Milestones by age
| Age | Gross motor | Fine motor and vision | Hearing, speech and language | Social |
|---|---|---|---|---|
| 6 weeks | Lifts head briefly when prone | Fixes and follows to midline | Startles to sound | Social smile |
| 3 months | Good head control | Follows through 180°; hands open | Coos; turns to voice | Laughs, enjoys handling |
| 6 months | Sits with support (tripod); rolls | Palmar grasp; transfers between hands | Babbles in syllables | Puts objects in mouth |
| 9 months | Sits without support; crawls; pulls to stand | Inferior pincer grip; looks for dropped toy | "Mama", "dada" without meaning | Stranger anxiety; waves bye-bye |
| 12 months | Cruises; walks with one hand held | Neat pincer grip; releases on request | 2–3 words with meaning | Plays pat-a-cake; drinks from a cup |
| 18 months | Walks well; runs stiffly; climbs stairs holding on | Tower of 3–4 cubes; scribbles | 6–20 words; points to body parts | Feeds with a spoon; symbolic play |
| 2 years | Runs; kicks a ball | Tower of 6; copies a vertical line | Two-word phrases | Parallel play; helps undress |
| 3 years | Stairs with alternating feet; rides a tricycle | Tower of 9; copies a circle | Three-word sentences; knows name and sex | Plays with others; dry by day |
| 4 years | Hops on one foot | Copies a cross; draws a person with 3 parts | Tells stories; asks "why" | Dresses with help; has a friend |
| 5 years | Skips | Copies a triangle; draws a person with 6 parts | Fluent speech; counts to 10 | Dresses alone; understands rules |
Limit ages — refer if not achieved
| Milestone | Limit age |
|---|---|
| Social smile | 8 weeks |
| Head control | 4 months |
| Sitting without support | 9 months |
| Standing with support | 12 months |
| Walking independently | 18 months |
| Pincer grip | 12 months |
| First words with meaning | 18 months |
| Two-word phrases | 30 months |
| Understandable speech to strangers | 4 years |
Any loss of skills already gained is abnormal at any age and needs urgent assessment for a neurodegenerative, metabolic or epileptic cause.
Taking a developmental history
- Ask about each domain in turn, and the age each milestone was reached
- Check the child health record book and compare with siblings
- Ask about vision, hearing and school performance
- Ask about regression and new behaviour problems
- Take the perinatal history — prematurity, asphyxia, jaundice, neonatal seizures and meningitis
- Take the family history — consanguinity, similar problems, learning difficulty
- Observe play at the end of the history
Developmental quotient = (developmental age ÷ chronological age) × 100. Below 70 suggests significant delay. Correct for prematurity until 2 years.
Screening tools
| Tool | Use |
|---|---|
| Denver Developmental Screening Test II | Screening from birth to 6 years across four domains |
| Schedule of Growing Skills II | Screening from birth to 5 years |
| Ages and Stages Questionnaire | Completed by parents |
| Griffiths or Bayley scales | Detailed diagnostic assessment |
| M-CHAT-R | Autism screening at 16–30 months |
Causes of delay
| Pattern | Common causes |
|---|---|
| Global delay | Perinatal asphyxia, kernicterus, meningitis and encephalitis, prematurity, chromosomal disorders (Down syndrome), congenital hypothyroidism, congenital infections, severe malnutrition, neglect |
| Motor delay alone | Cerebral palsy, neuromuscular disease (Duchenne), spinal cord lesions |
| Speech delay alone | Hearing loss, autism, lack of stimulation, familial |
| Social and communication delay | Autism spectrum disorder |
See Spastic cerebral palsy for the commonest cause of motor delay in our wards.
Examiner questions
References
- Kliegman RM, St Geme JW, Blum NJ, Tasker RC, Wilson KM, et al., eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia: Elsevier; 2025.