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
| Age | Milestone |
| Newborn | Limbs flexed, symmetrical pattern Marked head lag on pulling up |
| 6 – 8 weeks | Raises head to 45 degrees in prone (tummy-time) |
| 6 – 8 months | Sits without support (initially with a round back, then eventually with a straight back by 8 months) Limit age: 9 months |
| 8 – 9 months | Crawling |
| 10 months | Stands independently Cruises around furniture |
| 12 months | Walks unsteadily – a broad gait, with hands apart Limit age: 18 months |
| 15 months | Walks steadily |
| 2.5 years | Runs and jumps |
Vision and fine motor development
| Age | Milestone |
| 6 weeks | Follows moving object or face by turning the head (fixing and following) Limit age: 3 months |
| 4 months | Reaches out for toys Limit age: 6 months |
| 4 – 6 months | Palmar grasp |
| 7 months | Transfers toys from one hand to another Limit age: 9 months |
| 10 months | Mature pincer grip Limit age: 12 months |
| 16 – 18 months | Makes 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 |
Hearing, speech and language development
| Age | Milestone |
| Newborn | Startles to loud noises |
| 3 – 4 months | Vocalises alone or when spoken to, coos and laughs “aa, aa” |
| 7 months | Turns to soft sounds out of sight Polysyllabic babble (“babababa, lalalalala”) |
| 7 – 10 months | Sounds used indiscriminately at 7 months Sounds used discriminately to parents at 10 months “Dada, Mama” |
| 12 months | Two to three words other than ‘Dada’ or ‘Mama’ Understands name “Drink” |
| 18 months | 6-10 words Is able to show two parts of the body “Where is your nose?” – Baby will point |
| 20 – 24 months | Joins two or more words to make simple phrases “Give me teddy” |
| 2.5 – 3 years | Talks constantly in 3 – 4-word sentences Understands 2 joined commands “Push me fast Daddy” |
Social, emotional and behavioural development
| Age | Milestone |
| 6 weeks | Smiles responsively Limit age: 8 weeks |
| 6 – 8 months | Puts food in their mouth |
| 10 – 12 months | Waves bye-bye, plays peek-a-boo |
| 12 months | Drinks from a cup with two hands |
| 18 months | Holds spoon and gets food safely to mouth |
| 18 – 24 months | Symbolic play Limit age: 2 – 2.5 years |
| 2 years | Toilet training: dry by day Pulls off some clothing |
| 2.5 – 3 years | Parallel play Interactive play evolving Takes turns |
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
Text references
- 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]
Images references
1. Gross motor: “Stumbling Baby” by Christopher is licensed under CC BY 2.0.
2. Vision and fine motor:
- “Shaelyn” by Mike Schmid, Flickr is licensed under CC BY-SA 2.0
- “Bubble Boy” by Mark Evans, Flickr is licensed under CC BY 2.0
- “Baby Learns How To Grab 2” by Thomas, Flickr is licensed under CC BY 2.0
- “This work” by Flickr is licensed under CC BY 2.0
3. Social, emotional and behavioural development:
- “First smile” by Upsilon Andromedae, Flickr is licensed under CC BY 2.0
- “plum and stuff” by Sami Keinänen, Flickr is licensed under CC BY-SA 2.0
- “IMG_6591” by Abigail Batchelder, Flickr is licensed under CC BY 2.0
- “Drinking Water” by Henry Burrows, Flickr is licensed under CC BY-SA 2.0
- “Open wide” by Alexis Millican, Air Force Medical Service Photos is licensed under CC BY 2.0
