Milestones Matter: Your Child's Growth & Development By Age 5

Birth through age 5 is an exciting time to watch your child grow and learn to do many new things. These are the years you'll likely see them start smiling, talking, walking and making friends for the first time.

While most children meet developmental milestones around a certain age, some may take longer to reach them. If you ever have any questions about your child's development, it is always good to talk to your pediatrician. Trust your instincts—you know your child best!

Here are just some of the physical, social, emotional and cognitive milestones you can expect to see as your child grows:

• By 2 months: Tries to look you and smiles when you talk or smile at them.

• By 4 months: Looks at you and moves or makes sounds to get or keep your attention.

• By 6 months: Likes to look at themselves in the mirror. Brings objects to their mouth.

• By 9 months: Looks when you call their name. Makes different sounds like "mamamama" and "babababa."

• Around 12 months: Play games with you like pat-a-cake. Looks for things they see you hide, like a toy under a blanket.

• At 18 months: Moves away from you, but looks to make sure you are close by. Points to show you something interesting.

• By 2 years: Points to things in a book when you ask a question like "Where is the bear?" Tries to use switches, knobs or buttons on a toy.

• By 3 years: Talks with you in conversation using 2 to 3 back-and-forth exchanges. Talks well enough for others to understand, most of the time.

• By 4 years: Pretends to be something else during play (teacher, superhero, dog). Tells what comes next in a well-known story.

• By 5 years: Answers simple questions about a story after hearing it, like when you ask, "What happened to the friend?" Can follow rules or take turns when playing games with other children.

3 things to remember

• Celebrate developmental milestones performed by your child.

• Act early by talking to your pediatrician about concerns.

• Keep in mind that you know your child best.

Next steps: track your child's development

You can celebrate and easily track your child's development with these free milestone checklists from the Center for Diseases Control and Prevention (CDC). Take the completed checklist to your child's next well-child visit at the pediatrician. You can share all the milestones your child is reaching and any concerns you may have about your child's development, including those that may not be captured through milestones.

If you or your pediatrician have any concerns about your child's development, ask for a referral to a medical, school or developmental specialist. Be sure to follow through on scheduling and attending appointments with any specialists. They will be able to do a more complete evaluation on your child. They will also work with your pediatrician to decide on the next steps to take to help support your child's growth and development.

Developmental screening: recommendation from the AAP

The American Academy of Pediatrics (AAP) recommends that children receive screening for development during routine checkups at 9 months, 18 months and 30 months and for autism at 18 and 24 months. Screening also can be done whenever a parent or provider has a concern.

Not sure if your child has had a developmental screening? Ask your pediatrician to screen your child or to share results with you from the most recent screen.

Do college students and teens need a flu shot?

​Yes. A flu shot is especially important this year, and they should get their COVID-19 shot or booster dose, too.

You may have heard of recent flu outbreaks on college campuses. Flu viruses are known to spread quickly among college students and teens. Group social activities, crowded classrooms and shared living spaces make it easier for the flu to be passed around to others.

If you are a college student or the parent of a college student or teen, be sure that they get their flu vaccine as soon as possible.

Can't they get their shot at home during the school break?

Don't wait. It is not possible to know when flu season will get into full swing. Also, it takes a couple of weeks to develop full protection after vaccination. That's why it is best to be fully vaccinated before the season starts. Flu vaccination is the best way to prevent flu from spreading, which is why their best bet is to get the flu shot before traveling. Most college health clinics offer influenza vaccine for students.

For college students, a flu vaccine and a COVID-19 vaccine are recommended this season. You can receive a flu shot and a COVID-19 shot at the same visit.

COVID-19 vaccination will not protect against flu. All eligible teens and college students are encouraged to get the COVID-19 vaccine and flu vaccine. Both vaccines are recommended by the American Academy of Pediatrics, and they can be given at the same time safely.

Isn't it too late to get a flu shot?

Flu activity often starts in October, peaks in February and can last into May. This season, it is not likely that flu activity will be as low as it was during the pandemic. Experts think that the number of people with flu was so low because of the strict COVID-19 prevention measures. This year, the influenza virus is expected to circulate among people and cause disease, just like other respiratory viruses have done since the summer.

The Centers for Disease Control and Prevention is already investigating several reports of flu outbreaks involving a strain of influenza A virus, including at college campuses in several states. The flu vaccine protects against four flu virus strains, including an influenza A virus strain that is like the strain linked to these outbreaks.

What about antiviral drugs?

If someone is sick with the flu, antivirals can help shorten their illness. But antiviral drugs are a second line of defense that can be used to treat flu if you get sick. They are not a substitute for getting a flu vaccine.

Anyone who has a higher risk of serious illness from the flu should get antivirals right away if they get sick with the flu, regardless of their vaccination status. To be most effective, antiviral drugs must be taken as soon as possible after symptoms start.

Remember

The flu vaccine is the best way to help prevent seasonal flu and its potentially serious complications. By getting a flu vaccine and COVID-19 vaccine, college students can help prevent viruses from spreading to others in their community who are most at risk of getting very sick or going to the hospital.

Distinguishing Respiratory Illnesses: RSV, Flu, and COVID-19 in Children

When faced with a child exhibiting symptoms like a stuffy nose, cough, and fever, it's essential to differentiate between respiratory illnesses such as the flu, COVID-19, and Respiratory Syncytial Virus (RSV). This article aims to shed light on the commonalities and distinctions among these viral infections, offering clues to help parents identify the specific ailment affecting their child.

RSV symptoms encompass fever, cough, fatigue, stuffy nose, shortness of breath, and distinctive signs like wheezing, grunting, and chest movements with breathing. The intensity typically peaks between days 3 and 5, lasting around 7 to 14 days.

Flu symptoms include fever, chills, headache, body aches, cough, fatigue, stuffy nose, and sore throat, often accompanied by vomiting and diarrhea. Onset occurs approximately 1 to 4 days after exposure to an infected person.

COVID-19 presents with symptoms such as fever, cough, fatigue, muscle aches, congestion, shortness of breath, sore throat, and additional indicators like vomiting, diarrhea, or loss of taste/smell. Symptoms may manifest 2 to 14 days after infection.

Common cold symptoms involve fever, cough, fatigue, stuffy nose, sore throat, and sneezing, usually caused by various viruses. Healthy children may experience 6-10 colds annually.

Seek medical attention if your child exhibits rapid breathing, wheezing, chest caving, persistent shortness of breath, prolonged vomiting or bloody diarrhea, extreme lethargy, poor feeding, dehydration, or a fever exceeding specified thresholds.

Dual infections, such as simultaneous flu and COVID-19, can occur. Secondary illnesses like bronchiolitis or pneumonia may also develop, requiring diagnostic tests for confirmation.

Prevention is key. Immunizations, including flu and COVID-19 vaccines, are crucial. RSV-specific immunizations like nirsevimab for infants and RSVpreF for pregnant individuals are recommended. Additionally, instill good hygiene practices in children, such as covering their mouths and noses when coughing or sneezing and promoting regular handwashing.

In conclusion, understanding the nuances of these respiratory illnesses is vital for accurate identification and timely medical intervention. If in doubt, consult your pediatrician, emphasizing the importance of routine care and immunizations for overall child well-being.

Supporting Your Child with a Congenital Heart Defect as They Grow

Welcoming a new baby into the family is a transformative experience, but it comes with distinct challenges when the newborn has a congenital heart defect. These issues involve heart abnormalities present at birth, ranging from a simple hole in the heart to more complex conditions like missing vessels or chambers.

Fortunately, advancements in medical care have enabled individuals with heart defects to lead longer and healthier lives. Regardless of successful surgical interventions, it's crucial for children to continue regular check-ups with a pediatric cardiologist to detect any potential issues early and maintain overall well-being.

Understanding how congenital heart defects can impact your child's development is essential. Children with these conditions may reach developmental milestones at varying rates, benefitting from early intervention for skill acquisition and overcoming challenges. Educational milestones might also differ from their peers, necessitating occasional school absences for medical appointments.

Regardless of age, involving your child in their congenital heart defect care is vital. Collaborating with pediatric cardiologists and healthcare providers empowers them to make informed decisions about their health as they transition into adulthood. The healthcare team plays a pivotal role in identifying risks and supporting nutritional, exercise, and cardiac needs throughout their development.

Preparing for the transition from pediatric to adult cardiac care is crucial for children with congenital heart defects. Pediatric cardiologists may only oversee their care up to a certain age, prompting the need to transition to adult congenital cardiologists. Families should proactively plan for this shift, encouraging their child to take on more responsibility for their health, including scheduling doctor visits, understanding health insurance, and managing medications during their college years and beyond.

Emotional support is equally important in the journey of dealing with a heart defect diagnosis. It's not uncommon for families to feel isolated and overwhelmed by emotions such as sadness, fear, guilt, and confusion. Connecting with others in the community who share similar experiences can provide a valuable support network during these challenging times.

RSV: When It's More Than Just a Cold

Almost all children get respiratory syncytial virus (RSV) at least once before they are 2 years old. For most healthy children, RSV is like a cold. But some children get very sick with RSV.

If you are the parent of a baby or young child, you may have questions about RSV and how to prevent it. Read on to learn more.

What is RSV?

RSV is one of the many viruses that cause respiratory illness. It spreads like a cold virus from person to person. It enters the body through the nose or eyes, usually from contact with infected saliva, mucus or nasal discharge.

This virus usually occurs in the late fall through early spring months. The timing can vary in some parts of the country.

RSV is the most common cause of hospitalization in children under age 1 year. Two to three out of every 100 infants with RSV infection may require a hospital stay. Those babies may need oxygen to help with breathing or (intravenous) IV fluids if they are not eating or drinking. Most of these children get better and can go home after a few days.

New ways to protect babies from RSV

Two new tools protect babies from severe illness during RSV season. You can choose RSV immunization during pregnancy, or your baby can be immunized after they are born. Most infants will likely only need protection from either the maternal RSV vaccine or infant immunization, but not both.

RSV vaccine during pregnancy

Pregnant people can receive the maternal RSV vaccine at 32 through 36 weeks pregnancy if their baby will be born during RSV season. The vaccine reduces the risk of RSV hospitalization for babies by 57% in their first six months after birth.

RSV immunization for babies

For infants and some toddlers, an RSV immunization called nirsevimab can be given as an injection and may be included with or between your baby's routine immunizations. Nirsevimab has been shown to reduce the risk of both RSV-related hospitalizations and health care visits in infants by about 80%.

The shot works a little differently than a vaccine. It provides antibodies that start working to protect babies right away. The protection lasts throughout a typical RSV season.

What about palivizumab?

For some children, there is another product called palivizumab that is given as an injection once a month during RSV season. It is for children under age 24 months with certain conditions that place them at high risk for severe RSV.

Children who receive nirsevimab should not get palivizumab. However, if your child did not get all doses of palivizumab, they may be eligible for nirsevimab. Children who received palivizumab in their first season can get nirsevimab in their second season if they are eligible.

RSV symptoms in babies

Typically, RSV causes cold symptoms, which may be followed by bronchiolitis or pneumonia. RSV symptoms are typically at their worst on days 3 through 5 of illness. Symptoms generally last an average of 7-14 days.

Call your pediatrician right away if your child has any:

• Symptoms of bronchiolitis (listed above)

• Symptoms of dehydration (fewer than 1 wet diaper every 8 hours)

• Pauses or difficulty breathing

• Pale, gray or blue-colored skin, lips or nail beds, depending on skin tone

• Significantly decreased activity and alertness

Some children with RSV may be at increased risk of developing a bacterial infection, such as an ear infection. Call your doctor if your child has:

• Symptoms that worsen or do not start to improve after 7 days

• A fever (with a rectal temperature of 100.4°F or higher) and they are younger than 3 months of age (12 weeks).

• A fever that rises above 104°F repeatedly for a child of any age.

• Poor sleep or fussiness, chest pain, ear tugging or ear drainage

Pediatricians diagnose children with a cold or bronchiolitis by asking about their symptoms and by doing a physical exam. Your pediatrician may do a nasal swab test to determine if your child has RSV or another virus. A chest x-ray and/or oxygen saturation test may also be done to check for lung congestion. Because most children recover without difficulty and because there is no treatment specific for RSV, these tests are often not necessary.

How to help your child with mild RSV feel better

There is no specific treatment for RSV and medications, like steroids and antibiotics, do not help with RSV.

To help your child feel more comfortable, begin by doing what you would for any bad cold:

• Nasal saline with gentle suctioning to allow easier breathing and feeding.

• Cool-mist humidifier to help break up mucus and allow easier breathing.

• Fluids & frequent feedings. Make sure your child is staying hydrated. Infants with a common cold may feed more slowly or not feel like eating because they are having trouble breathing. Try to section baby's nose before trying to breast or bottle-feed. Supplementing with water or formula is unnecessary for breastfed babies. If difficult for the baby to feed at the breast, expressing breastmilk into a cup or bottle may be an option.

• Acetaminophen or ibuprofen (if older than 6 months) to help with low-grade fevers. Always avoid aspirin and cough and cold medications.

Keep in mind, children and adults can get RSV multiple times—even during a single season. Often, however, repeat infections are less severe than the first one.

Other ways to help prevent RSV

• Stay up to date on vaccines. Keep your children up to date on their immunizations and get the whole family annual flu and COVID shots. Adults over age 60 years can get the RSV vaccine. And getting vaccinated with Tdap―to protect against whooping cough—is especially important for adults who are around infants.

• Limit your baby's exposure to crowds, other children, and anyone with colds. Keep children home from school or child care when they are sick and teach them to cover their coughs and sneezes.

• Wash your hands. Just as you would to prevent germs at any time, use soap and water and scrub for at least 20 seconds. Remind children to practice good hand hygiene all through the year.

• Go germ-free. Disinfect objects and surfaces in your home regularly and avoid exposing your child to smoke from tobacco or other substances.

• Feed your baby breastmilk. It has unique antibodies to prevent and fight infections.

Medicine is always advancing! Scientists continue to explore new options to prevent and treat RSV. In the meantime, rest assured that most people recover well from RSV.