Medical expert of the article
New publications
Monitoring the development of a healthy child
Last reviewed: 04.07.2025

All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Visits to healthy children are aimed at ensuring the healthy development of the child during education, preventive vaccinations, early detection and treatment of diseases, and helping parents optimize the emotional and intellectual development of the child.
The American Academy of Pediatrics has developed guidelines for monitoring children who have no significant health problems and who are growing and developing appropriately for their age. Those who do not meet these criteria should be monitored more frequently and intensively. If a child is first monitored late or if certain procedures were not performed at the appropriate age, this should be done as soon as possible.
In addition to the physical examination, the child's intellectual and social development, as well as the relationship with the parents, should be assessed. This can be determined by taking a detailed history from the parents and the child, personally observing the child's behavior, and even sometimes by consulting external sources such as teachers and caregivers. Tools available for use in the office make it easier to assess intellectual and social development.
Both physical examination and screening procedures are important parts of preventive work with infants and older children. Most parameters, such as weight, are mandatory for all children, but some are used selectively for certain groups, such as lead levels at 1 and 2 years.
General examination of the child
Physical development of the child
Length (from the crown of the head to the heels) or height (from the time the child can stand) and weight should be measured at each visit. Head circumference should be measured at each visit until the child is two years old. The child's growth rate is monitored using growth centile curves (somatograms).
Blood pressure
From the age of three, blood pressure should be monitored regularly using a cuff of the appropriate size. The width of the rubber part of the cuff should be about 40% of the circumference of the arm, and its length should cover 80 to 100% of the circumference. If a suitable cuff that meets these criteria is not available, it is better to use a larger cuff.
A child's systolic and diastolic blood pressure is considered normal if it is within the 90th centile; the values of each centile vary depending on gender, age, and height (height centiles), so reference to centile tables is necessary. Systolic and diastolic blood pressure between the 90th and 95th centiles should prompt the physician to monitor the child and evaluate risk factors for hypertension. If all measured values are consistently at or above the 95th centile, the child should be considered to have hypertension and its cause should be determined.
[ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 12 ], [ 13 ], [ 14 ], [ 15 ]
Head
The most common problem is otitis media with effusion, which is manifested by changes in the eardrum. Tests for detecting hearing loss have been described previously.
The eyes should be examined at each visit, assessing movements (convergent or divergent strabismus); deviations in the size of the eyeball, which may indicate congenital glaucoma; differences in pupil size, iris color, or both may indicate Horner syndrome, trauma, neuroblastoma; asymmetry of the pupils may be normal, or may be a manifestation of ocular pathology or intracranial pathology. The absence or distortion of the red reflex indicates cataracts or retinoblastoma.
Ptosis and hemangioma of the eyelid impair vision and require attention. Children born before 32 weeks of gestation should be examined by an ophthalmologist to detect retinopathy of prematurity and refractive errors, which are common. By the 3rd or 4th year of life, vision is checked using Snellen charts or a newer method using a device. Special pediatric charts are preferable; visual acuity less than 0.2-0.3 requires evaluation by an ophthalmologist.
Diagnosis of dental caries is important, you should contact a dentist if your child has cavities in the teeth, even if these are only baby teeth. Candidal stomatitis is common in young children and is not always a sign of immunodeficiency.
Heart
Cardiac auscultation is performed to detect new murmurs or rhythm disturbances; a functional blowing timbre murmur is common and requires differential diagnosis with pathological murmurs. Palpation of the apical impulse may reveal cardiomegaly; asymmetric femoral pulses may indicate coarctation of the aorta.
[ 16 ]
Stomach
Palpation is performed at each visit because many mass lesions, such as Wilms tumor and neuroblastoma, become palpable only as the child grows. Fecal matter in the left lower quadrant can often be palpated.
Spine and limbs
Children who can stand should be examined for scoliosis by assessing posture, shoulder and clavicle symmetry, trunk tilt, and especially paravertebral asymmetry when bending forward. Leg length discrepancies, tight adductor muscles, asymmetry in abduction or creasing of the legs, or a palpable, audible click of the femoral head as it returns to the acetabulum are signs of hip dysplasia.
Feet turned inward are a sign of adduction of the muscles of the anterior surface of the leg, rotation of the tibia or femur. Such children need treatment, they should be referred to an orthopedist.
Examination of the genitals
All sexually active patients should be screened for sexually transmitted diseases; girls should have an external genital examination. Young women aged 18 to 21 years should be offered a pelvic examination and routine Pap tests. Testicular and inguinal examinations are mandatory at each visit to detect undescended testicles in younger children, testicular masses in late puberty, and inguinal hernia at any age.
[ 17 ], [ 18 ], [ 19 ], [ 20 ], [ 21 ], [ 22 ]
Examination of the child
[ 23 ], [ 24 ], [ 25 ], [ 26 ]
Blood tests
To detect iron deficiency, hemoglobin or hematocrit levels should be measured at 9 to 12 months of age in full-term infants, at 5 to 6 months of age in preterm infants, and annually in girls who have begun menstruating. HbS may be measured at 6 to 9 months of age if not previously done as part of the newborn screening.
Recommendations for testing blood lead levels vary by state. Generally, screening should be done between 9 and 12 months of age for children at risk (those living in homes built before 1980), with a second screening at 24 months. If the doctor is unsure whether the child is at risk, testing should be done. Levels greater than 10 mcg/dL (> 0.48 μmol/L) pose a risk of developing neurological damage, although some experts believe that any level of lead in the blood can be toxic.
Cholesterol testing is indicated for children over age two who are at high risk based on family history. If other risk factors are present or family history is unknown, testing is done at the physician's discretion.
[ 27 ], [ 28 ], [ 29 ], [ 30 ]
Hearing
Parents may suspect hearing loss if their child stops responding appropriately to sound stimuli, or does not understand speech, or if speech is not developing. Because hearing loss also affects speech development, hearing problems should be corrected as quickly as possible. Therefore, at each early childhood visit, the physician should try to obtain information from the parents about the child's hearing ability and be prepared to conduct an examination or refer the child to an audiologist if there is any suspicion of hearing loss in children.
Audiometry can be performed in the primary care setting; most other audiologic procedures (electrophysiological tests) should be performed by an audiologist. Traditional audiometry can be used in children over the age of three; younger children can also be assessed by observing their responses to sounds presented through headphones, noting their attempts to localize the sound, or performing a simple task. Tympanometry, another office-based procedure that is applicable to children of all ages, is used to evaluate middle ear function. Abnormal tympanograms often indicate eustachian tube dysfunction or the presence of fluid in the middle ear not detected by otoscopy. Although otoscopy is useful in evaluating middle ear function, it is more effective when combined with tympanometry.
Other screening tests
Tuberculin testing should be done if exposure to MBT ( Mycobacterium tuberculosis ) is suspected in all children born in developing countries and in children of recent immigrants from these countries. Sexually active adolescents should have an annual urine test for leukocyturia; some clinicians also add testing for chlamydial infection.
Vaccination of children
Vaccinations are given according to the schedule recommended by the Centers for Disease Control and Prevention, the APA, and the American Academy of Family Physicians. A tetanus toxoid booster shot is needed in adolescence, and according to new data, a meningococcal vaccine should be given at age 11 to 12.
Disease prevention in children
Prevention talks are part of every well-child visit and cover a wide range of topics, from encouraging parents to put their baby to sleep on their back to injury prevention, from nutrition advice to discussing violence, guns, and abuse.
Safety
Recommendations for injury prevention vary by age.
For children from birth to 6 months, safety recommendations focus on using rear-facing car seats, reducing hot water temperatures at home to less than 120 degrees F (49 degrees C), preventing falls, placing the baby to sleep on his or her back, and avoiding food and other objects that could be aspirated by the baby.
For children 6 to 12 months, recommendations include continuing to use car seats [which can be moved to forward-facing positions once the child reaches 9 kg (20 lb) and 1 year of age, although rear-facing car seats remain the safest], avoiding walkers, using safety latches, preventing falls from fold-out tables and stairs, and being vigilant in supervising the child in the bath and while the child is learning to walk.
For children 1 to 2 years of age, review of vehicle safety for both passenger and pedestrian use, tying window cords, using safety pads and latches, preventing falls, and removing firearms from the home is recommended. Precautions for children 2 to 4 years of age include all of the above plus use of age- and weight-appropriate car seats. For children over 5 years of age, preventive measures include all of the above plus use of a bicycle helmet, protective gear when playing sports, instructions on how to cross the street safely, clothing controls, and sometimes use of life jackets when swimming.
Nutrition
Poor nutrition leads to childhood obesity. Recommendations vary by age; recommendations for children under two years of age have been discussed previously. As the child grows, parents can allow some variety in food choices, while generally keeping the diet within healthy parameters. Frequent snacking and high-calorie, salty, and sugary foods should be avoided. Soda is considered one of the most important components in the development of obesity.
Exercises
Physical inactivity is also at the root of childhood obesity, and the benefits of maintaining good physical fitness and emotional health should encourage parents to ensure that they instill healthy habits in their children from an early age. Infants and toddlers should be allowed to explore independently, but under strict supervision and in a safe environment. Outdoor play should be encouraged from the first year of life.
As the child grows, games become more complex, often developing into school sports. Parents should set a good example and encourage both free informal play and play-based sports, always keeping safety in mind and promoting a healthy attitude towards sports and competition. Playing sports and participating in family activities provides children with exercise and has a positive impact on the child’s psyche and development.
Limiting the time spent watching TV, which is directly linked to physical inactivity and obesity, should begin at birth and continue until the end of adolescence. Similar restrictions should be set for video games and, as the child grows, for computer work not related to education.
[ 33 ]