Editor's note: This story was originally published in Health Care Quarterly, a magazine about Southern Nevada's health care industry. Stories in Health Care Quarterly were submitted by doctors and their affiliates.
Marissa Mussi is the marketing manager for Sunrise Children’s Hospital.
As children grow from newborn into young adults, they cross several milestones along the way — both medically and developmentally. Each year, health care needs change and there are different milestones that should be met. Knowing what to look for allows parents to provide support and prepare children as they reach the milestones. In some cases, it allows parents to realize when something may need to be done.
During the first year, babies are busy with everything from cooing, crawling, and walking to everything in-between. To help the baby reach these milestones, there are many routine doctor visits within the first year.
“In the first year, checkups are frequent because during this time, there is a big transition from the newborn period with social, language, cognitive and motor development,” said Dr. Lesa Brookes, pediatrician at Healthy Kids Pediatrics.
Checkups typically begin within the first week of a child’s life and occur regularly throughout the first year. The baby will go for a second checkup around two weeks old to ensure there are no significant changes in weight, no ongoing signs of jaundice and to address any concerns the parents may have while in this transition. The remaining checkups needed within the first year occur at 1 month, 2 months, 4 months, 6 months,
9 months, and 12 months of age. During these checkups, the physician is able to check the baby’s overall health, address any concerns the parents may have, administer vaccinations, and check on the developmental progress of the infant.
After the first year, other routine visits are: the 15-month, 18-month, 24-month, 30 month, and the 36-month checkups. Once the child turns 3, checkups are done on an annual basis. The annual visits are for the doctor to assess how the child is progressing on all levels. As the child gets older and starts to enter into puberty, the visits also serve as a time for the physician to talk to the child about any questions or concerns they have that they may not be comfortable speaking to their parents about. Between the annual visits, if there are any questions or concerns regarding the child’s health or developmental progress, do not wait for the annual visit to bring these concerns to the physician, see a physician before.
The importance of vaccinations
Within the first year, a baby receives its first series of vaccinations. The first shot, Hepatitis B, is typically given while the baby is still at the hospital. Brookes and her partner at Healthy Kids Pediatrics, Dr. Atousa Ghaneian, follow the American Academy of Pediatrics/Centers for Disease Control and Prevention vaccine schedule. According to the schedule, the remaining shots are then administered during checkups at 2 months, 4 months and 6 months. Shots are typically done in a combination vaccine to minimize the number of actual injections. At 9 months, this time is used to catch up on any vaccinations they may have missed. At 12 months, the child receives their next set of shots which consists of MMR (measles, mumps and rubella), Varicella (chicken pox), and Hepatitis A.
“Vaccinations at this stage play an imperative role in the child’s overall health and development,” said Brookes. “They are especially important at this young age when children are highly susceptible to illnesses.”
After these shots are administered, the child will then receive their next series of injections around four years old. The shots administered at age four consist of vaccination boosters that are required to enter school.
As children enter into their adolescent years, additional vaccinations are needed, such as: Tdap (Tetanus, diphtheria and acellular pertussis) and Meningococcal. In addition, vaccinations to prevent against Human Papillomavirus (HPV) can be administered starting as young as age 9 up until the age of 26 years old. The HPV vaccination is part of a three-dose series which can be given to both males and females.
In terms of development, the developmental progress is different from one baby to the next, so there is a spectrum in which the milestones can occur; the following are just average ages. At 2 months, babies will start cooing; 4 to 6 months, babies start to sit up with some support. At
9 months, babies can sit up without the need for support and begin to crawl. Around 12 months, babies start to take their first few steps while holding onto things and by 15 months babies can walk on their own. If at 18 months, the child still isn’t walking at all, then Brookes recommends seeing a physician.
It's all the talk
Speech development starts as early as 2 months when the baby starts cooing. Around 6 months the baby starts making noises with more consonants. “At 9 months, babies will start to form simple words such as ‘mama’ or ‘dada,’ but these words are nonspecific. This means they do not actually associate the words to mom or dad. However, by 12 months, babies are able to say mama and dada with specific relationship to mom and dad,” said Brookes.
As the child gets older, their vocabulary should gradually increase:
12 months: Mama and dada, plus two or three other words
15 months: Mama and dada, plus four to six other words
18 months: Mama and dada, plus 10 to 20 other words
2 years: 50 words and start to combine words to make two word sentences
3 years: Approximately 250 words and start to combine words to make three word sentences
In addition to vocabulary progression, clarity is important as well. By 2 years old, a child’s speech should be clear enough for a stranger to understand at least 50 percent of what is being said. By 3 years old, 75 percent clarity and by age 4, their speech should be 100 percent clear. If at 15 months old the child does not say any words, then check with a physician.
Parents and guardians play a huge role in childhood development. Brookes suggests several ways in which parents can aid in developmental progression: simple interactions such as talking to the child and explaining why and how; bonding or holding the child; reading to the child a few minutes every day helps with language skills and motor skills; and also listening to music.
When it comes to potty training, the average age is 21/2 years old for daytime dryness. By age 4, the child should be potty trained, but may experience occasional nighttime wetness. Potty training should be introduced at 18 months and then the topics should be revisited again at 2 years old. However, it is important that the child is ready to be potty trained and that it is not forced. If it is forced then it can create a power struggle. According to Brookes, some key indicators to determine if a child is ready for potty training are: dry periods for two hours, awareness of the difference between wet and dry, physically able to pull their pants up and down, and able to walk over to the toilet. Another important factor is that the child shows interest. If the child is capable of the above tasks and they show interest, then it is less likely there will be a power struggle. Once the child is potty trained, occasional bed wetting may still occur. If bedwetting is still constant after age 7, then Brookes recommends seeing a urologist.
Pre-kindergarten is a big transition for parents and children. This is a time to help prepare the child for elementary school and aids in the developmental progression of the child. The stimulation from being around other children assists with language progression. Pre-K also helps see how the child interacts with other children and helps to ease the separation between child and parent.
The adolescent accent
Puberty is different for both boys and girls. For girls, the early signs of puberty can start as early as age 8 but the average age is 9 years old. If puberty starts before the child reaches 8 years of age, see a physician. The early signs of puberty in a female consist of oily skin, widening of the hips, increase of body fat and muscle and signs of breast development. By age 13, if a female has not experienced any of these signs, then it is a sign of delayed puberty. Approximately two years after breast development starts, then girls will get their period. The average age at which girls start their period is 12 years old. It is not uncommon for their period to be irregular for the first year. Girls will experience their growth spurt or maximum growth rate roughly twelve months before they start their period. After a girl achieves her period, she is within about two inches of her adult height.
For boys, early signs of puberty start as early as 9 years old. Some of the noticeable early signs in boys are oily skin, body fat and muscle growth, a change in voice and testicular enlargement. If there are no signs of early puberty by age 14, then they are considered to have delayed puberty. Boys experience their growth spurts or reach maximum growth rate later than girls.
Puberty can be a sensitive time for both girls and boys as they experience several physical and emotional changes. It is recommended for parents to mention puberty to children around age 9. The first mention of puberty doesn’t need to be in-depth but just to introduce the topic and what they will experience. Even though the child may not be going through puberty themselves, it is important to address the topic because other children they may know may be experiencing it. When talking to a child about puberty, it is important to gauge the maturity of the child. This will help determine how to approach the topic or how in-depth to go in the discussion.
Parental involvement in the child’s life is important throughout all stages. This helps with the developmental progression and helps to create trust. Open lines of communication between a parent and a child are important as the child will be more willing to go to the parent with questions about their own health.
The time to switch from a pediatrician to a primary care physician on average is age 18 to 21 depending on the growth of the child but it is important to keep regular exams going to maintain your child’s health. Sunrise Children’s Hospital is Nevada’s largest, most comprehensive children’s hospital that offers services for newborns to teens. They are here to treat the many milestones that occur throughout a child’s life as well as any serious bumps and bruises they may encounter along the way.