Developmental milestones (newborn and infant): Clinical sciences

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Introduction0:00–0:57

Developmental milestones during the first years of life are crucial for lifelong development and learning. These milestones are functional skills that follow a predictable sequence by specific ages and are divided into five major categories.
Gross motor development, which relates to the movement of large muscles, fine motor development, which relates to the movement of small muscles, cognitive development, which covers reasoning, memory and problem solving, social emotional development, which describes attachment to and interactions with others.
And finally, language development, which covers both receptive and expressive communication, understanding normal developmental milestones will help you recognize when a child could be at risk for a developmental delay.
Early intervention services can then be implemented to improve developmental outcomes. When an infant presents for assessment of their developmental milestones, you should begin your examination with a focused history and physical exam during the history portion.

History & Physical0:57–2:06

Be sure to review birth history including gestational age and birth weight. And remember to ask about family history of developmental delays.
You should also take an interval, history by asking the family what new skills their baby has learned since the last clinic visit.
Additionally, ask the caregiver if they have any concerns about their baby's development since they spend the most time with their baby, they are often the first to notice when something isn't quite right.
Now. Here's a clinical pearl to keep in mind if the caregiver has a concern about their baby's development, that's a red flag.
So during your assessment, pay special attention to the caregiver's concern. The examination is also an opportune time for you to see firsthand what the baby can do during your exam, take some time to play with the baby.
A playful and interactive exam is entertaining for the infant and gives you a snapshot of the baby's development. Now, at each visit, your goal is to assess the infant's developmental milestones according to their age.

Birth2:06–3:27

Using a combination of direct observation and caregiver reports. Shortly after birth, you should assess their neurologic and motor development by checking reflexes that are present in the neonatal period.
For example, you can check for the rooting reflex by stroking the side of the newborn's mouth or cheek. And in response, they should turn their head towards your hand while opening their mouth.
After they open their mouth. You can check for the suck reflex by placing a gloved finger in their mouth and touching the roof of their mouth.
Finally, don't forget to assess the moral reflex also called the startle reflex. You can trigger the moral reflex with sudden movements or loud sounds or you can hold the baby horizontally and make a dropping motion with your hands in response, the baby should throw back, their head, extend out their arms and legs cry and then pull their arms and legs back.
In, in addition to assessing developmental milestones, you should assess for red flags that may signal the risk of a developmental delay.
These include prematurity, low birth weight and caregiver, indifference, meaning a caregiver that is not responsive to their newborn.

1 Month3:27–4:32

Now, let's move on to the developmental milestones. You should see in a one month old, gross motor milestones include being able to lift their chin during tummy time or the time they spend on their tummies, turning their heads to both sides when laying on their backs and moving both of their arms and legs equally fine.
Motor milestones include keeping their hands fisted and near their face. Cognitive skills include looking at faces as far as a social emotional development goes.
They recognize their caregivers, voices and they cry when distressed. Lastly important language milestones include startling to loud sounds and making throaty noises.
Red flags you should look for include poor movement or feeding due to low muscle tone, not responding to loud sounds or focusing on objects within a few inches from their face and caregiver indifference.

2 Months4:32–5:39

Ok. Moving on to a two month old.
By this time, the infant's gross motor development include being able to lift their head and chest when on their tummies, although their head legs when they're supported in a sitting position, fine motor skills include un fisted hands, nearly half of the time and the ability to hold their hands together.
At midline. Cognitive skills include opening their mouth when they see a breast or bottle, recognizing their caregiver and looking at toys that are presented to them.
Social emotional development includes a reciprocal smile, which is when the infant smiles in response to their caregivers smile and important language skills including cooing, which consists of vowel sounds like oh and ah and making sounds in response to their caregivers.
Red flags you should look for include not lifting their head during tummy time and not looking at faces or responding to voices.
Now let's switch gears and discuss milestones for a four month old. In this case, the gross motor milestones include propping themselves up on their wrists during tummy time, holding their head up straight and steady when sitting with support and rolling from prone to supine.

4 Months5:39–6:56

Fine motor skills at this age include open un fisted hands. Most of the time the infant also enjoys reaching for objects and playing with a rattle for cognitive milestones.
The infant is now looking at their hands with interest in learning about the world by putting everything in their mouth.
Social emotional milestones include a spontaneous smile where the infant starts smiling all on their own back and forth vocalizations where the infant alternates making noises with their caregiver and realizing they can move and make noises when they want to get attention in terms of language, the infant will turn toward the voice of someone speaking and they begin to laugh out loud when they're happy.
Red flags you should look for include being unable to bring their hands together at midline and not smiling or vocalizing.
Next. Let's look at the milestones seen in a six month old new gross motor skills include sitting in a tripod position where legs are spread and hands are in front for support and rolling from Supine to prone.

6 Months6:56–8:03

New fine motor skills include transferring objects between hands and using a raking grasp where they curl their fingers around an object to bring it towards them.
Cognitively speaking, these infants enjoy banging and shaking their toys and can interact with their reflection in a mirror.
Their social emotional development includes knowing familiar people and experiencing stranger anxiety around unfamiliar people.
Language skills include babbling which uses consonants to make sounds like ba and ma recognizing their name and understanding the word, no red flags you should look for include being unable to transfer objects between hands or if the infant doesn't turn toward voices, smile or laugh.

9 Months8:03–9:06

The next developmental milestone assessment is at nine months. Gross motor milestones include being able to pull themselves to a standing position and starting to crawl while fine motor skills include using a radial digital grasp to hold objects between their fingers and thumb.
Cognitive milestones are notable for the development of object permanence like looking for hidden toys. Social emotional development is characterized by separation anxiety where they become unsettled.
When caregivers are out of sight as their language skills continue to grow. Most nine month olds are able to repetitively use simple words like mama and dad da.
Though nonspecifically, while babbling red flags, you should look for in a nine month old include not sitting or rolling, lack of babbling with consonants and an absence of back and forth communication with caregivers.

12 Months9:06–10:22

Finally, let's talk about the milestones you should see at 12 months or one year. The gross motor skills of these infants include standing unsupported and taking their first independent steps.
Fine motor skills include using a fine pincer grasp, holding a crayon well enough to scribble and having enough coordination to build a two block tower and throw their toys cognitive wise, they're able to cooperate with dressing and finger feed themselves.
They're also interested in looking at picture books. Their social emotional skills include getting their caregivers attention to share what they are interested in and pointing to an object they want.
Language milestones include using their first words, waving bye bye, saying mama and dad with specific meaning and being able to follow a simple one step, verbal command that includes a gesture like put your toy on the table.
Red flags that you should look for in a 12 month old include being unable to stand, not responding to their name and apparent indifference to their caregiver.
OK? Once you've reviewed the developmental milestones.

Assess for red flags10:22–11:15

You should assess for red flags. If red flags are present, then the infant is at risk of developmental delay.
In this case, you should administer an age appropriate developmental screening tool to assess and document the infant's development.
You should also consider referral to a specialist for diagnostic evaluation, which may include the use of visual motor tests and auditory milestone scales.
This will ensure timely implementation of early intervention services such as speech language, physical or occupational therapy.
On the other hand, if red flags are absent, then development is likely progressing appropriately, you can provide reassurance and anticipatory guidance to the family and continue with developmental assessments.

Review11:15–11:55

All right. As a quick recap, developmental milestones are skills learned during the first years of life that follow a predictable sequence by specific ages.
The developmental assessment of an infant starts with a focused history and physical and includes asking for any caregiver concerns.
The milestones are assessed by age and subdivided into gross motor fine motor, cognitive, social, emotional and language milestones.
When a developmental red flag is identified during your assessment, proceed with an age appropriate developmental screening tool and consider referral for a diagnostic evaluation of their development.