Developmental milestones (toddler): Clinical sciences

Developmental milestones are behaviors and functional skills that children are expected to acquire by a specific age. These milestones are typically achieved in a predictable sequence 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 includes reasoning, memory, and problem-solving; social-emotional development, which describes attachment to and interactions with others; and finally, language development, which consists of receptive and expressive communication.

Understanding normal developmental milestones will help you recognize when a child is at risk for a developmental delay that would benefit from a more detailed evaluation and early intervention services, such as physical, occupational, or speech-language therapy.

Now, when a toddler presents for assessment of their developmental milestones, first, you should obtain a focused history and physical exam. During the history, be sure to review birth history, including gestational age and weight at birth, since prematurity and low birth weight are associated with developmental delays. Also, ask whether there is a family history of developmental delays, as some developmental disorders have a genetic component. You should also take an interval history to determine what new skills the toddler has learned since the last clinic visit.

Now, here’s a clinical pearl to keep in mind! Caregivers spend the most time with their toddler and are often the first to notice when something isn’t quite right. Whenever a caregiver is concerned about their child’s development, that is a red flag, so be sure to investigate further!

When it comes to the physical exam, you should check reflexes, assess muscle tone, and test their balance. You should also observe how the child interacts with their caregiver, the world, and with you, as this can help you gauge the child’s development.

Remember, at each well child visit, your goal is to assess the child’s developmental milestones according to their age, using a combination of direct observation and caregiver report.

Once you are done with history and physical exam findings, it’s time to assess the toddler’s developmental milestones, based on age. Let’s start by discussing expected milestones for a 15-month-old. By this age, toddlers achieve several gross motor milestones, including the ability to walk well, run with a stiff-legged gait, and crawl up stairs using their hands and feet. Fine motor coordination has improved, and now they can build a three-block tower.

As far as cognitive development goes, a 15-month-old can turn the pages of a thick board book and will explore their toys with purpose. They will also try to use objects appropriately, like reading from a book or talking on the phone. Newly acquired social-emotional skills include copying other children while playing; demonstrating affection, like giving hugs and kisses; and showing empathy when someone else is hurt or crying.

Their understanding of language has grown, and now they can follow simple one-step directions, like “bring the ball,” and they use 3 to 5 of their own words.

In addition to assessing the developmental milestones, remember to check for red flags that may signal a developmental delay. These include the absence of a pincer grasp; the inability to say “mama” or “dada”; and not pointing or using other gestures to ask for things.

Next, let’s discuss the developmental milestones you should see in an 18-month-old. Newly acquired gross motor skills include the ability to run well and creep down stairs. At this age, toddlers can seat themselves in a chair and have enough coordination to throw a ball while standing. Fine motor coordination has become more refined, and now they can build a four-block tower.

As far as cognitive development goes, 18-month-olds can use spoons and drink from cups, and they can match pairs of objects, like toys, socks or shoes. Further social-emotional development has given them the skills to engage in simple pretend play. And because they are now self-conscious, they will demonstrate shame when caught doing something wrong.

At this age, toddlers have achieved the language skills needed to understand the word “mine” and to point to themselves and to familiar people when named. Finally, in this age group, toddlers have a vocabulary of 10 to 25 words.