2 Growth, Development, and Health Promotion
Learn how to assess children’s physical growth and development, interpret variation and milestones, and tailor preventive care to each age and family.
and are distinct
is measurable physical change, such as increasing weight, length, height, and head circumference. is the gradual acquisition of motor, language, cognitive, social, and emotional abilities. They are related but distinct, and each child follows an individual pattern.
Assess physical over time
Measure accurately and interpret physical measurements over time rather than relying on a single percentile. In U.S. practice, use WHO standards from birth to age 2 and CDC from age 2 onward.
For infants, track weight, recumbent length, and head circumference. For older children and adolescents, track stature, weight, and BMI-for-age. support assessment but do not independently establish a diagnosis.
Consider measurement quality, gestational age, family stature, nutrition, health conditions, and the child’s overall pattern. A child may normally track at a high or low percentile. A substantial change in trajectory, persistently poor weight gain, or that does not fit the child’s history warrants assessment rather than assumptions based on one measurement.
Monitor and respond to concerns
occurs at every well-child visit through ongoing discussion with caregivers and observation. Assess skills across gross motor, fine motor, communication, cognition, and social-emotional domains.
with standardized general tools is recommended at 9, 18, and 30 months. Autism-specific screening is recommended at 18 and 24 months. Screening should also occur when concerns arise. If a child loses skills, misses , or a caregiver is concerned, evaluate and refer promptly rather than waiting for the next routine screening.
Understand across childhood
describe skills most children can do by a given age; they are guides, not rigid deadlines or a test of a child’s worth or potential. Timing varies, and skills emerge across a range. CDC milestone checklists describe skills that at least 75% of children can do by a specified age. They support monitoring but do not replace validated screening.
Infancy (birth–12 months): is rapid. Newborns rely on caregivers for regulation and show reflexive movement. By about 2 months, many babies look at faces, respond to sounds, and smile socially. By 6 months, many recognize familiar people, reach for objects, roll, and exchange sounds. Near 12 months, many use a caregiver name such as “mama” or “dada,” play simple social games, and place objects in containers. Mobility and communication increase through the year.
Toddlerhood (1–3 years): Walking, climbing, and hand skills progress as children explore and seek autonomy. Early words develop into short combinations, and pretend play, imitation, and social interaction grow. Tantrums and testing limits can be common while self-control and language are still developing.
Preschool years (3–5 years): Coordination, self-care, conversation, imaginative play, and cooperative interaction expand. Children increasingly follow simple rules and express feelings, although attention and impulse control remain immature compared with older children.
School age (about 6–11 years): is generally steadier before puberty. Learning, reasoning, coordination, and independent self-care develop. Peer relationships and competence become increasingly important; children benefit from predictable routines, encouragement, and supportive limits.
Adolescence (about 12–18 years): Puberty brings physical maturation and a spurt, with timing and tempo varying widely. Abstract reasoning and planning develop over time, while identity, privacy, autonomy, and peer relationships become more salient. Emotional responses may be intense while judgment and self-regulation are still maturing. Respectful, confidential, developmentally appropriate conversations support care.
Interpret variation in context
Developmental variation can reflect differences in temperament, opportunity, culture, language exposure, family expectations, and the sequence in which skills emerge. A child may be advanced in one domain and progress more gradually in another. For children born preterm, clinicians may consider when interpreting early . Cultural and linguistic context should inform assessment without dismissing a genuine concern.
Physical and are influenced by interacting factors:
Genetics and family pattern: Parental stature and inherited traits influence potential and pubertal timing.
Prenatal and perinatal history: Fetal , gestational age, and early health may affect subsequent and .
Nutrition and health: Adequate food and micronutrients support ; chronic illness, feeding difficulty, and some medications can affect trajectories.
Sleep, activity, and stress: Routines, opportunities for movement and play, emotional security, and prolonged stress influence well-being and learning.
Environment and access: Housing, environmental exposures, safety, access to health care, and social and economic conditions shape opportunities for healthy .
Consider the whole child and family context. or developmental concerns call for careful measurement, history, examination, and follow-up—not blame.
Tailor preventive care to age
Preventive care combines physical assessment, , screening, immunization, and tailored to the child and family. The AAP Bright Futures periodicity schedule outlines recommended visits, screenings, and assessments from infancy through adolescence. Additional visits may be needed when concerns or health needs arise.
Infants: Support responsive caregiving, safe sleep, feeding guidance, routine immunization, oral health as teeth emerge, and injury prevention. Encourage talking, reading, play, and supervised opportunities for movement.
Toddlers and preschoolers: Promote varied nutritious foods, active play, consistent sleep routines, language-rich interaction, dental care, and safety measures suited to increasing mobility and curiosity. Give caregivers practical guidance on behavior and positive, age-appropriate limits.
School-age children: Encourage regular meals, sleep, physical activity, dental care, learning support, social connection, and safety at home, school, and during recreation. Children ages 6–17 should get at least 60 minutes of moderate-to-vigorous physical activity daily; children ages 3–5 should be active throughout the day.
Adolescents: Discuss nutrition, activity, sleep, body image, emotional health, relationships, safety, and substance-use prevention in a respectful, nonjudgmental way. Offer time for private conversation consistent with applicable law and clinical practice, explain confidentiality and its limits, and involve the adolescent in decisions.
Partner with children and families
treats caregivers and young people as partners. Ask what matters to them, use understandable and culturally responsive language, acknowledge strengths, and agree on feasible next steps. When a developmental concern is identified, explain options clearly and connect the family with appropriate evaluation and early supports.