Chapter 4 l Development

Table 4-2. Developmental Milestones

Gross Motor Visual Motor Language Social Adaptive

Birth • Symmetric • Visually fixes on an • Alerts to sound • Regards face

movements in supine object
• Head flat in prone

2 months • Head in midline while • Follows past midline • Smiles in response to • Recognizes parent
held sitting touch and voice
• Raises head in prone
• Begins to lift chest

4 months • Holds head steadily • Reaches with both • Laughs • Likes to look around
• Supports on forearms arms together • Orients to voice
in prone • Hands to midline • Coos
• Rolls from prone to
supine

6 months • Sits with support • Unilateral reach • Babbles • Recognizes that

(tripod) • Raking grasp someone is a
• Feet in mouth in stranger
• Transfers object
supine

7 months • Rolls from supine to

prone
• May crawl
• Starts to sit without
support

9 months • Crawls well • Immature pincer • “Mama,” “dada,” • Plays gesture games
• Pulls to stand grasp indiscriminately • Explores environment
• Starting to cruise • Holds bottle • Understands “no” (crawling and
• Throws object (not • Understands gestures cruising)
overhand)

12 months • May walk alone (must • Mature pincer grasp • 1-2 words other than • Imitates actions
by 18 months) • Crayon marks “mama” and “dada” • Comes when called
(used appropriately)
• Object permanence • Cooperates with
(from 10 months) • Follows 1-step dressing
command with
gesture

15 months • Creeps up stairs • Scribbles and builds • 4-6 words • Uses cup and spoon
• Walks backward towers of 2 blocks in • Follows 1-step (variable until 18
imitation command without months)
gesture

18 months • Runs • Scribbles • 15-25 words • Imitates parents in

• Throws objects spontaneously • Knows 5 body parts tasks
overhand while • Builds tower of 3 • Plays in company of
standing blocks other children

(Continued)

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 USMLE Step 2 CK l Pediatrics

Table 4-2. Developmental Milestones (Cont’d)

Gross Motor Visual Motor Language Social Adaptive

24 months • Walks up and down • Imitates stroke (up or • 50 words • Parallel play
stairs one foot at a down) with pencil • 2-word sentences
time • Builds tower of • Follows 2-step
7 blocks commands
• Removes clothing • Uses pronouns
inappropriately

3 years • Alternates feet going • Copies a circle • ≥250 words • Group play
up the stairs • Undresses • 3-word sentences • Shares
• Pedals tricycle completely • Plurals • Takes turns
• Dresses partially • All pronouns • Knows full name, age
• Unbuttons and gender
• Dries hands

4 years • Alternates feet going • Copies a square • Knows colors • Plays cooperatively
downstairs • Buttons clothing • Recites songs from • Tells “tall tales”
• Hops and skips • Dresses completely memory

• Catches ball • Asks questions

5 years • Skips alternating feet • Copies triangle • Prints first name • Plays cooperative
• Jumps over lower • Ties shoes • Asks what a word games
obstacles • Spreads with knife means • Abides by rules
• Answers all “wh-” • Likes to help in
questions household tasks
• Tells a story
• Plays pretend
• Knows alphabet

Clinical Recall

A young boy is able to walk and build a tower with 7 blocks. He plays well
alongside other children and can say “my toy” or “my turn,” with an
inventory of about 50 words. What is the most likely age of the child?

A. 12 months
B. 15 months
C. 18 months
D. 24 months
E. 36 months

Answer: D

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