TABLE 4

Developmental Milestones in the First 2 Years of Life

MilestoneAverage Age of Attainment, moDevelopmental Implications
Gross motor
    Head steady in sitting2.0Allows more visual interaction
    Pull to sit, no head lag3.0Muscle tone
    Hands together in midline3.0Self-discovery
    Asymmetric tonic neck reflex gone4.0Child can inspect hands in midline
    Sits without support6.0Increasing exploration
    Rolls back to stomach6.5Truncal flexion, risk of falls
    Walks alone12.0Exploration, control of proximity to parents
    Runs16.0Supervision more difficult
Fine motor
    Grasps rattle3.5Object use
    Reaches for objects4.0Visuomotor coordination
    Palmar grasp gone4.0Voluntary release
    Transfers object hand to hand5.5Comparison of objects
    Thumb-finger grasp8.0Able to explore small objects
    Turns pages of book12.0Increasing autonomy during book time
    Scribbles13.0Visuomotor coordination
    Builds tower of 2 cubes15.0Uses objects in combination
    Builds tower of 6 cubes22.0Requires visual, gross, and fine motor coordination
Communication and language
    Smiles in response to face, voice1.5Child more active social participant
    Monosyllabic babble6.0Experimentation with sound, tactile sense
    Inhibits to “no”7.0Response to tone (nonverbal)
    Follows 1-step command with gesture7.0Nonverbal communication
    Follows 1-step command without gesture (eg, “Give it to me”)10.0Verbal receptive language
    Speaks first real word12.0Beginning of labeling
    Speaks 4–6 words15.0Acquisition of object and personal names
    Speaks 10–15 words18.0Acquisition of object and personal names
    Speaks 2-word sentences (eg, “Mommy shoe”)19.0Beginning grammaticization, corresponds with vocabulary of ≥50 words
Cognitive
    Stares momentarily at spot where object disappeared (eg, yarn ball dropped)2.0Lack of object permanence (out of sight, out of mind)
    Stares at own hand4.0Self-discovery, cause and effect
    Bangs 2 cubes8.0Active comparison of objects
    Uncovers toy (after seeing it hidden)8.0Object permanence
    Egocentric pretend play (eg, pretends to drink from cup)12.0Beginning symbolic thought
    Uses stick to reach toy17.0Able to link actions to solve problems
    Pretend play with doll (gives doll bottle)17.0Symbolic thought
  • Modified from: Behrman RE, Jenson HB, Kliegman R, eds. Nelson Textbook of Pediatrics. 16th ed. Philadelphia, PA: Saunders; 2003.