Parents, caretakers, physicians, and early childhood educators are expected to monitor child development and identify children with suspected disabilities so they can access and benefit from services.  To understand atypical development, caretakers first must understand typical development.  Developmental milestones are guidelines that enable parents and professionals to monitor a child’s skills according to other children of the same age.  Healthy development describes the physical, mental, and social development of a child who is achieving skills according to the expected timeframe.  Every child is unique and develops at his/her own pace, however most children develop new skills in a predictable order.  When one skill is developed, it allows for a more difficult skill to be learned.

The following developmental domains map out the major typical skills and some possible warning signs.  Please note that this list is not all inclusive.

Communication:

• Infants are able to distinguish between happy and angry voices within weeks of birth.
• At 1 year of age a child should be using 3 to 10 words consistently.
• At 2 years of age a child should be able to utilize two to three word phrases and be able to engage in two-way communication with a caregiver.
•  At 3 years of age a child should be able to speak in complete sentences.
• At 5 years of age a child should be more complex and abstract including the ability to understand quantity concepts, label smaller body parts, form grammatically correct questions and describe similarities.

Communication RED FLAGS

• Not talking at 18 months of age.
•  Not attempting to communicate needs and wants at 12 months of age.
• No recognition of common objects at 18 months of age.
• Unable to understand simple commands (Examples: Are you hungry? Do you want a bottle?) at 12 months of age.
• Difficulty of intelligibility – understand less than 50% of language at 2 years of age.
• Stuttering, lack of fluency in speech after 4 years of age.
• Unable to initiate conversations or ask questions at 2 ½ years of age.
• Not using pronouns appropriately (me, mine, yours) at 2 years of age.

Fine Motor Skills

• Infants age birth to 3 months should be able to bring their hands to their mouth and grasp and hold an object.
• At 1 year of age a child should be able to stack blocks and turn pages in a book.
• At 2 years of age a child should be able to imitate scribbles and complete simple puzzles.
• At 3 years of age a child should be able to string beads and use good hand and finger coordination.
• Between ages 4 and 5, a child will be able to color within lines, copy shapes and use scissors in a coordinated fashion.

Gross Motor Skills

• From birth, infants should be able to turn their heads from side-to-side.  At about 3 months, they should be able to roll in both directions.
• At 1 year of age a child should be able to squat and resume a standing position.
• Between 12 and 18 months of age a child should begin walking independently.
• At 2 years of age a child should be able to use stairs independently, jump, run and enjoy ‘rough and tumble’ play.
• At 3 years of age a child should be able to hop on one foot and easily avoid obstacles while moving around his/her environment.
• Between ages 4 and 5 balance, coordination and agility should improve and increase.

Motor RED FLAGS

• Abnormal movement (extension or arching) and 3 to 6 months of age.
• Extreme variations in muscle tone (low or high tone) at birth to 3 months of age.
• Highly favored head position at 2 months of age.
• Not walking independently by 18 months of age.
• Toe walking (extreme) at 2 years of age.
• Hands remain fisted after 2 months of age.
• Sensory concerns such as aversions to certain textures or movements, avoidance of looking at certain objects or seeking out input (rocking or mouthing objects).
• Difficulty with hand-finger coordination (trouble picking up small objects, inability to cross mid-line, etc.).

Cognition

• Infants will momentarily look at an object held in front of them, turn their head toward the source of a sound and enjoy exploring with their own hands.
• At 1 year of age a child will enjoy putting objects into a container and then dumping them out.  At this age a child will also start to vary play and move around barriers to get toys.
• At 2 years of age a child will begin to sort shapes, begin to understand the concept of ‘one’ and will be able to complete simple puzzles.
• At 3 years of age a child begins to enjoy pretend-play and start to show interest in how things work.
• Between the ages of 4 and 5, a child will start to identify shapes, numbers, letters and colors and understand size concepts.

Cognition RED FLAGS

• No eye contact at 3 months of age.
• No exploration of toys at 6 months of age.
• Not reaching for toys at 9 months of age.
• Lack of interest in playing with toys at 9 months of age.
• Easily distracted, extremely short attention span at 12 months of age.
• Inability to retain information at 12 months of age.
• Difficulty focusing on activities at 18 months of age.
• Preference to play alone all the time at 3 years of age.
• No cooperative play at 5 years of age.

Behavior RED FLAGS

• Negative behavior occurs multiple times per day.
• No self-calming and difficulty calming with intervention.
• Self-injury (head-banging, hitting, etc.).
• Behavioral interventions fail and do not impact behavior.
• After implementing routine and structure, the negative behavior still occurs.

If you suspect a developmental delay, it is important that you talk to your child’s pediatrician and discuss the possible need for early intervention services.

Early intervention is a system that assesses children ages 0-3 for developmental delays or disabilities.  The focus is on helping children acquire the typical developmental skills which develop in the first three years of life.  Part C of the Individuals with Disabilities Act (IDEA) requires that early intervention services be available in every state in the United States.  There are several ways to connect with community early intervention programs:

• Ask your child’s pediatrician for a referral.
• Visit your state agencies website (i.e.www.wisconsin.gov) and search for the early intervention office in your state.
• Contact your local pediatric hospital and ask where to call about the early intervention program in your area.

The National Early Childhood Technical Assistance Center (NECTAC) is also a great source of this information.  Use NECTAC’s Contact Finder located under “State Programs Under IDEA” and select “Part C Coordinators”.  The contact finder is located at: www.nectac.org/contact/contact.asp.

If your child has passed his/her third birthday, services are provided to eligible children free of charge through the public school system.  It is appropriate to call your child’s local school, even if he/she is not a student there and inquire about an evaluation through IDEA, the nation’s special education law.

Has following developmental milestones like the ones listed above been helpful in identifying if your child needs early intervention services?

Ann Becker is the Administrator of Health Programs at Penfield Children’s Center and oversees operation of the Therapy Department, Special Care Nursery, Behavior Clinic and Special Education Department.

Adapted from National Center for Learning Disabilities Every Child is Learning: A Training Program for Parents and Teachers