Category: Milestones

What should a 1-year-old child be able to do?

[mme_highlight] When you celebrate your baby’s first birthday, you realize that your child has grown very fast and is becoming an independent walker. A child of this age likes to play “peek-a-boo”, waves for good-bye and understands that objects continue to exist even if he/she does not see them. [/mme_highlight]

When you celebrate your baby’s first birthday, you realize that your child has grown very fast and is becoming an independent walker. Also, she/he can independently feed her/himself and loves to explore the world around him/her.

Cognitive development

The child becomes more and more curious and interested in the world around him/her. He/she begins to associate names and objects and can point at objects when parents ask him/her to identify the objects that are part of her/his daily routine. The baby becomes capable of adapting the position of the body when a parent puts on the clothes.
In addition, children begin to imitate adults; in fact, 78% of children aged 12 months had at least one imitative act and besides that, children like to imitate the sounds of animals.

A child of this age likes to play “peek-a-boo”, waves for good-bye and understands that objects continue to exist even if he/she does not see them. Kids gain this important new skill- they can find a hidden object. Now, the child also can make a tower that consists of 2 blocks.

Motor development

One year old children rapidly develop the ability to move independently, as the data below demonstrates.

[mme_databox]

• 97% of children have ability to crawl;
• 95% of children can walk with assistance;
• 75% of children can stand alone;
• 50% of children have ability to walk without support;
• 50% of children walk with heel strike;
• 95% of children can squat without support.

[/mme_databox]

Also, one year old toddler improves his/her fine motor skills. Now, he/she can turn several pages of the book at once and can use pincer grasp to grab or hold small objects (the use of tip of the thumb and index finger). Many kids can grasp a pencil and start to scribble.

Children at this stage also acquire new eating habits, as shown below.

[mme_databox]

• 30 % of children can drink from a cup;
• 84 % of children eat with the spoon;
• 90 % of children can eat biscuit or bread.

[/mme_databox]

Social/Emotional

In this period, children learn to recognize their feelings and learn to cope with them. Temper tantrums are a common occurrence. In addition, separation anxiety and fear of strangers become more apparent. According to the parents’ statements, the frequency of temper tantrums is eight times per week for one-year-olds and the duration of temper tantrums is two minutes on average.

Children still don’t have the ability to play with others or to share the toys at this age.

Language / communication

One year-old child understands about 80 words and can understand simple commands (e.g. “no”, “drink”, “eat” etc.). Also, babbling starts to resemble adult speech (by intonation, manner and duration). Besides words “mama” and “dada”, she/he can clearly say at least 2 words.

The toddler understands the meaning of the word “no”, but she/ he often does not obey the command.

What are the alarm signs I should be worried about?

• If the child does not say a word or babbling does not become more complex;
• if the child cannot stand with support;
• If the child does not crawl;
• If the child does not point to objects when parents ask to identify objects of everyday use;
• If there is no nodding or waving “good-bye”, or if he/she does not play “peek-a-boo”;
• If he/she does not respond to his/her name;
• if he/she prefers to play alone.

What are the risk factors that can impair development?

As the baby is moving more and more, parents should provide the safety of the place where the baby stays and plays. Parents should prevent the possibility of crashes, therefore harsh and fragile items must be removed. Keep away poisons and small items that can cause choking.

Parents should remove water tanks, pools, sink and bathtub, because the baby can drown in a small amount of water. Take into account that the child may come in contact with hot liquids and hot surfaces. Thus, parents must protect child from possible contact with power sources.

In addition, pay attention to the possible existence of signs of autism. If the baby does not babble or shows repeated gestures and he/she avoids communication and eye contact with others, you should contact a doctor.

Also, pay attention to the possibility of anemia, especially in children who are not fed with iron fortified infant formula or if the intake of vegetables is not sufficient.

What should parents do to encourage the development of baby at this age?

During this period, baby is dealing with temper tantrums. You should stay calm and support your baby, with love and tenderness. Do not punish your baby, but rather reward her / his for the good behavior.

The good way to have some pleasant time with your toddler is listening to music. Baby is curious and he / she likes new things, like new sounds and rhythms.

You should often repeat things through communication in order to give your baby confidence and security. For example, you may ask several times a day: “What does a cat say?” or “Where is the dog on the picture?”.

Remember that your baby certainly likes to play “peek-a-boo”,“patty-cake” or building a tower over and over again.

Summary and Recommendations

• Your one-year-old will show developmental progresses every day. Knowing what to expect makes it easier for you to recognize the progresses and help the child to achieve them.
• Cognitive Development: one-year olds are curious about the world around them, identify and point at objects; they can wake goodbye and play peek-a-boo and also look for a hidden object.
• Motor Development: one-year-olds can stand up and walk with support and progressively with more independence. They can use pincer grasp to hold objects and turn pages of a book.
• Social/Emotional Development: separation anxiety and fear of strangers are typical of this stage. Temper tantrums are frequent.
• Language Development: the child can understand about 80 words and can say a few words other than “mama” and “dada”.
• Each child has her/his own pace, but if you think your child is not developing adequately, seek for medical advice.

[mme_references]
References

• http://www.nlm.nih.gov/medlineplus/ency/article/002005.htm
• http://www.cdc.gov/ncbddd/actearly/milestones/milestones-1yr.html
• http://www.health.qld.gov.au/ph/documents/childhealth/28129.pdf

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What should a baby be able to do between 21 and 24 months?

[mme_highlight] Toddlers at this age also perceive differences between the colors, shapes and sizes of objects. They begin to express their likes and dislikes. Between the 21^st and 24^th months, the child becomes a confident walker and a reliable runner. Children can also ride the tricycle. Toddler can say a sentence consisting of 2 to 4 words. [mme_highlight]

Each child develops at his/her own pace. During this period, children become increasingly aware of their capabilities. The toddler is still dependent on parental care and he/she believes that he/she is the center of the world. Nevertheless, children gradually begin to become more independent and improve their motor, cognitive, communicative and social skills every day.

Cognitive development

Children are now able to find the hidden object under several layers of blankets. Also, they like to hide the objects and then to ask parents to find them. They know to identify about 10 parts of body. Although they cannot name the colors, they definitely understand the difference between them. Toddlers at this age also perceive differences between the shapes and sizes of objects.

93% of children recognize the image in the mirror as their own body. In addition, they begin to express their likes and dislikes.

Motor development

Between the 21^st and 24^th months, the child becomes a confident walker and a reliable runner.

[mme_databox]

• 97 % of children between 21 and 24 months can run;
• 50% of children between 21 and 24 months can stand on one leg longer than 6 seconds (for instance, children can stand on one leg while the other is used to kick the ball) ;
• 90% of children between 21 and 24 months can stand on their tiptoes.

[/mme_databox]

Children can also ride the tricycle. During the previous months, he/she has mastered in climbing up the stairs and now the child overpowers climbing down the stairs.

A toddler of this age likes to play with a ball: she/he can throw the ball and catch it in a sitting position. Fine motor control is improved, so your child can grab small objects. You should expect your child to begin opening doors and closets, because she/he may now reach for door handle. In addition, children learn to undress themselves.

Children can walk backwards and they can pull the toy at the same time.

Regarding feeding at this age, researchers have found the data below:

[mme_databox]

• 80% of the children were self-feeding until the end of 24 months;
• 54% of children were using adult spoons by 24 months.

[/mme_databox]

Social / Emotional

He/she loves to play with older children and adults. On the other hand, toddlers still behave as they are the center of world, so they do not want to share toys with others and begin to show shyness in contact with strangers.  During this period, approximately 25 to 50% of children still suck their thumbs.

Now, child knows to show a wide variety of emotions (e.g. sympathy, joy, anger, modesty, guilt, fear etc.). According to a study from the University of Minnesota, 91 % of two year old children have temper tantrums once a week.

Language / communication

[mme_databox]
Average lexicon length by age

– 270  words by 22 months;

– 320 words by 23 months;

– 300 words by 24 months.

25 to 50% of speech is intelligible to unfamiliar adults. Children begin to use pronouns like “my” and “me”.

Toddler can say a sentence consisting of 2 to 4 words. The average age when child begins to say the sentence is 22.1 months and at the age of 24 months 60% of children have ability to combine the words.
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Representation of words in toddler’s vocabulary

[mme_databox]

• about 50% of words are nouns
• 50% of words are verbs or action words.

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What are the alarm signs parents should be aware of?

• If the child does not point to objects when parents ask to identify an object;
• If the child is silent during the play and there is no babbling;
• If the child does not respond when his/her parents ask a question;
• If the child does not use 2 word sentences (e.g. “no more”)
• If the child does not imitate the behavior of adults;
• If the child does not identify objects of daily routine (e.g. phone, hair brush etc.).

What are the risk factors that can impair development?

The child becomes more independent, which is directly related to the increased freedom to move. Therefore, you should protect the child from injury and keep the windows closed.

Make sure that the child does not play with toys that are not appropriate for the child’s age (e.g. too small toys). Parents should pay attention to what children put in the mouth, because choking is a common occurrence.

[mme_databox]
Choking in children

• 60% of choking incidents were food-related;
• 13% of choking incidents were caused by swallowing coins;
• 19% of choking incidents were caused by swallowing gum or candy.

[/mme_databox]

Keep away from children medicines, cleaning products and chemicals. All of these can cause fatal poisoning.

What should parents do to encourage the development of baby at this age?

Encourage your child to play with a ball. You can kick the ball and encourage him/her to kick the ball back. You can also take the child to the park and watch him/her climbing on the equipment.

You should support all children’s attempts to communicate with you. Ask your child questions such as “What is this?”, “How can I use this?” Give your child a bunch of small toys to play in order to practice fine motor skills. When child completes simple tasks you entrusted to him/her, you should reward him/her.

Summary and Recommendations

• Almost completing the second year of life, your child will continue showing developmental progresses every day. Knowing what to expect makes it easier for you to recognize the progresses and help the child to achieve them.
• Cognitive Development: The child identifies about 10 parts of the body, distinguishes different shapes, colors and sizes and expresses likes and dislikes.
• Motor Development: Most children at this period are confident walkers and reliable runners. They can stand on only one leg and they can ride a tricycle.
• Social/Emotional Development: Children like to play with older children but still do not like to share toys. They express emotions and sometimes have temper tantrums.
• Language Development: The lexicon incredibly enlarges and a good part of what a child says can be understood by an adult. They can build 4 words sentences.
• Each child has her/his own pace, but if you think your child is not developing adequately, seek for medical advice.

[mme_references]
References

• American Academy of Pediatrics. (1999) Steven P. Shelov, S.P. & Hannemann, R.E. (eds.)Caring for Baby and Young Child: Birth to Age 5. New York: Bantam.
• Rossetti, L.M. (2005) The Rossetti Infant-Toddler Language Scale: A Measure of Communication and Interaction. East Moline:  LinguiSystems, Inc.
• http://www.cdc.gov/ncbddd/actearly/milestones/milestones-2yr.html
• Bates et al. Individual differences and their implications for theories of language development. Chapter 4 for Paul Fletcher & Brian MacWhinney (Eds.), Handbook of Child Language. Oxford: Basil Blackwell, 1995.

[/mme_references]

Development milestones 18 to 21 months

[mme_highlight] Toddlers in this age group can identify about 6 parts of body. The child also begins to turn one page at a time.  Over 90% of children in this period can independently walk and 80 % of kids can run. [/mme_highlight]

In this period, children improve complex fine motor activities. The toddler continues the cognitive and social development, enjoys socializing with other children and begins to understand the importance of language for social interaction. Most children in this age group are ready to start toilet training.

Cognitive development

Toddlers in this age group can identify about 6 parts of body (e.g. child touches her/his nose when parents ask “Where is the nose?”). Also, they love to dance to the rhythm of music. Parents should expect the development of self-regulation (children begin to voluntarily control their behavior and attention). According to research, 33% of children between 18 to 20 months are able to voluntarily control their behavior.

In addition, children become aware of themselves (self-awareness). 68% of children recognize the image in the mirror as their own body.

Children love to imitate their parents (e.g. during the game, toddlers choose similar toys that parents take and use them the same way). 84% of children perform synchronic imitation and the duration of imitation lasts from 10 to 20 seconds in 18 months old children; the duration increases by 21 months old toddlers (26 to 39 seconds).

At this age, a toddler can identify objects that are used in the daily routine (spoon, phone, hairbrush etc.). The child also begins to turn one page at a time and knows to identify (e.g. pointing to picture when parents ask “Where is the dog?”):

• At least 2 pictures with animals;
• On average 4 pictures with animals.

Motor development

Over 90% of children in this period can independently walk and 80 % of kids can run. 98 % of children at the age of 18 months walk with heel strike. He/she begins to climb the stairs, but also to climb the furniture. The child is now also able to walk back a few steps, can climb up and down on chairs and perform other actions while walking (pushing or pulling a toy while walking).

At the age of 20 months, the child is able to squat without holding on, grab a toy, get up and keep on going, but she/he is still insecure in overcoming the obstacles and often falls down.

The toddler continues to improve coordination and to develop fine motor skills, so do not be surprised if your child begins to use a crayon and starts to scribble on a paper. In addition, children are able to independently drink from a cup and eat using a spoon. They love to play with blocks and they should know to build a tower with at least 4 blocks.

Social/Emotional skills

In this period child enjoys the company of adults, and especially loves to play with older children. The toddler can act aggressively (hitting or pulling hair) and this is normal because she/he wants to try out new patterns of behavior.

Children often imitate everyday situations and conversations through play. At the age of 18 months, 85% of children begin to pretend play (e.g. brush doll’s hair, use vacuum cleaner etc.).

Language/communication development

At the age of 18 months toddler has about 10 words in the vocabulary. At the age of 21 months, a child knows to say about 20 words. He/she understands two-steps commands (e.g. “go, get a toy!”) and begins to link two words in phrases, such as “no more”. About 30% of children have the ability of combining words.

[mme_databox]
Representation of words in toddler’s vocabulary

• 60 % of toddler’s first 50 words are nouns;
• Less than 20% of words are verbs or action words.

[mme_databox]

It was noticed that children whose parents read stories at 6 months of age have 40% increase in receptive vocabulary at the age of 18 months. On the other hand, toddlers whose parents did not use to read have only a 16 % increase in receptive vocabulary.

What are the alarm signs parents should be aware of?

• If the child does not walk independently until 21 months;
• If the child does not imitate adults;
• If the child cannot identify objects present in everyday use;
• If the toddler cannot say at least 6 words;
• If the child does not babble trying to imitate the adults’ conversation;
• If the child does not show interest in peers;
• If the toddler cannot understand simple instructions.

What are the risk factors that can impair development?

During this period, the child likes to climb all over the furniture. Therefore, you should pay attention and protect the child from falling. Tipping over the furniture is the cause for 12% of baby walker injuries. In addition, parents should install stair gates because falling down the stairs is the cause of 76% of baby walker injuries.

Parents should remove dangerous objects (knives, glassware etc.) and ensure that child cannot reach them when he/she climbs on a piece of furniture. Parents should also remove items that can easily fall hurting the child.

The child is curious and he/she likes to touch and see everything. So, you should keep her/him away from sources of fire and make sure that toddler has no access to hot irons or oven.

What should parents do to encourage the development of the baby at this age?

At this age, parents should talk to the child as much as possible (e.g. explain the function of the object) as this helps to enrich the child’s vocabulary. It is recommended to arrange puzzles with large pieces.

Parents should involve children in their daily routine and encourage them to imitate everyday situations (e.g. Give your child toys in the form of cooking set and encourage her/him to imitate adults). In addition, ask your child to identify the parts of body and familiar objects.

Parents should be supportive and patient during toilet training and should reward child for a well-done task.

Summary and Recommendations

• Between 18 and 21 months of age, your child will show developmental progresses every day. Knowing what to expect makes it easier for you to recognize the progresses and help the child to achieve them.
• Cognitive Development: The child identifies parts of the body, loves to dance and listen to new rhythms. Children develop a sense of self-awareness and can turn one page at a time while reading a book.
• Motor Development: Most children walk by 18 months, use crayons and build a tower of 4 blocks.
• Social/Emotional Development: Children love to play with older children.
• Language Development: By 18 months the lexicon is composed of 10 words and of 20 words by 21 months.
• Each child has her/his own pace, but if you think your child is not developing adequately, seek for medical advice.

[mme_references]
References

• http://library.med.utah.edu/pedineurologicexam/html/18month.html
• http://www.childrenshospital.org/az/Site873/mainpageS873P1.html
• http://www.cdc.gov/ncbddd/actearly/milestones/milestones-18mo.html
• American Academy of Pediatrics. (1999) Steven P. Shelov, S.P. & Hannemann, R.E. (eds.)Caring for Baby and Young Child: Birth to Age 5. New York: Bantam.
• http://www.biomedcentral.com/1471-2431/13/29/table/T6
• Hans Ulrich et al. Growth, developmental milestones and health problems in the first 2 years in very preterm infants compared with term infants: a population based study. Eur J Pediatr (2002) 161: 151–156
• Mark Nielsena, Cheryl Dissanayakeb. Pretend play, mirror self-recognition and imitation:a longitudinal investigation through the second year. Infant Behavior & Development 27 (2004) 342–365

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Development milestones 15 to 18 months

[mme_highlight] Your toddler can now hold the cup and drink from it without spilling the contents, as well as chewing the food well. . Now he/ she can also walk without support and carry objects while walking.       A 15-18 month old child can make choices. He/ she can choose what to wear, eat or play.  [mme_highlight]

The home of a “15 to 18 months old child” is easily recognizable. Moms have a hard time keeping things organized. Open shelves and toy boxes are always a mess. It is sometimes difficult for parents to understand what their child needs. Indeed, your child is now recognizing you and expressing his/her love through words. You may be surprised to see how your child can now play balls and balance that glass of milk. If you have these experiences to share, your child is on the right track as far as developmental cycle is concerned.

For the better understanding of the developmental milestones, we will divide the skill-set into four sections: motor, cognitive, social and language skills.

Motor skills

Now your child has become physically more independent. Your toddler can now hold the cup and drink from it without spilling the contents, as well as chewing the food well. Some data related to food intake manners are described below.

[mme_databox]

• 55 % of 15 months old children can drink from a cup;
• 90 % of 15 months old children can eat bread or biscuit without help;
• 64 % of 15 to 18 months old children can eat with a spoon.

[/mme_databox]

Your child can recognize the objects and get pick them if asked to. Now he/ she can also walk without support and carry objects while walking.

[mme_databox]

• 97 % of 15 months old children can stand alone;
• 95 % of 15 months old children can walk without support.

[/mme_databox]

Balancing is one skill they seem to have mastered in, so do not be surprised if you see your toddler building a wall with cubes. Children love balls and by now they can throw and pick them. You should be extra cautious as the toddlers can now open the closed doors.

Cognitive skills

A 15-18 month old child can make choices. He/ she can choose what to wear, eat or play. You can be surprised as to how much recognition capacity your child has developed. He /She can identify family members in the photographs and remember more things. They have developed a little insight about the life around them and understand the cause and effect relationship. So they know that when you turn off lights, it is dark. Do not be confused when your toddler does things over and over again. This is a skill that helps them to understand how something works polishing their problem-solving skill.

[mme_databox]
Children at this age love imitating their parents and siblings:

• 40 % of 15 months old children imitate parents’ activities and daily household routines.
• 75 % of 18 months old children imitate parents’ activities and daily household routines.

[/mme_databox]

Language skills

Reading to your child everyday is a very healthy practice. Frequent use of words helps them to build vocabulary. Toddlers at this stage understand and respond to your simple directions such as standing up or sitting down. Children are very expressive with words and they figure out how to express better. Though their lexicon contains only 10-20 words, those faces express what is in their hearts.

Social Skills

Socializing, like the other skills, is updated on a daily basis. Children at 15-18 months can understand “you” and “me”. They are now interested in strangers and play with other children, though claim things that are not theirs. So words like “me” and “mine” are an important part of their vocabulary.

What should parents do to encourage their children development at this age?

In order to improve using of fingers, parents could encourage children to play a toy like a piano. Also, parents should teach children to make choices through simple games and ask children to make choices, for instance, choosing a toy among others. In addition, include your child in household routines and teach him/her to recognize objects and understand their function.

Identifying of body parts is a useful and interesting game. Also, imitation of familiar people and situations can be beneficial for your child’s development.

Risk factors: can autism be identified at 18 months?

Autism has gained significance in recent times. Children with autism do not need sympathy but they need opportunity to flourish. Years of research have brought in a tool that can help to assess the risk of autism in children at a very early age.  A brief evidence based understanding is presented below.

In 2000, Baird et al screened 16,235 children aged 18 months for childhood autism (CA) and studied them for 6 years, with further screening at 3 and 5 years. They used Checklist for Autism in Toddlers (CHAT) for the screening and identification of autism in children. At 18 months, nineteen cases of CA were identified using CHAT.
Children with other developmental disorders such as language disorders were also identified. VanDenHeuvel et al (2007) came to a conclusion that the use of CHAT can be a valuable tool to assess autism at an early stage in the life of the child.

Summary and Recommendations

• Between 15 to 18 months, your child will show developmental progresses every day. Knowing what to expect makes it easier for you to recognize the progresses and help the child to achieve them.
• Cognitive Development: your child begins making choices: between toys, food, clothes… Imitating behavior is frequent and should be encouraged at this stage.
• Motor Development: child are able to drink from a cup, chews food well and is capable of using a spoon. Children become able of independently walking and even walking while carrying objects.
• Social/Emotional Development: Your child plays with others, but frequently claims things that do not belong to her/him.
• Language Development: the lexicon comprises about 10 to 20 words, but the child also expresses a lot with her/his face.
• Each child has her/his own pace, but if you think your child is not developing adequately, seek for medical advice.

[mme_references]
References

• Baird G, Charman T, Baron-Cohen S, Cox A, Swettenham J, Wheelwright S, et al. A screening instrument for autism at 18 months of age: a 6-year follow-up study. J Am Acad Child Adolesc Psychiatry.2000 Jun;39(6):694-702.
• VanDenHeuvel A,Fitzgerald M,Greiner B, Perry IJ. Screening for autistic spectrum disorder at the 18-month developmental assessment: a population-based study. Ir Med J. 2007 Sep;100(8):565-7.

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What should a baby be able to do between 12 and 15 months?

[mme_highlight] At this time your child can begin to walk. By the end of 15 months, toddlers know on average 3 words besides “mama” and “dada.”Children at this age like to draw attention to himself/herself and use various behaviors to achieve this. Kids also love to imitate their parents and perform pretend play. [mme_highlight]

During this period dramatic changes occur in the development of your child. Many parents are excited and can`t wait to see what will happen the next day, because the child begins to independently walk and says the first word. In addition, children enjoy imitating their parents and they develop new fine motor skills, so they can now use a spoon to eat.
However, the child is still dependent on his/her parents and he/she needs full care and attention. Therefore, parents should not leave the child alone with strangers, because in this period stranger anxiety is emphasized.

Cognitive development

Children enjoy their reflection in the mirror. By the end of 15 months, 28% of children can recognize the image in the mirror as himself/ herself. Kids also love to imitate their parents and perform pretend play:

[mme_databox]

• 18 % of children exhibit pretend play by the end of 12 months;
• 40 % of children exhibit pretend play by the end of 15 months;
• 40% of children perform a synchronic imitation (imitation while watching their parents).

[/mme_databox]

Motor development

At this time your child can begin to walk.

[mme_databox]

• 97 % of children can walk with assistance at the age of 12.4 months;
• 90 % of children can stand alone with 13.4 months;
• 75 % of children can walk independently with 13.4 months.

[/mme_databox]

Changes regarding manners of food intake are also noticeable:

[mme_databox]

• 90% of children can remove food from spoon with lips between 12 to 14 months of age;
• 29 % of children can independently eat using the spoon between 12 to 14 months of age;
• 14 % of children can drink from regular cup without help;
• 90 % of children can eat bread or biscuit by the end of 15 months.

[/mme_databox]

Toddlers can squat and stand and squat again without assistance. Also, children can crawl up and down the stairs. Many of children can give “high five”.

Regarding fine motor skills, the child also uses one hand to hold the object and the other hand to manipulate it. Also, a child uses his/ her index finger to point.

Social/ Emotional development

The child still does not show interest in play with his/ her peers. If two or more children play together, they will perform parallel play. In this period, children still consider that they are the center of the world and treat other children like toys/ objects. The child is still afraid of the presence of strangers.

In addition, children at this age like to draw attention to himself/herself and use various behaviors to achieve this. They can begin to scream or laugh and then frequently use certain type of behavior which is the most effective in order to accomplish his/ her desires. This behavior is the part of socialization process.

Language development

Children understand the simple (one-step) commands and execute them without gestures. By the end of 15 months, toddlers know on average 3 words besides “mama” and “dada.” Now, children babble and combine vocals to invent new words. Children of this age are nodding their heads in order to say “no.”

What are the risk factors that can impair development?

As children in this period begin to say the first words, we should pay attention to the way in which they communicate, because parents detect some early signs of autism. If a child does not say any word at all or if he/ she cannot establish eye contact these can be early signs of autism, and therefore you should contact a pediatrician.

As children now begin to move independently, parents should pay attention if their child uses predominantly one side of the body over the other or if one side of body is too limp/ rigid. This may indicate a potential problem, so parents should contact a doctor.

What are the alarm signs parents should be aware of?

• The child does not say a word;
• The child does not know the function of objects such as a spoon, phone, hairbrush;
• The child does not walk (with or without assistance) by the end of 15 months;
• The child loses skills which had already been achieved.

What should parents do to encourage the development of toddlers at this age?

Parents must encourage children to talk, so they can play a kind of “repeat after me” game. Also, while parents are doing daily routines, they should explain what they are doing. This simple procedure also improves your child’s cognitive development.

A child of this age loves to use things that adults use every day. However, this can lead to injury sometimes. Therefore, children should be provided with copies of that objects that are safe (e.g. plastic toy keys instead of real keys).

Although children of this age do not play together, you can encourage your child to establish social contacts. So, you can provide toys that are designed to be shared with other children. In addition, children should be placed in many different situations in order to learn how to behave.

Summary and Recommendations

• Between 12 and 15 months, your child will show developmental progresses every day. Knowing what to expect makes it easier for you to recognize the progresses and help the child to achieve them.
• Cognitive Development: Children imitate parents and perform pretend play.
• Motor Development: most children can stand alone and the majority can walk by 15 months. Fine motor skills and eating skills are also improved: children can eat with a spoon, eat biscuits and some can drink from a regular cup.
• Social/Emotional Development: Children show a self-centered playing and behavior, using different strategies to be the centre of all attentions.
• Language Development: Children can understand one step commands and have a lexicon with 3 words other than “mama” and “dada”.
• Your child moves more and more, so parents must ensure safety of the environment where the baby stays, preventing falls, shocking, poisoning and drowning.
• Each child has her/his own pace, but if you think your child is not developing adequately, seek for medical advice.

[mme_references]
References

• http://www.parentingweekly.com/baby/baby_information/toddler_dev_12_15_mos.htm
• http://www.webmd.com/parenting/baby/milestones-12-15-months
• http://www.milestones4kids.com/pdf/dev_milestones/M4Kids%2012m-15m.pdf
• http://firstyears.org/miles/chart.htm

[/mme_references]

Development milestones 10 to 12 months

[mme_highlight] During this period, the baby becomes aware that the objects, even if hidden, continue existing.  Children say their first word between 10 and 11 months on average. The child can stand with support and starts trying to stand alone, shows a pincer grasp skill to hold objects, can hold a spoon and crawls.  [mme_highlight]

Between 10 and 12 months, babies continue with a rapid development- they become more and more physically active, spend a lot of time in an upright position and continue to improve their communication skills. They show interest in more complex games and love to read books with parents.

Cognitive development

During this period, the baby becomes aware that the objects, even if hidden, continue existing (e.g. if you show her/him a toy and then hide it, it is probably that the baby manages to find the toy). In the same way, if you leave the room, the baby will realize that you still exist. He/she understands how to use objects which parents use every day. During this period, babies imitate their parents (e.g. love to use the phone or hairbrush).

Motor development

The baby develops more subtle motor skills.  Your baby will adapt the body when you dress him/her (e.g. she/he stretches arms when parents put on a sweater). By 10 months, all babies should be able to sit alone, while some children are also able to stand with the assistance of adults. Data from the World Health Organization is shown below.

[mme_databox]

• 95% of children at the age of 10 months can stand with support of adult
• 99% of children have this skill at the age of 11.4 months

[/mme_databox]

During this period, baby becomes skilled at catching small items by using pincer grasp with fingers. In addition, baby uses its finger to point to the object that interests him/her. During this period, the child is improving motor activities such as holding a cup or a spoon (with a little help she/he is able to drink from a cup). Also, the baby improves “hand-eye” coordination.
Babies are very skilled in the crawling in this period. Some children in this period can also stand alone for a few seconds. The baby is more often on the legs, but she/he is still unsure and needs support to begin the first steps.

[mme_databox]

• 90% of children at the age of 10.5 months can crawl;
• 97% crawl at 12 months;
• 50% of children begin crawling at age 10.8 months;
• 75% of children can stand alone at the age of 12 months;
• 10% of children begin to walk independently at the age of 10 months;
• 25% of children can walk at the age of 11 months;
• 50% of children can walk at the age of 12 months.

[7mme_databox]

Social/Emotional

Your 10 month old baby loves to play, but she/he is still focused on her/himself, so do not expect her/him to play with peers. She/ he loves to play peek-a-boo and pat-a-cake. Also, stormy emotional reactions are usual during this period. Babies have tantrums and express their dissatisfaction sometimes in a violent way; it was found that up to 20 % of babies bang their head and boys do that three times more than girls.

Language/communication

Babbling increasingly begins to resemble a speech of adults. When babies babble they mimic intonation of adults. During this period, the baby recognizes her/his own name and the names of close relatives and he/ she also understands the meaning of the words “no” and “wave bye-bye”. In addition, some children point out using the finger when parents name certain objects.
Parents can expect their child to say the first real words such as “mama”, “dada” etc. He/she understands between 20 and 50 terms on average. Also, baby is able to understand and execute simple actions such as “come to mama” or “do not”.

According to The YouGov research, children say their first word between 10 and 11 months on average. On the other hand, 4% of children had not said their first word by 3rd year of life.

[mme_databox]
Age of first word

• 34% of girls said their first word before 9th months of age
• 27% of boys said their first word before 9th months of age

Most common first word

• “dadda” (15%) or “daddy” (13%)
• “mama” (10%)

[/mme_databox]

What are the alarm signs parents should be aware of?

• The baby doesn’t show desire to move, crawl or stand;
• The baby is not interested in communication, does not respond to commands of parents or does not make eye contact;
• The baby cannot sit at the age of 10 months;
• The baby does not babble in a “conversation” with others;
• Babbling doesn’t become more complex;
• The baby does not show interest in new facilities.

What are the risk factors that can impair development?

During this period, the baby begins to move more, crawl or walk by holding to the furniture. Therefore, parents must ensure the safety of the environment and of the baby- keep her/him away from stairs and other places where falls can occur, remove small items that can cause shocking and items that can lead to poisoning. Never leave your baby alone.

What should parents do to encourage the development of baby at this age?

The baby at this age loves to explore. Encourage your baby to move- set a toy on the floor and encourage your baby to crawl to reach the toy. At this age, babies understand both verbal and non-verbal communication, so when you say the word “NO”, you must be serious, and never laugh at this point, because the baby will be confused. Talk to your baby and read stories as much as you can, because this will help building vocabulary. Play “hiding” games.

During this period, the baby recognizes the images and characters from the books and can even understand the plot of a simple story, so it is useful to spend some time with your child and read to him/her. It is useful to give your child a bunch of different toys and encourage him/her to play with them, as this contributes to the development of fine motor skills and improves “hand-eye” coordination.

It is interesting to observe your baby while she/he plays with the telephone. It is useful to talk to the baby using sentences like “Who are you calling?” or “Hello…” and thus encouraging the baby to continue the conversation. When the baby has humor tantrums, parents must remain calm and try to soothe the baby too.

Summary and Recommendations

• Almost completing the first year of life, your child will show developmental progresses every day. Knowing what to expect makes it easier for you to recognize the progresses and help the child to achieve them.
• Cognitive Development: The child looks for a hidden object and tries to imitate adults.
• Motor Development: The child can stand with support and starts trying to stand alone, shows a pincer grasp skill to hold objects, can hold a spoon and crawls.
• Social/Emotional Development: Humor tantrums are frequent; however, your baby loves playing play peek-a-boo and pat-a-cake and also listening to stories.
• Language Development: Babbling resembles adult speech. Your child understands many words, including the meaning of “no”. Be serious when you say it. Your baby first words can be pronounced by 10 to 12 months.
• Your child moves more and more, so parents must ensure safety of the environment where the baby stays, preventing falls, shocking, poisoning and drowning.
• Each child has her/his own pace, but if you think your child is not developing adequately, seek for medical advice.

[mme_references]
References:

• Child development: Infants (0-1 year old). Centers for Disease Control and Prevention. http://www.cdc.gov/ncbddd/child/documents/0-1YearOldsPositiveParenting.pdf. Accessed March 1, 2011.
• Shelov SP, et al. Caring for Your Baby and Young Child: Birth to Age 5. 5th ed. New York, N.Y.: Bantam Books; 2009:249.
• WHO Multicentre Growth Reference Study Group. WHO Motor Development Study: Windows of achievement for six gross motor development milestones. Acta Paediatrica Supplement 2006;450:86-95.

[/mme_references]

Development milestones 8 to 10 months

[mme_highlight] By the end of the 10^th month, the baby has developed depth perception. The baby tries to put everything to mouth. Your baby should be able to crawl and stand with support. During this period, the baby develops stranger anxiety. An 8 to 10 month old baby typically babbles and speaks one or two words.   [/mme_highlight]

Developmental milestones are not absolute, but they nevertheless give an idea about the pace of growth and development of children. June M. Reinisch (1) conducted a study with 4653 infants to study the factors that may influence the developmental milestones and identified that development is faster in male infants as compared to female infants.
He also found that 3 out of 10 primary milestones are achieved earlier in male children as compared to female babies. He suggested that sex differences, physical and social and environmental factors greatly influence the age at which developmental milestones are achieved.

Cognitive development

By the end of the 10^th month, the baby has developed depth perception.

Hand- mouth coordination is established, and therefore the baby tries to put everything in his/her mouth and also may try to feed himself with hands.  In addition, baby uses one or more fingers to point objects around him/her.

Motor skills

By the end of this period, your baby should be able to crawl by using his/ her hands on the ground while knees support the weight of trunk. Crawling is initiated mostly in the backward direction but progressively baby learns to move forward while crawling. The baby is also able to stand with support and can hold objects with his/her index finger and thumb.
Now, a baby can sit without support and spends fair amount of time in a sitting position. According to a research report presented by Joyce S. Salls (2):

[mme_databox]

• 50% of babies can sit without support at the age of 5.9 months ;
• 99 % can sit without support at the age of 10 months (unless they have a serious developmental condition).

[/mme_databox]

Regarding eating habits:

[mme_databox]

• 11 % of children can use spoon without spilling too much;
• 10 % of children can drink from a cup;
• 70 % of 9 months old children can eat bread or biscuit.

[/mme_databox]

Social/Emotional skills

During this period, the baby develops stranger anxiety, which means your baby may not feel comfortable in the presence of unknown faces and she/ he may cry or get agitated if he/she is separated from his/ her parents. Between 8 and 10 months, a child responds or reacts to simple vocal commands and may have his/ her favorite toys.

Baby is interactive and shows interest in playing games like pat-a- cake and peek- a- boo. In addition, baby can play by himself by banging toys together to make noise. A baby also learns to wave bye-bye.

Language/communication skills:

An 8 to 10 month old baby typically babbles and speaks one or two words like “bababababe” or “mamamama”. Baby also tries to copy or imitate others by making different noises.

Parents should expect that their baby understands the meaning and context of “no” and may respond to his/ her name.

What are the alarm signs parents should be aware of?

By the end of 10th month, the intensity of weight gain and height slows down, suggesting the baby is maturing. Your baby’s bowel and eating habits also become regular. Make sure to seek the pediatrician if your baby presents with one or more of the following issues:

• If your baby does not put on weight;
• If your baby cannot stand with support;
• If your baby cannot sit properly (even with support);
• If your child does not say anything;
• If he/ she does not play any interactive games;
• If your child does not show any activity or response to name;
• If your baby does not seem to recognize familiar people.

What are the risk factors that can impair development?

• If the baby does not turn or look up when his/ her name is called;
• If the baby does not respond to the word “no”;
• If the baby does not listen when spoken to;
• If the baby does not know common words like “cup”, “shoe”, “mom”.

What can parents do to stimulate development?

Parents should make the physical environment around the baby as stimulating as possible. You can give him/her colored story books and take him/ her to different places to enhance his/ her memory. Parents should also try to enrich his/ her vocabulary by naming different objects.

Besides, parents can provide to child large toys that he/ she can drag or push in order to learn standing with support or walking.

Finally, parents must keep up with regular pediatric visits and take care of the immunizations of the baby. Healthcare providers suggest regular screening of infants at 6, 9 and 12 months of age. According to the reports of CDC, 1 out of 6 children has developmental disabilities.
According to CDC, a rise of 17.1% has been observed in the prevalence of developmental disabilities over the course of past 12 years; the overall prevalence of developmental disabilities being 13.8%.

Summary and Recommendations

• Between 8 and 10 months, your child will show developmental progresses every day. Knowing what to expect makes it easier for you to recognize the progresses and help the child to achieve them.
• Cognitive Development: Babies develop depth perception. Putting everything to mouth is normal and indicates eye-hand coordination has developed.
• Motor Development: Sitting without support, crawling and standing with support are major features of this period. The baby uses spoon and holds objects between index finger and thumb.
• Social/Emotional Development: Your baby loves to play pat-a-cake and peek-a-boo. Stranger anxiety is very common.
• Language Development: Babies babble and imitate sounds. They may say 1 or 2 words.
• Your child moves more and more, so parents must ensure safety of the environment where the baby stays, preventing falls, shocking, poisoning and drowning.
• Each child has her/his own pace, but if you think your child is not developing adequately, seek for medical advice.

Development milestones 6 to 8 months

[mme_highlight] By his/her 6^th month, your child can transfer objects from one hand to another and pick up the dropped objects. He/ She can almost stand with a little support from you. He/she can now recognize name and responds with a smile, eye contact or head turn. [mme_highlight]

In the short span of two months, between the ages of 6 to 8 months, a child achieves many important developmental milestones that parents should recognize to give support and a positive reinforcement and hence help their children development.

Motor development

By his/her 6^th month, your child can transfer objects from one hand to another and pick up the dropped objects. He/ She can almost stand with a little support from you. A sense of independence of child at this stage is obvious as he/ she can sit on a high chair. Good news at this stage is that your baby can sleep 6-8 hours at a stretch at night, so you can also expect a good night sleep after months of less or almost no-sleep. Some of the features of gross motor skills in this age group are shown below.

[mme_databox]

• 90 % of babies can sit without support at the age of 7.5 months;
• 50 % of babies can stand with assistance at the age of 7.4 months;
• 28 % of babies can crawl at the age of 7.4 months;
• 10 % of babies can walk with assistance at the age of 7.4 months;
•  3 % of babies can stand alone at the age of 7.7 months.

[/mme_databox]

During this period your baby will also acquire some new eating skills.

[mme_databox]

• 96 % of babies between 7 and 8 months of age can grasp food with hands;
• 42 % of babies between 7 and 8 months of age can drink from sippy cup;
• 5 % of babies betweenf 7 and 8 months of age can feed herself/himself with a spoon.

[/mme_databox]

Teething begins around 6^th month, so you can expect increased drooling. By 6^th month, you can also expect that the weight of your baby has doubled his birth weight.

Cognitive development

The most recognizable cognitive skill of this stage is anxiety before strangers. Your child can recognize you, often babbles one- syllable words (example: da-da, ba-ba) and imitates your actions. However they begin to fear strangers. Hence even going to the pediatrician for a check-up can be a hard task as the child will have stranger anxiety and may not cooperate.

Language development

Children at this stage play with sounds. They enjoy listening to their own voice and can locate the sounds. The vision at this stage is between 20/60 and 20/40. He/she can now recognize name and responds with a smile, eye contact or head turn. This stage is definitely very important as communication skills of your child will strengthen your bond.

What should parents do to encourage the development of their babies at this age?

Reading to your child since an early age helps him/her to build vocabulary. Read, sing and speak to your child as much as you can. Try imitating words such as “ma-ma, da-da”. This helps them to learn language and communicate. You can also start naming objects around the room. Children at this stage respond to voices, so get toys that have sounds and are brightly colored (avoid buying toys with small parts that can lead to choking hazard).
Play games like peek-a-boo, as it develops physical, social and language skills of the child. Your child is imaginative, hence provide him/her with paper and see how they tear them off. Though at one go, you may feel the act to be destructive, it actually is enhancing his/her physical and cognitive skill. Always remember to speak clearly with your child.

When buying toys, never select toys with small parts. They can accidently choke the epiglottis. Your 6 month-old child uses furniture to stand, hence avoid tables with edges that can harm your child. Furniture must be safe and steady.

What are the alarm signs I should be worried about?

• Baby cannot pick up small items using thumb and first finger;
• Baby cannot pass an object from one hand to the other;
• Baby cannot release objects voluntarily;
• Baby cannot sit on floor without support;
• Baby cannot move forward on tummy or rolls continuously to get an item.

What are the risk factors that can impair development?

In this period, children start eating solid foods, so parents should register the occurrence of allergies. Also, parents must gradually include solid food and especially foods which are rich in iron in order to prevent the development of anemia.

Summary and Recommendations

• Between 6 and 8 months of age, your child will show developmental progresses at a fast pace. Knowing what to expect makes it easier for you to recognize the progresses and help the child to achieve them.
• Cognitive Development:
• Motor Development: Your child transfers objects between hands and is capable of picking up dropped objects. Between 6 and 8 months children may stand with support. At this stage, new eating skills are acquired: children can use finger grasp to hold food, drink from a sippy cup or hold a spoon.
• Social/Emotional Development: fear of strangers is a typical feature of this age.
• Language Development: children recognize their name and localize sounds.
• Each child has her/his own pace, but if you think your child is not developing adequately, seek for medical advice.

[mme_references]
References:

• Feigelman S. The first year. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 8.
• Gill SV, May-Benson TA, Teasdale A, Munsell EG. Birth and developmental correlates of birth weight in a sample of children with potential sensory processing disorder.BMC Pediatr. 2013 Feb 25;13:29

[/mme_references]

What should a baby be able to do between 4 and 6 months?

[mme_highlight] The majority of infants aged 4 to 6 months can lift and support their heads without help. Most infants can recognize their own name at this stage and understand the permanence of objects. The infants in this group can babble repeatedly. [mme_highlight]

Though children develop at different rates, each child’s development follows the same basic pattern. Development moves from simple to complex. Once a skill is mastered, the child moves on to the next skill eventually integrating all the different skills and using them spontaneously and appropriately.

In this age group, the baby is now more alert and and continues to grow and develop at its own unique pace. Development between 4 to 6 months includes overall development of motor, cognitive and social skills. Between 4 and 6 months, babies can lift their head up 90 degrees, laugh out loud, follow an object in an arc about 6 inches above the face for 180 degrees from one side to the other, roll over, pay attention to a raisin or other very small object, squeal in delight, reach for an object, smile spontaneously, keep head level with body when pulled to sitting and say goo-goo or similar vowel consonant combinations.

In the age group of 4 to 6 months, the baby is likely to develop motor skills, improve hand eye co-ordination, clearer vision, and develop social skills by babbling, squealing, gurgling and laughing.

Cognitive development

Most infants can recognize their own name at this stage. They also understand the permanence of objects and pay attention to a very small object such as a raisin and stay awake for 1 & ½ to 2 hours at a and may sleep through the night.

Motor development

It has been found that an infant’s ability to stabilize the head and balance the trunk is a prerequisite to sitting without support and using hand and arm movements in self feeding process. The majority of infants aged 4 to 6 months were reported to lift and support their heads without help. About 68% of children were studied to be able to grasp food with their hands.

Some of the features of gross motor skills in this age group are:

[mme_databox]

• 98 % of babies can lift and support head;
• 78 % of babies can roll over on purpose;
• 65 % of babies can roll from front to back;
• 62 % of babies can roll from back to front;
• 50 % of babies can roll from back to front and front to back;
• 33 % of babies can sit alone without support;
• 10 % of babies can crawl when left lying on the stomach.

[/mme_databox]

Social and emotional development

The majority of infants between 4 to 6 months can turn towards a voice, react to and even imitate the intonation in other’s voices, particularly the voice of the mother. They may make wet razzing sound, shows signs of personality development, cries when family or caregiver leaves and demands attention.

Language development

The infants in this group can babble repeatedly when excited and can even say ah-goo or other vowel consonant sound.

What are the alarm signs parents should be aware of?

• If the baby’s muscles seem very stiff;
• If the baby’s muscles seem very floppy;
• If the head is controlled when body is pulled to a sitting position;
• If the baby reaches with one hand only;
• If the baby refuses to cuddle;
• If the baby does not seem to enjoy people around;
• If the baby shows no affection for the mother or care giver;
• If one or both eyes appear to be consistently turned in or out;
• If the baby does not respond to sounds;
• If the baby does not smile spontaneously by the end of 5 months;
• If the baby cannot sit with help at the end of 6 months;
• If the baby does not make squealing sounds or laugh by the end of 6 months;
• If the baby does not actively reach for objects by 6 months.

What should parents do to encourage the development of babies at this age?

Parents should provide opportunity to the baby for learning large motor skills, therefore baby’s position should be frequently changed and parents should force baby to stand or to sit in a frog position, fly through the air and lift up on all fours.

Blocks, soft dolls and stuffed animals, real or toy household objects, balls and finger games help in the development of the dexterity of baby’s little fingers and hands.

Parents should speak more slowly, more clearly with their baby, focus on single words and emphasize imitation. Sing songs to your baby and use books to read to him/ her.

Caregivers should encourage socialization; therefore, children must be exposed to a variety of people of different ages and be taught simple greetings and other basic social graces.

Play games that stimulate intellect, continue sharpening the auditory perception of the baby, encouraging imitation and ultimately encouraging language development. Introduce concepts such as “soft teddy”, “car goes fast”, “tea is hot” and so on. Encourage curiosity and creativity from this age. Give the baby a chance to experiment and explore. Encourage a love for learning.

You should provide quiet time to your baby – cuddling, kissing and embracing him/her gives him/her love and a sense of security.

Summary and Recommendations

• Between 4 and 6 months, your child will show developmental progresses every day. Knowing what to expect makes it easier for you to recognize the progresses and help the child to achieve them.
• Cognitive Development: Babies can recognize their own name and acquire the notion of object permanence.
• Motor Development: Babies can support their head without help, roll over and some can sit with support and grasp food with hands.
• Social/Emotional Development: The baby turns head to voice and shows initial personality development; cry is frequent whenever a loved one leaves.
• Language Development: Babbling and vowel sounds are the main features of this period.
• Your child moves more and more, so parents must ensure safety of the environment where the baby stays, preventing falls, shocking, poisoning and drowning.
• Each child has her/his own pace, but if you think your child is not developing adequately, seek for medical advice.

[mme_references]
References

• Academy, N. C. (n.d.). Child Developmental Milestones. Northern California.<7li> Milestones: 1 to 6 months. Retrieved from Babycenter: http://www.babycenter.com/0_milestones-1-to-6-months_1496585.bc
• Carruth, B. R., Ziegler, P. J., Gordon, A., & Hendricks, K. (2004). Developmental Milestones and Self-Feeding Behaviors in Infants and Toddlers. Journal of American Dietic Association, S51-S56.
• Eisenberg, A., Murkoff, H. E., & Hathaway, S. E. (1996). What To Expect The First Year. NewYork: Workman Publishing.
• Mayo, S. C. (2011, JUne 17). Infant and toddler health. Retrieved from Mayo Clinic: http://www.mayoclinic.com/health/infant-development/FL00099

[/mme_references]

Development milestones 2 to 4 months

[mme_highlight] At this age, your baby puts toys and almost everything in the mouth, which indicates the presence of “hand-mouth” coordination. At two months, the baby begins to fixate objects and tracks moving objects with eyes. When the baby is positioned on tummy, she/he can lift the head and chest for 90 degrees while supporting on elbows.  [mme_highlight]

Between the second and fourth months of life, a baby continues the rapid development of both motor and cognitive function and also at emotional and social levels. The baby begins to discover its senses during this period.

Motor control over the arms is faster developed than the motor control over the legs, because the development of the nervous system occurs in this specific way – firstly, motor control is established over the muscles of the head and neck, then it follows motor development of arms and back and finally the legs.
Also, control of muscle is established from center to the periphery (e.g. firstly, motor control over the shoulder muscles, then upper arm muscle, then lower arm muscles and finally the muscles of baby’s hand).

Cognitive Development

During this period infants discover their own hands.

[mme_databox]

• 37 % of babies become aware of their own hands between 8th to 10th week of life;
• 97 % of babies discover their own hands until the end of fourth months.

[/mme_databox]

At this stage, the baby starts to babble and use a variety of ways to show when he/she is hungry, thirsty or unsatisfied. Baby can mimic the facial expressions of the people they are looking at. Also, babies can recognize the voice of mother and can find ways of claiming for her attention.

Motor Development

At two months, the baby begins to fixate objects and tracks moving objects with eyes. When a baby is positioned on the back, he/she tracks with eyes a colorful toy, as well as the face of the person who moves it. The hands are more frequently open.

During the third month, the baby manages to partially lift the chest from the base relying on the forearm. The legs are now almost fully extended and knees are slightly bent toward the tummy. When baby is positioned on the back, she/ he turns head from side to side, cheerfully react when she/he sees a toy with vivid colors and extends hand in order to reach it. Three months old baby can keep up the head almost for a full minute.

At the age of three months, when the baby is lying on the stomach, she/he can detect the object that is in front of him/her and tries to grab it. Some babies are able to sit with using arms as a support.

[mme_databox]
Sitting with support

• 50 % of babies between 2.5 to 3 months of age;
• 90% of babies at 4.5 months
• <1 % of babies are able to sit without support by the age of 4 months.

[/mme_databox]

During the fourth month, when the baby is positioned on tummy, she/he can lift the head and chest for 90 degrees while supporting on elbows. While positioned on the back, baby tracks the objects in front of him/her and tries to reach them (do not be afraid if it fails, because hand-eye coordination is not yet completely established). At this age, your baby puts toys and almost everything in the mouth, which indicates the presence of “hand-mouth” coordination.

From the age of 4 months, “eye-hand” coordination is established – baby can see the toy, try to reach and grab it. Some babies can roll over.

[mme_databox]
Rolling over

• 50% of babies by 3 months can roll from stomach to back without rotation (the movement begins from the head)
• 10 % of babies are able to roll from back to stomach with rotation (more complex movement compared to rolling over without rotation).

[[mme_databox]

Social/Emotional Development

A baby begins to notice members of family that she/he sees every day. About 90 % of babies laugh by 3 months. Also, when parent tickles baby, loud laughter can be expected. At the age of 4 months, the baby begins to give spontaneous smile to loved ones. It loves to play with people and can start crying if the game stops.

Language/communication

At the age of two months, a baby starts to “communicate” with sounds such as “a”, “u” and “e”. Regarding the development of “sound signals”, at this age baby begins to produce “rrr” voices. At the age of four months, the baby begins to produce sounds.

What are the risk factors that can impair development?

During this period, parents should not give baby small objects. Baby pushes everything in the mouth (“hand-mouth” coordination is developed) and it can cause choking. The baby should be lying on a hard surface, for example on soft pillow. There is a risk of suffocation when the head is buried in a pillow, because the baby cannot to turn her/himself. Note that among children younger than 1 year whose cause of death was unintentional injuries, 81.5% died from suffocation.

Do not leave your baby alone or unattended, especially in places where she/he can fall when she/he is rolling over the bed. Do not ignore your baby’s cries, because it can lead to fear of separation. If you notice that your baby is too rigid, you should contact a pediatrician because it could indicate a developmental anomaly.

What are the alarm signs I should be worried about?

• The baby does not seem to be aware of hands by 2 months;
• The baby does not react to loud noises ;
• The baby does not fixate objects or does not track moving objects with eyes by 2 to 3 months;
• The baby can’t support the head;
• The baby doesn’t smile;
• The baby doesn’t notice new face or act upset when notices new face;
• The baby doesn’t grasp objects by 3 to 4 months;
• The baby doesn’t babble by 3 to 4 months;
• The baby doesn’t try to put objects in mouth by 4 months;
• The baby doesn’t try to imitate parents’ sounds by 4 months;
• The baby does not push down the leg when she/he feels stable surface under the feet by 4 months;
• The baby loses skills he/she had already acquired.

What should parents do to encourage the development of baby at this age?

The baby needs a soothing calm environment. Quiet music or gentle mother’s voice can contribute to the adequate development of a baby. While your baby is awake, you should put her/him lying down on her/his stomach, because this encourages the strengthening of back muscles.
Parents should encourage their baby to look at the toys, to track moving toys with eyes and try to catch it- all of these can be implemented through simple games when the baby is in the mood.

You should spend a lot of time with your baby out in the nature, because this is of major importance for your child to discover the world. Parents should talk and sing to the baby. While your child is on her/his stomach trying to reach a toy or other object, parents should provide stability, for instance, by putting their hand over the baby’s pelvis and press it lightly to the ground.

Also, parents should give a child an interesting toy with vivid colors and toys that make sounds. The rolling skill can be encouraged with this simple game: place a toy next to the right or left side of baby; the baby usually rolls from tummy to back or vice versa.
If your baby looks interested in this game, repeat this over and over again. In addition, parents can help improve the “eye-hand” and “hand- mouth” coordination through simple games.

Summary and Recommendations

• Between 2 and 4 months, your baby will show developmental progresses every day. Knowing what to expect makes it easier for you to recognize the progresses and help the child to achieve them.
• Cognitive Development: the baby recognizes voices, claims for attention
• Motor Development: your baby can now fixate objects and follow a moving object with her/his eyes. Eye-mouth and eye-hand coordination begin to be noticeable at this stage. Chest lift and holding head for at least a minute are also prominent achievements for the period between 2 and 4 months. Your child will also show rolling over skills.
• Social/Emotional Development: Your baby recognizes familiar faces and laughs at them.
• Language Development: You will hear sounds such as “a”, “u” and “e” from your baby.
• Each child has her/his own pace, but if you think your child is not developing adequately or if alarm signs are noticed, parents should contact a pediatrician as soon as possible.

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References

• Important Milestones: Your Baby at Four Months. Centers for Disease Control and Prevention. http://www.cdc.gov/ncbddd/actearly/milestones/milestones-4mo.html. Accessed May 13, 2013
• Important Milestones: Your Baby at Two Months. Centers for Disease Control and Prevention. http://www.cdc.gov/ncbddd/actearly/milestones/milestones-2mo.html. Accessed May 13, 2013
• Feigelman S. The first year. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds.Nelson Textbook of Pediatrics. 18th Ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 8
• Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web‐based Injury Statistics Query and Reporting System(WISQARS). National Center for Injury Prevention and Control Website. Unintentional fatal and nonfatal injuries, children ages 19 and under. Available from: http://www.cdc.gov/injury/wisqars/index.html. Accessed May 15, 2013.

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