Peds Milestones

Growth & Development Toddlers, Preschoolers, School Agers

Physical Growth
- Height and weight growth slows, is steady
- Birth weight quadrupled by 2-3 years old
- "Pot-Bellied"
- Legs grow more than trunk
- 18 months: Anterior Fontanel closes
- 24 months: possibility of toilet training readiness
Gross Motor
- 15 months: walking without help
- 30 months: runs well
- 30 months: jumps with both feet
- Can feed and undress self
- Left or Right handedness emerges
Fine Motor
- 15 months: builds tower with 2 cubes
- 15 months: scribbles
- 18 months: imitates a drawn line
- 30 months: builds tower with 8 cubes
Vocalization/Socialization
- 15 months: uses "No", even if agreeing
- 18 months: 10+ words
- 18 months: points to 2-3 body parts
- 18 months: ownership develops and uses word "Mine"
- 24 months: 300 words and 2-3 word phrases
- Gender identify and body image develop
- Sexual curiosity
Anticipatory Guidance
- Water safety
- Auto safety
- Aspiration/Choking Prevention
- Time-outs (1 minute/per year of age)
- Teach Handwashing
- Emergency Planning
Nutrition
- Solid foods
- 3 meals, 2 snacks/day
- Limit sweets/high fat foods
- Physiologic anorexia
- Age-related challenges
- Small, frequent meals and snacks
Sleep and Misc.
- 12-14 hours of sleep/day
- At least 1 nap/day
- Toilet Training
- Temper Tantrums
- Sibling Rivalry
Health Prevention
- General hygiene
- Firm discipline
- Screen Time
- Toilet Training

Physical Growth 3-6 years old
- Slow, steady growth
- Gain 2-3kgs/year
- Grow 2.5-3.5cm/year
Gross Motor Progress
- 3 y/o – rides a tricycle, can stand on one foot
- 4 y/o – skips and hops on one foot, throws ball overhead
- 5 y/o – walks backward, throws and catches ball
Fine Motor Progress
- Copying figures
- Dressing independently
Vocalization/Socialization
- 2100 words
- Speak with multiple word sentences
- Constant chatter
- Asks many questions, "WHY?:
- Can name body parts
Anticipatory Guidance
- Stranger safety
- Firearm safety
- Helmet safety
- Water safety
- Car safety
Nutrition
- May still be a picky eater until age 5
- Protein, limited sat fats
- Follow 5-2-1-0 framework
Sleep Habit
- Need around 12 hrs/day
- Typically no daytime nap
- Difficulty with falling asleep
- Potential for night terrors
Health Promotion
- Immunizations
- Dental Health

Physical Growth
- 6-12 years old
- Slow, steady growth
- Avg. weight gain of 2.5kg/year
- Increase height of 5.5cm/year
- Muscle mass and body maturity
- Healthiest Times
Physical Growth ...
- Thinner
- 6y/o: Vision matured
- 10-12y/o boys: slow in growth
- 10-12y/o girls: faster in growth
- Eustachian tubes move downward
- Baby teeth gone, 28-32 permanent teeth
- Puberty ~12-14y/o
- Differences?
Gross Motor Progress
- Play becomes more creative
- More graceful and poised
- Dance
- Active Play (team sports)
- Watching for s/s:
- Fatigue
- Dehydration
Fine Motor Progress
- 8y/o: dresses self without help
- Coordination improves
Vocalization/Socialization
- 6 y/o: 8,000-14,000 words
- Reading improves
- 6y/o: more cooperative at sharing
- 6y/o: jealously heightens, r/t siblings
- 6-9y/o: dramatic and boastful
- 8-9y/o: interested in boy-girl relationships
- 10-12y/o: friend oriented
Anticipatory Guidance
- Car Safety
- Water Safety
- Fire and Burn Safety
- Helmet Safety
- Bullying
Nutrition
- Increased appetite r/t energy needs
- Less of a "picky" eater
- Challenges?
Sleep Habit
- 6-7y/o: requires ~12 hours of sleep
- 12y/o: requires ~9-10 hours of sleep
- Positive Sleep Habit
- Routine
- Quiet Time
- Room Environment
Health Prevention
- Dental Caries
- Lack of Hygiene
- Define rules
- Ensure accountability
- New School Adjustment
- Peers, Latchkey
- Prevention of overweight/obesity