Developmental Milestones in the First 2 Years of Life
| Milestone . | Average Age of Attainment, mo . | Developmental Implications . |
|---|---|---|
| Gross motor | ||
| Head steady in sitting | 2.0 | Allows more visual interaction |
| Pull to sit, no head lag | 3.0 | Muscle tone |
| Hands together in midline | 3.0 | Self-discovery |
| Asymmetric tonic neck reflex gone | 4.0 | Child can inspect hands in midline |
| Sits without support | 6.0 | Increasing exploration |
| Rolls back to stomach | 6.5 | Truncal flexion, risk of falls |
| Walks alone | 12.0 | Exploration, control of proximity to parents |
| Runs | 16.0 | Supervision more difficult |
| Fine motor | ||
| Grasps rattle | 3.5 | Object use |
| Reaches for objects | 4.0 | Visuomotor coordination |
| Palmar grasp gone | 4.0 | Voluntary release |
| Transfers object hand to hand | 5.5 | Comparison of objects |
| Thumb-finger grasp | 8.0 | Able to explore small objects |
| Turns pages of book | 12.0 | Increasing autonomy during book time |
| Scribbles | 13.0 | Visuomotor coordination |
| Builds tower of 2 cubes | 15.0 | Uses objects in combination |
| Builds tower of 6 cubes | 22.0 | Requires visual, gross, and fine motor coordination |
| Communication and language | ||
| Smiles in response to face, voice | 1.5 | Child more active social participant |
| Monosyllabic babble | 6.0 | Experimentation with sound, tactile sense |
| Inhibits to “no” | 7.0 | Response to tone (nonverbal) |
| Follows 1-step command with gesture | 7.0 | Nonverbal communication |
| Follows 1-step command without gesture (eg, “Give it to me”) | 10.0 | Verbal receptive language |
| Speaks first real word | 12.0 | Beginning of labeling |
| Speaks 4–6 words | 15.0 | Acquisition of object and personal names |
| Speaks 10–15 words | 18.0 | Acquisition of object and personal names |
| Speaks 2-word sentences (eg, “Mommy shoe”) | 19.0 | Beginning grammaticization, corresponds with vocabulary of ≥50 words |
| Cognitive | ||
| Stares momentarily at spot where object disappeared (eg, yarn ball dropped) | 2.0 | Lack of object permanence (out of sight, out of mind) |
| Stares at own hand | 4.0 | Self-discovery, cause and effect |
| Bangs 2 cubes | 8.0 | Active comparison of objects |
| Uncovers toy (after seeing it hidden) | 8.0 | Object permanence |
| Egocentric pretend play (eg, pretends to drink from cup) | 12.0 | Beginning symbolic thought |
| Uses stick to reach toy | 17.0 | Able to link actions to solve problems |
| Pretend play with doll (gives doll bottle) | 17.0 | Symbolic thought |
| Milestone . | Average Age of Attainment, mo . | Developmental Implications . |
|---|---|---|
| Gross motor | ||
| Head steady in sitting | 2.0 | Allows more visual interaction |
| Pull to sit, no head lag | 3.0 | Muscle tone |
| Hands together in midline | 3.0 | Self-discovery |
| Asymmetric tonic neck reflex gone | 4.0 | Child can inspect hands in midline |
| Sits without support | 6.0 | Increasing exploration |
| Rolls back to stomach | 6.5 | Truncal flexion, risk of falls |
| Walks alone | 12.0 | Exploration, control of proximity to parents |
| Runs | 16.0 | Supervision more difficult |
| Fine motor | ||
| Grasps rattle | 3.5 | Object use |
| Reaches for objects | 4.0 | Visuomotor coordination |
| Palmar grasp gone | 4.0 | Voluntary release |
| Transfers object hand to hand | 5.5 | Comparison of objects |
| Thumb-finger grasp | 8.0 | Able to explore small objects |
| Turns pages of book | 12.0 | Increasing autonomy during book time |
| Scribbles | 13.0 | Visuomotor coordination |
| Builds tower of 2 cubes | 15.0 | Uses objects in combination |
| Builds tower of 6 cubes | 22.0 | Requires visual, gross, and fine motor coordination |
| Communication and language | ||
| Smiles in response to face, voice | 1.5 | Child more active social participant |
| Monosyllabic babble | 6.0 | Experimentation with sound, tactile sense |
| Inhibits to “no” | 7.0 | Response to tone (nonverbal) |
| Follows 1-step command with gesture | 7.0 | Nonverbal communication |
| Follows 1-step command without gesture (eg, “Give it to me”) | 10.0 | Verbal receptive language |
| Speaks first real word | 12.0 | Beginning of labeling |
| Speaks 4–6 words | 15.0 | Acquisition of object and personal names |
| Speaks 10–15 words | 18.0 | Acquisition of object and personal names |
| Speaks 2-word sentences (eg, “Mommy shoe”) | 19.0 | Beginning grammaticization, corresponds with vocabulary of ≥50 words |
| Cognitive | ||
| Stares momentarily at spot where object disappeared (eg, yarn ball dropped) | 2.0 | Lack of object permanence (out of sight, out of mind) |
| Stares at own hand | 4.0 | Self-discovery, cause and effect |
| Bangs 2 cubes | 8.0 | Active comparison of objects |
| Uncovers toy (after seeing it hidden) | 8.0 | Object permanence |
| Egocentric pretend play (eg, pretends to drink from cup) | 12.0 | Beginning symbolic thought |
| Uses stick to reach toy | 17.0 | Able to link actions to solve problems |
| Pretend play with doll (gives doll bottle) | 17.0 | Symbolic thought |
Modified from: Behrman RE, Jenson HB, Kliegman R, eds. Nelson Textbook of Pediatrics. 16th ed. Philadelphia, PA: Saunders; 2003.