LessonsHealth Promotion and Maintenance
Growth, development and what to teach at each age
Recognize the milestones that matter, name the age-appropriate safety advice, and say when a delay needs referring rather than watching.
The milestones that get asked
- 2 months: social smile; lifts the head when prone.
- 4 to 6 months: rolls over; reaches and grasps; babbles.
- 6 to 8 months: sits without support; stranger anxiety appears.
- 9 to 12 months: pulls to stand; pincer grasp; first words; walks by about 15 months.
- 2 years: two-word phrases; runs; about half of speech understandable to a stranger.
- 3 to 4 years: speech a stranger understands; rides a tricycle; dresses with help.
- 5 years: skips; ties laces; draws a person with a body.
The exam asks about the age by which something should be established, not the average age it appears. A 12-month-old who is not sitting is behind by a wide enough margin to investigate rather than watch.
Safety, by what the child can newly do
Injury advice follows ability. The moment a child can do something new is the moment the hazard changes.
- Infant: back to sleep on a firm surface with nothing else in the crib; rear-facing car seat in the back; no small objects once rolling and reaching begins.
- Toddler: locked cupboards and gates once walking; constant supervision near water; no small hard foods.
- Preschool: road and stranger safety; helmets; supervised swimming.
- School age: booster seat until the seat belt fits properly; sport protective equipment; internet safety.
- Adolescent: driving, alcohol and drugs, contraception and sexual health, and firearms if present in the home.
Screening across adulthood
- Blood pressure at every visit; lipids and diabetes screening periodically from mid-adulthood.
- Colorectal cancer screening from 45 for average risk.
- Mammography discussed from 40 and routine from 50 for average risk; cervical screening from 21.
- Bone density from 65 in women, earlier with risk factors.
- Annual influenza vaccine; pneumococcal and shingles vaccines for older adults; a tetanus booster every ten years.
Screening intervals shift as guidance is revised, so the exam tends to ask the principle — average risk versus increased risk, and the age at which a conversation starts — more often than the exact year.
Worth remembering
- Judge a milestone against the age by which it is established, not the average age.
- Safety advice follows what the child can newly do.
- Sitting unsupported by 8 months; a stranger understands the speech by 4 years.
- Colorectal screening from 45 at average risk; cervical from 21.