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Home Notes Maternal and Child Health Nursing

Notes Maternal and Child Health Nursing

Normal Pediatric Developmental Milestones

By Iris Dawn Tabangcora, RN - September 1, 2016

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The development of a child mostly takes place in the early years of his life. At this stage, parents are still
overwhelmed with how fast babies grow and develop. Parents take much time and patience in picking the
best resource to understand a childʼs development. Therefore, lots of questions are thrown in the air for the
nurse to answer. Some questions prove to be challenging, and it is important for nurses to be able to know
the normal developmental milestones like the back of their hands.

The first word, smile, and roll over are called developmental milestones. The child can tick off a milestone
on his growing list of firsts depending on how he play, speak, move, and learn. While it is always
emphasized that children develop at their own pace, developmental milestones are there to shed light on
the general changes that should be expected as the child ages.

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Contents [hide]

1 General Principles of Developmental Milestones

2 Domain #1: Normal Motor Development
3 Domain #2: Normal Language Development
4 Domain #3: Cognitive Development
5 Domain #4: Social Development

General Principles of Developmental Milestones

For excellent developmental assessment and surveillance, nurses must know the general principles of
developmental milestones. The four key domains that should be periodically assessed include motor
development, language development, problem-solving, and psychosocial skills.

Development occurs in an orderly, predictable, and intrinsic manner. For example, development proceeds
from head to toe in a proximal to distal fashion. Reactions to stimuli develop from general into more specific
and goal-directed reactions. Children gain independence from early years of total dependence.

Lastly, both intrinsic and extrinsic factors can affect development. Some examples of intrinsic factors are
physical characteristics, health state, temperament, and genetic attributes. On the other hand, extrinsic
factors include personalities of family members, economic status, learning experiences in the environment,
and cultural setting to which the child is born.

Domain #1: Normal Motor Development

Motor milestones can both be assessed through history interview and observation. Evaluating gross motor
development usually involves neuro maturational markers like primitive reflexes and postural reactions.

For example, Moro reflex is one primitive reflex that is present at birth and disappears usually between 3-6
months of age. If the baby has stronger and more sustained primitive reflexes, a CNS injury might be
considered. On the other hand, parachute reaction is one postural reaction that is acquired. This actually
helps the body become oriented in space through an interplay of visual, proprioceptive, and vestibular
adjustment done by cerebral and cerebellar brain structures. Delayed development of postural reactions
can signify CNS damage.

On the other hand, fine motor skills involve the use of small muscles of the hands. The control progresses
from the use of proximal muscles to the distal muscles. As the baby improves on balance during sitting and
moving, the hands become more focused on manipulation of objects.

Here is a table of motor development milestones:

Gross Motor Milestones

Age Milestone

Birth Turns head side to side

Lifts head when lying prone

2 months
Head lags when pulled from supine position

Rolls over

No head lad when pulled from supine position

4 months

Pushes chest up with arms

Sits alone

6 months
Leads with head when pulled from supine position

Pulls to stand

9 months
Cruises

12 months Walks

Fine Motor Milestones

Birth Keeps hands tightly fisted

Brings hands together to midline and then to

3-4 months
mouth

4-5 months Reaches for objects

Rakes objects with whole hand

6-7 months
Transfers object from hand to hand

Uses immature pincer (ability to hold small object

9 months
between thumb and index finger)

Uses mature pincer (ability to hold small object

12 months
between thumb and the index finger)

Red flags in motor development include: 1) persistent fisting beyond 3 months which indicate neuromotor
problems; 2) early rolling over, early pulling to stand instead of sitting, and persistent toe walking which may
all indicate spasticity; and 3) early hand dominance (before 18 months of age), which may signify weakness
of the opposite upper extremity associated with hemiparesis.

Domain #2: Normal Language Development

Language is the single best indicator of intellectual potential. Language is the ability to communicate with
symbols. It is often mistaken as synonymous with speech, the latter being defined as a vocal expression of
language. This is the domain with the most number of delays.

It is also interesting to note that a child can usually understand 10 times (receptive language) as many
words as he or she can speak (expressive language). The first two (2) years of life is the time for optimal
language acquisition.

Here is a table of basic language milestones:

Age Milestone

Attunes to human voice

Birth
Develops differential recognition of parentsʼ voices

Cooing (runs of vowels), musical sounds (e.g. ooh-

2-3 months
ooh, aah-aah)

Babbling (mixing vowels with mixed consonants)

6 months
[e.g. ba-ba-ba]

Jargoning (e.g. babbling with mixed consonants,

inflection, and cadence)
9-12 months
Begins using mama, dada (nonspecific)

12 months 1-3 words, mama and dada (specific)

20-50 words

18 months
Beginning to use two-word phrases

Two-word telegraphic sentences (e.g. mommy

come)
2 years
25-50% of childʼs speech should be intelligible

Three-word sentences

3 years More than 75% of the childʼs speech should be

intelligible

Domain #3: Cognitive Development

This domain talks about thinking, memory, learning, and problem-solving. By evaluating problem solving
and language milestones, infant intelligence can be estimated. There is a poor correlation between gross
motor skills and cognitive potential.

Here is a table of cognitive concepts:

Age Concept

Object permanence (people and objects continue

to exist even when an infant cannot see them).
9 months This ability to maintain an image of a person is the
reason why separation anxiety (6-18 months)
develops when a loved one leaves the room.

Cause and effect (understanding which actions

9-15 months
cause certain results).

1-3 years Magical thinking

Domain #4: Social Development

It refers to the ability to interact with people and the environment. It is dependent on cultural and
environmental factors. Here is a table of social milestones:

Age Concept

Attachment (bonding with a primary caregiver

12-36 months begins at birth and empathy development is critical
during this period).

A sense of self and independence (process of

15 months
separation and individuation begins).

Social play (exhibit parallel play during the first 2

12-24 months
years of life).

In the grand scheme of things, it is essential for nurses to understand normal development as well as the
variations that are considered acceptable so nurses can recognize pathologic patterns and developmental
delays. Prompt planning and intervention will then be instituted for children who may benefit from referral to
early intervention programs.

What other milestones can you add to the list? Share this to co-nurses and families that could
benefit from this!

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