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Pediatric Developmental Milestones

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0-3 years old

Grasp Milestones:

    • 0-2 months: palmar grasp is strong, hands are usually fisted, with their hands in their mouth
    • 2-4 months: the child begins reaching for objects with one arm
    • 4-8 months: radial palmar grasping pattern and shakes rattles, raking motion to pick up objects by trapping objects between the thumb and side of index finger

    • 8-12 months: uses gross fisted grasp using the radial side of hand, immature pincer grasp, transfers objects from one hand to the other, uses two hands together to hold large objects
    • 1-2 years: uses a mature pincer grasp, has controlled release of objects, scribbles with a crayon, and begins in hand manipulation objects (moving objects from fingers into palm)

    • 2-3 years: move objects from palm to fingers without use of the other hand, uses both hands for wind-up boys, string large beads, copies simple line and circle, snips with scissors
  • In-Hand Manipulation Skills:
    • 12-15 months: finger-to-palm translation skill emerges where the child grasps an object with the pads of the fingers and thumb and moves it into the palm (i.e. picking up a coin with the fingers and thumb and moving it into the palm of the hand
    • 2-2.5 years: palm-to-finger translation emerges which requires isolated control of the thumb and the child begins with finger flexion and moves to finger extension (i.e. moving a coin form the palm of the hand to the finger pads before placing the coin in a vending machine)

    • 5 years: simple rotation emerges where a child turns or rolls an object held at the finger pads at approximately 90º or less (i.e. unscrewing a small bottle cap)
  • Gross Motor Milestones:
    • 2-4 months: infant in prone lifts head 90º and weight bears through their lower chest and forearms
    • 4 months: may begin to flex their neck to keep head aligned with their shoulders
    • 4-6 months: can lift head in prone to visualize activities in the room, can prop on hands, can weight shift from side to side
    • 6 months: rolling each direction, can push up on all fours, side sit, and sit independently
    • 6-8 months: begin to crawl and half kneel
    • 7-9 months: pull to stand and cruising
    • 10-13 months: full/tall kneel, standing, and may take first steps
    • 1-1.5 years: walks well but can sometimes fall, and crawls up and downstairs
    • 1.5-2 years: begins running with poor coordination
    • 2-3 years: standing on one foot, kicking a ball, and can catch a 10-inch ball
  • Play/Leisure Milestones:
    • 0-3 months: imitation of simple gestures and facial expressions
    • 2-4 months: hands often clasped together
    • 4-8 months: transfer objects from one hand to the other and puts toys in mouth, engages in social play with parents
    • 8-12 months: uses both hands to hold toys, finger-feeds self, picks up toys with a pincer grasp, functional play emerges
    • 1-2 years: stacks 3-5 1” blocks, scribbles, tosses a small, ball, turns the pages of a book, imitates peers in play, engages in parallel play, plays with dolls, realistic props, action figures, etc, enjoys banging and throwing objects

    • 2-3 years: uses both hands to open lids, winds up wind-up toys, strings large beads, snips with scissors, colors large forms, begins to engage in symbolic and pretend play
  • Feeding and Oral Motor Milestones:
    • 0-6 months: rooting and suckling reflexes
    • 2-4 months: open mouth for spoon bottle or nipple and sucking ability is strong
    • 6-12 months: explore objects orally and coordinates the suck, swallow breath pattern
    • 7-8 months: move food with tongue, begins diagonal jaw chewing, and finger feeds
    • 8 months: close lips around spoon to remove food, drinks from a sippy cup, can start to drink from a straw
    • 12 months: beings to rotary chew (becomes proficient by 1-2 years), and begins to use spoons
    • 1-2 years: can bite off pieces of food, may transition from bottle to small cup at 12 months, Small cup without a lid by 2 years old with cup half full
  • Eating Skill Milestones:
    • 1-4 months: liquids only
    • 5 months: liquids and beginning pureed foods, formula or breast milk remains the primary source of nutrition
    • 6 months: liquids and pureed foods
    • 8-9 months: soft foods, mashed table foods, and meltable solids
    • 12 months: easily chewable foods, including soft meats, chopping table food
    • 18 months: coarsely chopped table food, some raw fruits, most cooked meats
    • 24 months: most table food; use caution with raw veggies, foods with skins, tough meats, or small round foods that increase the risk of choking
  • Activities of Daily Living Milestones:
    • 1-2 years: begins to help with dressing such as lift arms to help with a shirt, begins to pull off socks and shows
    • 2-3 years: putting on shoes and socks and pulls shirt overhead, develops daytime control with toileting with a few accidents and needs help to wipe self

3-5 years old

  • Grasp Milestones:
    • 3-4 years: can do simple fasteners and utilizes a static tripod grasp on a writing utensil

    • 4-6 years: can print name, copy letters/numbers/short sentences, use a fork/knife, and utilizes a dynamic tripod grasp on a writing utensil
  • In-Hand Manipulation Skills:
    • 3-3.5 years: shift emerges which involves linear movement of the objects on the finger surface to allow for repositioning of the object on the pads of the finger (i.e. used in dressing tasks such as buttoning, and snapping)
    • 3-4 years old: complex rotation emerges where the child can rotate a small object 180º- 360º once or repetitively. The fingers and thumb alternate in producing the movement and the fingers move independently of one another (i.e. turning a pencil over to use the eraser)

  • Gross Motor Milestones:
    • 3-5 years: can hop on one foot
    • 4 years: can catch a small ball
    • 4-5 years: can skip and gallop
    • 4-6 years: can maintain prone extension and supine flexion
    • 5-7 years: can hang from monkey bars and pump a swing
  • Play/Leisure Milestones:
    • 3-4 years: builds with construction toys, dresses dolls, cuts out large shapes with scissors
    • 4-6 years: completes puzzles up to 20 pieces, enjoys building with Legos, opens most packaging, and can manage a computer mouse, turn taking
    • 7-10 years: cursive writing, games with rules, board games, sports, cooperation and competition
  • Eating Skill Milestones:
    • 2-5 years: feeds self with a fork and drinks from a regular full sized cup
    • 5-10 years: can spread soft foods with a knife and cut meats
  • Activities of Daily Living Milestones:
    • 4-5 years: pulls down and up pants without fasteners
    • 4-6 years: buttons, unbuttons, snaps, and zippers, learns to tie shoes, manage lunch box/containers, day and night time controlled with toileting but may need assistance to wipe self
    • 5-6 years: should be fully independent with dressing besides zippers, fully independent with toileting, may need supervision while brushing teeth

    • 7-10 years: can tie knots, brush teeth independently, and can shower and groom themselves but may need cues to initiate and being thorough
    • 11-17 years: fully independent with all aspects of showering and grooming

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