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Children acquire functionalskills 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 developmentalproblems. Early recognition is key in the management of developmentaldelay – 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:
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
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
Cruises around furniture
Walks unsteadily – a broad gait, with hands apart
Limit age: 18 months
Runs and jumps
Vision and fine motor development
Follows moving object or face by turning the head (fixing and following)
Limit age: 3 months
Reaches out for toys
Limit age: 6 months
4 – 6 months
Transfers toys from one hand to another
Limit age: 9 months
Mature pincer grip
Limit age: 12 months
16 – 18 months
Makes marks with crayons
14 months – 4 years
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
Startles to loud noises
3 – 4 months
Vocalises alone or when spoken to, coos and laughs “aa, aa”
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”
Two to three words other than ‘Dada’ or ‘Mama’
Understands name “Drink”
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
Limit age: 8 weeks
6 – 8 months
Puts food in their mouth
10 – 12 months
Waves bye-bye, plays peek-a-boo
Drinks from a cup with two hands
Holds spoon and gets food safely to mouth
18 – 24 months
Limit age: 2 – 2.5 years
Toilet training: dry by day
Pulls off some clothing
2.5 – 3 years
Interactive play evolving
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.
Simplified ‘limit age’ guides have been produced for health practitioners and parents to facilitate the early identification of developmental delay (here is an example).
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]