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Warning Signs And Where To Go For Help

What is Normal Development?

Child development is a dynamic process shaped by a complex interplay between genetic and environmental factors. Development is the acquisition of skills and abilities in a progressive manner as the child grows. Normal development means that a child will be expected to acquire certain skills encompassing his or her gross motor, fine motor, speech and language, cognitive and social skills at an expected age. There is enormous variation in both the rate and the pattern of normal development.

When should I be worried?

A child is expected to attain a certain skill at a particular age and this is called developmental milestone. The sequences of development are similar in most children and the developmental milestones are useful markers to observe the rate of development. If a child does not acquire these skills in a timely fashion, there is a possibility that he or she has developmental delay. Delay in any developmental sequence, plateauing or regression of development requires an early referral to the doctor for further assessment. The following developmental milestones and warning signs are a guide to delay at varying ages that may assist to identify children requiring intervention early.

Developmental Milestones and Warning Signs

Age

Gross Motor

Fine Motor

Speech/ Language

Social

Warning Signs

6 weeks

Head in midline without the head turning to one side consistently. Little or no head lag when pulled to sitting position 

 

Fixates and follows past
Hands often open
Vocalizes when pleased (coo)
Quietens to sound
Startles to sound

Spontaneous smile

Does not fix on mother’s face
Persistent hand fisting 

 

3 months

Holds up head and upper chest on forearms, with buttocks flat

 

Hand regard
  
Follows object from side
to side (180o)
 
Grasps objects placed in hand

Laughs, chuckles
 

Turns head to sound
(Media 1)

Show pleasure by laughing or looking excited when the baby is picked up and cuddled or his/her hair is stroked

 

Little interest in people, noise

Fisting of hands
Thumb held across palm

No smile or vocalising

 

6 months

Lifts head in anticipation when pulled to sit Supports weight on
flattened palms and extended arms in prone position


Reaching out
(single- handed reach)  

Palmar grasp

Babbles (monosyllabic)

Puts objects into mouth 

Responds to social games such as peek-a-boo and shows anticipation

Becoming stanger aware (reacting by withdrawing or crying)

Persistent squint

Hand preference

Not reaching for a toy placed in front of them

Not looking at people talking

9 months

Media 2

Crawl Sit n crawl 2 (Video)

Sit steadily
 Stands holding on

Pulls self to stand (Video)

Transfer objects

Bang 2 cubes

Exploration with index finger

Object permanence

Locates sound above and below the ear

‘word like” sounds with intonation (jargon)

Looks for fallen toy

Waves bye-bye

Plays peek-a-boo
 

Holds, bites and chews finger food

No double
syllable babble

Does not look at objects

Persistence of hand regard

Lack of interest in social games

18 months

Walk steadily and  stop safely

Run steadily but unable to avoid obstacles

Climb up stairs with hand-held and 2 feet per step

Able to build a tower of 3-4
cubes

Imitates stroke

1- 6 words

Points to 2-3 body parts when asked

Imitates household activities

Holds spoon and gets food safely to mouth

Not walking
independently

No clear
spontaneous words

Not defining objects by their use

No joint attention

2 years

Run safely avoiding obstacles

Walk up and down stairs, 2 feet per step, holding on rail

Throw a ball

 

 

Able to build a tower of 6 cubes

Circular scribble

Able to imitate vertical line

50+ words

Put 2 words together

Obeys simple commands

Able to name
3 objects

Understands preposition eg in,on

Eats with spoon skilfully

Puts on shoes, pants

Dry by day

Plays near
other children but not with them

No phrased speech (2 words)

Absence of simple pretend play

 

3 years

Pedal tricycle
 

Walks upstairs, one foot per step, and downstairs, two feet per step

Hops on one foot for 3 steps (each foot)

Throw a ball overhead

Able to build a tower of 9 cubes

Copies circle and imitates +

Put 3- 4 words together

Name 2 colours

Able to sing nursery rhymes

Understands preposition eg under, in front of/ behind

Eats with fork and spoon

Dresses and undresses with help

Dry by night

Plays with others

Does not
interact with others

Not routinely using two to three word sentences

 

4 years

Stand on one foot for about 6 secs

Walks upstairs and downstairs, adult manner

Rides tricycle and make sharp turns easily

Draws a person with 3 parts

Copies +

Sentences of 5+ words

Uses conjunctions (and, but)

Names 4 colours

Wash and dry hands

Imaginative play

Not understanding ‘what’ and ‘why’ questions

Unable to use sentences

 

5 years

Stands on one foot for 10 secs

Runs on toes

Skips on both feet

Bends at waist and touch his/her toes

Copies
and 

Draws person with 6 parts

Fluent speech

Present a picture depicting multiple activities and ask ‘look at the picture and tell me what is happening” (describing narrative)

Understands rules of play

Dresses and
undresses completely

 

Where should I seek help?

If your child does not achieve the developmental milestones at the expected age or displays warning signs, please seek medical attention from your healthcare provider at the nearest health clinic or hospital with paediatric services.

 

Last Reviewed : 17 November 2015
Writer : Dr. Aina Mariana bt. Abdul Manaf
Accreditor : Dr. Ranjini S. Sivanesom