Complete Guide to Developmental Milestones

Movement Milestones

• Makes jerky, quivering arm thrusts
• Brings hands within range of eyes and mouth
• Moves head from side to side while lying on stomach
• Head flops backward if unsupported
• Keeps hands in tight fists
• Strong reflex movements

Visual and Hearing Milestones

• Focuses 8 to 12 inches (20.3 to 30.4 cm) away
• Eyes wander and occasionally cross
• Prefers black-and-white or high-contrast patterns
• Prefers the human face to all other patterns
• Hearing is fully mature
• Recognizes some sounds
• May turn toward familiar sounds and voices

Smell and Touch Milestones

• Prefers sweet smells
• Avoids bitter or acidic smells
• Recognizes the scent of his own mother’s breastmilk
• Prefers soft to coarse sensations
• Dislikes rough or abrupt handling

Developmental Health Watch

If, during the second, third, or fourth weeks of your baby’s life, she shows any of the following signs of developmental delay, notify your pediatrician.

• Sucks poorly and feeds slowly
• Doesn’t blink when shown a bright light
• Doesn’t focus and follow a nearby object moving side to side
• Rarely moves arms and legs; seems stiff
• Seems excessively loose in the limbs, or floppy
• Lower jaw trembles constantly, even when not crying or excited
• Doesn’t respond to loud sounds

Movement Milestones

• Raises head and chest when lying on stomach
• Supports upper body with arms when lying on stomach
• Stretches legs out and kicks when lying on stomach or back
• Opens and shuts hands
• Pushes down on legs when feet are placed on a firm surface
• Brings hand to mouth
• Takes swipes at dangling objects with hands
• Grasps and shakes hand toys

Visual and Hearing Milestones

• Watches faces intently
• Follows moving objects
• Recognizes familiar objects and people at a distance
• Starts using hands and eyes in coordination
• Smiles at the sound of your voice
• Begins to babble
• Begins to imitate some sounds
• Turns head toward direction of sound

Social and Emotional Milestones

• Begins to develop a social smile
• Enjoys playing with other people and may cry when playing stops
• Becomes more communicative and expressive with face and body
• Imitates some movements and facial expressions

Developmental Health Watch

Although each baby develops in her own individual way and at her own rate, failure to reach certain milestones may signal medical or developmental problems requiring special attention. If you notice any of the following warning signs in your infant at this age, discuss them with your pediatrician.

• Doesn’t seem to respond to loud sounds
• Doesn’t notice her hands by two months
• Doesn’t smile at the sound of your voice by two months
• Doesn’t follow moving objects with her eyes by two to three months
• Doesn’t grasp and hold objects by three months
• Doesn’t smile at people by three months
• Cannot support her head well at three months
• Doesn’t reach for and grasp toys by three to four months
• Doesn’t babble by three to four months
• Doesn’t bring objects to her mouth by four months
• Begins babbling, but doesn’t try to imitate any of your sounds by four months
• Doesn’t push down with her legs when her feet are placed on a firm surface by four months
• Has trouble moving one or both eyes in all directions
• Crosses her eyes most of the time (Occasional crossing of the eyes is normal in these first months.)
• Doesn’t pay attention to new faces, or seems very frightened by new faces or surroundings
• Still has the tonic neck reflex at four to five months

Movement Milestones

• Rolls both ways (front to back, back to front)
• Sits with, and then without, support of her hands
• Supports her whole weight on her legs
• Reaches with one hand
• Transfers object from hand to hand
• Uses raking grasp (not pincer)

Visual Milestones

• Develops full color vision
• Distance vision matures
• Ability to track moving objects improves

Language Milestones

• Responds to own name
• Begins to respond to “no”
• Distinguishes emotions by tone of voice
• Responds to sound by making sounds
• Uses voice to express joy and displeasure
• Babbles chains of consonants

Cognitive Milestones

• Finds partially hidden object
• Explores with hands and mouth
• Struggles to get objects that are out of reach

Social and Emotional Milestones

• Enjoys social play
• Interested in mirror images
• Responds to other people’s expressions of emotion and appears joyful often

Developmental Health Watch

Because each baby develops in his own particular manner, it’s impossible to tell exactly when or how your child will perfect a given skill. The developmental milestones listed in this book will give you a general idea of the changes you can expect, but don’t be alarmed if your own baby’s development takes a slightly different course. Alert your pediatrician, however, if your baby displays any of the following signs of possible developmental delay for this age range.

• Seems very stiff, with tight muscles
• Seems very floppy, like a rag doll
• Head still flops back when body is pulled up to a sitting position
• Reaches with one hand only
• Refuses to cuddle
• Shows no affection for the person who cares for him
• Doesn’t seem to enjoy being around people
• One or both eyes consistently turn in or out
• Persistent tearing, eye drainage, or sensitivity to light
• Does not respond to sounds around him
• Has difficulty getting objects to his mouth
• Does not turn his head to locate sounds by four months
• Doesn’t roll over in either direction (front to back or back to front) by five months
• Seems inconsolable at night after five months
• Doesn’t smile spontaneously by five months
• Cannot sit with help by six months
• Does not laugh or make squealing sounds by six months
• Does not actively reach for objects by six to seven months
• Doesn’t follow objects with both eyes at near (1 foot) [30 cm] and far (6 feet) [180 cm] ranges by seven months
• Does not bear some weight on legs by seven months
• Does not try to attract attention through actions by seven months
• Does not babble by eight months

• Shows no interest in games of peekaboo by eight months

Movement Milestones

• Gets to sitting position without assistance
• Crawls forward on belly by pulling with arms and pushing with legs
• Assumes hands-and-knees position
• Creeps on hands and knees supporting trunk on hands and knees
• Gets from sitting to crawling or prone (lying on stomach) position
• Pulls self up to stand
• Walks holding on to furniture
• Stands momentarily without support
• May walk two or three steps without support

Milestones In Hand and Finger Skills

• Uses pincer grasp
• Bangs two cubes together
• Puts objects into container
• Takes objects out of container
• Lets objects go voluntarily
• Pokes with index finger
• Tries to imitate scribbling

Language Milestones

• Pays increasing attention to speech
• Responds to simple verbal requests
• Responds to “no”
• Uses simple gestures, such as shaking head for “no”
• Babbles with inflection
• Says “dada” and “mama”
• Uses exclamations, such as “oh-oh!”
• Tries to imitate words

Cognitive Milestones

• Explores objects in many different ways (shaking, banging, throwing, dropping)
• Finds hidden objects easily
• Looks at correct picture when the image is named
• Imitates gestures
• Begins to use objects correctly (drinking from cup, brushing hair, dialing phone, listening to receiver)

Social and Emotional Milestones

• Shy or anxious with strangers
• Cries when mother or father leaves
• Enjoys imitating people in play
• Shows specific preferences for certain people and toys
• Tests parental responses to his actions during feedings (What do you do when he refuses a food?)
• Tests parental responses to his behavior (What do you do if he cries after you leave the room?)
• May be fearful in some situations
• Prefers mother and/or regular caregiver over all others
• Repeats sounds or gestures for attention
• Finger-feeds himself
• Extends arm or leg to help when being dressed

Developmental Health Watch

Each baby develops in his own manner, so it’s impossible to tell exactly when your child will perfect a given skill. Although the developmental milestones listed in this book will give you a general idea of the changes you can expect as your child gets older, don’t be alarmed if his development takes a slightly different course. Alert your pediatrician if your baby displays any of the following signs of possible developmental delay in the eight-to twelve-month age range.

• Does not crawl
• Drags one side of body while crawling (for over one month)
• Cannot stand when supported
• Does not search for objects that are hidden while he watches
• Says no single words (“mama” or “dada”)
• Does not learn to use gestures, such as waving or shaking head
• Does not point to objects or pictures

Movement milestones

• Walks alone
• Pulls toys behind her while walking
• Carries large toy or several toys while walking
• Begins to run
• Stands on tiptoe
• Kicks a ball
• Climbs onto and down from furniture unassisted
• Walks up and down stairs holding on to support
• Milestones in hand and finger skills
• Scribbles spontaneously
• Turns over container to pour out contents
• Builds tower of four blocks or more
• Might use one hand more frequently than the other

Language milestones

• Points to object or picture when it’s named for him
• Recognizes names of familiar people, objects, and body parts
• Says several single words (by fifteen to eighteen months)
• Uses simple phrases (by eighteen to twenty-four months)
• Uses two- to four-word sentences
• Follows simple instructions
• Repeats words overheard in conversation

Cognitive milestones

• Finds objects even when hidden under two or three covers
• Begins to sort by shapes and colors
• Begins make-believe play

Social and emotional milestones

• Imitates behavior of others, especially adults and older children
• Increasingly aware of herself as separate from others
• Increasingly enthusiastic about company of other children
• Demonstrates increasing independence
• Begins to show defiant behavior
• Increasing episodes of separation anxiety toward midyear, then they fade

Developmental health watch

Because each child develops at his own particular pace, it’s impossible to tell exactly when yours will perfect a given skill. The developmental milestones will give you a general idea of the changes you can expect as your child gets older, but don’t be alarmed if he takes a slightly different course. Alert your pediatrician, however, if he displays any of the following signs of possible developmental delay for this age range.

• Cannot walk by eighteen months
• Fails to develop a mature heel-toe walking pattern after several months of walking, or walks exclusively on his toes
• Does not speak at least fifteen words by eighteen months
• Does not use two-word sentences by age two
• Does not seem to know the function of common household objects (brush, telephone, bell, fork, spoon) by fifteen months
• Does not imitate actions or words by the end of this period
• Does not follow simple instructions by age two
• Cannot push a wheeled toy by age two

Movement milestones

• Hops and stands on one foot up to five seconds
• Goes upstairs and downstairs without support
• Kicks ball forward
• Throws ball overhand
• Catches bounced ball most of the time
• Moves forward and backward with agility

Milestones in hand and finger skills

• Copies square shapes
• Draws a person with two to four body parts
• Uses scissors
• Draws circles and squares
• Begins to copy some capital letters

Language milestones

• Understands the concepts of “same” and “different”
• Has mastered some basic rules of grammar
• Speaks in sentences of five to six words
• Speaks clearly enough for strangers to understand
• Tells stories

Cognitive milestones

• Correctly names some colors
• Understands the concept of counting and may know a few numbers
• Approaches problems from a single point of view
• Begins to have a clearer sense of time
• Follows three-part commands
• Recalls parts of a story
• Understands the concept of same/different
• Engages in fantasy play

Social and emotional milestones

• Interested in new experiences
• Cooperates with other children
• Plays “Mom” or “Dad”
• Increasingly inventive in fantasy play
• Dresses and undresses
• Negotiates solutions to conflicts
• More independent
• Imagines that many unfamiliar images may be “monsters”
• Views self as a whole person involving body, mind, and feelings
• Often cannot distinguish between fantasy and reality

Developmental health watch

Because each child develops in his own particular manner, it’s impossible to tell exactly when or how he’ll perfect a given skill. The developmental milestones listed here will give you a general idea of the changes you can expect as your child gets older, but don’t be alarmed if his development takes a slightly different course. Alert your pediatrician, however, if your child displays any of the following signs of possible developmental delay for this age range.

• Cannot throw a ball overhand
• Cannot jump in place
• Cannot ride a tricycle
• Cannot grasp a crayon between thumb and fingers
• Has difficulty scribbling
• Cannot stack four blocks
• Still clings or cries whenever his parents leave him
• Shows no interest in interactive games
• Ignores other children
• Doesn’t respond to people outside the family
• Doesn’t engage in fantasy play
• Resists dressing, sleeping, using the toilet
• Lashes out without any self-control when angry or upset
• Cannot copy a circle
• Doesn’t use sentences of more than three words
• Doesn’t use “me” and “you” appropriately

Movement milestones

• Stands on one foot for ten seconds or longer
• Hops, somersaults
• Swings, climbs
• May be able to skip

Milestones in hand and finger skills

• Copies triangle and other geometric patterns
• Draws person with body
• Prints some letters
• Dresses and undresses without assistance
• Uses fork, spoon, and (sometimes) a table knife
• Usually cares for own toilet needs

Language milestones

• Recalls part of a story
• Speaks sentences of more than five words
• Uses future tense
• Tells longer stories
• Says name and address

Cognitive milestones

• Can count ten or more objects
• Correctly names at least four colors
• Better understands the concept of time
• Knows about things used every day in the home (money, food, appliances)

Social and emotional milestones

• Wants to please friends
• Wants to be like her friends
• More likely to agree to rules
• Likes to sing, dance, and act
• Shows more independence and may even visit a next-door neighbor by herself
• Aware of sexuality
• Able to distinguish fantasy from reality
• Sometimes demanding, sometimes eagerly cooperative

Developmental health watch

Because each child develops in her own particular manner, it’s impossible to predict exactly when or how your own preschooler will perfect a given skill. The developmental milestones listed here will give you a general idea of the changes you can expect as your child gets older, but don’t be alarmed if her development takes a slightly different course. Alert your pediatrician, however, if your child displays any of the following signs of possible developmental delay for this age range.

• Exhibits extremely fearful or timid behavior
• Exhibits extremely aggressive behavior
• Is unable to separate from parents without major protest
• Is easily distracted and unable to concentrate on any single activity for more than five minutes
• Shows little interest in playing with other children
• Refuses to respond to people in general, or responds only superficially
• Rarely uses fantasy or imitation in play
• Seems unhappy or sad much of the time
• Doesn’t engage in a variety of activities
• Avoids or seems aloof with other children and adults
• Doesn’t express a wide range of emotions
• Has trouble eating, sleeping, or using the toilet
• Can’t differentiate between fantasy and reality
• Seems unusually passive
• Cannot understand two-part commands using prepositions (“Put the cup on the table”; “Get the ball under the couch.”)
• Can’t correctly give her first and last name
• Doesn’t use plurals or past tense properly when speaking
• Doesn’t talk about her daily activities and experiences
• Cannot build a tower of six to eight blocks
• Seems uncomfortable holding a crayon
• Has trouble taking off her clothing
• Cannot brush her teeth efficiently
• Cannot wash and dry her hands