As children grow older, they develop in several different ways. Child development includes physical, intellectual, social, and emotional changes.

Children grow and mature at very different rates. It's hard to say what "normal" is. There can be big differences in height, weight, and build among healthy children. Diet, exercise and genes are all factors. Some children begin puberty or are close to it before they are teenagers.

Children start to become more independent from their parents. They may rebel. They also look outward - to their friends, who are usually of the same sex. Peer approval becomes very important. Your child may try new behaviors to be part of "the group." This can also be the time that parents or teachers recognize learning disabilities or behavioral problems in children. These problems can get worse as time goes on, so it is important to get help early.

Child development describes the changes children experience as they grow older. As children grow physically, they also develop in their knowledge, skills, and behavior.

Parents and other adults, such as grandparents and child care providers, play important roles in children’s development. As a parent, you are the most important teacher in your child’s life. You also know your child best. Learning more about how children grow and develop is one way to build on what you already know and get new ideas about how to support your child’s learning and well-being.

The following table shows some of the main areas of child development.

All these areas of development are connected. We should always think about the whole child. For example, once children learn to use words, it is much easier for them to express their emotions. And once they begin to crawl, they begin to explore more and learn about other parts of the world around them.

Children develop at their own pace, so you never know exactly when your child will learn a new skill. Developmental milestones are skills that children often learn at a certain age. Developmental milestones give you an idea of the changes you can expect as your child gets older. It’s helpful to be familiar with these milestones, but remember that small variations are perfectly normal.

When we talk about a child’s growth, we often think first about height and weight. These are two important parts of your child’s physical health. Each time you visit your doctor, your child’s growth since your last visit will be measured.

Your child’s health is the foundation of all growth and development. Of course, your child’s health includes more than physical growth. Some other important parts of your child’s health include their cognitive (learning and thinking) development, social and emotional growth, and mental health. All aspects of health and development work together to form your child’s overall well-being.

You are the most important person to support and promote your child’s health and wellness, so it is important to find quality health care services and professionals. Expect professionals to answer your questions, listen to your input, and be available. You know your child best, and are his or her primary advocate.

The following table lists some of the most important parts of children's health and wellness.

Brain development (learning and thinking)

• Supporting your child’s brain development

Physical health

• Making sure that you have a medical home
• Ensuring that your child receives well-child physical exams
• Using healthy habits to prevent illness
• Managing illness

Nutrition

• Making informed decisions about breastfeeding and formula feeding
• Offering nutritious meals that meet your child’s needs and give him or her energy to learn

Social, emotional, and mental health

• Helping your child understand and learn to share his or her feelings
• Helping your child learn to have positive relationships
• Encouraging your child to explore and learn
• Learning strategies for parenting in tough times and coping with depression or other difficult feelings
• Building resilience in yourself and your child

Oral health

• Encouraging oral and dental health so children are better able to eat, speak, and focus on learning

Active living

• Providing age-appropriate amounts of physical activity in your child’s daily routines to support physical health and positive behaviors

Safety and injury prevention

• Creating and maintaining safe environments
• Educating your child on ways to avoid injuries
• Identifying and reporting suspected child abuse and neglect

The early years of a child’s life are very important for his or her health and development. Healthy development means that children of all abilities, including those with special health care needs, are able to grow up where their social, emotional and educational needs are met. Having a safe and loving home and spending time with family―playing, singing, reading, and talking―are very important. Proper nutrition, exercise, and sleep also can make a big difference.

Effective Parenting Practices

Parenting takes many different forms. However, some positive parenting practices work well across diverse families and in diverse settings when providing the care that children need to be happy and healthy, and to grow and develop well. A recent report looked at the evidence in scientific publications for what works, and found these key ways that parents can support their child’s healthy development:

• Responding to children in a predictable way
• Showing warmth and sensitivity
• Having routines and household rules
• Sharing books and talking with children
• Supporting health and safety
• Using appropriate discipline without harshness

Parents who use these practices can help their child stay healthy, be safe, and be successful in many areas—emotional, behavioral, cognitive, and social.

Social networks that include extended family, friends, and fellow parents can make a big difference for you and your child. Social support in the form of friendship and connections to a community can help us be better nurturers of our children. And practical support such as help with transportation, babysitting, or lending clothes helps us manage our lives and give our children what they need.

Social networks can help families do the following:

• Meet their basic needs, achieve their goals, and successfully raise their children

• Overcome obstacles such as unsafe neighborhoods, family violence, and homelessness

• Feel cared for and receive help from others

• Strengthen parenting skills

Family social networks can help children interact with various safe and caring adults, have different experiences, learn to understand different points of view, and grow up safe and healthy.

Your child care program may be able to help you develop supportive relationships. Check to see what opportunities your child care provider offers for families to get to know each other. For example, your provider may offer “meet and greets,” potlucks, message boards, parent councils, family volunteer activities, parent information sessions, and parenting classes presented by community partners. If your program does not offer such opportunities, ask for them!

Many times parents are not sure how to respond to their child’s challenging or unpredictable behaviors. Often, just when you feel that you’ve finally figured everything out and settled into a routine, something changes and it gets challenging again.

These changes may just be a normal part of a child’s growth and development, but they can still feel frustrating and overwhelming. For example, you might be struggling with your child’s crying or temper tantrums, communication, discipline, eating, toileting, sleeping, or getting along with others. Behaviors can also be influenced by an environment that is stressful or unhealthy, a major change or disruption in the family, or stresses experienced by the child, parents, or caregivers. These issues may not be as easy to address, and can feel overwhelming for both children and parents.

All of a child’s behaviors have meaning and communicate messages. Adults recognize some of these communications right away—like a toothless grin. Other behaviors may be confusing, and you can only take a guess at what they might mean. A child’s behavior might do any of the following:

• Show how they feel about themselves

• Communicate their needs and feelings

• Establish important connections with the people around them

• Be part of exploring the world and how the world responds to them

Children, especially young children, are learning new ways to communicate all the time. At a young age, children don’t always have the skills to tell us what they want, need, or feel. When this happens, children are likely to behave in ways that are confusing or challenging to their parents and caregivers. It is up to us to try to understand children’s behaviors and help them learn to express their feelings in appropriate ways.

Your child care provider can be a good partner and source of support when you are finding your child’s behavior challenging. A trusted provider can work with you to handle challenging behaviors in constructive ways. You are more likely to be successful if you and your provider are handling things the same way.

Talk with your provider about changes in your child and any concerns. Offer your own opinions and ask questions, and find out what your provider is seeing when you’re not there. When you’re ready, you can work together to create a plan to address the behavior.

The early years of a child’s life are very important for later health and development. One of the main reasons is how fast the brain grows starting before birth and continuing into early childhood. Although the brain continues to develop and change into adulthood, the first 8 years can build a foundation for future learning, health and life success.

How well a brain develops depends on many factors in addition to genes, such as:

• Proper nutrition starting in pregnancy
• Exposure to toxins or infections
• The child’s experiences with other people and the world

Nurturing and responsive care for the child’s body and mind is the key to supporting healthy brain development. Positive or negative experiences can add up to shape a child’s development and can have lifelong effects. To nurture their child’s body and mind, parents and caregivers need support and the right resources. The right care for children, starting before birth and continuing through childhood, ensures that the child’s brain grows well and reaches its full potential.

To learn and grow appropriately, a baby’s brain has to be healthy and protected from diseases and other risks. Promoting the development of a healthy brain can start even before pregnancy. For example, a healthy diet and the right nutrients like sufficient folic acid will promote a healthy pregnancy and a healthy nervous system in the growing baby. Vaccinations can protect pregnant women from infections that can harm the brain of the unborn baby.

During pregnancy, the brain can be affected by many types of risks, such as by infectious diseases like Cytomegalovirus or Zika virus, by exposure to toxins, including from smoking or alcohol, or when pregnant mothers experience stress, trauma, or mental health conditions like depression. Regular health care during pregnancy can help prevent complications, including premature birth, which can affect the baby’s brain. Newborn screening can detect conditions that are potentially dangerous to the child’s brain, like phenylketonuria (PKU).

Healthy brain growth in infancy continues to depend on the right care and nutrition. Because children’s brains are still growing, they are especially vulnerable to traumatic head injuries, infections, or toxins, such as lead. Childhood vaccines, such as the measles vaccine, can protect children from dangerous complications like swelling of the brain. Ensuring that parents and caregivers have access to healthy foods and places to live and play that are healthy and safe for their child can help them provide more nurturing care.

Children are born ready to learn, and have many skills to learn over many years. They depend on parents, family members, and other caregivers as their first teachers to develop the right skills to become independent and lead healthy and successful lives. How the brain grows is strongly affected by the child’s experiences with other people and the world. Nurturing care for the mind is critical for brain growth. Children grow and learn best in a safe environment where they are protected from neglect and from extreme or chronic stress with plenty of opportunities to play and explore.

Parents and other caregivers can support healthy brain growth by speaking to, playing with, and caring for their child. Children learn best when parents take turns when talking and playing, and build on their child’s skills and interests. Nurturing a child by understanding their needs and responding sensitively helps to protect children’s brains from stress. Speaking with children and exposing them to books, stories, and songs helps strengthen children’s language and communication, which puts them on a path towards learning and succeeding in school.

Exposure to stress and trauma can have long-term negative consequences for the child’s brain, whereas talking, reading, and playing can stimulate brain growth. Ensuring that parents, caregivers, and early childhood care providers have the resources and skills to provide safe, stable, nurturing, and stimulating care is an important public health goal.

When children are at risk, tracking children’s development and making sure they reach developmental milestones can help ensure that any problems are detected early and children can receive the intervention they may need.

Skills such as taking a first step, smiling for the first time, and waving “bye-bye” are called developmental milestones. Children reach milestones in how they play, learn, speak, behave, and move (for example, crawling and walking).

Children develop at their own pace, so it’s impossible to tell exactly when a child will learn a given skill. However, the developmental milestones give a general idea of the changes to expect as a child gets older.

As a parent, you know your child best. If your child is not meeting the milestones for his or her age, or if you think there could be a problem with your child’s development, talk with your child’s doctor and share your concerns. Don’t wait.

Parents, grandparents, early childhood providers, and other caregivers can participate in developmental monitoring, which observes how your child grows and changes over time and whether your child meets the typical developmental milestones in playing, learning, speaking, behaving, and moving.

Developmental screening takes a closer look at how your child is developing. A missed milestone could be a sign of a problem, so when you take your child to a well visit, the doctor, nurse, or another specialist might give your child a brief test, or you will complete a questionnaire about your child.

If the screening tool identifies an area of concern, a formal developmental evaluation may be needed, where a trained specialist takes an in-depth look at a child’s development.

If a child has a developmental delay, it is important to get help as soon as possible. When a developmental delay is not found early, children must wait to get the help they need to do well in social and educational settings.

You know your child best, and your doctor and child care provider are your partners in paying attention to your child’s growth and development.

Developmental screening is a way to tell if children are learning basic skills when they should, or if there are delays. Developmental screening can be done by professionals in health care, community, or school settings. A developmental screening will help tell if your child needs to see a specialist.

Talk with your child’s doctor or nurse if you notice signs of a possible developmental delay in your child. Your doctor, nurse, or child care provider should be able to link you with screening services for young children in your area. Screening is recommended at certain ages, but it should be done at any age if you are concerned about your child’s development.

Why are developmental screenings so important?

Developmental screenings can help you find out if your child needs more help with development or needs more evaluation. As many as one in four children through age 5 are at risk for a developmental delay or disability. For a lot of children, these delays are not identified as early as possible. As a result, these children wait to get the help they need to do well at school and at home.

I have concerns that my child could have a delay. Who can I contact to get my child a developmental screening?

Many people can help you get developmental screening for your child, including your child’s doctor, teacher, or child care provider.

Also, your state has resources that can provide a free screening. You do not have to wait for a doctor’s referral to access these screenings. Who you call depends on the age of your child:

• If your child is younger than 3 years old, you can contact your state’s early intervention system, which is there to help all children with development delays get help through a wide range of services.

• If your child is 3 years or older, contact your local public school system. Even if your child is not old enough for kindergarten or enrolled in a public school, the school system will be able to help you find local help.

  It can be challenging to access developmental screenings and navigate the early intervention and public school level systems. It can be especially hard if you are feeling concerned about your child. Ask your child care provider or doctor for help if you need support. Sometimes it helps to plan out what you will say. For example, you could say something like this:

  “I’m concerned about my child’s development and would like to talk with someone about having my child screened. Can you help me or let me speak with someone who can?”

  You will be asked for some general information about yourself and your child, and you will want to be prepared to share your specific concerns about your child.

  All children under 21 who are covered by Medicaid are provided physical, mental, developmental, dental, hearing, and vision screenings. This is called the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.

As a parent, you have many responsibilities. High-quality child care programs work closely with you to care for your children and help you meet your family’s goals. The best child care providers will ask you for feedback on whether they are meeting your and your child’s needs.

Finding a provider who sees you as a partner is important because strong relationships between all the people important to children—parents, extended family members, family friends, and teachers—help children grow and learn. High-quality environments and good relationships prepare children for school and future success.

High-quality child care providers will work to develop a long-term relationship with you that is based on trust and respect. They will want to learn about your family and talk about what you feel is going well. If you are experiencing challenges, they will listen to you, and work with you to find a solution.

What do partnerships look like in high-quality programs? You can expect programs to do the following:

• Welcome all families.

• Support you in developing strong relationships with your children.

• Support you in making connections with other families.

• Include you in activities and programs that support your child’s development.

• Offer activities at times that work for your family’s schedule.

• Communicate with you in clear language and in your home language if it is not English.

• Ask for your opinion on how they can improve quality.

• Create opportunities to share information about your child’s learning and development.

• Honor your family’s culture, language, and experience in supporting your child’s learning and development.

• Make sure you have access to your child at all times.

• Offer opportunities for home visits to support relationship building.

• Support you as a decisionmaker in the child care program. Some programs, including Head Start, may offer opportunities for leadership training or mentoring.

• Help families transition to new learning settings; for example, preparing to move from child care into prekindergarten or kindergarten.

• Invite you to provide feedback on the program.

• Ask you to share your knowledge about your child before offering their own solutions. They respect your knowledge and acknowledge your strengths.

• Build a trusting relationship with you so that you can safely discuss your concerns.

• See you as the expert on your child and support your parenting.

If your child is not meeting the milestones for his or her age, or you are concerned about your child’s development, talk with your child’s doctor and share your concerns. Don’t wait!