Developmental milestones are used to assess the maturation of functions through different stages of development from birth to 5 years. Key areas of development include gross motor skills, fine motor skills, language, personal-social, and cognitive skills. Standardized developmental assessments evaluate children's abilities in these domains compared to typical developmental milestones to identify potential delays or weaknesses for targeted intervention. Principles of child development, developmental norms from birth to 5 years, and factors that can affect development are outlined.

1. DEVELOPMENTALMILESTONES

2.  Development specifies maturation of functions.
 It is related to maturation and myelination of nervous
system and indicates acquisition of a variety of skills for
optimum functioning of the individual.
 Developmentalassessment includes early identification
of problems through screeningand surveillance.

3. • THE GOAL OF DEVELOPMENTAL ASSESSMENT IS
NOT ONLY TO GENERATE A DIAGNOSIS BUT ALSO
TO ANALYSE THE PATTERN OF STRENGTHS AND
WEAKNESS IN ORDER TO DIRECT TREATMENT.

4. PRINCIPLES OF DEVELOPMENT
• Development is a continuous process, starting in utero
• Sequence of attainment of milestone is same,
• rate of development varies from child to child based on their
neurological status known as ‘dissociation’
• Development is cephalo-caudal and proximal to distal
• Certain primitive reflexes need to be lost before any milestone
to develop. Ex walking reflex, palmar grasp, ATNR
• Generalized mass activity is replaced by specific individual
responses

5. • Gross Motor - the development of locomotion
• Vision and fine manipulation – the development of
eye-hand control
• Hearing & speech - the development of language
• Personal & social - integration of acquired abilities to
reflect understanding of environment
4 fields of development

6. GROSS MOTOR : Involves control of child over his body.
Tested in :
1. Prone
2. Supine
3. Sitting
4. Standing
Gross Motor Milestones

7. MOTOR DEVELOPMENT MILESTONES- Age:0-3 months
Ventral
suspension
Development prone Supine Sitting
in/of
Age: 0-3 months
4 weeks – lifts head
momentarily for a few
moments
6 weeks – head lifted in
line to the plane of
body
8 weeks – head lifted
beyond the plane of
body
12 wks – brings head to
plane of body and then
above plane of body
and maintains in that
position.
1st Month - Complete
Head Lag
2nd Month – Partial
Head lag
3rd Month - Moderate
Head Control
Head lag
• Newborn – can turn
head to 1 side
• 1 mth – lifts chin
momentarily
• 3 mths – lifts head
and upper chest
1st Month – Holds Head
up momentarily
2nd Month – Head Bobs
3rd Month - Moderate
Head Control

8. MOTOR DEVELOPMENT MILESTONES - Age:4-6 months
prone supine sitting standing
Age:4-6 months
Stabilization
Weight bearing
Motion
4th Month –
Pushes with
feet
4th Month – Enjoys
sitting with full truncal
support
4th Month
- No Head Lag
- ATNR Gone
4th Month – Head
steady, holds head and
chest off Couch
5th Month – Full Head
Control
6th Month -
• Weight Bearing on
extended arms
• Holds chest and
abdomen above
couch
• Rolls over from
Prone to Supine

9. Development
in/of
prone supine sitting standing
Age:6-9 months
MOTOR DEVELOPMENT MILESTONES - Age:7-9 months
7th Month – Weight
Bearing Present,
bounces actively
8th Months- Pulls self
to standing position
9th Month - Stands
holding on to furniture
10th month- Cruises
6th to 7th Month –
Grasps his feet and
tries to bring it to his
mouth
7th Month – Sits briefly with
support of pelvis, Weight bearing
on one hand
8th Months- Sits alone with back
straight
9th Month- Can Lean Forward
7th Month Rolls over
from Supine to Prone
Position, Weight
bearing on one hand
8th Month- Weight
bearing on hand and
knees
9th Month- Trying to
crawl

10. Development in/of prone supine sitting standing
Age:10-12 months
MOTOR DEVELOPMENT MILESTONES - Age:10-12 months
10th Month – Pulls self to
standing Position
11th Month- Walks side
ways holding on to
furniture, walks with 2
hands held
12th Month- walks with one
hand held, rises
independently,, bears
walking
10th Month – Pulls self
to sitting Position
11th Month- Can lean
sideways, can
turnaround to pick
objects (Pivot)
10th Month – Pulls self
to sitting Position
9th Month – Crawls with
abdomen on the couch
11th Month- Creeps-
abdomen off ground,
kneeling supported

11. Development in/of prone supine sitting standing
Age:12-18 mos
MOTOR DEVELOPMENT MILESTONES - Age:13-18 months
13th Month - Stands
alone
15th Month – Walks
alone with broad base
and high stepping gait,
takes several steps
sideward
18th Month- Runs
stiffly, walks upstairs
with one hand held,
pulls hand as he walks,
walks normally
• throws ball without
falling
15th Month – Crawls
upstairs
18th Month – Sits on a
small chair

12. 18 months
• Walk forward 10 feet with narrow base of
support
• Walk backwards 5 steps
• Walk upstairs and downstairs with hand held
• Kick a ball forward 3 feet
• Throws ball while standing
• Seats self in small chair

13. • 20 months – squats , carries large object
• 22 months- kicks ball with demonstration

14. 24 months/ 2 Yrs-
• Runs without loss of balance
• climb on furniture
• Walk backward & sideways
• Walks upstairs and down stairs, two feet
per step
• Kicks ball without demonstration
• Throws ball 3 feet away

15. MOTOR DEVELOPMENT MILESTONES - Age:21-60 months
 36 Months/3 Yrs-
• Stands momentarily on single foot for 3 sec
• Goes upstairs with 1 foot per step and downstairs with 2 feet per
step,
• Rides tricycle,
• catches ball with stiff arms
• Walks heel to toe
• Jumps In place

16. 48 Months/4 Yrs-
• Down stairs with 1 foot per step,
• hop on 1 feet,
• throw a ball overhand
• Catches bounced ball
• Standing jump

17.  5 years –
• skips
• jumps backward
 6 years
• Tandem walking
 7 years
 Bicycle

18. FINEMOTORORADAPTIVEMILESTONES
Includes eye coordination, hand eye coordination, hand mouth
coordination and manipulation with hand (grasping, thumb-finger
apposition, dressing)
Eye coordination:
1 Month– follows moving objects less than 90 degree
2 Months – follows object from side to side – 180 Degree (Unsteady
Movement)
2-3 Months – follows with steady movements of eyes
3-6 Months - Binocular vision develops

19. 2 Months- Hand predominantly closed
3 Months – Hands open, grasps reflex gone, Reaches towards objects and
misses, Hand regard present
4 Months – Approaches objects but overshoots, Hand in midline and plays
with them
5 Months – reaches out & grasps object with ulnar side, no more hand
regard, bidexterous grasp
6 Months - transfers objects from hand to hand, unidextrous reach
8 month- radial grasp
9 Months – immature pincer grasp, attempts to pick fallen toys
10 mths – pincer grasp(between thumb and forefinger) – picks up pellet
12 Months - mature pincer grasp
12 months- casting – throwing deliberately on to floor one after another
FINEMOTORORADAPTIVEMILESTONES-
Hand eye coordination

20. Hand-mouth coordination:
4 months- mouthing starts
11 months – mouthing stops
12 Months– tries to feed with spoon but may spill
15 Months – feeds with spoon
18 Months – feeds self from cup
Hand skills: Book:
18 Months – turn 2-3 pages at a time
24 Months – turns 1 page at a time
FINEMOTORORADAPTIVEMILESTONES

21. Scribbling:
12-18 Months- scribbles
18 Months– copies vertical line
24 Months– copies horizontal line, HANDEDNESS is established
3 yrs – circle
4 yrs – cross, rectangle
5 yrs – triangle
6 yrs- hexagon
7yrs- kite
8yrs- doube cross
9 yrs- cylinder
11 yrs - cube
FINEMOTORORADAPTIVEMILESTONES

22. Towerofcubes
15 months – tower of 2 cubes
1.5 Years – tower of 3 cubes
2 Years – tower of 6 cubes ,
train of cubes
3 Years – tower of 9 cubes,
bridge
4 Years – gates with cubes
5 Years – stairs from model with
cubes
6 years- builds stairs from
memory

23. beads
• 2 yrs- large beads
• 3 yrs- strings small beads well
• 3 yrs- cuts paper with scissors – side to side
awkwardly
• 4 yrs- cuts circle
• 5 yrs- cuts properly

24. Socio Emotional Development

25. PERSONAL & SOCIAL DEVELOPMENT
1m Face regard-looks intently at mother
2 mth - social smile
3 mths - recognises mother/caretaker
4 mths – laughs loud
6 mths - enjoys mirror
6-9 months stranger anxiety (disappears by 1 year)
7 months – separation anxiety
8 months – object permanence - the understanding that objects continue to exist
even when they cannot be sensed
9 mths - waves bye-bye, pulls mother to attract her
12m Comes when name is called, understands phrases, plays simple ball
game
18 mths – complaints when wet or soiled
2yrs Asks for food, pulls people to show toys.
3 years – helps in dressing
5 years – dresses and undresses

26. BOWEL&BLADDERCONTROL
• 1.5-2yrs Start toilet training
• 1.5 yrs Bowel control is achieved
• 1.5-2 yrs Dry by day
• 2 yrs 50 % dry by night
• 3 yrs 75 % dry by night
• 5 yrs 90 % dry by night

27. language
• 1m Turns head to sound
• 2m Vocalizes
• 3m Cooing and babbling
• 4m Laughs aloud
• 6m Monosyllables
• 9m Bi syllables
• 12m Speaks 1st true word, repetition, knows 2 words with meaning
• 15-18m Jargon speech
• 18m Knows 10 words with meaning
• 2yrs Uses pronouns, points 1 part of body, speaks simple sentence
with 3 words.
• 3yrs Knows name and sex, shares toys, asks questions
• 4yrs Tells a story, plays co-operatively in a group, goes to toilet
alone
• 5yrs Names 5 colors, helps in household tasks

28. Play Milestones
• 10m Plays peek-a-boo
• 1yr Egocentric pretend play, solitary
• 2yr Parallel play
• 4yr cooperative Plays with others
• 5yr Domestic play
• 7-8 yrs- social play

29. directions

30. •PARENTING
•POVERTY
•LACK OF
STIMULAION
•VIOLENCE AND
ABUSE
•MATERNAL
DEPRESSION
•INSTITUTIONALIS
•INFANT AND CHILD
NUTRITION
•IRON DEFICIENCY
•IODINE DEFICIENCY
•INECTIOUS DISEASE
•IUGR
•PREMATURITY
•PERINATALASPHYXIA
• MATERNAL
FACTORS
GENETIC
FACORS
NEONATAL
PSYCHO-
SOCIAL
POST
NEONATAL
PROTECTIVE
BREAST
FEEDING
MATER
NAL EDU

32. Indication for
developmental assessment
Follow up of high risk neonates for early detection of cerebral palsy or
intellectual disability
Complete evaluation of children with developmental, chromosomal or
neurological disorders
To differentiate children with delay in specific domain of development or
global developmental delay

33. ⦿ DEVELOPMENTAL MILESTONES SERVE AS AN
IMPORTANT BASIS OF MOST STANDARDIZED
ASSESSMENTAND SCREENING TOOLS
⦿ TWO SEP
ARATE DEVEVELOPMENTAL
ASSESSMENT OVER TIME ARE MORE
PRODUCTIVE THAN A SINGLE ONE

34. ⦿WHETHER PARENTS ARE CONCERNED OR NOT
⦿RIGHT QUESTIONS
⦿AGE SPECIFIC QUESTIONS
⦿CHECK DOUBTFUL REPL
Y
⦿CHECK THE ANSWERS ABOUT ONE MILESTONES
BY ANOTHER AND BY EXAMINATION

35. ⦿FAMILY HISTORY-FIRST, SECOND AND THIRD
DEGREE RELATIVE
⦿SOCIAL HISTORY-CAPACITY TO COPE WITH A
CHILD WITH DISABILITY

36. ⦿Observe vocalization and gestures to attract
others attention, to indicate needs . in
response to others vocalization and to share
emotion
⦿Note speech quality ,use of language to
express and responding to conversation

37. ⦿DQ=developmental agechronological age*100
⦿For The infants who were born prematurely
should the chronological age should be
corrected during the gestational age till 2yrs
of life
⦿Interpretation-
⦿>=85-normal
⦿71-84-mild to moderate
⦿<=70-severe delay

38. Prerequisites
 Should be done in a place free from distractions
 Child should not be hungry, tired, ill or irritated
 Playful mood with mother around
 Adequate time to make child and family
comfortable
 A developmental kit

39. Equipment required: The following equipment is required
for developmental testing in the fi rst 5 years:
• Ten 1-inch cubes
• Hand bell
• Simple formboard
• Goddard formboard
• Coloured and uncoloured geometric forms
• Picture cards
• Scrap book
• Cards with circle, cross, square, triangle, diamond
drawn on them.
• Patellar hammer
• Paper
• Pellets (8 mm)

40. Goodenough ‘draw-a man’
test
 The child is asked to draw a man carefully, in
the best way he knows how and to take his
time.
 The test is most suitable for children
between 3 and 10 years of age.
 The child receives one point for each of the
items which is present in his drawing. For
each four points 1 year is added to the basal
age which is 3 years. As a child draws circle
at 3 years, the starting point for drawing a
person, the basic score is considered 3 and
the formula is: 3 + n/4, where n is the
number of parts drawn.
 Interpretation- the score is low in children
who suffered hypoxia in utero and high in
children with certain emotional disorders

41. Gesell ‘incomplete man’ test
 3 years One or two
parts
 4 years Three
parts
 4½ years Six parts
 5 years Six or
seven parts
 6 years Eight
parts

42. Goddard formboard. (Best
of three trials)
 3½ years -56 seconds.
 4 years -46 seconds.
 4½ years -40 seconds
 5 years -35 seconds
 6 years -27 seconds
 7 years -23 seconds
 8 years -20 second

43. Coloured geometric forms
2½ years- Places one
3 years -Places three
4 years- Places all
Uncoloured geometric forms
3 years -Places four
3½ years- Places six
4 years -Places eight
4½ years- Places nine
5 years -Places all

44. Digits
• 2½ years - Repeats two, one of three trials
• 3 years - Repeats three, one of three trials
• 3½ years - Repeats three, two of three trials
• 4 years - Repeats three, three of three trials
• 4½ years - Repeats four, one of three trials
• 5 years - Repeats four, two of three trials
• 6 years - Repeats five
• 7 years - Repeats three backwards: (‘Say these figures
backwards’)
• 8 years - Repeats six digits, one of three trials

45. Simple orders.
(Put the ball under the chair, at the side of
the chair, behind the chair, on the chair.)
3 years -Obeys two
3½ years -Obeys three
4 years- Obeys four
Book
15 months- Interested
18 months- Turns pages two or three at a
time Points to picture of cat or dog
2 years- Turns pages singly

46. Screening tests

47. Screening Tool for Motor
Milestones
Child Development Centre, Kerala Grading for Motor Milestones
Developmental screening of all babies, particularly graduates of neonatal
intensive care units (including vision and hearing domain), is important in
identification of potentially handicapping conditions that may be prevented
or ameliorated if addressed early.
Motor Milestones Grading: (Assessed at completed 4 months)
Grade 0 - No head holding at all.
Grade I - Head erect and steady momentarily.
Grade II - Dorsal suspension—lifts head along with body.
Grade III - Prone position—elevates on arms, lifting chest.
Grade IV- Holds head steady while mother moves around.
Grade V - Head balanced at all times

48. . Sitting grading: (Assessed at completed 8
months)
Grade 0 No sitting at all.
Grade I Sits momentarily.
Grade II Sits 30 seconds or more leaning forward.
Grade III Sit with the child’s back straight.
Grade IV While sitting, can turn around and
manipulate a toy.
Grade V Raises self to sitting position

49. . Standing grading: (Assessed at completed 12 months)
Grade 0 Not standing well.
Grade I Stands holding on to a furniture momentarily.
Grade II Take few steps with both hands supported.
Grade III Can stand alone with legs apart.
Grade IV Come to standing position by throwing weight on arms.
Grade V Without support takes few steps.
(Interpretation of CDC grading: Grade III, IV, V—
normal for that age

50. Trivandrum Developmental
Screening Chart (TDSC)
 This is a simple developmental screening test for babies below 2 years;
 it is used in large scale community developmental screening programs by
anganwadi workers (community health workers) and other health workers.
 The left end of each horizontal dark line represents the age at which 3% of
children passed the item and the right end represents the age at which 97% of
the children passed the item.
 A vertical line is drawn or a pencil is kept vertically, at the level of the
chronological age of the child being tested. If the child fails to achieve any item
that falls short on the left side of the vertical line, the child is considered to
have a developmental delay.

52. Bayley developmental
screening chart
• It measures the mental(cognitive) and motor development and test
the behaviour of infants from one to 42 months of age
• It takes 45-60min to complete , administered by examiners who are
experienced clinicians
• The examiners presents a series of test materials to the child and
observes the child’s responses and behaviours
Mental scale – it yields a score called mental development index ,
evaluates severe types of abilities, sensory/perceptual acuities,
discriminations and response , acquisition of object constancy, memory
learning and problem solving, vocalisation , basis of abstract thinking,
habituation, mathematical concept formation

53. Behavior rating scale-
Motor scale – it assesses the degree of body control ,
large muscle coordination, fine coordination, postural
imitation, stereognosis
It has 30 items which rates child’s relevant behaviors and
measures attention/arousal , orientation, emotional
regulation.

54. Baroda developmental
screening test
• It is a simplified bayley scales having 22 motor items and 31 mental
items
• It is grouped age wise , one monthly in the first 1 months and 3
monthly thereafter till 30 months
• The 50 percent and 97 percent age placement of each item has been
plotted on a graph and joined to have two smooth curves. The total
number of items passed by a child is plotted against his chronological
age or corrected age if preterm
• When this point falls below 97 percentile curve , this child is
considered to have developmental delay and is subjected to detailed
assessment

55. Denver developmental
screening test(ddst)
• It is used to assess for examining the developmental
progress of children from birth until the age of six
• The test consists of 125 items divided int 4 domains
• Social- aspects of socialisation inside and outside the
home
• Fine motor – eye/hand coordination, manipulation of
small objects eg. Grasping and drawing
• Language- production of sounds, ability to recognise ,
understand and use of language
• Gross motor – siting, walking, jumping and other
movements

56. • Performance rated as pass/ caution/delay
• Interpretation-
• Draw a vertical line at the child’s chronological age on the charts , if the infant
was premature , substract the months premature from chronological age
• The more items a child fails to perform passed by 90% of his/her peers, the
more likely the child manifests a significant developmental deviation

57. Definitive test

58. Stanford–Binet
Intelligence Scales
• it is an individually administered intelligence test that was revised from
the original Binet–Simon Scale by Lewis Terman, a psychologist at
Stanford University. The Stanford–Binet Intelligence Scale is now in its
fifth edition (SB5) and was released in 2003.
• The test measures five weighted factors and consists of both verbal and
nonverbal subtests.
• The five factors being tested are knowledge, quantitative reasoning,
visual-spatial processing, working memory, and fluid reasoning
• It is for age group 2-23yrs
• Yields intelligent quotient

59. Fluid reasoning Knowledge
Quantitative
reasoning
Visual-spatial
processing
Working
memory
Early reasoning Vocabulary
Non-verbal
quantitative
reasoning (non-
verbal)
Form board and
form
patterns(non-
verbal)
Delayed
response (non-
verbal)
Verbal
absurdities
Procedural
knowledge (non-
verbal)
Verbal
quantitative
reasoning
Position and
direction
Block span (non-
verbal)
Verbal analogies
Picture
absurdities (non-
verbal)
Memory for
sentences
Object series
matrices (non-
verbal)
Last word

60. IQ Range ("deviation IQ") IQ Classification
145–160 Very gifted or highly advanced
130–144 Gifted or very advanced
120–129 Superior
110–119 High average
90–109 Average
80–89 Low average
70–79 Borderline impaired or delayed
55–69 Mildly impaired or delayed
40–54 Moderately impaired or delayed

61. Binet- Kamath intelligence
scale
• It undertook a revision of the Stanford binet scale
• Age limit is of 3 yrs to 22 yrs
• For each item passed the child earns a credit of 2
months, 4 months or 6 months depending on the
corresponding age