GROSS MOTOR

Age
NB

Ventral Suspension

Prone

Supine/Pull to sit

Head hangs, back round, hip, knee flex

Pelvis high, knees under abdomen

Complete head lag / held sitting fully

rounded back

4w
6w

Head up momentarily

8w
10 w
3/12

Head up in plane of body momentarily

hip extended
HEAD IN PLANE OF BODY

Pelvis flat, hips extended chin

intermittently off couch
Less head lag / held sitting, back
straightening head up

Head above plane of body

Held standing - sags at knees and hip

WEIGHT ON FOREARMS, CHEST OFF

COUCH
NO HEAD LAG , BACK STRAIGHT,
STEADY
Head elevated in anticipation

4/12
5/12
6/12

8/12
9/12
11/12
10/12
1 yr
13/12
15/12
18/12
24/12
30/12
3 yr
4yr
5yr

HELD STANDING:,BEARS FULL WEIGHT

WEIGHT ON HANDS, ARMS

EXTENDED,

SUPINE: SPONTANEOUS HEAD

ELEVATION
SITS WITH HANDS FORWARDS FOR
SUPPORT

SITTING STEADY NO SUPPORT

STANDING HOLDING ON TO FURNITURE, CRAWL ON ABDOMEN
PIVOTS / WALKS WITH TWO HANDS HELD, CRUISING
Creeps, hands and knees, abdomen off the ground
Walks with one hand held, FIRST STEP
WALKS WITHOUT SUPPORT
Crawls up stairs
Walks up stairs one hand held / jumps both feet, throws ball
WALKS UP STAIRS WITH TWO FEET ON STAIRS AT A TIME (2 YEARS UP- 2 FEET) ; RUNS, walk backwards, kicks ball
GOES UP STAIRS ONE FOOT ON STAIR AT A TIME ALTERNATING
STAND ON ONE LEG (3 LIMBS 3 YRS)
WALKS DOWN STAIRS (four years down), hops on one foot, climbs
Skips

[Key Milestones are those in CAPITAL LETTERS]

FINE MOTOR or ADAPTIVE

3/12
4/12
5/12
6/12
7/12
8/12
9/12
10/12
1 year
15 months

HOLDS rattle placed in hand

Hands together in the center
REACHES for objects
TRANSFERS objects, PALMAR grasp of objects
Radial grasp, Rakes at pellets
Intermediate grasp
Index finger approach
Assisted pincer grasp / Offers object to mother but does not release it
UNASSISTED PINCER GRASP / RELEASE OBJECTS ON REQUEST and gives to mother
Inserts raisin into bottle

PEN AND PAPER (Percerptuo-motor)

SLOXSTD 1, 2,3,4,5,6,7
Dots and Jabs - Less than 18 months
S - Scribble > 18 months
L Line 24 months (first vertical then horizontal)
O Drawing Circle by 3 years
X - Cross by 4 years
S - Square by 5 years
T- Triangle by 6 years
D - Diamond by7 years
The examiner demonstrates by drawing the geometric shapes for children under 3 years. Present drawn model to children over 3 years.

TOWER of CUBES / BRICKS

2 to 3 brick tower at 15 months
4 brick tower at 18 months
After 18 months - Rule of thumb: (approximately age / 3 minus 1) = no. of bricks
6 brick tower at 21 months
3 years 3 brick bridge
7 brick tower at 24 months
5 years 5 brick bridge
8 brick tower at 27 months
9 brick tower at 30 months
10 brick tower at 36 months

[Key Milestones are those in CAPITAL LETTERS]

LANGUAGE
Two components:

Expressive: What the child expresses orally or through gestures or by writing

Receptive: What the child understands through words or gestures

Receptive comes before expressive (Child should understand before he can express)
Age
Newborn
1/12
3/12

Receptive
Quiet to voice
Recognizes mothers voice

6/12
7/12
9-10/12
11/12
12/12 (1
year)
14/12
15/12
18/12 (1.5
years)
24/12 (2
years)
30/12
3 years
4 years
5 years

Follows gestures
ONE STEP COMMAND (GIVE ME, COME HERE)
Names all family members
Jargon, follows simple commands

Expressive
Cries
Quiet to voice
COOING / VOCALIZATION WHEN TALKED TO, recognizes
mothers voice
Monosyllables ba, ma
VOWEL SOUNDS (aaah, oooh)
REPETITIVE CONSONANTS MAMA, DADA WITHOUT
MEANING
FIRST WORD USUALLY MAMA OR DADA WITH MEANING ,
POINTING AT OBJECTS
Names all family members
Jargon, follows simple commands
10 - 15 words
Three word sentences subject, verb, object (Me go home).

Uses pronoun I
UNDER STAND TWO STEP COMMANDS (bring the cup and give it
to me)
UNDER STAND 3-4 STEP COMMANDS (bring the cup and keep on
the table and come here)

Full name,
Counts 3 objects, Knows age and sex (& name)
Coins 4 coins correctly; Can tell a story
Names colours,

Jargon strings of different sounds unlike at 9 months when it is the same sound over and over. The sounds like as if the child is speaking a
foreign language with rising and falling speech like sound variation (managabalakapa)

Rules of Thumb for language

Number of words:
12 months (one year): One word with meaning
18 months (1.5 year): About 10 - 15 words with meaning
24 months: 48 - 50 words with meaning
By 3 years you cannot count the words in the childs vocabulary
Childs speech understood by a stranger
By the end of the second year: A stranger should be able to understand 25 % -50 % of a normal childs speech
By the end of third year stranger should be able to understand 75% of what the child speaks.
th
By the end of 4 year: A stranger should be able to understand 100% of what the child says.
Full Name: 2.5 years
Age and sex (and name): 3 years
PAST tense by 4 years
TALE (tell a story correctly) by 4 years
SING songs by 4 years
FUTUR(e) tense by 5 years
Between 2-5 years: number of words in sentence is equal to childs age (Nelson)
Understand one step command: One year
Understand two step command: 3 years
Understand >3 step command: 5 years
What do children usually speak? Usually start speaking words in the following order:
Kinship words mama, dada thatha, pattie etc
Parts of body
Common objects
Common Animals
Colours
Before they speak they can understand so they may point of turn to the answer. For example: Where is your head ? and child will point
before he knows the word for head
6 syllabic (3 word) sentences by 3 years
10 syllabic (>5 word sentences) by 5 years

SOCIAL & ADAPTIVE

6 weeks
2/12
3/12
By 6/12
By 9/12
10/12
1 year

Social smile
Cooing / vocalization when talked to
Sustained social contact, vocalizes great deal; Recognises mother
Smiles at mirror
Stranger reaction
Responds to bye-bye, peek-a-boo
Postural adjustment to dressing

15/12
18/12

Indicates desire by pointing

Feeds self

Dressing
< 2 years: makes postural adjustment while dressing and undressing
2 years: helps in UNDRESSING
3 years: helps in DRESSING
5 years: Dress and Undress on his own

SPHINCTER CONTROL
Bowel control is usually acquired before bladder control
< 15 months
Unconscious voiding of infant
15 months
Tells mother that he has wet his pants ( 1st sign of sphincter control)
1.5 years to 2 years
By 18 months starts being aware of full bladder. Dry by day
Gives mother enough time to place him on pottie when he tells her
2 years to 3 years
Dry by night if lifted out at 10 pm or 11 pm .
4years
Goes to toilet on his own

VISION
Newborn
6 weeks
3/12
4/12
5/12
6/12
9/12

1year
2 years

Turns toward diffuse light; fixate on face; dolls eye reflex

0
FOLLOW FACE or coloured object; blink to menace reflex; follows object up to 90
Eyes converge for finger play
0
FOLLOW OBJECTS THROUGH 180 TURNING HEAD
REACH FOR OBJECT in the visual field; Able to regard raisin on table
MOVES EYES IN ALL DIRECTIONS; Squint at this stage is abnormal
Able to pick raisin with raking grasp;
Object constancy: looks for toys which have dropped
Peek-a-boo, pat-a-cake
Possible to test with rolling balls of 3mm at 3 meters
Toy matching

Play
From birth - 6 months vision dominant modality
Initial (6 months to 12 months)
Initially the infant explores his or her own body plays with hands, other parts of the body
Explorative (exploring the object, does not meaningfully play with it): mainly mouths objects, bangs, rubs
12 -15 months
Imitative play (Imitates what is shown), Imitates parents
Demonstrates appropriate use of common objects
Casting (throws when he loses interest)
12-18 months
Pretend play
First on self like feeding oneself
18-30 months
Pretend on another object (like playing with a car, feeding a doll)
Sequential pretending ( 2-3 years)
Dresses the doll, feeds it and puts it to sleep

By four years children play with each other and games become more complex involving roleplaying, imagination, rules ( doctor-nurse/
police and robbers)
Till 3 years usually parallel play with other children. Sits with other children but usually play their own games
3-5 years,
Play with other children, understand rules

1800 Flip
Supine: Are the limbs flexed or extended, relation of head trunk and limbs, any abnormal posture like ATNR posture
Traction or pull to sit: Any head lag, how is the grasp
Sitting: position of head, back
Vertical suspension: Position of head and trunk, any scissoring, weight bearing
Ventral suspension: Floppy or not, position of head

Rules of Thumb
At 3 years
TRIcycle
Bridge of 3 cubes
3 word sentences
Counts 3 objects
Repeats 3 numbers
Stands on one leg (3 limbs used)

References are mainly from Nelson, Illingworth, and few articles.

Dr. Samuel P Oommen MD DNB