Growth and Developmental Milestones

Milestones of Prenatal Development

Prenatal Developmental Events

• Week 1 Fertilization and implantation; beginning of embryonic period
• Week 2 Endoderm and ectoderm appear (bilaminar embryo)
• Week 3 First missed menstrual period; mesoderm appears (trilaminar embryo); somites begin to form
• Week 4 Neural folds fuse; folding of embryo into human-like shape; arm and leg buds appear; crown-rump length 4-5 mm
• Week 5 Lens placodes, primitive mouth, digital rays on hands
• Week 6 Primitive nose, philtrum, primary palate
• Week 7 Eyelids begin; crown-rump length 2 cm
• Week 8 Ovaries and testes distinguishable
• Week 9 Fetal period begins; crown-rump length 5 cm; weight 8 g
• Week 12 External genitals distinguishable
• Week 20 Usual lower limit of viability; weight 460 g; length 19 cm
• Week 25 Third trimester begins; weight 900 g; length 24 cm
• Week 28 Eyes open; fetus turns head down; weight 1,000-1,300 g
• Week 38 Term

Developmental Milestones in 1^st 2 Year of Life

Gross Motor Milestones

• Holds head steady while sitting - 2 months: (Allows more visual interaction)
• Pulls to sit, with no head lag - 3 months: (Muscle tone)
• Brings hands together in midline - 3 months: (Self-discovery of hands)
• Asymmetric tonic neck reflex gone - 4 months: (Can inspect hands in midline)
• Sits without support - 6 months: (Increasing exploration)
• Rolls back to stomach - 6.5 months: (Truncal flexion, risk of falls)
• Walks alone - 12 months: (Exploration, control of proximity to parents)
• Runs - 16 months: (Supervision more difficult)

Fine Motor Milestones

• Grasps rattle - 3.5 months: (Object use)
• Reaches for objects - 4 months: (Visuomotor coordination)
• Palmar grasp gone - 4 months: (Voluntary release)
• Transfers object hand to hand - 5.5 months: (Comparison of objects)
• Thumb-finger grasp - 8 months: (Able to explore small objects)
• Turns pages of book - 12 months: (Increasing autonomy during book time)
• Scribbles - 13 months: (Visuomotor coordination)
• Builds tower of 2 cubes - 15 months: (Uses objects in combination)
• Builds tower of 6 cubes - 22 months: (Requires visual, gross, and fine motor coordination)

Communication and Language Milestones

• Smiles in response to face, voice - 1.5 months: (More active social participant)
• Monosyllabic babble - 6 months: (Experimentation with sound, tactile sense)
• Inhibits to "no" - 7 months: (Response to tone (nonverbal))
• Follows 1-step command with gesture - 7 months: (Nonverbal communication)
• Follows 1-step command without gesture - 10 months: (Verbal receptive language (e.g., "Give it to me"))
• Says "mama" or "dada" - 10 months: (Expressive language)
• Points to objects - 10 months: (Interactive communication)
• Speaks first real word - 12 months: (Beginning of labeling)
• Speaks 4-6 words - 15 months: (Acquisition of object and personal names)
• Speaks 10-15 words - 18 months: (Acquisition of object and personal names)
• Speaks 2-word sentences (e.g., "Mommy shoe") - 19 months: (Beginning grammatization, corresponds with 50-word vocabulary)

Cognitive Milestones

• Stares momentarily at spot where object disappeared - 2 months: (Lack of object permanence (out of sight, out of mind; e.g., yarn ball dropped))
• Stares at own hand - 4 months: (Self-discovery, cause and effect)
• Bangs 2 cubes - 8 months: (Active comparison of objects)
• Uncovers toy (after seeing it hidden) - 8 months: (Object permanence)
• Egocentric symbolic play (e.g., pretends to drink from cup) - 12 months: (Beginning symbolic thought)
• Uses stick to reach toy - 17 months: (Able to link actions to solve problems)
• Pretend play with doll (e.g., gives doll bottle) - 17 months: (Symbolic thought)

Emerging Patterns of Behavior During the 1st Year of Life

Neonatal Period (1st 4 wk)

• Prone: Lies in flexed attitude; turns head from side to side; head sags on ventral suspension
• Supine: Generally flexed and a little stiff
• Visual: May fixate face on light in line of vision; doll's eye movement (oculocephalic reflex) of eyes on turning of the body
• Reflex: Moro response active; stepping and placing reflexes; grasp reflex active
• Social: Visual preference for human face

At 1 mo

• Prone: Legs more extended; holds chin up; turns head; head lifted momentarily to plane of body on ventral suspension
• Supine: Tonic neck posture predominates; supple and relaxed; head lags when pulled to sitting position
• Visual: Watches person; follows moving object
• Social: Body movements in cadence with voice of other in social contact; beginning to smile

At 2 mo

• Prone: Raises head slightly farther; head sustained in plane of body on ventral suspension
• Supine: Tonic neck posture predominates; head lags when pulled to sitting position
• Visual: Follows moving object 180 degrees
• Social: Smiles on social contact; listens to voice and coos

At 3 mo

• Prone: Lifts head and chest with arms extended; head above plane of body on ventral suspension
• Supine: Tonic neck posture predominates; reaches toward and misses objects; waves at toy
• Sitting: Head lag partially compensated when pulled to sitting position; early head control with bobbing motion; back rounded
• Reflex: Typical Moro response has not persisted; makes defensive movements or selective withdrawal reactions
• Social: Sustained social contact; listens to music; says "aah, ngah"

At 4 mo

• Prone: Lifts head and chest, with head in approximately vertical axis; legs extended
• Supine: Symmetric posture predominates, hands in midline; reaches and grasps objects and brings them to mouth
• Sitting: No head lag when pulled to sitting position; head steady, tipped forward; enjoys sitting with full truncal support
• Standing: When held erect, pushes with feet
• Adaptive: Sees raisin, but makes no move to reach for it
• Social: Laughs out loud; may show displeasure if social contact is broken; excited at sight of food

At 7 mo

• Prone: Rolls over; pivots; crawls or creep-crawls (Knobloch)
• Supine: Lifts head; rolls over; squirms
• Sitting: Sits briefly, with support of pelvis; leans forward on hands; back rounded
• Standing: May support most of weight; bounces actively
• Adaptive: Reaches out for and grasps large object; transfers objects from hand to hand; grasp uses radial palm; rakes at raisin
• Language: Forms polysyllabic vowel sounds
• Social: Prefers mother; babbles; enjoys mirror; responds to changes in emotional content of social contact

At 10 mo

• Sitting: Sits up alone and indefinitely without support, with back straight
• Standing: Pulls to standing position; "cruises" or walks holding on to furniture
• Motor: Creeps or crawls
• Adaptive: Grasps objects with thumb and forefinger; pokes at things with forefinger; picks up pellet with assisted pincer movement; uncovers hidden toy; attempts to retrieve dropped object; releases object grasped by other person
• Language: Repetitive consonant sounds ("mama," "dada")
• Social: Responds to sound of name; plays peek-a-boo or pat-a-cake; waves bye-bye

At 1 yr

• Motor: Walks with one hand held; rises independently, takes several steps (Knobloch)
• Adaptive: Picks up raisin with unassisted pincer movement of forefinger and thumb; releases object to other person on request or gesture
• Language: Says a few words besides "mama," "dada"
• Social: Plays simple ball game; makes postural adjustment to dressing

Emerging Patterns of Behavior From 1-5 Year of Age

15 MO

• Motor: Walks alone; crawls up stairs
• Adaptive: Makes tower of 3 cubes; makes a line with crayon; inserts raisin in bottle
• Language: Jargon; follows simple commands; may name a familiar object (e.g., ball); responds to his/her name
• Social: Indicates some desires or needs by pointing; hugs parents

18 MO

• Motor: Runs stiffly; sits on small chair; walks up stairs with 1 hand held; explores drawers and wastebaskets
• Adaptive: Makes tower of 4 cubes; imitates scribbling; imitates vertical stroke; dumps raisin from bottle
• Language: 10 words (average); names pictures; identifies 1 or more parts of body
• Social: Feeds self; seeks help when in trouble; may complain when wet or soiled; kisses parent with pucker

24 MO

• Motor: Runs well, walks up and down stairs, 1 step at a time; opens doors; climbs on furniture; jumps
• Adaptive: Makes tower of 7 cubes (6 at 21 mo); scribbles in circular pattern; imitates horizontal stroke; folds paper once imitatively
• Language: Puts 3 words together (subject, verb, object)
• Social: Handles spoon well; often tells about immediate experiences; helps to undress; listens to stories when shown pictures

30 MO

• Motor: Goes up stairs alternating feet
• Adaptive: Makes tower of 9 cubes; makes vertical and horizontal strokes, but generally will not join them to make cross; imitates circular stroke, forming closed figure
• Language: Refers to self by pronoun "I"; knows full name
• Social: Helps put things away; pretends in play

36 MO

• Motor: Rides tricycle; stands momentarily on 1 foot
• Adaptive: Makes tower of 10 cubes; imitates construction of "bridge" of 3 cubes; copies circle; imitates cross
• Language: Knows age and sex; counts 3 objects correctly; repeats 3 numbers or a sentence of 6 syllables; most of speech intelligible to strangers
• Social: Plays simple games (in "parallel" with other children); helps in dressing (unbuttons clothing and puts on shoes); washes hands

48 MO

• Motor: Hops on 1 foot; throws ball overhand; uses scissors to cut out pictures; climbs well
• Adaptive: Copies bridge from model; imitates construction of "gate" of 5 cubes; copies cross and square; draws man with 2-4 parts besides head; identifies longer of 2 lines
• Language: Counts 4 pennies accurately; tells story
• Social: Plays with several children, with beginning of social interaction and role-playing; goes to toilet alone

60 MO

• Motor: Skips
• Adaptive: Draws triangle from copy; names heavier of 2 weights
• Language: Names 4 colors; repeats sentence of 10 syllables; counts 10 pennies correctly
• Social: Dresses and undresses; asks questions about meaning of words; engages in domestic role-playing

Disclaimer

The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.