Developmental Milestones Through Age 6

growth & development motor development

Tab

Table 1. Developmental Milestones

Age Gross Motor Fine Motor Self-Help 1 month

Problem-solving Social/Emotional Receptive Language Expressive Language

• Chin up in Hands fisted Sucks well • Gazes at black- . Discriminates • Startles to voice/ . Throaty noises prone position near face

white objects mother's voice sound Turns head in

• Follows face • Cries out of supine position

distress 2 months • Chest up in Hands unfisted. Opens mouth. Visual threat Reciprocal Alerts to voice/ Coos

prone position 5046

at sight of present

smiling:

sound

• Social smile Head bobs when • Retains rattle breast or • Follows large, responds to

(6 weeks) held in sitting if placed in bottle

highly

adult voice and

. Vowel-like noises position

hand

contrasting smile

• Holds hands

objects together

Recognizes

mother 3 months • Props on

Hands unfisted . Brings hands. Reaches for Expression of Regards speaker Chuckles 5000

to mouth face

disgust (sour

• Vocalizes when prome position Inspects

Follows objects taste, loud

talked to fingers

in circle (in sound)

• Bats at objects

supine

Visually follows position) person who is

• Regards toys moving across a

room 4 months . Sits wis tunk . Hands held . Briefly holds • Mouths objects. Smiles • Orients head in • Laughs out loud

support

predominately onto breast • Stares longer spontaneously direction of a Vocalizes when open

or bottle at novel faces at pleasurable voice

alone when pulled to . Clutches at

than familiar sight/sound Stops crying to clothes

• Shakes rattle Stops crying at soothing voice

• Props on wrists . Reaches

• Reaches for parent voice

• Rolls Front to persistently

ring/rattle • To and fro

• Plays with

alternating rattle

vocalizations 5 months • Sits with pelvic • Palmar grasps . Gums/ • Turns head to Recognizes • Begins to • Says "Ah-goo"

cube

mouths look for

caregiver

respond to • Razzes, squeals Roils back to Transfers pureed food dropped spoon visually

name

. Expresses anger objects: hand

Regards pellet Forms

with sounds mouth-hand

or small

attachment

other than crying protection Holds hands

cracker

relationship to

• St with arms together

caregiver sucoorting Reaches/grasps

dangling ring 6 months. St

. Transfers Feeds self Touches . Stranger anxiety • Stops

• Reduplicative hand-hand crackers reflection and familiar versus momentarily to babble with . Rakes pellet Places hands vocalizes unfamiliar

consonants Takes second on bottle Removes cloth people) • Gestures for "up". Listens, then

• Pros in prone cube and holds

on face

vocalizes when

• prone

on to first

Bangs and

adult stops position, bears . Reaches with

shakes toys

• Smiles/vocalizes one hand

to mirror

"no"

Increasing variety of syllables

• Explores

different

aspects of toy

• Observes cube

in each hand

• Finds partially

hidden object

• Looks from Looks toward

object to parent familiar object and back when when named wanting help • Attends to music (eg, with a wind-up toy)

7 months • Bounces when • Radial-palmar • Refuses

grasp

excess food

• Sits without

support steadily . Lateral

protection

• Puts arms out

to sides for

balance 8 months • Gets into sitting Bangs spoon Holds own

position

after

bottle Commando demonstration . Finger feeds crawls

• Scissor grasp Cheerios® or

• Pulls to sitting of cube

string beans kneeling • Takes cube out position

of cup

• Pulls out large

peg

Seeks object after it falls silently to the floor

• Lets parents Responds to Says "Dada"

know when "Come here" (nonspecific) happy versus • Looks for family • Echolalia (8 to 30 upset

members, months)

• Engages in gaze "Where's • Shakes head for

monitoring: mama?"... etc "no" adult looks away and child follows adult glance with own eyes

(continued)

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growth & development motor development

Table 1. Developmental Milestones-continued

Ta

Age

Gross Motor

Fine Motor

Self-Help

Receptive Language Expressive Language

9 months

Bites, chews cookie

. "Stands" on feet • Radial-digital

and hands

grasp of cube Begins creeping Bangs two

Pulls to stand cubes together

• Bear walks (all

four limbs straight)

Enjoys gesture games Orients to name well Orients to bell

Says "Mama" (nonspecific) Nonreduplicative

babble

• Imitates sounds

Looks

Problem-solving Social/Emotional

Inspects bell Uses sounds to

• Rings bell get attention

• Pulls string to Separation obtain ring anxiety

• Follows a point,

"Oh look at...

• Recognizes

familiar people

visually Uncovers toy Experiences fear under cloth Pokes at pellet preferentially in bottle

when name is

• Tries to put called

cube in cup. but may not be able to let go Finds toy under . Gives objects to cup

adult for action

• Looks at

after pictures in demonstration book

(lets adult know he or she needs help)

• Enjoys peek-a- • Says "Dada" boo

(specific) Waves "bye-bye" . Waves "bye-bye" back

Stops activity when told "no"

• Bounces to music

10 months • Creeps well . Clumsy release • Drinks from

• Cruises around of cube

cup held for furniture using • Inferior pincer child two hands

grasp of pellet Stands with one • Isolates index hand held

finger and . Walks with two pokes

hands held 11 months • Pivots in sitting Throws objects. Cooperates

position

• Stirs with

with dressing Cruises furniture spoon

using one hand

• Stands for a

few seconds

• Walks with one

hand held 12 months. Stands well • Scribbles after Finger feeds

with arms high, demonstration part of meal

legs splayed Fine pincer Takes off hat

• Posterior

grasp of pellet protection

Holds crayon

• Independent • Attempts steps

tower of two

cubes 13 months Walks with • Attempts to • Drinks from

arms high and release pellet cup with out (high

in bottle

some spilling guard)

Says first word Vocalizes to songs

Rattles spoon

in cup

• Lifts box lid to

find toy

Shows objects to parent to share interest Points to get desired object (proto imperative pointing) Shows desire to please caregiver Solitary play Functional play

Follows one-step command with

gesture

• Recognizes

names of two objects and looks when named

. Points to get

desired object (proto-imperative

pointing)

• Uses several

gestures with vocalizing (eg, waving, reaching)

• Uses three words

Immature jargoning: inflection without real words

• Looks

appropriately when asked, "Where's the

ball?"

• Dangles ring by

string Reaches around clear barrier to

obtain object

• Unwraps toy in

cloth

• Dumps pellet

out of bottle after demonstration

14 months

Stands without pulling up

Falls by collapse

• Walks well

Follows one-step command without gesture

Removes

socks/shoes

• Chews well

• Puts spoon in

mouth (turns over)

• Names one object

Points at object to express interest (proto declarative pointing)

Imitates back and forth

scribble

• Adds third

cube to a two- cube tower Puts round peg in and out of hole Builds three- to four-cube tower tow Places 10 cubes in cup Releases pellet into bottle

15 months • Stoops to pick

up toy

• Creeps up stairs

• Runs stiff

legged

• Walks carrying

toy

• Climbs on

furniture

• Uses three to five

words Mature jargoning with real words

Uses spoon with some

spilling

• Attempts to

brush own

hair

• Fusses to be

changed

Turns pages in b ook

• Places circle in

single-shape puzzle

• Points at object

to express interest (proto declarative

pointing)

• Purposeful

exploration of toys through trial and error Shows empathy (someone else cries, child looks

sad)

• Hugs adult in

reciprocation Recognizes without a demonstration that a toy requires activation; hands it to

adult if can't operate Kisses by touch- ing lips to skin Periodically visually relocates caregiver Self-conscious; embarrassed when aware of people observing

• Points to one

body part

• Points to one

object of three

when named

• Gets object from

another room upon demand

Uses 5 to 10 words

16 months • Stands on one

foot with slight support

• Walks

backwards

• Walks up stairs

with one hand held

Puts several round pegs in board with

urging

• Scribbles

spontaneously

Picks up and drinks from cup Fetches and carries objects (same room)

Dumps pellet out without demonstration Finds toy observed to be hidden under

layers of covers . Places circle in

form board

Understands simple commands "Bring to mommy" Points to one picture when named

(continued)

270 Pediatrics in Review Vol.31 No.7 July 2010

growth & development motor development

Table 1. Developmental Milestones-continued

Age

Gross Motor

Fine Motor

Self-Help

18 months • Creeps down

stairs

• Runs well

• Seats self in

small chair

• Throws ball

while standing

• Makes four

cube tower Crudely imitates vertical stroke

• Removes

garment

• Gets onto

adult chair unaided Moves about house without adult

Problem-solving . Matches pairs

of objects Replaces circle in form board after it has been turned

around (usually with trial and

error)

Social/Emotional

• Passes M-CHAT

• Engages in

pretend play with other people (eg, tea party, birthday party) Begins to show shame (when does wrong) and

possessiveness

• Begins to have

thoughts about feelings Engages in tea party with stuffed animals Kisses with pucker

Receptive Language Expressive Language

Points to two of Uses 10 to 25 three objects words when named • Uses giant words Points to three (all gone, stop body parts

that) Points to self • Imitates

• Understands environmental "mine"

sounds (eg, Points to familiar animals) people when Names one picture named

on demand

20 months • Squats in play

. Carries large

object Walks downstairs with one hand held

Completes round peg board without

urging

• Makes five-to

six-cube tower

• Completes

square peg board

Places only edibles in mouth

Feeds self wit

spoon entire meal

. Deduces

location of hidden object Places square in form board

points to three pictures Begins to understand her/him/me

Holophrases ("Mommy?" and points to keys, meaning: "These are Mommy's keys.") Two-word

combinations

• Answers requests

with "no" Uses 25 to 50 words Asks for more Adds one to two words/week

Completes form board

Closes box with lid Imitates

vertical line

• Imitates

circular scribble

Uses spoon

well

• Drinks from

cup well Unzips zippers Puts shoes on partway

• Watches other

children

intensely

• Begins to show

defiant behavior

Points to four to five pictures when named

Points to five to

six body parts

• Points to four

pieces of clothing when named

22 months • Walks up stairs

holding rail, putting both feet on each

step

• Kicks ball with

demonstration Walks with one foot on walking

board 24 months. Walks down

stairs holding rail, both feet on each step Kicks ball without demonstration Throws overhand

• Makes a

single-line

train" of cubes Imitates circle

• Sorts objects

• Matches

objects to pictures Shows use of familiar objects

• Parallel play

• Begins to mask

emotions for social etiquette

• Follows two

step command

• Understands me/you

Points to 5 to 10 pictures

. Two-word sentence

(noun + verb)

• Telegraphic speech

• Uses 50+ words

50% intelligibility Refers to self by name Names three pictures

horizontal line

• Opens door

using knob

• Sucks

through a straw Takes off clothes without buttons Pulls off pants Holds self and verbalizes toilet needs Pulls pants up with assistance

Strings large

28 months. Jumps from

bottom step with one foot

leading

• Wa is on toes

• Matches

shapes

• Matches colors

• Reduction in

separation anxiety

Understands "just one"

• Repeats two digits

• Begins to use

pronouns

(), me, you)

• Names 10 to 15

pictures

• Valo backward

10 stess 30 months . Was o stairs

Iniwardly Unscrews jar lid Turns paper pages (often several at

once)

• Makes eight-

cube tower

• Makes a

"train" of cubes and includes a stack

Washes

hands

• Puts things

away

• Brushes teeth

with assistance

Imitates adult activities (eg, sweeping, talking on phone)

alternating feet

• Jumps in place

• Stands with

both feet on

balance beam

• Wallos with one

foot on balance

beam 33 months. Walks swinging

arms opposite of legs (synchronous gait)

• Replaces circle

in form board after it has been turned around (little or no trial and

error)

• Points to small

details in

pictures . Points to self

in photos

• Points to body

parts based on function ("What do you hear with?")

Follows two prepositions: "put block

in ...on box"

• Understands

actions words: "playing ... washing ... blowing"

• Echolalia and

jargoning gone Names objects by use Refers to self with correct pronoun Recites parts of well-known story/ fills in words

. Makes 9- to Toilet trained

10-cube tower • Puts on coat

• Puts six square unassisted

pegs in pegboard Imitates cross

Begins to take

turns

• Tries to help

with household tasks

Understands three

prepositions . Understands

dirty, wet Points to objects by use: "ride in ... put on feet ... write with"

• Gives first and last

name

Counts to 3

• Begins to use past

tense . Enjoys being read

to (short books)

(continued)

Pediatrics in Review Vol.31 No.7 July 2010 271

growth & development motor development

Table 1. Developmental Milestones-continued

others

diffe

Age Gross Motor Fine Motor Self-Help

Problem-solving Social/Emotional Receptive Language Expressive Language 3 years • Balances on one. Copies circle Independent Draws a two-to • Starts to share • Points to parts Uses 200+ words

foot for 3 Cuts with scissors: eating

three-part person with/without of pictures (nose Three-word sentences seconds

side-to-side Pours liquid from. Understands long/ prompt

of cow, door of Uses pronouns Goes up stairs. (awkwardly) one container to short, big/small, Fears imaginary car)

correctly alternating feet, Strings small another

more/less

things

Names body 75% intelligibility no rail

beads well • Puts on shoes • Knows own gender . Imaginative play parts with • Uses plurals

• Pedals tricycle Imitates bridge of without laces • Knows own age Uses words to function • Names body parts by

• Walks heel cubes

• Unbuttons Matches letters/ describe what Understands use to toe

numerals

someone else is negatives

Asks to be read to

• Catches ball

thinking ("Mom · Groups objects with stiff arms

thought I was (foods, toys)

asleep") 4 years • Balances on one. Copies square Goes to toilet Draws a four- to Deception: Follows three- Uses 300 to 1,000

foot 4 to 8 Ties single knot alone

six-part person interested in step commands words seconds

Cuts 5-inch circle • Wipes after bowel • Can give amounts "tricking" others. Points to things . Tells stories

• Hops on one Uses tongs to movement

(usually less than 5) and concerned that are the 100% intelligibility foot two to transfer

Washes face/ correctly

about being same versus Uses "feeling" words three times Writes part of hands

• Simple analogies: trick

• Uses words that tell

• Standing broad first name • Brushes teeth - dad/boy: • Has a preferred Names things about time jump: 1 to Imitates gate alone

mothers??? friend

when actions are 2 feet

with cubes • Buttons

- ice/cold: fire • Labels happiness, described (eg,

• Gallops

• Uses fork well

???

sadness, fear, swims in water,

• Throws ball

- ceiling/up: and anger in self you cut with it, overhand

floor/??? Group play it's something 10 feet

• Points to five to six

you read, it tells Catches

colors

time...) bounced ball

. Points to letters/

Understands (41/2 yrs)

numerals when

adjectives: bushy. named

long, thin,

• Rote counts to 4

pointed

• "Reads" several

common signs/

store names 5 years. Walks down • Copies triangle Spreads with • Draws an 8-to Has group of Knows right and . Repeats six- to

stairs with rail, . Puts paper clip knife

10-part person friends

left on self eight-word sentence alternating feet on paper

Independent • Gives amounts Apologizes for Points to

Defines simple words

• Balances on Can use clothes- dressing

(<10)

mistakes

different one in . Uses 2,000 words one foot >8 pins to transfer Bathes

Identifies coins • Responds

a series

• Knows telephone seconds

small objects independently • Names letters/ verbally to good • Understands "er" number

• Hops on one • Cuts with scissors

numerals out of fortune of others endings (eg. Responds to "why" foot 15 times • Writes first name

order

batter, skater) questions

• Skips

• Builds stairs from

• Rote counts to 10

Understands Retells story with

• Running broad

model

• Names 10 colors

adjectives: busy, clear beginning, jump 2 to 3

• Uses letter names as

long, thin, middle, end feet

sounds to invent

pointed

• Walks backward

spelling

• Enjoys rhyming heel-toe

Knows sounds of

words and

• Jumps backward

consonants and

alliterations short vowels by end

. Produces words of kindergarten

that rhyme

• Reads 25 words

• Points correctly

to "side," "middle"

"corner" 6 years • Tandem walks • Builds stairs from • Ties shoes • Draws a 12-to Has best friend • Asks what un- . Repeats 8- to 10

memory

• Combs hair 14-part person of same sex familiar words word sentences Draws diamond Looks both ways • Number concepts Plays board mean

• Describes events in

• Writes first and at street

to 20

games

. Can tell which order last name Remembers to Simple addition/ Distinguishes words do not • Knows days of the

• Creates and writes bring belongings subtraction

fantasy from belong in a week short sentences

• Understands seasons reality , group

10,000 word

• Forms letters with

Sounds out • Wants to be like

vocabulary down-going and

regularly spelled friends and counterclockwise

words

please them strokes

. Reads 250 words by. Enjoys school

• Copies flag

end of first grade

mall

Copyright 2007 by Chris Johnson, MD, AAP Council on Children with Disabilities. Adapted by the authors with permission and contributions from Frances Page Glascoe, PhD, and Nicholas Robertshaw, authors of PEDS: Developmental Milestones, Franklin Trimm, MD, Vice Chair of Pediatrics, USA/APA Education Committee; the Centers for Disease Control and Prevention "Act Early" initiative; the National Institute for Literacy/Reach Out and Read; and the Inventory of Early Development by Albert Brigance published by Curriculum Associates, Inc. Permission is granted to reproduce these pages on the condition that they are only used as a guide to typical development and not as a substitute for standardized validated screening for developmental problems.

272 Pediatrics in Review Vol.31 No.7 July 2010