Paeds developmental milestones

Question 1

6 weeks gross motor skills

Answer 1

• Good head control- raises head to 45° when on tummy

- Stabilises head when raised to sitting position

Question 2

6 weeks fine motor/vision skills

Answer 2

Tracks objects/face

Question 3

6 weeks speech/language

Answer 3

Stills, startles to loud noises

Question 4

6 weeks social

Answer 4

Social smile (visual problem if not)

Question 5

6 months gross motor skills

Answer 5

• Sit without support, rounded back

- Rolls tummy (prone) to back (supine) (vice versa slightlv later)

Question 6

6 months fine motor/vision

Answer 6

• Palmar grasp (5 months)

- Transfer hand to hand

Question 7

6 months speech/language

Answer 7

• Turns head to loud sounds
• Understands “bye bye” / “no” (7m)
• Babbles (monosyllabic)

Question 8

6 months social

Answer 8

• Puts objects to mouth (stops at 1 year)
• Shakes rattle
• Reaches for bottle / breast

Question 9

9 months gross motor

Answer 9

• Stands holding on
• Straight back sitting (7 ½ m)
• Crawls

Question 10

9 months fine motor/vision

Answer 10

• Interior pincer grip

- Object permanence

Question 11

9 months speech/language

Answer 11

• Responses to own name
• Imitates adult sounds
• Says mama and dada

Question 12

9 months social

Answer 12

• Stranger fear (6-9 mtns - 2 yrs)

- Holds and bites food (usually weaned after 6 mnths)

Question 13

12 months gross motor

Answer 13

Walks alone (9-18m)
18m is threshold for worry (i.e. Duchenne’s MD, hip problems, cerebral palsy etc)

Question 14

12 month fine motor/visual

Answer 14

• Neat pincer grip (10m)
• Casting bricks (should disappear by 18m – persistence
  beyond this = abnormal)
• Tower of 2 bricks

Question 15

12 months speech/language

Answer 15

• Shows understanding of nouns (“where’s Mummy?”)
• 3 words (50% at 13m)
• Points to own body parts (15m), doll (18m)

Question 16

12 months social

Answer 16

• Waves “bye bye”
• Hand clapping
• Plays alone if familiar person nearby
• Drinks from beaker with lid

Question 17

18 months gross motor

Answer 17

• Runs (16m)

- Jumps (18m)

Question 18

18 months fine motor/visual

Answer 18

• Tower of 4 bricks

- Drawing to and fro (15 m)

Question 19

18 months speech/language

Answer 19

• Shows understanding of nouns (“show me the x”)

- 1 to 6 different words

Question 20

18 months social

Answer 20

Imitates every day activities

Question 21

2 years gross motor

Answer 21

• Runs tiptoe
• Walks upstairs, both feet on each step
• Throws ball at shoulder level

Question 22

2 years fine motor/visual

Answer 22

• Draws a vertical line
• Tower of 8 blocks
• Puzzles: shape matching is >2 yr skill. Random effort <2 yr
• Turns several pages of book at a time

Question 23

2 years speech/language

Answer 23

• Shows understanding of verbs (“what do you draw with, what do you eat with?”)
• 2 words joined together (50+ words)

Question 24

2 years social

Answer 24

• Eats skilfully with spoon (21⁄2 years)

- Plays near others but with them

Question 25

2.5 years gross motor

Answer 25

• Kicks ball

Question 26

2.5 years fine motor/visual

Answer 26

Draws a horizontal line

Question 27

2.5 years speech/language

Answer 27

• Shows understanding of prepositions in/on (“put the cat on the bowl”)
• 3 – 4 words joined together

Question 28

3 years gross motor

Answer 28

• Hops on one foot for 3 steps (each foot)

- Walks upstairs, one foot per step; downstairs two feet per step

Question 29

3 years fine motor/visual

Answer 29

• Draws a circle
• Builds bridge/train with bricks
• Single cut with scissors
• Puts Grittiths beads on a string

Question 30

3 years speech/language

Answer 30

• Understands negatives (“which of these is NOT an animal?”)

- Understands adjectives (“which one is red?”)

Question 31

3 years social

Answer 31

• Begins to share toys with friends  Plays alone without parents
• Eats with fork and spoon
• Bowel control

Question 32

3.5 years fine motor/visual

Answer 32

• Cuts pieces with scissors

Question 33

3.5 years language

Answer 33

Understands comparatives (“which boy is bigger than this one?” while pointing to middle-sized boy! Or draw circles to illustrate point

Question 34

4 years gross motor

Answer 34

Walks upstairs / downstairs in adult manner

Question 35

4 years fine motor/visual

Answer 35

• Draws Cross, Square (4.5 yrs), Triangle / person (5 yrs)
• Builds bricks: 12 blocks tower, step, big step (5 years)
• Cuts paper in half with scissors
• Put small beads on a string

Question 36

4 years speech/language

Answer 36

• Understands complex instructions (“Before you put x in y, give z to Mummy”)
• Uses complex narrative / sequences to describe events

Question 37

4 years social

Answer 37

• Concern/sympathy for others if hurt
• Has best friend
• Bladder control (41⁄2 years)- referral if >5 years
• Engages in imaginative play, observing rules (41⁄2 to 5 years old)
• Eats skilfully with little help
• Handles knife (at 5 yrs)
• Dressing and undressing

Question 38

Referral points

Answer 38

• doesn’t smile at 10 weeks
• cannot sit unsupported at 12 months
• cannot walk at 18 months

Fine motor: hand preference before 12 months is abnormal and may indicate cerebral palsy

Most common causes of gross motor problems: variant of normal, cerebral palsy and neuromuscular disorders (e.g. Duchenne muscular dystrophy)

Speech and language problems: always check hearing, other causes include environmental deprivation and general development delay