Overview
Developmental milestones are a set of benchmarks in gross motor, fine motor, language, cognition, social/emotional, and behavior patterns expected by a certain age.
Assessment of developmental disorders must take into account gestational age at birth; e.g., a premature baby should be expected to reach their milestones appropriately for their chronological age.
Pediatricians assess developmental milestones at every well-child visit for:
- Screening
- Surveillance
Developmental Milestones: 0–12 Months
Growth parameters 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.
| Age | Gross motor | Fine motor | Language | Social/cognitive |
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| 1 month |
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Hands clenched in fists brought near face most of the time | Makes sounds |
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| 2 months |
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| 4 months |
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| 5 months |
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| 6 months | Sits for brief moment propped on hands |
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Stranger anxiety 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 (radial-palmar grasp) |
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| 9 months |
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Grasps with 2 fingers and thumb below (radial-digital or 3-finger grasp) |
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| 10 months |
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Grasps pellet with side of index finger and thumb (inferior pincer grasp) | Says “dada” (specific) |
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| 12 months | Takes 1st independent steps (walking may be delayed up to 18 months) |
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Says at least 1 word other than “dada” or “mama” |
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Developmental Milestones: 1–5 Years
| Age | Gross motor | Fine motor | Language | Social/cognitive |
|---|---|---|---|---|
| 15 months |
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Builds 3- to 4-cube tower | Uses 3–5 words |
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| 18 months |
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| 24 months |
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| 3 years |
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| 4 years |
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| 5 years |
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Screening Recommendations
It is recommended to use standardized screening for early identification of developmental or behavioral problems.
| Age | Benefit of screening |
|---|---|
| 9-month visit | Might identify motor, vision, hearing, or communication problems |
| 18-month visit | Might identify motor delays, language delays, and symptoms of autism spectrum disorders (ASD) |
| 24-month visit | Might identify patients with ASD who were missed at the 18-month screening |
| 30-month visit | Might identify motor, language, and cognitive delays |
| 4-year-old visit | Screen for school readiness (e.g., fine motor, gross motor, handwriting, communication, 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 level. Present at birth and disappear during normal childhood development of higher-functioning brain 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). 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 Nervous system The nervous system is a small and complex system that consists of an intricate network of neural cells (or neurons) and even more glial cells (for support and insulation). It is divided according to its anatomical components as well as its functional characteristics. The brain and spinal cord are referred to as the central nervous system, and the branches of nerves from these structures are referred to as the peripheral nervous system. General Structure of the Nervous System 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 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: the fear of being around unfamiliar people. Stranger anxiety 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 revolves around the age of 2 years.
- Separation anxiety: the anxiety that a child develops when they are separated from their parents. Separation anxiety 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 doesn’t affect development or cause significant distress.
References
- Centers for Disease Control and Prevention. Developmental Disabilities. Retrieved May 17, 2021, from https://www.cdc.gov/ncbddd/developmentaldisabilities/
- 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.
- 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.
