Age 2

Language skills: Your 2-year-old should be linking two or more words together and speak clearly enough for parents (or others who have daily contact with the child) to understand approximately half the words the child speaks. He or she should know some adjectives, such as "big" and "happy" and have a spoken vocabulary of approximately 50 words.

Social skills: At this age, your child is becoming aware of his or her identity as an individual, separate from others. He or she will become more interested in playing with others and separation anxiety will begin to fade. He or she may start becoming defiant and asserting individuality.

Cognitive skills: Make-believe enters into the picture at this age, bringing a fun element into playtime. Your child should be able to sort objects by shape and color and understand some spatial concepts, such is "in" and "on." Peek-a-boo and hide-and-seek may become favorite games, and your child should be able to find hidden objects. A child starts with some interest in coloring at this age and should be scribbling, so be careful with markers and crayons!

Physical skills: Children should begin walking (toddling) on their own at about 12 to 14 months of age; at approximately age 2, they can walk on tiptoes, climb on furniture and begin to run. They can also build a tower or 4 or more blocks and will empty objects out of a container (or cabinet).

Children become very active and busy around the age of 2 and their awareness of themselves as an individual generally gives rise to a greater sense of independence which, along with their mobility and curiousity, has generated the "terrible twos" label. At this point, your home should be thoroughly childproofed because a 2-year-old can and will get into everything within reach.

Age 3

This is an exciting time for a toddler. It's a time of huge intellectual, social and emotional growth. It's a fun time for parents, as well, as your child becomes more responsive to social cues and physically able to interact in play with both adults and children.

Language skills: Your child should, at the age of 3, be able to identify most common objects, such as dog, cat, house, car, etc. He or she should also be able to say his or her first name and age. Use of pronouns (I, you, we, they) and some plurals begins at this age and he or she will be able to answer simple questions.

Social skills: By the age of 3, a child should be able to take turns with playmates and siblings, as well as imitate parents and playmates. (This is the age when you will often see your own behaviors mimicked in public, much to your chagrin!) He or she will separate easily from you to go to play or to preschool and will openly express affection.

Cognitive skills: Children at this age love make-believe and dress-up and they should be playing with toys and one another, making up an imaginary environment and situations. They will be more confident about sorting objects by shape and color and understand more spatial concepts (over, under, around). If you show them a circle, they should be able to copy it.

Physical skills: At around the age of 3, a child should be able to walk up and down stairs, using alternate feet on each step (as opposed to scooting), although for safety handholding or a handrail would be encouraged. He or she should be able to kick a ball, climb an object (jungle gym, ladder), run and pedal a tricycle. Fine motor manipulation begins to improve and he or she should be able to turn the pages of a book, one page at a time. He or she should be able to stack a tower or 6 or more objects or blocks.

This is the age where, if your work requires it, you may wish to consider preschool for your child, rather than daycare of some kind. Preschool provides a higher level of directed activity and learning than daycare and begins teaching essentials while encouraging social skills.

Age 4

At this age, a child is only (usually) one year away from entering kindergarten. He or she is more independent - and assertive of independence - and focusing more on adults and children outside the family. Interactions with family and others help shape personality and individual ways of thinking and moving.

Language skills: Your child should be speaking clearly enough for strangers to understand, describe the use of common objects, tell simple stories and use verbs that end in "ing," as well as some irregular past tense verbs, such as "ran" and "fell."

Social skills: At this point, your child should be trying to solve problems or puzzles, be cooperating with playmates and become interested in new experiences. As noted above, independence is asserting itself more and more.

Cognitive skills: Four-year-olds become involved in more complex imaginary play at this time, concocting elaborate fantasies, story lines and characters. They understand more complex spatial concepts (behind, next to) and understand the concept of same and different. They should be able to draw a person with 2 to 4 body parts and print some capital letters and name some colors.

Physical skills: At this age, a child should be able to dress and undress on his or her own. They can use scissors (safety scissors, please!). At play, they should be able to throw a ball overhand, kick it forward, catch bounced balls most the time, and balance on one foot for a few seconds.

The preschool years are a fantastic time of growth and development, exploration of self and surroundings, and learning about life, family and society. Take time to enjoy these years with your child and participate in their learning process.

Even with a normal, healthy baby, well-baby exams are important to measure growth and development milestones to make certain your baby is staying healthy. Make sure you have a pediatrician you trust and who will take the time to talk to you about your baby's growth and progress.

Measurements

Most well-baby checkups begin with measurements of your baby's length, weight and head circumference. You'll need to undress your baby, so keep a blanket handy.

Your pediatrician will have a growth chart and mark the baby's height, weight and head circumference measurements against a "normal" growth curve for age. Some babies will be "off the chart," or way above the growth curve for their age. Premature infants will fall below the growth curve, but there is an adjustment for "gestational age." If your baby is 4 weeks premature, they are considered "newborn" at one month. Some preemies catch up quickly; others take longer, usually depending on the amount of prematurity. If your baby is losing on the growth curve, your pediatrician may become concerned about failure-to-thrive or other factors, such as adequate feeding and sleep habits. Don't be fixated on the growth chart, however; a baby who's in the 95th percentile for height and weight isn't necessarily healthier than a baby who's in the 5th percentile. What's most important is steady growth from one visit to the next.

Physical examination

Your pediatrician will perform a head-to-toe physical examination of your baby at every visit. Some of the things they will look at:

• Head: Soft spots (fontanels) are areas on your baby's head that give your baby's brain room to grow. They typically disappear some time between 12 and 18 months of age, when the skull bones fuse together. The doctor will also check the shape of your baby's head. If there are flattened areas, you may be advised to place the baby in different positions. Don't worry - not everyone has a perfectly rounded skull!
• Ears. Ear infections are common in infants and toddlers and can cause hearing loss if not treated. Your doctor will check the baby's external auditory canal and then examine the tympanic membrane (eardrum) with an instrument to make sure it's pink and pearly and not bulging. Bulging and discoloration of the eardrum is an early sign of ear infection. (Watch for crying and tugging at the ears for early signs of ear infection. Ask me how I know this!) There should be no discharge from the ear, which is a sign of severe infection. The pediatrician will also check your baby's response to sounds, to make sure hearing is good. Hearing tests typically aren't necessary for well-baby exams.
• Eyes. Plugged tear ducts are a common problem in newborns. This can frequently be resolved by massage the duct area, which is very simple and painless; your pediatrician will show you how to do this if there are signs of tear duct plugging. If that doesn't resolve the problem, the procedure to clear the tear duct is very simple. Your doctor will also check the baby's eyes with an instrument to see inside the eye and test pupil response to light. As your baby gets older, the doctor will also check to make sure the baby tracks objects with his/her eyes without turning the head.
• Mouth. Thrush is a yeast infection very common in newborns. Your doctor will examine the baby's mouth for signs of thrush, which is easily treated. As your baby grows and develops, the exam will also look for teeth breaking through the gums on schedule.
• Skin. In the first few weeks after birth, the doctor will examine the umbilicus to make sure it is clean and that the residual cord is healthy and in the process of falling off. Make sure you keep it clean with a swab soaked in alcohol - the more you clean it, the faster it will fall off. Your doctor will look for unusual skin conditions, such as birth marks, rashes and jaundice (a yellowish discoloration of the skin and eyes). Jaundice is common in newborns and frequently disappears on its own; if it doesn't, light therapy may be recommended to clear it up. Make sure when you bathe your baby that you lift all the folds of skin and clean thoroughly, as rashes and sores may occur if dirt is trapped and irritates the baby's tender skin.
• Heart and lungs. Your pediatrician will listen to the baby's heart to make sure there are no abnormalities in the beat. Murmurs are not always a cause for concern but you may be referred to a specialist if your pediatrician is concerned. The pediatrician will listen to make sure lung sounds are healthy and normal.
• Abdomen. When your pediatrician palpates the baby's abdomen, he or she is feeling for enlarged organs or excessive gas or signs of tenderness. Some babies also have umbilical hernias; these are also common and typically resolve by 1 or 2 years of age.
• Genitalia. Your doctor will examine the genitalia to make sure they are clean and normal, without signs of discharge, lumps or tenderness. In boys, the testes will be examined to make sure they are normally descended.

Development milestones will be covered in another article.

Make sure you ask if you have any questions. Pediatricians generally schedule a generous block of time for well-baby exams, especially for first-time parents. It's important for both the parents and the baby to have confidence that what you're doing is what's best for your baby.