What are the expected developmental milestones for a 15-month-old child?

15-Month Developmental Milestones

At 15 months, children should be walking independently and standing, putting 1 block in a cup, banging 2 objects together, and demonstrating a 2-finger pincer grasp. 1

Motor Milestones at 15 Months

Gross Motor Skills

• Independent walking is the hallmark gross motor achievement expected by 15 months 1
• Standing without support should be well-established 1
• Children typically achieve independent walking between 12-14 months, with median onset at 13 months in population studies 2

Fine Motor Skills

• 2-finger pincer grasp for picking up small objects should be present 1, 3
• Putting 1 block in a cup demonstrates emerging problem-solving and hand-eye coordination 1
• Banging 2 objects together shows bilateral coordination 1

Critical Context for Assessment

These milestones represent mean ages of performance, and the American Academy of Pediatrics recommends that standardized developmental testing be performed at this visit. 1 The 15-month visit is specifically designated as a key surveillance checkpoint where formal screening should occur. 1

Adjustment for Prematurity

• For infants born earlier than 36 weeks' gestation, correct for prematurity for at least the first 24 months when assessing developmental milestones 1, 3

Developmental Surveillance Components

At the 15-month visit, clinicians should: 1

• Elicit and attend to parents' concerns about their child's development
• Document developmental history including prenatal, perinatal, and interval information
• Make accurate observations of the child's spontaneous motor function during play
• Identify risk and protective factors in the child's environment
• Watch posture, play, and spontaneous movement without stressful performance demands

Red Flags Requiring Immediate Evaluation

Motor Regression

• Loss of any previously acquired motor skills (such as walking, standing, or fine motor abilities) warrants immediate evaluation for progressive neuromuscular disorders 1, 3

Significant Delays

• Absence of independent walking by 15 months should trigger concern, though some normal variation exists 1, 2
• Inability to stand independently at 15 months requires further assessment 1
• Absence of pincer grasp beyond 12 months warrants referral to early intervention and occupational therapy 3

Concerning Patterns

• Asymmetry in movement patterns or persistent one-handed activities may indicate unilateral cerebral palsy and requires immediate evaluation 3
• Hypotonia, feeding difficulties, or dysmorphic features warrant earlier subspecialist referral 3

When Milestones Are Not Met

If a child has not achieved independent walking or other expected milestones by 15 months, immediately refer to early intervention services while diagnostic investigations proceed—do not wait for subspecialist appointments to initiate therapy. 3 Children benefit from educationally and medically based therapies regardless of whether a specific neuromotor diagnosis has been identified. 3

Immediate Actions

• Refer to early intervention or special education resources even before establishing a specific diagnosis 3
• Refer to pediatric physical therapy for gross motor delays while diagnostic workup continues 3
• Refer to occupational therapy for significant fine motor delays 3
• Schedule close follow-up within weeks, not months, for ongoing developmental monitoring 3

Common Pitfalls to Avoid

• Do not dismiss parental concerns even when clinical observations seem reassuring—parent concern is a valid reason to trigger formal diagnostic investigations 3
• Do not use vague terminology like "at risk of developmental delay"—if motor dysfunction is present but diagnosis cannot be confirmed, use the interim clinical diagnosis of "high risk of cerebral palsy" 3
• Do not delay therapy referrals while waiting for diagnostic clarity—early intervention optimizes outcomes regardless of final diagnosis 3
• Do not forget to correct for prematurity in children born before 36 weeks' gestation 1, 3