Developmental milestones in children
| Age | Social/emotional skills | Language | Cognitive | Movement/physical development |
| 2 months | Smiles at people | Coos and makes gurgling sounds; turns head toward sounds | Pays attention to faces; follows objects with eyes | Holds head up; begins to push up when lying on tummy |
| 4 months | Likes to play with people; copies facial expressions (smiling or frowning) | Babbles; cries in different ways to show hunger, pain, or tiredness | Uses hands and eyes together (e.g., reaching for a toy); follows moving things; recognizes familiar people | Holds head steady without support; pushes legs down when on a hard surface; may roll over from tummy to back; brings hands to mouth; holds toys |
| 6 months | Recognizes strangers | Responds to sounds by making sounds; responds to own name; begins to say consonant sounds (m, b) | Brings objects to mouth; tries to get objects that are out of reach; passes objects from one hand to the other | Rolls over in both directions; begins to sit without support |
| 9 months | May be afraid of strangers; may be clingy with family members | Understands “no”; makes different sounds (e.g., “mamamama”); uses a finger to point at objects | Plays peek-a-boo; picks up things between thumb and index finger (pincer grasp) | Stands with support; sits without support; pulls to stand; crawls |
| 1 year | May be shy or nervous with strangers; cries when parents leave; plays games like “pat-a-cake” | Responds to simple spoken requests; uses simple gestures (e.g., shaking head for “no” or waving “bye-bye”); says “mama” and “dada” | Explores things by shaking, banging, and throwing; finds hidden things easily; looks at the right picture or thing when it’s named; drinks from a cup; follows simple directions | Pulls up to stand; walks holding on to furniture (“cruising”); may stand alone; may take a few steps without holding on |
| 18 months | May have temper tantrums; engages in pretend play; explores alone with a parent close by | Says several single words | Knows and names ordinary objects (e.g., spoon, phone); scribbles; follows one-step verbal commands | Walks alone; may walk up steps; can undress themselves; drinks from a cup; eats with a spoon |
| 2 years | Copies adults and other children; shows more independence; may show defiant behavior; plays beside other children | Knows names of familiar people and body parts; says 2-4 word sentences | Sorts shapes and colors; plays make-believe games; builds towers with 4 or more blocks; may show hand preference (left/right); follows 2-step instructions | Stands on tiptoes; kicks a ball; begins to run; walks up and down stairs holding on; draws straight lines or circles |
| 3 years | Takes turns; shows concern for a crying friend; shows a wide range of emotions; dresses and undresses self; separates easily from parents | Follows 2- or 3-step instructions; says name and age; talks well enough for strangers to understand; carries on a conversation with 2-3 sentences | Plays with toys with moving parts; plays make-believe with dolls, animals, and people; builds towers with more than 6 blocks; does puzzles with 3 or 4 pieces | Climbs well; runs easily; pedals a tricycle; walks up and down stairs one foot at a time |
| 4 years | Likes to play with other kids; cooperates with other children | Uses basic grammar correctly (e.g., “he,” “she”); sings a song or recites a poem from memory; tells stories; can say first and last name | Names colors and numbers; understands the idea of counting; starts to copy capital letters | Hops and stands on one foot for up to 2 seconds; pours; cuts with supervision; catches a bounced ball |
| 5 years | Wants to please friends and be like them; mostly follows rules; is aware of gender | Speaks clearly; tells a simple story using full sentences | Counts 10 or more things; can draw a person with at least 6 body parts; can print letters or numbers; draws a triangle and other geometric shapes | Stands on one foot for 10 seconds or longer; hops; may skip; uses a fork and spoon; can use the toilet independently |
Enuresis, primary and secondary: Nocturnal enuresis is defined as nighttime bedwetting in children 5 years of age or older. Secondary enuresis is bedwetting in children who were previously continent at night, and it’s often associated with stressors such as a new baby in the home, a recent move, or the loss of a loved one.
Management includes decreasing fluid intake after dinner, avoiding caffeinated beverages in the evening and at night, using a bed alarm (most sustained effect), and medications such as desmopressin and tricyclic antidepressants. Desmopressin (synthetic vasopressin) acts on the renal collecting duct and distal tubules to enhance reabsorption of water, which decreases excessive nocturnal urine production.