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Developmental Milestones

 Note

These developmental milestones are only a guide. There is a range of normal age when developmental milestones are achieved by normal children. Most children achieve some milestones earlier and other milestones later than the population-averages indicated below. Some infants skip a milestone and demonstrate the next milestone at appropriate age. Some children are slower in achieving some milestones but are normal as they catch up. Please check with your CYH nurse or doctor if in doubt.

 

 

GROSS MOTOR

 

PRONE (when lying on tummy) 

Birth                 -           head to one side (clears nose and airway from mattress)

                                    pelvis high, knees drawn up under the tummy

6 week              -           only chin lifted off the couch                            

12 week            -           chin and shoulder off the couch                                    

6 months          –           bears weight of upper body on hands with extended arms

 

VENTRAL SUSPENSION (when held face down with examiner’s hand under tummy)

Birth                 -           lack of head control

4 week              -           momentary tensing of neck muscles

6 week              -           momentarily holds head in plane of body

8 week              -           maintains head in the plane of body

12 weeks          -           maintains head beyond plane of body i.e. lift head above the plane of body against gravity

                                   

Rolling over and crawling

6 months          -           rolls over prone to supine (tummy to back)

7 months          -           rolls over supine to prone (back to tummy)

10 months         -           crawl

11 months         -           creep

13 months         -           bear walking (just before walking)          

 

 

STANDING 

 Walking (stepping) reflex disappears by 6-8 weeks (except when neck extended – 5 months or more)

6 months          -           bears almost all weight with minimal flexion in hips and knees

7 month            -           bounces

8 month            -           readily bears weight on legs

9 month            -           stands holding furniture, stands with support

10 month          -           pulls self to standing position, but cannot let himself down

                                         lifts one foot off the ground

11 month          -           cruises around furniture

12 month          -           walks holding one hand of adult

13 month          -           stands without support

14 month          -           walks without help with broad base, high stepping gait, steps of unequal length and direction

                                         knees bent

                                        toeing out

                                        shoulder abducted, elbows flexed

15 month          -           creeps up stairs

                                        gets to standing position without help

16 month          -           climbs stairs holding rail

1 ½ year           -           runs

                                    walks well, seldom falls

                                    walks sideways

2 years             -           runs well

                                    walks backwards, runs backwards

                                    picks up object without falling

                                    climbs up the stairs with both feet per step

                                    jumps on same spot

2 ½ years          -           Walks on tiptoe on request

3 years             -           climbs up the stairs placing 1 foot per step

                                     Walks down the stairs – places both feet per step

                                    stands on one foot for a few seconds

                        -           rides tricycle

4 years             -           hops on one foot

                                       Walks down the stairs 1 foot per step

 

 

SITTING

 

Pulled to Sit Manoeuvre – 

Newborn           –           head lag

2 month            -           hold head momentarily

3 month            –           no head lag

6 month            –           lifts head in anticipation when about to be pulled up

                                        hands held out to be lifted

7 month            -           spontaneous and repeated raising of head

 

Held in sitting position

2 month            –           head held up but recurrently bobs forward

4 month            -           holds head up, but head wobbles if sudden trunk movement by examiner

                                    sits straight with minimal lumbar curvature

5 month            -           head stable when body gently rocked by examiner

6 months          -           sits with arms forward for support

7 month            –           sits without support for few seconds

9 month            –           sits for 10 minutes

10 month          -           pulls self to sitting and standing position

11 month          -           pivots while sitting to look backwards (righting)

15 month          -           can seat himself in a chair (climbs up the chair – stands on chair – turns around – sits down)

 

 

 

 

 

FINE MOTOR

 

MANIPULATION

Grasp reflex disappears at 2 – 4 months

3 months          -           desire to grasp objects

                                    excitement shown by rapid movements of limbs, fast breathing, widening of eyes

4 months          -           approaches objects with hands but overshoots

                                    holds and shakes a toy when given in his hands

                                    hand regard (also seen in visually impaired) – plays with own hands held in midline

5 months-         -           ulnar grasp (holds objects with ulnar aspect of the palm)

                                   mouthing of objects (puts everything in the mouth)

                                    splashes in bath

                                   crumples paper

6 months          -           drops a cube if another is offered

                                    grasps and plays with own feet

                                    holds own bottle

6-8 months        -           radial grasp (holds objects with radial side of palm i.e. thumb, forefinger & middle finger)

                                  ring and little finger press a cube against the hand (thenar eminence of hand)

7 months          -           retains first cube / transfers when another is offered

                                    bangs objects on table

                                    feeds self with a biscuit

9 months          -           brings 2 cubes together and compares / bangs on each other

                                    pincer grasp

                                    reaches objects with index finer

                                    beginning to release objects

10 months         -           places objects in mother’s hands but will not release it

11 months         -           releases objects in mother’s hands

                                    enjoys give and take game

                                    rolls ball towards adult

                                    stops mouthing of objects

13 months         -           holds 2 cubes in one hand (1 cubic inch size)

15 months         -           enjoys throwing objects to the floor one after another especially when there is someone to   

                                     pick them up for him

15 months         -           builds tower of 2 cubes

1 ½ years          -           tower of 3 cubes

2 years             -           tower of 6 cubes

3 years             -           tower of 9 cubes  &  bridge of 3 cubes

 

DRESSING

15 months         -           takes off shoes

1 ½ years          -           takes off socks & gloves, unzips fasteners

2 years                         -           puts on pants, socks and shoes

3 years             -           dresses and undresses himself except back buttons and occasional advice about

                                       back and front and advice about correct foot for correct shoe

5 years                         -           tie own shoelaces, fully independent for dressing

 

FEEDING

 2nd week            -           may need 6-12 feeds per 24 hours

                                    2 feeds in night

10 weeks          -           skip night feed intermittently

3.5 – 4 months  -           skips1 feed at night and sleeps 6-7 hours straight (wide variations)

6 months          -           chewing, feeds self with biscuit

                                    begins to hold spoon, holds bottle

9 month            -           4 feeds per day (wide variations)

1 year               -           rotates spoon when near own mouth while attempting to feed self

                                    3 meals per day (wide variations)

1 ½ years          -           can feed self with minimal spilling – no rotation of spoon

                                    By 1.5-2 years, picks up a cup – drinks – puts cup down

                                    turns 2 to 3 pages at a time

2 years             -           turns one page at a time

3 years             -           uses knife and fork

 

GENERAL UNDERSTANDING

 1 month            -           follows a dangling toy (or human face) <90 degrees

 2 month            -           follows a dangling toy beyond midline

 3 month            -           follows a dangling toy 180 degrees       

 4 month            -           turns head to almost all sounds with curiosity

 5 month            -           when baby drops a toy, he/she looks to see where is it has gone to

                                    enjoys mirror

 6 month            -           stranger anxiety

                                    Enjoys peek a boo

 7 month            -           responds to name

                                    inhibits to “no”

                                    pats own image in mirror with joy

 9 month            -           claps hands (pat a cake)

                                    waves bye-bye (hand movement that simulates bye-bye)                                  

11 month          -           puts object in and out of container

                                    repeats performances laughed at

                                    hides self behind towel/object (peek-a-boo)      

 12 month          -           kisses on request

 1 ½ year           -           points to body parts

                                    carries out simple orders

                                    points correctly to a picture e.g. bird, aeroplane

 13 month          -           kisses own image in mirror

 2 years                         -           obeys 4 simple orders given together

                                    parallel play – plays near other children without joining them

 2 ½ years          -           imitates lines with pencil

                                    peak of negativism

                                    helps to put things away

                                   interest in sex organs

 2-3 years           -           gives first name on request

 3 years             -           knows own sex

                                    constantly asking questions

                                    knows some nursery rhymes

                                    may count up to 10

 3-4 years           -           gives surname (full name) on request

 5 years             -           knows four colours by 4-5 years

                                    knows own age

                                    writes full name

 

PLEASURE

 Show displeasure before pleasure

Learns to say “no” before “yes”

First few days   -           quietens when picked up – first sign of pleasure

On feeding        -           pleasure shown by splaying of toes, alternate flexing and extension of toes

6-12 weeks        -           social smile

8-12 weeks        -           vocalises with pleasure

 3 months          -           squeals with delight

 4 months          -           massive response of pleasure – moves trunk & limbs, fast breathing, wide eyes

                                    laughs loud

                                    smiles when pulled to sit

 5 months          -           becomes ticklish

                                    Laughs on seeing a finger approaching for tickling

 6 months          -           smiles at another baby

 Later – enjoys all newly acquired skills eg: sitting, standing, walking, games and company

 

VISION

28 weeks gestation        Blink reflex in response to light 

 Light reflex        -           > 29th week – sometimes present in < 28week gestation babies

                                          well developed at 32 weeks gestation

 32 weeks          -           turns head to diffuse soft light

                                    maintains eye closure till bright light is removed

 Birth (40 weeks)-            fixates on human face for few seconds

                                    follows dangling ring in a range of 45 degrees if 8 to 10 inches away

                                   transiently follows moving person or bright target

 1 month            -           follows human face or bright object through 90 degrees 

                                    fixates on mother as she speaks

 2 month            -           follows human face or bright object past midline

 3 month            -           follows human face or bright object through 180 degrees, horizontally first then vertically

 6-12 weeks        -           smiles at mother as she speaks (social smile)

 3 months          -           fixates on feeding bottle

 4 months          -           fixates on ½ inch brick (grasping with eyes)

 

Binocular vision -           begins 1 ½ months, Well developed by 4 months

 

4 months          -           hand regard – also seen in visually impaired (hence not a visual milestone)

5 months          -           excited to see his food being prepared

6 months          -            visually attentive for near and far. Watches small rolling balls at 5+ feet. Full conjugate eye movements. Intermittent appearence of squint is not uncommon in infants until this age

1 year               -           Sustained visual interest for near and far, follows rapidly moving objects

 

Acquity of vision-        

Birth                 -           Can see well at 30-45 cm (focal point of eyes at birth)

                                    Preference for human face, mum and dad’s face

                                   Acuity of vision 20/150 feet (what an adult can see at 150 feet, baby will see if it is at 20 feet)

6 months          -           20/40 feet (6/12 meters) = bi-ocular vision excellent by this age, works well for all activities of 6 months old

2 years              -           20/20 feet (6/6 meters) = same as adult 

HEARING

2 months          -           turns eyes to sound

3 months          -           turns head and eyes to sound

5 months          -           turns head downwards to sound

6 months          -           turns head upwards to sound

8 months          -           turns head in a curving arc to sound

10 months         -           turns head diagonally (e.g. lower left to upper right) in response to sound

 

SPEECH

6-12 weeks        -           social smile (smile in recognition to someone talking at 30-45cm distance from face)

2 ½ months       -           vocalises vowels

3 ½ months       -           consonants for displeasure

                                            consonants for pleasure

3 – 4 months     -           holds long conversation with mother

4 months          -           laughs loud

6 months          -           Monosyllabic babble

7 months          -           Poly syllabic babble

10 months         -           word with meaning / imitate sounds eg:   “g for dog”

10 – 11 months             -           1 word

1 year               -           3 words with meaning

15 months         -           jargon speech (at least 1 meaningful word)

2 years                         -           uses pronouns (2-3 years)

                                    3 words together in a sentence – may be with a lisp

3 years                         -           gives first name on request

4 years             -           gives surname & full name on request

 

SPHINCTER CONTROL

15-18 months    -           tells mother that he has wet his pants

18 months         -           may say “no” when asked

                                    tells just before passing urine / stool

18-30 months    -           dry during day

3 years             -           dry at night (75% children)

                                    May need treatment if not dry at night by 5-7 years