Normal Childhood Developmental Milestones
Normal childhood developmental milestones are specific physical, cognitive, and social skills that children achieve at predictable time periods, with delays warranting attention and potentially early intervention. 1 These milestones serve as important indicators of a child's healthy development and can help identify potential developmental concerns early.
Gross Motor Milestones
| Age | Gross Motor Skills |
|---|---|
| 2 months | Lifts head and chest when lying on stomach |
| 4 months | Rolls over from front to back; supports weight on elbows and wrists when prone |
| 9 months | Rolls over from back to front; sits without support; pulls to stand; comes to sit from lying; crawls |
| 12 months | Walks independently; stands |
| 18 months | Walks backward; runs; walks up steps with hand held |
| 2 years | Rides on toy without pedals; jumps up |
| 3 years | Pedals tricycle; climbs on and off furniture |
| 4 years | Climbs stairs without support; skips on one foot |
Fine Motor Milestones
| Age | Fine Motor Skills |
|---|---|
| 4 months | Hands unfisted; plays with fingers in midline; grasps objects |
| 9 months | Reaches for and transfers cubes; rakes small objects with 4 fingers; picks up small objects with 3 fingers |
| 12 months | Puts one block in a cup; bangs two objects together; uses 2-finger pincer grasp |
| 18 months | Scribbles; dumps small objects from bottle; builds tower of 2 cubes |
| 2 years | Builds tower and horizontal train with 3 blocks |
| 3 years | Copies a circle; draws a person with head and one other body part; builds a bridge with 3 blocks |
| 4 years | Draws a person with 6 parts; draws a simple cross; buttons medium-sized buttons |
Language and Social Milestones
| Age | Language and Social Skills |
|---|---|
| 10 months | Responds to their name |
| 12 months | Uses 2-3 meaningful words |
| 18 months | Uses several single words; follows simple commands |
| 2 years | Uses 2-word phrases; follows 2-step commands |
| 3 years | Uses 3-word sentences; engages in pretend play; takes turns in games |
| 4 years | Tells stories; uses complete sentences; plays cooperatively with other children |
Self-Feeding Milestones
| Age | Self-Feeding Skills |
|---|---|
| 5 months | Introduction of puree/smooth foods |
| 9-10 months | Finger feeding begins |
| 10 months | Cup drinking |
| 16-20 months | Self-feeding with spoon |
Important Considerations
Corrected Age: For preterm infants (born before 36 weeks gestation), developmental milestones should be assessed using corrected age (age from due date rather than birth date) for the first 24-36 months of life 2, 3.
Continuous Surveillance: The American Academy of Pediatrics recommends continuous developmental surveillance throughout childhood, with additional screenings whenever concerns are raised by parents, healthcare professionals, or others involved in the child's care 1, 2.
Key Assessment Ages: Formal developmental assessments are particularly important at 9,18,30, and 48 months 1, 2.
Early Intervention: Early identification of developmental delays allows for timely referral to therapeutic services, which can significantly improve outcomes 3.
Red Flags Warranting Further Evaluation
- Absence of rolling to both sides, sitting without support, or motor symmetry by 9 months 1
- Not sitting, standing, or walking independently by 18 months 1
- Loss of previously attained skills at any age 1
- Persistent primitive reflexes beyond expected age
- Asymmetry in movement or strength
- Significant delays in language acquisition
Predictive Value of Developmental Milestones
- Early achievement of motor milestones, particularly standing with assistance, may predict better cognitive and adaptive skills at age 4 years 4.
- Language development milestones are stronger predictors of later IQ than other cognitive domains 5.
- The age of reaching developmental milestones can predict a substantial part of later IQ variance from 24 months 5.
- Early language skills can help identify children who may have exceptional cognitive abilities (from 12 months) or disabilities (from 8 months) 5.
Risk Factors for Developmental Delays
- Preterm birth 3
- Family history of speech and language delay 6
- Prolonged sucking habits (pacifier use, thumb sucking) 6
- Male gender 6
- Oropharyngeal anomalies 6
- Hearing problems and middle ear infections 6
- Exposure to multiple languages in the home environment 6
By understanding these normal developmental milestones and monitoring children's progress, healthcare providers can identify potential developmental concerns early and initiate appropriate interventions when needed.