Recommendations to Promote Developmental Progress: Newborn to 3 Years

Your child was born prematurely (early) if he was born before or at 36 weeks’ gestation. In the initial year of life, your child’s developmental milestones typically remain consistent with their adjusted (or corrected) age. The adjusted age is the age your child was expected to be if born at term. If your child is less than 2 years and was born preterm, the adjusted (or corrected) age is used to monitor your child’s development. The developmental gap between the chronologic age and adjusted age begins to close as your child nears 2 years. However, there are some children who may take a little longer to close their gap. 

If your child was born before or at 36 weeks’ gestation and is less than 2 years of age, calculate the adjusted (corrected gestational) age as outlined below and use that age as your reference point when monitoring your child’s development. If your child was born at 37 weeks’ gestation or later, there is no need to adjust.

(Actual or chronological age in weeks) – (weeks of prematurity) = (corrected or adjusted age)

Example: 

• A child who is 6 months chronologic age and who was born at 28 weeks’ gestation. 
• (6 months x 4 weeks) – (40 – 28 weeks) = (corrected or adjusted age)
• (24 weeks) – (12 weeks) = 12 weeks adjusted age (3 months)

Now that you have calculated your child’s adjusted age, use the “Developmental Milestones” chart to see how well your child is progressing. Be sure to discuss any questions or concerns with your developmental specialist.

Pediatrix® Developmental Medicine of Dallas provides follow-up care for children who were in the NICU, born prematurely or at high risk for delays. In our clinic, children are typically seen at 3 months, 6 months, 12 months, 18 months, 24 months and 36 months. Additional visits may be scheduled if there are specific needs your developmental specialist wants to monitor more closely. If there are no developmental concerns at 36 months of age, your child will return for a baseline school-readiness assessment prior to starting kindergarten.

• A good rule of thumb is to change the way your baby’s head faces in the crib each week. For example, if you go home from the NICU on a Wednesday, place your baby’s head facing one direction (on their back) in the crib or bassinet. The following Wednesday, change it to the other side. This will encourage them to turn their head to different sides as they hear noises or see people walk by. 
• If your baby’s head appears flatter on one side (for example, the right) then encourage them to look to the opposite side (in this case, left). 
• Place them on your right arm holding them to encourage them to look at you to the left. 
• If in a crib, place a mobile on the left side to encourage them to turn in that direction. 
• Tummy time during the day will also help. In time and with effort, the flattening can round out.
• If minimal improvement is noted with the above strategies, sometimes physical therapy and/or a helmet for improving the head shape may be indicated. 

• This position encourages your baby to lift their head and develop strength in their neck, shoulders and upper back. This strength is needed to roll over, sit and, eventually, crawl. 
• If your baby is not yet term (40 weeks is considered term), start with tummy time on your chest for the first few weeks. Once your baby is term, place them on the tummy on a firm flat surface with their arms forward and elbows directly under the shoulders.
• To encourage your baby to lift their head, lie face to face in front of your baby or place a bright toy or mirror about six to eight inches in front of the baby. 
• It is fine to start tummy time with a small semicircular pillow or rolled towel/blanket propped under your baby’s chest and arms. However, your child will get stronger as they learn to push against a flat surface without assistance. You may have to assist with lifting the chin the first few times. 
• To start, set short goals for frequent tummy time. You can place your baby on the tummy after each diaper change and increase the duration slowly. Soon, your baby will become strong and enjoy this position for longer periods. 
• Goal: 60 minutes total throughout the day broken into smaller periods.

Tummy time and gastrostomy/tracheostomy tubes: 

• If your baby goes home with a G-tube, it will still be important to do core strengthening and tummy time exercises. This can be scary at first, but not trying can lead to weakness and delayed motor skills. Once the tube site has healed (usually by two weeks after surgery), your baby will likely be able to do tummy time as they would if they did not have a tube and the tube/button is protected. If your baby has an actual tube, you will want to tape it in place securely. This is not true for G-Buttons. 

How to protect the G-tube site: 

• A button pad (button buddy) that slides around the site and functions as a small pillow can protect the tube site. 
• There are also feeding tube belts that wrap around your child to keep the tube/button secure. 
• Alternatively, some parents make these from soft cotton fabric. 

Alternative tummy time strategies: 

• Place your baby over a boppy pillow (if they are big enough and will not slide down), or use a rolled blanket to keep weight off the tube/button. The pillow or blanket should be positioned under the shoulders and chest to lift your baby’s body off the floor.
  • There are also G-tube protectors/special pillows with holes that can be used for tummy time. 
• Placing your baby across your lap while you are sitting is another good alternative. 
• Always supervise during tummy time to ensure tubes do not move with changes in position. 
• Similar strategies can be used for children with other medical equipment, such as a tracheostomy tube.

• In addition to tummy time, spending time on the floor encourages children’s motor progress. As your child pushes up onto their arms and knees into a quadruped (all fours) position, they prepare to crawl. When you place toys out of reach, they learn to move toward the target. Similarly, spending time on the floor also helps with learning to roll, sitting independently, pulling to stand and then, eventually, walking by strengthening your child’s core (stomach) muscles, as well as the leg and arm muscles. 
• AVOID walkers, exersaucers and jumping equipment that encourage babies to stiffen their legs and back. This can interfere with learning to sit, crawl and walk well. 

• Your child loves the sound of your voice, even if you are not seeing a response yet. Your voice is one of the things they remember and know about you from the womb. Talk with your child as you narrate what you are doing. As your baby responds with their own sounds, imitate those sounds so your baby knows you are listening and learns the art of reciprocal communication.
• Sing songs as you interact with your baby throughout your daily routine.
• Smile and look at your child as you speak, sing and listen to their response. Babies love to watch faces move and learn how to communicate by imitating you.
• As your child’s language develops, try to engage them in conversation, even if you don’t understand the response. Some children can become frustrated when they are not understood. In those instances, encourage your child to show you what they are trying to communicate. 
• Typically, you will understand your child better than others. As a rule of thumb, a stranger will understand 50% of what your child says at age 2. A stranger will understand 100% what your child says at age 4. 

• If you have not started reading, now is the time to start. Cuddle up with a book as part of your routine. Studies have shown that babies who were talked to and read to often have better early language skills and reading skills once they get to school. We also know that exposing your young child to books early helps them learn to love them and want to read as they get older. 
• Bedtime is often a great time to incorporate reading into your daily routine. As you read, encourage looking at the pictures by describing what you see. Create your own story from the pictures and feel free to embellish them as you read.
• As your child develops language, have them create stories from the pictures they sees. Have your child talk about colors in the pictures, number items, identify letters and identify the sound each letter makes. Books are a great tool for teaching pre-academic skills. 
• Goal: 30 minutes daily

• For children under 18 months, avoid or limit the amount of time they are exposed to a screen (e.g., television, tablets, phones) except video chatting, which is interactive. 
• If you choose to introduce screen time to your child between 18 to 24 months, ensure that you engage in using these tools with your child and choose high-quality media. However, it is acceptable to avoid screen time and encourage other opportunities for learning through reading, coloring, building blocks and imaginative play. 
• For children 2 years and older, media exposure should be limited to one hour or less per day. Ensure programs and apps are high quality. 

For more information on what to expect in the first three years of life, see our Developmental Milestones chart:

• Monitor what your child watches, how much time is spent on a screen and the effect prolonged screen time has on your child. Based on this information, as a family, decide what is the appropriate amount of screen time, which content is beneficial to your child and when should screen time be avoided throughout the day. This can be navigated by creating a schedule or a family media plan  (Family Tech Planners | Common Sense Media or AAP Media Plan (healthychildren.org)). 
• Common Sense Media (Common Sense Media: Age-Based Media Reviews for Families | Common Sense Media) is a great website that can help you determine high-quality, age-appropriate programs and apps. 

For more information on what to expect in the first three years of life, see our Developmental Milestones chart:

All therapy options should have a parent training component. The provider should give parents training and exercises to practice skills between therapy sessions.  

Children under age 3 can receive evaluations, therapies and support for developmental concerns. This therapy is state funded.  

Find the local ECI service office by city, county or zip code

Some of the ECI providers offer a parent-child therapy program for toddlers at risk for or diagnosed with autism, called Pathways. 

Treat issues related to gross motor skills, coordination and reflexes. 

Treat difficulties with sensory processing, possible fine-motor delays and limitations in the acquisition of age-appropriate self-care skills.

The ability to engage in social interactions and convey emotions in an age-appropriate manner can be negatively impacted by delays and deficits in communication. Speech therapy not only works on speech, but all communication, including following directions, the use of gestures, sharing emotions, social skills and play skills. Some children with speech delays may benefit from alternative communication methods.

A speech pathologist or occupational therapist trained in feeding disorders can evaluate and treat feeding difficulties, including increased gag reflex, drooling, tongue protrusion, difficulties with chewing, a tendency to stuff the mouth and pocketing food, and being a selective eater primarily due to sensory issues around food. 

You may also benefit from participation in outpatient psychotherapy to provide emotional support and help with parenting tools particular to your child’s issues. In particular, play therapy with a therapist who understands your child's issues may allow your child to process feelings through play, learn how to regulate behavior and/or express emotions in a safe way. A type of parent-child therapy called parent child interactive therapy (PCIT) is especially useful at building relationships and teaching appropriate parent responses to opposition, tantrums, nonresponse to directives and other behaviors. This can be done with a licensed therapist, counselor, social worker or psychologist, who has training and experience with this specific modality.

This article explains what to look for when seeking behavioral play therapy for children. Though this article addresses ADHD symptoms, the information also applies to children who struggle with managing behavior and emotion due to other reasons.