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Pediatric Milestones: Understanding the First 5 Years

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Contact Hours: 3

This educational activity is credited for 3 contact hours at completion of the activity.

Course Purpose

The purpose of this course is to provide healthcare professionals with a brief overview of the key stages of early childhood development from infancy to age five, exploring significant makers that define a child’s thinking, emotions, and physical abilities, and recommendations for intervention for timely and effective support when delays are identified.

Overview

The developmental journey of the first five years of a child’s life is marked by a series of accomplishments within the physical, cognitive, emotional, and social domains. Known as pediatric milestones, these markers indicate the maturation of a child’s skills and are critical tools for identifying any developmental concerns. This course examines the key stages of early childhood development from infancy to age five, exploring significant makers that define a child’s thinking, emotions, and physical abilities. This course also discusses practical strategies for identifying developmental delays, approaches for encouraging development, and recommendations for intervention for timely and effective support.

Course Objectives

Upon completion of this course, the learner will be able to:

  • Review cognitive and physical milestones for pediatrics, ages infant to 5 years old.
  • Recognize cognitive and physical delays for pediatrics, ages infant to 5 years old.
  • Identify interventions for pediatrics, ages infant to 5 years old, when cognitive or physical delays are identified.
  • Understand the nurse’s role in conducting developmental screenings for childhood development.

Policy Statement

This activity has been planned and implemented in accordance with the policies of FastCEForLess.com.

Disclosures

Fast CE For Less, Inc and its authors have no disclosures. There is no commercial support.

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Definitions

Definitions

BabblingA stage in child development and a state in language acquisition during which an infant is experimenting with uttering articulate sounds but does not yet produce any recognizable words. 
Centers for Disease Control and Prevention (CDC)The nation’s leading science-based, data-driven, service organization that protects the public’s health. 
ChildrenHuman being between the stages of birth and puberty, or between the developmental period of infancy and puberty.
Cooperative PlayWhen the child is interested in both the individuals and the activity that they are playing.
Emotional IntelligenceRefers to the ability to perceive, understand, and manage one’s own emotions and relationships.
Emotional ReciprocityThe ability to engage in interactions with two or more people.
Fine Motor SkillsMovements that require coordination of the fingers, hands, and wrists to grab, hold, and manipulate objects.
Grasping ReflexAn involuntary flexion-adduction movement involving the hands and digits.
IdentityThe qualities, beliefs, personality traits, appearance, and/or expressions that characterize a person or a group.
Imaginative PlayWhen children act out various experiences or scenarios they may have had, or something in which they are interested. 
Individualized Education Plans (IEPS)Helps children with disabilities by providing personalized resources to help them be more successful in school.
Individuals With Disabilities Education Act (IDEA)A federal law that provides a free appropriate public education to and ensures special education and related services to eligible children with disabilities. 
InfantRefers to a baby from birth to about 2 months of age.
NascentJust coming into existence and beginning to display signs of future potential.
Parallel PlayA type of play where children play next to or near each other, but not with each other.
Pincer GraspThe coordination of the index finger and thumb to hold an item.
Primary CaregiverSomeone who cares for another person who is unable to care for themselves.
Rooting ReflexAn innate response of the head to the stimulation of the mouth, face, or cheek by touch/stroking. 
Self-EsteemConfidence in one’s own worth or abilities.
Self-RegulationThe skill of controlling one’s behavior, emotions, and thoughts to achieve goals and values.
Stranger AnxietyA type of distress children experiences when exposed to strangers.
TactileSense of touch.
ToddlerA child 1 to 3 years old.
Introduction

The developmental journey of the first five years of a child’s life is marked by a series of accomplishments within the physical, cognitive, emotional, and social domains. Known as pediatric milestones, these markers indicate the maturation of a child’s skills and are critical tools for identifying any developmental concerns. According to the Centers for Disease Control and Prevention (CDC), as many as 16% of children have some type of developmental disorder, including 0.5% who have autism, 0.7% who have intellectual disabilities, 7.7% who have learning disabilities, and 3.7% who have developmental delays. Further research suggests that more than 12% of children under 3 years of age are likely to be eligible for the services provided under the Individuals With Disabilities Education Act (IDEA).1

This course examines the key stages of early childhood development from infancy to age five, exploring significant makers that define a child’s thinking, emotions, and physical abilities. This course also discusses practical strategies for identifying developmental delays, approaches for encouraging development, and recommendations for intervention for timely and effective support.

Importance of Milestones

Pediatric milestones are guideposts for cognitive and physical development. In the cognitive domain, these markers reflect the acquisition of essential skills such as problem-solving, memory, and language. For instance, a child’s ability to grasp objects, sit up, crawl, and eventually walk are physical milestones that align with neurological and muscular development. These achievements not only signify the maturation of the brain and body, but they also lay the foundation for more complex cognitive processes as the child grows. Beyond the physical and cognitive domains, milestones bear profound implications for emotional and social development. The ability to express and recognize emotions, form attachments, and engage in social interactions represents fundamental emotional and social maturation. These early connections contribute significantly to developing a child’s social intelligence, empathy, and interpersonal skills. Understanding and responding to these emotional and social cues are fundamental aspects of a child’s well-being and future relationships.1,2

The fulfillment of these pediatric milestones during the formative years is not a mere checklist but rather a predictor of long-term well-being. Research indicates that children who achieve developmental milestones within expected timelines are more likely to experience positive outcomes in various aspects of life, including academic achievement, mental health, and social integration. Conversely, delays or difficulties in reaching these milestones may signal underlying challenges that, if unaddressed, could impact a child overall, resulting in physical, cognitive, or behavioral difficulties overall.3,4,5

Infant Milestones

A rapid progression of developmental milestones marks the initial months of a newborn’s life, each contributing to the groundwork of their cognitive, motor, sensory, and social abilities. Below is a detailed breakdown of key milestones by three, six, and nine months. These developmental markers provide a framework for understanding a newborn’s progress during the first few months of life, though individual variations are normal. Regular monitoring and supportive interactions with caregivers are crucial in ensuring healthy development during these early stages.

2 – 3 Month Milestones

At three months, infants exhibit the rooting reflex; the turning of their head toward stimuli that touch their cheek or mouth. This reflex aids in breastfeeding and early interactions. The grasping reflex is a developmental milestone that is noted by an infant’s ability to grasp, for instance a caregiver’s finger, signaling early motor control. While in a prone position, three-month old infants can lift and control their heads for short periods, laying the groundwork for further motor development. Sensory development has also progressed, with newborns able to visually track moving objects or people within their field of vision, enhancing visual and cognitive stimulation. Infants also start to turn their heads toward sounds, demonstrating early auditory awareness. Early vocalizations, such as cooing and babbling, are typically noted during this time, indicating the early development of communication skills. Additionally, infants begin to respond to social stimuli with genuine smiles, signifying the emergence of social bonding.1,6,7

4 – 6 Month Milestones

As infants reach six months, motor skills advance significantly. Many infants can roll over in directions, highlighting increased strength and coordination. With support, infants can sit upright, demonstrating enhanced core strength. Reaching and grasping skills also improve as hand-eye coordination and depth perception improve. Infants make substantial gains in learning to gauge distances more accurately and to grab objects deliberately. However, exploratory mouthing continues to serve as the main form of sensory investigation. During this age, infants also start recognizing familiar faces and may display preferences for primary caregivers. Communication skills improve with more deliberate verbalizations and the emergence of responsive laughter, signifying a growing sense of humor and social engagement.1,8,9

9-month Milestones

By the ninth month, infants demonstrate further motor development by beginning to crawl, demonstrating increased mobility and coordination. Using furniture for support, infants can pull themselves to a standing position, displaying improved leg strength. Pincer grasp, which allows infants to hold objects between their thumb and forefinger, also improves with the refinement of fine motor skills. As sensory awareness improves, tactile exploration overcomes exploratory mouthing as the predominant mode of investigating objects. Additionally, infants begin to understand that objects continue to exist even when out of sight, marking an important cognitive milestone. At the same time, babbling takes on a more intentional and communicative quality, and infants begin to exhibit stranger anxiety, a normal developmental phase of wariness or unease around unfamiliar faces.10,11

1st Year Infant Milestones

Given the rapid and dynamic growth in the first twelve months of life, an infant meets several developmental milestones by its first year. Motor skills and physical development advance to sitting independently, crawling, and, for some, taking those inaugural steps toward walking unsupported. Fine motor skills evolve, allowing infants to explore objects with increasing dexterity—grasping small items between thumb and forefinger, transferring objects between hands, and even attempting to feed themselves. The exploration of their physical environment becomes a dynamic adventure, with each achievement contributing to the growing independence and coordination of their movements. Language development by the first year is marked by an expanding repertoire of vocalizations and communication attempts. Cooing and babbling develop into a range of sounds that begin to mimic the cadence and rhythm of the spoken language in the environment.12, 13, 14

One of the most eagerly anticipated language milestones is the emergence of the first recognizable words, as infants begin associating specific sounds with objects or people in their environment. Considering social milestones, strong attachments and the beginnings of self-awareness typically emerge by the first year. Infants start forming secure attachments to their primary caregivers, demonstrating preferences for familiar faces and comfort in their presence. Social smiling evolves into reciprocal interactions as infants respond to the facial expressions and gestures of others. Additionally, the onset of stranger anxiety around six to nine months continues to the first year, reflecting the growing awareness of social boundaries. Emotionally, infants exhibit a range of feelings, from joy and excitement to frustration and distress, signaling the nascent development of emotional regulation and expression. 12, 13,14

2nd Year Milestones

The second year brings a whirlwind of developmental milestones as toddlers transition from infancy to increased autonomy, refining motor skills, expanding language capabilities, and furthering social and emotional competencies. Toddlers in their second year are often on the move, refining their motor skills with newfound coordination and balance. Many toddlers master walking independently and may even attempt to run, jump, or climb. Fine motor skills continue to progress, allowing toddlers to stack blocks, turn pages of a book, and experiment with simple utensils during meals. The exploration of their physical environment becomes more adventurous as toddlers actively engage in activities that enhance both their gross and fine motor skills.12,15,16

The second year is also a linguistic blossoming for toddlers. Vocabulary expands rapidly, and toddlers start combining words to form simple sentences. This stage is often characterized by a heightened curiosity about the world, with toddlers using language as a tool for both exploration and communication. They may engage in “parallel play,” where they play alongside peers as opposed to on their own, demonstrating an emerging understanding of social dynamics. Simple questions, expressive gestures, and a growing ability to follow simple instructions mark significant strides in their linguistic and communicative abilities. 12,15,16

Social interactions become increasingly complex during the second year as toddlers navigate the intricacies of relationships with peers and adults. They develop a burgeoning sense of independence, and while this may present as persistent stubbornness, expressing preferences and asserting their will is an essential aspect of development and self-awareness. Emotional expressions become more nuanced, with toddlers showing empathy, understanding simple emotions in others, and expressing a wider range of feelings themselves. The emergence of imaginative play and the ability to engage in simple make-believe scenarios indicate cognitive growth and an expanding grasp of the world around them. 12,15,16

3rd Year Milestones

Third-year milestones are marked by expanding physical capabilities, language fluency, and social-emotional understanding. At three years old, children demonstrate enhanced control over their motor skills. Running and climbing activities become more coordinated, as does the ability to kick and throw a ball with some precision. Fine motor skills progress, allowing for more intricate activities such as building with smaller blocks, holding a crayon with a tripod grip, and attempting to dress themselves, reflecting growing independence in daily tasks. By this age, children are usually fully potty trained, using the toilet for urination and bowel movements instead of relying on diapers. It signifies the child’s growing independence and the development of motor skills, control over bodily functions, and an understanding of self-care.12,17

By this age, language development has also undergone notable acceleration. Children exhibit a substantial increase in vocabulary, constructing more complex sentences and expressing themselves with greater clarity. Narratives become a central feature of communication as children eagerly share stories and observations from their expanding world. Additionally, their ability to understand and follow more detailed instructions takes a significant leap, laying the groundwork for increased autonomy. Three-year-olds are also more engaged in cooperative play, demonstrating an understanding of sharing, turn-taking, and playing alongside peers, marking their flourishing emotional intelligence. Their empathy deepens as they recognize and respond to the feelings of others, highlighting an emerging capacity for emotional reciprocity. Developing a sense of identity and self-esteem becomes more apparent as children express preferences, make choices, and take pride in their accomplishments. 12,17

4th Year Milestones

Fourth-year milestones continue to build on the foundation laid in previous developmental stages, with the refinement of motor skills, the deepening of language abilities, and the advancement of social and emotional competencies. At four years old, children display increased coordination and mastery over their motor skills. Running and climbing become more agile, with an added ability to navigate obstacles confidently. Fine motor skills continue progressing, enabling children to manage smaller objects with better precision, dress themselves more independently, and engage in activities that demand greater manual dexterity, such as drawing recognizable shapes and basic writing strokes. Language development by the fourth year reaches higher sophistication, with children expanding their vocabulary and communicating with greater complexity. Sentences become more intricate, and storytelling becomes a prominent form of expression. The acquisition of grammatical rules advances, allowing for more accurate and contextually appropriate language use. Additionally, children demonstrate a growing interest in literacy, recognizing letters and attempting to write their names. Children in bilingual environments begin to differentiate the languages spoken but may still use words or phrases interchangeably.12,18

Fourth-year social developmental markers also show evolving social awareness and emotional intelligence. Children engage in more elaborate and imaginative play scenarios, often incorporating peers into their games and demonstrating an enhanced understanding of cooperative play. They become more attuned to social rules and expectations, showing an emerging sense of empathy and consideration for others’ feelings. Self-regulation improves, allowing children to manage their emotions more effectively and engage in problem-solving activities with peers. 12,18

5th Year Milestones

As children enter their fifth year, they emerge as increasingly capable individuals, culminating in motor skill refinement, language fluency, and social-emotional competence. Children of this age are ready to navigate the challenges of school and its associated social interactions. Five-year-old children display enhanced physical coordination and mastery over both gross and fine motor skills. Running, jumping, and hopping become more controlled, demonstrating increased agility and balance. Fine motor skills advance further, enabling activities such as intricate drawing, writing strokes, coloring within lines, and more precise manipulation of small objects. Hand-eye coordination reaches a level that supports activities like catching and throwing a ball with improved accuracy. Language development continues to flourish at five years old. Children engage in more complex conversations, expressing ideas with clarity and detail. Vocabulary expands to include a wide range of words, and sentence structure becomes increasingly sophisticated.12,19

Reading skills progress, with many children recognizing familiar words and showing an interest in simple books. Writing abilities evolve as they attempt to form letters and simple words. Significant social and emotional development strides also mark the fifth year. Children form more intricate friendships and engage in cooperative play, demonstrating the ability to negotiate and compromise with peers. Empathy deepens, allowing children to understand and respond to the emotions of others. Self-regulation continues to improve, with children demonstrating a growing ability to manage frustration and disappointment. Independence flourishes as they take on more responsibilities and show a heightened interest in activities that require sustained focus. 12,19

What to Do About Delays

The abovementioned milestones are general guidelines, and individual variations are normal. For example, while many children may begin rudimentary speech in their second year, others may not begin until their third. Therefore, a delay may not be a matter of concern, provided other developmental milestones are reached with continuous progression. Parents and caregivers can enhance development by engaging in supportive activities that enhance skills and offset delays.

Infants ( ages 0 – 12 months)

For infants, parents and caregivers should establish a responsive, language-rich environment where regular, positive interactions take place, such as talking and singing to the infant, making eye contact, and responding to their cues. Engaging in activities like tummy time can also help promote physical strength and motor skills as well as facilitate bonding. Additionally, to aid in cognitive development, sensory exploration can be encouraged by providing age-appropriate toys with various textures, colors, and sounds that stimulate their senses. Incorporating activities that encourage reaching, grasping, and kicking supports the progress of fine and gross motor skills.

For Toddlers (Ages 1 – 3)

For toddlers, parents and caregivers should create a safe yet stimulating environment that promotes development. Outdoor play that involves running, jumping, and climbing supports the refinement of gross motor skills. In addition, activities that involve stacking, sorting, and manipulating objects can help improve fine motor skills. Providing age-appropriate toys and activities such as puzzles and art projects can encourage exploration, imagination, coordination, and creativity. Engaging in conversations with toddlers, reading books together, and introducing new words contribute to their expanding vocabulary. Encouraging toddlers to express themselves through gestures, simple words, and, eventually, short sentences foster effective communication skills. Play dates can also provide opportunities for interaction with other children, enhancing their social skills. Additionally, introducing basic self-care habits, such as tooth brushing and hand washing, encourages a sense of independence.

For Children (Ages 4 – 5)

For children above four, parents and caregivers can implement a range of activities and strategies to support their continued development and address potential delays. Engaging in conversations, asking open-ended questions, reading together, and encouraging storytelling enriches their vocabulary and enhances their cognitive abilities. Introducing structured play activities such as educational games and puzzles promotes reasoning skills such as problem-solving and pattern recognition. Interactive and imaginative play, like role-play and pretend scenarios, nurtures creativity and social development. Activities such as drawing, coloring, and cutting with child-safe scissors contribute to fine motor control, while engaging in activities like ball games, bike riding, or dancing further develops gross motor skills. Social interactions can also help promote emotional development. Encouraging participation in group activities, play dates, and organized sports fosters social skills, cooperation, and teamwork.

For All Ages:

Establishing a consistent routine is key for encouraging development for all ages. It contributes to a child’s sense of security and routine, positively influencing their emotional well-being. This includes regular bedtime routines, sleep schedules (12 – 16 hours for infants, 11 -14 hours for toddlers, and 10- 13 hours for children five and under), and meals. Regular healthcare check-ups that include vision and hearing screenings, as well as assessments of motor skills and cognitive abilities, are also helpful for monitoring developmental progress. They allow healthcare professionals to identify and promptly address any concerns if present.

When to Seek Treatment

While each child develops at their own pace, and occasional variations are natural, persistent delays in multiple domains may warrant closer attention. In such cases, seeking guidance from healthcare professionals, such as pediatricians or developmental specialists, can be instrumental in identifying any potential underlying issues and implementing appropriate interventions. Early identification and tailored support can significantly contribute to a child’s developmental success. Parents should be attentive to the following early warning signs that may indicate potential developmental issues in their child:1,2,3,4

  • Any significant regression in previously acquired skills or behaviors.
  • Difficulty forming age-appropriate social connections, limited interest in peer interactions, or challenges in expressing and understanding emotions.
  • Difficulty with fine motor skills, like using utensils or holding a pencil.
  • Difficulty with gross motor challenges, such as coordination issues or avoidance of physical activities.
  • Difficulty with speech and language development, including limited vocabulary, speech articulation issues, or delays in understanding and responding to verbal communication.
  • Persistent behavioral issues, such as extreme shyness, aggression, or difficulties with attention and focus.
  • Persistent delays in achieving developmental milestones, such as rolling over, sitting, crawling, and walking.

Upon recognizing these warning signs, parents should schedule a consultation with the child’s pediatrician or healthcare provider to discuss concerns and seek guidance on the appropriate next steps. Developmental screening should be done during this time to assess the child’s strengths and areas of concern. This can help identify specific domains that may require targeted interventions. If delays are identified, parents should inquire about and engage with early intervention services. These may include speech therapy, occupational therapy, or developmental support tailored to the child’s needs. These forms of early interventions have a significant impact on a child’s developmental trajectory, often leading to better outcomes and improved long-term functioning. Interventions can also prevent secondary issues such as academic difficulties, behavioral challenges, or social isolation. Parents should also collaborate with educators to implement additional support within educational settings. This may involve creating individualized education plans (IEPs) or accommodations to address specific challenges. If needed, parents can seek referrals for specialized evaluations by developmental pediatricians, child psychologists, or other child specialists who can provide a comprehensive assessment of the child’s developmental profile.1,2,3,4

Nursing Considerations

By involving parents in decision-making processes and care plans, nurses promote an integrated approach to pediatric healthcare. This collaborative model ensures that parents feel supported and informed, fostering a sense of shared responsibility for the child’s well-being. Nurses play a multifaceted role in promoting the health of pediatric patients, becoming instrumental advocates for their well-being. This role includes responsibilities such as conducting developmental screenings to routinely assess a child’s progress against expected milestones and identifying potential delays or concerns that parents or other caregivers may not have recognized. Nurses should engage in meaningful interactions with young patients and their families. By establishing trust and rapport, nurses can create a supportive atmosphere that eases the often stressful experience of healthcare visits and create opportunities for patient education.20,21

Nurses and other healthcare professionals should always tailor their language and approach to suit the unique needs of each child, fostering an environment where the child feels heard and understood. This skill becomes especially critical when addressing sensitive topics or explaining medical procedures to both children and their parents. Nurses must also empower parents with knowledge about age-appropriate developmental milestones, nutritional requirements, and crucial safety measures. When delays and concerns are identified, nurses should focus on family-centered care, clearly and comprehensively explaining the development issues to parents and involving them in decision-making processes and care plans. This collaborative model ensures parents feel supported and informed, fostering a sense of shared responsibility for the child’s well-being. 20,21

Conclusion

Pediatric milestones are a cornerstone for assessing and supporting a child’s developmental journey through early childhood. From the foundational achievements of motor skills and language acquisition in the first year to the nuanced complexities of social and emotional intelligence by age five, each milestone serves as a benchmark for a child’s capabilities. It is important to understand that these milestones are not isolated achievements. They are predictors of long-term well-being, influencing academic success, mental health, and social integration. To achieve this, parents and caregivers should actively engage with their children to encourage continuous development. It is important to note that these milestones are not fixed points, nor do they necessarily follow a specific chronological order. Some children’s fine motor skills may advance faster than their verbal skills, and vice versa, as variations in timelines are common.

However, perceived delays should not be ignored as they may signal underlying challenges with potential long-term impacts on a child’s overall health and functioning. Parents and caregivers must remain vigilant, monitoring skill progress and behavior. Parents and caregivers should also engage in activities that support development at each stage and schedule regular check-ups. If persistent delays or other warning signs are noted, they should promptly seek professional guidance and early intervention support. Nurses and other healthcare professionals are key in fostering a comprehensive approach to addressing a child’s well-being. They educate and enable parents and caregivers to be part of the decision-making processes and care plans. Such a family-centered care strategy enhances clinical outcomes, providing the foundation for each child to receive the support they need to thrive.

References
  1. ‌Zubler, J. M., Wiggins, L. D., Macias, M. M., Whitaker, T. M., Shaw, J. S., Squires, J. K., Pajek, J. A., Wolf, R. B., Slaughter, K. S., Broughton, A. S., Gerndt, K. L., Mlodoch, B. J., & Lipkin, P. H. (2022). Evidence-Informed Milestones for Developmental Surveillance Tools. Pediatrics, 149(3). https://doi.org/10.1542/peds.2021-052138
  2. Zhuo, H., Xiao, J., Tseng, L., & Liew, Z. (2022). Developmental Milestones of Infancy and Associations with Later Childhood Neurodevelopmental Outcomes in the Adolescent Brain Cognitive Development (ABCD) Study. Children, 9(10). https://doi.org/10.3390/children9101424
  3. Hitzert, M. M., Roze, E., Van Braeckel, K. N. J. A., & Bos, A. F. (2014). Motor development in 3-month-old healthy term-born infants is associated with cognitive and behavioural outcomes at early school age. Developmental Medicine & Child Neurology, 56(9), 869–876. https://doi.org/10.1111/dmcn.12468
  4. van Batenburg-Eddes, T., Henrichs, J., Schenk, J. J., Sincer, I., de Groot, L., Hofman, A., Jaddoe, V. W. V., Verhulst, F. C., & Tiemeier, H. (2013). Early Infant Neuromotor Assessment is Associated with Language and Nonverbal Cognitive Function in Toddlers. Journal of Developmental & Behavioral Pediatrics, 34(5), 326–334. https://doi.org/10.1097/dbp.0b013e3182961e80
  5. Piek, J. P., Dawson, L., Smith, L. M., & Gasson, N. (2008). The role of early fine and gross motor development on later motor and cognitive ability. Human Movement Science, 27(5), 668–681. https://doi.org/10.1016/j.humov.2007.11.002
  6. CDC. (2018, October 22). Important Milestones: Your Baby By Two Months. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-2mo.html
  7. Your baby’s developmental milestones at 2 months. (n.d.). Www.unicef.org. https://www.unicef.org/parenting/child-development/your-babys-developmental-milestones-2-months
  8. Centers for Disease Control and Prevention. (2018). Important milestones: Your baby by six months. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-6mo.html
  9. Your baby’s developmental milestones at 6 months | UNICEF Parenting. (n.d.). Www.unicef.org. Retrieved November 28, 2023, from https://www.unicef.org/parenting/child-development/your-babys-developmental-milestones-6-months#R643530-5BfC5b15-L1L7Z4B
  10. CDC. (2018). Important Milestones: Your Baby By Nine Months. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-9mo.html
  11. UNICEF. (n.d.). Your baby’s developmental milestones at 9 months. Www.unicef.org. https://www.unicef.org/parenting/child-development/your-babys-developmental-milestones-9-months
  12. Flensborg-Madsen, T., Grønkjær, M., & Mortensen, E. L. (2019). Predictors of early life milestones: Results from the Copenhagen Perinatal Cohort. BMC Pediatrics, 19. https://doi.org/10.1186/s12887-019-1778-y
  13. CDC. (2019, October 16). Important Milestones: Your Baby By One Year. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-1yr.html
  14. UNICEF. (n.d.). Your toddler’s developmental milestones at 1 year. Www.unicef.org. https://www.unicef.org/parenting/child-development/your-toddlers-developmental-milestones-1-year
  15. Centers for Disease Control and Prevention. (2018, October 22). Important Milestones: Your Baby By Two Years. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-2yr.html
  16. UNICEF. (2023). Your toddler’s developmental milestones at 2 years. Www.unicef.org. https://www.unicef.org/parenting/child-development/your-toddlers-developmental-milestones-2-years
  17. Centers for Disease Control and Prevention. (2018, October 22). Important Milestones: Your Baby By Three Years. Centers for Disease Control and Prevention; Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-3yr.html
  18. CDC. (2018). Important Milestones: Your Baby By Four Years. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-4yr.html
  19. Centers for Disease Control and Prevention. (2018, August 29). Important milestones: Your baby by five years. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-5yr.html
  20. Olli, J., Vehkakoski, T., & Salanterä, S. (2014). The habilitation nursing of children with developmental disabilities—Beyond traditional nursing practices and principles? International Journal of Qualitative Studies on Health and Well-Being, 9. https://doi.org/10.3402/qhw.v9.23106
  21. Reticena, O., Yabuchi, N. T., Pereira Gomes, M. F., Siqueira, E., & Fracolli, L. A. (2019). Role of nursing professionals for parenting development in early childhood: A systematic review of scope. Revista Latino-Americana de Enfermagem, 27. https://doi.org/10.1590/1518-8345.3031.3213
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