Growth and Developmental milestone;

Developmental Milestones*
Age Behavior

Birth Sleeps much of the time

Sucks

Clears airway

Responds with crying to discomforts and intrusions

4 wk Brings hands toward eyes and mouth

Moves head from side to side when lying on stomach

Follows an object moved in an arch about 15 cm above face to the midline

Responds to a noise in some way (eg, startling, crying, quieting)

May turn toward familiar sounds and voices

6 wk Regards objects in the line of vision

Begins to smile when spoken to

Lies flat on abdomen

Head lags when pulled to a sitting position

3 mo Holds head steady on sitting

Raises head 45° when lying on stomach

Opens and shuts hands

Pushes down when feet are placed on a flat surface

Swings at and reaches for dangling toys

Follows an object moved in an arch above face from one side to the other

Watches faces intently

Smiles at sound of caretaker's voice

Vocalizes sounds

5–6 mo Holds head steady when upright

Sits with support

Rolls over, usually from stomach to back

Supports self in a standing position

Reaches for objects

Recognizes people at a distance

Listens intently to human voices

 Smiles spontaneously

Squeals in delight

Babbles to toys

7 mo Sits without support

Bears some weight on legs when held upright

Transfers objects from hand to hand

Holds own bottle

Looks for dropped object

Responds to own name

Responds to being told “no”

Combines vowels and consonants to babble

Moves body with excitement in anticipation of playing

Plays peek-a-boo

9 mo Sits well

Crawls or creeps on hands and knees

Pulls self up to standing position

Works to get a toy that is out of reach; objects if toy is taken away

Gets into a sitting position from stomach

Stands holding on to someone or something

Says “mama” or “dada” appropriately in reference to parents

Plays pat-a-cake

Waves bye-bye

12 mo Walks by holding furniture (“cruising”) or hands

May walk 1 or 2 steps without support

Stands for a few moments at a time

Drinks from a cup

Speaks several words

Helps dress self

18 mo Walks well

Can climb stairs holding on

Turns several book pages at a time

 Speaks about 10 words

Pulls toys on strings

Partially feeds self

2 yr Runs well

Climbs up and down stairs alone

Turns single book pages

Puts on simple clothing

Makes 2- or 3-word sentences

Verbalizes toilet needs

3 yr Rides a tricycle

Dresses well except for buttons and laces

Counts to 10 and uses plurals

Recognizes at least 3 colors

Questions constantly

Feeds self well

Can take care of toilet needs (in about half of children)

4 yr Alternates feet going up and down stairs

Throws a ball overhand

Hops on one foot

Copies a cross

Washes hands and face

5 yr Skips

Catches a bounced ball

Copies a triangle

Knows 4 colors

Dresses and undresses without help

*The sequence is fairly consistent, but the timing of milestones varies; times above represent
median values.
Environmental influences, ranging from nutrition to stimulation and from the impact of
disease to the effects of psychologic factors, interact with genetic factors to determine
the pace and pattern of development.

Assessment of development occurs constantly as parents, school personnel, and

clinicians evaluate children. Many tools are available for monitoring development more
specifically. The Denver Developmental Screening Test facilitates evaluation in several
domains. The scoring sheet indicates the average ages for achieving certain milestones
and nicely shows the critical concept of a range of normality. Other tools can also be
used (see Table 2: Physical Growth and Development: Developmental Milestones* ).

Motor development: Motor development includes fine motor (eg, picking up small
objects, drawing) and gross motor (eg, walking, climbing stairs) skills. It is a continuous
process that depends on familial patterns, environmental factors (eg, when activity is
limited by prolonged illness), and specific disorders (eg, cerebral palsy, intellectual
disability, muscular dystrophy). Children typically begin to walk at 12 mo, can climb stairs
at 21 mo, and run well at 2 yr, but the age at which these milestones are achieved by
normal children varies widely. Motor development cannot be significantly accelerated by
applying increased stimulation.

Language development: The ability to understand language precedes the ability to

speak; children with few words usually can understand a great deal. Although delays in
expressive speech are typically not accompanied by other developmental delays, all
children with excessive language delays should be evaluated for the presence of other
delays in development. Children who have delays in both receptive and expressive
speech more often have additional developmental problems. Evaluation of any delay
should start with an assessment of hearing. Most children who experience speech delay
have normal intelligence. In contrast, children with accelerated speech development are
often of above-average intelligence.

Speech progresses from the utterance of vowel sounds (cooing) to the introduction of
syllables that start with consonants (ba-ba-ba). Most children can say “Dada” and
“Mama” specifically by 12 mo, use several words by 18 mo, and combine words into
some sentences by 2 yr. The average 3-yr-old can carry on a conversation. These
milestones are highly variable.

Cognitive and social/emotional development: Cognitive and social/emotional

development refers to the intellectual and psychologic maturation of children as their
physical development allows them to interact more with other people and the external
world. There are multiple theories of these forms of development in children and
adolescents; the oldest and most famous are those proposed by Freud, Piaget, and
Erikson. All are based on clinical observations, but none has been tested in large
groups of children. In general, these models are considered useful for describing
aspects of development in some children, but none is universally applicable.
Increasingly, appropriate attachments and nurturing in infancy and early childhood are
recognized as critical factors in cognitive growth and emotional health. For example,
reading to children from an early age, providing intellectually stimulating experiences,
and providing warm and nurturing relationships all have a major impact on growth in
these domains. Intellect is appraised in young children by observations of language
skills, curiosity, and problem-solving abilities. As children become more verbal,
intellectual functioning becomes easier to assess using a number of specialized clinical
tools. Once children start school, they undergo constant monitoring as part of the
academic process.

Emotional growth and the acquisition of social skills are assessed by watching children
interact with others in everyday situations. When children acquire speech, the
understanding of their emotional state becomes much more accurate. As with intellect,
emotional functioning can be delineated more precisely with specialized tools.

When will my baby take his first step or say her first word? During their first year, babies start to
develop skills they will use for the rest of their lives. The normal growth of babies can be broken
down into the following areas:

• Gross motor - controlling the head, sitting, crawling, maybe even starting to walk
• Fine motor - holding a spoon, picking up a piece of cereal between thumb and finger
• Sensory - seeing, hearing, tasting, touching and smelling
• Language - starting to make sounds, learning some words, understanding what people
say
• Social - the ability to play with family members and other children

Babies do not develop at the same rate. There is a wide range of what is considered "normal."
Your baby may be ahead in some areas and slightly behind in others. If you are worried about
possible delays, talk to your baby's health care provider.

Alternative Names
Growth milestones for children; Normal childhood growth milestones; Childhood growth
milestones

Information

Child development is complex. Any "checklist" or calendar of developmental milestones will

blur or miss important aspects, and may trouble parents whose child is developing normally or
falsely reassure parents whose child should be evaluated for potential problems.

For every developmental milestone, there is a normal range in which a child may reach that
milestone. For example, walking may begin as early as 8 months or as late as 18 months and
be considered normal. If you have concern about your child's development, call the child's
primary care provider.

One of the reasons for frequent well-child visits to the pediatrician in the early years is to
assess your child's development. Any concerns on the part of the doctors, parents, teachers, or
childcare providers are important to discuss and address, and may trigger a more detailed
developmental assessment.

Below is a general list of some of the things you might see children doing at different ages, but
these are NOT precise guidelines. There are many different normal paces and patterns of
development. This article provides just one example.

Infant -- birth to 1 year

• Able to drink from a cup

• Able to sit alone, without support
• Babbling
• Displays social smile
• Eruption of 1st tooth
• Plays peek-a-boo
• Pulls self to standing position
• Rolls over by self
• Says mama and dada, using terms appropriately
• Understands "NO" and will stop activity in response
• Walks while holding on to furniture or other support
• Walks without support

Toddler -- 1 to 3 years

• Able to feed self neatly, with minimal spilling

• Able to draw a line (when shown one)
• Able to run, pivot, and walk backwards
• Able to state first and last name
• Able to walk up and down stairs
• Begins pedaling tricycle
• Can name pictures of common objects and point to body parts
• Dresses self with only minimal help
• Imitates speech of others, "echoing" word back
• Learns to share toys (without adult direction)Masters walking
• Learns to take turns (if directed) while playing with other children
 • Recognizes and labels colors appropriately
• Recognizes gender differences
• Uses more words and understands simple commands
• Uses spoon to feed self

Preschooler -- 3 to 6 years

• Able to draw a circle

• Able to draw stick figures with 2 to 3 features for people
• Able to skip
• Balances better, may begin to ride a bicycle
• Begins to recognize written words -- reading skills start
• Catches a bounced ball
• Enjoys doing most things independently, without help
• Enjoys rhymes and word play
• Hops on one foot
• Rides tricycle well
• Understands size concepts
• Understands time concepts
• Starts school

School-age child -- 6 to 12 years

• Beginning skills for team sports (soccer, T-ball, etc.)

• Begins to lose "baby" teeth and erupt permanent teeth
• Girls begin to show growth of armpit and pubic hair, breast development
• Menarche (1st menstrual period) may occur in girls
• Peer recognition begins to become important
• Reading skills develop further
• Routines important for daytime activities
• Understands and able to follow sequential directions

Adolescent -- 12 to 18 years

• Adult height, weight, sexual maturity

• Boys show growth of armpit, chest, and pubic hair; voice changes; and testicular/penile
enlargement
• Girls show growth of armpit and pubic hair; breast development; menstrual periods
• Peer acceptance and recognition is of vital importance
• Understands abstract concepts
Interactive Checklist: By the End of 3 Months

Simply fill out your child's name, age and today's date and then check off the milestones your child has
already achieved. Then click "Create Checklist."

Child's Name:
Child's Age:
Today's Date: September 30, 2010
Social and Emotional
Begins to develop a social smile
Enjoys playing with other people and may cry when playing stops
Becomes more expressive and communicates more with face and body
Imitates some movements and facial expressions

Movement
Raises head and chest when lying on stomach
Supports upper body with arms when lying on stomach
Stretches legs out and kicks when lying on stomach or back
Opens and shuts hands
Pushes down on legs when feet are placed on a firm surface
Brings hand to mouth
Takes swipes at dangling objects with hands
Interactive Checklist:
Grasps and Bytoys
shakes hand the End of Seven Months
Simply
Vision fill out your child's name, age and today's date and then
checkWatches
off the milestones your child has already achieved. Then click
faces intently
"Create Checklist."
Follows moving objects
Child'sRecognizes familiar objects and people at a distance
Name:
Child'sStarts
Age: using hands and eyes in coordination
Today's Date:September 30, 2010
Hearing and Speech
Smiles at the sound of your voice
Social and Emotional
Enjoys social play
Interested in mirror images
Responds to other people's expressions of emotion and
appears joyful often

Movement
Rolls both ways (front to back, back to front)
Sits with, and then without, support on hands
Supports whole weight on legs
Reaches with one hand
Transfers object from hand to hand
Uses hand to rake objects

Vision
Develops full color vision
nteractive Checklist: By the End of 1 Year (12 Months) Retur
tools p
Simply fill out your child's name, age and today's date and then check off the milestones your child has already
achieved. Then click "Create Checklist." More

Child's Name:
Child's Age:
Today's Date: September 30, 2010

Social and Emotional

Shy or anxious with strangers
 Cries when mother or father leaves
Enjoys imitating people in his play
Shows specific preferences for certain people and toys
Tests parental responses to his actions during feedings
Tests parental responses to his behavior
May be fearful in some situations
Prefers mother and/or regular caregiver over all others
Repeats sounds or gestures for attention
Finger-feeds himself
Extends arm or leg to help when being dressed

Movement
Reaches sitting position without assistance
Crawls forward on belly
Assumes hands-and-knees position
Creeps on hands and knees
Gets from sitting to crawling or prone (lying on stomach) position
Pulls self up to stand
Walks holding on to furniture
Stands momentarily without support
May walk two or three steps without support

Hand and Finger Skills

Uses pincer grasp
Bangs two objects together
Puts objects into container
Takes objects out of container
Lets objects go voluntarily
Pokes with index finger

Language
Pays increasing attention to speech
Responds to simple verbal requests
Responds to "no"
Uses simple gestures, such as shaking head for “no”
Babbles with inflection (changes in tone)
Says "dada" and "mama"
 Uses exclamations, such as "Oh-oh!"
Tries to imitate words

Cognitive
Explores objects in many different ways (shaking, banging, throwing, dropping)
Finds hidden objects easily
nteractive Checklist: By the End of 2 Years (24 Months)

Simply fill out your child's name, age and today's date and then check off the milestones your child has already achieved
Then click "Create Checklist."

Child's Name:
Child's Age:
Today's Date: September 30, 2010

Movement
Walks alone
Pulls toys behind her while walking
Carries large toy or several toys while walking
Begins to run
Stands on tiptoe
Kicks a ball
Climbs onto and down from furniture unassisted
Walks up and down stairs holding on to support

Hand and Finger Skills

Scribbles on his or her own
Turns over container to pour out contents
Builds tower of four blocks or more
Might use one hand more often than the other

Language
Points to object or picture when it’s named for him
Recognizes names of familiar people, objects, and body parts
Says several single words (by 15 to 18 months)
 Uses simple phrases (by 18 to 24 months)
Uses 2- to 4-word sentences
Follows simple instructions
Repeats words overheard in conversation

Cognitive
Finds objects even when hidden under two or three covers
Begins to sort by shapes and colors
Begins make-believe play

Social
nteractive Checklist: By the End of 3 Years (36 Months)

Simply fill out your child's name, age and today's date and then check off the milestones your child has
already achieved. Then click "Create Checklist."

Child's Name:
Child's Age:
Today's Date: September 30, 2010

Movement
Climbs well
Walks up and down stairs, alternating feet (one foot per stair step)
Kicks ball
Runs easily
Pedals tricycle
Bends over easily without falling

Hand and Finger Skills

Makes up-and-down, side-to-side, and circular lines with pencil or crayon
 Turns book pages one at a time
Builds a tower of more than six blocks
Holds a pencil in writing position
Screws and unscrews jar lids, nuts, and bolts
Turns rotating handles

Language
Follows a two- or three-part command
Recognizes and identifies almost all common objects and pictures
Understands most sentences
Understands placement in space ("on," "in," "under")
Uses 4- to 5-word sentences
Can say name, age, and sex
Uses pronouns (I, you, me, we, they) and some plurals (cars, dogs, cats)
Interactive Checklist: By the End of 4 Years (48 Months)

Simply fill out your child's name, age and today's date and then check off the milestones your child has
already achieved. Then click "Create Checklist."

Child's Name:
Child's Age:
Today's Date: September 30, 2010

Movement
Hops and stands on one foot up to five seconds
 Goes upstairs and downstairs without support
Kicks ball forward
Throws ball overhand
Catches bounced ball most of the time
Moves forward and backward with agility

Hand and Finger Skills

Copies square shapes
Draws a person with two to four body parts
Uses scissors
Draws circles and squares
Begins to copy some capital letters

Language
Has mastered some basic rules of grammar
Speaks in sentences of five to six words
Speaks clearly enough for strangers to understand
Tells stories

Cognitive
Correctly names some colors
Understands the concept of counting and may know a few numbers
Tries to solve problems from a single point of view
Begins to have a clearer sense of time
Follows three-part commands
Recalls parts of a story
Understands the concepts of "same" and "different"
Engages in fantasy play

Social
Interested in new experiences
Cooperates with other children
Plays "Mom" or "Dad"
Increasingly inventive in fantasy play
Dresses and undresses
Negotiates solutions to conflicts
More independent
 Emotional
Imagines that many unfamiliar images may be "monsters"
Views self as a whole person involving body, mind, and feelings

Interactive Checklist: By the End of 5 Years (60 Months)

Simply fill out your child's name, age and today's date and then check off the milestones your child has already achieved
Checklist."

Child's Name:
Child's Age:
Today's Date: September 30, 2010

Movement
Stands on one foot for 10 seconds or longer
Hops, somersaults
Swings, climbs
May be able to skip

Hand and Finger Skills

Copies triangle and other shapes
Draws person with body
Prints some letters
Dresses and undresses without help
Uses fork, spoon, and (sometimes) a table knife
Usually cares for own toilet needs

Language
Recalls part of a story
Speaks sentences of more than five words
Uses future tense
Tells longer stories
 Says name and address

Cognitive
Can count 10 or more objects
Correctly names at least four colors
Better understands the concept of time
Knows about things used every day in the home (money, food, appliances)

Social
Wants to please friends
Wants to be like her friends

Age 2 Age 3 Age 4

Language skills
Speaks about 50 words
Links two words together
Uses some adjectives (big,
happy)
Speaks clearly enough for
parents to understand
some of the words
Social skills
Becomes aware of his or
her identity as a separate
individual
May become defiant
Speaks 250 to 500 or more Answers simple questions
words
Speaks in three-and four- Speaks in complete
word sentences sentences
Uses pronouns (I, you, we, Uses prepositions (under,
they) and some plurals beside, in front)
States first name Speaks clearly enough for
strangers to understand
Imitates parents and Cooperates with playmates
playmates
Takes turns Tries to solve problems
Becomes interested in
playing with other children
Separation anxiety begins
to fade
Cognitive skills
Begins to play make-
believe
Begins to sort objects by
shape and color
Scribbles
Finds hidden objects
Physical skills
Walks alone and stands on
tiptoe
Climbs on furniture and
begins to run
Builds a tower of six or
more blocks
Empties objects from a
container
• See Also
Expresses affection openly May have a best friend
Easily separates from parents Becomes more independent
Asks "why" questions Becomes involved in more
complex imaginary play
Correctly names some colors Prints some capital letters
Copies a circle Draws a person with two to
four body parts
Understands the concepts of Understands the concepts o
same and different morning, afternoon and nigh
Walks up and down stairs, Stands on one foot for at
alternating feet least five seconds
Kicks, climbs, runs and Throws ball overhand, kicks
pedals a tricycle ball forward and catches
bounced ball most of the tim
Builds a tower of nine or Dresses and undresses
more blocks
Manipulates small objects Uses scissors
and turns book pages one at
a time