Growth and Development Milestones*
MILESTONES OF THE INFANT (NEWBORN TO 11 MONTHS)
PHYSICAL DEVELOPMENT
Newborn
10% loss of birth weight in first 3 to 4 days of life
73% of body weight is fluid
Head circumference is 70% of adult size
Needs to consume 120 cal/kg of weight per day
Sleeps 20 to 22 hours/day, with brief waking periods of 2 to 3 hours
Feeds every 2½ to 5 hours
2 to 4 Months
Posterior fontanel closes
Obligate (preferential) nose breathers (until about 5 months)
Begins drooling
5 to 6 Months
Doubles birth weight
Teeth may begin to erupt
Moves food to back of mouth and swallows during spoon feedings
Sleeps through the night for up to 8 hours
Goes 4 to 5 hours between feedings
Has 2 to 4 naps per day
7 to 9 Months
Begins teething with lower central incisors, followed by two upper incisors
Mashes food with jaws
Sleeps 14 to 16 hour/day, including naps
10 to 11 Months
Sleeps 14 to 16 hour/day and still naps
Stops drooling
Grows about 0.5 in/month
SEXUAL
All Infants
Oral stage oral gratification and sucking needs (Freud)
10 Months
Begins sexual identity
LANGUAGE
Newborn
Alerting
Social smile
2 to 3 Months
Laughs and squeals
Coos
Utters single vowel sounds such as “ah” and “eh”
4 Months
Utters two-syllable vowel sounds
Includes consonant sounds such as “m” and “b”
Produces belly laughs
Orients to voices of others
5 Months
Razzing
Intersperses vowel and consonant sounds
6 Months
Babbles
Uses about 12 speech sounds
7 Months
Makes “talking sounds” in response to caregiver while others are talking
Coos and squeals
Vocalizes up to four different syllables
8 to 10 Months
10 to 11 Months
Imitates speech sounds
Understands name and “no”
Understands “bye” and “pat-a-cake”
Imitates definite speech sounds
Uses jargon
Communicates by pointing to objects and by using gestures
Responds to simple verbal requests
VISION
Newborn
Fixates on human face and demonstrates preference
Blink reflex present
2 Months
Follows to midline
Produces rears
Visual acuity is hyperoptic
4 Months
Follows objects to 180 degrees
5 Months
Visual acuity 20/200
Recognizes feeding bottle
6 Months
Inspects hands
Fixates on objects 3 ft away
Strabismus no longer within normal limits
Develops hand-eye coordination
8 Months
Has permanent eye color
Depth perception developing
10 Months
Tilts head backward to see up
HEARING
Newborn
Startles to loud noises
Prefers high-pitched voices
Quieted by low-pitched noises
Responds to human voice over other noises
Reflexive responses to auditory stimuli as seen by generalized body movement (blinking or crying)
Recognizes certain sounds, ignores others; attends to quiet sounds more than loud ones—these are learned rather than reflexive behaviors
Turns to voice (quiet listening)
5 Months
Orients to bell (looks to side)
Stops crying in response to music
7 Months
Orients to bell (looks to side, then up)
10 Months
Localizes sound from above or below
Orients to bell (turns directly to bell)
GROSS MOTOR
Newborn
Turns head when prone but cannot support head
Adjusts posture when held at shoulder
May squirm to corner or edge of crib when prone
Arm and leg movement are reflexive
6 Weeks to 2 Months
Holds head up 45 to 90 degrees when prone
May hold head steady when in supported sitting position
3 Months
Rolls over from back to side
Holds head erect and steady
4 Months
When supported, sits with rounded back and bended knees
May bear weight on legs when assisted to stand
Head lag disappears when pulled to sitting position
5 Months
Pulls to sitting position
Rolls from back to stomach
Sits alone momentarily
Shows unilateral reaching
6 Months
Sits without support
May creep an inch forward or backward
Moves from place to place by rolling
Begins drinking from a cup
7 Months
Stands while holding on
Early stepping movements
Begins to crawl or hitch
Raises head spontaneously when supine
8 Months
Pulls to standing position
Raises self to sitting position
Palmar grasp disappears
9 Months
Walks with help
Crawls, creeps, or hitches when permitted
Sits down
Holds own bottle
Drinks from cup or glass
10 Months
Continues walking skill development with help
Stands alone
May climb up and down stairs
Sits without support
Recovers balance
Changes from prone to sitting position
11 Months
May walk alone
Begins to stoop and recover
Pushes toys
“Cruises”
FINE MOTOR
Newborn
Follows to and slightly past midline
2 to 3 Months
Keeps hands open predominately
Reflex grasp replaced by voluntary grasping
Grasps objects such as rattle in open hand
May bring hands together at midline
4 Months
Uses ulnar-palmar prehension with a cube
Reaches for objects
Hands predominantly open
5 Months
Attempts to “catch” dangling objects with two hands
Begins using forefinger and thumb in pincer grasp (opposable thumb-prehension)
Recovers rattle
Reaches for and grasps objects
6 to 7 Months
Can grasp at will
Holds and manipulates objects
Scoops pellet
Transfers from hand to hand
Demonstrates inferior pincer
Bangs objects together
Can release objects
8 to 9 Months
Combines spoons or cubes at midline
Retains two of three cubes offered
Achieves neat pincer grasp of pellet
Feeds self finger foods using only one hand
Releases objects at will
Rings bell
Holds bottle and places nipple in mouth when desired
10 to 11 Months
Plays “pat-a-cake” (a midline skill)
Puts several objects in a container
Holds crayon adaptively
Bangs two cubes together
Looks for hidden object (object permanency) (Piaget)
Achieves neat pincer grasp
PLAY
All Infants
Engages in solitary play
May be imitative
Explores and manipulates
5 to 7 Months
Resists toy pull
Picks up tiny objects
Plays “peek-a-boo”
Works to get toy that is out of reach
8 to 9 Months
Plays “pat-a-cake”
Recognizes self in mirror
10 to 11 Months
Plays ball
Achieves object permanence (searches for dropped objects)
COGNITIVE
Newborn
Substage I (Piaget)
Practice of reflexes and reflex-like actions
1 to 3 Months
Substage II: Purposeful (Piaget)
Reproduces reflex actions
4 to 7 Months
Substage III: Objects (Piaget)
Oriented and imitative actions
Accidental actions are repeated
Develops habits
Responds negatively to removal of a toy
8 to 11 Months
Substage IV (Piaget)
Coordination, intentional goal direction, and achievement
Experiments with object permanence
Imitates and models behavior
No concept of death
Enjoys “peek-a-boo” game
Attempts to flee from unpleasant events
Recognizes anticipatory signs
Repeats actions that elicit response from others
Dislikes restrictions
Shakes head for “no”
Appears interested in picture book
SOCIAL
Newborn
Regards face and establishes eye contact
1 to 2 Months
Smiles responsively
Enjoys cuddling and motion
3 Months
Smiles spontaneously
4 to 5 Months
Smiles at mirror image
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