Lesson 2.

2: Typical Development of the Child

Principles of Normal or Typical Development in Infancy and Early

Childhood

Developmental milestones are behaviors or physical skills seen in infants and children as
they grow and develop. Like rolling over, crawling, walking, and talking are all considered
milestones. The milestones are different for each age range.
When there are problems in prenatal development and birth, deviations from the normal
developmental milestones in infancy and early childhood can be expected. The general principles
of normal development are useful guides in observing the presence of such deviations.
1. Normal development progresses in step-by-step sequences.
2. All areas of development are interrelated.
3. The skills acquired will determine how well the skills will be learned.
4. Although there are developmental milestones in each of the growth areas, children
manifest individual differences in their rate of development. Each child develops at his
or her own pace.

There is a normal range in which a child may reach each milestone. For example, walking
may begin as early as 8 months in some children. Others walk as late as 18 months and it is still
considered normal.

One of the reasons for well-child visits to the health care provider in the early years is to
follow your child’s development. Most parents also watch for different milestones. Talk to your
child’s provider if you have concerns about your child’s development.

Below is a general list of some of the things you might see children doing at different ages.
These are NOT precise guidelines. There are many different normal paces and patterns of
development.

Gross Motor Skills

Gross motor (physical) skills are those which require whole body movement and which
involve the large (core stabilizing) muscles of the body to perform everyday functions, such as
standing and walking, running and jumping, and sitting upright at the table. They also includes
eye-hand coordination skills such as ball skills (throwing, catching, and kicking) as well as riding
a bike or a scooter and swimming.
 Gross motor skills are important to enable children to perform every day functions, such
as walking and running, playground skills (e.g. climbing) and sporting skills (e.g. catching,
throwing and hitting a ball with a bat). However, these are crucial for everyday self-care skills like
dressing (where you need to be able to stand on one leg to put your leg into a pant leg without
falling over) and climbing into and out of a car or even getting into and out of bed.

Table 1. Gross Motor Skills table

Activity Approx. Activity Approx.

Age Age
Raises chin while lying on 1 mo. Walks alone unsupported 18 mos.
stomach
Raises chest while lying on 2 mos. Sits self in small chair 18 mos.
stomach
Reaches for objects but misses 3 mos. Walks carrying large objects 20 mos.
Headset forward, steady lumbar 4 mos. Raises self from sitting 22 mos.
curvature position with hips first
Turns over from lying to a supine 4-6 mos. Runs well without falling 2 yrs.
position
Sits on lap, grasps objects 5 mos. Kicks the ball without 2 yrs.
overbalancing
Sits on high chair, grasps objects 6 mos. Jumps with both feet on 2.5 yrs.
place
Sits alone with good posture 10 mos. Picks up objects from the 2.5 yrs.
floor without help
Creeps and crawls, pulls to a 11 mos. Stands on one foot without 3 yrs.
standing position falling over
Walks with help, walks alone 12 mos. Pedals tricycle 3 yrs.
Climbs stair-step 13 mos.

Receptive Language
Receptive language means the ability to understand information. It involves
understanding the words, sentences and meaning of what others say or what is read.

Table 2. Receptive Language table

Activity Approx. Activity Approx.

Age Age
Understands few words 11 mos. Points to 5 body parts on 1 yr. 10
self or doll mos.
Points to 1 named body part on 1 yr. Follows 3-step command 2 yrs.
request given once
Stops activity to name objects 1 yr. Understands 200-400 words 2 yrs.
stops activity to respond to “no” 1 yr. Understands 800 words 3 yrs.
Points to familiar persons, objects 1 yr. 3 Verbalizes past experiences 3 yrs.
on request mos.
Follow one-step simple command 1 yr. 3 Points to big, little, soft, loud 3 yrs.
mos.
Points to 3 named body parts on 1 yr. 5 Follows commands with 2-3 4 yrs.
request mos. actions
Follow two-step command 1 yr. 8 Understands 1,500 words 4 yrs.
mos.
Points to 5-6 pictures of common 1 yr. 9
objects on request mos.

Expressive Language
Expressive language means being able to put thoughts into words and sentences, in a way
that makes sense and is grammatically accurate. Expressive language is the ability to request
objects, make choices, ask questions, answer, and describe events. Speaking, gesturing
(waving, pointing), writing (texting, emailing), facial expressions (crying, smiling), and
vocalizations (crying, yelling) are all variations of expressive language.

Table 3. Expressive Language table

Activity Approx. Activity Approx.

Age Age
Says first word 10 mos. Uses plurals 2 yrs.
Shakes head and says “no-no” 11 mos. Asks question 2 yrs.
Imitates sounds of others (mama) 1 yr. Uses negative in speech 2.5 yrs.
Uses 3 words in speaking 13 mos. Enunciates vowel sounds 2.5 yrs.
vocabulary
Use of verbs appear 14 mos. Enunciates consonant 3 yrs.
sounds
Uses at least six words 17 mos. Speech is about 75 to 80% 3 yrs.
intelligible
Refers to self by name 21 mos. Uses 3 to 4 syllable words 3 yrs.
Uses me and you 2 yrs. Says 6 to 8 words sentences 4 yrs.
Says 50 to 200 words 2 yrs. Speech is about 90 to 95% 4 yrs.
intelligible
Knows full name 2 yrs.
Eating Skills
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Table 4.Eating Skills table

Activity Approx. Activity Approx.

Age Age
Sucks and swallows liquids Birth Holds cup with two hands 1 yr.
Gagging reflex Birth Chews table food 1.3 yrs.
Sucks and swallows liquids from Grasps spoon & places in
2 mos. 1.3 yrs.
spoon mouth with some spilling
Eats strained baby foods from Can manage spoon without
3 mos. 1.5 yrs.
spoon help with little spilling
Brings hands against bottle when Requests for food when
3 mos. 1.11 yrs.
eating hungry
Requests for liquid when
Sips from a cup that is held 4 mos. 1.11 yrs.
thirsty
Gets excited at sound of food Can hold small glass with
4 mos. 2 yrs.
preparation one hand without help
Holds spoon with assistance Mos. Can use fork to get food 3 yrs.
Can feed self-soft food 6 mos. Can spread butter on bread 3 yrs.
Begins to bite and chew food 6mos. Can help set table 4 yrs.
Can use fork to separate
Holds own bottle 7 mos. 4 yrs.
food
Can pour water from pitcher
Can chew small lumpy food 8 mos. 4 yrs.
to glass
Can take bottle out of mouth & put
9 mos. Can use a knife to cut food 5 yrs.
it back
Can set the table without
Can use fingers to feed self 10 mos. 6 yrs.
assistance

Dressing Skills
Dressing may seem like a simple task, but it is actually a task that requires
multiple skill sets from children. Dressing requires skills such as fine and gross motor
coordination, body awareness, bilateral coordination, right/left discrimination, postural stability,
and motor planning.

Table 5. Dressing Skills table

Activity Approx. Activity Approx.

Age Age
Can pull and tug at clothing 3-4 mos. Attempts to place feet in 30 mos.
shoes
Holds out limbs when dressing 1 yr. Can choose own outfit 3 yrs.
Can remove shoes by self 1.2 yrs. Can unbutton clothes 3 yrs.
Can place socks on feet by self 1.5 yrs. Places clothing on in correct 3.6 yrs.
direction
Can pull up pants 1.6 yrs. Can dress and undress with 4 yrs.
supervision
Can unzip 1.7 yrs. Can button front buttons on 4.8 yrs.
clothing
Attempts to put on own shoes 2 yrs. Can zip up and down/snap 5 yrs.
simple snaps
Pulls up pants 2 yrs. Can tie shoes with bows 5.6 yrs.
Undressed self 30 mos. Can unlace bows on shoes 5.6 yrs.
Can put on shirt and coat 30 mos. Dresses self completely 5.6 yrs.

Grooming Skills
Grooming are the things that you do to make your appearance clean and neat, for example
brushing your hair, or the things that you do to keep an animal's hair or fur clean and neat. She
pays great attention to make-up, grooming and clothes.

Table 6. Grooming Skills table

Activity Approx. Activity Approx.

Age Age
Cries when removed from 5 mos. Can brush teeth with 3.6 yrs.
bathroom assistance
Splashes water with hands and 6 mos. Can wash and dry face with 4 yrs.
feet towel alone
Grimaces when face is washed 6 mos. Can brush teeth alone 4 yrs.
with cloth
Exhibits resistance to washing 8 mos. Can put away toys with 4 yrs.
face supervision
Can open and pull out drawers 1.6 yrs. Can hung up clothes on 4 yrs.
hook
Can wash hands and face but not 2 yrs. Brushes hair alone 5 yrs.
well
Can wash front of body while in 2 yrs. Hangs up own clothes alone 5 yrs.
bath
Can run a brush through hair 2.5 yrs. Washes self alone 6 yrs.

Toileting Skills
Toilet training is the process of training a child to use the toilet for bowel and bladder use
(i.e. wees and poos). Toilet training may start with a potty (small toilet bowl-shaped device) or
you may skip this and simply begin with the toilet. Most children will find it easier to control their
bowel before their bladder and it usually takes longer to learn to stay dry throughout the night
than daytime.

Table 7.Toileting Skills table

Activity Approx. Activity Approx.

Age Age
About 4 bowel movements a day 1 mo. Climbs on the toilet by self 2.6 yrs.
associated with waking up
2 bowel movements a day either at 2 mos. Can control bladder for up to 2.6 yrs.
waking up or after being fed 5 hrs.
Some delay shown between 4 mos. Begins to develop a routine 3 yrs.
feeding and elimination for elimination
Stays dry for 1 to 2 hours interval 7 mos. Attempts to wipe self but 3.6 yrs.
fails
May awaken at night & cry to be 1.5 yrs. Stays dry at night 4 yrs.
changed
May indicate wet pants 1.5 yrs. Can toilet self without 5 yrs.
assistance
Has only occasional accidents 1.10 yrs. Washes & dries own hands 5 yrs.
after toileting
Uses same words for both 1.10 yrs. One bowel movement a day 5 yrs.
functions of elimination
Begins to differentiate between 2 yrs.
elimination functions
 Lesson 2.3: Atypical Development of the Child

Red Flags or Atypical Development of a Child

In clinical terms, there are few absolute indicators often referred to as “red flags,” that
identify the orthopedic or developmental markers suggesting the need for further evaluation.
The Red Flags Early Identification Guide (for children aged birth to five years) is a health
resource for professionals (including general practitioners, child health nurses, allied health
professionals and early childhood educators) working with families, to help identify
developmental concerns early, so families can receive support from the right professionals at the
right time.

Here are some tips for using the guide

• Children’s Health Queensland recommends this resource be used in discussions with
parents/carers about typical development and parental understanding/expectations of
development. This process facilitates identification of parental concerns/questions about a
child’s growth, development and activities of daily living.
• A single red flag is not always an indication for concern or referral, rather the functional impact
of one or more red flags on the child’s everyday functioning and participation, should be taken
into consideration.
• The negative statements of ‘does not’ and ‘not able to’ have been used to highlight a delay/lack
of acquisition of skills. The red flags have been linked to the absence or delay of skill/s which lie
at the boundary of the typical developmental range. Therefore the guide should not be used as a
‘milestones’ screener, as the red flags are not developmental milestones.
• This second edition includes revised red flags and directions for appropriate use.

Table 8.Red Flags Behavior

Area 6 mos. 9 mos. 12 mos.

Social emotional Does not smile. Not sharing Does not notice
enjoyment with someone new
others using eye Does not play
contact or facial early turn-taking
expression. games (e.g.
peekaboo,
rolling a ball)
Communication Not starting to Not using No babbled
babble (e.g. aahh; gestures (e.g. phrases that
oohh) pointing, sound like talking
 showing, No response to
waving) familiar words
Not using two (e.g. bottle,
part babble (e.g. daddy)
bubu, dada)

Cognition, Fine Not reaching for Does not hold Does not feed
Motor and Self-Care and holding objects self finger or
(grasping) toys Does not “give” hold own
Hands frequently objects on bottle/cup
clenched request Unable to pick up
Does not explore Cannot move toy small items
objects with from one hand using index
hands, eyes and to another finger and thumb
mouth
Does not bring
hands together ad
midline
Gross Motor Not holding head Not rolling No form of
and shoulders up Not sitting independent
with good control independently/wi mobility (e.g.
when lying on thout support crawling,
tummy Not moving (e.g. commando
Not holding head creeping, crawling, bottom
with control in crawling) shuffle)
supported sitting Not taking weight Not pulling to
on legs when stand
held in standing independently
and holding on
for support

Area 18 mos. 2 yrs. 3 yrs.

Social Emotional Lacks interest in When playing No interest in
playing and with toys tends pretend play or
interacting with to bang, drop or interacting with
others throw them other children
rather than use
them for their
purpose (e.g.
cuddle dolls,
build blocks)
 Communication No clear words Not learning Speech difficult
Not able to new words for familiar
understand short Not putting people to
requests (e.g. words together understand
“Where is the (e.g. “push car”) Not using simple
ball?) sentences

Cognition, Fine Does not scribble Does not Does not

Motor and Self-Care with a crayon attempt to feed attempt
Does not attempt self using everyday self-
to stack blocks spoon and/or care skills (such
after help with as feeding or
demonstration dressing dressing)
Difficulty in
manipulating
small objects
(e.g. threading
beads)
Gross Motor Not standing Not able to walk Not able to walk
independently independently independently
Not attempting to Not able to walk Not able to run
walk without up and down or jump
support stairs holding on

Red flags at any

Area 4 yrs. 5 yrs.
age
Social Emotional Unwilling or Play is different Strong parental
unable to play than their concerns
cooperatively friends Significant loss
of skills
Lack of
response to
sound or visual
stimuli
Poor interaction
Communication Speech difficult Difficulty telling a with adults and
to understand parent what is other children
not able to follow wrong Lack of, or
directions with Not able to limited eye
two steps (e.g. answer question contact
“Put your bag in a simple Differences
away and then go conversation (e.g. between right
play”) “What’s your and left sides of
name? Who is body in strength,
 your family? What movement or
do you like to tone
watch on TV?”) Marked low tone
(floppy) or high
Cognition, Fine Not toilet trained Concerns from tone (stiff and
Motor and Self-Care by day teacher about tense) and
Not able to draw school significantly
lines and circles readiness impacting on
Not able to development
independently and functional
complete motor skills
everyday
routines such
as feeding and
dressing

Gross Motor Not able to walk, Not able to walk,

run climb, jump, run, climb, jump,
and use stairs and use stairs
confidently confidently
Not able to catch, Not able to hop
throw or kick a five times on
ball one leg and
stand on one leg
for five seconds

For a parent, these red flags should serve as a catalyst prompting developmental
screening to ensure that the child is on the right developmental path. If your child shows two or
more of these signs, please ask your pediatric healthcare provider for an immediate evaluation.
It is also highly recommended that whenever a parent suspects that there may be such concerns
that you go through a referral process to ensure that your child gets the help he or she needs.
Doctors used to (and some still do) take a “wait and see” approach, but today it is clear that early
intervention is the key to the greatest possible outcomes for children with such issues.