Have you ever compared your baby with the neighbor’s friendly kid and wondered ‘Why doesn’t my baby smile yet’ or ‘My baby is already attempting to stand up, is he strong enough to do it?’ There’s really no need to fret or start comparisons. All babies are unique and their responses and actions vary naturally within specific age ranges for all milestones. And there’s an easy way to put your mind at ease and that is – Developmental Screening of your child at each succeeding stage.

From birth to five years of age, children acquire functional skills that are useful to track their progress and allow identification of potential developmental problems. As a Pediatrician, I apply scientific, standardized Development Screening tools and questionnaires to check four functional areas:

• Gross motor
• Vision and fine motor
• Hearing, speech and language
• Social, emotional and behavioral

I take feedback from parents and use direct observation of the child as well to develop a comprehensive report. These screenings assist in detecting language impairment, mild intellectual disabilities, speech delays, learning disabilities, autistic spectrum, physical disabilities and other disorders, if any. Early recognition and intervention contribute to better management of a developmental delay.  But I assure you that the experience is anything but depressing or stressful, as it may be sounding right now. In fact, as a result of the screenings, I have often observed parents becoming better observer of their child’s development behaviors and changes. It also gives me an opportunity to communicate about the development strengths of the child to their parents.      

To give you a basic idea of which developmental milestone to expect at each age, have a look at the table below. But a word of caution, avoid jumping to conclusion just because one or more milestone appears to be missing. A better alternative is to contact your pediatrician for a detailed investigation.

DEVELOPMENTAL MILESTONES — BIRTH TO FIVE YEARS

Skills	Birth to 12 Months	One Year to Two Years	Two to Three Years	Three to Four Years	Four to Five Years
Cognitive Skills	Follows moving object with eyes. Looks directly at faces and responds to gestures. Places toy in and takes toy out of containers. Beginning of memory—object permanence. Looks for hidden objects. Listens to and follows simple directions.	Imitates adults through actions and words. Names simple objects. Listens to and follows commands and requests. Explores the environment. Acts like “little scientist.” Matches simple objects.	Can name and recognize one color. Matches shapes and objects by function. Stacks objects such as blocks, five high. Responds to simple direction. Has limited attention span. Identifies objects in picture books. Can describe own activity. Begins to understand function of objects in familiar environments.	Can name and recognize six colors. Begins to understand concept of time, including past and present. Understands concept of pretending. Knows own full name and age. Attention span is somewhat longer, but easily distracted. Can match by “family” group or function.	Matches pictures of familiar objects. Draws people figures with recognizable parts. Counts to five. Knows street and town where he lives. Points to and names six colors. Matches commonly related objects. Has extended attention span. Has increased understanding of time, function, and whole and part.
Language Skills	Cries, babbles, and coos. Looks at speaker when spoken to and responds using variety of sounds. Capable of vowel and consonant sounds, often using repetition. Begins to imitate sounds. Begins to use intonation for meaning.	Speaks first words. Able to speak 50 meaningful words to communicate. Identifies and names simple objects. Uses gestures to enhance communication. Indicates possession by using words mine, me. Uses the word no frequently to voice autonomy.	Talks constantly. Refers to self by proper pronouns. Uses plurals. Uses complete sentences consisting of three to four words. Asks questions: why, where, how?	Talks in sentences. Can relate present or past experiences. Uses past tense for verbs. Has extensive vocabulary. Can repeat a song or nursery rhyme. Can understand and use size comparisons. Asks questions for information.	Has basic grammatical structure in use. Uses increasingly complex language. Has large vocabulary base. Understands more complex directions. Uses directions in play. Able to listen to long stories.
Fine Motor Skills	Reaches for objects; grasps and plays with them. Puts objects in mouth. Uses pincer grasp. Shifts objects between hands. Drops objects; picks them up.	Stacks three objects, such as blocks, in a tower. Turns pages (two or three at a time). Turns doorknobs. Throws small ball. Scribbles, paints with large movements, holds brush with whole hand. Drinks from a cup without help. Begins using a spoon. Places round objects into holes.	Can turn pages of book one at a time. Paints using wrist action. Holds crayon with fingers, not whole hand. Moves fingers independently of others. Strings beads. Cuts using scissors, but hasn’t mastered it. Shows hand preference. Manipulates clay by rolling and pounding.	Drives pegs into holes, nails into wood. Can copy circle or cross. Manipulates clay and play dough into recognizable objects. Able to stack objects nine high. Cuts using scissors.	Cuts on a straight line. Copies simple figures. Prints a few capital letters.
Gross Motor Skill	Lifts head. Turns from side to side; rolls over. Sits with back straight and head steady. Able to crouch. Crawls. Pulls self up into a standing position, then walks along furniture, using both hands. Stands without support.	Takes first steps. Walks alone without help. Stands without support. Walks backwards. Walks upstairs using one hand. Jumps using both feet. Pulls and pushes toys. Throws a ball with overhand motion without falling.	Runs well. Kicks ball without losing balance. Stands on one foot. Jumps short distances with both feet. Rides a tricycle, but has not necessarily mastered both steering and peddling. Walks upstairs alternating feet. Walks on tiptoe.	Runs around obstacles. Throws ball overhand, with direction. Hops on one foot. Climbs up slide and slides down unassisted. Walks a line. Can catch ball bounced to her. Masters riding a tricycle.	Turns somersault. Walks up and down stairs unassisted, alternating feet. Jumps forward as many as ten times without falling. Walks backward in a line, heel to toe. Can swing at a stationary ball with a bat.
Social Skills	Smiles spontaneously. Discriminates between familiar people and strangers. Responds to own name. Understands words no-no. Imitates simple actions of others.	Shows emotions such as affection, joy, fear, anger, and jealousy. Recognizes self in mirror. Refers to self by name. Hugs and kisses. Throws temper tantrums. Loves to help put things away. Imitates adult activities. Initiates play.	Better control of temper tantrums. Begins to share toys. Plays near other children (parallel play). Begins real dramatic play. Participates in group activities like circle time.	Plays with others (associative play). Able to share and take turns. Acts out whole scenes in dramatic play.	Plays with other children (cooperative play). Dramatic play resembles reality, including dressing up. Pretending is acknowledged. Acknowledges sex differences.
Self-Mastery Skills	Holds bottle. Feeds self finger foods. Holds cup with two hands; needs assistance to drink from it. Cooperates with being dressed.	Takes off shoes and other clothing; can unzip. Verbalizes needs such as food, drink, and toileting. Eats and drinks well without assistance.	Understands gender identity. Feeds self. Drinks from drinking fountain. Takes off jacket or coat. Toilets with help. Opens doors.	Knows own gender identity. Buttons and unbuttons clothing. Washes hands without help. Pours well from small pitcher. Spreads with knife. Toilets without help.	Laces shoes. Follows instructions given in a group. Uses knife to cut food. Can help set table. Can help in simple food preparation. Knows name of city she lives in.

 

Now that you are familiar with what all you can expect, you may also be curious about what not to expect, in other words – red flags to look out for. Given below is a brief list, but again there’s no need to panic if any such observation is made and a professional consult is always a smart choice.

Red Flags – Early Identification Guide

Area	6 months	9 months	12 months	18 months	2 years	3 years	4 years	5 years
Social emotional	Does not smile or interact with people	Not sharing enjoyment with others using eye contact or facial expression	Does not notice someone new Does not play early turn-taking games (e.g. peekaboo, rolling a ball)	Lacks interest in playing and interacting with others	When playing with toys tends to bang, drop or throw them rather than use them for their purpose (e.g. cuddle dolls, build blocks)	No interest in pretend play or interacting with other children Difficulty noticing and understanding feelings in themselves and others (e.g. happy, sad)	Unwilling or unable to play cooperatively	Play is different than their friends
Communication	Not starting to babble (e.g. aahh; oohh)	Not using gestures (e.g. pointing, showing, waving) Not using two part babble (e.g. bubu, dada)	No babbled phrases that sound like talking No response to familiar words (e.g. bottle, daddy)	No clear words Not able to understand short requests (e.g. ‘Where is the ball?’)	Not learning new words Not putting words together (e.g. ‘push car’)	Speech difficult for familiar people to understand Not using simple sentences (e.g. ‘Big car go’)	Speech difficult to understand Not able to follow directions with two steps (e.g. ‘Put your bag away and then go play’)	Difficulty telling a parent what is wrong Not able to answer questions in a simple conversation (e.g. ‘What’s your name? What do you like to watch on TV?’)
Cognition, fine motor and self-care	Not reaching for and holding (grasping) toys Hands frequently clenched Does not explore objects with hands, eyes and mouth Does not bring hands together at midline	Does not hold objects Does not ‘give’ objects on request Cannot move toy from one hand to another	Does not feed self finger foods or hold own bottle/ cup Unable to pick up small items using index finger and thumb	Does not scribble with a crayon Does not attempt to stack blocks after demonstration	Does not attempt to feed self using a spoon and/or help with dressing	Does not attempt everyday self care skills (such as feeding or dressing) Difficulty in manipulating small objects (e.g. threading beads)	Not toilet trained by day Not able to draw lines and circles	Concerns from teacher about school readiness Not able to independently complete everyday routines such as feeding and dressing Not able to draw simple pictures (e.g. stick person)
Gross motor	Not holding head and shoulders up with good control when lying on tummy Not holding head with control in supported sitting	Not rolling Not sitting independently/ without support Not moving (e.g. creeping, crawling) Not taking weight on legs when held in standing	No form of independent mobility (e.g. crawling, commando crawling, bottom shuffle) Not pulling to stand independently and holding on for support	Not standing independently Not attempting to walk without support	Not able to walk independently Not able to walk up and down stairs holding on	Not able to walk up and down stairs independently Not able to run or jump	Not able to walk, run, climb, jump and use stairs confidently Not able to catch, throw or kick a ball	Not able to walk, run, climb, jump and use stairs confidently Not able to hop five times on one leg and stand on one leg for five second

Red flags at any age:

• Strong parental concerns
• Significant loss of skills
• Lack of response to sound or visual stimuli
• Poor interaction with adults or other children
• Lack of, or limited eye contact
• Differences between right and left sides of body in strength, movement or tone
• Marked low tone (floppy) or high tone (stiff and tense) and significantly impacting on development and functional motor skills

Developmental Screening is encouraged at every stage to ensure that your child is growing, adapting and learning at the pace expected from that specific age group. Even if a child experiences delay, there are several interventions that can assist the child in overcoming or adjusting in order to have a better outcome than can be expected if left to his/her own devices. Please feel free to contact us for a better understanding of developmental screening.