Normal Pediatric Developmental Milestones

Developmental Milestones: 1 Month

What are some of the developmental milestones my child should reach by one month of age?

In the very beginning, it may seem that your baby does nothing but eat, sleep, cry, and fill his diapers. By the end of the first month, he'll be much more alert and responsive. Gradually he'll begin moving his body more smoothly and with much greater coordination-especially in getting his hand to his mouth. You'll realize that he listens when you speak, watches you as you hold him, and occasionally moves his own body to respond to you or attract your attention.

Here are some other milestones to look for.

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

Developmental Milestones: 3 Months

What are some of the developmental milestones my child should reach by three months of age?

Your baby enters her second year and becomes a toddler, crawling vigorously, starting to walk, even talking a little. Exploring the boundaries established by your rules and her own physical and developmental limits will occupy much of her time for the next few years.

Here are some other milestones to look for.

  • 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

Developmental Milestones: 2 Year Olds

What are some of the developmental milestones my child should reach by two years of age?

Your baby enters her second year and becomes a toddler, crawling vigorously, starting to walk, even talking a little. Exploring the boundaries established by your rules and her own physical and developmental limits will occupy much of her time for the next few years.
Here are some other milestones to look for.

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

Developmental Milestones: 3 to 4 Year Olds

What are some of the developmental milestones my child should reach by three to four years of age?

With your child's third birthday, the "terrible twos" are officially over and the "magic years" of three and four begin-a time when your child"s world will be dominated by fantasy and vivid imagination. During the next two years, he'll mature in many areas.

Here are some milestones to look for.

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

  • seaks 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

Developmental Milestones: 4 to 5 Year Olds

What are some of the developmental milestones my child should reach by four to five years of age?

Before you know it, the somewhat calm child of three becomes a dynamo of energy, drive, bossiness, belligerence, and generally out-of-bounds behavior. You may be reminded of the earlier trials and tribulations you went through when he was two. Also obvious during this time is the tremendous spurt of imaginative ideas that spring from children's minds and mouths. All of this behavior and thinking will help your youngster build a secure foundation as he emerges into the world of kindergarten.

Here are some other milestones to look for.

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

  • vopies triangle and other geometric patterns

  • fraws 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