Developmental Milestones – OSCE Guide

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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

Gross Motor Developmental Milestones
Gross motor developmental milestones 1

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

 

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

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”

Hearing, Speech and Language Developmental Milestones
Hearing, speech and language developmental milestones 3

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
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

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:

3. Social, emotional and behavioural development:


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