Physical Development

From birth through puberty, every stage of your child’s life brings new milestones – and new questions. Rainbow pediatricians provide guidance for the concerns they hear most often:

When do babies start to talk, crawl and walk?

One of the most exciting things about being a parent is watching your child learn and grow. While every child is different, there are some predictable ages at which, on average, most children should show you a new skill (developmental milestone). You and your pediatrician will be paying attention to your child’s development and will decide if things are happening on-time or if they are delayed. Be sure to let your pediatrician know if you have any concerns about when or how your child meets her milestones.

Talking: Babies start communicating with us from the moment they are born. They start by watching our faces for non-verbal cues and by listening to the sounds and tone of our voices and the words we use. Most babies will start cooing and laughing by two to three months. Next, you might hear your baby “jargoning” or “babbling,” where he will express the tones and inflections of speech without words that we adults recognize. Most babies will start experimenting with consonant sounds (like ba-ba-ba or da-da-da) between seven and ten months of age, and most children with have a few words (commonly, “mama”, “dada”, plus one additional word) by their first birthday.

Walking: To walk, your baby has to develop the strength and coordination to pull to stand, balance on two feet, and then keep that balance while moving. On average, babies will start “cruising” (pulling to stand and walking along furniture for support) by about nine months, and will start walking on their own around their first birthday.

Crawling: Believe it or not, crawling is not actually a developmental milestone! While many babies will learn to crawl before they learn to pull to stand or cruise, some never do. They may get around by rolling, or scooting on their back or bottom, or they may skip crawling altogether in favor of two-footed locomotion.

How much sleep do babies (children) need?

Babies and children need LOTS of sleep! Most babies do not have a regular sleep schedule until they are around six months old. Newborns will sleep in one to two hour increments for up to 18 hours of the day and may be equally alert or sleepy during the day or night. Usually by one month of age, infants will consolidate some of their sleep for longer stretches, and by two to three months, many infants will settle into a three nap per day plus overnight schedule. By six months, infants will sleep approximately 14 hours per day, while one year-olds sleep just under 14 hours per day. Toddlers will often resist going to sleep – they don’t want to miss anything! Having a set nighttime routine with consistent bedtime can help your toddler get the rest they need.

What are normal bowel movements?

Everyone is different when it comes to bowel movements. Most children have bowel movements daily to every other day, but for some, more than once a day or only once a week can be normal. Bowel movements should be soft and passed without difficulty. Bowel movements that are hard in consistency and difficult to pass can be a sign of constipation. Very loose or watery stools are abnormal, as well as white, black, or bloody stool.

What is normal urination?

Most infants urinate 8-10 times per day, and this slows down as they age. Once bladder control is reached, most children urinate 4-5 times per day.

How do I know if my child has asthma?

Signs of asthma include shortness of breath, as well as coughing or wheezing during activity or exposure to cold air, smoke, or other lung irritants. Over time, if coughing at night or wheezing becomes a prominent symptom during routine viral infections, it can also be a sign of asthma.

How do I know if my child is diabetic?

Signs of diabetes include excessive thirst and urinating more than usual. A child who has been toilet trained for a while may also start to have accidents with urination if they have diabetes. Other signs include weight loss and vomiting.

When can my child sit in the car without a booster seat?

Children should ride in a booster seat until they are eight years old, 80 pounds, AND four foot nine inches tall. They must meet all of these before safely riding in car with the seat belt only.

Do we need to use sunscreen on children?

Sunscreen with SPF of at least 15 should be used consistently starting at six months of age when you are out in the sun. Try to reapply sunscreen every two hours and after swimming or excessive sweating. Before six months of age, try to keep your child out of the sun as much as possible (sun hats strollers with a canopy are helpful).

What are the signs of puberty and how long does it last?

Puberty begins in girls with breast development and in boys with enlargement of the testicles. Other signs of puberty include pubic and underarm hair, acne, body odor, physical growth, and periods (in girls). Girls begin puberty between eight and 13 years of age, and boys begin puberty between nine and 14. Puberty lasts until it is over! It can take from two to five years to progress through the physical stages of puberty.

How do I know if my child has mono?

Mono – or mononucleosis – is a viral illness caused by the Epstein-Barr virus. Younger children often have mild symptoms like sore throat and fever that go away in a few days. Older children and adolescents can develop a more severe sore throat, fever, and fatigue. They may also have swollen glands (lymph nodes) on their neck. If your child or adolescent has any of these symptoms, or if you are concerned they may have mono, you should make an appointment with your pediatrician. Your pediatrician can do blood tests to help diagnose mono.

Browse our Frequently Asked Questions for more answers from Rainbow doctors.

Nutrition + Your Child

Breast milk? Bottles? Time for soft foods? Making the right choices for your baby’s nutrition can be daunting. Get started with help from Rainbow experts:

What’s the difference between breast milk and formula?

Choosing how to feed your newborn can seem overwhelming. Breastmilk and breastfeeding have many benefits for infants, and is recommended by pediatricians for most babies. However, your personal preferences, changes in caregivers, or your infant’s particular needs might prompt formula or bottle feeding. Either way, in the first six months of life, your infant’s main source of nutrition and fluid will come from the breastmilk or formula they drink. Both contain the mix of sugar, fat, electrolytes and protein your infant needs to stay well hydrated and to grow. While formula manufacturers have worked hard to find the right balance of nutrients, only breastmilk contains immunoglobulins – proteins that help protect your infant from infections.

Most formulas are cow’s milk-based. Compared to regular cow’s milk, infant formulas have specially-processed the protein, fat, and sugars (lactose) in the milk to better approximate the composition of human breastmilk. Formulas also contain extra iron to prevent anemia. Some families choose soy-based formulas instead – sometimes because they wish their child to consume a vegetarian diet. Some babies with allergies need a hydrolyzed (hypoallergenic) formula, while some babies who have particular medical conditions that require a specialized formula. If you chose to bottle-feed, your pediatrician can help you pick which is the right formula for your baby.

How do I know my baby is eating healthily?

As a newborn and young infant (through six months of age), the only nourishment your baby needs is breastmilk or formula. Infants shouldn’t drink plain water until they are at least six months old. If you choose to give your baby juice, wait until he is at least six to nine months old, and then limit juice to no more than four ounces per day.

Signs of feeding problems in young infants under the age of six months include:

  • Too much feeding – taking more than six ounce per bottle-feed, vomiting most or all food after a feeding, or having very loose or watery stools
  • Too little feeding – nursing less than ten minutes per feed, wetting fewer than four diapers per day, having very hard or very rare stools, or always seems hungry
  • Allergy –vomiting most food immediately after a feed, more than eight watery stools per day or blood in stools, or bad skin rashes
  • Talk with your pediatrician if you have any concerns about how or what your baby eats.

When should babies start eating food?

To eat solid food, you baby needs to master the following skills:

  • She needs to be able to hold her head steady while sitting upright (in a high chair or on her own) – most babies will achieve this between four and six months of age.
  • She needs to be big enough to take solid food – this usually occurs when baby is about 13 pounds or has doubled her birthweight.
  • She needs to be interested in food – a baby who is excited about food will watch you closely and open her mouth wide if she sees food headed her way.

Browse our Frequently Asked Questions for more answers from Rainbow doctors.

Emotional Development

Every kid has a unique way of telling (or showing) you how he feels. Rainbow doctors share their advice for understanding everything from crying newborns to silent teenagers:

How do you know when an infant is happy and healthy?

Every infant and child is different, with different personalities, and different temperaments. However, to be happy and healthy, all babies need to feel safe and secure – that their caregiver is “tuned into them”, will play and interact with them when they are happy, and will reassure them or meet their needs when they aren’t feeling well. Here are a few cues to look for at different ages to tell you that your infant is happy and healthy:

  • Newborns: turning to your face or the sound of your voice
  • 0-3 months: relaxing in your arms or snuggling in close when held
  • 3-6 months: smiling and laughing spontaneously
  • 6-9 months: babbling, getting excited to see you
  • 9-15 months: checking in with you, looking to you for reassurance or even crying when strangers enter their personal space (“stranger anxiety”)

What is too much crying?

All babies cry – routinely up to three or four hours every day! Babies cry for lots of reasons. While crying is the main way babies tell us that they are hungry or uncomfortable, babies also cry to get rid of extra energy, or to shut out light or noise that they find overwhelming. As your baby grows, she will develop different-sounding cries for everything from “I’m hungry” or “leave me alone” to “I’m uncomfortable” or “I want to snuggle.” If your baby is crying, make sure she’s warm, clean, dry and fed; then try to console her by rocking, singing, swaddling, or burping her. If all else fails or you find yourself getting frustrated, put youy baby down on her back in her bassinet or crib and let her cry on her own for a little while. If your baby is crying and nothing you try settles her down, she might be telling you that she is sick or has an infection. Check her temperature – if it is over 100.4 F, call your pediatrician.

Is it normal for toddlers to hit, scream and bite? How should they be disciplined?

There are three things parents need to remember about toddlers:

  • Toddlers have very little self-control.
  • Toddlers often act out when they are tired, frustrated, or just want your attention.
  • Toddlers are excellent mimics, looking to adults around them to show them how to respond to situations where they are angry or frustrated. An adult who strikes out or screams when angry tells a toddler that it is ok to hit and scream rather than use words to express their upset.

Therefore, the best intervention is prevention – everyone who cares for your child should be a good role model, and they should agree to and enforce the same rules that you do.

The key is to remember that toddlers cannot be reasoned with, but learn by getting attention from you for a behavior – this is called reinforcement. There are two kinds of reinforcement: positive reinforcement is praise and attention for wanted behavior. Therefore, be sure to “catch your toddler being good”, and be sure to praise your toddler when he uses his words to express frustration rather than screaming, biting, or hitting. Negative reinforcement occurs when you give attention to bad behaviors: this might including bribing or negotiating with your child to get them to stop a behavior, or getting upset or angry yourself when your toddler is misbehaving.

So, what should you do if your toddler breaks an important rule, or acts out by hitting or biting? First, reprimand the child immediately with a firm but calm voice so that he knows what he did wrong. Next, try a time out, especially for “dangerous” behaviors like biting and hitting – time-out removes your child from his bad behavior and gives him a chance to cool off. Usually one minute of time-out for each year of age is sufficient. Time out should be boring, with minimal interaction and eye contact, and should end while your child is still calm, quiet and still (that is, before he starts acting out again!).

If your child seems unusually aggressive, if you are worried about safety, or if you can’t cope on your own, talk to your pediatrician – She can help you sort out other strategies or supports to help your toddler learn to handle their frustration.

Does my toddler need to play with others?

The short answer to this question is yes, playing with other children allows your child to develop important social skills, like sharing, and awareness of others, they can’t learn as well from adults.

This is because one-year-olds occupy the center of their own universe – they know that other people exist, but don’t yet have a good sense of how others think or feel. Therefore, most young toddlers will play next to other children, rather than with them. Because she is the most important person in the universe, sharing is difficult, and she may become possessive over toys. When your young toddler is playing with other children, reassuring her that the other child is only looking or isn’t going to take a particular toy may help keep the situation calm.

As your toddler grows closer to two years of age, she will likely still be somewhat selfish but will also spend more and more time imitating the people around her and playing pretend. Playing with other children gives your toddler plenty of opportunity to practice sharing skills and learn how to imagine herself in someone else’s shoes. Try starting with small playgroups of two to three children: this way adults can monitor to be sure everyone is safe while allowing the children to learn to play together.

How can I discipline my child without her thinking I’m an ogre?

As a parent, it is your job to discipline your children so they grow up knowing what is right and what is wrong. Discipline should be done in a loving environment, and should not include corporal punishment. Time-out for younger children, and taking away privileges for older children can be helpful. Also, remember to praise your children when they do something good! This way, your child is hearing positive reinforcement from you, so you will not always be the "bad guy". Discipline involves praising good behavior as well as discouraging bad behavior.

When does teasing turn into bullying?

Children often tease one another, but bullying is when the teasing becomes a pattern over time, and it happens over and over again. A bully is trying to control other children by showing power over them and scaring them. Bullying can be physical, verbal, or social. Alert your child's teacher and school if you believe your child is a victim of bullying.

How do I know if my child is depressed and what should I do about it?

Children and teenagers may not look typically “depressed.” They can appear sad or tearful, but you might also notice that they are irritable or withdrawn from family, school or friends. If you are worried that your child or teen is depressed, you should make an appointment with your pediatrician to discuss your concerns.

What are the best ways to maintain open lines of communications with sullen teenagers?

It might be difficult to get your teenager to start talking. Parents should try to be available and be honest. Let teens know that you are there to talk, and you are willing to talk about anything. Take advantage of time driving in the car or time at the kitchen table to ask questions. And remember to listen!

How do you punish a kid who’s way bigger than you?

Spanking and other forms of corporal punishment are not recommended by pediatricians. Older children and adolescents should be disciplined with methods appropriate for their developmental stage. As children get older and become more independent, clear rules and expectations are important. Natural consequences and loss of privileges can be used.

Browse our Frequently Asked Questions for more answers from Rainbow doctors.

Educational Development

Should she be reading? Writing? Doing long division? Rainbow doctors provide answers to some commonly asked questions about educational milestones:

When do children start to read?

Love of books, language, and reading starts in infancy. Sharing books and reading to your young child will help her learn that books are fun and that reading together is enjoyable. She will learn new words and will be more ready to start school. Children whose parents or caregivers read to them early in life tend to read on their own at a younger age, and tend to do better in school when compared to other children.

Try reading together for five to ten minutes each evening with the TV off as part of your bedtime routine. At one year, your child can pay attention to a book for a few minutes, will enjoy the colors and pictures and feel of the book, and may imitate your reactions to the book. Let your two year-old pick out the book to share each evening (it may be the same book over and over again), and try asking your child questions about pictures or the story. By age three, your child should be able to name the book she wants to share. She may even know the story well enough to correct you if you skip a favorite word or page!

Is television bad for kids?

Let's face it, television is a part of our culture and difficult to avoid. Not all television is bad, and some programming can be educational. Parents should closely monitor what their children are watching, and the American Academy of Pediatrics recommends no more than 2 hours of "screen time" (TV, video games, computers, etc.) per day. Televisions should not be placed children's bedrooms where it is difficult to monitor and can cause difficulties with sleep.

How do I know if my child has a learning disability?

A learning disability can present with difficulty keeping up with peers in school or not reaching academic potential, and may be subject specific, such as isolated reading or math difficulty. There are many other issues that can cause a child to have problems in school, such as ADHD, depression, anxiety, sleeping disorders, etc. If you suspect that your child may have a learning disability it is important to talk to your child's teacher and principal, since the school system is responsible for performing evaluations for learning problems. Your pediatrician can also look into other issues that can cause problems in school.

How do I know if my child is gifted?

Some signs of a gifted child include high verbal and reasoning skills, ability to learn quickly and absorb large amounts of information, and very good memory skills. They may also be able to read well above their grade level. Keep in mind that just because a child is gifted does not mean that they could not also have a learning problem such as dyslexia or language problem, and gifted children may become bored in regular classes which could cause behavioral problems.

Browse our Frequently Asked Questions for more answers from Rainbow doctors.