Developmental milestones are physical or behavioral signs of maturation and development of infants and children. Developmental milestones are predictable time periods that most children learn and master new skills. Skills to master include, but are not limited to: motor skills such as walking, social skills such as reciprocating a smile and language skills such as using spontaneous phrases to communicate wants and needs. Milestones develop in a sequential fashion. This means that a child will need to develop some skills before he can develop new skills. For example, children must first learn to pull up to a standing position before they are able to walk. Each milestone that a child acquires builds on the last milestone developed.
There are multiple areas in which children develop in a sequential fashion. These can include cognitive development, academic development, fine motor skills, gross motor skills, social and play skills, emotional development and language skills. We offer milestones for the three primary areas (gross motor, social and language development) that are often associated with developmental delays or possible autism.
Social Development
This is the child’s ability to interact with others. Social milestones are often harder to pinpoint than physical or gross motor milestones. Examples of this type of development would include: a six-week-old baby smiling, a ten-month-old baby waving bye-bye, or a five-year-old boy knowing how to take turns while playing games at school. Social development includes play skills, imaginative play with peers and reciprocating others’ social overtures.
Speech and Language Development
Long before children can say words or form a sentence, they are active language learners. Within a few short years, young children go from infants without language to excellent communicators, tellers of stories. Speech and language milestones include the child’s ability to understand others (receptive language), use language to communicate (expressive language) and use language in a social fashion (pragmatic language). For example, this includes a 10- month old baby reciprocating social babbling, a 12-month-old baby saying his first words, a two-year-old naming parts of his body, or a five-year-old learning to say “feet” instead of “foots”.
Gross Motor Development
From the newborn period, babies want to explore their world. They are eager to move their eyes, mouths, and bodies toward people and objects that comfort and interest them. Gross motor development is a child’s ability to use large muscles. For example, a six-month-old baby learns how to sit up with some support, a 12-month-old baby learns to pull up to a standing position while holding onto furniture, and a five-year-old learns to skip.
What You Should Expect at 1 Month:
Motor Skills:
- Follows objects visually with eyes
- Feeds well
- Moves symmetrically
Language Skills:
- Appears to respond to sound
- Cries to let you know when he / she is hungry, tired, cold, sick, wants to be held, etc.
What You Should Expect at 2 Months:
Motor Skills:
- Follows objects visually through range of 90 degrees
- Lifts head up on own momentarily
- Feeds well
Social Skills:
- Beginning to smile socially (smile when you smile at him / her)
- Discovers hands, may spend time looking at and exploring hands
Language Skills:
- May coo when you talk to him / her
- Starting to look in direction where sounds are coming from
What You Should Expect at 3-4 Months:
Motor Skills:
- Turns head toward direction of sound
- Visually tracks 180 degrees
- Supports weight on forearms to in-prone position (in “puppy prop”)
Language Skills:
- Gurgles, coos or similar sounds; varies pitch of voice
Social Skills:
- Imitates some facial expressions
- Enjoys playing; may cry when playing stops
- Smiles at sound of parent’s voice
- Sensory motor play emerges (grasping / retaining objects, mouthing them)
What You Should Expect at 6 Months:
Motor Skills:
- Holds head upright and steady
- Sits independently in tripod
- When placed prone, will lift chest off ground on extended arms
- Rolls over from stomach to back, from back to stomach
- Will pick up toy if placed within reach and can transfer toy from one hand to other
Language Skills:
- Makes m, b, d sounds
- Imitates reciprocal babbling
- Uses sound to express joy and displeasure
- Changes tone of voice “ah-oo”
- Stops babbling to listen to you talk and then babbles again (reciprocal babbling)
Social Skills:
- Reciprocates social smiles
- Turns head to look at where new sound is coming from, looks at speaker
- Visually interested in new things so tracks/reaches for objects with either hand
- Makes eye contact with parents
- When sharing eye contact with parent, stops smiling if parent looks away and looks to see where parent went
- Take away a toy and this child just looks for what is next
What You Should Expect at 9 Months:
Motor Skills:
- Can bear some weight on legs when held upright
- Will feed self a cookie or cracker
Language Skills:
- Turns head when name is called
- Babbles chain of sounds
Social Skills:
- Enjoys social play such as peek-a-boo
- Exploratory play emerges (manipulates objects, bang/throw objects)
What You Should Expect at 12 Months:
Motor Skills:
- Extends arm or leg to help with being dressed
- Beginning to walk
Language Skills:
- Babbling goes from monotone to inflection (change in tone)
- Says “da-da” to dad and “ma-ma” to mom
- Uses exclamations such as “oh-oh”
- Can follow a point (Understands when someone points and say “look at the ____”)
- Waves good-bye and can use other simple gestures
- Understands one step command associated with a gesture
- Gestures imitatively and to make some needs known (reaches up to be picked up, points to bottle or food, waves bye-bye)
- Points to comment (see that butterfly?)
- Has at least one word that means something
- “Jargon” multisyllabic babbling with inflection
- Reciprocal jargon
Social Skills:
- Imitates actions in his / her play, such as clapping when you clap
- Responds to own name most of the time
- Brings parent interesting toys and gives them to or shows them to parent
- Points to share interest
- Plays peek-a-boo
- Functional play emerges (e.g. builds towers with blocks)
- Wary of doctors and strangers and seeks comfort from caregiver
- Take away a toy and child looks for where it went
- Attachment to a blanket or stuffed animal is common
What You Should Expect at 15-18 Months:
Language Skills:
- Points to a desired item that is out of reach
- Follows simple commands with gestures
- Understands some one step command without the gesture
- Can retrieve an object from another room when asked
- Points to a few body parts upon request
- Can name a few objects in a book when you point at them
- By 18 months, has about 10 words in vocabulary
Social Skills:
- Points to an object of interest to get adults to look at it
- Shows parents objects
- Enjoys playing pretend (simple pretend play such as talking on a toy phone, feeding a doll)
- Imitates pretending to feed the doll or stuffed animal
- Uses toys appropriate to their function (comb goes with hair, bells are shaken to ring, dials are turned to produce result)
What You Should Expect at 2 Years:
Language Skills:
- Follows 2-step directives
- Says 50-100 words
- Says several 2-word phrases
- Has >50 words to too many to count
- Presents with 2-word combinations
- Uses words to make needs known rather than grunting with point
- 50% of words are intelligible to strangers
Social Skills:
- Imitates behaviors of others
- Becoming more interested in other children
- Enjoys complex pretend play such as tea parties or building a fort
- Enjoys Symbolic Play (pretending an object is something else, such as pretending to talk on a banana instead of a telephone)
- Imitates housework or using tools or gender modeling
What You Should Expect at 3 Years:
Language Skills:
- Follows 2-3 step directives
- Understands most sentences
- Uses 4-5 word sentences
- Uses pronouns and plurals
Social Skills:
- Spontaneously imitates adults and children
- Spontaneously shows affection to familiar peers
- Can take turns in a game
- Engages in multiple step complex pretend play – several successive pretend play scenarios (i.e. feeding, changing clothes and putting doll to sleep)
What You Should Expect at 4 Years:
Language Skills:
- Speaks in 5-6 word phrases
- Tells stories
Social Skills:
- Interested in new experiences
- Cooperates with other children
- Plays imaginatively / fantasy play
- Negotiates solutions to conflicts
What You Should Expect at 5 Years:
Social Skills:
- Wants to please friends
- Wants to be like friends
- Has preference for certain peers over others
The National Center on Birth Defects and Developmental Disabilities launched a campaign to promote child development. For more information on child development, visit the Act Early website: http://www.cdc.gov/ncbddd/autism/actearly/.
What if my child does not meet a developmental milestone?
Children may meet developmental milestones a little earlier or later than their peers. However, there are definite windows of time when most children will meet a milestone. For example, children learn to walk anytime between 9 and 15 months of age. So, if your child is 13 months of age and not yet walking, there may be no need to worry if he is crawling and pulling to a stand. He has acquired the skills he needs to learn to walk and may begin walking soon. However, if you have a child 16 months of age who is not yet walking, it is a good idea to talk with your child’s pediatrician to make sure there aren’t any medical or developmental problems since age 16 months is outside of the normal “window” or time frame in which children learn to walk.
We recommend that if your child is not meeting developmental milestones, you take an active approach that includes obtaining evaluations, assembling your treatment team and starting early intervention in order to give your child the support he may need. Parents should consult with their pediatrician, and there are also several clinical specialists who are specifically trained in various areas of development who can be consulted. Dr. Knapp is a pediatric psychologist who specializes in child development and families can schedule an assessment to determine if their child requires treatment intervention. Appropriate referrals will be made and may include speech pathologists, occupational and physical therapists, neurologists, audiologists, behavioral therapists and early intervention programs.