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Overview
In the first 5 years, your child’s brain develops more than at any other time in their life.
Your child’s early experiences create millions of new connections in their brain. This period of development lays down the foundations for learning, health and behaviour throughout their life.
All children develop at different rates. Some will be slower than others (developmentally delayed) but then catch up over time. Others may have an underlying problem that causes the delay.
Developmental checks
Your public health nurse (PHN) will carry out developmental checks on your child at different stages. These checks are sometimes called examinations.
These are to find out if your child is growing properly. It is also to see if they are able to do things that children of the same age are able to do.
Make sure you bring your child to their developmental checks. It can help identify any health or developmental problems. Early diagnosis and treatment can help to improve issues your child may have.
Developmental checks happen when your child is:
- 3 months
- 9 to 11 months
- 18 to 24 months
- 3 years
Keep reading to see what happens at each stage. Your PHN or community medical doctor will contact you to arrange a time for each of these appointments. Let them know if your contact details change. The checks usually take place in your local health centre.
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Your child’s developmental checks – 3 months
Your baby’s first developmental check takes place when they are 3 months old.
The public health nurse (PHN) or community medical doctor will carry out the following checks:
Physical
Your baby will get a physical examination. This means the PHN or community medical doctor will check your baby’s:
- respiration (breathing)
- skin
- fontanelles (the soft spot on your baby’s head)
- mouth
- palate (the roof of the mouth)
- neck
- eyes
- ears
- abdomen (the belly area and the space between the chest and pelvis)
- genitalia
- spine
- limbs (arms and legs)
Testes
If your baby is a boy, the nurse will check their testicles (testes) to make sure they have moved down into the scrotum (this is called testicular descent).
Response
The PHN or community medical doctor will check how alert your baby is, if they smile and other facial interactions. They will also ask you about your baby’s alertness.
Posture and large movements
This is to check how your baby holds their body (posture) and how they make large movements.
Large movements (also called ‘gross motor skills’) are the movement and coordination of the arms, legs and other large body parts.
The nurse will check if your baby lifts their head when lying face down and if they use their forearms (the part of the arm between the elbow and wrist) for support.
They will place your baby in a sitting position and look to see if their head hangs forward or backward. They will also see if your baby holds their head erect for several seconds and if their legs can take their weight.
The nurse will check how your baby uses their hands. The nurse will be looking to see if:
- their hands loosely open
- they are beginning to clasp and unclasp objects
- they respond to finger play
- they watch hands – both their own and the nurse’s
Eyes
The nurse will check to see if your baby can follow a moving object with their eyes. They will also check how the pupils in their eyes react to light.
They will also check to see if your baby has a lazy eye (also called ‘amblyopia’). This is where one of the eyes is not developing properly and the brain starts to ignore input from the weaker eye.
Fine movements
Fine movements (also called ‘fine motor skills’) are the use of smaller muscles like the muscles in the hands and fingers.
The nurse will see if your baby will hold a rattle for a few seconds when placed in their hands.
Hearing and speech
The nurse will check if your baby:
- is startled when they hear loud sounds
- goes quiet or smiles when spoken to
- seems to recognise your voice and goes more quiet if crying
- increases or decreases their sucking behaviour in response to sound
- makes pleasure sounds like cooing
- cries differently for different needs
- smiles when they see you
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Your child’s developmental checks – 9 to 11 months
Your baby will be checked by the public health nurse (PHN) as follows:
Physical development
Your baby will get a physical examination. The PHN will check:
- respiration (breathing)
- skin
- fontanelles (the soft spot on your baby’s head)
- mouth
- palate (the roof of the mouth)
- neck
- eyes
- ears
- abdomen (the belly area and the space between the chest and pelvis)
- genitalia
- spine
- limbs (arms and legs)
Testes
If your baby is a boy, the nurse will check their testicles (testes) to make sure they have moved down into the scrotum (this is called testicular descent).
Posture and large movements
Posture is how your baby holds their body.
Large movements (also called ‘gross motor skills’) are the movement and coordination of the arms, legs and other large body parts. Examples include sitting and crawling.
Your baby will be checked to see if they can:
- sit with support (for example, on your lap)
- sit without support
- try to crawl
- roll both ways
- support their weight on their legs
Eyesight
The nurse will check if your baby can see well. They will shine a light in their eyes to see how the pupils respond.
Your baby’s eyes will be watched to see how they track moving objects.
The nurse will also check to see if your baby’s eyes are looking in the same direction.
Fine movements
Fine movements (also called ‘fine motor skills’) are the use of smaller muscles like the muscles in hands, fingers and wrists.
The nurse will check to see if your baby:
- pokes at objects with their index finger
- eats finger foods
- uses their hands to rake objects
- transfers from one hand to the other
Hearing
The nurse will check if your baby:
- enjoys games like peek-a-boo and pat-a-cake
- turns and looks in the direction of sounds
- listens when spoken to
- recognises words for common items like cup, shoe or book
- begins to respond to requests like “come here” or “want more?”
Speech development
The nurse will check if your baby:
- babbles
- has both long and short groups of sounds such as “tat upup bibibibi”
- uses speech or non-crying sounds to get and keep attention
- uses gestures to communicate (waving, holding arms to be picked up)
- copies or imitates different speech sounds
- has one or two words (hi, dog, dada, mama) around first birthday, although the sounds may not be clear
Social, emotional, play and behaviour
The nurse will check to see if your baby can:
- play games like peek-a-boo
- copy or imitate clap hands
- point with their index finger
- respond to people’s expressions
- take interest in their own reflection in a mirror
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Your child’s developmental checks – 18 to 24 months
Your child will be checked as follows:
Physical development
The public health nurse will check their:
- respiration (breathing)
- skin
- mouth
- palate (roof of the mouth)
- neck
- eyes
- ear
- spine
- limbs (arms and legs)
Testes
If your child is a boy, the nurse will check their testicles (testes) to make sure they have moved down into the scrotum (this is called testicular descent).
Posture and large movements
Posture is how your child holds their body.
Large movements (also called ‘gross motor skills’) are the movement and coordination of the arms, legs and other large body parts. Examples include sitting, crawling and walking.
Your child will be checked to see if they can:
- walk alone
- walk up steps with one hand held
- carry toys while walking
- kick a ball
- begin to run
- climb up and down from furniture without help
Eyesight
The nurse will check to see if your child’s eyes look in the same direction.
Fine movements
Fine movements (also called ‘fine motor skills’) are the use of smaller muscles like the muscles in hands, fingers and wrists.
The nurse will check if your child can:
- pick up small objects
- catch sight of and name small toys
- turn over a container to spill out the contents
- build blocks
- begin to sort out shapes by size and colour
- feed themselves with a spoon
- drink from a cup
Hearing and speech
The nurse will ask if your child passed the universal newborn hearing screening (UNHS) test shortly after birth.
The nurse will check your child’s hearing by checking if they can:
- point to a few body parts when asked
- follow simple commands or instructions (“roll the ball”, “kiss the baby”)
- understand simple questions (“where’s your shoe?”)
- listen to simple stories, songs and rhymes
- point to pictures in a book when they are named
Your child’s speech will be checked. The nurse will check if your child:
- says more words every month
- uses some 1 or 2-word questions (“where’s Kitty?”, “go bye-bye?”, “what’s that?”)
- puts 2 words together (“no water”, “mommy book”)
Social, emotional, play and behaviour
The nurse will check if your child:
- shows more independence
- gets separation anxiety (extreme anxiety about being separated from parent or other care giver)
- shows affection to familiar people
- plays alone and does messy and pretend play
- copies or imitates other people
- more excited about the company of other children
- begins to show defiant behaviour
- shows emotion (laughing, frustration, anger)
- says “no” and shakes their head
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Your child’s developmental checks – 3¼ to 3½ years
This check will happen between 3-and-a-quarter and 3-and-a-half years of age.
Posture and large movements
Posture is how your child holds their body.
Large movements (also called ‘gross motor skills’) are the movement and coordination of the arms, legs and other large body parts. Examples include sitting, crawling and walking.
The public health nurse will check or ask if your child:
- jumps
- climbs well
- pedals a tricycle
- turns around corners
- walks forward, backwards and sideways
- balances on 1 foot
- sits with legs in front
Testes
If your child is a boy, the nurse will check their testicles (testes) to make sure they have moved down into the scrotum (this is called testicular descent).
Eyesight
The nurse will ask you about your child’s eyesight (vision).
They will check to see if your child’s eyes look in the same direction.
Fine movements
Fine movements (also called ‘fine motor skills’) are the use of smaller muscles like the muscles in hands, fingers and wrists.
The nurse will check if your child can:
- pick up pins and threads
- hold a pencil
- copy a circle
Hearing and speech
The nurse will ask if your child passed the universal newborn hearing screening (UNHS) test shortly after birth.
They will ask if your child can hear:
- you when you call from another room
- television, radio and other devices at the same loudness level as other family members
The nurse will ask about your child’s speech.
They will check if your child can:
- answer simple questions like “who?”, “what?”, “where?” and “why?”
- talk about activities at play school or a friend’s home
- usually be understood by people outside of the family
- uses a lot of sentences that have 2 or more words – for example “mammy get in car” or “daddy eating dinner”
- usually talk easily without repeating syllables or words
You will also be asked about your child’s interaction skills, for example if they can:
- name familiar things
- say their own first name, age and gender
- use words like “I”, “me”, “we”, “you”
- use some plural words like “cars”, “dogs”
- understand words like “in”, “on” and “under”
Cognitive
The cognitive check looks at learning, thinking and problem-solving.
The nurse will ask if your child:
- does puzzles with 3 to 4 pieces
- turns one page at a time when looking at a book
- builds a tower with 6 or more blocks
- can work toys with buttons, levers and moving parts
- screws and unscrews jar lids or turns door handles
Social, emotional, play and behaviour
The nurse will ask if your child:
- uses imaginative play
- takes turns
- copies adults and friends [and siblings?]
- shows affection to friends without being prompted or asked to do so
- separates easily from their parents but may get upset with any major changes in their routine
- holds eye contact
- understands commands or instructions
- is toilet trained
For more information on your child’s everyday care and development plus how to keep them safe, active and healthy check out the HSE website https://www2.hse.ie/babies-and-toddlers/
You will also be able to use their ‘chat feature’ to talk to an expert.
Q: My two-year-old son is a very picky eater. Do you have any advice to help increase the number of vegetables he will eat?
QUESTION