Growth and development

During a well-child visit, your pediatrician will check your child’s development and communication skills. We watch how they behave and ask you questions about family history. 

This information can help us decide if your child might have autism spectrum disorder (ASD). We also use the modified checklist for autism in toddlers (MCHAT). You answer 23 questions and your pediatrician uses the information to come up with next steps, if needed. 

Your pediatrician usually tests vision and hearing at well-child visits. Schools also do these tests because changes to hearing and vision often go unnoticed. If the school’s test results are unusual, make a follow-up appointment with your pediatrician. 

We do sports physicals. Sports physicals can be done during well-child visits. During a sports physical, we'll make sure it’s safe for your child to be in a certain sport. The physical includes a medical history review and a physical exam.  

• Raises head for short periods when laying on stomach 
• Turns eyes toward familiar voices
• Shows startle reflex (sudden arm movements)

• Smiles
• Makes more vocal noises
• Starts to visually track moving objects
• Holds head up and pushes up while lying on stomach

• Grasps and shakes toys 
• Starts to roll 
• Tries to put weight on legs
• Has better control of head and neck
• Has better distance vision; knows familiar objects and people 
• Coos and laughs 
• Enjoys social play
• Shows interest in mirror images

• Rolls both ways
• Sits with support — the tripod sit
• Reaches with one hand
• Uses “raking” motion of fingers to hold objects 
• Starts to respond to name or nickname 
• Responds to facial changes
• Reaches for objects away from them 
• Babbles   

• Babbles 
• Gets into a sitting position from laying 
• Sits unsupported
• Starts to crawl forward
• Pulls up to a standing position 
• Cries when parents leave and acts shy or anxious around strangers 
• Plays peek-a-boo
• Finds hidden objects
• Eats with fingers 
• Tests parent’s response
• Waves and claps 

• Moves along furniture 
• Starts to walk on their own 
• Says one or two words 
• Understands what you’re saying 
• Points with first (pointer) finger
• Holds something between thumb and first finger 

• Walks on their own
• Runs and dances 
• Says three to five words 
• Copies things such talking on the phone, cleaning, etc. 
• Sorts shapes

• Says 15 words 
• Points to show someone an object of interest 
• Pulls toys when walking 
• Eats with utensils 
• Plays simple pretend, such as feeding a baby doll 
• Points to body parts such as nose, eyes and mouth 

• Follows one-step directions 
• Says around 50 to 100 words 
• Says several two-word sentences
• Is understood by adults half the time 
• Kicks and throws a ball overhand

• Knows names of body parts and familiar people 
• Says two- to four-word sentences 
• Names pictures in picture book 
• Follows two-step directions 
• Climbs on and off furniture without help 
• Walks up and down stairs without holding on to anything
• Draws a straight line and a circle 

• Hops and stands on one foot for up to five seconds
• Goes up and down stairs without help 
• Draws circles and squares 
• Begins to copy capital letters 
• Knows what “same” and “different” mean
• Says five- to six-word sentences
• Speaks clearly enough for strangers to understand them
• Knows names of some colors 
• Knows a few numbers and what it means to count 
• Follows three-step directions 
• Joins in fantasy play 
• Plays with other children 
• Can dress and undress themselves 

• Hops, somersaults, swings and climbs 
• Copies shapes and patterns such as triangles and squares
• Draws a person with a body and some letters 
• Dresses and undresses themselves without help 
• Remembers part of a story 
• Says sentences with more than five words 
• Knows the names of at least four colors 
• Likes to sing, dance and act 
• Knows the difference between fantasy and reality 
• Acts both demanding and cooperative 

• Talks about doing things in future tense
• Tells longer stories and uses full sentences 
• Says their own name and address 
• Knows the idea of time 
• Knows about everyday items in the home, such as food, money and appliances
• Wants to be like his/her friends 
• Acts more agreeable and follows rules

Boys and girls show different signs when they enter puberty. 

Signs for girls:

• Breast development. Girls will get breast buds behind the nipple as early as 8 years old and as late as 13 years old. It may happen unevenly and the area may be sore. This is normal and improves with time. 
• Growth spurts one year after puberty begins. This is why girls are usually taller than boys are at this age. 
• Periods start. Menstruation, the normal monthly bleeding from the vagina, starts about 18 months to two years after puberty begins. 
• If your daughter is not showing any signs of puberty by age 13, talk to your pediatrician. 

Signs for boys: 

• Testes and scrotum, the sac that holds the testes, grow. This often begins around age 11 but can happen between the ages of 9 and 14. 
• Growth spurts two years after puberty begins. 
• If your son is not showing any signs of puberty by age 14, talk to your pediatrician.  

Boys’ and girls’ bodies go through several changes as they enter puberty. Help your child by telling them what to expect. Don’t wait until they have already entered puberty. Start talking about these changes early, before they happen.

Main changes for girls:

• Body hair. Hair will begin to grow in the genital area, under the arms and on the legs. This is often the first sign of puberty.   
• Body shape. Her breasts will grow and she may become curvier. Girls also have fast growth spurts during puberty. After a girl has her period, she probably won’t grow more than two inches. 
• Menstrual cycle: 
  • This doesn’t just refer to a girl’s period. Before a girl begins to menstruate regularly, she may have small amounts of clear or white vaginal discharge. This is from the increased estrogen (female sex hormone) in her body. 
  • When it comes to periods, girls can have very different experiences. Some have bright red blood with their first period and others only have spotting. Some have periods once a month, while others have periods every other month or less often for the first few years. 
  • Some girls also have stomach cramps or pain. If the pain is bad even after taking medicine, talk to your pediatrician. 
• Acne. This is common due to changes in hormone levels. 
• Body odor and sweating under the armpits are normal.

Main changes for boys: 

• Body hair. Hair will begin to grow in the genital area. Over time, hair will also grow on their thighs, face, legs, arms, underarms and chest. 
• Body shape. Their bodies will begin to fill out during this time. Some boys may feel insecure as they compare themselves to others. As a parent, you can help by talking to your son. Tell him what to expect and what’s normal/not normal. 
• Genital changes: 
  • The scrotum and testicles will almost double in size during puberty. The skin will get darker, stretch and begin to hang. In most cases, one testicle hangs lower than the other does. 
  • Some boys may have adult-sized genitals as early as age 13. The penis will grow in length and then width. 
  • One in three boys may also notice pink pearly bumps, called papules, on the crown of their penis. 
  • About a year after their testicles grow, boys often have their first ejaculation, or discharge of semen from the penis. Some may have an ejaculation in their sleep (called wet dreams). Others may masturbate to have their first ejaculation. 
  • Some boys have random, involuntary erections. This will happen less often as they grow older. They shouldn’t be ashamed or embarrassed about it. 
• Voice changes. A boy’s voice box and vocal cords get bigger, causing his voice to crack and the voice to sound lower. 
• Acne. This is common due to changes in hormone levels. 
• Body odor and sweating under the armpits are normal. 

You can help your child by telling them what to expect and what is happening to their bodies. Make sure they know the changes are natural and they can come to you with any questions. If they still feel unsure, offer to set up an appointment with their pediatrician.