Developmental Milestones - OSCE Guide | Paediatrics

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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

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

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 milestones (stacking blocks and drawing shapes) — Fine Motor Milestones (stacking blocks and drawing shapes)

Hearing, Speech and Language Development

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

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

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. 2^nd Ed. Queensland Government. [LINK]