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Normal Pediatric Developmental
Milestones
By Iris Dawn Tabangcora, RN - Last Updated on January 19, 2017

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The development of a child mostly takes place in the early years of his
life. At this stage, parents are still overwhelmed with how fast babies
grow and develop. Parents take much time and patience in picking the
best resource to understand a child’s development. Therefore, lots of
questions are thrown in the air for the nurse to answer. Some questions
prove to be challenging, and it is important for nurses to be able to know
the normal developmental milestones like the back of their hands.

The !rst word, smile, and roll over are called developmental milestones.
The child can tick o" a milestone on his growing list of !rsts depending
on how he play, speak, move, and learn. While it is always emphasized
that children develop at their own pace, developmental milestones are
there to shed light on the general changes that should be expected as
the child ages.

1. General Principles of Developmental Milestones

2. Domain #1: Normal Motor Development
3. Domain #2: Normal Language Development
4. Domain #3: Cognitive Development
5. Domain #4: Social Development

General Principles of Developmental

Milestones
For excellent developmental assessment and surveillance, nurses must
know the general principles of developmental milestones. The four key
domains that should be periodically assessed include motor
development, language development, problem-solving, and psychosocial
skills.

Development occurs in an orderly, predictable, and intrinsic manner. For

example, development proceeds from head to toe in a proximal to distal
fashion. Reactions to stimuli develop from general into more speci!c and
goal-directed reactions. Children gain independence from early years of
total dependence.
Lastly, both intrinsic and extrinsic factors can a"ect development. Some
examples of intrinsic factors are physical characteristics, health state,
temperament, and genetic attributes. On the other hand, extrinsic
factors include personalities of family members, economic status,
learning experiences in the environment, and cultural setting to which
the child is born.

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Domain #1: Normal Motor Development

Motor milestones can both be assessed through history interview and
observation. Evaluating gross motor development usually involves neuro
maturational markers like primitive re#exes and postural reactions.

For example, Moro re!ex is one primitive re#ex that is present at birth
and disappears usually between 3-6 months of age. If the baby has
stronger and more sustained primitive re#exes, a CNS injury might be
considered. On the other hand, parachute reaction is one postural
reaction that is acquired. This actually helps the body become oriented
in space through an interplay of visual, proprioceptive, and vestibular
adjustment done by cerebral and cerebellar brain structures. Delayed
development of postural reactions can signify CNS damage.

On the other hand, !ne motor skills involve the use of small muscles of
the hands. The control progresses from the use of proximal muscles to
the distal muscles. As the baby improves on balance during sitting and
moving, the hands become more focused on manipulation of objects.

Here is a table of motor development milestones:

Gross Motor Milestones

Age Milestone
Birth Turns head side to side
Lifts head when lying prone
Head lags when pulled from
2 months
supine position

Rolls over
No head lad when pulled from

4 months supine position

Pushes chest up with arms

Sits alone
Leads with head when pulled from
6 months
supine position

Pulls to stand
9 months Cruises

12 months Walks
Fine Motor Milestones
Birth Keeps hands tightly !sted
Brings hands together to midline
3-4 months
and then to mouth
4-5 months Reaches for objects
Rakes objects with whole hand
Transfers object from hand to
6-7 months
hand

Uses immature pincer (ability to

9 months hold small object between thumb
and index !nger)
Uses mature pincer (ability to hold
12 months small object between thumb and
the index !nger)

Red #ags in motor development include: 1) persistent !sting beyond 3

months which indicate neuromotor problems; 2) early rolling over, early
pulling to stand instead of sitting, and persistent toe walking which may
all indicate spasticity; and 3) early hand dominance (before 18 months of
age), which may signify weakness of the opposite upper extremity
associated with hemiparesis.

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Domain #2: Normal Language

Development
Language is the single best indicator of intellectual potential. Language is
the ability to communicate with symbols. It is often mistaken as
synonymous with speech, the latter being de!ned as a vocal expression
of language. This is the domain with the most number of delays.

It is also interesting to note that a child can usually understand 10 times

(receptive language) as many words as he or she can speak (expressive
language). The !rst two (2) years of life is the time for optimal language
acquisition.

Here is a table of basic language milestones:

Age Milestone
Attunes to human voice
Develops di"erential recognition
Birth
of parents’ voices

Cooing (runs of vowels), musical

2-3 months
sounds (e.g. ooh-ooh, aah-aah)
Babbling (mixing vowels with
6 months
mixed consonants) [e.g. ba-ba-ba]
Jargoning (e.g. babbling with
mixed consonants, in#ection, and
cadence)
9-12 months
Begins using mama, dada
(nonspeci!c)

1-3 words, mama and dada

12 months
(speci!c)
20-50 words
Beginning to use two-word
18 months
phrases

Two-word telegraphic sentences

 (e.g. mommy come)
2 years
25-50% of child’s speech should
be intelligible

Three-word sentences
More than 75% of the child’s
3 years
speech should be intelligible

Domain #3: Cognitive Development

This domain talks about thinking, memory, learning, and problem-
solving. By evaluating problem solving and language milestones, infant
intelligence can be estimated. There is a poor correlation between gross
motor skills and cognitive potential.

Here is a table of cognitive concepts:

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Age Concept
Object permanence (people and
objects continue to exist even
when an infant cannot see them).

9 months This ability to maintain an image

of a person is the reason why
separation anxiety (6-18 months)
 develops when a loved one leaves
the room.
Cause and e"ect (understanding
9-15 months which actions cause certain
results).
1-3 years Magical thinking

Domain #4: Social Development

It refers to the ability to interact with people and the environment. It is
dependent on cultural and environmental factors. Here is a table of
social milestones:

Age Concept
Attachment (bonding with a
primary caregiver begins at birth
12-36 months
and empathy development is
critical during this period).
A sense of self and independence
15 months (process of separation and
individuation begins).
Social play (exhibit parallel play
12-24 months
during the !rst 2 years of life).

In the grand scheme of things, it is essential for nurses to understand

normal development as well as the variations that are considered
acceptable so nurses can recognize pathologic patterns and
developmental delays. Prompt planning and intervention will then be
instituted for children who may bene!t from referral to early
intervention programs.

What other milestones can you add to the list? Share this to co-
nurses and families that could bene"t from this!
 Iris Dawn Tabangcora, RN
Iris Dawn is a nurse writer in her 20s who is on the constant lookout for latest stories
about Science. Her interests include Research and Medical-Surgical Nursing. She is
currently furthering her studies and is seriously considering being a student as her
profession. Life is spoiling her with spaghetti, acoustic playlists, libraries, and the beach.

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