TABLE 3.
Birth to 12 months ‘red flags’ developmental milestones chart – levels of evidence
| Age | Gross motor | Fine motor | Speech-language | Cognitive | Social-emotional |
|---|---|---|---|---|---|
| Newborn | Moro, asymmetrical tonic neck, positive support primitive reflexes (3) (E) Flexed posture (4) (A) |
Hand grasp primitive reflex (3) (E) | Root, suck primitive reflexes (5) (E) Orients to sound (0–3 months) (6) (E) Variable cries (0–3 months) (6) (E) |
Visual focal length ∼10 in (7) (E) Turns to visual stimuli (8) (E) Prefers human face (eyes), contrast, colours, high pitched voice (7,8) (E) |
Cries when infant cries (empathy) (8) (E) |
| Two months | Head up 45° in prone (0.5 months, 2 months) (4) (A) | Holds placed rattle (9) (C) | Gurgles (0–3 months) (6) (E) | Follows horizontal arc (9) (C) | Awake more during day (7) (E) |
| Four months | Asymmetrical tonic neck primitive reflex develops (1–3 months) (3)(E) Lifts chest in prone (2.5 months, 4 months) (4) (A) |
Brings hands together in midline (2.5 months, 4 months) (4) (A) Extends straight arms toward rattle, supine (3 months) (9) (C) Reaches and grasps rattle (9) (C) |
Coos (2–4 months) (6) (E) | Watches hands (0–3 months) (8) (E) Explores environment by looking around (0–3 months) (8) (E) Anticipates routines (3 months) (7) (E) Looks to find caregiver (3 months) (7) (E) |
Calms when spoken to, picked up, sucking, or looking (0–3 months) (8) (E) Enjoys eye contact (0–3 months) (8) (E) Facial expressions of joy, anger, sadness, distress, surprise (0–3 months) (8) (E) Self-soothes to sleep (3–4 months) (7,8) (E) |
| Six months | Primitive reflexes gone (3) (E) Pulls to sit (3.5 months, 5 months) (4) (A) Sits tripod (4.5 months, 6 months) (4) (A) |
Shakes rattle (9) (C) Holds cube between 2 hands (9) (C) (BLOCKS) Holds one cube in each hand (9) (C) (BLOCKS) Ulnar-palmar grasp (4th and 5th fingers), radial-palmar grasp (1st and 2nd fingers) (9) (C) (BLOCKS) |
Looks toward person talking to him (3–6 months) (6) (E) Vocalizes to answer (3–6 months) (5,6) (E) Laughs (3–6 months) (5,6) (E) |
Bangs objects together (3–6 months) (10) (D) Trial and error problem solving (0–6 months) (8) (E) Looks for dropped object (4–6 months) (11) (D) |
Predictable schedule (3–6 months) (7) (E) Smiles to initiate engagement and respond (3–6 months) (12) (E) Back-and-forth engagement through facial expressions and eye contact; shares enjoyment (joyful looks) (3–6 months) (12) (E) Prefers familiar people (3–6 months) (8) (E) Shows interest in other infants (empathy) (8) (E) |
| Nine months | Postural reflexes present (4–9 months) (3) (E) Rolls both ways (6 months, 8.5 months) (4) (A) Sits well (6.5 months, 8 months) (4) (A) |
Transfers (7 months) (9) (C) (BLOCK) Radial-digital grasp (thumb with 1st and 2nd fingers, no palm) (7 months) (9) (C) (BLOCKS) Touches Cheerio* with finger (7 months) (9) (C) Raking pincer grasp (8 months) (9) (C) |
Looks to familiar named object (6–8 months), inhibits to ‘no’ (6–9 months) (10) (D) Vocalizes to initiate (6–8 months) (6) (E) |
Object permanence (7 months) (8) (E) Explores caregiver’s face (7 months) (8) (E) Searches for hidden toy (7 months) (8) (E) |
Attachment development established (7 months) (8) (E) |
| 12 months | Gets to sit (9 months, 11 months) (4) (A) Crawls† (9 months, 11 months) (4) (A) Pulls to stand (8 months, 10 months) (4) (A) Walks with one hand held (9) (C) Catches rolling ball (9) (C) |
Pincer grasp (11 months) (9) (C) Voluntary cube release (10 months), into cup (11 months) (9) (C) (BLOCKS) Holds bottle (6 months, 12 months) (13) (B) |
Turns to name (8–12 months), understands routine commands (8–12 months) (6) (E) Babbles (6–10 months) (6) (E) or gestures intentionally for behaviour regulation (BUBBLES) (request: reach, point, up; refusal: push, arch away) and social interaction (attention seeking: move arms and legs; social game: imitate clapping; representational: bye-bye) (9–12 months) (14) (E) |
Looks for object not seen hidden (8) (E) Trial and error exploration (6–12 months) (8) (E) ‘Cause and effect’ toys (pushes button to see pop-up or pulls string to hear sounds) (6–12 months) (8) (E) |
Plays pat-a-cake (14) (E) Peek-a-boo (initiates by putting blanket over head) (9–12 months) (10,14) (D,E) (TOWEL) Gives to infants (empathy) (6) (E) Joint attention: gives or shows by extending object to comment (9–12 months) (10,14) (D,E) |
Numbers in parentheses indicate reference(s). Words in capital letters in parentheses are suggestions of props to elicit skills.
General Mills, Canada;
Some typically developing infants never crawl (7). A High-quality evidence (4), based on 90th percentile (ie, age by which 90% of children have mastered this gross motor skill). Ages in brackets represent the 50th and 90th percentiles; B High-quality evidence (13), based on 90th percentile (ie, age by which 90% of children have mastered this self-care skill). Ages in brackets represent the oldest age from the 50th percentile age range and the oldest age from the 90th percentile age range; C High-quality evidence (9), based on 50th percentile (ie, age by which 50% of children have mastered this gross or fine motor skill). Ages in brackets represent the 50th percentile age range; D Low- (10) or moderate- (11) quality evidence, based on ‘oldest age’ by which the communication, cognitive or social-emotional skill has been typically mastered. No percentiles provided. Age range in brackets; E Low-quality evidence (3,5–8,12,14), based on ‘oldest age’ by which the cognitive or social-emotional skill has been typically mastered. No percentiles provided. Age range in brackets