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Paediatrics
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Developmental Milestones – OSCE Guide

Children acquire functional skills throughout their childhood and we use the term ‘development’ to describe those skills acquired between birth and approximately 5 years of age. It’s important we’re able to recognise these skills as they are useful to track a child’s progress as they grow and to allow identification of potential developmental problems. Early recognition is key in the management of developmental delay – making the knowledge of these key age-related moments or ‘developmental milestones’ all the more important.

Areas of Development

Developmental milestones may be separated into four functional areas:

  • Gross motor
  • Vision and Fine motor
  • Hearing, Speech and Language
  • Social, Emotional and Behavioural

Developmental milestones must be considered in regards to their ‘median age of acquisition’ (when half of a standard population of children achieve that level) and the ‘limit age’ by which they should have been achieved. Limit ages are generally considered to be two standard deviations from the mean age of acquisition. If the skill is not achieved by this age, more detailed assessment, investigation or intervention may be required. For instance, when considering the milestone of walking – the median age is 12 months, with a limit age of 18 months.

Developmental milestones are acquired in a serial manner – one after the other – and their achievement follows a similar pattern between children. Below is a list of milestones by median age of acquisition, sorted by functional areas.

Gross Motor Development

NewbornLimbs flexed, symmetrical pattern

Marked head lag on pulling up
6 – 8 weeksRaises head to 45 degrees in prone (tummy-time)
6 – 8 monthsSits without support (initially with a round back, then eventually with a straight back by 8 months)

Limit age: 9 months
8 – 9 monthsCrawling
10 monthsStands independently 

Cruises around furniture
12 monthsWalks unsteadily – a broad gait, with hands apart

Limit age: 18 months
15 monthsWalks steadily
2.5 yearsRuns and jumps
Gross Motor Developmental Milestones
Gross Motor Developmental Milestones

Vision and Fine Motor Development

6 weeksFollows moving object or face by turning the head (fixing and following)

Limit age: 3 months
4 monthsReaches out for toys

Limit age: 6 months
4 – 6 monthsPalmar grasp
7 monthsTransfers toys from one hand to another

Limit age: 9 months
10 monthsMature pincer grip

Limit age: 12 months
16 – 18 monthsMakes marks with crayons
14 months – 4 years  

Brick building		Tower of three – 18 months

Tower of six – 2 years

Tower of eight or a train with four bricks – 2.5 years

Bridge (from a model) – 3 years

Steps (after demonstration) – 4 years
2 – 5 years   Pencil skills (see below):

Drawing without seeing how it is done.

Can copy 6 months earlier.		Line – 2 years

Circle – 3 years

Cross – 3.5 years

Square – 4 years

Triangle – 5 years
Fine Motor Developmental Milestones
Fine Motor Developmental Milestones 2
Fine motor milestones (stacking blocks and drawing shapes)
Fine Motor Milestones (stacking blocks and drawing shapes)

Hearing, Speech and Language Development

NewbornStartles to loud noises
3 – 4 monthsVocalises alone or when spoken to, coos and laughs   “aa, aa”
7 monthsTurns to soft sounds out of sight 

Polysyllabic babble (“babababa, lalalalala”)
7 – 10 monthsSounds used indiscriminately at 7 months  

Sounds used discriminately to parents at 10 months “Dada, Mama”
12 monthsTwo to three words other than ‘Dada’ or ‘Mama’  

Understands name “Drink”
18 months6-10 words

Is able to show two parts of the body “Where is your nose?” – Baby will point
20 – 24 monthsJoins two or more words to make simple phrases  “Give me teddy”
2.5 – 3 yearsTalks constantly in 3 – 4-word sentences  

Understands 2 joined commands “Push me fast Daddy”
Hearing, Speech and Language Developmental Milestones
Hearing, Speech and Language Developmental Milestones 3

Social, Emotional and Behavioural Development

6 weeksSmiles responsively

Limit age: 8 weeks
6 – 8 monthsPuts food in their mouth
10 – 12 monthsWaves bye-bye, plays peek-a-boo
12 monthsDrinks from a cup with two hands
18 monthsHolds spoon and gets food safely to mouth
18 – 24 monthsSymbolic play

Limit age: 2 – 2.5 years
2 yearsToilet training: dry by day 

Pulls off some clothing
2.5 – 3 yearsParallel play 

Interactive play evolving

Takes turns
Social, Emotional and Behavioural Developmental Milestones
Social, Emotional and Behavioural Developmental Milestones 4

Tips for assessing development

  • Consider the child’s age and then using the above examples, focus your questions on the likely areas of current developmental progress.
  • Offer the child suitable toys to assess skills through play.
  • Observe how the child uses toys and interacts with people.

Red flags

  • Simplified ‘limit age’ guides have been produced for health practitioners and parents to facilitate the early identification of developmental delay (here is an example).

References

Reference Texts

  • Lissauer, T., Clayden, G., & Craft, A. (2012). Illustrated textbook of paediatrics. Edinburgh: Mosby.
  • Tasker, R. C., McClure, R. J., & Acerini, C. L. (2013). Oxford handbook of paediatrics. Oxford: Oxford University Press.
  • Child Development Program (2016). Red Flags Early Identification Guide. 2nd Ed. Queensland Government. [LINK]

Reference Images

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