MORNING ACTIVITY

DEVELOPMENTAL MILESTONES

BY DR. THANAA ATALLAH

 GROSS MOTOR
FINE MOTOR
SELF–HELP
COGNITIVE/ACADEMIC
SOCIAL EMOTIONAL
RECEPTIVE LANGUAGE
EXPRESSIVE LANGUAGE
 1 MONTH
• Turn head in supine.
• Head up in prone
• Hands fisted near face.
• Suckle well.
• Follows face.
• Discriminates mother's voice/cries out of distress.
• Startles to loud noise
• Makes sounds other than crying
 2 MONTHS
• Chest up in prone
• Retains rattle if placed in hand
• Holds hands together
• Opens mouth at sight of breast or bottle.
• Recognizes mother.

• Reciprocal smiling: Responds to adult voice and smiles.

• Alerts to voice/sound.

• Social smile (six weeks)

 3 MONTHS
• Props on forearms in prone

• Rolls to side.

• Inspects fingers/Bats at objects.

• Brings hands to mouth.

• Reaches for parent's face.
• Visually follows person who is moving across a room.
• Regards speaker.
• Chuckles.
• Vocalizes when talked to.
 4 MONTHS
• Sits with trunk support.

• No head lag when pulled to sit.

• Props on wrists.

• Rolls front to back.

• Clutches at clothes

• Plays with rattle

• Briefly holds onto breast or bottle.

• Mouths objects

• Reaches for ring/rattle Shakes rattle

• Smiles spontaneously

• Stops crying at parent's voice.

• Orients head in direction of a voice.

• Laughs out loud.

 5 MONTHS

•Sits with pelvic support

•Rolls back to front
•Grasps cube using whole hand (palmar grasp)
•Transfers objects: Hand-mouth-hand
• Holds hands together
•Turns head to look for dropped spoon
•Recognizes caregiver visually
•Begins to respond to name.
•Expresses anger with sounds other than crying.
 6 MONTHS
• Sits momentarily propped on hands.
• Pivots in prone (on belly).
• Transfers hand-hand
• Feeds self crackers
• Removes cloth on face
• Stranger anxiety: Recognizes familiar
versus unfamiliar people.
• Stops momentarily to "no“
• vocalizes to mirror.
 7 MONTHS
• Sits without support (steady).
• Grasps using side of hand (radial-palmar grasp).
• Refuses excess food
• Looks from object to parent and back when wanting
help (eg, with a wind-up toy).
• Looks toward familiar object when named.
 8 MONTHS
• Commando crawls
• Pulls to sitting
• kneeling.

• Grasps with all four fingers and side of thumb (scissor grasp)

• Takes cube out of cup

• Holds own bottle.

• Responds to "come here“.
• Looks for family members when asked (eg, "Where's Mama?", etc).
• Says "Mama" (nonspecific).
• Imitates sounds.
 9 MONTHS
• "Stands" on feet and hands.
• Begins creeping.
• Grasps with two finger and thumb below (radial-digital).

• Bites, chews cookie.

• Pulls string to obtain an attached toy out of reach.
• Separation anxiety.
• Recognizes familiar people visually.
• Orients to name well.
• Turns head upward and diagonally to view source of sound.
• Says "Mama" (nonspecific).
• Nonreduplicate babble/ Imitates sounds.
 10 MONTHS
• Creeps well.
• Cruises around furniture with two hands.
• Walks, two hands held.
• Grasps pellet with side of index finger and thumb
(inferior pincer grasp).
• Drinks (not sucks) from cup held for him/her.
• Experiences fear.
• Enjoys peek-a-boo.
• Waves "bye-bye" for and back.
• Says "Dada" (specific ).
 11 MONTHS
• Walks, one hand held.
• Pivots in sitting.
• Stands for a few seconds.

• Throws objects.

• Stirs with spoon.

• Cooperates in dressing.
• Looks at pictures in book.
• Stops activity when told "no“.
• Bounces to music.
• Says first word.
 12 MONTHS
• Stands well with arms high and legs splayed (posterior
protection)
• Fine pincer grasp of pellet.
• Attempts tower of two cubes.
• Takes hat off.
• Follows one-step command with gesture.
• Recognizes names of two objects , looks when named.
• Points in order to get desired object.
 13 MONTHS
• Walks with arms high and out (high guard).
• Attempts to release pellet in bottle.
• Drinks from cup with some spilling.
• Looks appropriately when asked "where's the ball?," Etc.
• Solitary/ functional play.
• Uses three words.
• Immature jargoning (inflections without real words).
 15 MONTHS
• Creeps up stairs.
• Climbs on furniture.
• Builds three- to four-cube tower.
• Releases pellet into bottle.

• Uses spoon with some spilling.

• Turns pages in book.
• Hugs adult in reciprocation.
• Points to one body part.
• Gets object from another room upon demand.

• Uses three to five words.

• Mature jargoning (with real words).

 18 MONTHS
• Creeps down stairs.
• Runs well.
• Throws ball (standing).
• Makes four-cube tower.
• Matches pairs of objects.

• Begins to show shame (when done wrong) and possessiveness.

• Understands "mine“.

• Points to familiar people when named.

• Uses 10 to 25 words.

• Imitates environmental sounds (eg, animals).

• Names one picture on demand.

 24 MONTHS
• Walks down stairs, holding rail, both feet on each step.

• Makes a single-line "train" of cubes.

• Opens door using knob.

• Sucks through straw.

• Takes off clothes without buttons.

• Parallel play.

• Follows 2-step commands.

• Understands "me"/"you“.

• Points to 5 to 10 pictures.

• Uses 2-word sentences (noun+verb).

• 50+ word vocabulary.

• Names 3 pictures.
 30 MONTHS
• Goes up stairs, with rail, alternating feet.
• Makes an 8-cube tower.
• Washes hands.
• Brushes teeth with assistance.
• Imitates adult activities (eg, sweeping, talking on the
phone, pretending to hunt animals).

• Echolalia and jargoning gone.

 36 MONTHS
• Goes up stairs, no rail, alternating feet.

• Pedals tricycle.

• Walks heel-toe.

• Copies circle.

• Imitates bridge of cubes.

• Eats independently.

• Puts on shoes without laces // Unbuttons.

• Draws a 2- to 3-part person.

• Understands big/small, more/less.

• Knows own gender, own age.

• Imaginative play.

• Names body parts when function is described.

• Uses 200+ words.

• 3-word sentences.
 4 - 5 YEARS
• Gallops.
• Throws ball overhand: 10 feet.
• Copies square.
• Imitates making a complex gate with cubes .
• Writes part of first name.
• Goes to toilet alone
Washes face/hands // Brushes teeth alone.
• Buttons.
• Uses fork well.
 YEARS 5 - 4
• Draws a 4- to 6-part person.
• Points to 5 to 6 colors.
• Rote counts to 4.
• Has a preferred friend.
• Group play
• Follows 3-step commands.
• Repeats 4- to 6-syllable sentences.
• Uses 300 to 1000 words.
• tells stories.
• Uses words that tell about time.
 5 – 6 YEARS
• Walks down stairs, alternating feet, without using rail.
• Skips.
• Copies triangle.
• Builds stairs with cubes from model.
• Cuts with scissors.
• Writes first name.

• Independent dressing.
• Draws an 8- to 10-part person.
• Rote counts to 10.
• Names 10 colors.
• Reads 25 words.
 YEARS 6 – 5

• Has a group of friends.

• Knows right and left on self.
• Repeats 6- to 8-syllable sentences.
• 2000 word vocabulary.
• Knows telephone number.
5 months: grasps cube using whole hand (palmar grasp).
7 months: grasps using side of hand (radial-palmar grasp).
8 months: grasps with all 4 fingers and side of thumb (scissor grasp).
9 months: grasps with two finger and thumb below (radial-digital).
10 months: grasps pellet with side of index finger and thumb (inferior
pincer grasp).
12 months: fine pincer grasp of pellet.
 5 months 7 months 8 months

12 months 10 months 9 months

• 3 years: copies circle

• 4 years: copies cross

• 46/12: copies square

• 5- 6 years: copies triangle

• 6-7 years: copies flag

• 16 months: Places circle in form board ◯△◻.

• 18 months : Re-places circle in form board after it has been

turned around (usually with trial and error) ◻▽◯.

• 20 months: Places circle and square in form board ◯△◻.

• 22 months: Completes form board with three shapes ◯△◻.

• 11 months: says first word
• 12 months: 2 words
• 13 months: 3 words
• 15 months: 3- 5 words
• 16 months: 5-10 words
• 18 months: 10 – 25 words
• 22 months: 25 – 50 words
• 24 months: 50 + words / Uses 2-word sentences (noun+verb)
• 36 – 42 months: 200+ words / 3-word sentences.
• 4 – 5 years: 300 to 1000 words / 4- to 6-syllable sentences
• 5 – 6 years: 2000 word vocabulary / 6- to 8-syllable sentences
• 6 – 7 years: 10,000 word vocabulary / 8- to 10-word sentences
 In general,
wait for 3 months for milestones acquired in
1st year
and 6 months for milestones acquired in
2nd year
to list it under the “red flag” signs.
 RED FLAGS
By 3 months: persistent fisting,
failure to alert to environmental stimuli.
By 6 months: poor head control,
failure to reach for objects,
absent smile.
By 10 months: not sitting without support.
By 12 months: no babbling,
no pointing,
no gasturing
By 18 months: not walking without support,
no single word with meaning.
By 30 months: no 2-3 word sentence.
 KEY POINTS
■ Always refer the child to audiology if language is delayed.
■ Never ignore parents’ concerns.
■ Suspect delays and refer early.
■ Developmental screening, using standardized parent
report measures, is more accurate than clinical judgment.
■ Autism usually manifests as language delay.
 REFERENCES
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• HTTPS://WWW.UPTODATE.COM/CONTENTS/IMAGE?CSI=14220F41-A281-48FC-84BD-
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Thank you