OnExam

Assess all 4 areas: gross motor, fine motor, language, and social/adaptive. Pay particular attention to the loss of a previously demonstrated skill.

Premature infants (born at less than 37 wks) should have their expected developmental milestones corrected to their due date instead of their actual birth date until they are at least two years old.

2 Months

  • Gross motor
    • Lifts head to 45 degrees while prone
  • Fine motor
    • None expected
  • Language
    • Coos
  • Social/adaptive
    • Responsive smile

4 Months

  • Gross motor
    • Rolls over front to back
    • Holds head steady while supported in sitting/upright position
  • Fine motor
    • Holds an object placed in hand briefly
    • Brings hands to midline
  • Language
    • Laughs
  • Social/adaptive
    • Responds to people with excitement

6 Months

  • Gross motor
    • Rolls back to side/front
    • Sits with support
  • Fine motor
    • Reaches for/grasps objects
  • Language
    • Makes noises when talked to
  • Social/adaptive
    • Vocalizes pleasure or displeasure

9 Months

  • Gross motor
    • Sits well without support
    • Transitions from sitting to standing with support
  • Fine motor
    • Opposes thumb and finger to grasp objects (scissor grip)
  • Language
    • Bisyllabic babbling (mama, dada)
    • Makes sounds or gestures to get attention or help
  • Social/adaptive
    • Responds differently to different people
    • Looks for hidden objects
    • Plays social games (peek-a-boo, nose touching)

12 Months

  • Gross motor
    • Crawls or “bum shuffles”
    • Pulls to a stand and cruises
  • Fine motor
    • Shows a neat fingertip to fingertip to thumb pincer grip
  • Language
    • Says 3+ words
    • Responds to name
    • Understands simple requests with a gesture
  • Social/adaptive
    • Follows your gaze/point to reference a distant object
    • Distressed by separation from parent

15 Months

  • Gross motor
    • Cruises sideways with support
    • Crawls up a few steps
    • Tries to squat to pick up toys
  • Fine motor
    • Picks up and eats finger foods
  • Language
    • Says 5+ words
  • Social/adaptive
    • Shows fear of strange people or places

18 Months

  • Gross motor
    • Walks alone
  • Fine motor
    • Feeds self with spoon
    • Makes towers of 3-4 blocks
  • Language
    • Says 20+ words
    • Points to several body parts
    • Imitates speech and gestures
  • Social/adaptive
    • Points to distant objects to share enjoyment or garner attention
    • Removes hat or socks

2 Years

  • Gross motor
    • Walks backwards 2 steps
    • 2 footed jump
    • Throws a ball
  • Fine motor
    • Imitates a vertical stroke and circular scribble
  • Language
    • Combines 2+ words
    • Says 50+ words
    • Understands 2 step directions
  • Social/adaptive
    • Engages in pretend play with toys
    • Puts objects into a container

3 Years

  • Gross motor
    • Walks up stairs with rail
    • Pedals tricycle
  • Fine motor
    • Opens jars or turns knobs
    • Turns pages
  • Language
    • Understands 2 and 3 step directions
    • Forms 5+ word sentences
    • Names familiar objects or places
  • Social/adaptive
    • Shares some times
    • Plays make believe games
    • Listens to music or story for 5-10 mins

4 Years

  • Gross motor
    • Walks up and down stairs with alternate feet
  • Fine motor
    • Undoes buttons and zippers
  • Language
    • Understands 3 step directions
    • Asks and answers lots of questions
  • Social/adaptive
    • Tries to comfort someone who is upset
    • Uses a toilet

5 Years

  • Gross motor
    • Hops on 1 foot several times
  • Fine motor
    • Throws and catches a ball
  • Language
    • Counts out loud or on fingers to answer “How many?”
    • Speaks clearly in adult-like sentences
    • Retells the sequence of a story
  • Social/adaptive
    • Dresses and undresses with little help
    • Cooperates with adult requests
    • Separates easily from parent

Milestones Tool

Denver Developmental Screen

  • The Denver II Developmental Screen is a tool used to evaluate the development of children from 2 months to 6 years. There are a series of bars, which indicate the percentages of children that meet a particular milestone by a certain age. There is a concern when a child does not reach a milestone that 90% of children would have reached by their corrected age. A delay in 4 milestones is suggestive of global developmental delay.
  • Rourke Baby Record

  • An Evidence based guide to monitoring the health of children over the first 5 years of life
  • Nipissing Developmental Screen

  • The Nipissing is a screening tool used to screen for developmental delay in meeting milestones. It is a questionnaire that can be given to parents before their health visit
  • References

    1. Swartz MH. Textbook of Physical Diagnosis: History and Examination. Philadelphia: W.B. Saunders Company; 2002.
    2. Bickley LS, Szilagyi PG. Bates' guide to physical examination and history taking. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2009.
    3. Behrman RE, Kliegman, RM, Jenson HB. Textbook of Pediatrics. 17th edition. Saunders; 2003.
    4. Rourke, L., Leduc, D., Rourke, J. Rourke Baby Record: Evidence Based Infant/Child Health Maintenance, Colleges of Family Physicians of Canada and Canadian Pediatric Society, Retrieved November 2013 from http://www.rourkebabyrecord.ca/pdf/RBR2011Nat_Eng.pdf