A new sentence at breakfast. Taking turns during a game. Learning to button a shirt. Everyday moments can tell parents a great deal about how their child is developing.
Before school starts, take time to notice how your child communicates, plays, moves, and handles daily routines. Write down questions or changes you want to discuss with their healthcare provider.
If you are looking for a child development assessment in San Antonio, Pediatric Heroes and Families Primary Care Clinic lists child development assessments and preventive health care among its services. A visit gives you a place to share observations and discuss appropriate next steps. Learn more in the Pediatric Heroes FAQ.
A child development assessment reviews how a child is learning and building skills. Depending on the child’s age and your concerns, the process may include health history, parent questions, observation, and screening.
It helps to understand three related terms:
Developmental monitoring: Watching how your child’s skills change during everyday life and discussing progress at healthcare visits.
Developmental screening: Using a standardized questionnaire or tool to identify whether a closer evaluation may be needed.
Developmental evaluation: A more detailed assessment to understand specific concerns and possible support needs.
A milestone checklist can help you organize observations, but it does not replace a validated screening tool or establish a diagnosis. CDC guidance on developmental monitoring and screening
Milestones describe skills most children can do by a certain age. They help families notice progress and identify questions worth discussing.
The examples below focus on preschool and kindergarten ages. They are a starting point for conversation, not a complete assessment or a school admission test.
The CDC’s age-4 milestones include:
• Speaking in sentences of four or more words.
• Talking about something that happened during the day.
• Pretending to be a teacher, animal, or another character during play.
• Naming a few colors.
• Catching a large ball most of the time.
• Holding a crayon or pencil with fingers and thumb rather than a fist.
You can notice these skills during ordinary play, meals, and conversations. There is no need to turn each activity into a test. Review the full CDC age-4 milestone checklist for additional examples.
The CDC’s age-5 milestones include:
• Taking turns or following rules while playing with other children.
• Telling a story with at least two events.
• Keeping a conversation going for more than three back-and-forth exchanges.
• Counting to 10.
• Paying attention for five to 10 minutes during activities such as stories or crafts; screen time does not count.
• Buttoning some buttons and hopping on one foot.
Check the full CDC age-5 milestone checklist. If your child is not meeting a milestone, share that concern with their provider rather than trying to interpret it alone.
Toddlers and younger preschoolers need different expectations. Choose the checklist that matches your child’s age instead of comparing them with a kindergarten-age sibling or classmate.
The CDC provides developmental milestone checklists from 2 months through 5 years.
For older children, bring examples of how daily activities are going rather than applying a preschool checklist.
Useful topics for a pediatric development checkup include:
| Area | Observations to share |
|---|---|
| Learning | Tasks your child enjoys, avoids, or finds increasingly difficult |
| Communication | Trouble explaining needs, understanding directions, or joining conversations |
| Daily activities | Difficulties with handwriting, dressing, organization, or coordination |
| Social experiences | Friendship concerns, participation in groups, or distress around school |
| Behavior and emotions | Changes in frustration, confidence, mood, or ability to manage transitions |
| Routines | Changes in sleep, independence, or participation in familiar activities |
Ask your child what feels easy and what feels hard. For teens, leave room for their own questions and concerns during the visit.
These observations give the provider context; they do not, by themselves, identify a developmental or mental health condition.
Contact your child’s provider promptly if your child loses a skill they previously used. Do not wait for school to begin or for the next routine checkup to mention a loss of language, movement, or other abilities.
Also ask for guidance if your child is not meeting age-based milestones or you have concerns about how they learn, speak, play, or move. The CDC recommends acting early and discussing whether screening or evaluation is appropriate. What to do when you have developmental concerns
A teacher’s or caregiver’s concern is also worth bringing to the conversation. Ask for a specific example and share it with the provider.
A concern does not automatically mean your child has a delay. An assessment can help clarify whether follow-up, additional screening, or a referral would be useful.
Development should be discussed during routine well-child care, but a formal screening is not automatically required for every child simply because school is starting.
The American Academy of Pediatrics recommends standardized general developmental screening at 9, 18, and 30 months, with additional screening when concerns arise. Its guidance specifically emphasizes addressing concerns identified at ages 4 and 5 as children approach school entry. AAP guidance on developmental surveillance and screening
Ask your provider whether your child’s history or current concerns call for a screening or more detailed evaluation.
You do not need a complete explanation for what is happening. A few clear examples are useful.
Before the appointment, write down:
• What you noticed: Describe the activity or situation.
• When it started: Include whether it is new, ongoing, or getting more difficult.
• How often it happens: Note whether it occurs occasionally or during most attempts.
• Where it happens: Home, school, childcare, activities, or several settings.
• What helps: Include any support or approach that makes the task easier.
• Your child’s strengths: Share interests, recent progress, and activities they enjoy.
For example, “My child often needs each direction repeated during the morning routine” gives the provider more context than “My child never listens.”
Bring relevant school notes, previous screening results, therapy reports, a current medication list, and any existing school support plan. Tell the provider which languages your child hears and uses.
Summer offers opportunities to practice skills in a relaxed setting:
• Read together and talk about the pictures or what happens next.
• Play simple games that involve taking turns.
• Offer drawing materials, blocks, or puzzles.
• Let your child help with manageable tasks, such as putting away toys.
• Practice asking for help and talking about feelings.
• Use pretend play to explore classroom routines or meeting new people.
These activities create opportunities for learning and connection. They also help you notice what your child enjoys and where support might help. The CDC offers more ideas in its age-4 and age-5 guidance.
Continue seeking advice about concerns while practicing at home.
Families can also ask about public early childhood services:
• Children younger than 3: Texas Early Childhood Intervention, or ECI, accepts referrals from parents and others concerned about a child’s development. Find information through Early Childhood Texas.
• Children age 3 and older: Contact your local public school district about an evaluation through its Child Find or special education process. You can ask about an evaluation without waiting for a medical diagnosis. CDC guidance on requesting an evaluation
Your healthcare provider can help you understand how medical follow-up and school-based support may fit together.
If you have questions about growth, learning, behavior, speech, or school readiness, bring them to Pediatric Heroes. When booking, explain your main concern so the clinic can help arrange the appropriate visit.
Schedule a visit with Pediatric Heroes to discuss your child’s development before school starts. Visit the appointments page or contact the clinic to get started.
A child development assessment reviews areas such as communication, movement, learning, behavior, and social-emotional skills. It may include parent questions, observation, and standardized screening, with referral for a more detailed evaluation when appropriate.
Use an age-appropriate checklist to observe communication, play, learning, movement, and everyday independence. For children ages 4 and 5, examples include conversation, pretend play, turn-taking, drawing, and dressing skills. Discuss any concerns with your child’s provider.
Bring specific examples of your concerns, when they started, and where they happen. Include relevant school notes, therapy reports, previous screening results, medication lists, and questions from teachers or caregivers.
No. A concern is a reason to review your child’s needs. A provider can help determine whether follow-up, screening, additional support, or referral is appropriate.
No. Contact your child’s provider when a concern arises, especially if your child has lost a skill they previously used. Early discussion can help your family identify appropriate next steps.
