DEVELOPMENTAL MILESTONES

1. DEVELOPMENTAL MILESTONES
“DEVELOPMENT IS NOT MERE ATTAINMENT OF MILESTONES”
DR ARAVIND A

2. INTRODUCTION
Development is a continuous process from conception till maturity.
It goes through a process of many preceding stages of development.
Sequence of development is same, rate of development varies from
child to child
Certain primitive reflexes need to be lost before any milestone to
develop. Ex walking reflex, palmar grasp, ATNR
Development is cephalo-caudal
“What a child does is not important, how a child does it is more
important”

3. 4 fields with a sequence of development
Gross Motor - the development of locomotion
Vision and fine manipulation – the development of eye-hand
control
Hearing & speech - the development of language
Personal & social - integration of acquired abilities to reflect
understanding of env.

4. FIRST STEP OF DEVELOPMENT IS HEAD CONTROL
GROSS MOTOR : Involves control of child over his body.
Tested in :
Ventral Suspension: Baby held in prone position and lifted off the bed.
Newborn – head flops down
4 weeks – lifts head momentarily for a few moments
6 weeks – head lifted in line to the plane of body
8 weeks – head lifted beyond the plane of body
12 wks – brings head to plane of body and then above plane of body
and maintains in that position.
VENTRAL SUSPENSION IS THE MOST SENSITIVE METHOD TO CHECK HEAD
CONTROL IN FIRST 3 MONTHS.

6. Supine :
Child placed supine and gently pulled up by the arms
Newborn – head lag
By 16-20 wks – head in plane of body or ahead with back straight
Prone:
Newborn – can turn head to 1 side
1 mth – lifts chin momentarily
3 mths – lifts head and upper chest
6 mths –lifts head & chest
5-8 mths – rolls over, first back to side and front
8 mths – crawls

12. Sitting:
5 mths – sits with support
8 mths – sits steadily with back straight, without support
10 mths – pulls from supine to sitting position
Standing:
4 mths-Bears weight on legs
9 mths – early stepping movements, pulls to standing with help of
furniture
10 mths – cruising
13 –15 mths – walks unsupported
15 mths – walks sideways/backwards

13. Climbing stairs :
15 months – crawls up stairs
18 months – walks up stairs with one hand held
2 yrs – climbs stairs – 2 feet per step
3 yrs – climbs up stairs – one foot per step, rides tricycle
4 yrs – climbs down one foot per step

17. Key Gross motor milestones:
3 mths – neck holding
5 mths – sitting with support
8 mths – sitting without support
9 mths –standing with support
10 months – cruising
12 mths – standing without support
14 mths – walking without support
18 mths – running
24 mths – walking upstairs

18. FINE MOTOR OR ADAPTIVE MILESTONES
Includes eye coordination, hand eye coordination, hand
mouth coordination and manipulation with
hand(grasping, thumb-finger apposition, dressing)
Eye coordination:
4 wks – regards torch/red ring kept at 20 cm in front
6 wks – follows object from side to side –unsteadily
2-3 mths – follows with steady movements of eyes
Binocular vision by 3-6 months

19. Hand eye coordination:
4 mths – tries to grasp red ring dangling in front but may overshoot
5 mths – reaches out & grasps object with ulnar side
6 mths – radial grasp, transfers objects from hand to hand
10 mths – pincer grasp(between thumb and forefinger) – picks up pellet
Hand-mouth coordination:
1 yr – tries to feed with spoon but may spill
15 mths – feeds with spoon
18 mths – feeds self from cup

20. Hand skills: Book:
13 mths – turn 2-3 pages at a time
24 mths – turns 1 page at a time
Scribbling:
12-24 mths – scribbles
1.5 yrs – copies vertical line
2 ½ yrs –copies horizontal line
3 yrs – circle
4 yrs – cross, rectangle
5 yrs – copies cross, triangle

23. Tower of cubes
15 months – tower of 2 cubes
18 months – tower of 3 cubes
24 months – tower of 6 cubes
3 months – tower of 9 cubes
4 years – bridge with cubes
5 years – gate with cubes

24. ● Disappearance of asymmetric tonic neck reflex
enables infant to examine objects in midline
and grasp with both hands

25. LANGUAGE DEVELOPMENT
1 mth - turns head towards sound
3-5 mths - vowel sounds, gurgles
6 mths - monosyllables
9 mths - bisyllables
10 mths - understands spoken speech
12 mths - speaks 2 words with meaning
18 mths - 20 words
24 mths - joins 2-3 words in a short sentence
2.5 yrs – knows full name
3 yrs - 250 words, knows age and sex
RULE OF THUMB: NO OF WORDS IN A TYPICAL SENTENCE EQUALS THE CHILD’S AGE

26. BOWEL & BLADDER CONTROL
Early months - gastrocolic reflex  defecates after each feed
7 mths - no relation to feeds
Toilet trainable by 18mths - 2 yrs
BED WETTING NORMAL TILL 4 yrs in girls and 5 yrs in boys

27. PERSONAL & SOCIAL DEVELOPMENT
2 mth - social smile
3 mths - recognises mother/caretaker
4 mths – laughs loud
6 mths - enjoys mirror
7-8 mths – separation/stranger anxiety
9 mths - waves bye-bye
18 mths – complaints when wet or soiled
3 years – helps in dressing
5 years – dresses and undresses

28. DEVELOPMENTAL SCREENING:
Denver Development Screening Test: Most widely used - 4 scales, 125
items
Baroda Development Screening Test: Adapted from Bayley scales for
Indian children
Trivandrum Development Screening Test

30. REFERENCES
Growth and development of child – ILLINGSWORTH
NELSON textbook of pediatrics 20th edition
FORFER & ARNELL textbook of pediatrics

31. SELF ASSESSMENT

34. ● HANDEDNESS IS ESTABLISHED AT
● OBJECT PERMANENCE IS ESTABLISHED AT
● CHILD TELLS STORIES AT

35. Neonatal period
Prone: turns head side to side, head sags on
ventral suspension, legs in flexed attitude
Visual: dolls eye movement of eyes on turning of
the body
Reflex: moro reflex active, grasp reflex active

36. 1 month
● Prone: head lifted momentarily on ventral
suspension, legs more extended
● Supine: head lags in sitting position
● Visual : follows moving object

37. 2 month
● Prone: head sustained in plane of body on
ventral suspension
● Supine: head lag continues
● Visual : follows moving object 180 degrees
● Social: smiles on social contact

38. 3 months
● Prone: head above the plane of body on ventral
suspension
● Supine: reaches for objects
● sitting position – head control starts with
bobbling motion
● Reflex: moro reflex disappears

39. 4 months
● Hands in midline, reaches objects
● No head lag in sitting position
● Laughes out loud

40. 7 months
● Rolls over
● Crawls or creeps
● Sits with support
● Immature pincer grasp
● Uses monosyllable words
● Teeth eruption starts

41. 10 months
● Sits without support, back straight
● Cruises or walks with support
● Mature pincer grasp
● Object permanence (constancy)
● Says mama, dada
● Waves bye-bye
● Stranger anxiety

42. 1 year
● Walks few steps
● Releases object to request or gesture
● Simple ball game