1. Assess the child's growth and development as charted on the achondroplasia growth charts. Obtain lower segment measurements once weight bearing is established.

2. Continue to follow head growth.

3. Continue to watch for thoracolumbar gibbus and development of lumbar lordosis. Discuss avoiding the use of walkers, jumpers, or backpack carriers. Any kyphosis present should disappear as the child begins to bear weight. Weight-bearing and walking may occur late; however, they are expected by 2 years of age. When weight-bearing begins, the external rotation of the hips should self-correct to a normal orientation within 6 months.

4. Anticipate some bowing of the legs because of fibular overgrowth at the knees and ankles. If bowing leads to an inability to walk, consult a pediatric orthopedist.

5. Check the childs hips for hip flexion contractures. Prescribe exercises that may decrease lumbar lordosis and hip flexion contractures [19]. Check the hips for external rotation. Refer the child to a pediatric orthopedist, if necessary.

6. Speech evaluation should be done no later than 2 years of age. If speech is abnormally delayed conductive hearing loss due to chronic serious otitis media should be excluded.

7. Watch for obstructive sleep apnea. Children with achondroplasia often sweat and snore in association with sleep. If upper airway obstruction is suspected (increased retraction, choking, intermittent breathing, apnea, deep compensatory sighs), further pulmonary evaluation and neurologic examination including somatic sensory-evoked responses, sleep studies, and magnetic resonance imaging are needed.

Anticipatory guidance
1. Consider adapting the home so the child can become independent (lower the light switches, faucets, and supply step stools).

2. Occupational therapy consultation may be needed.

3. Discuss adapting age-appropriate clothing with snapless, easy-opening fasteners and tuckable loops.

4. Discuss adaptation of toys, especially tricycles, to accommodate short limbs.

5. Discuss adaptation of toilets to allow comfortable independent use, with an extended wand for wiping.

6. Discuss the use of a stool during sitting so that the childs feet are not hanging. Feet need support while the child is sitting at a desk or in a chair. A cushion behind the child's back may be required for good posture.

7. Review weight control and eating habits to avoid obesity, which becomes a common problem in mid to late childhood [22].

8. Discuss orthodontic bracing in the future and the possible need for braces after 5 years of age.

9. Encourage the family to develop activities in which the affected child can take part; avoid gymnastics, high diving, acrobatics, and collision sports.

10. Discuss how to talk with the child and other friends or family members about short stature.

11. Encourage preschool attendance so that the child can learn to socialize in an age-appropriate way, and work with parents to prepare the teacher and the other children so the child is not given unnecessary special privileges.

12. Discuss toileting at school and special preparations needed by the school because of the child's short stature.

13. Discourage the child from jumping to decrease unnecessary stress on joints, particularly the joints of the spine