6-Month Well-Child Visit: Developmental Milestones and Key Discussions
Motor Milestones Expected by 6 Months
At 6 months, infants should demonstrate rolling over prone to supine, supporting themselves on elbows and wrists in prone position, keeping hands unfisted, playing with fingers at midline, and grasping objects. 1
Gross Motor Skills
- Rolling from prone (stomach) to supine (back) position 1
- Supporting weight on elbows and wrists when placed on stomach 1
- Lifting head and chest when prone 1
Fine Motor Skills
- Hands should be unfisted most of the time 1
- Playing with fingers at midline 1
- Grasping and reaching for objects 1
Critical Red Flags Requiring Urgent Evaluation
Any infant at 6 months who is not rolling over requires immediate referral to early intervention services and concurrent referral to pediatric physical therapy and pediatric neurology for comprehensive neuromotor evaluation. 2
Warning Signs at 6 Months
- Absent rolling by 6-7 months 2
- Inconsistent head control in prone position 2
- Persistent asymmetry in movement patterns 2, 3
- Hypotonia (floppiness or decreased muscle tone) 2
- Dysmorphic features 2
- Regression or loss of any previously acquired motor skills 1, 2, 3
Why Urgency Matters
Motor delays at 6 months may signal serious underlying neuromuscular disorders, including cerebral palsy, spinal muscular atrophy, or other progressive conditions that benefit from early diagnosis and intervention. 2 Cerebral palsy can be accurately diagnosed before 6 months' corrected age using validated tools with 86-98% sensitivity, making early identification critical for optimizing long-term outcomes. 2
Developmental Surveillance at This Visit
The American Academy of Pediatrics recommends continuous developmental surveillance at every well-child visit, with formal standardized developmental screening scheduled for 9,18, and 30 months. 1, 3
What to Address at 6 Months
- Elicit and attend to parents' concerns about their child's development 1
- Document developmental history 1
- Make accurate observations of the child's spontaneous motor function 1
- Identify risk and protective factors 1
- Watch the child's posture, play, and spontaneous motor function without stressful demands of performance 1
Prematurity Correction
For infants born earlier than 36 weeks' gestation, correct for prematurity for at least the first 24 months of life when assessing developmental milestones. 1, 4
Additional Screening Recommendations
Maternal Postpartum Depression
Screen mothers of infants up to six months of age for postpartum depression. 5
Vision and Hearing
Pay specific attention to sensory function, as visual and hearing impairments have higher incidence in preterm infants. 4
Anticipatory Guidance Topics
Safety
- Car seats should remain rear-facing until two years of age or until the height or weight limit for the seat is reached 5
Nutrition
- Continue breastfeeding; cessation before six months is associated with childhood obesity 5
- Avoid transition to solid foods before six months 5
- Avoid juice and sugar-sweetened beverages before one year of age 5
Dental Health
Screen Time
Screen time should be avoided, with the exception of video chatting, in children younger than 18 months. 5
When to Schedule Additional Screening
Additional screening should be performed whenever concerns are raised by parents, healthcare professionals, or educators, regardless of scheduled screening age. 3
The next formal standardized developmental screening is recommended at the 9-month visit, when the infant should roll to both sides, sit well without support, and demonstrate motor symmetry. 1, 3
Immediate Action for Concerning Findings
Do not wait for subspecialist appointments to initiate therapy services—refer to early intervention immediately, even before a specific diagnosis is established. 2 Children with motor delays benefit from educationally and medically based therapies regardless of whether a specific neuromotor diagnosis has been identified. 2 Early intervention services should be activated within weeks, not months. 2