April Milestones

What are Infant Milestones?

Babies grow at an amazingly fast rate during their first year of life. In addition to baby's' physical growth in height and weight, babies also go through major achievement stages, referred to as developmental milestones. Developmental milestones are easily identifiable skills that the baby can perform, such as rolling over, sitting up, and walking.

These milestones are usually classified into three categories:

  1. Motor development
  2. Language development
  3. Social/emotional development

·       Babies tend to follow the same progression through these milestones; however, no two babies go through these milestones at exactly the same time.

·       Babies also spend different amounts of time at each stage before moving on to the next stage.

·       Contact a healthcare professional with any concerns about a baby's development.  

The First Month

During the first month of life, most of a baby's behavior is reflexive, meaning that his/her reactions are automatic. Later, as the nervous system develops, a baby will put more thought into his actions. Some of the newborn reflexes are described below.

Mouthing reflexes: These reflexes are important for baby's survival, helping them find the source of food. The sucking and swallowing reflexes are most important. A baby will automatically begin to suck when their mouth or lips are touched. The rooting reflex is when the baby turns his head toward your hand if their cheek is touched. This helps baby find the nipple for feeding. The rooting reflex begins to fade around 4 months.

Startle (Moro) reflex: The startle reflex occurs when a baby hears a loud noise or when he falls backward, his arms and legs extend away from his body. This reflex is most noticeable during the first month and usually fades by 2 or 3 months.

  
Grasp reflex:
A baby will grasp a finger or object when it is placed in the palm of her hand. This reflex is strongest during the first 2 months and usually fades by 5-6 months.

Stepping reflex: Even though baby cannot support his own weight, if his feet are placed on a flat surface, he will begin to step one foot in front of the other. The stepping reflex usually disappears by 2 months.

By the end of the first month of life, most babies may display the following:

  1. Raises head when on stomach
  2. Keeps hands in tight fists
  3. Focuses 8-12 inches away, looks at objects and faces, and prefers the human face over other patterns

Shows a behavioral response when hearing a noise (such as eye blinking, acting startled, change in movements or breathing rate). 

 
 

Age 1-3 Months

Between 1-3 months of age, babies begin the transformation from being a totally dependent newborn to becoming an active and responsive infant. Many of the newborn reflexes are lost by this age. At this age, a baby's vision changes dramatically; he becomes more aware and interested in his/her surroundings. A baby might follow a moving object, recognize familiar things and people at a distance, and start using his/her hands and eyes in coordination. At this age, babies usually turn toward familiar voices and smile at their parent's faces or other familiar faces. They also begin to coo (make musical vowel sounds, such as ooo or aaa).

The neck muscles become stronger during these first few months. At first, babies can only hold their heads up for a couple of seconds while on their stomachs. The muscles are strengthened each time the head is held up. By 3 months of age, babies lying on their stomachs can support their heads and chests up to their forearms.

Arm and hand movement develops fast during this stage. What was once a tight, clenched fist is now an open hand grabbing and batting at objects. Babies explore their hands by bringing them in front of their face and putting them in their mouths.

By the end of this period, most babies have reached the following milestones:

Motor Skills

·       Supports head and upper body when on stomach

·       Stretches out legs and kick when on stomach or back

·       Opens and shut hands

·       Brings hands to mouth

·       Grabs and shakes hand toys

·       Swipes and bats at dangling objects

·       Pushes down legs when on a flat surface

·       Follows moving objects

Language Skills

·       Makes cooing sounds

Social/Emotional Skills

·       Smiles at familiar faces

Enjoys playing with other people

 
 

Age 4-7 Months

From 4-7 months of age, babies learn to coordinate their new perceptive abilities (including vision, touch, and hearing) and motor skills such as grasping, rolling over, sitting up, and may be even crawling. Babies now have more control over what they will or will not do, unlike earlier months in which they mainly reacted by reflex. Babies will explore toys by touching them and putting them in their mouths instead of just looking at them. They can also communicate better and will do more than simply cry when they are hungry or tired or when they want a change in activity or a different toy.

By this time, babies have developed a strong attachment for their parents, and they may show a preference for their primary caretakers; however, babies at this age usually smile and play with everyone they meet.

Once babies can lift up their heads, they'll push up using their arms and arch their back to lift up the chest. These movements help strengthen the upper body and are in preparation for sitting up. They may also rock while on their stomachs, kick their legs, and swim with their arms. These movements are necessary for rolling over and crawling. By the end of this period, babies should be able to roll over from stomach to back and back to stomach and probably are able to sit without any support.

By age 4 months, babies can easily bring toys to their mouth. They use their fingers and thumb in a claw-like grip to pick up objects. Because at this age babies will instinctively explore objects by putting them in their mouths, it is important to keep small objects out of reach to prevent accidental swallowing. By age 6-8 months, they can transfer objects from hand to hand, turn them from side to side, and twist them upside down. Babies also discover their feet and toes during this stage.

Babies' broadening range of vision is apparent as they concentrate and focus on objects and follow movements. Babies at this age like increasingly complex patterns and shapes. They also like looking at themselves in a mirror. They continue to babble, but now they raise and lower their voices as if asking a question or making a statement.

By the end of this period, most babies have reached the following milestones:

Motor Skills

·       Rolls over both ways (stomach to back, back to stomach)

·       Sits up with, and then without, support of his hands

·       Reaches for object with one hand using the raking grasp

·       Transfers objects from hand to hand

·       Supports whole weight when on legs and held upright

·       Explores objects with hands and mouth

·       Explores objects by banging and shaking

Language Skills

·       Laughs

·       Babbles consonants (like ba-ba-ba-ba-ba)

Social/Emotional Skills

·       Distinguishes emotions by tone of voice

·       Finds partially hidden objects 

Age 8-12 Months

By age 8 months, most babies can sit up without support. They also figure out how to roll down to their stomachs and return to a sitting position again. Some babies are in constant motion; they'll arch their necks and look around while on their stomachs and grab at their feet or objects while on their backs. All this activity is preparing them for crawling, which is usually mastered between 7-10 months. Crawling is important for the development of integrated communication between the two sides of the brain. Some babies never crawl but rather scoot on their bottoms or move on their stomachs, like an army crawl.

Babies become increasingly more mobile during this stage; now is the time to childproof so baby can explore and discover without the possibility of injury. Baby gates are important to block off stairs or rooms that could be dangerous (such as bathrooms).

After crawling is mastered, babies begin to pull themselves up to a standing position. They then begin to take some steps while holding on to something for support. This will change into cruising around the furniture. As their balance improves, babies may gradually take a few steps without holding on. Many babies' first steps are taken around 12 months, but earlier or later than this is completely normal.

By the end of this stage, babies begin to use the pincer grasp, using the thumb and first or second finger to pick up small objects. As babies learn how to open fingers, they are able to drop and throw things. Babies also more thoroughly investigate objects by shaking them, banging them, and moving them from hand to hand. Babies are interested in objects with moving parts, such as wheels and things that open and close. They also like to poke their fingers through holes.

Babies also show a lot of growth in their language development during this period. They begin to make recognizable syllables like "ma" or "da," which eventually turn into "mama" or "dada." They can also imitate speech sounds they hear others make. By age 12 months, many babies say at least one word (other than mama and dada) clearly. They understand the meaning of no and begin to follow simple commands. Babies communicate nonverbally by pointing, crawling, or gesturing toward desired objects. They can also initiate and play gesture games, such as peek-a-boo and pat-a-cake.

During this stage, babies also learn object permanence, the concept that an object still exists when taken out of their sight. For example, if a toy is hidden under a blanket, babies will pick up the blanket and search for it. Babies also learn that objects have functions besides being just something to chew on or bang with (such as a hair brush or phone).

Separation anxiety and stranger anxiety usually begin during this period and are a normal part of babies' emotional development. Separation anxiety occurs when parents leave a babies' sight, resulting in great distress with fussing and crying. Separation anxiety usually peaks between ages 9-18 months and fades before their second birthday. Stranger anxiety is a reaction of distress with an infant encounters a stranger.

By the end of this period, most babies have reached the following milestones:

Motor Skills

·       Gets in and out of a sitting position independently

·       Gets on hands-and-knees position and crawls

·       Pulls self up to standing position, walks holding on to furniture, stands without support and, eventually, takes a few steps without support and begins to walk

·       Uses pincer grasp (thumb and first finger)

·       Places objects into container and takes them out of container

·       Begins to do more functional activities, such as hold a spoon or turn pages in a book

Language Skills

·       Says "mama" and "dada" and uses these terms specifically referring to a parent

·       Uses exclamations such as "oh-oh!"

·       Tries to imitate words and may say first word

·       Uses simple gestures, such as shaking head for "no" or waving for "bye-bye"

·       Plays interactive gesture games, such as pat-a-cake and peek-a-boo

Social/Emotional Skills

·       Easily finds hidden objects

·       Uses objects correctly such as holding phone up to ear or drinking from a cup

·       Is shy around strangers

  • Cries when mom or dad leaves

On to Toddlerhood

The first year of life is an amazing time for babies. They usually triple their birth weight and are about 28-32 inches tall by their first birthday. The once dependent baby who relied on reflexes to act and respond has become more independent and can move at will. Rolling over, sitting up, crawling, picking up objects, and standing are usually mastered in the first year. They may even be taking a few steps on their own. Babies can now use gestures, different cries, and some simple words to communicate their wants and needs. They have developed a relationship with their parents and caretakers and engage in purposeful two-way interactions. The next stage is toddlerhood, where babies further develop their walking, talking, and thinking. 

When to Seek Medical Care

Parental concern about their child's development has been shown to be very effective in identifying children with developmental delays. Thus, parents should consult with their primary care professional whenever a concern arises regarding their infant's development. Although a range of several months exists during which time babies should achieve each developmental milestone, failure to reach milestones within these established ranges is abnormal and associated with a probability of a developmental disability.

During a baby's regular check-ups, a primary-care professional usually monitors and charts developmental progress. Many doctors use standardized screening tests to identify children who are at risk for developmental disabilities so they may be referred for further evaluation and intervention.

Some infants are at a high risk for developmental disorders and their development should be monitored more closely. This includes babies with birth defects, genetic disorders (some are identified prenatally), metabolic abnormalities, and neurological problems (such as seizures or feeding problems).

If a delay in a child's development is suspected, it is important to resist the temptation to wait and see. A child may be referred for hearing and vision testing or further specialty consultation and evaluation. Early diagnosis and intervention are very important in improving the long-term outcomes for developmental disorders of all types.