Developmental milestones and red flags

CASTRO, Kevin Cedrick R. 2010-06974

B SE – CA-English and SPED EDSP 102

Developmental Milestones and Disabilities that Can Affect the Individual’s Development

Age

Physical

Cognitive Language Social/Emotional Self-help

Fine Motor Skills Gross Motor Skills

0 month

Purposeful grasp Transfer objects from hand to hand Plays with fingers, hands and toes Holds and manipulates objects; sucks on everything! Can grab at objects (by 6 months) Can smile at self in mirror (by 5 months)

Head at 90 degree angle, uses arms to prop Visually track through midline Roll over Head lag disappears Plays with feet Exercises body by stretching, moving Touch genitals, rock on stomach for pleasure Usually responds to objects or faces as they move Reacts to sound of voices, rattle or bell

Listens attentively to sounds and voices (by 1 month) Cries deliberately for assistance (by 1 month) Coordinates eye movements (by 2 months) Discovers hands and feet as extension of self (by 3 months) Likes to repeat enjoyable acts (by 4 months) Recognizes and responds to name (by 5 months) Studies objects intently (by 6 months)

Reacts to loud sounds Calms down or smiles when spoken to Recognizes your voice and calms down if crying When feeding, starts or stops sucking in response to sound Coos and makes pleasure sounds Has a special way of crying for different needs Smiles when he or she sees you

Reacts to discomfort and pain Recognizes parent’s voice Makes eye contact Shows affection by looking, waving, kicking and smiling Shows feelings of security when held or talked to Expresses delight May form attachment to one special object Laughs when tickled Builds trust when cries are answered

Can coordinately suck when they are breastfeeding or drinking formulae milk through a nipple artificial

1 month

2 months

Has already been able to open their mouth when see breast or nipple artificial

3 months

Show their interest or enthusiasm feeling when seeing mother’s breast (ASI) or nipple artificial

4 months

Follows sounds with his or her eyes Responds to changes

Start to place their toys into their mouth

5 months

Vocalizes to him/herself, people and toys Can raise him/herself up on forearms (while on tummy) and hold head up Rolls from back to tummy (by 4-6 months)

in the tone of your voice Notices toys that make sounds Pays attention to music Babbles in a speech-like way and uses many different sounds, including sounds that begin with p, b, and m Laughs Babbles when excited or unhappy Makes gurgling sounds when alone or playing with you

May begin to cling to primary caregiver

Put their both hands on mother’s breast or bottle when milk-feeding.

6 months

Able to hold their bottle by themselves. Able to feed themselves by using their thumb and finger tips. Start to be able to hold the spoon and try to feed themselves. Drink water or milk from the covered cup or directly drink it from the open cup by sips via the edge of the cup.

7 months “Raking” with hands Finger-thumb opposition Eye-hand coordination, but no hand preference Transfers toys from hand to hand

Sits in “tripod” Push head and torso up off the floor Support weight on legs Gets to and from sitting Crawls, pulls to standing

Anticipates events (by 7 months) Finds hidden objects (by 10 months) Can point to body parts Puts nesting toys together correctly Develops expectations about familiar events

Enjoys playing peek-a-boo and pat-a-cake Turns and looks in the direction of sounds Listens when spoken to Understands words for common items such as “cup,” “shoe,” or “juice”

Enjoys being near people and played with No longer smiles indiscriminately Responds gaily to play interactions with others Cries, smiles, kicks, coos, laughs to attract social attention

8 months

9 months

Stooping and recovering Learns to crawl, stand up and walk Sits without support (by 8 months) Sees almost everything with good vision Begins to cruise and eventually walk

Waves bye-bye

Responds to requests (“Come here” or “Want more?”) Babbles using long and short groups of sounds (“tata, upup, bibibi”) Babbles to get and keep attention Communicates using gestures such as waving or holding up arms Imitates different speech sounds Has one or two words (“Hi,” “dog,” “Dada,” or “Mama”) by first birthday

Responds differently to strangers (stranger anxiety by 8 months) Shouts for attention (by 8 months); rejects confinement Cries if other child cries

10 months

Pays attention to his/her own name Recognizes different tones of voice and responds Able to interpret the emotional expression of familiar adults Copies simple actions of others Recognizes himself as an individual apart from mother Learning to cooperate; shows guilt at wrongdoing Actively seeks to maintain interactions with adult

11 – 11.9 months

Displays separation anxiety when apart from mother Tries to alter mother's plans through persuasion or protest Teases and tests parental limits Can demonstrate affection Discriminates positive and negative attention

1 – 1.6 year

Picks up small objects with pointer finger and thumb Turns pages in a book Can build a tower of cubes

Can throw a ball Walks well Can walk while holding an object More complex motor skills

Identifies family members in photographs Enjoys cause and effect-relationship Is able to make choices between clear alternatives Begins to solve problems Remembers more

Knows a few parts of the body and can point to them when asked Follows simple commands (“Roll the ball”) and understands simple questions (“Where’s your shoe?”) Enjoys simple stories, songs, and rhymes Points to pictures, when named, in books

Prefers to keep caregiver in sight while exploring environment Demands personal attention May reveal stubbornness Unable to share Responds to simple requests

Eating

Feed him/herself with a spoon.

Hold a cup by the handles.

Drink from a cup, with little spilling.

Play with food.

1.6 – 2 years Can draw scribbles

Kicks backward and forward Stands on a balance beam Walks up stairs with help; learns to climb up stairs first, then down Runs well Enjoys riding small-wheeled riding toys

Sorts shapes and colors Mimics adult behavior Points to and names objects Refers to self by name Learns by helping Learns concepts such as size, shape and weight as he/she moves and plays with objects in the environment.

Acquires new words on a regular basis Uses some one- or two-word questions (“Where kitty?” or “Go bye-bye?”) Puts two words together (“More cookie” or “No juice”) Uses many different consonant sounds at the beginning of words

Is possessive Begins to show empathy Reveals a sense of trust Begins to play next to children Shows emotions of pride and embarrassment May dawdle Engages in imaginative play Tests limits of behavior Performs for an audience

Suck from a straw.

Begin to chew food with mouth closed.

Give up nursing or drinking from a bottle near the age of two years.

Drinks from a straw

Dressing

Take off hat.

Take off socks.

Take off shoes when the laces are undone.

Unzip large zippers.

Grooming

Enjoy trying to brush teeth.

Wash and dry hands with help.

Household

Help with simple

2 – 2.6 years

Improving fine motor skills and eye-hand coordination: cut with scissors, draw shapes Strings large beads Holds scissors

Rule of Three: 3 yrs: 3 ft, 33 lbs. Weight gain: 4-5 lbs per year Growth: 3-4 inches per year Physically active,

Comprehends size Beginning to understand time sequences (e.g. before lunch) Matches shapes and colors

Has a word for almost everything Uses two- or three-word phrases to talk about and ask for things Uses k, g, f, t, d, and n sounds

Has a strong sense of ownership May begin cooperative play May show need for security object Is becoming more

2.6 – 3 years

correctly Zips and snaps

can’t sit still for long Clumsy throwing balls Refines complex skills: hopping, jumping, climbing, running, ride “big wheels” and tricycles Walks backwards Can balance on one foot (by 3 years) Learns to use the potty, most are toilet-trained Walks up and down stairs independently

Counts and manipulates objects Is beginning to think about consequences Is able to concentrate for longer periods of time

Speaks in a way that is understood by family members and friends Names objects to ask for them or to direct attention to them

independent household tasks

Push and pull doors open and shut.

3 – 3.9 years

Hears you when you call from another room Hears the television or radio at the same sound level as other family members Answers simple “Who?” “What?” “Where?” and “Why?” questions Talks about activities at daycare, preschool, or friends’ homes Uses sentences with four or more words Speaks easily without having to repeat syllables or words

Completely undresses self Independently puts on socks, coat, sweater, pants Manipulates large buttons and snaps Eats entire meal independently Uses a spoon and fork effectively Can pour liquid with some assistance Washes hands unassisted Learns toilet training Wipes nose unassisted

4 – 4.9 years

Can catch a beanbag Can copy a simple design Uses scissors to cut a straight line

Can hop on one foot, skip and jump Can catch a ball with both hands

Comprehends special concepts (e.g. around, in front, high, next to) Rote counts up to 20 Can complete a 6-8 piece puzzle Begins to understand time concepts Understands simple math concepts Recalls main details of a story

Pays attention to a short story and answers simple questions about it Hears and understands most of what is said at home and in school Uses sentences that give many details Tells stories that stay on topic Communicates easily with other children and adults Says most sounds correctly except for a few (l, s, r, v, z, ch, sh, and th) Uses rhyming words Names some letters and numbers Uses adult grammar Uses possessives Uses double negatives Joins sentences

Enjoys being with other children Has an increased drive for independence Expresses anger more dramatically Is aware of social approval or disapproval Performs for others Has pride in personal accomplishments Develops sex role identification Begins taking turns and negotiating

Can cut with a knife independently Can put shoes on right feet; tie shoes Knows clothing front from back Toileting – fully independent Brushes teeth independently Buttons front buttons Feeds self with fork (held with fingers). Zips separating front zipper.

5 – 5.9 years

Follows up to 4 step directions Uses third person Tells simple jokes Has a 2000 word vocabulary

6 years Ties shoe laces. Learns to skip with rope.

Draws with precision and to detail. Developing reading skills well. May write independently.

Fluent speech. Can pronounce majority of the sounds of his/her own language. Talk fluently and with confidence.

Stubborn and demanding Eager for fresh experiences May be quarrelsome with friends.

Able to perform and complete routine chores such as sweeping floors or cleaning desks with much more accuracy

Enjoys many activities and stays busy

Likes to paint and draw

Can already eat by him/herself

Bathe all by himself

7 years

Hand-eye coordination is becoming even more refined Able to write and draw with control and precision

Grows 2 to 2.5 inches Can perform more difficult movements such as standing in one place while twisting, turning, or spinning Can combine motor skills such as running and kicking a ball (such as in soccer) or performing dances to music

More interested in complicated projects because they have greater attention span

Uses serious,

logical thinking;

Is thoughtful and

reflective

Able to understand

reasoning and

Uses a vocabulary of several thousand words Begins to grasp that letters represent the sounds that form words

Desires to be

perfect and is quite

self-critical

Worries more; may

have low self-

confidence

Tends to complain;

has strong

emotional reactions

Understands the

difference between

Able to ride a bicycle without training wheels

make the right

decisions

Can tell time;

knows the days,

months, and

seasons

Can describe

points of similarity

between two

objects

Able to solve more

complex problems

Individual learning

style becomes

more clear-cut

right and wrong

Takes direction

well; needs

punishment only

rarely

Avoids and

withdraws from

adults

Is a better loser

and less likely to

place blame

Waits for her turn

in activities

Starts to feel guilt

and shame

8 years old

Finger control is

quite refined

Stamina increases

Can run and swim

further

Seeks to

understand the

reasons for things

Begins to feel

competent in skills

and have

preferences for

some activities and

Can converse at an almost adult level

Reading may be a

major interest

Has strong need

for love and

understanding,

especially from

mother

Can be helpful,

cheerful, and

pleasant as well as

Dresses and grooms self completely Can use tools (i.e., hammer, screwdriver) Can already eat by himself/herself Can do almost all

subjects

Thinking is

organized and

logical

Begins to

recognize concept

of reversibility

(4+2=6 and 6-2=4)

rude, bossy, and

selfish

May be quite

sensitive and

overly dramatic

Emotions change

quickly

Impatient; finds

waiting for special

events torturous

Makes friends

easily; develops

close friends of

same sex

Favors group play,

clubs, and team

sports; wants to

feel part of a group

More influenced by

peer pressure

Can be obsessed

with, and motivated

by money

household chores Bathe all by himself

9 years old

Have stronger and

smoother muscle

control,

May experience

the beginnings of

puberty.

May also be more

susceptible to

body image

issues. Increased coordination Pushes self to physical limits Fatigues easily Numerous injuries Somatic complaints Tension outlets such as nail-biting, hair-twisting, lip-pursing

Are incredibly

curious about the

world around them,

and may want to

research topics that

interest them.

Have longer

attention spans and

will tend to spend

lots of time on

activities and

subjects that they

are excited about.

Able to think

critically, and may

want to share their

opinions about

things.

Read and write

increasingly more

complicated texts

Learn how to work

with multiple digits,

geometry, and data

organization in

math.

Growth of Language Patterns Used:

Descriptive

Loves vocabulary and language play and information

Baby-talk sometimes re-emerges

Use of hyperbole

Age of negatives; “I hate it”, ”I can’t”, “boring”, “yeah right”

Dirty jokes

Graffiti

Are more

emotionally mature

Are better able to

handle conflicts

and frustrations.

More independent,

and will be

emotionally more

ready to socialize

without their

parents (such as at

sleepovers at

friends' houses).

Have a strong

desire to belong to

a group and to fit

in, and may be

more susceptible to

peer influence and

peer pressure

May be more

moody and feel

more stress and

pressure, and will

rely upon the

support and love

provided by

parents.

10 years old Handwriting often sloppier than at nine

Large muscle development Needs outdoor time and physical challenge Snacks and rest periods helpful for growing bodies

Memorizing details

productively

Increased ability to

abstract

Likes rules and

logic

Classification and

collections of

interest; likes to

organize

Able to

concentrate, read

for extended

periods

Good problem

solvers

Proud of Academic

products

Good listeners, actively receptive Voracious readers Expressive, talkative, like to explain

Fairness issues peak and can be solved Quick to anger – quick to forgive Generally content Works well in groups Enjoys both family and peers Likes clubs, sports, and activities Usually truthful; developing more mature sense of right and wrong, good at solving social issues Cooperative and competitive

Can accomplish tasks in a shorter time due to longer attention span Can do all things by him/herself Can discriminate dangers when engaging in an activity

11 years old Fine motor capability is good

Vast appetite for food and physical activity Growth spurt of early adolescence for some girls Constant motion; restless More illness: colds, flu, ear infections Need for more sleep Physical aggression not uncommon

Prefers new tasks and experiences to reflection or revision of previous work Able to abstract Deductive reasoning advances Can establish and modify rules, develop hypotheses Increased ability to de-center and see world from various perspectives Loves to argue

Impulsive – talks before thinking Can be cruel or harsh with words Argumentative; debater Appreciates humor Imitates adult language

Moody; sensitive Oppositional; tests limits Often does best away from home Impulsive; rude; unaware Loves to argue Difficulty with decisions Self-absorbed Extremes of emotion Inclusion/exclusion; height of cliques; seeks to belong

12 years old

High Energy

Much Rest needed

Growth spurt:

signs of puberty

Menstruation for

majority of girls

Food important,

Increased ability to abstract in intellectual pursuits May show emerging ability in a particular skill or content area Can and will see both sides to an argument High interest in current events, politics, social

Sarcasm emerges Double meanings, word play, jokes of intellectual interest Enjoys conversation with adults and peers Peer “vocabulary” (slang) important

Adult personality begins to emerge More reasonable, tolerant than at 11 Enthusiastic, uninhibited Will initiate own activity Empathetic

especially mid-

morning in school

Physical education

and sports valued

justice; also pop culture, materialism Research and study skills advance with increase of organizational discipline

Self-aware, insightful Can set realistic goals in the short term Appears secure Peers more important than teachers and parents

References:

http://www.parentingme.com/1yrshelp.htm

http://childparenting.about.com/od/physicalemotionalgrowth/tp/Child-Development-Your-Nine-Year-Old-Child.htm


http://www.child-development-guide.com/child-development-milestone.html

http://childparenting.about.com/od/physicalemotionalgrowth/a/Your-7-Year-Old-Child-Physical-Development.htm

http://www.greatschools.org/special-education/health/731-developmental-milestones-your-7-year-old-child.gs


http://www.parentingme.com/1yrshelp.htm



http://www.child-development-guide.com/child-development-milestone.html

http://childparenting.about.com/od/physicalemotionalgrowth/a/Your-7-Year-Old-Child-Physical-Development.htm



Red Flags for the Development for Each Area until Age 5

Age Physical

Cognitive Language Social/Emotional Self-help Fine Motor Skills Gross Motor Skills

1 month

2 months

3 months Persistent fisting (hypertonia)

Rolling prior to 3 months (hypertonia)

4 months

5 months

6 months

Hands frequently clenched (motor, visual, and/or cognitive deficits, neuromuscular disorder)

Not reaching for and holding (grasping) toys (motor, visual, and/or cognitive deficits)

Not rolling

Not holding head and shoulders up when on tummy

(neuromuscular or neuromotor disorders)

No visual tracking (visual impairment)

No response to sounds (hearing impaired)

Not beginning to repeat actions to elicit pleasurable results

Avoids close contact or cuddling

Inconsolable at night

Difficult self soothing/regulating

Doesn't attempt to attract attention

No interest in games like peek-a-boo

Not starting to babble (hearing deficit)

Does not smile or squeal in response to people (visual loss, attachment problems, maternal depression)

7 months W-sitting and bunny hopping (spasticity or hypotonia)

Absent stranger anxiety

8 months

9 months Unable to hold and/or Not sitting without No gestures (e.g. pointing, showing,

Not sharing enjoyment with others using eye

release toys

Cannot move toy from one hand to another

Persistence of primitive reflexes (neuromotor disorders)

support

Not moving (e.g. creeping, crawling)

Does not take weight well on legs when held by an adult

for all included here (neuromuscular or neuromotor disorders, cerebral palsy)

waving)

Not using 2-part babbles (e.g. mama, dada)

contact or facial expressions (autism, vision impairment)

10 months

Not sitting independently

Not crawling ("commando" crawling--moving across the floor on his belly)


Inability to localize sound (unilateral hearing loss)

11 months

12 months

Majority of nutrition is still puree/liquid

Cannot chew solid food

Unable to pick up small items using index finger and thumb

Not creeping (on all fours, what is typically called "crawling")

Not sitting upright in a child-sized chair

Not pulling to stand

Not crawling or bottom

Doesn't search for hidden/removed objects (intellectual disability)

Continues to problem solve using repetition actions rather than trial and error (intellectual

No babbled phrases that sound like talking (

No response to familiar words (articulation disorder)

Not performing for social attention (autism, sensorial disorders)

Does not notice someone new (intellectual disability, autism, sensorial

shuffling

Not standing holding on to furniture


disability, learning disability)

Not anticipating effects of actions (knocking over blocks) (intellectual disability, learning disability, autism, ADHD)

Not using toys for intended purposes functional play (intellectual disability)

Not showing interest in children her age (autism,behavioral problems)

Extreme difficulty waiting for desired item (ADHD)

Rigidity regarding routine, food items, clothing, etc. (autism)

Limited or fleeting eye contact (communication disorder, autism)

Persistent mouthing of objects (intellectual disability)

impairment)

Does not play early turn-taking games (autism)

13 months

14 months Not standing alone (neuromuscular

Not feeding him/herself

disorders) finger foods

15 months

Not imitating body action on a doll (i.e., kiss the baby, feed the baby) (visually impaired, autism, intellectual disabilities)

Lack of consonant production (mild hearing loss, production problems)

Does not use at least 3 words (hearing impaired, intellectual disability)

Not attempting to use a spoon

Not picking up and drinking from a regular open cup

Not able to pull off hat, socks or mittens on request

16 months Lack of imitation (hearing loss, cognition problems, autism)

17 months

18 months

Not holding or scribbling with crayons (dysgraphia, intellectual disabilities)

Does not attempt to tower blocks (behavioral problems, intellectual disabilities)

Hand dominance (contralateral weakness)

Not attempting to walk without assistance

Not standing alone


Doesn't understand function of common objects (intellectual disability)

Continues to mouth or use sensory/exploratory tactics to play (intellectual disability)

Constantly moving from one item to another/inability to attend for brief periods (ADHD)

Requires constant attention to remain engaged (ADHD)

Lack of protodeclarative pointing (problem in social relatedness)

No clear words (articulation disorder, hearing impairment)

Cannot understand short requests (intellectual disability, hearing impairment, receptive disorders)

Does not say mama, dada or other names (articulation disorder, hearing impairment, intellectual disability)

Lacks interest in playing and interacting with others (autism, behavioral problems)

19 months Not attempting to wash own hands or face

20 months

21 months

22 months

Advanced noncommunicative speech (echolalia) (autism)

Not assisting with dressing tasks (excluding clothes fasteners)

23 months

24 months

Inability to walk up and down stairs

Unable to run

Unable to throw a ball


Does not have at least 50 words, and use at least 25 (intellectual disabilities)

Not putting words together, e.g. push car

Most of what is said is not easily understood

(communication disorders, receptive, production and articulation problems)

Not imitating actions and movements (autism)

Not engaging in pretend play (autism)

Not showing interest in children her age (autism, behavioral problems)

Extreme difficulty waiting for desired items (ADHD)

Too passive (autism, inert behavioral problems)

No interest in self-care skills, e.g. feeding, dressing

25 months

26 months

27 months

Not able to match two sets of objects by item (i.e., blocks in one container and people in another) (intellectual disability, learning

disability)

Not able to imitate a model from memory (i.e., show me how you brush your teeth) (intellectual disability, autism, ADHD)

28 months

29 months

30 months

Not jumping (neuromuscular disorders)

Not independent on stairs (up and down) (neuromotor or neuromuscular disorders)

No 2-word spontaneous phrases

31 months

Not able to match two sets of objects by color (visual impairment, intellectual disability, down syndrome)

32 months

33 months

34 months Not able to deliberately undo large buttons, snaps and shoelaces

35 months

3 years Difficulty manipulating small objects e.g.

Not running well

Cannot kick or throw a

Not demonstrating simple categorization

Speech difficult to understand

Extreme difficulty separating from parent

Difficulty helping with self-care skills (e.g.

threading beads (cerebral palsy, dysgraphia)

ball

Cannot jump with 2 feet together


(learning disability, intellectual disabilities)

Not using simple sentences e.g. big car go

Does not ask by name for objects

Repeats phrases in response to questions

Not initiating or reciprocating simple interactions with children her age

Abnormal aggression

Not interested in pretend play

Difficulties in noticing and understanding feelings in themselves and others

feeding, dressing)

4 years

Unable to use pencils in scribbling or drawing (dysgraphia, intellectual disabilities)

Cannot pedal a tricycle

Cannot catch, kick or throw a ball

Cannot balance well standing on one leg


No understanding of time, or recognizing concepts like "yesterday" and "next summer" (dyscalculia, intellectual disability)

Unable to draw lines and circles (dysgraphia, intellectual disability)

Speech difficult to understand

Unable to follow direction with two steps

Unable to play games with other children and agree to rules

No spontaneous singing, dancing, or acting

Unwilling to play cooperatively

Not toilet trained by day

5 years Cannot draw simple pictures (dysgraphia, intellectual disabilities)

Awkward when running, walking, climbing, and using

Cannot answer questions in a simple conversation (articulation disorders, receptive

disorders)

Play is different than their friends (autism)

Unable to dress him or herself

Unable to go to the

stairs (dyspraxia, physical impairment)

Ball skills are very different from other peers (neuromuscular

Unable to hop 5 times on each foot

Unable to follow the rules of a simple game (behavioral problems, intellectual disabilities)

Cannot draw simple pictures (dysgraphia,

Concerns from teacher about school readiness

Difficulty telling a parent what is wrong

bathroom without assistance

Unable to help with simple chores

Any age

Difference between left and right sides of body in strength, movement, or tone (cerebral palsy)

Loose or floppy movements (low tone) or stiff and tense (high toe) (dyspraxia, cerebral palsy)

Lack of response to sound or visual stimuli (sensorial impairments)

Lack of or limited eye contact (autism, visual impairment) all from self-help

(intellectual disabilities, autism, neuromotor or neuromuscular disorders, or lack of training from caregivers)

Poor interaction with adults or other children (behavioral problems, autism)

Strong parental concern

Significant loss of skills

Not achieving indicated developmental milestones

References:

http://www.fpnotebook.com/Peds/Neuro/DvlpmntlMlstn.htm

http://www.earlyinterventionsupport.com/development/cognitive/default.aspx

http://www.uic.edu/classes/sped/sped506/milestones.html

http://www.sensory-processing-disorder.com/child-developmental-checklist.html

http://www.health.qld.gov.au/rch/professionals/brochures/red_flag.pdf

http://www.fpnotebook.com/Peds/Neuro/DvlpmntlMlstn.htm

http://www.earlyinterventionsupport.com/development/cognitive/default.aspx

http://www.uic.edu/classes/sped/sped506/milestones.html

http://www.sensory-processing-disorder.com/child-developmental-checklist.html

http://www.health.qld.gov.au/rch/professionals/brochures/red_flag.pdf

Education

Developmental milestones and red flags