Developmental Milestones
This gross motor milestone is typically achieved by 6 months, when an infant can maintain balance without support and use hands freely.
What is “sitting without support”?
📌 Teaching point:
By ~6 months, most infants can sit briefly unsupported (often “tripod sitting” first). If not sitting by ~9 months, it’s a motor delay red flag.
This vaccine is routinely given at birth and is especially important for preventing chronic infection and liver disease later in life.
What is Hepatitis B (HepB)?
📌 Teaching point:
HepB is typically given within 24 hours of birth. If mom is HBsAg positive, infant also needs HBIG within 12 hours (plus vaccine), then follow-up serologies later.
A toddler presents with sudden barky cough, inspiratory stridor, and symptoms worse at night. This diagnosis is treated first-line with a steroid, and severe cases may need nebulized epinephrine.
What is croup (laryngotracheitis)?
📌 Teaching point:
Give dexamethasone to everyone (even mild). Add racemic epi if stridor at rest/moderate-severe distress, and observe for rebound.
A 2-year-old has rhinorrhea, low-grade fever, and ear pain. Otoscopy shows a bulging, erythematous tympanic membrane with decreased mobility.
What is acute otitis media (AOM)?
📌 Teaching point:
Key diagnostic feature is bulging TM (not just redness). Treat pain first. Antibiotics depend on age/severity; amoxicillin is typical first-line.
This sleep safety recommendation helps reduce the risk of SIDS and should be followed for every sleep until at least the first birthday.
What is “Back to sleep (supine sleep position)”?
📌 Teaching point:
Always place babies on their back for naps and nighttime sleep. It’s one of the highest-yield counseling points for SIDS risk reduction.
This language milestone usually appears around 2 months and is a key early sign of social communication (and not just reflexive crying).
What is “cooing”?
📌 Teaching point:
Cooing (vowel sounds like “oooh/aaah”) typically emerges at ~2 months. Lack of early vocalization can suggest hearing impairment or broader developmental concerns.
At the 2-month visit, infants routinely receive a combination of vaccines, name them.
What is the “2-month vaccine series DTaP, IPV, Hib, PCV, and Rotavirus”?
📌 Teaching point:
Core 2-month vaccines: DTaP, IPV, Hib, PCV, Rotavirus, and usually HepB depending on birth dose timing. This set repeats in a similar pattern at 4 and 6 months.
This diagnosis is suggested by a toxic-appearing child with fever, drooling, tripod positioning, and no cough, and you should avoid throat exam until the airway is secured.
What is epiglottitis?
📌 Teaching point:
This is an airway emergency. Don’t agitate the child or do anything that worsens obstruction. Call anesthesia/ENT, secure airway, then treat (often ceftriaxone + vancomycin, depending on local practice).
A school-aged child presents with itchy, watery eyes, sneezing, and boggy pale nasal turbinates, worse seasonally and with outdoor exposure.
What is allergic rhinitis?
📌 Teaching point:
First-line is intranasal corticosteroid for moderate/persistent symptoms (flonase). Add oral antihistamine for itching/sneezing (zyretc/claritin). Look for comorbid asthma and eczema.
This is the leading cause of accidental death in young children ages 1–4 and is often silent rather than noisy.
What is drowning?
📌 Teaching point: Drowning is quick + quiet. “They’ll splash and yell” is a myth—constant supervision matters.
This fine motor milestone is expected by 9 months, when an infant can pick up small objects using the thumb and index finger.
What is the “pincer grasp”?
📌 Teaching point:
The immature pincer starts around 9 months and becomes more refined later. If still using only a raking grasp after 9–10 months, think fine motor delay.
This oral vaccine must be started by 14 weeks and 6 days, and is generally not given after 8 months due to safety concerns.
What is Rotavirus vaccine?
📌 Teaching point:
Rotavirus is time-sensitive:
First dose must be started by 14w6d
Final dose must be given by 8 months 0 days
Reason: higher risk of intussusception with later administration.
A 6-week-old infant has a fever ≥38°C (100.4°F) at home, looks “fine” now, and has a normal exam. This situation still requires urgent evaluation due to high risk of serious bacterial infection.
What is neonatal fever / febrile infant (≤60 days)?
📌 Teaching point:
Age drives management: fever in infants ≤60 days is a can’t miss scenario even if well-appearing. Workup and disposition depend on age bracket and risk stratification—but don’t dismiss it.
A 3-year-old has fever for 3 days, then develops a sudden pink maculopapular rash as the fever resolves. The child now appears well and playful.
What is roseola (HHV-6/HHV-7)?
📌 Teaching point:
Classic pattern: high fever first, then rash after defervescence. It’s benign/supportive care, but febrile seizures can happen during the fever phase.
This car seat position is recommended for as long as possible—at minimum through age 2, but ideally until the child reaches the seat’s maximum height or weight limit.
What is “rear-facing car seat”?
📌 Teaching point:
Rear-facing is safest because it better protects the head/neck/spine. “As long as possible” depends on the car seat limits, not just age.
This is the earliest “true word” milestone, typically around 12 months, and it must be used consistently and meaningfully (not just babbling).
What is “saying 1 word (other than ‘mama/dada’) with meaning”?
📌 Teaching point:
By 12 months, a child often has 1–3 meaningful words. By 15 months, expect several words; by 18 months, ~10–25 words + increasing pointing/joint attention.
These live vaccines are first given at 12–15 months, and the second dose is routinely given at 4–6 years.
What is MMR (measles, mumps, rubella) and Varicella?
📌 Teaching point:
MMR and varicella vaccines are live attenuated. Dose 2 is often at 4–6 years, but can be given earlier if needed (minimum age and interval rules apply). Important for outbreaks/travel planning.
A previously healthy infant becomes suddenly limp, cyanotic, or apneic for several seconds, then returns to baseline. Before labeling it a benign event, you must rule out this “can’t miss” diagnosis that can present subtly in infants.
What is child abuse / abusive head trauma?
📌 Teaching point:
A BRUE-like event can rarely be the presenting sign of abusive head trauma, especially if the story doesn’t fit, there’s recurrence, abnormal neuro exam, bruising, or social red flags. Think safety first.
A 5-year-old has peri-umbilical pain that migrates to the right lower quadrant, fever, and anorexia. Exam shows guarding and rebound tenderness.
What is appendicitis?
📌 Teaching point:
Migration of pain + anorexia is high-yield. Don’t miss atypical presentations in younger kids. Imaging is often ultrasound first when stable to reduce radiation.
The most effective prevention for accidental poisoning in toddlers is this strategy
What is “locked/secure storage of medications and toxic substances”?
📌 Teaching point:
Most pediatric poisonings happen when products are accessible. Encourage locked storage + Poison Control number available (1-800-222-1222 in the U.S.).
This developmental “red flag” at 18 months is strongly associated with autism risk and should prompt urgent screening and referral, even if other milestones seem ok.
What is “not pointing to show interest / lack of joint attention”?
📌 Teaching point:
Joint attention (pointing to share interest, showing objects, checking caregiver’s face) is a critical social milestone. Absence by 18 months is a high-yield red flag → M-CHAT-R/F, hearing evaluation, and early intervention referral.
At the 11–12 year visit, adolescents routinely receive three key vaccines.
What are Tdap, HPV, and MenACWY?
📌 Teaching point:
The classic 11–12 yr trio:
Tdap (booster for tetanus/diphtheria/pertussis)
HPV (prevents cervical + other cancers; best immune response at this age)
MenACWY (with a booster later in adolescence)
Bonus high-yield add-on: MenB is optional/shared decision-making for many teens (often later).
A child with headache, vomiting, bradycardia, and irregular respirations is demonstrating this dangerous physiologic pattern, which signals increased intracranial pressure and impending herniation.
What is Cushing’s triad?
📌 Teaching point:
Cushing triad = HTN + bradycardia + abnormal respirations → late, ominous sign of increased ICP. Prioritize airway/ventilation, head elevation, hyperosmolar therapy per protocol, and emergent neuro involvement.
A child has dry cough for weeks, worse at night with night time awakenings multiple times a week. Episodes can be triggered by exercise and viral URIs. They improve with a bronchodilator and have a history of eczema and allergic shiners.
What is moderate persistent asthma (often cough-variant asthma)?
📌 Teaching point:
Asthma isn’t always “wheezing.” Chronic nighttime cough + triggers + response to albuterol strongly supports it. Long-term control is based on severity—inhaled corticosteroids are the cornerstone.
For adolescents with depression or suicide risk, the most important household intervention to reduce fatal outcomes is this method.
What is lethal means restriction?
📌 Teaching point: Suicide attempts with firearms are much more likely to be fatal. Temporary changes (locked storage, remove from home) are life-saving and time-sensitive.