Neonatal neurodevelopmental follow-up recommendations: 36 month visit

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Recommendations to encourage neurodevelopment in babies at 36 months old who are patients in the neonatal developmental follow-up clinic.

Key points

  • Babies who have been in the NICU or CCCU may be at risk for developmental issues due to medical problems before delivery, during delivery or after birth.
  • Recommendations at 36 months focus on encouraging different types of movement, creativity, and cognitive development.
  • Parents and caregivers should follow these recommendations to encourage neurodevelopment.

Talking and playing with babies are two of the most important things parents and caregivers can do to help them develop. There are many ways to encourage development. The recommendations provided are general and not all inclusive. The recommendations provide strategies to help promote gross motor skills, fine motor skills, early language development, and socialization.

  • Gross motor skills include big movements such as rolling, crawling, standing or walking.
  • Fine motor skills include hand movements such as reach and grasp.
  • Early language development includes cooing, babbling, and a baby’s first words.

What is the Neonatal Neurodevelopmental Follow-Up Clinic?

The Neonatal Neurodevelopmental Follow-Up Clinic is a specialized clinic for children who had medical complications related to, or immediately after, their birth. This clinic assesses gross-motor skills, fine-motor skills, social development, language and learning ability at specific ages to determine if the child is developing normally.

The majority of patients seen in the Neonatal Neurodevelopmental Follow-Up Clinic are referred from a Neonatal Intensive Care Unit (NICU) or a Cardiac Critical Care Unit (CCCU). Babies who have been admitted to the NICU or CCCU may be at risk for developmental issues due to medical problems before delivery, during delivery or after birth. These recommendations may be used to encourage development in babies who have not spent time in the NICU or CCCU, but still require care in the Neonatal Neurodevelopmental Follow-Up Clinic. Talk to your child’s doctor to see if you should be following these guidelines with your baby.

Babies and toddlers are assessed at specific ages in the clinic and given recommendations that parents and caregivers can refer to at home to help their baby achieve their maximum potential. These recommendations are for 36 months corrected age, as most of the babies followed in the clinic were premature at birth.

If you are concerned about your baby’s development, speak with your primary health-care provider.

Neonatal neurodevelopmental recommendations at 36 months

Gross motor

  • Practice jumping and different types of obstacle courses that involve different terrain and places to climb.
  • Practice riding toys with pedals (such as tricycles).
  • Encourage your child to practice going up and down stairs in a safe manner.

Fine motor

  • Let your child play with a variety of materials (sand, clay, playdough, paint, chalk) to make shapes or creative figures. Have your child roll playdough into balls or create ‘snakes.’
  • Encourage your child to help with dressing themselves. Have them practice doing up zippers and larger buttons on a shirt.
  • Encourage your child to use crayons, pencils and markers on paper to make lines and circles.
  • Use safety scissors to practice cutting paper.


  • When playing with your child, point out ideas like big/small, same/different, and faster/slower.
  • Provide structure and routine, which builds children’s confidence.
  • Allow opportunities for increasing independence, such as self-dressing, washing hands, tidying toys.
  • Have your child listen to and follow directions (“First, get your coat, then put it on, then get your boots”).
  • Play games that involve turn taking, cooperation, patience and following simple rules. Some examples are board games, tag, London Bridge, and Ring around the Rosie. Play Simon Says to help your child listen, remember, follow directions and take turns--Let your child be “Simon”, too!
  • Continue to read with your child and talk about the story and pictures. Let your child turn pages and say the words to familiar stories and rhymes.
  • While reading, talk about the characters and ask your child questions about the story, encouraging your child to predict what is going to happen and talking about what did happen, commenting on how the characters feel and how we know how they might feel.

Play/Cognitive development

  • Functional play — continue playing with toys/objects as they were intended to be used.
  • Encourage pretend play (e.g., feeding a doll or farm animals) and role-playing (e.g., play doctor).
  • Sorting and matching small objects, pictures and toys will help your child learn concepts like size, shape, colour, and number.
  • Large floor jigsaw puzzles; take turns putting the puzzle together; problem-solve as to where pieces go; talk about it; ask “5 W” questions.
  • Charades (put pictures into a grab bag) and follow the leader games are great for following directions, guessing, asking/answering questions and visual spatial development. Visual spatial development is important in developing skills such as drawing, puzzles, mazes and other tasks that require fine motor skills and body awareness.
  • Attendance at structured play groups, activities and daycare will provide opportunities for interaction with peers and assist with development of routines, socialization, self-help abilities and ongoing language development.
  • Electronic media use by children under the age of four years is discouraged. Children aged 2-4 should have less than one hour a day of screen time.
  • Encourage daily, unstructured and structured playtime, and read to your child daily to promote the developing brain.


  • Continue regular visits to family doctor/pediatrician to monitor growth.
  • Set a timer for two minutes while your child brushes their teeth. You can create a teeth brushing song together.
  • Maintain a regular sleep schedule for your child and let them fall asleep independently.

For more information on neonatal neurodevelopmental recommendations at different ages, please see the links below:

Parental mental health and well-being

All caregivers are encouraged to have ongoing discussions about their mental health and well-being with their family doctor. There are free community services available to promote coping and resilience for caregivers. Consider learning more about the following supports and interventions.

Last updated: March 30th 2021