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Developmental milestones are markers of a child’s development from infancy into childhood. They help determine if a child is undergoing typical development versus if a child has delayed in a given area or over multiple areas in the process of aging development. Milestones are social/emotional, gross and fine motor, language, and cognitive. This activity highlights the role of the interprofessional team in assessing developmental milestones. Objectives: Identify the common stages of development milestones. Assess the indications for assessing development milestones in infants and children. Identify the importance of diagnostic tests in regards to development milestones. Access free multiple choice questions on this topic.

Developmental milestones are a set of goals or markers that a child is expected to achieve during maturation. They are categorized into 5 domains: gross motor, fine motor, language, cognitive, and social-emotional and behavioral. Understanding and identifying the developmental milestones can help the provider more adeptly recognize delayed development, facilitating earlier interventions and improving outcomes. Typical Milestones Six months: Stranger anxiety; Rolls over; begins to say consonants while babbling; brings things to mouth. Nine months: Separation anxiety; stands on hands and feet, sits without support, crawls, pincer grasp; understands “no,” points with a finger, says “mama” or “baba;” plays “peek-a-boo.” Twelve months: Puts out arm or leg when dressed; cries when familiar people leave; stands well; responds to simple commands, makes gestures, puts things in a cup and removes them, bangs things together. Eighteen months: Engages in pretend play, kisses/hugs familiar people, walks alone, walks up steps, eats with utensils, says several individual words, points to 1 body part, scribbles with crayon, marker, or pen. Two years: Begins playing with other children, parallel play; stands on tiptoes, kicks a ball, throws a ball overhand; 2 to 4-word sentences, points to things in a book, strangers can understand 50% of language; stacks 4 or more blocks, follows 2-step instructions. Three years: Dresses/undresses self, copies others, takes turns; walks up and downstairs with 1 foot per stair, runs easily; strangers can understand 75% of language; stacks 6 or more blocks, turns pages in a book, pushes buttons, and turns knobs. Four years: Likes to play with others, more imaginative play; hops on 1 foot, can stand on 1 foot for 2 seconds, cuts with scissors; can recite a poem or sing songs, understands basic grammar; identifies some colors and numbers, draws a person with 2 to 4 body parts. Five years: Differentiates between real and pretend, wants to be like friends; can stand on 1 foot for 10 seconds, can somersault; easily understood by others, tells stories, uses future tense; counts to 10, draws a person with 6 body parts, prints some letters and numbers.[1]

How a child's development progresses in the first years of life can dictate the individual's lifelong development and the level of success they could achieve in adulthood. The role of the primary care physician is crucial in the recognition of normal development and the identification of developmental delays. The provider should outline appropriate anticipatory guidance to the caregiver and educate them on what they should expect their child to achieve as they grow. Developing a strong relationship with parents is important to ensure that when any abnormality in the child's development is identified, the parents acknowledge the perturbation and acquiesce to recommended intervention strategies and treatment plans. Developmental delays, such as speech and language delay, can be a presenting feature of conditions such as autism spectrum disorder and also serve as a prognostic factor.[10] Therefore, the recommendation of the American Academy of Pediatrics is to screen at 9, 18, and 30 months and screening for autism spectrum disorder at 18 and 24 months.[1] A child with motor delay should have a thorough physical examination, including a complete neurological exam; laboratory testing should include creatine kinase and thyroid function, and brain imaging should be considered. A further, complete evaluation is necessary if screening results concern developmental delay. Evaluations ideally performed by developmental specialists (neurodevelopmental pediatricians, developmental-behavioral pediatricians, pediatric neurologists, and pediatric psychiatrists) can occur at home or medical centers. Early childhood professionals such as educators, psychologists, social workers, and therapists must be included in the multidisciplinary team to ensure the child receives appropriate care. Referral to early intervention programs as early as possible is valuable to ensure more positive outcomes. These programs provide complete evaluations and connect families with the required services, providing them with service coordinators and social workers who can assist families with issues such as transportation, home visits, counseling, and insurance. It is essential to recognize that a specific diagnosis is not required to refer to Early Intervention and to educate parents that they can also request the referral.[2]