Bright Future – Developmental Milestones

Bright Future – Developmental Milestones

Developmental milestones are intended for discussion with parents for the purposes of surveillance of a child’s developmental progress and for developmental promotion for the child. They are not intended or validated for use as a developmental screening test in the pediatric medical home or in early childhood day care or educational settings. Milestones are also commonly used for instructional purposes on early child development for pediatric and child development professional trainees.

Age	social language and self-help	Verbal language (Expressive and receptive)	Gross Motor	Fine Motor
Newborn– 1 Week	Makes brief eye contact with adult when held	Cries with discomfort Calms to adult voice	Reflexively moves arms and legs Turns head to side when on stomach	Holds fingers closed Grasps reflexively
1 Month	Calms when picked up or spoken to Looks briefly at objects	Alerts to unexpected sound Makes brief short vowel sounds	Holds chin up in prone	Holds fingers more open at rest
2 Months	Smiles responsively (ie, social smile)	Vocalizes with simple cooing	Lifts head and chest in prone	Opens and shuts hands

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Age	social language and self-help	Verbal language (Expressive and receptive)	Gross Motor	Fine Motor
4 Months	Laughs aloud	Turns to voice Vocalizes with extended cooing	Rolls over prone to supine Supports on elbows and wrists in prone	Keeps hands unfisted Plays with fingers in midline Grasps object
6 Months	Pats or smiles at reflection Begins to turn when name called	Babbles	Rolls over supine to prone Sits briefly without support	Reaches for objects and transfers Rakes small object with 4 fingers Bangs small object on surface
9 Monthsb	Uses basic gestures (holds arms out to be picked up, waves bye-bye)	Says “Dada” or “Mama” nonspecifically	Sits well without support Pulls to stand Transitions well between sitting and lying Balances on hands and knees Crawls	Picks up small object with 3 fingers and thumb Releases objects intentionally
	Looks for dropped objects			Bangs objects together
	Picks up food with fingers and eats it
	Turns when name called

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Age	social language and self-help	Verbal language (Expressive and receptive)	Gross Motor	Fine Motor
12 Months	Looks for hidden objects Imitates new gestures	Says “Dada” or “Mama” specifically Uses 1 word other than Mama, Dada, or personal names Follows a verbal command that includes a gesture	Takes first independent steps Stands without support	Drops object in a cup Picks up small object with 2-finger pincer grasp
15 Months	Imitates scribbling Drinks from cup with little spilling Points to ask for something or to get help	Uses 3 words other than names Speaks in jargon Follows a verbal command with- out a gesture	Squats to pick up objects Climbs onto furniture Begins to run	Makes mark with crayon Drops object in and takes object out of a container
18 Monthsb,c	Engages with others for play Helps dress and undress self	Uses 6–10 words other than names	Walks up with 2 feet per step with hand held	Scribbles spontaneously
	Points to pictures in book Points to object of interest to draw attention to it	Identifies at least 2 body parts	Sits in small chair Carries toy while walking	Throws small ball a few feet while standing
	Turns and looks at adult if something new happens
	Begins to scoop with spoon

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Age	social language and self-help	Verbal language (Expressive and receptive)	Gross Motor	Fine Motor
2 Yearsc	Plays alongside other children (parallel) Takes off some clothing Scoops well with spoon	Uses 50 words Combines 2 words into short phrase or sentence Follows 2-step command Uses words that are 50% intelligible to strangers	Kicks ball Jumps off ground with 2 feet Runs with coordination	Stacks objects Turns book pages Uses hands to turn objects (eg, knobs, toys, and lids)
2½ Yearsb	Urinates in a potty or toilet Engages in pretend or imitative play	Uses pronouns correctly	Begins to walk up steps, alternating feet	Grasps crayon with thumb and fingers instead of fist
	Spears food with fork		Runs well without falling	Catches large balls
3 Years	Enters bathroom and urinates by self Plays in cooperation and shares Puts on coat, jacket, or shirt by self	Uses 3-word sentences Uses words that are 75% intelligible to strangers	Pedals tricycle Climbs on and off couch or chair	Draws a single circle Draws a person with head and 1 other body part
	Engages in beginning imaginative play Eats independently	Understands simple prepositions (eg, on, under)	Jumps forward	Cuts with child scissors

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Age	social language and self-help	Verbal language (Expressive and receptive)	Gross Motor	Fine Motor
4 Years	Enters bathroom and has bowel movement by self Brushes teeth	Uses 4-word sentences Uses words that are 100% intelligible to strangers	Climbs stairs, alternating feet without support Skips on 1 foot	Draws a person with at least 3 body parts Draws simple cross
	Dresses and undresses without much help			Unbuttons and buttons medium- sized buttons
	Engages in well-developed imaginative play			Grasps pencil with thumb and fingers instead of fist

Reproduced from Lipkin P, Macias M. Promoting healthy development. Table 1. Developmental milestones for developmental surveillance at preventive care visits. In: Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017.

a These milestones generally represent the mean or average age of performance of these skills when available. When not available, the milestones offered are based on review and consensus from multiple measures as noted.

b It is recommended that a standardized developmental test be performed at these visits.

c It is recommended that a standardized autism screening test be performed at these visits.

Sources: Capute AJ, Shapiro BK, Palmer FB, Ross A, Wachtel RC. Normal gross motor development: the influences of race, sex and socio-economic status. Dev Med Child Neurol. 1985;27(5):635–643; Accardo PJ, Capute AJ. The Capute Scales: Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS). Baltimore, MD: Paul H. Brooks Publishing Co; 2005; Beery KE, Buktenica NA, Beery NA. The Beery-Buktenica Developmental Test of Visual-Motor Integration, Sixth Edition (BEERY VMI). San Antonio, TX: Pearson Education Inc; 2010; Schum TR, Kolb TM, McAuliffe TL, Simms MD, Underhill RL, Lewis M. Sequential acquisition of toilet-training skills: a descriptive study of gender and age differences in normal children. Pediatrics. 2002;109(3):E48; Oller JW Jr, Oller SD, Oller SN. Milestones: Normal Speech and Language Development Across the Lifespan. 2nd ed. San Diego, CA: Plural Publishing Inc; 2012; Robins DL, Casagrande K, Barton M, Chen CM, Dumont-Mathieu T, Fein D. Validation of the Modified Checklist

for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F). Pediatrics. 2014;133(1):37–45; Aylward GP. Bayley Infant Neurodevelopmental Screener. San Antonio, TX: The Psychological Corporation; 1995; Squires J, Bricker D. Ages & Stages Questionnaires, Third Edition (ASQ-3): A Parent-Completed Child-Monitoring System. Baltimore, MD: Paul H. Brookes Publishing Co; 2009; Bly L. Motor Skills Acquisition Checklist. Psychological Corporation; 2000.