Healthy Growth and Development - School Age

Developmental Milestones

As children grow, they will learn new things for their age and stage of development - these are called developmental milestones. For example:

Does your four year old:

  • Speak clearly enough to be understood most of the time without repeating or stuttering on sounds or words?
  • Take turns and share with other children in small group activities?
  • Understand three-part related directions and longer sentences? ("put your toys away and wash your hands before lunch")
  • Hold a crayon or pencil correctly?
  • Try to hop on one foot?

For a complete list of what your four year old should be doing, visit

The Nipissing District Developmental Screen (NDDS) is an easy-to-use checklist that can be used to track your child's development from one month to six years of age.

By registering online at you will receive:

  • The NDDS checklist (in your inbox) at key times to see how your child is developing
  • Email reminders to check your child's development as they grow
  • Tips and activities to help your child's development

Call Region of Waterloo Public Health at 519-575-4400 if you have any questions about your child's development or how you can receive the NDDS.

Act now:

If you or someone around your child is concerned about their development at any age speak to your health care provider. Don't wait and see if they will "catch up" to other children their age.

The earlier a child gets support the more successful they will be in school.

Key areas of developmental concern are listed below.

Speech and Language Development

Early in life children learn to know what you are saying and to make sounds of their own. Without help some children may struggle with listening, speaking, learning to read and playing with other children.

Learning to speak is very important to your child's success in school and life.


Hearing is an important part of language development and your child's learning. Delayed speech is one sign of hearing problems in children.

The earlier a hearing problem is found and treated, the better chance your child has for learning in school.


Children need to have their eyes examined at six months of age and then once a year.

Difficulty learning, behavioural problems and poor social skills can be the result of poor vision.

Eye exams are covered by OHIP for children 18 years of age and under. Visit to find an optometrist.

Programs and services for children 0-6 years

The Region of Waterloo Service Pathway Referral List includes programs and services information, for families with children 0-6 years of age with concerns about their child's development including vision/hearing/speech difficulties, mental health or behavioural issues, and/or problems with their teeth or nutrition.

For additional programs and services available to parents and children check the New Parent Resource Guide

Physical Growth

A child's growth depends on:

  • Family Traits (parents' heights and weights, cultural background)
  • Environment
  • Nutrition

Children need to eat a variety of healthy foods and to be physically active to grow properly. For more information on nutrition for school aged children visit our Feeding Your School Age Child page.

Four to nine years

  • Every child grows at a rate that is normal for them.
  • Your child will grow taller and should gain weight gradually, but steadily during these years.
  • Boys and girls grow at about the same rate during this time.
  • Girls may be a little heavier than boys.
  • Boys tend to have more muscle; girls tend to have more fat.

How do I know if my child is growing normally?

  • Children grow at different rates.
  • You and/or your health care provider may keep track of your child's growth by taking the following measurements:  
    • Height 
    • Weight
  • Measurements should be plotted on a growth chart to see your child's growth pattern.
  • Your health care provider can help you decide if your child's growth pattern is normal for your child.  Don't forget that many factors influence your child's growth and need to be considered, such as family background, how well your child eats and the physical activity level of your child.  

Growth over time is more important than a single measurement.

The resource Is my child growing well? - Questions and Answers for Parents is available in English, French, Spanish, Punjabi, Chinese and Vietnamese at the Dietitians of Canada website.

Growth Charts

If you have any questions about your child's growth, check the information on the Growth Charts page.

Resources and more Information

"The Talk" from Tots to Teens

For more information please call Region of Waterloo Public Health, 519-575-4400.