Developmental milestones

Developmental milestones are skills or behaviors performed by most children at a certain age. These milestones are used to track growth and development.

Below you will find a list of developmental milestones to be achieved by children, milestones by age at which they should occur:

• 2 months
  • Holds head up in prone to 45 degrees
  • Does not accept weight on the lower extremities
  • No head control during support sitting
• 4 months
  • Rolls prone to side, supine to side
  • Head control demonstrated in supported sitting
  • Ulnar-palmar grasp
  • No head lag when pulling up to sit
• 6 months
  • Rolls supine to prone
  • Independent sitting
  • Prone on extended arms and weight shifting with extended arms
• 8-9 months
  • Creeping
  • Pull to stand via kneeling with furniture
  • Can stand independently for 1-2 seconds
  • Able to transfer objects between hands
  • Independent with side-sitting
• 10-15 months
  • Independently walking
  • Creeps up/down steps
  • Transfers floor to standing
• 20 months
  • Ascends steps with step-to-step pattern while holding unilateral rail or hand
  • Uncoordinated running pattern
  • Able to jump from a 2-inch step independently
• 24 months
  • Ascends steps with step-to-step pattern independently without holding unilateral rail or hand
  • Uncoordinated running at increased speed

Primitive reflexes

Primitive reflexes are involuntary motor responses to a newborn’s environment that originate in the brainstem and function to aid in survival. Each reflex will have a time in which it appears and then a time in which it is no longer present (age of integration).

See primitive reflexes below:

• Rooting
  • Define: stroking the cheek to allow for locating the bottle nipple or breast for consuming milk
  • Age appears: birth
  • Age integrates: 3-4 months
• Moro
  • Define: protective reflex activated by the sympathetic nervous system that occurs when a loud noise startles an infant
    • Arms and legs extend with fanned out fingers
    • Head extends
    • Infant cries
    • Infant quickly pulls arms/legs back into midline position
  • Age appears: birth
  • Age integrates: 2-4 months
• Palmar grasp
  • Define: grasping of an object when placed in the palm
  • Age appears: birth
  • Age integrates: 5-6 months
• Asymmetrical tonic reflex
  • Define: aids infant in developing muscle tone, hand-eye coordination, and motor skills
    • Infant turns head; face-side arm causes arm/leg to extend; while scalp-side arm/leg flexes
  • Age appears: birth
  • Age integrates: 6 months
• Spinal galant
  • Define: stroking laterally to the spinal column causes lateral flexing to the ipsilateral side
  • Age appears: birth
  • Age integrates: 3-9 months
• Tonic labyrinth
  • Define: aids the infant in learning how to control the head and neck
    • Neck flexion causes arms/legs to flex
    • Neck extension causes arms/legs to extend
  • Age appears: in utero
  • Age integrates: 3 ½ years
• Symmetrical tonic neck reflex
  • Define: aids the infant in learning how to control the upper and lower body independently
    • Infant head moves forward; arms flex and legs extend
    • Infant head moves backward: arms extend and legs flex
  • Age appears: 6-9 months
  • Age integrates: 9-11 months
• Landau
  • Define: aids infant in motor control and coordination
    • Infant held horizontally in the air with their head and back extended with an arch in the back
  • Age appears: 4-5 months
  • Age integrates: 12 months
• Babinski
  • Define: involuntary movement that occurs when the foot is stroked
    • The lateral edge of the foot is stroked, causing extension of the toes and fanning of the toes
  • Age appears: birth
  • Age integrates: 2 years
• Flexor withdrawal
  • Define: protective reflex that occurs when a sharp pressure is applied to the sole or the palm, causing withdrawal of the stimulated extremity
  • Age appears: birth
  • Age integrates: present throughout life
• Crossed extension
  • Define: protective reflex that occurs when a sharp pressure is applied to the sole or the palm, causing withdrawal of the stimulated extremity and extension of the unaffected limb
  • Age appears: birth
  • Age integrates: present throughout life
• Primary standing
  • Define: An infant, when placed in a standing position, will support some weight and extend lower extremities
  • Age appears: birth
  • Age integrates: 2 months
• Primary walking
  • Define: A protective reflex that occurs when a sharp pressure is applied to the foot, and the trunk is tilted forward, causing reciprocal stepping
  • Age appears: birth
  • Age integrates: 2 months
• Plantar grasp
  • Define: pressure on the sole or lower foot causes the toes to curl
  • Age appears: birth
  • Age integrates: 9 months

Newborn considerations

The normal gestational period is 40 weeks. Infants born before this time have an increased risk of developing congenital anomalies and developmental delays.

Infants are assessed at birth, minute 1, minute 5, and minute 10 after birth via the APGAR scale. The APGAR scale assesses appearance (color), pulse, grimace (reflex irritability), activity, and respirations. Each is scored with a 0, 1, or 2, with the goal of the score being between 7-10. At every assessment, the expectation is that the score will go up. If scores decline below 7, this indicates pathology present and possible complications.

Examination of the newborn also includes assessment of the musculoskeletal system, range of motion, posture, primitive reflexes as appropriate, and tone. Any abnormalities noted will be the rationale for performing specific outcome measures for assessment.

Outcome measures

• Albert infant scale
  • Define: gross motor skills assessment tool used to evaluate weight-bearing, posture, and antigravity movements in infants
  • Age for use of scale: 0-18 months
• Peabody development motor scale
  • Define: assesses gross and fine motor development to include spontaneous, elicited reflexes, and automatic reactions used primarily for developmental delay
    • More sensitive to change than the Bayley Scales of Infant Development
  • Age for use of scale: 0-42 months
• Gross motor function measure - 88 (GMFM-88)
  • Measures gross motor function in the cerebral palsy population
    • Focuses on voluntary movement in five phases — prone and supine, sitting, crawling and kneeling, standing, walking, and jumping
  • Age of use of scale: 0-5 years
• Bruininks-Oseretsky test of motor proficiency (BOT-2)
  • Developed to measure gross and fine motor skills for individuals with developmental delay
  • Age of use of scale: 4-21 years
• Bayley scales of infant development
  • Developed to measure motor and mental scales for children with developmental delay
    • Assesses 5 domains: cognitive, language, motor, social-emotional, adaptive
  • Age of use of scale: birth - 42 months
• Functional independence measure for children (WeeFIM)
  • Assesses function in self-care, mobility, locomotion, and social cognition in children status-post acute injury (such as spinal cord injury, traumatic brain injury, multiple fractures, etc.)
  • Age of use of scale: 3-8 years