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Child Development Timetable
Table 15-1: Growth and Caloric Requirements
| Age | Approx. Daily Weight Gain (g) | Approx. Monthly Weight Gain | Growth in Length (cm/mo) | Growth in Head Circumference (cm/mo) | Recommended Daily Allowance (kcal/kg/day) |
|---|---|---|---|---|---|
| 0-3 mo | 30 | 2 lb | 3.5 | 2.00 | 115 |
| 3-6 mo | 20 | 1.25 lb | 2.0 | 1.00 | 110 |
| 6-9 mo | 15 | 1 lb | 1.5 | 0.50 | 100 |
| 9-12 mo | 12 | 13 oz | 1.2 | 0.50 | 100 |
| 1-3 yr | 8 | 8 oz | 1.0 | 0.25 | 100 |
| 4-6 yr | 6 | 6 oz | 3 cm/yr | 1 cm/yr | 90-100 |
Developmental Milestones by Age
NEONATAL PERIOD (1st 4 Wk)
| Domain | Milestone |
|---|---|
| Prone | Lies in flexed attitude; turns head from side to side; head sags on ventral suspension |
| Supine | Generally flexed and a little stiff |
| Visual | May fixate face on light in line of vision; "doll's-eye" movement of eyes on turning of the body |
| Reflex | Moro response active; stepping and placing reflexes; grasp reflex active |
| Social | Visual preference for human face |
AT 1 MO
| Domain | Milestone |
|---|---|
| Prone | Legs more extended; holds chin up; turns head; head lifted momentarily to plane of body on ventral suspension |
| Supine | Tonic neck posture predominates; supple and relaxed; head lags when pulled to sitting position |
| Visual | Watches person; follows moving object |
| Social | Body movements in cadence with voice of other in social contact; beginning to smile |
AT 2 MO
| Domain | Milestone |
|---|---|
| Prone | Raises head slightly farther; head sustained in plane of body on ventral suspension |
| Supine | Tonic neck posture predominates; head lags when pulled to sitting position |
| Visual | Follows moving object 180 degrees |
| Social | Smiles on social contact; listens to voice and coos |
AT 3 MO
| Domain | Milestone |
|---|---|
| Prone | Lifts head and chest with arms extended; head above plane of body on ventral suspension |
| Supine | Tonic neck posture predominates; reaches toward and misses objects; waves at toy |
| Sitting | Head lag partially compensated when pulled to sitting position; early head control with bobbing motion; back rounded |
| Reflex | Typical Moro response has not persisted; makes defensive movements or selective withdrawal reactions |
| Social | Sustained social contact; listens to music; says "aah, ngah" |
GROSS MOTOR Milestones
| Milestone | Age (months) | Significance |
|---|---|---|
| Holds head steady while sitting | 2 | Allows more visual interaction |
| Pulls to sit, with no head lag | 3 | Muscle tone |
| Brings hands together in midline | 3 | Self-discovery of hands |
| Asymmetric tonic neck reflex gone | 4 | Can inspect hands in midline |
| Sits without support | 6 | Increasing exploration |
| Rolls back to stomach | 6.5 | Truncal flexion, risk of falls |
| Walks alone | 12 | Exploration, control of proximity to parents |
| Runs | 16 | Supervision more difficult |
FINE MOTOR Milestones
| Milestone | Age (months) | Significance |
|---|---|---|
| Grasps rattle | 3.5 | Object use |
| Reaches for objects | 4 | Visuomotor coordination |
| Palmar grasp gone | 4 | Voluntary release |
| Transfers object hand to hand | 5.5 | Comparison of objects |
| Thumb-finger grasp | 8 | Able to explore small objects |
| Turns pages of book | 12 | Increasing autonomy during book time |
| Scribbles | 13 | Visual-motor coordination |
| Builds tower of 2 cubes | 15 | Uses objects in combination |
| Builds tower of 6 cubes | 22 | Requires visual, gross, and fine motor coordination |
COGNITIVE Milestones
| Milestone | Age (months) | Significance |
|---|---|---|
| Stares momentarily at spot where object disappeared | 2 | Lack of object permanence (out of sight, out of mind [e.g., yarn ball dropped]) |
| Stares at own hand | 4 | Self-discovery, cause and effect |
| Bangs 2 cubes | 8 | Active comparison of objects |
| Uncovers toy (after seeing it hidden) | 8 | Object permanence |
| Egocentric symbolic play (e.g., pretends to drink from cup) | 12 | Beginning symbolic thought |
| Uses stick to reach toy | 17 | Able to link actions to solve problems |
| Pretend play with doll (e.g., gives doll bottle) | 17 | Symbolic thought |
COMMUNICATION AND LANGUAGE Milestones
| Milestone | Age (months) | Significance |
|---|---|---|
| Smiles in response to face, voice | 1.5 | More active social participant |
| Monosyllabic babble | 6 | Experimentation with sound, tactile sense |
| Inhibits to "no" | 7 | Response to tone (nonverbal) |
| Follows one-step command with gesture | 7 | Nonverbal communication |
| Follows one-step command without gesture | 10 | Verbal receptive language (e.g., "Give it to me") |
| Says "mama" or "dada" | 10 | Expressive language |
| Points to objects | 10 | Interactive communication |
| Speaks first real word | 12 | Beginning of labeling |
| Speaks 4-6 words | 15 | Acquisition of object and personal names |
| Speaks 10-15 words | 18 | Acquisition of object and personal names |
| Speaks 2-word sentences (e.g., "Mommy shoe") | 19 | Beginning grammatization, corresponds with 50 word vocabulary |
Table 16-3: Red Flags in Developmental Screening and Surveillance
These indicators suggest that development is seriously disordered and that the child should be promptly referred to a developmental or community pediatrician. Note: Most children do not have "red flags" and thus require quality screening to detect any problems.
POSITIVE INDICATORS (THE PRESENCE OF ANY OF THE FOLLOWING)
- Loss of developmental skills at any age
- Parental or professional concerns about vision, fixing, or following an object or a confirmed visual impairment at any age (simultaneous referral to pediatric ophthalmology)
- Hearing loss at any age (simultaneous referral for expert audiologic or ear, nose, and throat assessment)
- Persistently low muscle tone or floppiness
- No speech by 18 mo, especially if the child does not try to communicate by other means such as gestures (simultaneous referral for urgent hearing test)
- Asymmetry of movements or other features suggestive of cerebral palsy, such as increased muscle tone
- Persistent toe walking
- Complex disabilities
- Head circumference above the 99.6th centile or below 0.4th centile. Also, if circumference has crossed 2 centiles (up or down) on the appropriate chart or is disproportionate to parental head circumference
- An assessing clinician who is uncertain about any aspect of assessment but thinks that development may be disordered
NEGATIVE INDICATORS (ACTIVITIES THAT THE CHILD CANNOT DO)
- Sit unsupported by 12 mo
- Walk by 18 mo (boys) or 2 yr (girls) (check creatine kinase urgently)
- Walk other than on tiptoes
- Run by 2.5 yr
- Hold object placed in hand by 5 mo (corrected for gestation)
- Reach for objects by 6 mo (corrected for gestation)
- Point at objects to share interest with others by 2 yr
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