Did you know that children’s brains grow and change more in the first 1,000 days of their lives – that is, from the time of conception to their second birthdays – than at any other time?
The brain starts as a handful of microscopic cells. By 2 years of age, the brain has developed into a complex organ that allows children to learn to walk, talk, and read. And it’s ready for new changes and experiences, like learning math, reasoning, and complex thought.
These brain changes are amazing, but they are also dependent on each other. That means that if the brain lacks a necessary building block during this time, it will miss out on the developmental process that building block was supposed to make. This is why the first 1,000 days are so critical – and a great time to make sure your baby is off to a healthy start.
Food for Thought
Healthy eating and taking pre-natal vitamins are some of the best things a pregnant woman can do to keep her child’s brain healthy.
Once baby arrives, these are important for healthy brain development too:
Breastfeeding, which provides nutrients, growth factors, and types of cells not found in infant formula. The AAP recommends exclusive breastfeeding until six months of age if possible, and continuing after solids are introduced for at least the first year.
If you are not breastfeeding, give your baby an approved infant formula, which has the nutrients babies need in the first 6 months of life to have healthy brain development.
Eating a variety of healthy foods is important. The brain has wonderful potential, but it depends on the body getting all the nutritional building blocks it needs. In those first 1,000 days, even before your child is born, it needs:
Long chain polyunsaturated fatty acids (the special fats found in breastmilk, fish, and some nuts)
Your Pediatrician Can Help
Pediatricians have many resources to help families make good nutrition choices for their child’s developing brain. The American Academy of Pediatrics (AAP) has teams of expert pediatricians who write guidelines, such as Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health, that cover a wide variety of nutrition topics. Your pediatrician may refer to these when helping you make decisions about your child’s care.
And since healthy food for babies and toddlers can be expensive, your pediatrician may be able to connect you to programs in your community such as:
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
The Supplemental Nutrition Assistance Program (SNAP)
The Child and Adult Care Food Program (CACFP)
Food pantries and soup kitchens
Maternal, infant, and early childhood home visiting program
It’s Scientific
Scientists continue to study the role of healthy diets in children’s growth and development. The United States Department of Agriculture (USDA) and the Department of Health and Human Services (HHS) have called together groups of scientists to develop guidelines for feeding children between birth and 24 months of age, based on the best information we have from many years of study and investigation. This work is happening now and will take several years to complete.
Healthy brain development is so important in giving our children a long, healthy, and productive life. You can work with your pediatrician to understand the best things to do to help your child get the nutrients he or she needs to keep development on track.
New parents often ask what color I think the baby’s eyes are going to be. I never answer this question until the child is at least 1 year old; I mean, what if the parents believe me and use my answer to make major life decisions? When we talk about eye color, we’re really talking about the appearance of the iris, the muscular ring around the pupil that controls how much light enters the eye. After all, the pupil will always be black, except in flash photos, and the whites (sclera) should stay pretty much white, although jaundice may turn them yellow and inflammation may make them look pink or red.
Eye color changes over time
Iris color, just like hair and skin color, depends on a protein called melanin. We have specialized cells in our bodies called melanocytes whose job it is to go around secreting melanin. Over time, if melanocytes only secrete a little melanin, your baby will have blue eyes. If they secrete a bit more, his eyes will look green or hazel. When melanocytes get really busy, eyes look brown (the most common eye color), and in some cases they may appear very dark indeed.
Because it takes about a year for melanocytes to finish their work it can be a dicey business calling eye color before the baby’s first birthday. The color change does slow down some after the first 6 months of life, but there can be plenty of change left at that point.
Eye color is a genetic property, but it’s not quite as cut-and-dried as you might have learned in biology class.
Two blue-eyed parents are very likely to have a blue-eyed child, but it won’t happen every single time.
Two brown-eyed parents are likely (but not guaranteed) to have a child with brown eyes.
If you notice one of the grandparents has blue eyes, the chances of having a blue-eyed baby go up a bit.
If one parent has brown eyes and the other has blue eyes, odds are about even on eye color.
If your child has one brown eye and one blue eye, bring it to your doctor’s attention; he probably has a rare genetic condition called Waardenburg syndrome.
Cross-eyed?
Parents also often note that their newborns’ eyes appear to cross from time to time. For the first 6 months of life this can be normal. To begin with, to look at something the brain has to know where to point the eyes. For the first 2 to 4 weeks of life vision is not accurate enough for the baby’s eyes to find a target a lot of the time. Parents often feel like their newborns are looking past them rather than at them, because they are. By the fourth week of life, however, your baby will focus on your face if you’re cradling him.
Most visual development occurs in the brain, not in the eyes themselves. One of the greatest challenges for the developing brain is to coordinate visual signals from one side to the other. Nerve signals from the eyes travel through optic nerves and split off to both sides of the brain. To make sense of those signals, the 2 sides of the brain have to cooperate, comparing information and coordinating eye movement in the desired direction. Until age 2 months you may notice your infant will follow your face or a toy a little way, then lose it as it crosses from one side to the other. By 2 months, however, he should be able to track from right to left and back again.
The next big visual milestone occurs at 6 months of age. By this time the 2 sides of the brain are on good terms with each other. Until this point the eyes track together as long as they both have something to look at, but if one is deprived of input (from being covered by a hat, for example), it might drift off in its own direction. By 6 months of age the eyes should continue looking the same direction even if one of them is covered temporarily. We test this in the clinic by covering 1 eye for 3 seconds, then suddenly uncovering it and looking to see if it’s still tracking with the opposite eye. We call this test the cover-uncover test.
Sometimes the shape of a child’s face makes it look as though the eyes are crossed even when they are not. A child with a broad nasal bridge may appear to have an inward-looking eye, when in fact he’s just looking off to the side. You can check this by watching the light reflection in your child’s eyes from a window or lamp; if it falls in the same place on each eye, the eyes are working together.
Lazy eye (amblyophobia)
Even with office screening, however, we don’t always catch an eye that tends to deviate. Deviations occur more often when the child is tired. If you ever notice that your 6-month-old or older child has an eye that doesn’t always look the same way as its partner, alert his doctor. It’s critical that an eye specialist (ophthalmologist) examine the child. What some people call a lazy eye (amblyopia) may be a sign that one eye doesn’t see as clearly as the other. When the brain is forced to make 1 picture from 2 very different inputs, it starts to ignore the signals from the worse eye. Over time this process becomes irreversible, leading to partial blindness in the weaker eye. In most cases, you should address the problem before the child turns 3 to ensure he’ll grow up with normal depth perception. Treatments for amblyopia vary based on the cause and severity of the condition. Some children require glasses or patches that force the brain to pay attention to signals from the weaker eye. Other kids need surgery to shorten or lengthen certain muscles that control eye movement.
Remember the Charles Schulz character Linus and his blanket? He dragged it around wherever he went, nibbling on its corner or curling up with it when the going got tough. You may still remember your own favorite childhood blanket, doll or teddy bear, too. Security objects such as blankets are part of the emotional support system every child needs in their early years.
Your child may not choose a blanket, of course. They may prefer a soft toy instead. Chances are they’ll make her choice between months eight and twelve, and keep it for years to come. When your child is tired, it will help them sleep. When they are separated from you, it will reassure them. When they are upset, it will comfort them. When they’re in a strange place, it will help them feel at home.
From dependence to independence
These special comforts are called transitional objects. They help children make the emotional transition from dependence to independence. They work, in part, because they feel good: they’re soft, cuddly, and nice to touch. They’re also effective because of familiarity. This “lovey” has your child’s scent on it, and it reminds them of the comfort and security of their room. It makes them feel everything is going to be OK.
Despite myths to the contrary, transitional objects are not a sign of weakness or insecurity, and there’s no reason to keep your child from using one. In fact, a transitional object can be so helpful you may want to help then choose one and build it into their nighttime ritual.
Why having a duplicate is a good idea
The value of You can also make things easier by having two identical security objects. Doing this allows you to wash one while the other is being used, thus sparing your baby (and yourself) a potential emotional crisis and a bedraggled lovey.
If your baby chooses a large blanket for her security object, you can easily cut it into two. They have little sense of size and won’t notice. If they’ve chosen a toy instead, try to find a duplicate as soon as possible. If you don’t start rotating them early, your child may refuse the second one because it feels too new and foreign.
Don’t worry about thumb sucking
Parents often worry that transitional objects promote thumb sucking, and in fact they sometimes do (but not always). But it’s important to remember that thumb or finger sucking is a normal, natural way for young children to comfort themselves. They’ll gradually give up both the transitional object and the sucking as they matures and find other ways to cope with stress.
What makes a baby big or small? The following are some of the most common causes:
Large Babies: An infant can be born large when the parents are large or the mother is overweight. There is also a greater likelihood of a large newborn due to factors such as:
The pregnancy lasting longer than forty-two weeks
The fetus’s growth over stimulated in the uterus
Fetal chromosomal abnormalities
Weight gain during pregnancy
The mother’s ethnicity
The mother having diabetes before or during pregnancy
The mother having given birth to other children
Having a boy
Large infants may have metabolic abnormalities (such as low blood sugar and calcium), traumatic birth injuries, higher hemoglobin levels, jaundice, or various congenital abnormalities. Almost one-third of large babies initially have feeding difficulties. Your pediatrician will keep a close watch on these issues.
Small Babies: A baby may be born small for a number of reasons, including:
Being born early (preterm)
Being born to small parents
The mother’s ethnicity
Fetal chromosomal abnormalities
The mother’s chronic diseases such as high blood pressure, or heart or kidney disease
Malnutrition
The mother’s substance abuse during pregnancy
A small baby may need to have his temperature, glucose, and hemoglobin level closely monitored. After birth, the pediatrician will thoroughly evaluate a small infant and decide when he is ready to go home.
To determine how your baby’s measurements compare with those of other babies born after the same length of pregnancy, your pediatrician will refer to a growth chart.
Growth charts examine length and weight in boys and girls, from birth to thirty-six months. They are followed by body mass index for age charts for boys and girls, ages two to twenty years. (Body mass index, or BMI, is a measure of weight in relation to height.)
Eighty out of every one hundred babies born at forty weeks of pregnancy, or full term, weigh between 5 pounds 11-1⁄2 ounces (2.6 kg) and 8 pounds 5-3⁄4 ounces (3.8 kg). This is a healthy average. Those above the ninetieth percentile on the chart are considered large, and those below the tenth percentile are regarded as small. Keep in mind that these early weight designations (large or small) do not predict whether a child will be above or below average when he grows up, but they do help the hospital staff determine whether he needs extra attention during the first few days after birth.
At every physical exam, beginning with the first one after birth, the pediatrician will routinely measure the baby’s length, weight, and head circumference (the distance around his head) and will plot them on growth charts. In a healthy, well-nourished infant, these three important measurements should increase at a predictable rate. Any interruption in this rate can help the doctor better detect and address any feeding, developmental, or medical issues.
Did you know that hundreds of children younger than 1 year die every year in the United States because of injuries — most of which could be prevented?
Often, injuries happen because parents are not aware of what their children can do. Children learn fast, and before you know it, your child will be wiggling off a bed or reaching for your cup of hot coffee.
Car Injuries
Car crashes are a great threat to your child’s life and health. Most injuries and deaths from car crashes can be prevented by the use of car safety seats. Your child, besides being much safer in a car safety seat, will behave better, so you can pay attention to your driving. Make your newborn’s first ride home from the hospital a safe one — in a car safety seat. Your infant should ride in the back seat in a rear-facing car seat.
Make certain that your baby’s car safety seat is installed correctly. Read and follow the instructions that come with the car safety seat and the sections in the owners’ manual of your car on using car safety seats correctly. Use the car safety seat EVERY time your child is in the car.
NEVER put an infant in the front seat of a car with a passenger air bag.
Falls
Babies wiggle and move and push against things with their feet soon after they are born. Even these very first movements can result in a fall. As your baby grows and is able to roll over, he or she may fall off of things unless protected. Do not leave your baby alone on changing tables, beds, sofas, or chairs. Put your baby in a safe place such as a crib or playpen when you cannot hold him.
Your baby may be able to crawl as early as 6 months. Use gates on stairways and close doors to keep your baby out of rooms where he or she might get hurt. Install operable window guards on all windows above the first floor.
Do not use a baby walker. Your baby may tip the walker over, fall out of it, or fall down stairs and seriously injure his head. Baby walkers let children get to places where they can pull heavy objects or hot food on themselves.
If your child has a serious fall or does not act normally after a fall, call your doctor.
Burns
At 3 to 5 months, babies will wave their fists and grab at things. NEVER carry your baby and hot liquids, such as coffee, or foods at the same time. Your baby can get burned. You can’t handle both! To protect your child from tap water scalds, the hottest temperature at the faucet should be no more than 120°F. In many cases you can adjust your water heater.
If your baby gets burned, immediately put the burned area in cold water. Keep the burned area in cold water for a few minutes to cool it off. Then cover the burn loosely with a dry bandage or clean cloth and call your doctor.
To protect your baby from house fires, be sure you have a working smoke alarm on every level of your home, especially in furnace and sleeping areas. Test the alarms every month. It is best to use smoke alarms that use long-life batteries, but if you do not, change the batteries at least once a year.
Choking and Suffocation
Babies explore their environment by putting anything and everything into their mouths. NEVER leave small objects in your baby’s reach, even for a moment. NEVER feed your baby hard pieces of food such as chunks of raw carrots, apples, hot dogs, grapes, peanuts, and popcorn. Cut all the foods you feed your baby into thin pieces to prevent choking. Be prepared if your baby starts to choke. Ask your doctor to recommend the steps you need to know. Learn how to save the life of a choking child.
To prevent possible suffocation and reduce the risk of sudden infant dealth syndrome (SIDS), your baby should always sleep on his or her back. Your baby should have his or her own crib or bassinet with no pillows, stuffed toys, bumpers, or loose bedding. NEVER put your baby on a water bed, bean bag, or anything that is soft enough to cover the face and block air to the nose and mouth.
Plastic wrappers and bags form a tight seal if placed over the mouth and nose and may suffocate your child. Keep them away from your baby.
Did you know that hundreds of children younger than 1 year die every year in the United States because of injuries — most of which can be prevented?
Often, injuries happen because parents are not aware of what their children can do. Your child is a fast learner and will suddenly be able to roll over, crawl, sit, and stand. Your child may climb before walking, or walk with support months before you expect. Your child will grasp at almost anything and reach things he or she could not reach before.
Falls
Because of your child’s new abilities, he or she will fall often. Protect your child from injury. Use gates on stairways and doors. Install operable window guards on all windows above the first floor. Remove sharp-edged or hard furniture from the room where your child plays.
Do not use a baby walker. Your child may tip it over, fall out of it, or fall down the stairs in it. Baby walkers allow children to get to places where they can pull hot foods or heavy objects down on themselves.
If your child has a serious fall or does not act normally after a fall, call your doctor.
Burns
At 6 to 12 months children grab at everything. NEVER leave cups of hot coffee on tables or counter edges. And NEVER carry hot liquids or food near your child or while holding your child. He or she could get burned. Also, if your child is left to crawl or walk around stoves, wall or floor heaters, or other hot appliances, he or she is likely to get burned. A safer place for your child while you are cooking, eating, or unable to provide your full attention is the playpen, crib, or stationary activity center, or buckled into a high chair.
If your child does get burned, put cold water on the burned area immediately. Keep the burned area in cold water for a few minutes to cool it off. Then cover the burn loosely with a dry bandage or clean cloth. Call your doctor for all burns. To protect your child from tap water scalds, the hottest temperature at the faucet should be no more than 120°F. In many cases you can adjust your water heater.
Make sure you have a working smoke alarm on every level of your home, especially in furnace and sleeping areas. Test the alarms every month. It is best to use smoke alarms that use long-life batteries, but if you do not, change the batteries at least once a year.
Drowning
At this age your child loves to play in water. Empty all the water from a bathtub, pail, or any container of water immediately after use. Keep the door to the bathroom closed. NEVER leave your child alone in or near a bathtub, pail of water, wading or swimming pool, or any other water, even for a moment. Drowning can happen in less than 2 inches of water. Knowing how to swim does NOT mean your child is safe in or near water. Stay within an arm’s length of your child around water.
If you have a swimming pool, now is the time to install a fence that separates the house from the pool. The pool should be fenced in on all 4 sides. Most children drown when they wander out of the house and fall into a pool that is not fenced off from the house. Be prepared — install a fence around your pool now, before your child begins to walk!
Poisoning and Choking
Your child will explore the world by putting anything and everything into his or her mouth. NEVER leave small objects or balloons in your child’s reach, even for a moment. Don’t feed your child hard pieces of food such as hot dogs, raw carrots, grapes, peanuts, or popcorn. Cut all of his or her food into thin slices to prevent choking.
Be prepared if your child starts to choke. Learn how to save the life of a choking child. Ask your doctor to recommend the steps you need to take.
Children will put everything into their mouths, even if it doesn’t taste good. Many ordinary things in your house can be poisonous to your child. Be sure to keep household products such as cleaners, chemicals, and medicines up, up, and away, completely out of sight and reach. Never store lye drain cleaners in your home. Use safety latches or locks on drawers and cupboards. Remember, your child doesn’t understand or remember “no” while exploring.
If your child does eat something that could be poisonous, call the Poison Help line at 1-800-222-1222 immediately. Do not make your child vomit.
Strangulation and Suffocation
Place your baby’s crib away from windows. Cords from window blinds and draperies can strangle your child. Use cordless window coverings, or if this is not possible, tie cords high and out of reach. Do not knot cords together.
Plastic wrappers and bags form a tight seal if placed over the mouth and nose and may suffocate your child. Keep them away from your child.
And Remember Car Safety
Car crashes are a great danger to your child’s life and health. Most injuries and deaths caused by car crashes can be prevented by the use of car safety seats EVERY TIME your child is in the car. All infants and toddlers should ride in a rear-facing car safety seat as long as possible, until they reach the highest weight or height allowed by their car safety seat’s manufacturer. Most convertible seats have limits that will permit a child to ride rear-facing for 2 years or more. A rear-facing car safety seat should NEVER be placed in front of a passenger air bag. Your child, besides being much safer in a car safety seat, will behave better so you can pay attention to your driving. The safest place for all infants and children to ride is in the back seat.
Do not leave your child alone in a car. Keep vehicles and their trunks locked. Children who are left in a car can die of heat stroke because temperatures can reach deadly levels in minutes.
Remember, the biggest threat to your child’s life and health is an injury.
Between four and seven months, your baby will continue to gain approximately 1 to 1-1⁄4 pounds (0.45 to 0.56 kg) a month. By the time she reaches her eight month birthday, she probably will weigh about two and a half times what she did at birth. Her bones also will continue to grow at a rapid rate. As a result, during these months her length will increase by about 2 inches (5 cm) and her head circumference by about 1 inch (2.5 cm).
Your Baby’s Rate of Growth
Your child’s specific weight and height are not as important as her rate of growth. Continue to plot her measurements at regular intervals to make sure she keeps growing at the same rate.If you find that she’s beginning to follow a different curve or gaining weight or height unusually slowly, discuss it with your pediatrician.
Before you bring your newborn home from the hospital, your baby needs to have a hearing screening.
From birth, one important way babies can learn is through listening and hearing. Although most infants can hear fine, 1 to 3 of every 1,000 babies born in the U.S. have hearing levels outside the typical range.
Newborn screening and diagnosis helps ensure all babies who are deaf or hard of hearing are identified as soon as possible. Then, they can receive early intervention services that can make a big difference in their communication and language development.
The American Academy of Pediatrics (AAP) recommends hearing screenings for all newborns. The goal is for all babies to have a newborn hearing screening by one month of age, ideally before they go home from the hospital; identified by 3 months of age and enrolled in early intervention or treatment, if identified as deaf or hard of hearing, by the age of 6 months.
Why do newborns need hearing screening?
The hearing screening is a first and important step in helping understand if your baby may be deaf or hard of hearing. Without newborn hearing screening, it is hard to know when there are hearing changes in the first months and years of your baby’s life.
Babies may respond to noise by startling or turning their heads toward the sound, for example. But this doesn’t necessarily mean they can hear all the sounds around them and everything we say. Babies who are deaf or hard of hearing may hear some sounds but still not hear enough to understand spoken language.
Infants who are deaf or hard of hearing need the right supports, care, and early intervention services to promote healthy development. If the hearing status is not identified, it may have negative effects on the baby’s communication and language skills. Longer term, a missed hearing loss can also impact the child’s academic achievement and social-emotional development.
How is the newborn hearing screening done?
According to the most recent Centers for Disease Control and Prevention (CDC) data, over 98% of newborns in the United States receive newborn hearing screening.
There are two screening methods that may be used:
Automated Auditory Brainstem Response (AABR)—This screen measures how the hearing nerve and brain respond to sound. Clicks or tones are played through soft earphones into the baby’s ears. Three electrodes placed on the baby’s head measure the hearing nerve and brain’s response.
Otoacoustic Emissions (OAE)—This screen measures sound waves produced in the inner ear. A tiny probe is placed just inside the baby’s ear canal. It measures the response (echo) when clicks or tones are played into the baby’s ears.
Both screens are quick (about 5 to 10 minutes), painless, and may be done while your baby is sleeping or lying still. One or both screens may be used.
What if my baby does not pass the initial hearing screening?
If your baby does not pass the hearing screening at birth, it does not necessarily mean that she is deaf or hard of hearing. Fluid or vernix inside the baby’s ear, for example, or too much noise in the room can affect results. In fact, most babies who do not pass the newborn screening have typical hearing. But to be sure, it is extremely important to have further testing done.
About 1 or 2 in every 100 babies will not pass the initial hearing screening at birth and will need tests with an audiologist who has experience working with babies. This testing should include a more thorough hearing and medical evaluation.
Be sure to talk with your baby’s pediatrician about scheduling further tests if your baby does not pass the initial hearing screening at birth.The additional testing should be done as soon as possible, but before your baby is 3 months old.
Follow-up testing may start with one more screening similar to the type done in the hospital. Some hospitals or clinics may complete a diagnostic test at the time of follow-up, instead of re-screening. In young infants, the follow-up testing may be able to be completed while the baby naps.
If my baby is identified as deaf or hard of hearing, what are the treatment and intervention options?
If your baby’s audiologist confirms hearing changes, treatment and early intervention with a team of providers should start as soon as possible. Just like hearing children, children who are deaf or hard of hearing can achieve many things. Studies show your baby will have the best chance for spoken language development―on par with that of hearing peers―if any hearing changes are discovered, and support and intervention begins by 6 months of age. The earlier, the better.
In addition to your pediatrician and audiologist, every baby who is deaf or hard of hearing should be seen by a pediatric otolaryngologist who specializes in the mechanics of the ear. Your pediatrician should also recommend seeing a pediatric ophthalmologist, because some children can also have problems with their vision, and children who are deaf or hard of hearing are dependent on their vision for language input. Many children are also seen by a geneticist to determine if there is a hereditary cause of hearing changes.
Your state Early Hearing Detection and Intervention (EHDI) program can help provide you and your pediatrician with more information. Babies who are deaf or hard of hearing should be referred to Early Intervention for evaluation and services. Additionally, the Individuals with Disabilities Education Act (IDEA) supports intervention programs for children who are deaf or hard of hearing within early intervention and school programming.
The audiologist, together with the otolaryngologist, can tell you the type and degree of hearing change and what the next steps are. These next steps can vary depending on your family’s choices, as well as the type and degree of hearing change.
If my baby passes the newborn hearing screening, does it mean he or she will not have hearing loss later?
Unfortunately, no. Some babies may develop hearing loss later in childhood. Causes of late onset or progressive hearing loss in children can include genetics, frequent ear infections, other infections like measles or meningitis, a head injury, exposure to damaging levels of loud noises, and secondhand smoke. Newborns who need an extended period of neonatal intensive care may also be at an increased risk for hearing loss later.
Even if your baby passes the newborn hearing screening, you should still watch for possible signs of hearing loss as your child grows. Talk with your pediatrician if your child:Doesn’t startle at loud noises by 1 month or turn toward sounds by 3-4 months of age.Doesn’t notice you until he sees you.Concentrates on vibrating noises more than other types of sounds.Doesn’t seem to enjoy being read to.Is slow to begin talking, hard to understand, or doesn’t say single words such as “dada” or “mama” by 12 to 15 months of age.Doesn’t always respond when called, especially from another room.Seems to hear some sounds but not others. (Some hearing loss affects only high-pitched sounds; some children have hearing loss in only one ear.)Has trouble holding his or her head steady or is slow to sit or walk unsupported. (In some children with sensorineural hearing loss, the part of the inner ear that provides information about balance and movement of the head is also damaged.)Wants the TV volume louder than other members of the family.
If my baby passes the first hearing test, why is more screening needed?
Even if your child shows no signs of hearing changes, the AAP recommends they be screened again at ages 4, 5, 6, 8 and 10. Additional screenings are recommended sometime between ages 11-14, 15-17, and 18-21–or any time there is a concern. More frequent follow-up screenings may be recommended for children who have a higher risk for hearing loss. Hearing loss sometimes is gradual and hard to notice at first. Routine screenings can catch hearing changes early, when providing support and resources can have the most impact on the child’s development.
Remember:
Timing is everything. The sooner hearing changes are identified in a baby, the more likely interventions can help her reach her full potential. Talk with your pediatrician if you have any concerns about your child’s hearing.
The first weeks and months of a baby’s life are a period of amazing development. New skills and movements form quickly. These movement milestones are often called “motor development;” they are a source of delight for babies and their families.
Here’s an overview of some typical motor milestones to expect from birth to 3 months:
Month one
Your baby will not be able to control many of her movements during the first few weeks. As she begins to develop more physical abilities, her motions may still be jerky or jittery. But she’s learning fast, so hold on!
Eyes on you. Did you know one of the first parts of the body a baby can move are her eyes? Newborns can only see about a foot in front of them at first, but that’s just enough to move their eyes to gaze at faces near them. Your baby may also look toward familiar sounds and voices.
Neck control. Newborns can move their head to the side. You may see this with their first feeding, when the “rooting” reflex prompts them to turn toward the nipple. But infants don’t have much neck control the first few weeks. Your baby needs your help to support her head.
Newborn reflexes. In addition to rooting, your baby may show other reflex movements these first weeks. To see the step reflex in action, hold your baby securely under his arms (support his head, too!) as his feet touch a flat surface; he may put one foot in front of the other in a sort of “walking” motion. This reflex disappears after the first couple months, and most babies don’t take their first “real” steps until about a year old.
Month Two
Your baby’s nervous system has matured some by now. Certain newborn reflexes are beginning to give way to voluntary motions. With improved muscle control, movement becomes more fluid and wigglier. Here’s what else you can expect:
Heads up on tummy time. Most babies this age can lift their head up when lying on their tummies. Regularly giving your baby some “tummy time” is a great way to help her build strength in her neck and trunk. Some will cry when placed on their tummies, but usually do better after a few tries. It helps to have something interesting, such as mom’s face, in front of them so they have encouragement to lift their head. Although too young to actually crawl, your baby may try or begin to push up from a lying position.
Hand to mouth. During these weeks, your baby may begin to wave his arms around more when excited. Increasingly, his hands will catch his attention. He may spend a lot of time trying to move them in front of him where he can see them. After many tries, he may be able to move them to his mouth. His finger motion is still limited, though, so his hands will likely still be clenched in tight little fists. Sucking on them may become a way for him to soothe himself.
A tug of the lips. You may have already noticed random facial movements, including reflexive smiles, while your baby sleeps. But starting sometime around her sixth week, your baby may flash you her first real smile in a genuine gesture of affection or amusement.
Month Three
Your baby’s arm and leg movements continue to become smoother. The “startle” reflex is probably gone by now. She’s becoming stronger and better able to coordinate her motions.
Straightening out. You might notice your baby’s whole body now looks more relaxed. His hands will no longer be balled up in fists all the time. In fact, he may entertain himself by carefully opening and shutting them. He’ll also enjoy more actively kicking his legs, which are straightening out from their pulled-up newborn position.
Ready to roll. As her kicks continue to become more forceful, she may soon be able to kick herself over from her tummy to back. While most babies can’t roll from back to tummy yet, some may begin rolling over at this age. Be careful never to leave your baby alone on furniture where they could roll over.
Get a grip. Babies this age may begin to swipe at objects hanging just out of reach. While a newborn reflex causes babies to wrap their fingers around objects that touch the palm, your baby’s grasp may now be more deliberate. She may even be able to hold and shake hand toys.
Let’s bounce. When held up and supported in a “standing” position on a surface such as your lap, your baby may discover the joy of bouncing. This is a fun way to play together as your baby begins to hold some of his weight in his legs. It’s best to avoid leaving babies in bouncer seats or harnesses. These can actually slow your baby’s movement progress because they don’t let her practice using her muscles as much.
When to See Your Pediatrician
Remember, each baby’s movements may be a little different. If your baby doesn’t master her movements at exactly the same pace others might, it is usually not because of any developmental delay or other problem.
It is a good idea to talk with your pediatrician if you notice your baby does any of the following:
Stops doing something she used to do. All babies will have good days and bad days. They may go a few days before repeating a new skill. But, if your baby’s development is going backwards or consistently stopped, talk with your pediatrician.
Is not using a part or side of the body. Babies this age normally do not show whether they are left or right handed. If your baby only uses one hand or one side of his body, talk with your pediatrician.
Seems too floppy. Young infants may seem “floppy” until they develop more muscle control. But if your baby seems especially limp or droopy, it could mean she is sick or has an infection.
Jitters or shakes too much. Many newborns have shaky hands or quivery chins, but if their whole bodies are shaking, it could signal a medical problem. Call your pediatrician.
Once your baby reaches about four to seven months old, get ready for some exciting movement milestones. Some of the big challenges they’re working on at this age include rolling over both ways, for example, and sitting up!
Your baby will begin to master skills like these their back and neck muscles gradually get stronger. They’re also developing better balance in their trunk, head, and neck.
First, they’ll raise their head and hold it up while lying on their stomach. Encourage this by placing them on their stomach and extending their arms forward while they are awake. Then, get their attention with an attractive toy. Use it to coax them to hold their head up and look at you. This also is a good way to check their hearing and vision.
Getting ready to roll over
Once they’re able to lift their head, your baby will start pushing up on their arms and arching their back to lift their chest. This strengthens their upper body. This is key to keeping steady and upright when sitting. At the same time, your baby may rock on their stomach, kick their legs, and “swim” with their arms. These skills, which usually appear at about five months, are needed for rolling over and crawling. By the end of this period, they’ll probably be able to roll over in both directions. However, the time frame varies for different babies. Most children roll from stomach to back before the opposite direction, although doing it in reverse is perfectly normal.
Working on sitting up
Once your baby can raise their chest, help them practice sitting up. Hold them up or support their back with pillows as they learn to balance themselves. They’ll soon learn to “tripod,” which is leaning forward as they extends their arms to balance. Interesting toys in front of them will give them a focus as they gains their balance. It will be some time before they can get themselves to a sitting position without your help. But by six to eight months, if you position them upright, they’ll stay sitting without leaning forward on their arms. Then they can discover all the wonderful things the world has to offer from this new vantage point.
Gaining more control of hands & feet
By the fourth month, your baby is also getting better control of their hands. For example, most babies can easily bring interesting objects to their mouth now. During their next four months, they’ll begin to use their fingers and thumbs in a mitten- or claw-like grip or raking motion. They’ll manage to pick up many things.
Your baby won’t develop the pincer grasp with index finger and thumb until about nine months old. But by the sixth to eighth month, they’ll learn to transfer objects from hand to hand, and turn and twist them. Be sure to remove any objects from his environment that he could choke on or injure himself with.
As their physical coordination improves, your baby will discover new parts of their body. Lying on their back, they can now grab their feet and toes and bring them to their mouth. While being diapered, they may reach down to touch their genitals. When sitting up, he may slap his knee or thigh. Through these explorations he’ll discover many new and interesting sensations. They’ll start to understand the function of body parts.
When you place their feet on the floor, they may curl their toes and stroke the surface, use his feet and legs to practice “walking,” or bounce up and down. Watch out! These are all preparations for the next major milestones: crawling and standing.
Toys Appropriate for Your 4- to 7-Month-Old
Unbreakable plastic or mylar mirror
Soft balls, including some that make soft, pleasant sounds
Textured toys that make sounds
Toys that have fingerholds
Musical toys, such as bells, maracas, tambourines (make sure none of the parts can become loose)
See-through rattles that show the pieces making the noise
Old magazines with bright pictures for you to show him
