Anticipatory Guidance

[Note: the text for this page is taken from the original document and has not yet been altered for families.]


The one year old who is well cared for has a secure sense of attachment to his important caregivers, is developing an expanded capacity to communicate through sounds and gestures, and can navigate by cruising, perhaps by taking a few steps alone or, if necessary, by dropping to all fours and crawling with great speed.

At the beginning of this developmental period, a child's understanding of the world of people and objects is bound by what he can see, hear, feel, and manipulate physically. By the end of early childhood, the process of thinking moves beyond "the here and now" to incorporate the use of mental symbols and the development of fantasy. For the infant, mobility is a goal to be mastered. For the healthy young child, it is a mechanism for exploration and increasing independence. The one year old is beginning to use the art of imitation in his repetition of familiar sounds and physical gestures. The five year old has mastered most of the complex rules of his native language, and can communicate thoughts and ideas effectively.

The toddler stands on the threshold of the process of separation and individuation from his primary caregivers, who nurtured and protected him during his early months. By the end of early childhood, the well-adjusted child, having internalized the security of early bonds, pursues new relationships outside of the family as an individual in his own right. Understanding and respecting this evolving independence is an important parental challenge.

The healthy toddler has been immunized against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, Hemophilus influenza type B, and hepatitis B. His growth and development have been monitored, and adequate nutrition has been ensured through dietary supervision and supplemental vitamins, fluoride, and iron when necessary. By the end of early childhood, some children have had to contend with significant disease or disability, and virtually all have experienced the common nonpreventable early childhood illnesses. As a consequence, each child learns the difference between health/well-being and illness/discomfort.


The chubby, pot-bellied infant who tripled his birthweight in the first year of life slows his rate of gain significantly. The active toddler sheds his baby fat and straightens his posture. His physical strength, coordination, and dexterity all improve dramatically. The cautious and tentative walker becomes the reckless runner, climber, and jumper. As a fearless and tireless explorer and experimenter, the toddler is vulnerable to injury, but appropriate adult supervision can ensure an environment that balances safety with the freedom to take controlled risks.

The range of physical abilities among young children during this age period is considerable. Some are endowed with natural grace and agility; others demonstrate less "fine tuning" in their physical prowess, yet they "get the job done."

Parents and other caregivers can encourage young children's independence in eating by serving a nutritionally well-balanced selection of foods and allowing children to choose what and how much to eat. Good oral health is a part of the child's well-being. Early counseling on feeding practice is the essential first step. Regular dental visits, access to fluoride, and healthy nutrition and snacking practices can lead to the prevention of dental decay.

Although parents and other primary caregivers, including providers of child care services, have considerable control over the environment in which a young child is raised, the community also plays an important role. Children with access to safe play areas in a neighborhood free of violence have opportunities for the protected risk taking that is important during this developmental period. For those who grow up in the presence of physical and emotional dangers, the risk for harm is high.


Young children learn through play. If the toddler experienced the security of a nurturing and reliable source of protection and attachment during infancy, he now has a strong base from which to explore the world. The egocentricity of the young child is related less to a sense of selfishness than to a cognitive inability to see things from the perspective of others.

Young children live largely in a world of magic in which they often have difficulty differentiating what is real from what is make-believe. Some have imaginary friends. Many engage in elaborate fantasy play. Learning to identify the boundaries between fantasy and reality, and developing an elementary ability to think logically, are among the more important developmental tasks of this age period.

Caregivers need to provide a safe "laboratory" for these "young scientists" to conduct their "research." Children need access to a variety of tools and experiences. They need opportunities to learn through trial and error, as well as through planned effort. Their seemingly endless string of repetitive questions can test the limits of the most patient parent. These queries, however, must be acknowledged and responded to in a manner that not only provides answers but also validates and reinforces the child's burgeoning curiosity.


During the dynamic years from age one to five, children develop an emerging sense of themselves as individuals who live in families, as well as within larger social systems. Building on the secure and trusting relationships established in the first year of life, and venturing beyond the parallel play of toddlers, the maturing young child establishes an expanding network of friends and acquaintances.

The culture of the family and that of the community provide a framework within which the socialization process unfolds. The increasingly self-conscious young child grapples with such complex issues as gender roles, peer and/or sibling competition, and the difference between right and wrong. The temperamental differences that were manifested in the feeding, sleeping, and self-regulatory behaviors of the infant are transformed into the varied styles of coping and adaptation demonstrated by the young child. Some young children appear to think before they act; others are impetuous. Some children are slow to warm up while others operate on a very short fuse. Some accept limits and rules with more equanimity than others. The range of "normal" behavior is broad and highly dependent upon the match between the child's and the caregiver's styles. Aggression, acting out, excessive risk taking, and antisocial behaviors are common. Caregivers need to respond with a variety of interventions that set constructive limits and help children achieve self-discipline. Ultimately, healthy social and emotional development depend on how children view themselves and the extent to which they feel valued by others.

Health behavior

As young children identify with their parents, caregivers, and other important role models, they internalize a wide range of lifestyle attributes. They can benefit from the exhilaration of regular physical exercise and the joy of laughter shared with family and friends. Meals may be a pleasurable opportunity for nutrition and social interaction, or the focus of family conflict amidst the hurried ingestion of high-fat snacks. Well-monitored, selective television viewing may be an appropriate form of education and entertainment; conversely, television can be a constant source of passive diversion, background noise, and exposure to violence. When faced with adversity or stress, young children may be taught both healthy and unhealthy coping strategies, ranging from denial or retreat to active mastery. During a period when the power of role models and the process of identification are strong, young children incorporate salient features of the lifestyles of those who are most important in their lives. Good health supervision, a collaborative process that involves parents and professionals, can serve as a significant protective factor. In addition, health supervision can contribute to individual autonomy and a growing sense of personal competence and mastery, while enhancing positive interpersonal interactions and the development of rich human relationships.


The Early Childhood Periodicity Schedule shows the recommended health supervision visits for children judged not to be at undue risk. This primary schedule is based on an assessment of the needs of children and families, and of the ability of health professionals to introduce effective interventions.

An augmented schedule is recommended for young children with special health needs; those who live in poverty; those in dysfunctional families; those with insecure, isolated, or single parents; those with chronic illness or disability; those in foster care; those at risk for abuse and/or neglect; those experiencing emotional problems; and those at environmental risk. If major changes such as divorce, remarriage, death, or parental illness occur in the family between regularly scheduled visits additional health supervision visits should be arranged.

Early Childhood Periodicity Schedule

1 Year
15 Months
18 Months
2 Years
3 Years
4 Years

Anticipatory Guidance

Coming soon...

Last updated 8/21/96

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