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Developmental Milestones and Normal Growth

Developmental milestones are the skills or abilities that most children are able to perform when they reach a certain age. Understanding the appropriate milestones and at what age they are reached helps clinicians identify symptoms of delayed development. Developmental milestones are divided into 5 important domains: gross motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology, fine motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology, language, social, and cognitive. These milestones should be monitored by pediatricians at each well-child check Well-child check Well-child checks are visits scheduled at crucial ages in a child’s development. These checks are necessary to assess overall health, to provide preventive services, for early detection of disease and abnormalities, and for prompt management of health concerns. Infant Care. Early identification Identification Defense Mechanisms of developmental delays can prevent future complications and permits timely referral to appropriate supportive services.

Last updated: Sep 22, 2022

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Overview

Developmental milestones are a set of benchmarks Benchmarks Quality Measurement and Improvement in gross motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology, fine motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology, language, cognition, social/emotional, and behavior patterns expected by a certain age.

Assessment of developmental disorders must take into account gestational age Gestational age The age of the conceptus, beginning from the time of fertilization. In clinical obstetrics, the gestational age is often estimated as the time from the last day of the last menstruation which is about 2 weeks before ovulation and fertilization. Pregnancy: Diagnosis, Physiology, and Care at birth; e.g., a premature Premature Childbirth before 37 weeks of pregnancy (259 days from the first day of the mother’s last menstrual period, or 245 days after fertilization). Necrotizing Enterocolitis baby should be expected to reach their milestones appropriately for their chronological age.

Pediatricians assess developmental milestones at every well-child visit for:

Table: Expected milestones for motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology skills, social skills, hearing, vision Vision Ophthalmic Exam, language, and self-care
Gross motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology Fine motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology Social skills Hearing Vision Vision Ophthalmic Exam Language Self-care
3 months Lifts head briefly Tries to reach out with hands, hits objects nearby Recognizes caregiver, smiles Stops moving at new sound Looks at bright objects Smiles and makes noise Suckles
6 months Rolls back to stomach Stomach The stomach is a muscular sac in the upper left portion of the abdomen that plays a critical role in digestion. The stomach develops from the foregut and connects the esophagus with the duodenum. Structurally, the stomach is C-shaped and forms a greater and lesser curvature and is divided grossly into regions: the cardia, fundus, body, and pylorus. Stomach: Anatomy and can sit without support Can hold objects with whole hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy Responds to simple gestures Turns to look at sound Enjoys bright or moving objects Babbles with consonants Eats semisolid or crushed food
12 months Crawls and can pull self to stand Can hold objects with both hands and pass objects between hands Copies simple actions Enjoys music Is attracted to moving objects and tries to catch them Responds to names, can repeat simple words and sounds Drinks from a cup
2 years Can walk alone or with support from one hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy Can make a simple tower with building blocks Starts to play with other children Will turn and point to objects making sounds Is curious and looks closely at objects Makes simple sentences of 2–3 words Washes hands, eats with a spoon
3 years Can run Can do simple puzzles Plays cooperatively with other children Follows simple instructions Can sort objects Can ask and answer simple questions Can undress
5 years Can climb large stairs Can throw and catch a ball, can copy simple shapes Plays group games, separates easily from caregiver Is curious and listens to explanations Can recognize objects and places that are far away Uses lots of language, can tell stories and describe things Helps with simple household tasks, can undress alone

Developmental Milestones: 0–12 Months

Growth parameters Growth Parameters Child and Adolescent Care during the 1st year:

By the end of the 1st year, a child’s weight should be triple their birth weight, and their height should increase by 50% from their height at birth.

Table: Developmental milestones during the 1st year of life
Age Gross motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology Fine motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology Language Social/cognitive
1 month
  • Turns head while supine
  • Lift heads up in prone position
Hands clenched in fists brought near face most of the time Makes sounds
  • Responds differently to caregiver’s voice
  • Startled by loud noise
2 months
  • Holds head and chest up while prone
  • Has very brief head control while sitting up
  • Hands unfisted half of the time
  • Clasps hands
  • Coos
  • Vowel sounds
  • Social smile
  • Recognizes caregiver
4 months
  • Sits with trunk support
  • Rolls (prone to supine)
  • Pushes up on wrists
  • Loss of head lag when pulled from prone position
  • Hands open most of the time
  • Reaches and clutches consistently
  • Grasps items
  • Laughs loudly
  • Turns to voice
  • Stops crying to soothing voice
  • Looks around
  • Mouths objects
  • Spends more time looking at strange faces than familiar ones
5 months
  • Sits with pelvic support
  • Rolls back to front (supine to prone)
  • Palmar grasp Palmar Grasp Primitive Reflexes
  • Can transfer objects ( hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy to mouth to hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy)
  • Says “ah-goo”
  • Razzes, squeals
  • Begins to respond to name
  • Expresses anger in different way than crying
  • Recognizes caregiver visually
  • Can turn head to look for dropped objects
  • Forms attachment to caregiver
6 months Sits for brief moment propped on hands
  • Transfers objects ( hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy to hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy)
  • While holding object in 1 hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy, takes 2nd object in other hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy
  • Rakes small items
  • Babbles with consonants
  • Stops momentarily to “no”
  • May gesture to be picked up
Stranger anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder develops
7 months Sits steadily without support Grasps using side of hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy (radial-palmar grasp)
  • Looks toward familiar object when named
  • Increased syllable variety when babbling
  • Explores different aspects of a toy
  • Finds partially hidden objects
9 months
  • Pulls to stand
  • Crawls on 4 straightened limbs
Grasps with 2 fingers and thumb below (radial-digital or 3-finger grasp)
  • Says “mama” (nonspecific)
  • Nonreduplicate babble
  • Imitates sounds
  • Can use sound to get attention Attention Focusing on certain aspects of current experience to the exclusion of others. It is the act of heeding or taking notice or concentrating. Psychiatric Assessment
  • Object permanence
10 months
  • Cruises around furniture with 2 hands
  • Stands with 1 hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy held
  • Walks with both hands held
Grasps pellet with side of index finger and thumb (inferior pincer grasp) Says “dada” (specific)
  • Waves “bye-bye”
  • Plays peekaboo
12 months Takes 1st independent steps (walking may be delayed up to 18 months)
  • Fine pincer grasp
  • Builds tower of 2 cubes*
  • Throws objects
Says at least 1 word other than “dada” or “mama”
  • Comes when called
  • Follows 1-step command with gestures
*Number of cube towers a child can build = child age / 2

Developmental Milestones: 1–5 Years

Table: Developmental milestones: 1–5 years
Age Gross motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology Fine motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology Language Social/cognitive
15 months
  • Crawls/climbs up stairs
  • Stoops to pick up objects
  • Walks while carrying objects
Builds 3- to 4-cube tower Uses 3–5 words
  • Hugs adult
  • Shows empathy Empathy An individual’s objective and insightful awareness of the feelings and behavior of another person. It should be distinguished from sympathy, which is usually nonobjective and noncritical. It includes caring, which is the demonstration of an awareness of and a concern for the good of others. Psychotherapy
  • Can turn pages in a book
  • Knows at least 1 body part
  • Retrieves objects in another room when asked
18 months
  • Crawls/climbs down stairs
  • Runs well
  • Throws ball while standing
  • Makes 4-cube tower
  • Removes clothing
  • Uses vocabulary of 10–25 words
  • Names 1 picture on demand
  • Begins to show shame
  • Matches pairs of objects
  • Imitates environmental noises (e.g., animal sounds)
  • Engages in pretend play
24 months
  • Walks up and down stairs, bringing both feet to each step
  • Kicks ball
  • Throws overhand
  • Makes a single-line “train” of cubes
  • Can imitate horizontal line and circle
  • 50+ words in vocabulary
  • Uses 2-word sentences (noun + verb)
  • 50% of speech is clear.
  • Refers to self by name
  • Follows 2-step command
  • Understands “me”/”you”
  • Opens doors
  • Takes clothes off without help
  • Parallel play
3 years
  • Walks up and down stairs, with alternating feet
  • Rides tricycle
  • Balances on 1 foot Foot The foot is the terminal portion of the lower limb, whose primary function is to bear weight and facilitate locomotion. The foot comprises 26 bones, including the tarsal bones, metatarsal bones, and phalanges. The bones of the foot form longitudinal and transverse arches and are supported by various muscles, ligaments, and tendons. Foot: Anatomy for 3 seconds
  • Walks heel to toe
  • Copies circle
  • Makes a 9- to 10-cube tower
  • Uses 200+ words
  • Uses 3-word sentences
  • 75% of speech is clear.
  • Uses plurals
  • Understands negatives
  • Understands long/short
4 years
  • Balances on 1 foot Foot The foot is the terminal portion of the lower limb, whose primary function is to bear weight and facilitate locomotion. The foot comprises 26 bones, including the tarsal bones, metatarsal bones, and phalanges. The bones of the foot form longitudinal and transverse arches and are supported by various muscles, ligaments, and tendons. Foot: Anatomy for 4–8 seconds
  • Hops on 1 foot Foot The foot is the terminal portion of the lower limb, whose primary function is to bear weight and facilitate locomotion. The foot comprises 26 bones, including the tarsal bones, metatarsal bones, and phalanges. The bones of the foot form longitudinal and transverse arches and are supported by various muscles, ligaments, and tendons. Foot: Anatomy (2–3 times)
  • Catches ball
  • Copies a square
  • Ties single knot
  • Identifies colors
  • 100% of speech is clear.
  • Tells stories
  • Can write part of own 1st name
  • Expresses feelings in words
  • Group play
  • Follows 3-step commands
  • Has a preferred friend
  • Can go to toilet by self
  • Basic self-hygiene: face/hands/ teeth Teeth Normally, an adult has 32 teeth: 16 maxillary and 16 mandibular. These teeth are divided into 4 quadrants with 8 teeth each. Each quadrant consists of 2 incisors (dentes incisivi), 1 canine (dens caninus), 2 premolars (dentes premolares), and 3 molars (dentes molares). Teeth are composed of enamel, dentin, and dental cement. Teeth: Anatomy
5 years
  • Skips
  • Walks and jumps backward
  • Copies a triangle
  • Ties shoelaces
  • Writes first name
  • Can bathe and dress self
  • Counts to 10
  • Can speak in 5-word sentences
  • Can give definition of words
  • Identifies coins
  • Has group of friends
  • Apologizes for mistakes
  • Completes toilet training

Screening Recommendations

It is recommended to use standardized screening Screening Preoperative Care for early identification Identification Defense Mechanisms of developmental or behavioral problems.

Table: Screening Screening Preoperative Care recommendations for identification Identification Defense Mechanisms of developmental and behavioral problems
Age Benefit of screening Screening Preoperative Care
9-month visit Might identify motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology, vision Vision Ophthalmic Exam, hearing, or communication Communication The exchange or transmission of ideas, attitudes, or beliefs between individuals or groups. Decision-making Capacity and Legal Competence problems
18-month visit Might identify motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology delays, language delays, and symptoms of autism spectrum disorders ( ASD ASD Autism spectrum disorder (ASD) is a neurodevelopmental disorder marked by poor social skills, restricted interests/social interactions, and repetitive/stereotyped behaviors. The condition is termed a “spectrum” because of the wide variability in the severity of symptoms exhibited. Autism Spectrum Disorder)
24-month visit Might identify patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with ASD ASD Autism spectrum disorder (ASD) is a neurodevelopmental disorder marked by poor social skills, restricted interests/social interactions, and repetitive/stereotyped behaviors. The condition is termed a “spectrum” because of the wide variability in the severity of symptoms exhibited. Autism Spectrum Disorder who were missed at the 18-month screening Screening Preoperative Care
30-month visit Might identify motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology, language, and cognitive delays
4-year-old visit Screen for school readiness (e.g., fine motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology, gross motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology, handwriting, communication Communication The exchange or transmission of ideas, attitudes, or beliefs between individuals or groups. Decision-making Capacity and Legal Competence, and self-help skills)

Clinical Relevance

  • Primitive reflexes Primitive Reflexes Primitive reflexes are involuntary motor responses that can be elicited after birth. Although these reflexes are important for survival, they gradually disappear within the 1st year of life due to their inhibition by the developing frontal lobe. Primitive Reflexes: actions mediated by the brainstem or spinal cord Spinal cord The spinal cord is the major conduction pathway connecting the brain to the body; it is part of the CNS. In cross section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending tracts of myelinated axons). Spinal Cord: Anatomy level. Present at birth and disappear during normal childhood development of higher-functioning brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification regions ( cerebral cortex Cerebral cortex The cerebral cortex is the largest and most developed part of the human brain and CNS. Occupying the upper part of the cranial cavity, the cerebral cortex has 4 lobes and is divided into 2 hemispheres that are joined centrally by the corpus callosum. Cerebral Cortex: Anatomy). Primitive reflexes Primitive Reflexes Primitive reflexes are involuntary motor responses that can be elicited after birth. Although these reflexes are important for survival, they gradually disappear within the 1st year of life due to their inhibition by the developing frontal lobe. Primitive Reflexes can serve a similar function as developmental milestones in early-age infants to screen for the presence of any central nervous system Central nervous system The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. Nervous System: Anatomy, Structure, and Classification pathology.
  • Failure to thrive Failure to Thrive Failure to thrive (FTT), or faltering growth, describes suboptimal weight gain and growth in children. The majority of cases are due to inadequate caloric intake; however, genetic, infectious, and oncological etiologies are also common. Failure to Thrive: a condition seen in children and toddlers. Failure to thrive Failure to Thrive Failure to thrive (FTT), or faltering growth, describes suboptimal weight gain and growth in children. The majority of cases are due to inadequate caloric intake; however, genetic, infectious, and oncological etiologies are also common. Failure to Thrive is defined as weight below the 2nd percentile for age/ gender Gender Gender Dysphoria on more than 1 occasion or weight < 80% ideal weight for age. The condition has psychosocial and organic origins and long-lasting repercussions on the general well-being of the affected child. Failure to thrive Failure to Thrive Failure to thrive (FTT), or faltering growth, describes suboptimal weight gain and growth in children. The majority of cases are due to inadequate caloric intake; however, genetic, infectious, and oncological etiologies are also common. Failure to Thrive is another benchmark that must be assessed along with developmental milestones. 
  • Stranger anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder: the fear of being around unfamiliar people. Stranger anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder begins around 6 months of age and is attributed to a child’s developing ability to distinguish between familiar and unfamiliar persons. The child usually cries when they are approached by strangers, even in the presence of a caregiver. Stranger anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder revolves around the age of 2 years. 
  • Separation anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder: the anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder that a child develops when they are separated from their parents. Separation anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder is a normal phenomenon that starts around 9 months of age and resolves around 2 years of age when the child develops object permanence. The condition can return at any age during childhood, especially during periods of transition. Separation anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder doesn’t affect development or cause significant distress.

References

  1. Centers for Disease Control and Prevention. Developmental Disabilities. Retrieved May 17, 2021, from https://www.cdc.gov/ncbddd/developmentaldisabilities/ 
  2. Sadock BJ, Sadock VA, Ruiz P. (2014). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Chapter 31, Child Psychiatry, pages 1086-1090. Philadelphia, PA: Lippincott Williams and Wilkins.
  3. Lipkin PH, Macias MM (2020). Council on Children with Disabilities, Section on Developmental and Behavioral Pediatrics. Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening. Pediatrics.

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