Growth and Development, Ages 2 to 5 Years

When to Call a Doctor

Although your child grows at an individual pace, be aware of signs of a developmental delay. The earlier you identify a delay, the better chance you have of getting appropriate treatment for your child that can prevent or minimize long-term problems.

In general, talk to a doctor anytime your child:

• Does not seem to be reaching developmental milestones as expected.
• Is not growing at a steady pace. Each year between ages 2 and 5 years, expect your child to gain about 3 lb (1.4 kg) to 5 lb (2.3 kg) and grow about 3 in. (7.6 cm) . Although your child's height and weight are measured at routine well-child exams, call your doctor if your child's growth pattern concerns you in between these visits.
• Is not able to do some of the things he or she used to do, such as talking or running.
• Makes you so angry or frustrated with your child that you are worried about what you might do next.
• Acts overly aggressive, violent, or verbally abusive.
• Does not seem to be doing well, even though you can't pinpoint what makes you uneasy. Friends and other caregivers may also be concerned.

Call your doctor if by age 2 your child:¹

• Walks on his or her toes frequently and does not use a normal heel-toe pattern most of the time.
• Does not speak or use 2-word sentences.
• Does not imitate actions of others.
• Is not able to follow simple instructions.

Call your doctor if by age 3 your child:²

• Falls frequently while trying to walk or is not able to go up and down stairs.
• Drools frequently, does not speak clearly, and can't talk in 2- or 3-word sentences.
• Does not make regular eye contact.
• Can't build a tower of more than 4 blocks, move small objects, or copy a circle.
• Does not play "pretend" or like to play with toys and other children.
• Has problems separating from you.

Call your doctor if by age 4 your child:²

• Does not know how to throw a ball overhand, jump in place, or ride a tricycle.
• Can't hold a crayon between the thumb and fingers.
• Responds only to family members and does not enjoy being around other children.
• Does not use sentences with more than 3 words or use pronouns correctly.
• Shows no interest in playing "pretend."
• Has frequent temper tantrums.
• Is not toilet trained.
• Regularly resists getting dressed in the morning or going to sleep at night.

Call your doctor if by age 5 your child:²

• Goes from one activity to another without being able to focus on one thing for at least 5 minutes.
• Does not like to play "pretend" or try new activities.
• Regularly resists using the toilet, sleeping, or eating.
• Speaks unclearly or can't use plurals or other basic parts of speech.
• Has trouble building a tower out of blocks, holding a crayon, getting dressed, brushing teeth, or washing hands. These are all tasks related to motor skill development.
• Often behaves in ways that seem unusual. For example, he or she may seem:
  • Afraid, unable to separate from you easily, overly quiet, or unhappy.
  • To have little or no emotion.
  • Not to enjoy playing with other children or people other than close family members.

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Author:	Debby Golonka, MPH	Last Updated: April 24, 2007
Medical Review:	Michael J. Sexton, MD - Pediatrics Louis Pellegrino, MD - Developmental Pediatrics
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