Developmental Milestones
Delayed Developmental Milestones
Why tracking normal development is an essential part of childcare
Parents usually watch closely for their child’s “firsts” – the first genuine smile, the first step, and the first words.
But developmental milestones are about more than just giving the parents some great memories. Failing to learn new skills like other children can signify serious medical issues like brain damage due to a birth injury or injury during the newborn period.
For example, the first signs a child has cerebral palsy may come at a regularly-scheduled checkup with the baby’s doctor. The parents might report that their child is not sitting up, standing, or communicating as expected. The doctor may then notice physical symptoms like being too stiff or floppy.
It’s true that children sometimes progress at slightly different rates. One nine-month-old might be walking while another is just starting to crawl. However, a baby or child who misses several milestones is cause for concern.
With some conditions – like cerebral palsy – early intervention is crucial. Therapies, surgeries, medications, caregivers, and assistive technology can improve a child’s future and help them progress as far as possible.
What are Some of the Causes of Developmental Delays?
A child’s gestational age at birth can make a difference as they progress along average developmental timelines. Premature infants are more likely to have neurodevelopmental disabilities. When observing whether your child is hitting their goals, remember to adjust expectations based on their gestational age. For example, a baby born three months early might be three months late when meeting its milestones.
In addition, babies can be at risk for future developmental delays or disabilities because of the following factors:
- Complications during labor and delivery: Some of the more serious issues can result in brain damage to the baby. For example, delayed c-sections, umbilical cord problems, failure to respond to fetal distress and misuse of forceps and vacuum extractors can cause brain bleeds and oxygen-deprivation-related conditions like hypoxic-ischemic encephalopathy (HIE).
- Inadequate Neonatal Care: Babies may need neonatal resuscitation immediately after birth to prevent oxygen deprivation. Also, some babies are at risk for developing, neonatal hypoglycemia, hyperbilirubinemia (excessively high bilirubin levels in the blood) and kernicterus (a serious disorder that causes brain damage). These conditions require immediate treatment.
- Genetics: Genetic issues often cause conditions like Down syndrome and autism.
- Mother’s medical condition: Pregnancy can be complicated by infections and complications related to high blood pressure (preeclampsia), gestational diabetes, anemia, and sexually transmitted diseases. Problems with the mother’s health affect the developing fetus also.
The baby may also suffer injuries after being born that can cause brain damage and developmental delays.
During pregnancy, labor, delivery, and postnatal care, improper or inadequate care can cause cerebral palsy and brain injuries. And medical malpractice can sometimes be the cause of developmental delays and disabilities. The parents of a child with developmental delays might have a claim against health care professionals who failed to provide proper care or make the proper diagnosis.
Child Developmental Delay Categories
Medical professionals and researchers have divided these important states of development into several categories called “domains.”
- Movement/Physical Development: The milestones in this domain are about how children use their bodies for things like sitting, walking, and eating
- Social/Emotional Domain: This type of milestone relates to how children can relate to others and show emotion at certain ages
- Language/Communication: Developmental milestones listed in this domain relate to how children express their needs, share their thoughts, and understand what is said to them
- Cognitive (learning, thinking, problem-solving): This domain concerns how children learn, solve problems, explore their environments, and use skills like counting and learning letters
It’s important to note that some goals or achievements fit into more than one category. A child’s ability to follow instructions speaks to their communication and cognitive skills.
Is Your Child Meeting Recommended Milestones?
Your child’s doctor may give you some ideas of what stages your child is going through. However, you can also watch for signs of problems using the following information provided by the Centers for Disease Control and Prevention (CDC).
Select A Milestone
Developmental Milestones at TWO Months
Physical Development
- Hold their head up
- Try to push up when lying on their stomachs
- Begin to move arms and legs more smoothly
Social/Emotional Milestones
- May bring hands to their mouth and suck on hand to calm down
- Try to push up when lying on their stomachs
- Begin to move arms and legs more smoothly
Communication
- Coos and gurgles
- Looks in the direction of sounds
Cognitive Skills
- Begins paying attention to people’s faces
- Recognizes familiar people
- Begins to follow things with their eyes
- Reacts when activities become boring
When to be Concerned
Tell your baby’s doctor if your baby isn’t meeting milestones or if you notice the baby is not:
- Responding to loud noises
- Watching things that move through their field of vision
- Smiling at people
- Bringing their hands up to their mouth
- Holding their head up when pushing up from a lying down position
Developmental Milestones at FOUR Months
Physical Development
- Able to hold the head steady without support
- Brings hands to mouth
- Pushes down with legs when held on a hard surface
- Holds and shakes toys or swats at dangling toys
- Pushes up on elbows when lying on tummy
- May start rolling from tummy to back
Social/Emotional Milestones
- Will smile spontaneously, especially at people
- May copy other people’s movements and facial expressions
- Enjoys playing with people
- Might start crying when people stop playing with them
Communication
- Babbling, sometimes with expression
- Might copy sounds that they hear
- Uses different cries to indicate how they feel or what they need
Cognitive Skills
- Watches people’s faces
- Recognizes people and objects
- Demonstrates emotions like being happy or sad
- Recognizes and responds to affection from other people
- Follows moving objects with their eyes
- Reaches for toys with one hand
- Begins showing hand-eye coordination
When to be Concerned
Contact your baby’s doctor if your child is not meeting these milestones or:
- Doesn’t bring items to their mouth
- Can’t hold their head up
- Is having trouble moving their eyes or has unusual eye movements
Developmental Milestones at SIX Months
Physical Development
- Begins sitting without support
- Can rock back and forth
- May crawl backward before moving forward
- Can roll over from front-to-back and back-to-front
- Begins supporting weight when standing and may begin bouncing
Social/Emotional Milestones
- Begins to recognize familiar people and strangers
- May respond to other people’s emotions
- Enjoys playing with parents and other people
- Likes looking at themselves in mirrors
Communication
- Recognizes and responds to their name
- Makes sounds in response to other sounds
- Show emotions by making sounds
- Combines vowels when babbling
- Begins to make consonant sounds
- Takes turns making sounds with parents
Cognitive Skills
- Shows curiosity
- Reaches for nearby objects
- Looks at nearby objects
- Begins learning to pass items from one hand to the other
- Brings objects to their mouth
When to be Concerned
Contact your baby’s doctor if your child is not meeting these milestones or:
- Seems unable to show affection to caregivers
- Is floppy, like a rag doll
- Muscles are stiff and tight
Developmental Milestones at NINE Months
Physical Development
- Pulls on something to stand up
- Begins standing while holding onto things
- Can get into sitting position and sit unsupported
- Crawls
Social/Emotional Milestones
- May cling to familiar adults
- May show fear of strangers
- Enjoys certain favorite toys over other toys
Communication
- Uses fingers to point at interesting objects
- Begins making a variety of sounds
- Will copy sounds and gestures made by other people
- Understands the word “no"
Cognitive Skills
- Will watch the path of an item as it falls
- Can look for things they see you hide
- Is able to play peek-a-boo
- Can pick up things between thumb and index fingers
- Will put things in their mouth
- Can move things smoothly from one hand to the other
When to be Concerned
Contact your baby’s doctor if your child is not meeting these milestones or:
- Cannot respond to their own name
- Does not recognize familiar people
- Does not play games that involve back-and-forth playing
- Cannot sit without help
Developmental Milestones at ONE YEAR
Physical Development
- Can independently move to a sitting position
- Can pull up to stand and walk holding onto furniture
- Might be able to stand alone and take a few steps unassisted
Social/Emotional Milestones
- Typically shy or nervous around strangers
- Might show fear in certain situations
- Will cry when mom or dead leaves
- Starts to show favoritism for certain items and people
- Can repeat sounds or movements to get attention
- Will help with dressing by putting arms and legs forward
- Can play simple games like “peek-a-boo”
Communication
- Can respond to simple spoken requests
- Tries to repeat the words you say
- Can make noises that sound more like speech
- Is able to say simple words like “mama” and “uh-oh”
- Can use simple gestures like waving “bye-bye”
Cognitive Skills
- Will bang, shake, or throw things
- Can find hidden items
- Can move objects in and out of a container
- Will use familiar items correctly, like drinking from a cup
- Will copy other people’s gestures
- Can recognize pictures or things when named
- Can let go of things without help
- Will poke things with their index fingers
- Can follow simple directions
When to be Concerned
Contact your baby’s doctor if your child is not meeting these milestones or:
- Is not able to crawl or stand unsupported
- Is losing skills instead of gaining them
Developmental Milestones at EIGHTEEN Months
Physical Development
- Can walk alone and may pull toys
- May be able to walk up steps and run
- Can help with getting undressed
- Uses a spoon and cup when eating
Social/Emotional Milestones
- May fear strangers but show affection to people they know
- Could cling to caregivers in new situations
- Can explore alone but with parents nearby
- Can have temper tantrums
- May point out objects to other people
- May enjoy handing items to other people when playing
- Can play simple pretend games
Communication
- Can point out items they want
- Is able to speak several single words
- Can shake head while saying “no”
Cognitive Skills
- Able to follow one-step verbal commands given without gestures
- Will point to get people’s attention
- Can point to one body part
- Will scribble
- Understands ordinary items like telephones and spoons
- May pretend to feed dolls or stuffed animals
When to be Concerned
Contact your baby’s doctor if your child is not meeting these milestones or if the child:
- Doesn’t know how to use familiar things
- Isn’t gaining any words or does not know at least six words
- Is not concerned when caregivers leave or return
- Begins losing skills instead of gaining new ones
Developmental Milestones at TWO YEARS
Physical Development
- Can run, kick a ball, and stand on tiptoes
- Able to walk up and down stairs while holding onto something
- Independently climbs up and down from furniture
- Can draw or copy straight lines and circles
- Able to throw a ball overhand
Social/Emotional Milestones
- Is beginning to play with other children
- Usually gets excited when other children are around
- Begins to show more independence, but also more defiance
- May copy behavior from older children and adults
Communication
- Can make sentences of two to four words
- Begins repeating words overheard from other people’s conversations
- Able to follow simple instructions
- Can recognize the names of familiar people and body parts
- Can point to objects or pictures when they are named
- Also points to things in books
Cognitive Skills
- Able to finish sentences and rhymes in familiar books
- Can name objects contained in picture books
- Can follow two-step instructions
- Able to play simple make-believe games
- Can find objects even when hidden under several covers
- May sort shapes and colors
- Can build towers four or more blocks high
- Might begin using one hand more than the other
When to be Concerned
Contact your baby’s doctor if your child is not meeting these milestones or:
- Is not able to use common things, like spoons or brushes
- Cannot use two-word phrases
- Unable to walk steadily
- Begins to lose skills instead of gaining them
Developmental Milestones at THREE YEARS
Physical Development
- Climbs and runs well
- Can pedal a tricycle or other three-wheel bike
- Can walk up and down stairs with one foot on each step
Social/Emotional Milestones
- Understands concepts like “mine,” ”his,” or “hers”
- Can show a wide range of emotions
- Independently shows affection to friends
- Takes turns when playing games
- Copies what adults and friends do
- Can easily separate from mom and dad
- Becomes upset when significant changes in routine occur
Communication
- Talks well, carrying on conversations using two to three sentences
- Can speak and understand words like “I,” “me,” and some plurals
- Can understand words like “in,” “on,” and “under”
- Can name many familiar items and say friends’ names
- Can follow two or three step instructions
Cognitive Skills
- Understands the concept of “two”
- Can play make-believe with not only dolls but people and animals also
- Plays with toys that have moving parts, including buttons and levers
- Can build towers with at least six blocks
- Understands how to open jar lids and turn door handles
- Can turn book pages one at a time
- Can copy circles
When to be Concerned
Contact your baby’s doctor if your child is not meeting these milestones or your child:
- Falls down a lot
- Has trouble walking on stairs
- Cannot understand simple instructions
- Does not make eye contact
- Begins losing skills instead of progressing
Developmental Milestones at FOUR YEARS
Physical Development
- Can pour, mash, and cut their food with supervision
- Almost always catches a bounced ball
- Can hop or stand on one for at least 2 seconds
Social/Emotional Milestones
- Engages in make-believe play but may have trouble knowing what’s real and what’s make-believe
- Sometimes pretends to be Mom or Dad
- Know what they like and talk about it
- Prefers to play with other children than alone
- Enjoys new things
Communication
- Can say their first and last names
- Correctly uses basic rules of grammar
- May sing songs or repeat poems from memory
- May tell stories
Cognitive Skills
- Can name some colors and numbers
- Understands the idea of counting
- Is beginning to understand time
- Understands the concepts of “same” and “different”
- Can draw a person with 2 to 4 body parts
- Copies some capital letters
- Can use scissors
- Plays board or card games
- Explains what might happen next in a story
When to be Concerned
Contact your baby’s doctor if your child is not meeting these milestones or:
- Seems to be losing skills instead of gaining
- Speaks unclearly
- Cannot follow 3-part commands
- Does not want to get dressed, sleep, or use the toilet
Developmental Milestones at FIVE YEARS
Physical Development
- Can hop and may be able to skip
- Should be able to swing and climb
- Can use forks, spoons, and sometimes knives to eat
- Uses the toilet without assistance
Social/Emotional Milestones
- Tries to please and be like friends
- Understands the difference between what’s real and what’s make-believe
- May sing, dance, and act
- Understands gender
- Often follows the rules but also shows independence
- Behavior may swing between being very cooperative and being very demanding
Communication
- Speaks clearly
- Can say their name and address
- Can use future tense
- Uses complete sentences to tell simple stories
Cognitive Skills
- Able to print some letters and numbers
- Copies shapes, including triangles
- Uses at least six body parts when drawing a person
- Understands everyday items like food and money
- Can count ten or more items
When to be Concerned
Contact your baby’s doctor if your child is not meeting these milestones or:
- Begins losing skills or regressing
- Exhibits extreme behavior
- Has trouble focusing on activities
- Responds only superficially to other people
- Is unable to independently handle daily activities like brushing teeth or getting undressed
Is Your Child’s Birth Injury the Result of Medical Malpractice?
The parents of children who suffered birth injuries often want answers. They want to know what happened to harm their child’s brain. Was it preventable?
Our dedicated birth injury lawyers want to help you find those answers.
If your child is not meeting developmental milestones and you suspect this may have been caused in part by medical mistakes, Miller Weisbrod Olesky will thoroughly investigate the facts and hold responsible medical providers accountable by pursuing medical malpractice claims against them. The compensation our clients receive helps them pay for their child’s current and future medical treatment, therapy, equipment needed to help cope with disabilities, and the other expenses associated with caring for a child with brain injuries, seizure disorders, and cerebral palsy.
Sometimes families are hesitant to reach out to a medical malpractice attorney or law firm. Other parents feel overwhelmed by their circumstances and worried that they will not be able to help out in a lawsuit involving their child’s birth injury.
Why Should You Talk with the Knowledgeable Attorneys at Miller Weisbrod Olesky?
The only way to find out if you have a birth injury case is to talk to an attorney who understands birth injuries leading to a delay in developmental milestones.
At Miller Weisbrod Olesky, a team of committed attorneys, nurses and paraprofessionals uses our detailed medical negligence case review process to assess your potential claim. We start by learning more about you and your child and the status of meeting/missing developmental milestones. Then we gather medical records to determine what happened before, during, and after your delivery. We call in skilled medical experts who review your records and let us know if they think medical errors could have caused your child’s injuries.
If we feel medical negligence caused or contributed to your child’s injuries, we meet with you to discuss how you can receive compensation from the medical professionals who made the errors.
At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment when you do.
Contact Miller Weisbrod Olesky
Miller Weisbrod Olesky
At Miller Weisbrod Olesky, the attorneys, nurses, and staff understand that parents of children with birth injuries feel overwhelmed. So, every client has the attention and support of a team of trained, compassionate professionals. But we don’t just offer compassion.
We offer a process to help you discover whether your child’s birth injury, HIE, cerebral palsy or brain injury was caused by a medical error.
Call our offices today at 888.987.0005 for experienced assistance in a free consultation.
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