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a heart attack or stroke before age 55. If your child’s total cholesterol level is in the healthy range (less than 170 mg/dL) and the level of low-density lipoprotein (LDL; the bad cholesterol) is less than 110 mg/dL, the test should be repeated within 5 years. If the cholesterol levels exceed these numbers, the doctor will recommend steps to bring them down to the healthy range, such as losing weight, exercising more, and eating less saturated fat and cholesterol.

Lead

An elevated level of lead in the blood can stunt a child’s physical and mental development; the higher the level, the greater the damage. Doctors recommend that all children have a screening test for lead poisoning (see page 425) between 6 months and 6 years of age, depending on the child’s risk factors, such as exposure to lead-based paint in older homes. Many school systems require screening before a child enters school.

Urinalysis

Urine tests can detect potentially serious conditions such as urinary tract infections, kidney disorders, or diabetes, and can evaluate kidney function. A urine test is performed at each checkup, beginning with the child’s first checkup after toilet training (at about 3 to 4 years of age). If the child’s urine screening test result is abnormal, a sample of urine will be sent to a laboratory for examination under a microscope. Depending on the results of the test, the doctor will recommend appropriate treatment.

Tuberculin Skin Test

Most children in the United States are at low risk of developing tuberculosis (TB; see page 663), a highly contagious bacterial infection of the respiratory system, but many states or schools require regular testing for TB. To administer the tuberculin skin test, a doctor or nurse injects a tiny amount of the TB bacterium protein under the skin of the inner part of the arm. If the skin at the site swells, turns red, or hardens, it indicates that the child has been exposed to or infected with TB. In this case, the child will have a physical examination and a chest X-ray to evaluate his or her condition and determine appropriate treatment.

Developmental Milestones

Generally, all children acquire physical and intellectual skills in the same order. For example, children learn to sit before they learn to stand, and they learn words before they form sentences. However, the rate for acquiring these skills varies from one child to another. For this reason, the ages listed in the following pages for reaching each mile-stone on childhood development are an average within a wider range and should be used only as a rough guide. Your child may acquire these skills at a faster or slower rate than the average. If you have any concerns about your child’s development, talk to your doctor.

At 6 months a child usually:

• Babbles

• Forms simple words such as “dada” or “mama”

• Laughs

• Responds to own name

• Turns in the direction of sounds

• Sits supported

• Rolls over

• Reaches

• Grasps objects

• Transfers objects from hand to hand

• Pushes up on arms

At 12 months a child usually:

• Says first words

• Associates words and meanings

• Recognizes familiar people

• Follows simple commands

• Points to objects

• Uses thumb and fingers to pick up objects

• Plays alone with toys

• Uses both hands well

• Drinks from a cup without assistance

• Feeds self with fingers

• Crawls quickly

• Takes first steps alone

At 18 months a child usually:

• Uses some action words (such as “go” or “come”)

• Knows 10 or more words

• Knows some body parts

• Turns pages in a book

• Walks without help

• Runs stiffly

• Feeds self with a spoon

• Scribbles with crayons

• Climbs stairs

• Climbs on furniture

• Looks for hidden objects

• Competes with other children for toys

• Acts anxious when separated from parents

Drinking from a cup

Learning to drink from a cup takes practice. Most children can drink from a cup on their own by about 12 months of age. Start your child out with a cup with a lid to avoid spills.

Crawling