Overview
Developmental milestones are patterns in development that children are expected to progress through. Key age-related milestones have been established which allow for early identification and management of developmental delay.
Developmental milestones are split into four major domains:
- Gross motor – large movements such as maintaining posture, sitting, standing, walking,
- Fine motor and vision – skilled, precise movements and hand-eye coordination
- Hearing, speech, and language – understanding of communication and language
- Social, emotional, and behavioural – interacting and communicating with others
Any delay or regression in milestones warrants a referral to a paediatrician.
Gross Motor Milestones
Overview
Some major gross motor milestones are as follows:
| Age | Milestone |
| 6 weeks | Raises head to 45° when prone (during ‘tummy time) and can move head side to side |
| 6 months | Lifts head spontaneously Sits without support |
| 9 months | Can stand up with support Crawls Should be able to sit up without support by 9 months |
| 12 months | Walks alone – 18 months is the threshold for concern for walking |
| 18 months | Jumps, squats to pick things up from the floor |
| 2 years | RunsWalks up and down stairs holding onto support (e.g. a rail) |
| 2.5 years | Kicks ball |
| 3 years | Hops on one foot for 3 steps on each foot Walks up stairs without support |
| 4 years | Walks up and downstairs in an adult manner Hops on one leg |
Red flags
Delays in gross motor skills may suggest neurological abnormalities such as cerebral palsy, muscular dystrophy (especially in boys), or hypotonia (which may be associated with genetic disorders including Down’s syndrome, Prader-Willi syndrome etc.). These children should be referred to a paediatrician for assessment. Some gross motor red flags include:
- Not sitting unsupported by 8 months
- Not walking independently by 15 months for girls or 18 months for boys
In most cases, delays are normal variants, however, this can only be confirmed by ruling out other potential causes.
Fine Motor Milestones
Overview
Some major fine motor milestones are as follows:
| Age | Milestone |
| 6 weeks | Should fix and follow objects/faces from birth |
| 6 months | Holds items in palmar grasp Passes object from one hand to the other |
| 9 months | Points with finger Object permanence Early pincer grip Bangs cubes |
| 12 months | Good pincer crip Picking up and throwing bricks – disappears by 18 months |
| 15 months | Scribbles to and fro |
| 2 years | Circular scribble |
| 3 years | Tower of 9-10 bricks Cuts with scissors Copies circle |
| 4 years | Copies square or cross Builds 10-brick tower |
| 5 years | Draws a person |
Red flags
Some red flags include:
- Early asymmetry of hand function (hand preference) before 12 months
- Persistent throwing bricks (except in a temper tantrum) after 18 months
- Fixing and following should start from birth, if not doing so at 6 weeks, this is abnormal
- Squints beyond 8 weeks require an ophthalmology assessment
Hearing, Speech, and Language Milestones
Overview
Some major hearing, speech, and language milestones are as follows:
| Age | Milestone |
| 6 weeks | Quietens to parent’s voice Vocalises |
| 3 months | Turns to sound |
| 6 months | Babbles Turns to voice |
| 9 months | Double syllable babbles |
| 12 months | One or two words Imitates sounds Knows and responds to own name |
| 18 months | Points to 1 body part 6-12 words (refer at 18 months) Understands simple commands |
| 2 years | Combines 2 words Can name 2 body parts 20-50 words |
| 3 years | Basic sentences |
| 4 years | Tells stories Uses past tense Can count to 20 |
Red flags
Some red flags include:
- No double syllable babbles at 12 months
- No words at 18 months
- No 2-3 word sentences by 2.5 years
- Speech unintelligible by 4 years
Hearing should always be checked in children with delayed language development.
Social, Emotional, and Behavioural Milestones
Overview
Some major social, emotional, and behavioural milestones are as follows:
| Age | Milestone |
| 6 weeks | Social smile (refer at 10 weeks if not present, suggests visual problem) |
| 3 months | Laughs |
| 6 months | Stranger awareness present Not shy and engages with people |
| 9 months | Waves ‘bye-bye’Indicates wants Holds and bites food |
| 12 months | Understands ‘no’ Gives up a toy Claps hands |
| 18 months | Symbolic play Imitates everyday activities Drinks from a cup Asks for food/drink |
| 2 years | Can feed self with spoon Does not spill with cup |
| 3 years | Mostly dry by day Can dress with help and undress self Eats with fork and spoon Shares toys with friends Can play alone without parents |
| 4 years | Dresses with help Plays with other children Can dress and undress independently except for shoelaces and buttons Dry by day and nightImaginative play Has best friend |
Red flags
Some red flags include:
- No social smile at 10 weeks
- No interest in others at 18 months
