Developmental milestones in children - What to expect and how to spot delay

As children grow and develop, their progress is marked by ‘milestones’. These milestones give a general indication of what to expect at different stages.

Knowing whether your child is achieving milestones when they are expected can give an early indication of any developmental difficulties and the need for proper assessment and an early diagnosis if there is one.

These early years (0-5 years old) are exceptional years for a child, as they have a remarkable ability to learn and adapt. Developmental difficulties picked up during this time respond better to therapy than later in life. The younger the better!

Here is a list of SOME of the developmental milestones from birth to pre-school.

Babies.

Your child’s first year is a very busy one, as they learn to interact with their surroundings, and reach milestones in leaps and bounds.

My baby is 4 weeks old, what can I expect?

• Many reflexes are still present, such as ‘walking’ when the soles of their feet touch the ground and the grasp reflex when a finger/pen is placed in their palm.
• Spontaneous movement is large and jerky. Both left and right sides are used equally.
• Minimal head/neck control when pulled into sitting from lying,
• Able to look at objects and focus on them for short periods of time,
• Startles with sudden noises
• Sleeps most of the time when not being fed or playing.

My baby is 4 months old, what can I expect?

• Able to bring both arms together in front of chest/face.
• Waves arms symmetrically.
• Kicks vigorously with both legs alternating or together.
• Able to hold head up when pulled into sitting from lying, and can lift head and upper chest up when lying on tummy.
• Moves head deliberately and attentively to gaze around.
• Beginning to react to family situations, such as feeding times.

My baby is 6 months old, what can I expect?

• When lying, will lift one, or both feet and grasp it with hands.
• When hands are grasped, will pull up into sitting.
• Can roll from front to back and sometimes back to front.
• When held in standing, bears weight through feet and bounces up and down actively.
• Uses whole hand to grasp and passes object from one hand to another.
• Can visually follow an adult moving across a room.
• Laughs, chuckles and squeals aloud in play.

My baby is 9 months old, what can I expect?

• Sits alone for about 10 minutes on the floor.
• Attempts to crawl.
• Pulls up into standing.
• Reaches and grasps objects in hands, able to turn them about and pass from hand to hand.
• Beginning to point at objects.
• Looks for fallen toys in the correct direction.
• Babbles tunefully, and understands ‘no’ and ‘bye-bye’.
• Plays Peek-a-boo and imitates clapping.

My baby just turned 1! What can I expect?

• Can raise from lying to a standing position.
• Can walk around a chair/coffee table while holding on.
• May stand alone/walk alone.
• May crawl up stairs.
• Beginning to show an interest in pictures.
• Picks up objects with thumb and index finger.
• Turns to own name (if they feel like it!).
• Tries to help with dressing and feeding.
• Likes to ‘share’ and will offer toys when requested or spontaneously.

Toddlers.

This stage in life is often regarded as the most mobile with the least ‘sense’!

At 18 months:

• Kneels without help.
• Runs carefully.
• Can carry an object, like a large teddy-bear while walking.
• Imitates writing/drawing.
• May begin to show preference with one hand.
• Speak 6 – 20+ recognisable words.
• Understands and obeys simple instructions.
• Holds and drinks from cup.

At 2 years:

• Runs safely, being able to stop and start and run around objects.
• Can climb up onto furniture and can climb down.
• Can turn individual pages of a book.
• Puts 2 or more words together to form simple sentences.
• Spoon feeds self without spilling too much.
• Defends own possessions toys with determination.

At 3 years:

• Climbs up and down stairs with alternating feet, usually can jump from the bottom step.
• Rides a tricycle and can steer around wide corners.
• Throw and catch a large ball.
• Can negotiate playground equipment well.
• Can thread large beads (or pasta tubes) onto a string.
• Asks many questions, and carries a simple conversation.
• Enjoys vivid make-believe play.

Pre-school and beyond.

Over the next couple of years, your child may learn to:

• Climb ladders and trees.
• Dances rhythmically.
• Hops.
• Draws recognisable objects (house, person, etc.).
• Shows sense of humour in conversation and activities.
• Enjoys reciting or singing songs and rhymes.
• Undresses and dresses self independently.

When should I be concerned?

The milestones listed are only a few in the long list on the path to your child’s growth and development. There is a large range of normal variation!

However, here are a few things to look out for to help you ask the right questions:

• Significant asymmetry or a right/left preference in the first 18months. For example,this could be only reaching for toys with one hand or keeping their head turned to one side.
• Not tolerating tummy time by 3-4 months of age.
• Avoids weight bearing through legs (feet) or arms (hands) from 6-8 months onwards. (Dislikes the crawl position or being held in standing with feet on the floor.)
• A significant, unexplained delay in reaching milestones.
• And quality of movement. What does it look like? From about 3 months onwards, movement is relatively smooth and fluid. If your baby’s movements are small and jerky or they lack large spontaneous movements, it’s time to ask more questions.

This is a guideline only, and there are many other factors which may influence the achievement of milestones, and when they occur. If you have any concerns, talk to your doctor/paediatrician or Maternal and Child Health Nurse, or book an appointment with one of our paediatric physiotherapists for an assessment.