Milestones in babies and children are key factors in monitoring the growth rate of children and also as indicators of a child’s well-being. the different developmental milestones from newborn to childhood will be discussed using charts and tables for an easier understanding of each developmental stage.
Age groups used to categorize children according to their developmental milestones
- Neonates: this refers to a baby that is not more than 28 days. They are also called Newborns. This means the baby is only within 28 days and not more than that. Some people generally use 1 month to refer to a neonate but that is not correct. Weeks are used in medicine and so a neonate could also be referred to as a baby that is less than or equal to 4 weeks old.
- Infant: a baby that is more than 28 days but not more than 1 year.
- Toddler: is a baby that is within 1 to 3 years of age.
- Preschool: is from 3 to 5 years of age
- School: is a child from 6 to 10 years
- Adolescent: is a child from 11 to 14 years of age
- Child: This is a general term that can be used as an umbrella term for the description of babies above.
So now that we have clarified the terms for describing children, let us now discuss the different milestones of children according to the mentioned ages.
Importance of Developmental stages in Children
- It helps the parents to know if the child is healthy or not
- Useful in monitoring the rate at which a child grows relative to others
- Use to monitor the response of a child to medications especially if a child was initially retarded and is being treated. Hence the response to treatment can be monitored.
Parameters for monitoring developmental milestones in children
Babies’ developmental milestones are monitored with various parameters that aim to assess the different parts of the brain because a child may walk normally but that does not mean the intellect is normal, hence, the cognitive parameter is included also. Speech or language is also assessed. Below are the major parameters used while assessing the developmental stages of children.
- Cognition: which is the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses.
- Social behavior: which measures the way the child interacts with the environment and with people
- Motor(Muscular) movement: This measures the ability of the child to use the muscles to achieve a task such as crawling, walking, or running, etc.
- Dentition: This measures when the child erupts teeth and when the primary teeth get shed
- Head circumference: This is used for monitoring the child’s growth
- Length: This is also used for monitoring the child’s growth
- Language and communication skills: This measures the way the child uses words and the whole body to communicate
What are the possible causes of delayed developmental milestones in babies?
There are certain things that can affect or influence the rate and pattern of growth and development of a baby. Sometimes, a child can start growing normally but after some time starts having delayed milestones (this is not as Regression of Milestones) while others fail to grow properly right after birth. At whatever stage that growth becomes halted, there is a cause for that. These factors that affect milestones in babies are mentioned below:
- Biologic factors: genetic inheritance, intrauterine exposure to infections or teratogens (tumor-causing agents), perinatal accidents, illnesses, neurologic and hormonal maturation
- The Psychological factors: mother figure, feeding practices, child-rearing environment
- Social factors: socioeconomic status, extended family interactions, cultural practices, birth order, geopolitical environment
The Changes in Weight of a Normal well-fed Child (Baby) from birth to the first year
The normal birth weight of your baby should be between 2.5 kg to 3.5 kg. Children are expected to lose weight in the 1st week by 3-10% of the birth weight which is due to the use of the body fats for the production of heat and also loss of water in stool and urine. This loss of weight is normal and it is expected.
After 7-10 days of age, the child’s birth weight returns to the initial weight of about 2.5 to 3.5 kg and by day 10, the baby is expected to gain 30 g for each day for the first 3 months; and by the 3rd month, the weight gain increases to 15 g every day for another 3 months.
For the rest of the 6 months, the child will continue to gain about 9 to 12 g per day. If a child is exclusively breastfed, the child should double the birth weight by 4-5 months, triple it by 9-12 months and quadruple it at 2 yrs.
If you have a headache in understanding the analysis of the weight gain above, just understand this that the average weight for a well-fed 1 yr old baby (infant) should be 10 kg.
The Changes in length of a Normal well-fed Child (Baby) from birth to the first year
A baby’s length at birth should be between 45 cm to 55 cm (average of 50 cm). For the first 3 months, the length increases by 3.5 cm every month. After the 3rd month, the length increases at the rate of 2 cm per month for the next 3 months and by 1.2 -1.5 cm per month for the rest of the year. The average Length at 1yr should be about 75 cm.
The Changes occurring on the head of a Normal well-fed Child (Baby) from birth to the first year
The head circumference is the diameter from the forehead of the child to the occiput of the child. It is measured with a tailoring tape in centimeters.
- Head circumference at birth should be between 33 cm to 37 cm, and this increases by 2cm every month in the first 3 months and by 1cm every month for the next 3 months.
- After 6 months, the increase in head circumference should continue at 0.5 cm every month for the next 6 months. Then 10 cm for the rest of life (After 1 year)
- Therefore the Head circumference at 1 yr should be 45 cm to 49 cm
- Anterior fontanelle (AF) may increase in size after birth but diminishes after 6months and should effectively be closed between 9 months to 18 months
- The posterior fontanelle (PF) is expected to close by 4 months
A Fontanelle is a notch or depression that is seen on the head of babies and could be seen pulsating. It is important in the sense that when a child is dehydrated (that is, not having enough water in the body, the fontanelles are sunken inward and if the child is over-hydrated or if the pressure in the brain is high, the fontanelles are seen to be swollen. Neither of these conditions is good for the baby. So do ensure to check it regularly.
Developmental milestones for the eruption of teeth
There are generally two sets of teeth which are:
- Primary dentition(Milk teeth, Baby teeth, or Deciduous teeth)- these refer to the first set of teeth to erupt and consist of Canine, Incisssors, 1st, and 2nd molars.
- Secondary dentition(Permanent teeth): these consist of canines, incisors, 1st, and 2nd premolars,1st, 2nd, and 3rd molars. They are stronger and once lost, they cannot grow back again that is why they are called Permanent; hence the permanence is not referring to the fact that they cannot be removed but that they cannot be replaced when lost.
The time (months and years) for an eruption of teeth are described below and please take note of when Months or Years are considered.
Time for eruption (in months) and shedding (in years) of the Primary dentition
- Central Incisors: Lower central incisors are the first set of teeth to appear at about 6 to 7 months. Some children may erupt 2 months earlier or late than the stipulated time frame. The central incisors shed at about 6 to 8 years.
- Lateral incisors: erupt at 7 to 9 months and shed at 7 to 8 years
- Canines: erupt at 16 to 18 months and shed at 9 to 12 years
- 1st molars: erupt at 12 to 14 months and shed at 10 to 11 years
- 2nd molars: erupt at 20 to 24 months and shed at 11 to 12 years
The time for eruption of the primary dentition could be 2 months earlier or 2 months late in some children. The first molar maybe 4 months earlier or 4 months late in some children. For the Shedding of the primary dentition, some children could shed 6 months earlier or late.
Time (in years) for the eruption of Secondary dentition in both lower and upper jaws
- Central Incisors: erupt at 6 to 7 years for the lower jaw and at 7 to 8 years for the upper jaw
- Lateral incisors: erupt at 7 to 8 years for the lower jaw and at 8 to 9 years for the upper jaw
- Canines: erupt at 9 to 10 years for the lower jaw and at 11 to 12 years for the upper jaw
- 1st premolars: erupt at 10 to 12 years for the lower jaw and at 10 to 11 years for the upper jaw
- 2nd premolars: erupt at 11 to 12 years for the lower jaw and at 10 to 12 years for the upper jaw
- 1st molars: erupt at 6 to 7 years for the lower jaw and also at 6 to 7 years for the upper jaw
- 2nd molars: erupt at 11 to 13 years for the lower jaw and at 12 to 13 years for the upper jaw
- 3rd molars: erupt at 17 to 21 years for the lower jaw and also 17 to 21 years for the upper jaw
1st deciduous (milk) teeth erupt usually between 5 months to 8 months, but if no tooth has erupted even by the 13th month, then the teeth are said to be delayed unless there is a family history of delay in the development of teeth. Some diseases such as Rickets and Hypothyroidism could cause a delay in developmental milestones especially in erupting of teeth or in normal growth. Though sometimes the actual cause of delayed teeth eruption is not known and is therefore termed Idiopathic.
Shedding of teeth(Exfoliation) before 5 years is considered early and could be associated with some conditions such as lack of Vitamin C (Scurvy), Trauma, Gingivitis, or Histiocytosis X. It is best to see a Paediatrician for evaluation and treatment. Permanent teeth begin to grow out at 6-7 years of age
THE GROSS MOTOR DEVELOPMENT OF A CHILD
Gross motor development of a child of 0 – 3 months old
A child that is less than 3 months of age can use the muscles of the body to perform some actions such as:
- Lifts and turns the head when on the stomach: a child that is 2 months can use the neck muscles in order to turn the face from side to side even while lying on the stomach. This ability to control the neck makes the child turn the head whenever someone makes a noise.
- Can hold hands together: a child of 3 months can hold the two hands together and can also bring them to the mouth. When a child starts this, care should be taken especially with harmful things that might get into the hands of the child because they will not hesitate to take it to the mouth straight.
- Random movements: the ability of good neck control and hand control allows them to reach out to the things that attract them. These movements are normally jerky.
Gross motor development of a child of 3-6 months old
As the motor function increases due to an increase in control of muscles, the child is seen to perform some movements with the whole body such as rolling from stomach to back and rolling back from the lying on the back to the stomach.
It is good for the mother or the caregiver to be cautious at this period because the child could roll and fall from the bed to the floor. To prevent that, the bed should have guards at the sides that will prevent the child from falling.
At 3 to 6 months, a baby lying on the stomach can lift the head and chest while putting the weight on the hands. The child can also hold the head upright and steady
Gross motor development of a child of 6-9 months
- The baby can pull self to hands and knees i.e. the child can use the hand and try to touch the knees
- Sits without help: a baby of 6 months is expected to start sitting even without help. This means that even when they are lying down, they can get up and sit upright. Sitting starts at 6 months.
- Creeps or crawls (moves forward on hands and knees): crawling starts at 7 months and they are very destructive at this period because they try to explore their environment since they can move to objects that attract them. Hence, bare electrical wires, chemicals, and other harmful things should be kept out of their reach. That is the reason why drugs, matches, chemicals, etc have written caution which reads: ‘Keep out of reach of children‘ because to children, anything that is attractive is eatable.
Gross motor development of a child of 9-12 months
- At about 9 months, a child could stand when supported
- Stands without support after 9 months
- Walks with support
- Can take independent steps
Gross motor development of a child of 12-18 months
- The child begins to walk alone without anyone helping
- Begins to walk sideways and backward: as they acquire more balance and confidence, the baby now starts walking from forwards to sideways and also backward. Prior to this, if you are being observant, they have no confidence in moving backward and they normally fall to the ground if they do so, if they intend to go back, they have to make a turn and start walking forwards and never backward. But around 12 to 18 months, the baby should acquire this ability to move sideways and backward.
- Comes to standing without support: They increase in muscle strength allows a baby at this period to be able to stand without any support and can stand for a relatively few minutes.
- Crawls up and downstairs: The baby could walk at this moment but cannot walk while climbing the staircase, they, therefore, crawl both up and down the stairs.
- At 16 months, the child is expected to run without difficulty and is normally seen to be adventurous, trying to open things that are covered and moving things that are light in weight. This happens because they have acquired an ability that makes them explore their environment.
Gross motor development of a child of 2-3 years
- At about 2 to 3 years, the child is now expected to walk well, run well, stop or step up, and also be able to squat down.
- The baby at this period can also walk upstairs with an alternating foot pattern with one hand on the rail and in a gentle and slow manner which shows a new ability that is in the process of perfection.
- They can jump two inches off the ground or can be able to jump over a 2-inch hurdle set before them.
- The child now begins to stand on one leg for 1-3 seconds
Gross motor development of a child at 3-4 years.
- the baby can walk on a line that is drawn without stepping off but only in a forward manner and not backward.
- The child can hop on one foot as muscle control and perfection increases.
- Should have acquired the strength and ability to ride a tricycle
Gross motor development of a child at 4 – 5 years
- Walks on a line that is drawn but this time it is both forwards and backward
- Gallops and skips forward
- Walks up and downstairs, alternating steps, without support from the wall/rail
- Catches a tennis ball
- The child is prone to falling and injury at this period because they normally feel confident without knowing the implication.
Gross motor development of a child at 5-6 years.
Skips and jumps rope
Fine Motor Developmental Milestones of Children
Fine motor developmental stages of a child of 0 – 3 months
- Hands are in a fist, thumbs are tucked in
- Watches movements of her hands and can bring the hand to her mouth
- Swings at a target using her entire arm
- Follows a moving person with his/her eye
Fine motor developmental stages of a child of 3-6 months
- Picks up objects with one hand
- Transfers objects from one hand to another
- Holds hands together
- Reaches for a toy using both arms and holds it briefly
Fine motor developmental stages of a child of 6-9 months
- Uses thumb and fingertips to grasp objects, this is referred to as the pincer grasp
- Holds 2 objects, one in each hand at the same time
Fine motor developmental stages of a child of 9 – 12 months
- Begins to turn the pages of a book a few at a time
- Learns to poke and point at things using the index finger
- Grabs crayons or pencil in the fist and not with fingers
- Uses both hands and begins to show a preference for one; this is when children begin to write with either left or right i.e. they make the decision of being right-handed or left-handed at this period.
Fine motor developmental stages of a child of 12-18 months
- The child begins to build a tower of 2 or more blocks at this period
- Marks with crayon or pencil
- Learns to stack 2-3 cubes
- Can hold an object with one hand and manipulate it with the other hand
Fine motor developmental stages of a child of 18-24 months
- At this age, babies start using fingers and thumb to grasp crayons, this shows that the child has known now that the fingers can individually be manipulated to achieve a task.
- Imitates vertical and circular scribbles, that is, the baby learns to write by drawing irregular circular shapes.
- Turns pages of a book one at a time and no more few at a time, this shows the acquisition of minimal precision.
- Cuts paper using scissors and this could make them not to spare their hands too because the cutting of the paper is random and not orderly.
- Advances for 2-3 blocks tower to building a tower with 3-5 blocks
Fine motor developmental stages of a child of 2-3 years
The child learns and acquires the ability to Unbutton a shirt or dress at 2-3 years
Fine motor developmental stages of a child of 3-4 years
- Cuts across a paper with small scissors in an orderly manner
- Draws or copies a complete circle
- The child now has the ability to button a shirt or dress
Fine motor developmental stages of a child of 4 -5 years
- Prints first name (four letters)
- The child learns how to draw a person that has at least 3 parts such as the head, eyes, nose, etc.
- Draws recognizable pictures such as a cross, triangles, cups, etc.
- Learns to tie things such as shoes
Developmental milestones of Communication and speech in children
- Babies begin to ‘Coo‘ at 3 months
- Starts the babbling of Monosyllabic words or alphabets at 6 months
- Learns to stop doing something when someone says No at about 7 months of age
- Follow one-step command with gesture 7 months
- Learn to say: ‘Dada‘ or ‘mama‘ indiscriminately at 8 months, that is, without knowing whether it is a male or female.
- Learns to say: “Dada’ to a male and ‘mama’ to female at 10 months
- Follows one-step command without gesture at 10 months
- Starts waving bye-bye at 10 months
- Uses 2 words other than mama/dada 12 months
- Speaks 4-6 words at 15 months, such words are not fixed but determinant on the words frequently spoken near the baby.
- Children learn 10-15 words at 18 months: Can speak 2-word sentences such as Mummy water, Mama Oyoyo (a way of welcoming the mother in Northern Nigeria), Mummy, see.
- At 19 months also should have known 8 body parts
Developmental Milestones of Cognition in Children
- Learns to stare momentarily at a spot where an object disappeared whether the object was carried away by someone or it might have fallen off; this happens at 2 months;
- Stares at own hands at 4 months
- Bangs 2 cubes 8 months
- Uncovers toy (after seeing it hidden)– 8 months
- Egocentric symbolic play (e.g., pretends to drink from a cup or closes face with hands to show that he or she is not looking); this happens at 12 months
- Uses stick to reach a toy where the hand cannot reach 17 months
Developmental milestones in children of Social Behaviour
Milestones at 0 – 2 months of Age
- Not social
- Fed by a parent or caregiver
At 2 – 3 months
- Visually fixes attention to a face
- Smiles at a face (social smile)
Social Milestones at 3 – 4 months
- Communicates by crying
- Smiles spontaneously to mother’s face, voice, smile
- Enjoys being cuddled
At 4-9 months
- Enjoys being near people and played with
- No longer smiles indiscriminately but is selective
- Responds gaily to play interactions with others
- Cries, smiles, kicks, coos, laughs to attract social attention
- Responds differently to strangers (stranger anxiety-8 months), the reason why my niece – Seyilnen, cries when she sees me and laughs when she sees our little cousins. This is because she is seeing me as a stranger.
- Shouts for attention ( at 8 months)
- Rejects confinement to one place and prefer being left alone to do what he/she wants, which is not always the best for them.
- Cries if other child cries as a means of fear and not sympathy
At 10 – 12 months of age
- Pays attention to his/her own name
- Able to interpret the emotional expression of familiar adults
- Copies simple actions of others
- Shows guilt at wrongdoing especially when someone suddenly shouts at them when they try to do something harmful or wrong.
- Actively seeks to maintain interactions with adult
- Displays separation anxiety when apart from mother
- Developing a sense of humor
- Teases and tests parental limits
- Can demonstrate affection
Social Milestones at 1 – 2 years
- Recognizes self in a mirror or picture and may smile when self is seen in a mirror
- Refers to self by name
- Beginning to become independent
- Cooperates by helping to put things away such as picking a paper you throw and giving you back with the thought that they might be helping you.
- Responds to simple commands by an adult such as Come, Go, Stop, Run, etc.
- Social relationships with other children are awkward
- May hit, bite or fight over a toy
- Engages in social laughter
- Shows anger through aggressive behavior
Social Milestones for a child of 2 years
- Shows different facial expression reflects an emotional
- Defends own possessions but is beginning to share
- Asks for water
- Knows gender identity such as identifying whether he is a boy or she is a girl or that the father is a man and not a woman. This is why they call a man as an uncle and a woman as an Aunty.
- Participates in simple group activity singing and dancing with others
- Little interaction with other children
- Mother continues to be very important to the child even at this age
Social Milestones of children at 3 years
- Friends becoming more interesting than adults
- Shares toys, takes turns with assistance
- Uses ‘I, me, you‘
- Beginning to learn to take responsibility such as using a broom as if they were sweeping or trying to remove pants to pee or poopoo.
- Shows affection for younger siblings by crying when someone is taking them away or crying when someone beats them.
Social Milestones at 4 years
- Plays and interacts with other children
- Spurred on by rivalry inactivity
- Enjoys doing things for self
- Plays outside with little supervision; likes to be trusted
- Still home and mother-oriented
Social skills for a child of 5 years
- Wants to do what is expected such as praying before eating, clapping when all are clapping in the Sunday school, and trying to close eyes when all have closed eyes while praying.
- Willing to play with most other children in the class
- Engages with other children in cooperative play;
- Engages with other children in role assignments
- Chooses own friends; friendships change rapidly
- One or two best friends of the same gender