23rd November 2023

Developmental Milestones in Children

Developmental milestones are not set in stone and can vary from child to child. While there is a general timeline for when children typically reach these milestones, there is a wide range of what is considered normal development. Some children may achieve certain milestones earlier or later than others, and that is typically considered within the range of typical development.

These milestones have been developed through research studies and observations of large populations of children. The specific criteria and timeline for each milestone have been established by a range of organisations, including the American Speech-Language-Hearing Association (ASHA), the Centers for Disease Control and Prevention (CDC), and the World Health Organization (WHO). These milestones are used as guidelines to help identify children who may be experiencing delays in their development and may require further evaluation or intervention. It is important to remember that every child is unique and will develop at their own pace, so it is important to consider the whole child when evaluating their development.

Speech and language milestones

• 6 weeks – 2 months – First social smile and cooing.
• 3 months – Differentiate familiar and unfamiliar faces and localise sound sources.
• 6 months – Babbles (gaga, dada).
• 9-10 months – Babbles tunefully.
• 1 year – One-word stage (mamma, doggie).
• 16-18 months – 18-40 words.
• 2 years – Two-word stages with no propositions (mummy go, daddy go), 80-100 words.
• 3 years – Basic adult grammatical sentence.
• 5 years – Adult speech.

Language is slower to develop in boys, in twins, in larger families, in those from social classes 4 and 5, and in children with a lack of stimulation, e.g. deaf and neglected children.

Visual milestones

• 20-week foetus – Responds to bright light flashed on the abdominal wall.
• Birth – Vision is the least developed sense with acuity at 20/300, but can still track and scan objects, discriminate brightness levels, fixed focus at 20 cm, can see around 8-10 inches and have pupillary reflexes.
• 1 month – Differentiates faces from other stimuli, with a preference for face-like complex stimuli.
• 2 months – Depth perception, prefers 3D rather than 2D representations of faces.
• 4 months – Colour vision and accommodation reflex develop.
• 6 months – Accurate acuity (6/6) is achieved in most infants.

Reading an analogue clock

• Reception (ages 4-5) – Read the time to the hour.
• Year 1 (ages 5-6) – Read the time to the hour or half hour.
• Year 2 (ages 6-7) – Read the time to the hour, half hour, or quarter hour.

Motor milestones

Gross motor

• 3 months – Holds head up unaided.
• 6 months – Sits unaided, rolls from front to back.
• 12 months – Cruises by holding furniture.
• 18 months – Walks independently.
• 24-30 months – Runs and climbs stairs unaided with rails.
• 3 years – Feeds and simply dresses oneself.
• 4 years – Hops on one leg.
• 5 years – Climbs stairs one foot at a time.

Fine motor

• 3 years – Draws a circle.
• 4 years – Draws a cross.
• 4.5 years – Draws a square.
• 5 years – Draws a triangle.
• 7 years – Draws a diamond.

Play milestones

Children’s play activities are categorised according to the quality of interactions among each other.

• <2 years – Solitary play – The child plays on its own.
• 2 years – Parallel play – The child plays along with other children.
• 3 years – Co-operative play – The child interacts with other children in complementary ways, like sharing turn-taking.
• 5 years – Rule-governed play – The child understands the rules of games.

Development of the theory of mind 

Theory of mind refers to people’s intuitive understanding of their own and other people’s minds or mental states, including beliefs and thoughts. To use psychodynamic lingo, the theory of mind uses projection to form the basis of empathy through the projection of personal experiences to understand someone else’s subjective world. It develops by degrees from a very early age in humans:

• 3 years – Children normally have a well-developed theory of mind but cannot yet understand that people’s beliefs can be false.
• 4 years – Children understand that people’s beliefs can be false too.

Development of gender 

Kohlberg’s (1966) classic stage theory of gender development (not his moral development) proposed that children can correctly identify their gender by 2 years of age, understand that their gender remains stable across time by 4 years of age, and understand their gender to be constant and independent of external features by 7 years of age.

However, it is now recognised that gender identity is a multidimensional construct that includes an individual’s knowledge of an attitude towards gender groups. The development of a transgender or gender-nonconforming identity involves a complex interplay of phenomena over time. Fluidity in gender identity is being increasingly recognised.

Developmental fears and anxiety

An appreciation of different maturational aspects of personality structure is enormously helpful in evaluating the nature of a person’s experience of anxiety or depression. When we listen to an anxious patient, we all tend to project into our understanding of that anxiety the kinds of issues that define our own anxious proclivities. But anxieties differ markedly, depending on whether their origin is in the symbiotic phase, the separation–individuation phase, or the oedipal phase.

The first kind, generally referred to as annihilation anxiety, is the terror that the self will be overwhelmed, will be engulfed by another, and will cease to exist. It is the kind of anxiety that an unmedicated person in an acute schizophrenic state emanates. Annihilation anxiety survives in the psychology of most adults in residual fears of intimacy. One can easily find evidence of people’s anxiety that closeness with another person will threaten their independent existence.

The second kind, separation anxiety, affects all of us to some degree, as separations inevitably stimulate unconscious memory traces of frightening infantile disconnections, but it is an especially intense and central part of the experience of people organised at a borderline level of development. It is normally seen in infants at about 8 months (called stranger anxiety), which appears as an anxiety response to someone other than the caregiver. At the approach of a stranger, infants cry and cling to their mothers. Separation anxiety is most common at ages 10-18 months and generally disappears by the end of the third year. In the absence of the person to whom one is attached, one feels empty or insubstantial. It can be strong enough to keep a person in life-threatening situations, as when a battered spouse can deal more easily with the pain of physical abuse than the terror of loneliness. It can impel astonishing regressions and seemingly inexplicable explosions of hostility.

The third kind of anxiety, oedipal or superego anxiety, involves fears of punishment for unacceptable sexual, aggressive, or dependent strivings. There is no threat to the perception of reality and identity of the self, but one’s feeling of personal good-enoughness may be seriously compromised. Despite the fact that it originates after the child has consolidated a sense of self and reality, oedipal-level anxiety can be quite intense, given that oedipal fantasies typically involve ideas of death and retribution. The experience of personal success is a common trigger for oedipal anxiety: If an achievement has for someone the emotional significance of victory over a parent, he or she may become very anxious or symptomatic in the unconscious expectation of punishment for that crime.

Developmental trend of fears

• Infancy – Fear of loud noises, falling, strange objects and strange people.
• 3 years – Fear of animals.
• 4-5 years – Fear of the dark.
• >5 – Fear of imaginary creatures.
• Late childhood – Fear of open spaces and sex.
• Teenage onwards – Fears of failure, illness and death.
• Fears that show no particular age trend – Fear of snakes and natural events like storms.

References

• Hurvich, M. S. (1989). Traumatic moments, basic dangers and annihilation anxiety. Psychoanalytic Psychology, 6, 309–323.