Developmental milestones and screening tools

Developmental milestones and screening tools

• Developmental milestones are skills or behaviors that most children can do by a certain age. Developmental screening is a process of identifying children who may have developmental delays or disabilities and need further evaluation. 

• Developmental surveillance is a continuous and cumulative process of monitoring children's development at each health supervision visit.

• Developmental milestones are influenced by various factors, such as genetics, environment, culture, nutrition, health, and education. 

• Some factors can enhance or hinder a child's development, such as exposure to stimulation, quality of care, access to resources, or exposure to trauma. 

• Therefore, it is essential to provide children with optimal conditions for their growth and development, such as love, safety, nutrition, health care, education, and play.

• These milestones are based on averages and may vary from child to child. Each child is unique and develops at their own pace. 

• However, if a child is significantly behind or ahead of their peers in reaching certain milestones, it may indicate a developmental delay or a giftedness. 

• In such cases, it is important to consult a healthcare professional for further evaluation and intervention.

• Developmental milestones can be grouped into five domains: 

  • Physical

  • Cognitive

  • Language

  • Social-emotional

  • Adaptive 

• The following are some of the developmental milestones for each age group, based on the CDC's Learn the Signs. Act Early program and the AAP's Bright Futures guidelines. 

• Note that these are general guidelines and not all children will reach them at the same time or in the same order.

Birth-1 year:

Physical milestones:

• Lifts head and turns it when lying on the stomach (around 12 months)

• Begins to roll over (around 3-4 months)

• Sits with support and later independently (around 6-7 months)

• Begins crawling or scooting (around 7-10 months)

• Pulls self to a standing position (around 9-12 months)

• Takes the first steps with assistance (around 12 months)

Cognitive milestones:

• Tracks objects with eyes and responds to visual stimuli (1-2 months)

• Grasps objects and explores them with hands (3-4 months)

• Begins to babble and imitate simple sounds (5-6 months)

• Demonstrates object permanence (understands objects exist even if not seen) (7-8 months)

• Engages in simple problem-solving, such as picking up a dropped toy (9-10 months)

• Responds to simple commands and understands cause and effect (11-12 months)

Language milestones:

• Cries to communicate needs (birth)

• Cooing and gurgling sounds (2-3 months)

• Laughs and makes a variety of vowel sounds (4-6 months)

• Babbling with consonant sounds (7-9 months)

• Responds to own name and simple words (10-11 months)

• Says first words, like "mama" or "dada" (12 months)

Social-emotional milestones:

• Begins to show social smiles and expressions of happiness (2-3 months)

• Develops attachment to primary caregivers (4-6 months)

• Engages in back-and-forth interactions, such as peekaboo (7-9 months)

• Demonstrates stranger anxiety (10-12 months)

• Shows preferences for familiar toys and people (10-12 months)

Adaptive milestones:

• Develops sleep-wake cycles and begins to sleep for longer periods (2-3 months)

• Starts to self-soothe by sucking on fingers or thumbs (4-6 months)

• Begins to eat solid foods and self-feeds with fingers (6-8 months)

• Explores and plays with various textures and objects (9-12 months)

• Exhibits emerging independence in activities like holding a bottle (9-12 months)

• Develops basic coping mechanisms for mild discomfort or frustration (9-12 months)

1-3 years:

Physical milestones:

• Walks without help and runs with coordination

• Climbs stairs with alternating feet and jumps with both feet

• Throws and catches a ball with both hands

• Draws circles and lines with a crayon or pencil

• Uses a spoon and fork to feed self

• Dresses and undresses self with assistance

Cognitive milestones:

• Explores objects with curiosity and attention

• Follows simple one-step commands

• Imitates actions and words of others

• Names common objects and pictures

• Sorts shapes and colors

• Completes simple puzzles

Language milestones:

• Says first words around 12 months and uses two-word phrases by 24 months

• Understands simple questions and directions

• Points to body parts, animals, and familiar people when asked

• Uses pronouns (I, you, me) and plurals (dogs, cars)

• Asks "what", "where", and "why" questions

• Learns new words every day

Social-emotional milestones:

• Shows affection and empathy to others

• Plays alongside other children (parallel play)

• Expresses a range of emotions (happy, sad, angry, scared)

• Begins to share and take turns with guidance

• Shows independence and assertiveness

• Develops a sense of self and gender identity

Adaptive milestones:

• Adjusts to new situations and routines

• Shows interest in toilet training and may stay dry during the day

• Helps with simple household chores (putting away toys, wiping spills)

• Follows basic rules and limits

• Develops coping skills to deal with frustration and disappointment

3-6 years:

Physical milestones:

• Walks up and down stairs with ease and rides a tricycle or bicycle

• Balances on one foot, hops, skips, and jumps over obstacles

• Throws and catches a ball with accuracy and kicks a ball forward

• Draws shapes, letters, and numbers with a crayon or pencil

• Cuts paper with scissors and uses glue to paste things together

• Buttons, zips, snaps, and ties clothing

Cognitive milestones:

• Understands concepts of size, shape, weight, color, and number

• Counts to 10 or higher and recognizes some written numbers

• Matches objects that belong together (e.g., sock-shoe, spoon-fork)

• Recognizes patterns and sequences (e.g., red-blue-red-blue)

• Solves problems using trial and error or logic

• Remembers and retells stories or events

Language milestones:

• Speaks in complete sentences of four to six words or more

• Uses correct grammar most of the time (e.g., verb tense, pronouns)

• Asks and answers questions using who, what, when, where, how, why

• Describes objects or situations using adjectives or adverbs (e.g., big-small, fast-slow)

• Tells stories with a clear beginning, middle, and end

• Learns to read simple words or sentences

Social-emotional milestones:

• Shows interest in making friends and playing cooperatively (associative play)

• Understands feelings of others and responds appropriately (e.g., comfort, apologize)

• Expresses emotions verbally and regulates impulses (e.g., waits for turn, asks for help)

• Develops self-confidence and self-esteem (e.g., tries new things, accepts praise)

• Shows awareness of social norms and expectations (e.g., manners, rules)

• Develops a sense of morality (e.g., right-wrong, fair-unfair)

Adaptive milestones:

• Between ages 3 and 4, children can pour well from a small pitcher, spread soft butter with a knife, button and unbutton large buttons, wash hands independently, blow nose when reminded, use toilet independently, and open doors by turning handles.

• Between ages 4 and 5, children can cut easy foods with a knife, lace shoes, dress themselves completely, tie bows, brush teeth independently, and cross streets safely.

• Between ages 5 and 6, children can use utensils to pick up pieces of food, have an established sleep schedule, tolerate and wear different textures of clothes, take appropriate bites of food without stuffing their mouth, tolerate haircuts and nail cutting without crying, and ask a lot of why, how, when questions.

6-8 years:

Physical milestones:

• Develops better hand-eye coordination for activities like drawing and writing

• Refines gross motor skills in sports and physical activities

• Demonstrates improved balance and agility

• Learns and practices more complex movements, such as skipping and jumping rope

• Begins to participate in organized sports and activities

Cognitive milestones:

• Shows improved concentration and problem-solving skills

• Learns to read more fluently and comprehend complex texts

• Develops mathematical skills, including addition, subtraction, and basic multiplication

• Understands cause-and-effect relationships

• Demonstrates improved memory and organizational skills

• Engages in more complex and strategic games

Language milestones:

• Expands vocabulary and uses more sophisticated language

• Reads and comprehends more complex written material

• Writes longer and more detailed stories and essays

• Expresses ideas clearly in both verbal and written communication

• Learns and understands grammar rules and language nuances

• Shows an interest in learning new languages

Social-emotional milestones:

• Forms deeper and more meaningful friendships

• Understands and navigates social hierarchies and relationships

• Demonstrates increased empathy and consideration for others

• Develops a sense of humor and understands sarcasm

• Shows increased independence in decision-making and problem-solving

• Begins to understand and regulate emotions more effectively

Adaptive milestones:

• Takes on more responsibility for personal hygiene and selfcare

• Demonstrates increased independence in daily routines and tasks

• Participates in more complex household chores and responsibilities

• Manages time more effectively for homework and activities

• Develops awareness of personal strengths and areas for improvement

• Understands and follows safety rules in various settings

9-12 years:

Physical milestones:

• Continues to refine and improve gross and fine motor skills

• Develops better coordination and proficiency in sports and physical activities

• Demonstrates increased endurance and strength

• Engages in more complex physical challenges and activities

• Explores and shows interest in a variety of sports and recreational activities

Cognitive milestones:

• Shows advanced problem-solving and critical thinking skills

• Reads and comprehends more advanced literature

• Demonstrates proficiency in mathematics, including multiplication, division, and basic algebra

• Develops an interest in science and explores more complex scientific concepts

• Engages in independent research and projects

• Demonstrates improved study skills and time management

Language milestones:

• Communicates effectively in both verbal and written forms

• Writes essays and reports with a clear structure and supporting details

• Expands vocabulary and uses language creatively

• Understands and uses more advanced grammar and language conventions

• Engages in discussions and debates, expressing opinions thoughtfully

• Reads and comprehends complex texts across various subjects

Social-emotional milestones:

• Forms deeper and more complex friendships

• Navigates more complex social dynamics and relationships

• Demonstrates increased emotional intelligence and self-awareness

• Begins to explore personal values and beliefs

• Shows independence in decision-making and problem-solving

• Develops a sense of responsibility for oneself and others

Adaptive milestones:

• Takes on increased responsibility for personal hygiene and selfcare

• Manages more complex daily routines and tasks independently

• Takes on more significant household chores and responsibilities

• Demonstrates time management skills for academic and extracurricular activities

• Shows awareness of personal strengths, weaknesses, and areas for improvement

• Understands and follows safety rules in various settings

12-14 years:

Physical milestones:

• Undergoes puberty and experiences physical changes associated with adolescence

• Demonstrates improved coordination and motor skills

• Engages in organized sports and physical activities

• Develops greater strength and endurance

• May experience growth spurts and changes in body composition

• Explores and finds interest in various physical fitness activities

Cognitive milestones:

• Demonstrates advanced problem-solving and critical thinking skills

• Engages in more complex academic subjects and coursework

• Develops a deeper understanding of abstract concepts

• Demonstrates improved study skills and time management

• Begins to explore career interests and goals

• Engages in independent research and projects

Language milestones:

• Communicates effectively in both verbal and written forms

• Writes essays and reports with a sophisticated structure and supporting details

• Expands vocabulary and uses language creatively

• Engages in more advanced literary analysis

• Demonstrates proficiency in using technology for communication

• Reads and comprehends complex texts across various subjects

Social-emotional milestones:

• Forms deeper and more complex friendships and relationships

• Navigates more mature social dynamics and peer influences

• Develops a stronger sense of personal identity

• Begins to explore personal values, beliefs, and ethical considerations

• Demonstrates increased emotional intelligence and self-awareness

• Engages in discussions about social issues and global perspectives

Adaptive milestones:

• Takes on increased responsibility for personal hygiene and selfcare

• Manages more complex daily routines and tasks independently

• Demonstrates time management skills for academic and extracurricular activities

• Takes on more significant household chores and responsibilities

• Explores potential career paths through internships or part-time jobs

• Shows awareness of personal strengths, weaknesses, and areas for improvement

15-18 years:

Physical milestones:

• Continues to experience physical development and maturity

• Engages in regular physical activity for overall health and wellbeing

• Demonstrates proficiency in a chosen sport or physical activity

• Experiences further changes associated with late adolescence

• Develops habits for lifelong physical fitness and health

• Explores and finds interest in a variety of physical activities

Cognitive milestones:

• Engages in advanced academic coursework and specialized subjects

• Demonstrates critical thinking and problem-solving skills in real-world contexts

• Prepares for and takes on standardized testing for college or career pathways

• Begins to explore and narrow down academic and career interests

• Demonstrates proficiency in time management for academic and extracurricular activities

• Prepares for the transition to higher education or the workforce

Language milestones:

• Communicates effectively in both formal and informal settings

• Writes essays, research papers, and creative pieces with sophistication

• Engages in advanced literary analysis and critical thinking

• Uses technology for research, communication, and academic purposes

• Reads and comprehends complex texts across various disciplines

• Prepares and presents arguments and ideas persuasively

Social-emotional milestones:

• Forms deeper and more mature relationships with peers and mentors

• Explores and solidifies personal values, beliefs, and ethical considerations

• Navigates complex social dynamics and peer influences

• Demonstrates increased emotional intelligence and self-awareness

• Prepares for independence and autonomy in decision-making

• Engages in discussions about social justice, global issues, and personal responsibility

Adaptive milestones:

• Takes on increased responsibility for personal health and wellbeing

• Manages complex daily routines and tasks independently

• Demonstrates advanced time management skills for academic and extracurricular commitments

• Takes on more significant roles and responsibilities within the family or community

• Prepares for the transition to adulthood, including financial literacy and life skills

• Shows awareness of personal strengths, weaknesses, and areas for growth

• There are various tools that can be used to assess developmental milestones and screen for developmental concerns. 

• Some examples are:

  • CDC's "Learn the Signs. Act Early." program: This program offers free parent-friendly milestone checklists for children 2 months to 5 years of age, based on evidence-informed milestones that most children (≥75%) would be expected to achieve by specific health supervision visit ages. The checklists can be used to monitor children's development, support parent education, and identify children who may need further screening or evaluation. The checklists are available in print, online, or as an app.

  • Metro Manila Developmental Screening Test (MMDST): This is a screening tool developed in the Philippines for children 6 months to 6 years of age. It consists of four domains: gross motor, fine motor-adaptive, language, and personal-social. It uses simple materials such as a rattle, blocks, glass, bell, ball, cheese curls, and pencil. The test is administered by observing the child's performance of tasks that correspond to each domain and age group. The results are classified as normal, suspect, or abnormal.

  • Ages and Stages Questionnaires (ASQ): These are parent-completed questionnaires that screen children's development from 1 month to 5½ years of age. They cover five domains: communication, gross motor, fine motor, problem-solving, and personal-social. There are different versions of the ASQ for different ages and purposes, such as the ASQ3 for general screening and the ASQ:SE2 for social-emotional screening. The questionnaires are scored by adding up the points for each item and comparing them to cutoff scores that indicate the need for further assessment.

  • The Denver Developmental Screening Test II (DDSTII): a test for children from birth to 6 years old that assesses four domains: personal-social, fine motor-adaptive, language, and gross motor skills.

  • The Modified Checklist for Autism in Toddlers (MCHAT): a questionnaire for children from 16 to 30 months old that screens for autism spectrum disorder by assessing social communication and behavioral skills.