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Developmental Milestones

Sources: The Harriet Lane Handbook (23rd ed.), Kaplan & Sadock's Synopsis of Psychiatry, CDC guidelines

Domains of Development

Every milestone assessment tracks four domains:

Social/Emotional - attachment, play, self-regulation
Language/Communication - receptive and expressive language
Cognitive - thinking, learning, problem-solving
Movement/Physical - gross motor and fine motor

Milestone Table by Age

🍼 2 Months

Domain	Milestone
Social/Emotional	Calms when spoken to or picked up; smiles when you smile at her
Language	Makes sounds other than crying; reacts to loud sounds
Cognitive	Watches you move; looks at a toy for several seconds
Motor	Holds head up while on tummy; opens hands briefly

🍼 4 Months

Domain	Milestone
Social/Emotional	Smiles on own to get attention; chuckles when you try to make him laugh
Language	Cooing sounds ("ooo", "aahh"); turns head toward your voice
Cognitive	Opens mouth when sees breast/bottle if hungry
Motor	Holds head steady; holds a toy placed in hand; pushes onto elbows/forearms on tummy

🍼 6 Months

Domain	Milestone
Social/Emotional	Knows familiar people; laughs; likes mirror
Language	Takes turns making sounds; blows "raspberries"; squealing
Cognitive	Puts things in mouth to explore; reaches for toys
Motor	Rolls tummy to back; pushes up with straight arms; leans on hands when sitting

🍼 9 Months

Domain	Milestone
Social/Emotional	Stranger anxiety; multiple facial expressions; smiles at peek-a-boo
Language	Babbles: "mamama," "bababa"; lifts arms to be picked up
Cognitive	Object permanence beginning (looks for dropped objects); bangs two things together
Motor	Sits without support; transfers objects hand to hand; rakes food with fingers

👶 12 Months

Domain	Milestone
Social/Emotional	Plays pat-a-cake
Language	Waves bye-bye; says "mama"/"dada" with meaning; understands "no"
Cognitive	Puts objects in a container; searches for hidden toy
Motor	Pulls to stand; cruises furniture; pincer grasp; drinks from cup (held)

👶 15 Months

Domain	Milestone
Social/Emotional	Copies other children; hugs stuffed toys; shows affection
Language	1-2 words besides "mama"/"dada"; points to request help
Cognitive	Uses objects correctly (spoon, cup); stacks 2 blocks
Motor	Walks independently; scribbles

🧒 18 Months

Domain	Milestone
Social/Emotional	Moves away from caregiver, checks back
Language	~10 words; says "no" and shakes head
Cognitive	Pretend play begins (feeding a doll)
Motor	Walks up stairs with help; drinks from a cup

🧒 24 Months (2 Years)

Domain	Milestone
Social/Emotional	Notices when others are hurt; checks your face in new situations
Language	At least 2-word phrases ("more milk"); points to 2 body parts
Cognitive	Holds one thing while using other hand; plays with 2 toys at once
Motor	Kicks a ball; runs; walks up stairs; eats with a spoon

🧒 30 Months

Domain	Milestone
Social/Emotional	Plays alongside other children; shows off ("Look at me!")
Language	~50 words; two-word sentences with action word ("doggie run"); uses "I/me"
Cognitive	Pretend play; follows 2-step instructions; knows 1 color
Motor	Jumps off ground; turns book pages one at a time; twists doorknobs

🧒 3 Years

Domain	Milestone
Social/Emotional	Calms within 10 min of caregiver leaving; joins other children to play
Language	2+ back-and-forth exchanges; asks "who/what/where/why"; says first name
Cognitive	Draws a circle; avoids danger when warned
Motor	Strings beads; uses a fork; puts on loose clothing

🧒 4 Years

Domain	Milestone
Social/Emotional	Pretend play (teacher, superhero); comforts hurt friends; changes behavior by setting
Language	Sentences with 4+ words; recounts daily events; answers simple questions
Cognitive	Names some colors/numbers; understands basic rules of games
Motor	Catches a bounced ball; buttons some buttons

🧒 5 Years

Domain	Milestone
Social/Emotional	Follows rules in games; sings/dances/performs; does simple chores
Language	Tells a story with 2+ events; keeps a conversation 3+ exchanges; uses simple rhymes
Cognitive	Counts to 10; uses time words ("yesterday," "tomorrow"); writes some letters
Motor	Hops on one foot; buttons buttons

Primitive Reflexes (Newborn)

These disappear as the nervous system matures (Kaplan & Sadock's Synopsis, p. 2756):

Reflex	Description	Disappears
Moro (startle)	Arms abduct/extend when startled	By 4 months
Grasp	Fingers close on palmar stimulation	By 4 months
Tonic neck	Head rotation causes arm/leg extension ipsilaterally	By 4 months
Babinski	Toes spread when sole is stroked	By 12 months
Rooting	Lip puckering toward perioral stimulation	4-6 months

Key Developmental Red Flags

(Harriet Lane, Table 9.4 — any of these warrants immediate evaluation)

No social smile by 3 months
No babbling by 12 months
No single words by 16 months
No 2-word phrases by 24 months
Any loss of previously acquired language or social skills at any age
No walking by 18 months

Developmental Screening Guidelines (AAP)

Surveillance at every well-child visit
Formal screening at 9, 18, and 30 months (or 24 months if 30-month visit unavailable)
Autism-specific screening at 18 and 24 months