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Child developmental milestones

What is child development?
 Development is the process by which each child evolves from
helpless infancy to independent adulthood.

 Developmental assessment is the process of mapping a child’s

performance compared with children of similar age.
Developmental assessment is integral part of pediatric examination
and therefore it is essential that normal developmental and normal
variation are clearly understood. In general, assessment is ongoing
through to adolescent but is of more importance during the
preschool children-0-5 years. Thorough physical examination is
essential, particularly looking for minor abnormalities and noting
the size and shape of the head, height and weight.

Examination of assessment is then based on

1-gross motor status
2-vision and fine motor
3-hearing and speech
4-social skills.

 Gross motor: using large group of muscles to Sit, stand, walk, run,
etc.,
 Fine motor: using hands to be able to eat, draw, dress play, and
write.
 Social: interacting with others
What is developmental delay?
Many clinicians use the term “global developmental delay” to mean a
significant delay in two or more of the four main developmental domains
listed above.

Benefits of developmental assessment

 Early diagnosis of conditions with a genetic basis, such as Duchene
muscular dystrophy and fragile X syndrome, facilitates genetic
counseling for families, provides cares with reliable information before a
developmental problem becomes obvious and gives them more time to
adjust to the child’s difficulty and make appropriate management plans
for their family.

Neonatal Period (1st 4 Wk)

Gross motor: Lies in flexed attitude; turns head from side-to-side
head sags on ventral suspension. Generally flexed and a little stiff.

Visual, and fine motor : May fixate face or light in line of vision;
“doll's-eye&” delay movement of eyes on turning of the body.

Hearing: is fully mature, startle.

Reflex: Moro response active; stepping and placing reflexes; grasp

reflex active.

Social: Visual preference for human face.

4-8 week 
Grosse motor: Legs more extended; head lags on pull to sitting
position, holds chin up in prone position; head lifted momentarily to
plane of body on ventral suspension.
Visual, fine motor: Watches person; follows moving object side to
side 180 degree. Hearing and speech: listens to voice and coos.
Social: beginning to smile

3months
Gross motor: head lag partially compensated when pulled to sitting
position. Ventral suspension head is held up for prolonged period,
can hold shoulders off table when in prone position.

Vision and fine motor: open the hands spontaneously and grasp
reflex is gone. Vision: follows side away and vertically.
Hearing and speech: more responsive to noise and may turn to
sound, coos and laughs
social skills: smiles appropriately.
6-8months: end of 7month
Gross motor =sits momentarily, back straight. Good head control,
rolls over in both directions (front to back, back to front).
When standing, supports weight on legs and might bounce.
Fine motor and vision: transfers objects, alert, eyes move in all
directions, fixates on small objects-20 cm.
Hearing and speech: turn to sounds 0.5m, babbling chains of
consonants -Ka, dah.
Social skills: shows like and dislikes, mouthing, tries to hold bottle,
response to tickling.

Warnings

Poor head control 

Brisk reflexes and clonus 
Not alert 
Not Turing to sounds 
Persistent primitive reflexes. 

9-10months
Gross motors: pull to stand, sits alone and can turn to look (pivoting),
crawling, does not like being moved from sitting to lying supine .
walks holding furniture (“cruising”).
Fine motor and vision: pincer grasp, can see small objects at 3m

Hearing and speech =imitate sounds, Makes a lot of different 

sounds like “mamamama” and “bababababa”, test hearing at 1 m
(distraction test) *.

Social skills =hold, bites, chews biscuit, can wave bye, beginning of
suspicion of strangers, Plays peek-a-boo.

Warnings 

Not sitting 

Asymmetry of tone 

Poor response to sounds 

12 months
Gross motors: May stand alone, walk with one hand held.

Fine motor: release an object on command (give it to me)

Hearing and speech: 1-2 meaningful words, respond to name.

Social skills: come when called, casting object, mouthing stop.

15 months 
Gross motor: walk alone, crawled upstairs and unable to get down.
Vision and fine motor: Make tower of 3 cubes, makes a line.

Hearing and speech: jargon, flow simple command

Social skills: may names of some familiar object (ball). Indicates

some desires or needs by pointing, hug parent.

18 months
Gross motors: walks upstairs with assistance and creep down, run 
stiffly, sit on small chair.

Fine motor: feeds from spoon without falling, point to distant 

objects, stack 2 blocks, makes tower of 4 cubes; imitates
scribbling; imitates vertical stroke, turn pages in a book

Hearing and speech: at least 10 words, vocalize freely, responds 

quickly to simple commands, name picture, identify one or more
parts of body.

Social skills mimic the actions of others (domestic mimicry), 

stopped putting toys into mouth, kiss parent, complain when wet,
seek help in trouble, may have temper tantrums.

Warning 

Not standing 
Not walking
Poor attention span
 24 months 
Gross motors: runs well, climb on furniture, goes up and down stairs two
feet/step, kicks a ball without falling.

Fine motor: builds tower of 7blocks, imitate horizontal line, 

Hearing and speech: 2–3-word sentences, put 3 words together 

(subject, verb, object).
Social skills : plays beside other children, help to undress, hold
spoon well. Puts on socks and shoes.

3 years 

Gross motors: Can walk upstairs, one foot per step, able to jump, 
stands on one foot momentarily, may able to ride tricycle

Fine motor: Builds tower of10 blocks, draw a circle, imitates cross.

Hearing and speech: may know one to two colors, knows 4 body 
parts, count to 10, know age, sex, and first name,

Social skills: plays simple games in parallel with others children,

Separates easily from parents, wash hand, objects to major changes 
in routine, toilet trained by day.

4years
Gross motors : Hop on one foot up to 5 seconds, can walk 
downstairs in adult fashion, climb well.
Fine motor: draw square and Cross, draw man with 2-4 part of
body beside the head, use scissors.
Hearing and speech: know 3-4 colors, talks a lot, asks question-
tell stories, can say first and last name.

Social skills: toilet training well established, play with several 

children with interaction.

Note: The rate of development may vary between children, the 

sequence of development does not differ significantly

5year
Gross motors: may be able to skip, walk heel to toe. 

Fine motor: copies triangle, draws person with body. 

Hearing and speech :5 colors, repeat sentence of 10 syllables , say
address
Social skills: shows more independence, dress and undress.

Developmental decision
Normal
Probably normal-see again
Doubtful-see soon
Abnormal-refer for diagnosis and treatment

Locomotion variants:
some infant never crawls, they stand and walk 

Some do normal crawl with flexed knees 

Some do bear walk knees extended) 

Some commando crawl-on elbows rather than hands 