Developmental Milestones: from Baby to Preschool
During the first years of life, children go through a wonderful series of changes that are truly unique to every child. We gathered the expertise of a Pediatric Occupational Therapist and asked her to compile some of her experiences about developmental milestones, how to recognize them, and when to be concerned about possible delays. Below is what she put together, organized by age range - from newborn to toddler and beyond.
As you watch a flower slowly open, you witness continual change and new life, similarly to the experience of seeing a child grow. From waving goodbye, to smiling, rolling, and saying the first word, babies grow in developmental stages. Learning about your baby’s developmental milestones is an essential step to responding appropriately to meet your baby’s needs.
Learning to spot common milestones is an important first step in parenthood. Talk to your pediatrician if you are noticing significant delays in social emotional learning, cognition, speech and language, or physical movement. Acting sooner rather than later about a missing milestone can positively impact developmental progress in your child.
Research in child development shows that creating a safe environment, engaging with your baby, taking pleasure in their interests or preferences, and meeting their physical and emotional needs improves brain development and life success. Below is a detailed overview of important milestones, written from a Pediatric Occupational Therapist’s perspective and drawn from top research organizations in pediatrics, including the American Academy of Pediatrics, Mayo Clinic, Center for Disease Control and Prevention (CDC), Stanford University, Cleveland Clinic, and the U.S. Department of Agriculture (see our full list of resources at the end of this article).
Click on any milestone to read more details about it, and be sure to download and print the linked developmental milestone charts as a convenient reference!
- Newborn Milestones: 0 to 3 Months
- Infant Milestones: 4-6 Months
- Infant Milestones: 7-11 Months
- Toddler Milestones: 12-17 Months
- Hands You Book of Choice
- Repeats Sounds or Actions
- May say Mama and Dada
- Points to Objects of Interest
- Plays Peek-a-Boo
- Involved in Dressing Tasks
- Puts Objects in Containers
- Dumps, Stacks, Bangs Objects
- Starts Eats with Spoon
- Uses Both Legs Standing
- Stands Independently
- Takes First Steps
- May Start Walking
- Toddler Milestones: 18-23 Months
- Plays Pretend Games
- Parallel Plays with Kids
- Becomes Defiant with "No"
- Shows Excitement around Kids
- Searches for Interests
- Solves Simple Problems
- Shakes and Nods Head
- Identifies a Body Part
- Pulls Toy while Walking
- Eats Indendently with Spoon
- May Begin using Fork
- Throws Toys or Balls
- Walks on Stairs
- Kicks a Ball
- May Start Running
- Toddler Milestones: 24-36 Months
- Beyond Toddler
- Final Thoughts
Newborn to 3 Months: Milestones
From birth to 2 months old, several primitive reflexes are present and integrating that help a baby orient to food, latch to a nipple, feed, and self-soothe. At age 2 months old, babies should be smiling, looking at their parent, cooing and making gurgling noises, looking at people’s faces and following objects or motions with their eyes. They should hold their head upright while lying face down on their tummies, and they should bring both hands together at midline to touch the mouth (CDC, 2019).
Bringing hands together at midline and to the mouth is a critical milestone for bilateral integration, or coordination of both sides of the body, needed for self-feeding, play skills, and physical movement. The social emotional milestones at this stage are self-regulation and intimacy and attachment (ICDL, 2020). Both are being formed between parent/caregiver and the child through interaction and relationship. Self-regulation (being able to calm or self-soothe) is the first step in foundational social emotional development that is a building block for higher cognitive functioning.Babies regulate their breathing to that of their caregiver. So, using physical touch, monitoring your own heart rate and breathing while holding your baby, singing and talking to your baby, playing music, and gentle rhythmic rocking are ways to initiate selfsoothing behaviors that help with your child’s central nervous system development.
Social emotional learning and development later in life is also impacted by intimacy and communication with the parent/caregiver early on in life. A mother who is able to accurately respond to her baby’s signals (i.e. changes the diaper when wet or picks up her baby to feed when hungry) is better able to satisfy the emotional and physical needs of the child, thus creating a feedback loop of cause and effect that forms the basis for two-way communication needed in later in early childhood learning. This early intimacy leads to attachment and bonding. Infant massage and frequent time spent talking to your child, singing, reading, and tummy time can help your baby’s brain develop those social emotional bonds needed for learning and cognitive functioning.
4 to 6 Months: Milestones
At 4 months old, babies smile, making eye contact with parents/caregivers, and follow objects of interest with both eyes. They should be able to hold their heads up while lying prone (face down) on their tummies. According to the American Occupational Therapy Association (AOTA), tummy time is critical for postural muscle development of the head and neck needed for self-feeding.
The American Academy of Pediatrics publishes guidance on sleep and play positioning for babies and the importance of tummy time. At 4 months, babies should push up to their elbows while lying on their stomach. Another milestone listed by the CDC is that babies of this age will also push up through their legs when placed on a hard surface (2019). At this age, babies may start to roll from their tummy to back and spend sleeping hours on their back. So, playtime needs to be largely on the tummy to develop strong extension of the head and neck muscles and to prevent plagiocephaly or flattening of the head.
At 6 months old, babies will enjoy cause and effect games, look at themselves in a mirror, recognize faces and begin to recognize if someone is a stranger, and respond to other people’s emotions. Fine motor grasping skills for this age include the ability to pass objects from one hand to another (transferring) and bringing objects to the mouth. Consider investing in some of the best sensory toys to help your baby explore their rich multisensory worlds!
A 6-month old will also segmentally roll from back to front and front to back and will begin to sit upright without support. Developing strong core tummy muscles will facilitate proper digestion for feeding, play, and physical movement.
Once a child is able to sit upright without support, he or she can be placed in a highchair with a safety strap. Seating and positioning for feeding are complex topics and specialized information depending on child’s physical ability is needed for some parents. For more information on this see links below in the works cited on feeding and nutrition.
Talk to your pediatrician if you are noticing delays in social emotional learning, cognition, lack of curiosity in toys and objects of interest or people’s faces, or a delay in physical movement like rolling or sitting upright without support. Notify your doctor if your baby is not able to move one or both eyes in all directions while following a toy or object of interest (CDC, 2019).
7 to 11 Months: Milestones
At 9 months old babies are socially learning two-way communication patterns with open and close looped communication. Encouraging this type of communication through play can help develop speech and language skills. What is open loop communication? Your child’s interest and curiosity form the basis of the open loop and your ability to engage that interest and communication will close the loop. If you help your child achieve their goal, you are influencing their brain’s development in human interaction and communication.
Here are some examples of an open and close looped pattern in social interaction at this age: A child reaches for a toy and you pick it up and hand it to them, while saying, “Here is the toy you want”. Essentially, the caregiver is answering their curiosity and rewarding initiation in two-way communication. Another example would be peek-a-boo games or hiding desired objects beneath a blanket. These games help facilitate your child’s curiosity and exploration in a toy of interest through cause and effect.
At 9 months old, a baby will be copying sounds and gestures of others and using a finger to point to objects of desire, part of the two-way communication loop described above. Imitating your child’s movements and sounds can also help encourage self-awareness in the two-way interaction. He or she will understand the word, “no” as well (CDC, 2019).
Physically, your child should be crawling at this age and will start to pull to stand using objects, like the edge of a sofa. You can facilitate pulling to stand by placing toys on top of a sofa or small tabletop for toddlers. Other physical milestones include sitting independently and crawling at this age.
12 to 17 Months: Milestones
At a year to 15 months, your child will cry when you leave and will have favorite toys or preferences in play activities. Your child might hand you a book of choice, repeat sounds or actions, point to objects of interest, play peek-a-boo, and even try to get involved in dressing, by sticking an arm or leg out to assist. Your child will try to make sounds or say the words, “mama and dada,” possibly repeating some words you say with minimal accuracy.
Children will cognitively put objects in and out of containers (like blocks into and out of a cup), dump out toys, stack blocks, and bang two objects together. Your baby should reach across his/her body to obtain an object of interest and follow simple 1-step verbal commands, like “Pick up your toy.”
Physically, your baby should be able to sit independently and pull to stand up from a seated position. Your baby may be able to stand alone at 12 months or even start to take first steps between 12 and 15 months. Look out of simple gestures of communication skills like waving or shaking the head. At 12 to 15 months, your child will also use a spoon independently in addition to finger feeding (don’t be worried about a mess!) For more information on feeding milestones or nutrition, see our article on starting solid foods, and check out the references in the bibliography at the end of this article.
18 to 23 Months: Milestones
Children are learning complex communication and shared problem-solving skills between the age of 1 year to 2 years old, including closing circles of communication around wants and desires, searching for toys of interest or preference, and playing games of simple problem solving. For instance, to practice opening and closing container lids for fine motor strengthening, you may place cheerios or small blocks into a Tupperware container. Your baby should take interest in getting the desired objects out of the container with your assistance. This is a simple game of problem solving that can enhance your baby’s social emotional development and cognition.
At 18 months, your baby might play simple play-pretend games with a favorite toy. Your baby should feel comfortable exploring alone within a short distance of a caregiver or parent. Your baby might point to show you something, shake their head no or nod yes, or say single words. Cognitively, your baby is starting to learn body awareness and can point to 1 body part (eyes, nose, or mouth). Picking out a picture book that focuses on simple body parts and human anatomy for baby is a good way to engage in this learning conversation. Your baby should be able to walk alone and might explore taking steps at this age. He or she will pull a toy on a string while walking, eat independently with a spoon, and by the age of 2, use a fork with or without some assistance. Again, play and feeding will be messy!
By the time your child is 2 years old, he or she can build a tower of 4 or more blocks, assist with dressing and undressing, might name items in a picture book, follow simple instructions, and recognize the names of familiar body parts (arm, leg, mouth, etc.). Physically, your baby might start to throw a toy or ball, walk up and down stairs, kick a ball, or even begin to run. Socially and emotionally, by the age of 2, your baby will show defiance when told no, show excitement around other children or adults, might copy others (especially older siblings), and plays in parallel (or beside) other children.
24 to 36 Months: Milestones
From 18 months to 3 and 4 years old, children are creating emotional ideas and using symbols, according to Dr. Stanley Greenspan, the founder of the D.I.R. Floortime, or Floortime (Developmental Individual Relationship-based Model), (ICDL, 2019). This means that a child forms association between language and meaning. For instance, children draw concepts together like a dog barks and a car can crash, or a tower can fall down. He or she will also understand symbolic concepts like how a doll being fed by a mommy or daddy is similar to how baby is fed by mom or dad (ICDL, 2017). The brain grows most rapidly in early years by the interactions with caregivers. Language and cognition, math and quantity concepts are conveyed through interaction and relationship in early years (ICDL, 2017).
Children at the age of 36 months should be able to self-regulate, demonstrate frustration and temper tantrums if told “no,” and be able to calm down or self-soothe after a tantrum. A toddler at this age will communicate simple wants and desires, engage with other children in parallel games and play pretend with favorite toys, and interact in a game of chase. Your child should be comfortable independently exploring the environment with a nearby caregiver, should be naturally curious and eager to play especially around other children, and should be walking, running and talking in small sentences or with simple language.
Physically, by 36 months or 3 years of age, your toddler will run and walk, pedal a small tricycle, walk up and down stairs one foot at a time, and may climb fairly well. Your child should also be speaking in simple sentences and learning new words. Your toddler will have the fine motor capacity and finger dexterity to turn pages of a book one at a time (although may get excited and turn ahead!) He or she should also be able to stack at least 6 blocks in a tower and complete a 3 to 4-piece, wooden, form board puzzle like these by Melissa & Doug. Your child should be problem solving opening and closing container lids, trying to screw and unscrew lids on jars, and searching for hidden toys. He or she should be able to follow simple instructions. Your toddler will also start to demonstrate independence in dressing skills by taking on and off shirts, pants, and socks, but still needing assist for clothing and shoe fasteners.
Beyond Toddler: Milestones
After 3 years old, your child is no longer considered a “toddler” and moves into preschool age of 4 and 5 years old. It is important to remember that your child will show his or her own unique developmental progress and that the above article is a general guideline, drawing upon the best child development research from the Mayo Clinic, the American Academy of Pediatrics, the Interdisciplinary Council on Development and Learning (ICDL), and the Centers for Disease Control and Prevention (CDC).
For more information talk to your pediatrician. Ask for the best resources on feeding, nutrition, cognition, social emotional learning and play. Catching delays in these early milestones puts your baby at an advantage for access to the best care and, ultimately, success.
We have focused on highly observable behaviors that don't necessarily require an expert to detect. More nuanced and detailed milestone guides are available elsewhere, with more subtle behaviors that may involve expert training and observation. An example of an easily observed behavior is a baby bringing both hands together at midline and putting them in his or her mouth; more nuanced behaviors that require training to detect are things like cross-midline reaching, various hand grips, limb position during rolling, and motor asymmetries.
We cannot overstate the fact that each baby is a little bit different, and will progress differently through these milestones. While most babies and toddlers tend to reach these milestones during the specified age range, some may emerge before others, and some might shift a bit later. If you are ever concerned about developmental delays, always seek the advice of your pediatrician who will guide you in the appropriate direction. If you're concerned about autism, see our articles about how autism affects developmental milestones, and early signs of autism in babies and toddlers.
About the author: Danielle Feerst, OTR/L, is a pediatric occupational therapist who practices in South Carolina. She can be found at her website, daniellefeerst.com.