Developmental Milestones

Developmental screenings are also offered as requested by families or teachers throughout the community. This is a free service.

Download Developmental Milestone Checklist (PDF format)

What is child development?

Child development refers to how a child becomes able to do more complex things as they get older. Development is different than growth.  Growth only refers to the child getting bigger in size.  When we talk about normal development, we are talking about developing skills like:

Gross motor:  using large groups of muscles to sit, stand, walk, run, etc., keeping balance, and changing positions.

Fine motor:  using hands to be able to eat, draw, dress, play, write, and do many other things.

Language:  speaking, using body language and gestures, communicating, and understanding what others say.

Cognitive:  Thinking skills:  including learning, understanding, problem-solving, reasoning, and remembering.

Social:  Interacting with others, having relationships with family, friends, and teachers, cooperating, and responding to the feelings of others.

What are developmental milestones?

Developmental milestones are a set of functional skills or age-specific tasks that most children can do at a certain age range.  Your pediatrician uses milestones to help check how your child is developing.  Although each milestone has an age level, the actual age when a normally developing child reaches that milestone can very quite a bit.  Every child is unique!   The following information is from the American Academy of Pediatrics (AAP). 

Developmental Milestones by the End of the First Month

Movement

Makes jerky, quivering arm thrusts
Brings hands within range of eyes and mouth
Moves head from side to side while lying on stomach
Head flops backward if unsupported
Keeps hands in tight fists
Strong reflex movements

Visual

Focuses 8 to 12 inches away
Eyes wander and occasionally cross
Prefers black-and-white or high-contrast patterns
Prefers the human face to all other patterns

Hearing

Hearing is fully mature
Recognizes some sounds
May turn toward familiar sounds and voices

Smell and Touch

Prefers sweet smells
Avoids bitter or acidic smells
Recognizes the scent of his own mother's breast milk
Prefers soft to coarse sensations
Dislikes rough or abrupt handling

Developmental Health Watch

If, during the second, third or fourth weeks of your baby's life, she shows any of the following signs of developmental delay, notify your pediatrician.

Sucks poorly and feeds slowly
Doesn't blink when shown a bright light
Doesn't focus and follow a nearby object moving side to side
Rarely moves arms and legs; seems stiff
Seems excessively loose in the limbs, or floppy
Lower jaw trembles constantly, even when not crying or excited
Doesn't respond to loud sounds

Excerpted from Caring for Baby and Young Child: Birth to Age 5, Bantam 1999

© Copyright 2000 American Academy of Pediatrics

Developmental Milestones by the End of 3 Months

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
Grasps and shakes hand toys

Visual

Watches faces intently
Follows moving objects
Recognizes familiar objects and people at a distance
Starts using hands and eyes in coordination

Hearing and Speech

Smiles at the sound of your voice
Begins to babble
Begins to imitate some sounds
Turns head toward direction of sound

Social/Emotional

Begins to develop a social smile
Enjoys playing with other people, and may cry when playing stops
Becomes more communicative and expressive with face and body
Imitates some movements and facial expressions

Developmental Health Watch

Although each baby develops in her own individual way and at her own rate, failure to reach certain milestones may signal medical or developmental problems requiring special attention. If you notice any of the following warning signs in your infant at this age, discuss them with your pediatrician.

Still has Moro reflex after 4 months
Doesn't seem to respond to loud sounds
Doesn't notice her hands by 2 months
Doesn't smile at the sound of your voice by 2 months
Doesn't follow moving objects with her eyes by 2 to 3 months
Doesn't grasp and hold objects by 3 months
Doesn't smile at people by 3 months
Cannot support her head well at 3 months
Doesn't reach for and grasp toys by 3 to 4 months
Doesn't babble by 3 to 4 months
Doesn't bring objects to her mouth by 4 months
Begins babbling, but doesn't try to imitate any of your sounds by 4 months
Doesn't push down with legs when feet are placed on a firm surface by 4 months
Has trouble moving one or both eyes in all directions
Crosses her eyes most of the time. (Occasional crossing of the eyes is normal in these first months.)
Doesn't pay attention to new faces, or seems very frightened by new faces or surroundings
Still has the tonic neck reflex at 4 to 5 months

Excerpted from Caring for Baby and Young Child: Birth to Age 5.

© Copyright American Academy of Pediatrics

Developmental Milestones by the End of 12 Months

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. (What do you do when he refuses a food?)
Tests parental responses to his behavior. (What do you do if he cries after you leave the room?)
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

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
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
Looks at correct picture when the image is named
Imitates gestures
Begins to use objects correctly (drinking from cup, brushing hair, dialing phone, listening to receiver)

Developmental Health Watch

Each baby develops in his own manner, so it's impossible to tell exactly when your child will perfect a given skill. Although the developmental milestones will give you a general idea of the changes you can expect as your child gets older, don't be alarmed if his development takes a slightly different course. Alert your pediatrician if your baby displays any of the following signs of possible developmental delay in the 8- to 12-month age range.

Does not crawl
Drags one side of body while crawling (for over one month)
Cannot stand when supported
Does not search for objects that are hidden while he watches
Says no single words ("mama" or "dada")
Does not learn to use gestures, such as waving or shaking head
Does not point to objects or pictures

Excerpted from Caring for Baby and Young Child: Birth to Age 5, Bantam 1999

© Copyright 2000 American Academy of Pediatrics

Developmental Milestones by the End of 2 Years

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 spontaneously
Turns over container to pour out contents
Builds tower of four blocks or more
Might use one hand more frequently 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 two- to four-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

Imitates behavior of others, especially adults and older children
Increasingly aware of herself as separate from others
Increasingly enthusiastic about company of other children

Emotional

Demonstrates increasing independence
Begins to show defiant behavior
Episodes of separation anxiety increase toward midyear then fade

Developmental Health Watch

Because each child develops at his own particular pace, it's impossible to tell exactly when yours will perfect a given skill. The developmental milestones will give you a general idea of the changes you can expect as your child gets older, but don't be alarmed if he takes a slightly different course. Alert your pediatrician; however, if he displays any of the following signs of possible developmental delay for this age range.

Cannot walk by 18 months
Fails to develop a mature heel-toe walking pattern after several months of walking, or walks exclusively on his toes
Does not speak at least 15 words by 18 months
Does not use two-word sentences by age 2
By 15 months, does not seem to know the function of common household objects (brush, telephone, bell, fork, spoon)
Does not imitate actions or words by the end of this period
Does not follow simple instructions by age 2
Cannot push a wheeled toy by age 2

Excerpted from Caring for Baby and Young Child: Birth to Age 5, Bantam 1999

© Copyright 2000 American Academy of Pediatrics

Developmental Milestones by the End of 3 Years

Movement

Climbs well
Walks up and down stairs, alternating feet
Kicks ball
Runs easily
Pedals tricycle
Bends over easily without falling

Hand and Finger Skills

Makes vertical, horizontal and circular strokes 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-component command
Recognizes and identifies almost all common objects and pictures
Understands most sentences
Understands physical relationships ("on," "in," "under")
Uses four- and five-word sentences
Can say name, age and sex
Uses pronouns (I, you, me, we, they) and some plurals (cars, dogs, cats)
Strangers can understand most of her words

Cognitive

Makes mechanical toys work
Matches an object in her hand or room to a picture in a book
Plays make-believe with dolls, animals and people
Sorts objects by shape and color
Completes puzzles with three or four pieces
Understands concept of "two"

Social

Imitates adults and playmates
Spontaneously shows affection for familiar playmates
Can take turns in games
Understands concept of "mine" and "his/hers"

Emotional

Expresses affection openly
Expresses a wide range of emotions
By 3, separates easily from parents
Objects to major changes in routine

Developmental Health Watch

The developmental milestones give you a general idea of the changes you can expect as your child gets older, but don't be alarmed if her development takes a slightly different course. Each child develops at her own pace. Do consult your pediatrician, however, if your child displays any of the following signs of possible developmental delay for this age range.

Frequent falling and difficulty with stairs
Persistent drooling or very unclear speech
Inability to build a tower of more than four blocks
Difficulty manipulating small objects
Inability to copy a circle by age 3
Inability to communicate in short phrases
No involvement in "pretend" play
Failure to understand simple instructions
Little interest in other children
Extreme difficulty separating from mother

Excerpted from Caring for Baby and Young Child: Birth to Age 5, Bantam 1999

© Copyright 2000 American Academy of Pediatrics

Developmental Milestones by the End of 4 Years

Developmental Milestones by the End of 5 Years

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 geometric patterns
Draws person with body
Prints some letters
Dresses and undresses without assistance
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 Milestones

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
More likely to agree to rules
Likes to sing, dance and act
Shows more independence and may even visit a next-door neighbor by herself

Emotional Milestones

Aware of sexuality
Able to distinguish fantasy from reality
Sometimes demanding, sometimes eagerly cooperative

Developmental Health Watch

Because each child develops in her own particular manner, it's impossible to predict exactly when or how your own preschooler will perfect a given skill. The developmental milestones will give you a general idea of the changes you can expect as your child gets older, but don't be alarmed if her development takes a slightly different course. Alert your pediatrician, however, if your child displays any of the following signs of possible developmental delay for this age range.

Exhibits extremely fearful or timid behavior
Exhibits extremely aggressive behavior
Is unable to separate from parents without major protest
Is easily distracted and unable to concentrate on any single activity for more than five minutes
Shows little interest in playing with other children
Refuses to respond to people in general, or responds only superficially
Rarely uses fantasy or imitation in play
Seems unhappy or sad much of the time
Doesn't engage in a variety of activities
Avoids or seems aloof with other children and adults
Doesn't express a wide range of emotions
Has trouble eating, sleeping or using the toilet
Can't differentiate between fantasy and reality
Seems unusually passive
Cannot understand two-part commands using prepositions ("Put the cup on the table"; "Get the ball under the couch.")
Can't correctly give her first and last name
Doesn't use plurals or past tense properly when speaking
Doesn't talk about her daily activities and experiences
Cannot build a tower of six to eight blocks
Seems uncomfortable holding a crayon
Has trouble taking off clothing
Cannot brush her teeth efficiently
Cannot wash and dry her hands

Excerpted from Caring for Baby and Young Child: Birth to Age 5, Bantam 1999

© Copyright 2000 American Academy of Pediatrics

This information has been created for educational purposes only and is not intended to serve as medical advice.  It should not be used for diagnosing or treating a health problem or disease. It is not a substitute for professional care. If your child has any health concerns, please consult your health care provider.