encourage play and exercise for your child. Plan other fun activities for your child, so he/she has choices instead of TV.
• Limit the use of TV as a reward for good behavior. Try a trip to the park, a festival, a playground, or a visit to a relative's/friend's house instead. Television time should be decreased to one-half hour each day if your child is not doing well in school.
• Do not allow TV watching during meal times

Temper tantrums are a way a young child lets out strong emotions before he/she is able to express them in socially acceptable ways. Although a child may seem totally out of control, these fits of rage, stomping, screaming, and throwing themselves to the floor are a normal part of childhood development. Temper tantrums often occur only with a parent. They are a way a child communicates his/her feelings. Parents can learn from their child by understanding the situation that caused the temper tantrum to erupt.

Temper tantrums often begin at about 1 year of age and continue until age 3. Nearly all children have them, but by age 4, most children develop the necessary self-control, and temper tantrums stop.

What causes temper tantrums?

As a young child learns more and becomes more independent, he/she wants to do more than they can physically and emotionally manage. This is frustrating to the child, and the frustrations are expressed in a variety of ways. Temper tantrums are worse and occur more often when a child is hungry, tired, or sick. Some reasons children have temper tantrums include the following:

• Want to be on their own, and get upset when they cannot do what they want
• Are trying to get attention to test the rules
• Have something taken away from them
• Have not learned all the words to tell you what they are feeling or want, and this upsets them
• Do not understand what you want them to do
• Are tired or hungry
• Are worried or upset
• Feel stress in the home

How to prevent temper tantrums:

Although temper tantrums sometimes happen without warning, parents can often tell when a child is becoming upset. Knowing the situations when your child is more likely to have a tantrum and thinking ahead may help. An example is not letting your child become overtired or hungry. Some suggestions for preventing or minimizing temper tantrums include the following:

• Stick to routines for meals and sleep times. Avoid long outings, delayed meals, and naps
• Distract your child with a toy he/she is allowed to have
• Be reasonable about what to expect from your child, and do not expect your child to be perfect
• Help your child to avoid frustration. Prepare your child for changes or events by talking about them before they happen
• Let your child know your rules and stick to them

How to respond during a temper tantrum:

The following are helpful hints regarding the most appropriate ways to respond during your child's temper tantrum:

• Stay calm
• Ignore the child until he/she is calmer. Keep doing whatever you were doing prior to the tantrum occurring
• Do not hit or spank your child
• Do not give in to the tantrum. When parents give in, children learn to use inappropriate behavior to get their way
• Do not "bribe" your child to stop the tantrum. The child then learns to act inappropriately to get a reward
• Remove potentially dangerous objects from your child or your child's path
• Use time-out for a short period to allow the child to get back in control

What else should parents know about temper tantrums?

Temper tantrums generally happen less often as children get older. Children should play and act normally between tantrums. However, consult your child's physician if any of the following occur:

• Temper tantrums are severe, last long, or happen very often
• Your child has a lot of trouble talking and cannot let you know what he/she needs
• Temper tantrums continue or get worse after 3 to 4 years of age
• Your child has signs of illness along with temper tantrums or holds his/her breath to cause fainting
• Your child harms himself/herself or others during tantrums

Thumb sucking is one of the most common habits of children. The habit starts early in life, with 90 percent of newborns showing some form of hand sucking by 2 hours of age.

Thumb sucking is normal in infants and young children and should cause no permanent problems if it is not continued past the age of 5. Likewise, it is generally harmless for infants to use pacifiers.

The American Academy of Pediatric Dentistry states that most children stop thumb sucking on their own between the ages of 2 and 4. The Academy states there is no reason to be concerned until the front teeth start erupting. At this point, some problems may occur, including bite problems or protruding front teeth. Other problems that may occur with thumb sucking are sore thumbs, infections, and calluses on the thumb.

It is thought that pacifier use may actually be better than thumb sucking for the following reasons:

• Pacifiers are softer and cause less damage to the teeth
• The plastic rim on the pacifier provides some relief from the tension placed on the teeth
• Pacifiers can be cleaned

Consult your child's physician if you are concerned with your child's thumb sucking. Generally, it is not a problem for children under the age of 5.

Time-out is a type of discipline that is used to stop a child from performing a bad behavior "isolating" the child for a period of time. Time-out helps establish that the parent is in charge, and allows the child to think about what he/she has done. Time-outs are useful for aggressive and harmful behaviors in toddlers and preschool-aged children.

Where should a time-out occur?

The place for time-out to occur should be chosen ahead of time, not at the time of the behavior. The following are some examples of places for time-out:

• Crib or play pen
• Chairs or corners of the room
• A designated room

How long should a time-out last?

• A general guideline is one minute for each year of the child's age. For example, 3-year-olds get three minutes of time-out.
• A maximum length of time for time-out should be no more than five minutes

Placing your child in time-out

• The reason the child is being sent to time-out should be explained to him/her in very clear statements
• If the child does not go to time-out on his/her own, lead him/her there
• Do not spank or yell on the way to time-out

Stopping time-out

• As a parent, you decide when time-out is over, not the child. If the child "escapes" during time-out, restart the clock
• Tell your child time-out is over and allow him/her to resume normal activities
• Treat the child normally after time-out. Do not lecture again on the behavior.

Vision normally sharpens as a baby matures into childhood. However, vision problems may be suspected in children who are not responding to their environment properly. The following are some age-related guidelines that may help to decide if your child is having vision problems. It is important to remember that not every child is the same, and some children may reach milestones at different ages. Consult your child's physician if you are suspicious that your child is not seeing correctly or is experiencing other problems with his/her vision.

Milestones related to vision or seeing

• Birth
  • Poor eyesight
  • Infant will blink in response to bright light or touching eye
  • Eyes are sometimes uncoordinated, may look cross-eyed
  • Able to stare at an object if held 8 to 10 inches away
  • Initially fixes eyes on a face or light, then begins to follow a moving object
• 1 month
  • Looks at faces and pictures with contrasting black and white images
  • Can follow an object up to 90 degrees
  • Watches parent closely
  • Tears begin to form
• 2 to 3 months
  • Begins to be able to see an object as one image
  • Looks at hands
  • Follows light, faces, and objects
• 4 to 5 months
  • Beginning to reach hands to objects, may bat at hanging objects with hands
  • Can stare at a block
  • Recognizes bottle
  • Will look at self in mirror
  • Will look at own hand
• 5 to 7 months
  • Has full color vision, able to see at longer distances
  • Can pick up a toy that is dropped
  • Will turn head to see an object
  • Likes certain colors
  • Will touch image of self in mirror
• 7 to 11 months
  • Can stare at small objects
  • Begins to have depth perception
  • Plays peek-a-boo
• 11 to 12 months
  • Can watch objects that are moving fast
• 12 to 14 months
  • Able to place shapes in proper holes
  • Becomes interested in pictures
  • Recognizes familiar objects and pictures in books, may point to some objects when asked, "Where is the...?"
  • Points and gestures for objects and actions
  • Recognizes own face in mirror
• 18 to 24 months
  • Able to focus on objects near and far
  • Scribbles with crayon or pencil, may imitate drawing straight line or circle
  • Can point to body parts (nose, hair, eyes) when asked
• 36 to 48 months
  • Can copy shapes
  • Vision is nearing 20/20
  • Names colors
• 48 to 72 months (4 to 6 years)
  • Recognizes and recites the alphabet
  • Ready to begin reading
  • Has complete depth perception
  • Uses scissors
  • Can name coins and money

Immunizations (also called vaccinations) are a set of shots given to infants and children at different ages to help keep them from developing dangerous childhood diseases. The diseases vaccinations protect against have serious complications and can even be fatal. Making sure your child receives immunizations when scheduled is the best way to help protect your child.

The importance of immunizations

Immunization is key to preventing disease among the general population. Vaccines benefit both the people who receive them and the vulnerable, unvaccinated people around them because the infection can no longer spread. In addition, immunizations reduce the number of deaths and disability from infections, such as whooping cough and chickenpox.

Although children receive the majority of the vaccinations, adults also need to stay up-to-date on certain vaccinations, including tetanus and diphtheria. In addition, those adults who have never had chickenpox or measles during childhood (nor the vaccines against these specific diseases) should consider being vaccinated. Childhood illnesses such as mumps, measles, and chickenpox can cause serious complications in adults.

About guidelines for childhood immunizations

Many childhood diseases can now be prevented by following recommended guidelines for vaccinations:

• Meningococcal vaccine - to protect against meningococcal disease
• Hep B - to protect against hepatitis B
• Polio vaccine - to protect against polio
• DTaP and Tdap - to protect against diphtheria, tetanus (lockjaw), and pertussis (whooping cough)
• Hib vaccine - to protect against Haemophilus influenzae type b, which causes spinal meningitis
• MMR - to protect against measles, mumps, and rubella (German measles)
• Pneumococcal vaccine - to protect against pneumonia, infection in the blood, and meningitis
• Varicella - to protect against chickenpox
• RotaTeq® - to prevent rotavirus gastroenteritis in infants
• Hep A - to prevent viral infection of the liver
• HPV - to protect females from human papillomavirus, which is linked to cervical cancer

A child's first vaccination is given at birth. Immunizations are scheduled throughout childhood, with many beginning within the first few months of life. By following a regular schedule and making sure a child is immunized at the right time, you are ensuring the best defense against dangerous childhood diseases.

Please visit the Online Resources page for the most up-to-date guidelines from the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics.

Reactions to immunizations

As with any medication, vaccinations may cause reactions, usually in the form of a sore arm or low-grade fever. Although serious reactions are rare, they can happen, and your child's physician or nurse may discuss these with you before giving the shots. However, the risks of contracting the diseases the immunizations provide protection from are higher than the risks of having a reaction to the vaccine.

Treating mild reactions to immunizations in children

Children may need extra love and care after getting immunized, because the shots that keep them from getting serious diseases can also cause discomfort for a while. Children may experience fussiness, fever, and pain after they have been immunized.

• Fever
  • DO NOT GIVE ASPIRIN. You may want to give your child acetaminophen, a medication that helps to reduce pain and fever, as directed by your child's physician.
  • Give your child plenty to drink
  • Clothe your child lightly. Do not cover or wrap your child tightly.
  • Sponge your child in a few inches of lukewarm (not cold) bath water
• Swelling or pain
  • DO NOT GIVE ASPIRIN. You may want to give your child acetaminophen, a medication that helps to reduce pain and fever, as directed by your child's physician.
  • A clean, cool washcloth may be applied over the sore area as needed for comfort

If more serious symptoms occur, call your child's physician right away. These symptoms may include:

• A large area of redness and swelling around the area where the injection was given. The skin area may be warm to touch and very tender. There may also be red streaks coming from the initial site of the injection.
• High fever
• The child is pale or limp
• The child has been crying incessantly for several minutes
• The child has a strange cry that is not normal (a high-pitched cry)
• Shaking, twitching, or jerking of the body

If you decide not to breastfeed or are unable to breastfeed, commercial iron-fortified formulas can provide adequate nutrition for your infant. Infant formulas contain adequate amounts of protein, calories, fat, vitamins, and minerals for growth. However, formula does not contain the immune factors that are in breast milk. The immune factors that are found in breast milk can help prevent infections.

Infants who take enough iron-fortified infant formula usually do not need vitamin and mineral supplements. Fluoride is sometimes needed after 6 months of age if the water supply does not have enough fluoride. Check with your baby's physician about fluoride supplements. Types of infant formula include the following:

Cow's milk-based formula

Most infants should be able to tolerate a standard cow's milk formula such as Enfamil® with iron, Similac® with iron, or Nestlé® Carnation® Good Start®. These formulas use cow's milk as a base, but have been modeled after breast milk. These formulas have lactose as the carbohydrate (sugar) source. They are available in ready-to-feed cans, liquid concentrate, and powder.

Soy-based formulas

Soy-based infant formulas can provide adequate nutrition for your infant. Soy-based infant formulas can be used if an infant is not tolerating the sugar (lactose) found in cow's milk-based formulas. Soy formulas do not contain lactose as the sugar source. Sometimes, soy formulas are used if your infant is not tolerating cow's milk protein. However, infants who are allergic to cow's milk formula can also be allergic to soy-based formulas. Consult your baby's physician before changing your his/her formula.

Protein hydrolysates

These are special formulas usually used if your baby is unable to tolerate standard infant formula. These formulas are more expensive than standard formulas. Often these formulas are used if your baby has a cow's milk protein allergy, or if he/she is unable to digest a standard infant formula. Consult your baby's physician before using these formulas.

Low-iron formulas

Standard cow's milk-based formulas are also available in low-iron forms. Iron is a very important mineral for growth and development. A lack of iron in the diet can cause iron deficiency anemia. Many people think that the iron in formula can cause constipation. This is not true. Low-iron formulas should not be used unless recommended by your baby's physician.

Keep your baby on breast milk or infant formula until he/she is 1 year old. After this time, you may change over to whole milk. Children under 2 years old should not drink skim or low-fat milk.

Helpful feeding information for your toddler

The toddler (ages 1 to 3 years) phase can often be challenging when it comes to feeding. Several developmental changes occur at this time. Toddlers are striving for independence and control. Their growth rate slows down, and with this comes a decrease in appetite. These changes can make meal time difficult. It is important for parents to provide structure and set limits for the toddler.

The following are suggestions to help manage mealtimes so that the toddler gets the nutrition he/she needs:

• Avoid battles over food and meals
• Provide regular meals and snacks
• Be flexible with food acceptance, as toddlers are often afraid of new things
• Be realistic about food amounts. Portion size should be about one-fourth the size of an adult portion
• Limit juice intake to about 4 to 6 ounces per day
• Dessert should not be used as a reward. Try serving it with the rest of the food
• Make the food easy for your toddler to eat:
  • Cut food into bite-sized pieces
  • Make some foods soft and moist
  • Serve foods near room temperature
  • Use ground meat instead of steak or chops
  • Use a child-sized spoon and fork with dull prongs
  • Seat your child at a comfortable height in a secure chair
• Prevent choking by:
  • Slowly adding more difficult-to-chew foods
  • Avoiding foods that are hard to chew and/or swallow, such as nuts, raw carrots, gum drops, jelly beans, and peanut butter (by itself)
  • Modifying high-risk foods: cut hot dogs into quarters, cut grapes into quarters, and cook carrots until soft
  • Always supervising your child when he/she is eating
  • Keeping your child seated while eating

Helpful feeding information for your preschooler

Preschool-aged children (ages 4 to 5) are still developing their eating habits and need encouragement to eat healthy meals and snacks. These children are eager to learn, especially from other people, and will often imitate the eating behaviors of adults. They need supervision at mealtime as they are still working on chewing and swallowing skills.

The following are some helpful mealtime hints for preschool-aged children:

• Prepare meals, provide regularly scheduled snacks, and limit unplanned eating
• Poor behavior at mealtime should not be allowed. Focus on eating, not playing with food or playing at the dinner table.
• Keep offering a variety of foods. Have the attitude that, sooner or later, your child will learn to eat almost all foods.
• Make mealtime as pleasant as possible. Do not put pressure on your child to eat, or force your child to "clean" his/her plate. This may lead to overeating, which can cause your child to gain too much weight. Children will be hungry at mealtime if snacks have been limited during the day.
• Provide examples of healthy eating habits. Preschoolers mimic what they see their parents doing. If you have unhealthy eating habits, your child will not learn to eat healthily.

Helpful feeding information for your school-aged child

School-aged children (ages 6 to 12) continue to need healthy foods and nutritious snacks. They have a consistent but slow rate of growth and usually eat four to five times a day (including snacks). Many food habits, likes, and dislikes are established during this time. Family, friends, and the media (especially TV) influence their food choices and eating habits. School-aged children are often willing to eat a wider variety of foods than their younger siblings. Eating healthy after-school snacks are important, as these snacks may contribute up to one-third of the total calorie intake for the day. School-aged children have developed more advanced feeding skills, are better at feeding skills, and are able to help with meal preparation.

The following are some helpful mealtime hints for school-aged children:

• Always serve breakfast, even if it has to be "on the run." Some ideas for a quick, healthy breakfast include the following:
  • Fruit
  • Milk
  • Bagel
  • Cheese toast
  • Cereal
  • Peanut butter sandwich
• Take advantage of big appetites after school by serving healthy snacks such as the following:
  • Fruit
  • Vegetables and dip
  • Yogurt
  • Turkey or chicken sandwich
  • Cheese and crackers
  • Milk and cereal
• Set good examples for eating habits
• Allow children to help with meal planning and preparation
• Serve meals at the table, instead of in front of the television, to avoid distractions

Healthy food choices

The food guide pyramid is a guideline to help you and your child eat a healthy diet. The food guide pyramid can help you and your child eat a variety of foods while encouraging the right amount of calories and fat. The United States Department of Agriculture (USDA) and the US Department of Health and Human Services have prepared the following food pyramid to guide parents in selecting foods for children 2 years and older.

The Food Pyramid is divided into six colored bands representing the five food groups plus oils:

• Orange represents grains: Make half the grains consumed each day whole grains. Whole-grain foods include oatmeal, whole-wheat flour, whole cornmeal, brown rice, and whole-wheat bread. Check the food label on processed foods - the words "whole" or "whole grain" should be listed before the specific grain in the product.
• Green represents vegetables: Vary your vegetables. Choose a variety of vegetables, including dark green- and orange-colored kinds, legumes (peas and beans), starchy vegetables, and other vegetables.
• Red represents fruits: Focus on fruits. Any fruit or 100 percent fruit juice counts as part of the fruit group. Fruits may be fresh, canned, frozen, or dried, and may be whole, cut-up, or pureed.
• Yellow represents oils: Know the limits on fats, sugars, and salt (sodium). Make most of your fat sources from fish, nuts, and vegetable oils. Limit solid fats like butter, stick margarine, shortening, and lard, as well as foods that contain these.
• Blue represents milk: Get your calcium-rich foods. Milk and milk products contain calcium and vitamin D, both important ingredients in building and maintaining bone tissue. Use low-fat or fat-free milk after the age of two years. However, during the first year of life, infants should be fed breast milk or iron-fortified formula. Whole cow's milk may be introduced after an infant's first birthday, but lower-fat or skim milk should not be used until the child is at least two years old.
• Purple represents meat and beans: Go lean on protein. Choose low-fat or lean meats and poultry. Vary your protein routine - choose more fish, nuts, seeds, peas, and beans.

Activity is also represented on the pyramid by the steps and the person climbing them, as a reminder of the importance of daily physical activity.

According to the Dietary Guidelines for Americans 2005 (the most recent guidelines), a decrease in energy intake of 50 to 100 calories per day for children who are gaining excess fat can reduce the rate at which they gain weight. With this reduction in energy intake, they will grow into a healthy weight as they age. Help your child to find higher-calorie foods that can be cut from his/her daily intake.

Nutrition and activity tips

• Try to control when and where food is eaten by your children by providing regular daily meal times with social interaction and demonstration of healthy eating behaviors
• Involve children in the selection and preparation of foods and teach them to make healthy choices by providing opportunities to select foods based on their nutritional value
• For children in general, reported dietary intakes of the following are low enough to be of concern by the USDA: vitamin E, calcium, magnesium, potassium, and fiber. Select foods with these nutrients when possible.
• Most Americans need to reduce the amount of calories they consume. When it comes to weight control, calories do count. Controlling portion sizes and eating non-processed foods helps limit calorie intake and increase nutrients.
• Parents are encouraged to provide recommended serving sizes for children
• Parents are encouraged to limit children's video, television watching, and computer use to less than two hours daily and replace the sedentary activities with activities that require more movement
• Children and adolescents need at least 60 minutes of moderate to vigorous physical activity on most days for the maintenance of good health and fitness and for a healthy weight during growth
• To prevent dehydration, encourage children to drink fluids regularly during physical activity and drink several glasses of water or other fluids after the physical activity is completed

To find more information about the Dietary Guidelines for Americans 2005 and to determine the appropriate dietary recommendations for your child's age, sex, and physical activity level, visit the Online Resources page for the links to the Food Pyramid and 2005 Dietary Guidelines sites. Please note that the Food Pyramid is designed for persons over the age of two who do not have chronic health conditions.

Always consult your child's physician regarding his/her healthy diet and exercise requirements.

• Back to sleep for every sleep
  • Supine position (baby on its back) until baby is one year old, even if baby can roll over
  • Baby should be alone in a crib, portable crib, pack-and-play, or bassinet
• Use a firm sleep surface
  • A firm crib mattress covered by a fitted sheet
• Keep baby's face uncovered for easy breathing
  • Use a sleep sack instead of a blanket
• Room-sharing without bed sharing
  • Keep baby in a separate, but nearby, sleeping area. For example, a bassinet or portable crib in your room
• Keep soft objects and loose bedding out of the crib to reduce the risk of Sudden Infant Death Syndrome (SIDS), suffocation, entrapment, and strangulation
  • No pillows, bumper pads, blankets, comforters, stuffed animals, or other soft objects
• Avoid commercial devices marketing to reduce the risk of SIDS
  • These include wedges, sleep positioners, special mattresses, and portable recliners
• Don't rely on cardiorespiratory monitors to prevent SIDS
  • There isn't any evidence that these decrease SIDS
• Avoid overheating baby
  • The infant should be lightly clothed for sleep, and the bedroom temperature should be kept comfortable for a lightly clothed adult
  • In general, dress your baby in no more than one extra layer than you would wear
• Avoid exposure to smoke
  • Don't allow anyone to smoke around baby
• Consider offering a pacifier at naptime and bedtime
  • For breastfeeding infants, offer a pacifier only after nursing is well established
• Breastfeeding is recommended
• Immunize following the American Academy of Pediatrics (AAP) and Center for Disease Control (CDC) recommendations
• Provide supervised, awake tummy time
  • This helps with muscle development and minimizes the risk of plagiocephaly(flat heads).

Tummy Time

Since the American Academy of Pediatrics (AAP) started recommending that babies be put "back to sleep" more than 20 years ago, the occurrences of Sudden Infant Death Syndrome (SIDS) have dropped more than 50 percent. Unfortunately, more infants are developing flat spots on the back of their heads, a condition known as positional plagiocephaly.

In addition, because baby spends so much time on the back, there are fewer chances to work the muscles in the upper body (neck, shoulder, upper trunk, and arms), and motor development (grasping, manipulating toys) can be delayed. That can affect how long it takes your baby to master skills like lifting the head and rolling over, but also impact sitting and crawling.

You can start helping your baby today with the following ideas.

• Start early. You can start right away, as early as in the hospital. Aim for two to three times a day, for three to five minutes each time. Place your newborn belly-down on your chest or across your lap for a few minutes so baby gets used to the position. Your baby may not like tummy time at first, so try a slightly different approach if needed.
• Think comfort. As your baby grows stronger, lay baby on a flat, clean surface (e.g., blanket, play mat, etc.). If baby cries or squirms, try some extra padding by rolling up a small receiving blanket and tucking it under the chest.
• Safety first. Babies need time every day to be on their tummies, but always under careful supervision. Also, wait at least 20 minutes after feedings to avoid pressure on a full belly.
• Watch for cues. Choose a time when baby's in the quiet alert state: ready to play and interact.
• Make it fun. Get down on the floor in front of your baby and make eye contact. Next, place and rotate brightly colored toys in front of your baby at different distances to encourage reaching (and later, crawling). Choose toys in a variety of textures, colors, and shapes. A mirror is another good option.
• Get others in on the act. Encourage friends, family, and caregivers to get down on the floor for short periods of tummy time.
• Switch it up. On a weekly basis, change how you place baby in the crib. Rotate which end of the crib is considered the head and foot. This encourages baby to turn his/her head to see what's happening.

In addition to taking your child to the physician when your child is ill or needs an examination to participate in a particular activity, routine well-care visits are recommended.

Well-care, well-baby, or well-child visits are routine visits to the child's physician for the following reasons:

• Physical examinations
• Immunization updates
• Tracking growth and development
• Finding any problems before they become serious
• Information on health and safety issues
• Information on nutrition and physical fitness
• Information on how to manage emergencies and illnesses

Your child's physician can also provide guidance on other issues, such as the following:

• Behavioral problems
• Learning problems
• Emotional problems
• Family problems
• Socialization problems
• Puberty and concerns about teenage years

When should well-care visits be scheduled?

Your child's physician will give you a schedule of ages when a well-care visit is suggested. The American Academy of Pediatrics (AAP) recommends this schedule for routine well-care visits at the following ages:

• Before newborn is discharged from the hospital, or at 48 to 72 hours of age
• 2 to 4 weeks
• 2 months
• 4 months
• 6 months
• 9 months
• 12 months
• 15 months
• 18 months
• 24 months
• 2 years
• 3 years
• 4 years
• 5 years
• 6 years
• 8 years
• 10 years
• Annually, between the ages of 11 and 21 years

Buying the right bicycle

It is important that the bicycle your child rides is the right size. In addition, consider the following recommendations:

• The bicycle should not be too big or complicated
• Your child should be able to place the balls of his/her feet on the ground when sitting on the seat
• The bicycle should have a bell or a horn

Buying the right helmet

Although helmets can cost between $13 and $50, they can save money by possibly preventing a visit to your child's physician or the emergency room. When shopping for a helmet, take your child with you - a child will be more likely to wear a helmet if he/she picks it out. Helmets should meet the following requirements:

• The helmet should be approved by the American National Standards Institute (ANSI), the American Society for Testing and Materials (ASTM), and the US Consumer Product Safety Commission (CPSC). Approved helmets meet stringent safety standards.
• Your child should like his/her helmet (bright-colored helmets with stickers are very popular). This will increase the likelihood that he/she will wear it consistently.
• The helmet should fit your child's head so that when the straps are snug, the helmet does not move around on the head

Some helmets are multi-sport, which can be used for in-line skating, skateboarding, bicycling, or other wheel sports. Helmets that are specifically called "bicycle helmets" are designed only for that sport. Helmets come in many sizes and varieties, including many infant sizes.

Proper helmet wear

Helmets come with sponge pads to adjust the fit on your child's head. A properly-fitted helmet should meet the following requirements:

• The helmet should fit snug, not moving on the head
• The front edge of the helmet should be two finger widths above the eyebrows
• Front and back straps of the helmet should form a V just below the ear
• Front straps should be vertical, and the rear straps should be flat
• The chinstrap should be snug when your child opens his/her mouth (one finger should fit between the chin and chin strap when the mouth is closed)

Road rules

Since most bicycle crashes occur because the child breaks a traffic rule, it is important to teach your child the traffic and road rules. Besides wearing a bicycle helmet, teach your child the following traffic and road rules:

• Stop before riding into traffic from a driveway, sidewalk, parking lot, or other street
• Look left, right, and left again to check for cars
• If the road is clear, enter
• Ride on the far right of the road, with traffic
• Ride so cars can see you, wearing brightly colored clothes, especially at night
• Obey all traffic signals and stop signs
• Look back and yield to traffic coming from behind before turning left
• Ride bicycles in a single file
• Look for uneven pavement or other surface problems

Special note: Try to avoid letting your child ride his/her bicycle, in-line skates, or skateboard during non-daylight hours or during bad weather. If your child does ride at night, make sure his/her bicycle has a headlight, flashing taillight, and reflectors.

In-line skates

Even experienced in-line skaters can crash and sustain injuries. The following recommendations were derived from the National Safety Council and the US Consumer Product Safety Commission (CPSC):

• Always wear protective gear, such as elbow and knee pads, gloves, helmets, and wrist guards
• Buy durable skates with proper ankle support
• Always warm up your muscles before skating by skating slowly for five minutes or more
• Skate with knees slightly bent to maintain balance
• Practice stopping, which is done by bringing the foot with the heelstop forward until the heelstop is level with the toes of the other foot, bend the front knee, and lift the front foot's toes
• Always skate on the right side of sidewalks and other paths
• Pass on the left and warn others that you are passing
• Avoid skating in the street, especially where there is a lot of traffic
• Look for uneven pavement or other surface problems
• Check your skates regularly for wear and tear. Make sure the wheels are tightened.

Skateboards

Skateboards should never be used on surface streets. Even experienced skateboarders can fall, so learning how to fall safely can help reduce the risk of severe injuries. The following are recommendations from the National Safety Council regarding how to fall correctly:

• When losing your balance, crouch down on the skateboard so your fall is short
• Try to land on fleshy parts of your body when falling
• Try to roll as you fall, which prevents your arms from absorbing all the force
• Try to relax, rather than remaining stiff, when falling

When riding a skateboard, children should obey all traffic rules. Other safety precautions to take when skateboarding include the following:

• Wear protective gear such as helmets, padding, and closed-toe and slip-resistant shoes
• Check the skateboard for wear and tear
• Only allow one person per skateboard
• Do not hitch rides from bicycles, cars, or other vehicles
• Carefully practice tricks in designated skateboarding areas

Scooters

Although scooters have been around since the 1950s, the popular new scooters are often made of lightweight aluminum, weighing less than 10 pounds. They have quickly risen in popularity and are the cause of more and more emergency room visits. Health officials have seen a dramatic increase in scooter-related accidents and injuries. Most of the injuries occur among boys under the age of 15. The most common injuries are fractures or dislocations to the arm or hand, followed by cuts, bruises, strains, and sprains. Almost half of all injuries tend to occur to the arm or hand, while about one-fourth are to the head, and another fourth to the leg or foot. Deaths directly related to scooter accidents have also occurred.

The Centers for Disease Control and Prevention (CDC) recommends the same precautions for scooters as for bicycling and in-line skating. It is thought that many injuries might be prevented or reduced in severity if protective equipment is worn. Helmets can prevent 85 percent of head injuries, elbow pads can prevent 82 percent of elbow injuries, and knee pads can prevent 32 percent of knee injuries. Although wrist guards are effective in preventing injuries among in-line skaters, the protection they provide against injury for scooter riders is unknown, as wrist guards may make it difficult to grip the scooter handle and steer it.

Based on evidence of injury prevention effectiveness for other related activities, the following recommendations may help to prevent scooter-related injuries:

• Wear an approved helmet that meets safety standards
• Use knee and elbow pads
• Ride scooters on smooth, paved surfaces without traffic, and avoid streets and surfaces with water, sand, gravel, or dirt
• Do not ride scooters at night
• Young children should not use scooters without close supervision

Vehicle passenger safety studies reveal that nearly 80 percent of children's car seats used nationwide are not properly installed. To address this problem, Corewell Health Children's has teamed up with Mike Savoie Chevrolet to offer free safety seat checks and installation instructions for area families.

We offer monthly seat check locations in Detroit, Redford, and Troy. These free car seat safety checks are performed by certified child passenger safety technicians and are available by appointment only.

See specific location information and appointment availability before registering.

It is estimated that 39 percent of all homes in the US have some type of firearm, of which one in four is a handgun. Access to firearms in the home increases the risk of unintentional firearm-related death and injury among children. Unintentional shootings cause more than 20 percent of all firearm-related deaths among children ages 14 and under.

An underestimation of the child's ability to gain access to a firearm in the home is a common problem. In addition, unlike adults, children are unable to distinguish between a real gun and toy guns, and children are not able to make good judgments about how to safely handle a gun.

Firearms are often portrayed on television and in movies as glamorous. In addition, the consequence of firing a firearm may not be portrayed as seriously in the media, because children often see the "shot" actors alive in other movies. Toy guns may add to a child's perception that real guns, like toy guns, are harmless and fun. It is important that your child knows the difference between a real gun and a toy gun. Although the only sure way to keep your child safe from unintentional firearm-related injury and death in your home is to remove all firearms from the home, there are other ways to improve the safety of your child around firearms.

Proper storage

Firearms should always be stored unloaded and separate from ammunition. The firearm and ammunition should both be locked away and out of reach of children.

Educate your child

Teaching your child the dangers of guns may help prevent unintentional firearms-related injuries and death. A parent should teach a child if he/she sees a firearm, to:

• Not touch the firearm
• Leave the area
• Tell an adult immediately

Check with neighbors

Even if your own home is free of firearms, your child may visit another home where firearms are kept. Always check with neighbors, friends, and relatives to make sure they safely store their firearms out of reach of children.

Other safety devices

Safety devices such as gun locks, lock boxes, and gun safes should be used for every firearm in the house. Safety devices on firearms could prevent most unintentional fatal shootings of children ages 5 and under.

In order to protect you and your family, a thorough safety check of every room in your home should be conducted on a regular basis. Unintentional accidents, injuries, and non-traumatic emergencies may be prevented, and your family will be healthier and safer when you practice a little prevention.

The following checklist may be printed so it can be used for the inspection of your home:

Adult's bedroom

___ Do not leave medications, toiletries, or other household products in drawers or on nightstands.

___ To avoid accidental injuries or choking, keep penknives, nail files, scissors, and pocket change out of reach.

___ Install a smoke detector in the hallway outside of the bedrooms. Check and change the batteries regularly.

___ Make certain drapery cords and/or blind cords are well out of reach of children.

Child's bedroom

___ Make certain the crib mattress fits snugly.

___ Crib slats should be placed no wider than 2 and 3/8 inches apart.

___ Make certain the crib has been put together properly and is not missing screws or bolts - to prevent it from collapsing.

___ Make certain there is a carpet or rug beneath the crib or changing table to soften this impact if an infant falls.

___ Make certain drapery cords and/or blind cords are well out of reach of children and cribs.

___ Remove all crib gyms, hanging toys, and decorations from a crib by the time a baby can raise up on hands and knees.

___ Make sure there is a safety belt on the infant changing table, and that it is used consistently and properly.

___ Make sure baby powder and lotions are out of a baby's or child's reach. But, make sure the baby powder and lotions are within your reach, so you do not have to leave the infant to reach these items.

___ If your child can climb out of the crib, consider a youth bed with guard rails, or place the crib mattress on the floor.

___ Never leave small parts or pieces of a toy(s) in a child's room.

___ Make certain a night light is not near or touching drapes or the bedspread.

___ Never place a crib, playpen, or bed near a window.

___ Make certain window screens are securely in place, or that window guards are present, to prevent a child from falling from a window.

___ Make certain there are plug protectors in the unused electrical outlets.

___ If there is a lid on the toy box, it should not be heavy, hinged, or lockable. Children may crawl inside and become trapped.

Bathroom

___ Put a nonskid bath mat on the floor and a nonskid mat or decals in the bathtub.

___ Protect all electrical outlets with ground fault circuit interrupters.

___ Store medicines, cosmetics, toiletries, and cleansers well out of reach of children.

___ When children are present, put child-resistant safety latches on all cabinets storing potentially harmful substances.

___ Store electrical appliances, such as hair dryers and curling irons, out of reach.

___ Always unplug such an appliance before leaving it unattended, no matter how briefly.

___ To avoid accidental scalding, make certain the tap water temperature is set no higher than 120°F.

___ Never leave a child or disabled person unattended in a bathtub, or in a bathroom where there is a tub, sink, or bucket containing water.

___ Keep toilet lids closed.

Kitchen

___ Do not store vitamins (or medications) on the kitchen table, countertop, or windowsill.

___ Make certain knives, scissors, and other sharp utensils are out of reach.

___ Store dishwasher detergent and other cleaning supplies in their original containers and out of reach.

___ When children are present, install safety latches on cabinets and drawers within a child's reach.

___ Keep chairs and step stools away from counters and stoves.

___ Always turn pot handles inward when cooking on the stove. Use back burners whenever possible.

___ Keep the toaster out of the reach of toddlers.

___ Make certain appliance cords are not dangling, so they cannot be pulled from a counter.

___ Unplug appliance extension cords when not in use.

___ When children are present, use plug protectors for all unused wall outlets.

___ If a child is in a highchair, make sure it is sturdy and has a seat belt with a strap between the legs.

___ Keep a working fire extinguisher in your kitchen.

Living room

___ Keep houseplants out of reach of children. A number of plants are poisonous.

___ Make certain television sets and other heavy items are secure so they cannot be tipped over.

___ Remove unnecessary extension cords.

___ Put plug protectors in any unused electrical outlets when children are present.

___ Move tables and other objects with sharp edges away from the center of a room, especially if there are toddlers or disabled persons in the home.

___ Place protective material on sharp furniture edges.

___ Keep drapery and blind cords out of reach of children and/or disabled persons.

___ Secure area rugs - to prevent falls and slips.

Outdoors

___ Keep stairs and walkways clear of snow, wet leaves, or other debris.

___ Repair cracks or chips in cement sidewalks and stairs.

___ Make certain railings, gates, and fences are secure and in good repair.

___ Keep garbage cans covered.

___ There should be a fence with a locked gate between the house and the backyard swimming pool.

___ Garden tools and lawn equipment should be securely stored.

___ Play equipment, such as swing sets and garden furniture, should be properly anchored and assembled. Check regularly for rust, splintered wood, or cracks.

Miscellaneous

___ If you have a fireplace, wood-burning stove, or other heat source, place barriers around it to avoid accidental burns.

___ Inspect and clean chimneys and stovepipes regularly.

___ Make certain hazardous items, such as bug sprays, cleaners, auto care products, and weed killers, are secured and stored in their original containers in the garage, utility room, or basement.

___ Place "Mr. Yuk" stickers on all hazardous items.

___ The first action when a person has ingested a toxic substance is to consult with the local poison control center at the universal telephone number in the United States - 800.222.1222.

___ Make certain plastic bags, broken pieces of toys, buttons, screws, and other choking or suffocation hazards are stored out of reach of children.

___ Post emergency telephone numbers near each telephone in your home.

___ When children are present, safety devices, such as gates, locks, and doorknob covers, should be in use at all stairways and exits in your home.

___ Make sure all indoor and outdoor stairways and entries are well-lighted and clear.

___ Make certain bathrooms and bedrooms can be unlocked from the outside.

___ Keep matches and lighters out of the reach of children and disabled persons.

___ A home should have two unobstructed exits, in case of fire or other emergency.

___ Check all electrical cords to make sure they are not cracked or frayed.

___ Make certain outlets or extension cords are not overloaded.

___ It is best not to use space heaters. If they are used, make sure they are in safe condition. Never plug them into an extension cord. Do not place them near drapes or furnishings.

___ Paint or wallpaper should not be chipping or peeling.

___ Keep purses, backpacks, and other portable storage bags out of a child's reach. They may contain medicines, penknives, hard candies, and other items that may harm children.

Corewell Health Children’s is committed to serving the health needs of our community, including offering parents valuable information about the health and safety of their children. Avoid accidents and injury with the help of information about safety, and learn helpful tips about how to treat injuries.

For children between the ages of 5 and 14, unintentional injury-related deaths occur most often when riding in a car. Children are most often injured, suffer more severe injuries, or die in motor vehicle crashes when they are not properly restrained. According to the National SAFE KIDS Campaign, children under age 4 who ride in motor vehicles unrestrained are twice as likely to die or suffer injuries in a car crash.

With proper precautionary measures, such as the proper use of age-appropriate child safety seats, most unintentional injuries and unintentional injury-related deaths can be prevented. Children can get hurt when parents or caregivers do not properly restrain them when riding in a vehicle, or are unaware of the dangers associated with certain motor vehicle situations. High-risk situations may include, but are not limited to, the following:

• Lack of use of child safety restraints or improper use of safety restraints in motor vehicles
• improperly used or installed child safety seats
• Placing children in front of passenger seat airbags (either in an infant safety seat or sitting facing forward)
• Allowing children to ride in the cargo areas of pickup trucks
• Trunk entrapments
• Leaving children unattended in cars

Use of safety restraints in motor vehicles

Physically, children are smaller than average adults. Their smaller size means that the standard safety belts in motor vehicles do not properly fit to protect children's bodies.

One age group, from 4 to 8 years of age, is especially at risk for improperly using safety belts in motor vehicles. According to the Centers for Disease Control and Prevention (CDC), children do not fit in adult shoulder/lap belts (without a booster seat) until they are 58 inches tall and weigh 80 pounds.

However, children between the ages of 4 to 8 years who have outgrown their child safety seat are often placed too soon in adult lap/shoulder belts without a booster seat. Unfortunately, it is estimated that only 5 percent of children in this age group are properly restrained with booster seats in motor vehicles.

Use of child safety seats

Many people think they have installed their child safety seat correctly and believe they are using it properly. However, National SAFE KIDS Campaign Car Seat Check Ups prove differently. As many as 85 percent of child safety seats are found to be improperly installed and/or used when vehicles are stopped and checked. A child can suffer injuries or death in a motor vehicle crash if the child safety seat is not properly installed or used.

Some of the most common mistakes in installing or using child safety seats include the following:

• Safety belt not holding the seat in tightly and/or not in locked mode
• Harness straps not snug and/or routed correctly
• Harness retainer clip not at armpit level
• Locking clip not used correctly
• Car seat recalled and not repaired (includes booster seats)
• Infants placed rear-facing in front of an active airbag
• Children turned forward-facing too soon

Parents and caregivers should carefully read their vehicle owner's manual and the instructions that come with the child safety seat to ensure proper installation and use of the seat. Some child safety seats are not compatible with certain vehicles - try the child's safety seat in your vehicle before you purchase it. Also, place your child in the child safety seat before purchase to ensure proper fit.

The danger of airbags

Airbags, when properly used with the vehicle's lap/shoulder belt system, can save adult lives. However, airbags can increase the danger to a child's safety.

When infants in rear-facing child safety seats and children who are unrestrained are placed in the front seat with an airbag, they may be too close to an inflating airbag in the event of a crash. An airbag will inflate at speeds up to 200 mph, which can hurt passengers who are too close to the airbag. In addition, because of the child's size, the airbag can strike him/her on the head or neck, resulting in serious or fatal injuries.

To ensure your child is as safe as possible in a vehicle, never place him/her in front of an airbag. The safest place for small children riding in vehicles is the rear seat, away from the impact of head-on crashes. If your child must ride in the front seat, move the seat as far back as possible, away from the airbag. If the car has no back seat, infants will only be safe in their rear-facing child safety seats if the vehicle has no airbag, or if the airbag has been switched off (an option in some vehicles).

Riding in the cargo area of trucks

Pickup trucks, although popular vehicles, may not be as safe as other vehicles for small children. Limited cab space often leads to parents letting their children ride in the cargo area. However, riding in cargo areas increases the risk of dying 10 times when involved in a collision, compared to other types of collisions, according to the US Department of Transportation. Ejection (being thrown out) from the cargo area is the main cause of injury and death for cargo passengers. More than half of the deaths that occur among people riding in pickup truck cargo beds are children and teenagers. Covered cargo areas, too, can pose a danger to children because of carbon monoxide poisoning from exhaust fumes.

The National Highway Traffic Safety Administration (NHTSA) is campaigning for stricter passenger safety laws nationwide for passengers riding in pickup trucks. Currently, only one state prohibits riding in open beds of pickup trucks, and 21 other states have placed certain restrictions on riding in pickup truck open beds. To protect your children, the NHTSA recommends that children never be allowed to ride or play in the cargo areas of any vehicle.

Trunk entrapment

A child's nature is to explore his/her surroundings. Unfortunately, this exploration can place a child in danger. Unintentional trunk entrapment, when children lock themselves in a trunk, can be fatal. Between 35 and 40 percent of children ages 14 and under who accidentally lock themselves in a trunk will die due to hyperthermia (heat stroke) and/or asphyxiation (suffocation).

To prevent unintentional trunk entrapment, teach your children not to play in and around vehicles. Always lock the vehicle and keep the keys away from children. Carefully watch your young children when they are around vehicles. Keep rear fold-down seats closed inside the vehicle.

Certain automobile manufacturers now include escape releases or sensor systems in trunks. However, small children may not know how to operate these.

Leaving children unattended in cars

As tempting as it may be to run a quick errand, leaving children unattended inside a vehicle, "even for a minute," can be dangerous. When left unattended, children may be able to start the vehicle or put the vehicle in neutral. In addition, heat build-up or dangerously cold temperatures inside a vehicle can quickly become fatal to children.

Participating in sports is great for children both physically and psychologically. Sports can increase a child's physical coordination, fitness, and self-esteem. In addition, sports can teach children about teamwork and self-discipline.

However, because children's bodies are still growing and their coordination is still developing, children are more susceptible to sports injuries. Approximately 3.5 million children ages 14 and under are treated for sports-related injuries each year. Half of all of those injuries can be prevented with proper use of safety gear, changes to the playing environment, and the establishment of sports rules that help prevent injuries.

Most childhood sports injuries occur due to the following factors:

• Lack of education and awareness about safety precautions and potential injury
• Inappropriate or lack of equipment
• Improperly conditioned children

The following are safety precautions recommended to prevent sports injuries in children:

• Children should wear appropriate safety gear and equipment
• The playing environment should be safe
• The sport should be properly practiced with children of similar size, skill level, and physical and emotional maturity
• Children should be fit and mentally prepared
• Children practicing a sport should be supervised by an adult who enforces the safety rules
• Children should stay hydrated during and after sports

Safety gear and equipment

Safety gear should be sport-specific and may include such items as goggles, mouthguards, shin-elbow-knee pads, and helmets. The safety gear worn by a child should fit properly. In addition, sports equipment (such as bats, baskets, and goals) should be in good working condition and any damage should be repaired or replaced. The playing area should be free from debris and water.

Physical checkup

To make sure your child is physically fit to participate in a particular sport, your child's physician should conduct a "sports physical." These physicals can reveal your child's physical strengths and weaknesses and help determine which sports are appropriate. Most sports physicals for children include a health examination that measures height, weight, and vital signs, as well as check eyes, nose, ears, chest, and abdomen. In addition, your child's physician may perform an orthopedic examination to check joints, bones, and muscles.

Age

Starting a child in sports too young will not benefit the child physically. The American Academy of Pediatrics (AAP) recommends that children begin participating in team sports at age 6, when they better understand the concept of teamwork. However, no two children are alike, and some may not be ready physically or psychologically to take part in a team sport even at age 6. A parent should base his/her decision on whether to allow the child to take part in a particular sport based on the following:

• Age
• Weight
• Build
• Physical development
• Emotional development
• Child's interest in the sport

Note: The American Academy of Pediatrics (AAP) recommends that late-developing teens avoid contact sports until their bodies have developmentally "caught up" to their peers' bodies.

The importance of hydration

As your child participates in sports, he/she will sweat. This sweat must be replaced with equal amounts of fluids, usually 1 to 1 1/2 liters per hour of intense sports activity. Your child should drink fluids before, during, and after each practice or game. To avoid stomach cramps from drinking large amounts of fluids at once, encourage your child to drink about one cup of water (or a type of sports drink) every 15 to 20 minutes. Drinks to avoid include those with carbonation and caffeine. The following are the most common symptoms of dehydration. However, each child may experience symptoms differently. Symptoms may include:

• Extreme thirst
• Weakness
• Headache
• Dark-colored urine
• Slight weight loss

If your child exhibits signs of dehydration, make sure he/she receives fluids immediately, as well as a snack. The symptoms of dehydration may resemble other medical conditions or problems. Always consult your child's physician for a diagnosis.

Billions of toys to amuse children of all ages are sold each year in the US. Unfortunately, toys are also associated with thousands of injuries each year, some of which result in death. Children ages 4 and under are especially at risk for injury from toys. Injuries can range from falling, choking, strangulation, burning, drowning, and even poisoning. However, the leading cause of toy-related death is choking, usually on latex balloons.

Injury often results when a toy is misused or used by children who are too young for that particular toy. An example is a toy with small parts, designed for older children, which can cause choking when those small parts are ingested by a curious toddler.

Knowing what dangers are associated with certain toys and age groups can help you better protect your child from toy injuries. When selecting toys for your child, consider the following recommendations:

• Choose toys that are age-appropriate and meet your child's skill level and interest by reading the toy's labeling
• Avoid using latex balloons as much as possible. Use Mylar balloons instead.
• Make sure toys are used in safe environments, such as keeping a riding toy away from stairs
• Be involved in your child's play
• Store toys intended for older children separately from toys used by younger children
• Use a small parts tester to determine which small toys or parts are a choking hazard to children under age 3. A small parts tester allows for small objects to be inserted – if the object fits, it is a choking hazard.
• Check toys regularly for damage and other hazards
• Stay up-to-date on toy recalls through the US Consumer Product Safety Commission

Supervising your child's play, in addition to following the recommendations made by toy manufactures, could save lives.

Although most drownings occur in residential swimming pools, children can drown in just one inch of water (such as in buckets, bathtubs, wading pools, diaper pails, toilets, hot tubs, and spas). In addition, open waters such as oceans, rivers, and lakes pose a drowning threat to older children.

Consider these facts concerning drowning from the National SAFE KIDS Campaign:

• When a child is submerged two minutes in water, he/she loses consciousness
• Irreversible brain damage sets in after four to six minutes of water submersion
• Most children die if they are found after 10 minutes in the water

Parents are advised to take the following preventive steps to protect their children from drowning:

• Never leave your child unsupervised near water at or in the home, or around any body of water, including a swimming pool
• Learn cardiopulmonary resuscitation (CPR) and infant and child first aid
• Do not rely on personal flotation devices (PFDs) or swimming lessons to protect your child
• Install childproof fencing around swimming pools
• Make sure you have rescue equipment, a telephone, and emergency phone numbers near the swimming pool
• Insist that your child wear a US Coast Guard-approved personal flotation device on boats at all times
• Do not allow children to dive in waters less than 9 feet deep

Everyone should have a well-stocked first aid kit at home, in the car, and in the workplace. You may also want to stock a portable kit (a box or small bag) that can be taken to the site of an emergency.

It is important to check your kit regularly to restock items that have been used and to replace items that are out of date.

The contents of the kit vary depending upon the number of people it is designed to protect, as well as its intent for use. Recommended contents of a first aid kit include the following:

• Instruments
  • Bulb syringe
  • Scissors
  • Thermometer (oral and rectal)
  • Tweezers
• Bandages
  • Adhesive tape
  • Butterfly bandages
  • Elastic bandages
  • Hypoallergenic tape
  • Sling (triangular-shaped cloth)
  • Sterile cotton balls
  • Sterile eye patches
  • Sterile gauze pads (4" x 4")
  • Stretchable gauze roll
  • Waterproof tape
• Medications
  • Acetaminophen
  • Antacid
  • Antibiotic ointment
  • Antidiarrheal medication
  • Antihistamine
  • Aspirin
  • Antiseptic ointment
  • Calamine lotion
  • Decongestant
  • Hydrocortisone cream
  • Ibuprofen
  • Sugar or glucose solution
• Miscellaneous Items
  • Alcohol (rubbing 70 percent)
  • Alcohol wipes
  • Blanket
  • Candles
  • Chemical ice packs or ice bag
  • Chemical hot packs or hot water bottle
  • Cotton swabs
  • Disposable latex gloves
  • Face mask for cardiopulmonary resuscitation (CPR)
  • First-aid book
  • Flashlight
  • Hydrogen peroxide
  • Insect repellent
  • Insect sting swabs
  • Matches
  • Measuring spoons
  • Paper and pencil
  • Paper cups
  • Soap
  • Safety pins
  • Sewing needle
  • Sunscreen
  • Tissues
  • Tongue blades

You can also use the following everyday items in the event of an emergency:

• Disposable or cloth diapers for compresses, bandages, or padding for splints
• Dish towels for bandages or slings
• Umbrella, rolled magazine, or layered newspaper for use as a splint

In addition, it is helpful to carry the following items in your car:

• A large blanket
• Gallon-size bottle of water
• Flashlight and extra batteries

If your child or other family member has special medical needs, be sure to carry extra medical supplies when you go on an outing or trip. Some of these items might include the following:

• An insect allergy kit containing medications to be used by persons allergic to insect stings
• Medications, syringes, and special equipment or supplies

Be sure any member of your family who has special needs wears a Medic Alert® bracelet or necklace at all times. Applications are available in most pharmacies.

How much will my baby grow?

In the first month of life, babies usually catch up and surpass their birthweight, then steadily continue to gain weight. A weight loss of up to about 10 percent of birthweight is normal in the first two to three days after birth. However, the baby should have gained back to his/her birthweight by about the 10th or 11th day. While all babies may grow at a different rate, the following indicates the average for boys and girls up to 1 month of age:

• Weight
  • After the first 2 weeks, should gain about 1 ounce each day
• Average length at birth
  • 20 inches for boys
  • 19 3/4inches for girls
• Average length at one month
  • 21 1/2 inches for boys
  • 21 inches for girls
• Head size
  • Increases to slightly less than 1 inch more than birth measurement by the end of the first month

What can my baby do at this age?

Although a newborn spends about 16 hours a day sleeping, the time a baby is awake can be busy. Much of a newborn's movements and activity are reflexes or involuntary - the baby does not purposefully make these movements. As the nervous system begins to mature, these reflexes give way to purposeful behaviors.

Reflexes in newborns include the following:

• Root reflex
  • This reflex occurs when the corner of the baby's mouth is stroked or touched. The baby will turn his/her head and opens his/her mouth to follow and "root" in the direction of the stroking. The root reflex helps the baby find the breast or bottle
• Suck reflex
  • When the roof of the baby's mouth is touched with the breast or bottle nipple, the baby will begin to suck. This reflex does not begin until about the 32nd week of pregnancy and is not fully developed until about 36 weeks. Premature babies may have a weak or immature sucking ability, because they are born prior to the development of this reflex. Babies also have a hand-to-mouth reflex that accompanies rooting and sucking and may suck on their fingers or hands
• Moro reflex
  • The Moro reflex is often called a startle reflex because it usually occurs when a baby is startled by a loud sound or movement. In response to the sound, the baby throws back his/her head, throws out his/her arms and legs, cries, then pulls his/her arms and legs back in. Sometimes, a baby's own cries can startle him/her, initiating this reflex. The Moro reflex lasts until the baby is about 5 to 6 months old
• Tonic neck reflex
  • When a baby's head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow. This is often called the "fencing" position. The tonic neck reflex lasts until the baby is about 6 to 7 months old
• Grasp reflex
  • With the grasp reflex, stroking the palm of a baby's hand causes the baby to close his/her fingers in a grasp. The grasp reflex lasts only a couple of months and is stronger in premature babies
• Babinski reflex
  • : With the Babinski reflex, when the sole of the foot is firmly stroked, the big toe bends back toward the top of the foot, and the other toes fan out. This is a normal reflex until the child is about 2 years old
• Step reflex
  • This reflex is also called the walking or dance reflex because a baby appears to take steps or dance when held upright with his/her feet touching a solid surface

Newborn babies not only have unique reflexes, but also have a number of physical characteristics and behaviors that include the following:

• Head sags when lifted up, needs to be supported
• Turns head from side to side when lying on his stomach
• Eyes are sometimes uncoordinated, may look cross-eyed
• Initially fixes eyes on a face or light, then begins to follow a moving object
• Beginning to lift head when lying on stomach
• Jerky, erratic movements
• Moves hands to mouth

What can my baby say?

At this early age, crying is a baby's only form of communication. At first, all of a baby's cries sound similar, but parents soon recognize different types of cries for hunger, discomfort, frustration, fatigue, and even loneliness. Sometimes, a baby's cries can easily be answered with a feeding or a diaper change. Other times, the cause of the crying can be a mystery, and crying stops as quickly as it begins. Regardless of the cause, responding to your baby's cries with a comforting touch and words are essential in helping your baby learn to trust you and rely on you for love and security.

What does my baby understand?

You may find that your baby responds in many ways, including the following:

• Startles at loud noises
• Looks at faces and pictures with contrasting black and white images
• Gives attention to voices, may turn to a sound
• Hints of a smile, especially during sleep

How to help increase your baby's development and emotional security

Young babies need the security of a parent's arms, and they understand the reassurance and comfort of your voice, tone, and emotions. Consider the following as ways to foster the emotional security of your newborn:

• Hold your baby face to face
• Talk in a soothing tone and let your baby hear your affectionate and friendly voice
• Sing to your baby
• Walk with your baby in a sling, carrier, or stroller
• Swaddle your baby in a soft blanket to help him/her feel secure and prevent startling by the baby's own movements
• Rock your baby in a rhythmic, gentle motion
• Respond quickly to your baby's cries

How much will my baby grow?

While all babies may grow at a different rate, the following indicates the average for boys and girls 1 to 3 months of age:

• Weight
  • Average gain of about 1 1/2 to 2 pounds each month
• Height
  • Average growth of over 1 inch each month
• Head size
  • Average growth of about 1/2 inch each month

What can my baby do at this age?

As your baby begins to grow, you will notice new and exciting abilities that develop. Babies at this age begin to relax the tight muscle tone of newborns and begin extending their arms and legs more. While babies may progress at different rates, the following are some of the common milestones your baby may reach in this age group:

• Most reflexes begin to disappear
• Neck muscles become stronger, head bobs then is held erect
• Turns head from side to side when placed on abdomen
• Brings hands or objects to mouth
• Looks at hands
• Follows light, faces, and objects
• Listens to sounds
• Opens and closes hands
• Holds, then drops a rattle or other object
• Active leg movements
• At the end of 3 months
  • Raises head and chest when placed on abdomen
  • Beginning to reach hands to objects, may bat at hanging objects with hands

What can my baby say?

It is very exciting for parents to watch their babies become social beings that can interact with others. While every baby develops speech at his/her own rate, the following are some of the common milestones in this age group:

• Coos, makes vowel sounds
• Cries become more purposeful and are different for hunger, fatigue, etc

What does my baby understand?

A baby's understanding and awareness of the world around him/her increases during this time. While babies may progress at different rates, the following are some of the common milestones in this age group:

• Knows familiar voices, especially of mother and father
• Smiles in response to others
• Responds to social contact, may coo
• Moves arms, legs, and body in rhythm with others' voice

How to help increase your baby's development and emotional security

Young babies need the security of a parent's arms, and they understand the reassurance and comfort of your voice, tone, and emotions. Consider the following as ways to foster the emotional security of your newborn:

• Hold your baby face to face and make eye contact
• Talk to your baby with a soothing, animated voice
• Give your baby rattles and soft toys with different sounds
• Let your baby hear different sounds (i.e., wind chime, ticking clock, soft music, music box)
• Show your baby bright pictures of black and white images
• Hang a mobile with bright objects above your baby
• Call your baby by name
• Hold your baby during feedings and provide comfort when he/she is distressed, and cuddling when happy

How much will my baby grow?

While all babies may grow at a different rate, the following indicates the average for boys and girls 4 to 6 months of age:

• Weight
  • Average gain of 1 1/4 pounds each month; by 6 months, has doubled birthweight
• Height
  • Average growth of 1/2 to 1 inch each month
• Head size
  • Average growth of about 1/2 inch each month

What can my baby do at this age?

This age is very social, and babies begin moving in much more purposeful ways. While babies may progress at different rates, the following are some of the common milestones your baby may reach in this age group:

• Grasp, Moro, root, and tonic neck reflexes (reflexes normally present in young infants) disappear
• Balances head well
• Sits with support, back is rounded
• Begins to support body with legs when held in standing position
• Rolls from back to front and front to back by 6 months
• Moves object from one hand to other
• Grabs feet and toes when lying on back
• Makes "swimming" motions with arms and legs when placed on abdomen
• Begins drooling (not always a sign of teething)
• Naps two to three times a day, for one to three hours each (on average)
• Begins to sleep longer at night (six to eight hours consistently)
• Has full color vision, able to see at longer distances

What can my baby say?

It is very exciting for parents to watch their babies become social beings who can interact with others. While every baby develops speech at his/her own rate, the following are some of the common milestones in this age group:

• Coos and gurgles when talked to, or in response to toys
• Babbles, begins to imitate sounds
• By 6 months, makes single-syllable sounds (da, ma, ba)
• Laughs
• Squeals
• Blows bubbles or "raspberries"

What does my baby understand?

A baby's awareness of people and surroundings increases during this time, and he/she may begin to interact with persons other than parents. While babies may progress at different rates, the following are some of the common milestones in this age group:

• Recognizes familiar things and people
• May hold out arms to be picked up
• Begins to learn concept of object permanence (i.e., a partially hidden object under a blanket is still there)
• May show displeasure when object or person goes away
• May recognize his/her own name
• May begin to understand "no"
• Begins to understand cause and effect (the sound a toy makes when it is dropped)

How to help increase your baby's development and emotional security

Consider the following as ways to foster the emotional security of your baby:

• Repeat sounds and smile when your baby makes sounds
• Laugh with your baby
• Talk to and imitate your baby during feeding, dressing, changing diapers, and bath time
• Place safe toys near your baby to encourage reaching and grasping
• Encourage laughing and play by making funny faces or sounds, or blowing on baby's belly and laughing
• Play peek-a-boo games to help develop object permanence, the understanding that objects are still present even though they cannot be seen
• Show your baby bright picture books and interesting objects
• Show your baby his/her reflection in a mirror
• Read books and stories to your baby, and point out pictures
• Take your baby outside to see new things and people
• Hold your baby for feedings and cuddle when he/she is awake
• Hold and comfort your baby when he/she is unhappy

How much will my baby grow?

While all babies may grow at a different rate, the following indicates the average for boys and girls 7 to 9 months of age:

• Weight
  • Average gain of 1 pound each month; boys usually weigh about 1/2 pound more than girls
• Height
  • Average growth of about 1/2 inch each month
• Head size
  • Average growth of about 1/4 inch each month

What can my baby do at this age?

Babies are rapidly developing their physical abilities at this age. They become mobile for the first time and safety in the home becomes an important issue. While babies may progress at different rates, the following are some of the common milestones your baby may reach in this age group:

• Rolls over easily from front to back and back to front
• Sits leaning forward on hands at first, then unsupported
• Bounces when supported to stand
• Gets on hands and feet and rocks back and forth
• May creep, scoot, crawl - backwards first, then forward
• Begins to pull up to stand
• Reaches for and grasps objects using whole hand
• Bangs toy on table
• Can hold an object in each hand
• May hold a bottle
• Plays peek-a-boo
• Grasps object with thumb and finger by 8 to 9 months
• Begins teething, usually starting with the two center front teeth in the lower jaw, then the two center front teeth in the upper jaw
• Learns to drink from cup
• Puts everything into mouth
• Naps are usually twice, sometimes three times a day, for one to two hours each (on average)
• May begin to awaken during the night and cry

What can my baby say?

It is very exciting for parents to watch their babies become social beings that can interact with others. While every baby develops speech at his/her own rate, the following are some of the common milestones in this age group:

• Makes two-syllable sounds (ma-ma, da-da)
• Makes several different vowel sounds, especially "o" and "u"
• Repeats tones or sounds made by others

What does my baby understand?

A baby's awareness of people and surroundings increases during this time, and he/she may begin to interact with persons other than parents. While babies may progress at different rates, the following are some of the common milestones in this age group:

• Responds to own name and "no"
• Pays attention to conversation
• Appears to understand some words (i.e.,"eat")
• Prefers mother over others
• Enjoys seeing self in mirror
• Responds to changes in emotions of others
• Is afraid of strangers
• Shows interest in and dislike of foods
• Makes attention-getting sounds such as a cough or snort
• Begins to understand object permanence and can uncover a toy after seeing it covered
• May follow one-step commands with a sign to demonstrate (i.e.,"get the ball" while parent points to ball)

How to help increase your baby's development and emotional security

• Consider the following as ways to foster the emotional security of your baby:
• Give your baby safe toys that make noises when shaken or hit
• Play in front of a mirror, calling your baby by name and pointing to your baby's reflection in the mirror
• When talking to your baby, pause and wait for him/her to respond, just as when talking with an adult
• Play pat-a-cake and peek-a-boo
• Name common objects when shown to your baby
• Make a variety of sounds with your mouth and tone of voice
• Repeat and expand the sounds your baby makes, such as "ma-ma" when he/she says "ma"
• Show picture books and read stories to your baby every day
• Give your baby toys with objects or knobs to push, poke, or turn
• Give your baby toys that stack or nest, and show him/her how they work
• Build a tower with your baby and show him/her how to knock it down
• Establish a routine for bath and bedtime

How much will my baby grow?

While all babies may grow at a different rate, the following indicates the average for boys and girls 10 to 12 months of age:

• Weight
  • Average gain of about 13 ounces each month, birthweight is tripled at 1 year
• Height
  • Average growth of about 1/2 inch each month
• Head size
  • Average growth of about 1/4 inch each month

What can my baby do at this age?

As your baby continues to grow, you will notice new and exciting abilities that develop. While babies may progress at different rates, the following are some of the common milestones your child may reach in this age group:

• Pulls up to a standing position
• Can sit back down from standing position
• Cruises or walks around holding onto furniture
• May stand next to furniture without holding on
• May walk holding on to your finger or hand
• May begin to take steps and walk on own
• Plays "ball" receiving and returning a rolled ball
• Able to pick up food and small objects with fingers
• Can feed self finger foods
• Drinks from cup with spout
• Can turn pages in a book, often several at a time
• New teeth continue to erupt; may have four to six teeth by 1 year old
• Takes two naps a day and is able to sleep up to 12 hours at night without a feeding
• Make wake up at night looking for parents

What can my baby say?

Speech development is very exciting for parents as they watch their babies become social beings that can interact with others. While every baby develops speech at his/her own rate, the following are some of the common milestones in this age group:

• Says da-da and ma-ma and knows who these persons are
• Imitates sounds and some speech
• May say two words other than ma-ma, da-da
• Imitates animal sounds in response to questions (i.e.,"What does the cow say?")

What does my baby understand?

Babies at this age become much more aware of others as well as themselves. They are not yet confident that mother will return when she leaves. While children may progress at different rates, the following are some of the common milestones children may reach in this age group:

• Recognizes familiar objects and pictures in books, and may point to some objects when asked, "Where is the.....?"
• Follows a one-step command with the parent having to show the child how to do it
• Has preferences for people and toys, and may have a favorite toy or blanket
• Is curious and wants to explore
• Moves to music
• Drops objects on purpose for others to pick up
• Points and gestures for objects and actions
• May begin to pretend simple activities, such as cleaning or drinking from cup

How does my baby interact with others?

Separation anxiety and fear of strangers are common at this age. Separation anxiety is anxiousness and fearfulness of being separated from a parent, whether or not the parent is actually leaving the presence of the child. However, this is an important part of the relationship with the parent. While every child is unique and will develop different personalities, the following are some of the common behavioral traits that may be present in your child:

• Fear and anxiety of strangers; may cling and clutch parents
• Waves bye-bye
• Cries or shows emotions when told "no"

How to help increase your baby's learning and emotional security

Consider the following as ways to foster the emotional security of your baby:

• Walk away for short periods while your baby plays in a safe area to help teach him/her that you will come back each time
• Introduce your baby gradually to new people and things
• Look at picture books with your baby and talk about the pictures
• Give your baby finger foods and help him/her to use a spoon, but allow your baby to do it alone. Do not worry if your baby makes a mess, as experimentation is important
• Read stories to your baby every day
• When your baby asks for something by pointing, name the object as you give it to him/her
• Hold and cuddle your baby often
• Continue a bedtime routine of cuddling, rocking, and soothing
• Respond to your baby if he/she awakens and cries at night, but avoid turning on the light or picking up or holding your baby. Limit your interactions to soothing talk and patting, telling your baby it is time for sleep

How much will my baby grow?

After a baby's first birthday, the rate of growth begins to slow down. The baby is now a toddler and is very active. While all children may grow at a different rate, the following indicates the average for 1-year-old boys and girls:

• Weight
  • Average gain of about 8 ounces each month, birthweight has tripled by the end of the first year
• Height
  • Average growth of about 1/4 to 1/2 inch each month

What can my baby do at this age?

As your baby continues to grow, you will notice new and exciting abilities that develop. While babies may progress at different rates, the following are some of the common milestones your baby may reach in this age group:

• Walks alone by 15 months, then begins to run
• Can stop, squat, then stand again
• Sits down on small stool or chair
• Climbs stairs while holding on
• Dances with music
• Plays with push and pull toys
• Can build towers out of blocks
• Throws a ball overhand
• Puts two- to three-piece puzzles together
• Scribbles with crayon or pencil and may imitate drawing a straight line or circle
• Mostly feeds self with fingers
• Begins to feed self with spoon
• Drinks well from cup
• Can help with dressing and may be able to undress simple clothes (i.e., clothes without buttons or zippers)
• First molar (back) teeth appear
• Takes one afternoon nap
• May sleep 10 to 12 hours at night

What can my baby say?

Speech development is very exciting for parents as they watch their babies become social beings that can interact with others. While every baby develops speech at his/her own rate, the following are some of the common milestones in this age group:

• Imitates animal sounds and noises
• At one year, says four to six simple words
• At 18 months, says 10 to 15 words
• By 18 months, says two-word sentences (i.e., "Mommy up")
• By 2 years, says 100 or more words
• Asks "What is...?"
• Uses negative phrases such as "No want"

What does my baby understand?

By about 18 months of age, children begin to understand symbols - the relationship of objects and their meanings. While children may progress at different rates, the following are some of the common milestones children may reach in this age group:

• Waves bye-bye and plays pat-a-cake
• By 18 months, understands one-step questions and commands such as "Where is the ball?"
• By 24 months, understands two-step questions and commands such as "Go to your room and get your shoes"
• Understands object permanence (a hidden object is still there)
• Understands the cause-and-effect relationship better
• Likes to explore drawers and boxes to see what is inside
• Make-believe play increases (i.e., may imitate housework or feed a doll)
• Recognizes own face in mirror
• Can point to body parts (i.e., nose, hair, eyes) when asked
• Begins to understand use of certain objects (i.e., the broom is for sweeping the floor)
• May ask for parents' help by pointing

How does my baby interact with others?

As children begin to walk, they may begin to show independence and will try to walk further away from the parent, but will return. Separation anxiety and fear of strangers may lessen, then return at about 18 months. While every child is unique and will develop different personalities, the following are some of the common behavioral traits that may be present in your child:

• Plays alongside others without interacting, called parallel play
• May begin clinging to parents around 18 months
• May begin to say "no" more frequently to commands or needs
• May have temper tantrums
• May use a blanket or stuffed animal as a security object in place of the parent

How to help increase your baby's learning and emotional security

Consider the following as ways to foster the emotional security of your 1-year-old:

• Give your child toys that can be filled and emptied
• Give your child simple two- to six-piece puzzles
• Help your child build towers of blocks
• Encourage your child to "help" you with household tasks
• Give your child paper and large crayons to scribble and draw
• Talk to your child with clear, simple language about what you are doing
• Use the correct names for objects, even if your child does not. For example, your child might say "wa-wa," and you say, "Water, that is right."
• Expand your child's sentences. If your child says, "Want cookie," you say, "Do you want another cookie?"
• Read to your child every day using picture and story books
• Feed your child at family mealtimes

How much will my child grow?

In 3-year-olds, growth is still slow compared to the first year. Most children have become slimmer and lost the rounded tummy of a toddler. While all children may grow at a different rate, the following indicate the average for 3-year-old boys and girls:

• Weight
  • Average gain of about 4 to 6 pounds per year
• Height
  • Average growth of about 2 1/2 to 3 inches per year

What can my child do at this age?

As your child continues to grow, you will notice new and exciting abilities that develop. While children may progress at different rates, the following are some of the common milestones your child may reach in this age group:

• Runs and jumps easily
• Walks upstairs unassisted
• Rides a tricycle
• Washes and dries hands
• Stacks 10 blocks
• Easily draws straight lines and copies a circle
• Can stand on tip-toes
• Uses spoon well and feeds self
• Dresses and undresses self except for buttons and laces
• Can concentrate on tasks for 8 or 9 minutes
• Has all 20 primary ("baby") teeth
• Vision is nearing 20/20
• Bladder and bowel control are usually established; uses potty chair or toilet
• May sleep 11 to 13 hours total, may still take a short afternoon nap

What can my child say?

Speech development is very exciting for parents as they watch their children begin to speak clearly and interact with others. While every child develops speech at his/her own rate, the following are some of the common milestones in this age group:

• Should be able to say about 500 to 900 words
• Speech can be understood by others
• Speaks in two or three-word sentences and progresses to four to five-word sentences
• Can remember simple rhymes or lyrics
• Uses "please" and "thank you"
• Refers to self by using own name
• Names colors

What does my child understand?

While children may progress at different rates, the following are some of the common milestones your child may reach in this age group:

• Understands size differences (i.e., big and little)
• Understands past tense (yesterday)
• Understands long sentences
• Understands prepositions (on, under, behind)
• Uses pronouns correctly (I, you, he, me, etc.)
• Asks "why" constantly
• Counts up to four objects by 4 years old
• Says full name and age
• May have fears of certain things (i.e., dark, monster under bed, going down the drain)
• Attempts to solve problems
• Remembers certain events
• Can point to the correct picture when asked a simple question about it.

How does my child interact with others?

While every child is unique and will develop different personalities, the following are some of the common behavioral traits that may be present in your child:

• Begins to share and likes to play with other children
• Can take turns
• Temper tantrums are less frequent
• Begins to show feelings in socially acceptable ways

How to help increase your child's learning and emotional security

Consider the following as ways to foster the emotional security of your 3-year-old:

• Spend time allowing your child to talk with you
• Teach your child how things work
• Encourage play with other children
• Encourage your child to tell you stories
• Listen to your child and show that you are pleased by your child's talking
• Let your child do as much as possible for himself/herself when getting dressed, brushing teeth, and combing hair
• Have your child help with simple chores, such as picking up toys
• Give your child old clothes for "dress up" and allow him/her to pretend being a mom, dad, doctor, cowboy, etc. Even old sheets or towels can become skirts, capes, or turbans. You can also pretend you are an elephant, butterfly, robot, or other characters and play with your child.
• Sing songs or nursery rhymes and teach your child the words
• Read stories with your child and ask your child to name pictures in the stories or retell part of the story
• Help your child play with crayons and paper or chalk and chalkboard by showing how to draw circles and lines, and then put them together to make a stick figure. Make figure faces that are happy, sad, or surprised, and talk about the different feeling shown in each picture.
• Let your child build things out of blocks or boxes
• Give your child a safe space to ride a tricycle
• Listen to children's music with your child and dance
• Practice counting with your child
• Give your child the chance to play games with other children. Church groups, YWCA/YMCA recreation centers, or libraries often have preschool programs.
• Put puzzles together with your child
• Let your child have pretend playtime with dolls, cars, or toy cooking utensils
• Play "hide and seek" and "follow the leader"
• Let your child use his/her imagination by playing with play-dough or clay
• Trace your child's hand or whole body and make a picture
• Show your child you are proud of any artwork and hang it up for display
• Teach your child colors
• Play ball with your child. Play different games with the ball, such as tossing a ball into a box or rolling the ball up and down an incline.

How much will my child grow?

While all children may grow at a different rate, the following indicate the average for four to five-year-old boys and girls:

• Weight
  • Average gain of about 4.4 to 6.5 pounds a year
• Height
  • Average growth of about 3 inches per year
• Head size
  • Average growth of about 1 inch per year

What can my child do at this age?

As your child continues to grow, you will notice new and exciting abilities that your child develops. While children may progress at different rates, the following are some of the common milestones children may reach in this age group:

• Four-year-olds
  • Sings a song
  • Skips and hops on one foot
  • Catches and throws a ball overhand
  • Walks downstairs alone
  • Draws a person with three separate body parts
  • Builds a block tower with 10 blocks
  • Understands the difference between fantasy and reality
• Five-year-olds
  • Jumps rope
  • Talks backwards
  • Balances on one foot with eyes closed
  • Uses scissors
  • Begins learning to tie shoes
  • Copies shapes while drawing
  • Dresses self
  • Knows address and phone number
  • Recognizes and recites the alphabet
  • Permanent teeth may begin coming in

What can my child say?

Speech development in children is very exciting for parents as they watch their children become social beings that can interact with others. While every child develops speech at his/her own rate, the following are some of the common milestones children may reach in this age group:

• Four-year-olds
  • Can say approximately 1,500 different words
  • May put together four to five words into a sentence
  • Will ask questions constantly
  • May know one color or more
  • Likes to tell stories
  • May use some "bad" words (if heard spoken repeatedly)
• Five-year-olds
  • Can say approximately 2,000 words
  • May put together six to eight words into a sentence
  • May know four or more colors
  • Knows the days of the week and months
  • Can name coins and money
  • Can understand commands with multiple instructions
  • Talks frequently

What does my child understand?

As a child's vocabulary increases, so does his/her understanding and awareness of the world around them. Children at this age begin to understand concepts and can compare abstract ideas. While children may progress at different rates, the following are some of the common milestones children may reach in this age group:

• Four-year-olds
  • Begins to understand time
  • Begins more aware of people around him/her
  • May obey parent's rules, but does not understand right from wrong
  • Believes that his/her own thoughts can make things happen
• Five-year-olds
  • Increased understanding of time
  • Curious about real facts about the world
  • May compare rules of parents with that of friends

How does my child interact with others?

A very important part of growing up is the ability to interact and socialize with others. This can be a frustrating transition for the parent as children go through different stages, some of which are not always easy to handle. While every child is unique and will develop different personalities, the following are some of the common behavioral traits that may be present in your child:

• Four-year-olds
  • Very independent, wants to do things on his/her own
  • Selfish, does not like to share
  • Moody; mood swings are common
  • May be aggressive during mood swings and to others
  • Has a number of fears
  • May have imaginary playmates
  • Likes to explore the body and may play doctor and nurse
  • Might "run away" or threaten to do so
  • Fights with siblings
  • Will often play with others in groups
• Five-year-olds
  • Generally more cooperative and responsible than 4-year-olds
  • Eager to please others and make them happy
  • Has good manners
  • Dresses self completely without help
  • Gets along well with parents
  • Likes to cook and play sports
  • As child enters school, he/she may become more attached to parent

How to help increase your preschool child's social ability

Consider the following as ways to foster your preschool child's social abilities:

• Offer compliments for good behavior and achievements
• Encourage your child to talk to you and be open with his/her feelings
• Read to your child, sing songs, and talk with him/her
• Spend quality time with your child and show him/her new experiences
• Encourage your child to ask questions and explore
• Encourage physical activity with supervision
• Arrange times for your child to be with other children, such as in play groups
• Give your child the chance to make choices when appropriate
• Use a time-out for behavior that is not acceptable
• Encourage your child to express his/her anger in an appropriate manner
• Limit television watching to one hour a day - use free time for other, more productive activities

How much will my child grow?

While all children may grow at a different rate, the following indicates the average for school-aged children six to twelve years old:

• Weight
  • Average gain of about 5 to 7 pounds a year
• Height
  • Average growth of about 2.5 inches per year

What can my child do at this age?

As your child continues to grow, you will notice new and exciting abilities that your child develops. While children may progress at different rates and have diverse interests, the following are some of the common milestones children may reach in this age group:

• Six to seven-year-olds
  • Enjoys many activities and stays busy
  • Likes to paint and draw
  • May lose first tooth
  • Vision is as sharp as an adult's vision
  • Practices skills in order to become better
  • Jumps rope
  • Rides a bike
• Eight to nine-year-olds
  • More graceful with movements and abilities
  • Jumps, skips, and chases
  • Dresses and grooms self completely
  • Can use tools (i.e., hammer, screwdriver)
• Ten to twelve-year-olds
  • Remainder of adult teeth will develop
  • Likes to sew and paint

What does my child understand?

As children enter school age, their abilities and understanding of concepts and the world around them continue to grow. While children may progress at different rates, the following are some of the common milestones children may reach in this age group:

• Six to seven-year-olds
  • Understands concept of numbers
  • Knows daytime and nighttime
  • Knows right and left hands
  • Can copy complex shapes, such as a diamond
  • Can tell time
  • Can understand commands with three separate instructions
  • Can explain objects and their use
  • Can repeat three numbers backwards
  • Can read age-appropriate books and/or materials
• Eight to nine-year-olds
  • Can count backwards
  • Knows the date
  • Reads more and enjoys reading
  • Understands fractions
  • Understands concept of space
  • Draws and paints
  • Can name months and days of week, in order
  • Enjoys collecting objects
• Ten to twelve-year-olds
  • Writes stories
  • Likes to write letters
  • Reads well
  • Enjoys using the telephone

How does my child interact with others?

A very important part of growing up is the ability to interact and socialize with others. During the school-age years, parents will see a transition in their child as he/she moves from playing alone to having multiple friends and social groups. While friendships become more important, the child is still fond of his/her parents and likes being part of a family. While every child is unique and will develop different personalities, the following are some of the common behavioral traits that may be present in your child:

• Six to seven-year-olds
  • Cooperates and shares
  • Will cheat, if able
  • Jealous of others and siblings
  • Likes to copy adults
  • Likes to play alone, but friends are becoming important
  • Plays with friends of the same gender
  • May have temper tantrums
  • Modest about body
  • Likes to play board games
• Eight to nine-year-olds
  • Likes competition and games
  • Starts to mix friends and play with children of the opposite gender
  • Modest about body
  • Enjoys clubs and groups, such as Boy Scouts or Girl Scouts
  • Becoming interested in boy-girl relationships, but does not admit it
• Ten to twelve-year-olds
  • Friends are very important; may have a best friend
  • Increased interest in the opposite gender
  • Likes and respects parents
  • Enjoys talking to others

How to help increase your school-aged child's social ability

Consider the following as ways to foster your school-aged child's social abilities:

• Offer compliments for your child being cooperative and for any personal achievements
• Help your child choose activities that are appropriate for your child's abilities
• Encourage your child to talk with you and be open with his/her feelings
• Encourage your child to read
• Help your child choose activities that are appropriate for your child's abilities
• Encourage your child to talk with you and be open with his/her feelings
• Encourage your child to read
• Encourage your child to get involved with hobbies and other activities
• Encourage physical activity
• Encourage self-discipline; expect your child to follow rules that are set
• Teach your child to respect and listen to authority figures
• Encourage your child to talk about peer pressure and help set guidelines to deal with peer pressure

How much will my adolescent grow?

The teenage years are also called adolescence. During this time, parents will see the greatest amount of growth in height and weight in their child. Adolescence is a time for growth spurts and puberty changes. An adolescent may grow several inches in several months, followed by a period of very slow growth, then have another growth spurt. Changes with puberty (sexual maturation) may occur gradually, or several signs may become visible at the same time.

There is a great amount of variation in the rate of changes that may occur. Some teenagers may experience these signs of maturity sooner or later than others.

Growth increases and puberty changes:

• Females (between 13 to 18 years)
  • Weight: 68 to 110 pounds
  • Height: 8.5 to 9.5"
  • Puberty changes: 8 to 13 years of age

• Males (between 13 to 18 years)
  • Weight: 76 to 118 pounds
  • Height: 10.5 to 20"
  • Puberty changes: 9.5 to 14 years of age

What changes will occur during puberty?

Sexual and other physical maturation that occurs during puberty is a result of hormonal changes. As a child nears puberty, a gland in the brain, called the pituitary gland, increases the secretion of a hormone called follicle-stimulating hormone (FSH). This hormone then causes additional effects. In girls, FSH activates the ovaries to start producing estrogen. In boys, FSH causes sperm to develop.

Girls also experience puberty as a sequence of events, but their pubertal changes usually begin before boys of the same age. Each girl is different and may progress through these changes differently. The following are average ages when puberty changes may occur:

• Beginning of puberty: 8 to 13 years
• First pubertal change: breast development
• Pubic hair development: shortly after breast development
• Hair under the arms: 12 years old
• Menstrual periods: 10 to 16.5 years old

In boys, it is difficult to know exactly when puberty is coming. There are changes that occur, but they occur gradually and over a period of time, rather than as a single event. While each male adolescent is different, the following are average ages when puberty changes may occur:

• Beginning of puberty: 9.5 to 14 years old
• First pubertal change: enlargement of the testicles
• Penis enlargement: begins approximately one year after the testicles begin enlarging
• Appearance of pubic hair: 13.5 years old
• Hair under the arms and on the face, voice change, and acne: 15 years old
• Nocturnal emissions (or "wet dreams"): 14 years old

There are specific stages of development that both boys and girls go through when developing secondary sexual characteristics (the physical characteristics of males and females that are not involved in reproduction such as voice changes, body shape, pubic hair distribution, and facial hair). The following is a brief overview of the changes that occur:

• In girls, the initial puberty change is the development of breast buds, in which the breast and nipple elevate. The areola (dark area of skin that surrounds the nipple of the breast) increases in size at this time. The breasts then continue to enlarge. Eventually, the nipples and the areolas will elevate again, forming another projection on the breasts. At the adult state, only the nipple remains erect.
• In boys, the initial puberty change is the enlargement of the scrotum and testes. At this point, the penis does not enlarge. Then, as the testes and scrotum continue to enlarge, the penis gets longer. Next, the penis will continue to grow in both size and length.

Pubic hair development is similar for both girls and boys. The initial growth of hair produces long, soft hair that is only in a small area around the genitals. This hair then becomes darker and coarser as it continues to spread. The pubic hair eventually looks like adult hair, but in a smaller area. It may spread to the thighs and, sometimes, up the stomach.

What does my adolescent understand?

The teenage years bring many changes, not only physically, but also mentally and socially. During these years, adolescents increase their ability to think abstractly and eventually make plans and set long-term goals. Each child may progress at a different rate and may have a different view of the world. In general, the following are some of the abilities that may be evident in your adolescent:

• Develops the ability to think abstractly
• Sets goals
• Compares one's self to one's peers
• Is concerned with philosophy, politics, and social issues
• Thinks long-term

As your adolescent begins to struggle for independence and control, many changes may occur. The following are some of the issues that may be involved with your adolescent during these years:

• Wants independence from parents
• May be in love
• Male-female relationships become important
• Peer influence and acceptance becomes very important
• Has long-term commitment in relationship

How to assist your adolescent in developing socially

Consider the following as ways to foster your adolescent's social abilities:

• Encourage your adolescent to take on new challenges
• Talk with your adolescent about not losing sight of one's self in group relations
• Encourage your adolescent to talk to a trusted adult about problems or concerns, even if it is not you he/she chooses to talk with
• Discuss ways to manage and handle stress