Developmental Milestones

Developmental Milestones

The following resource was developed by Dr. Debbi Andrews and Dr. Cara Dosman from the University of Alberta, Department of Pediatrics, Division of Developmental Pediatrics.

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Developmental surveillance is an important part of healthy child monitoring, and many parents will have concerns about their child’s development. Developmental milestones are key skills that follow a predictable pattern as a child ages. Knowing your milestones will allow you to more confidently assess development, but many students dread memorization of long lists of milestones. There is a better way! 

The "Snapshots Developmental Milestones" reference summarizes common milestones from newborn to age five at the usual ages of well-child visits in Canada. These milestones are listed at about the 50th percentile of children, meaning that at a given age, 50% of children will have obtained the listed milestones, while half of children assessed may still be developing that skill. The table is colour-coded green because it represents what is typical at each age, in other words what you are very likely to find when seeing a child of that age in clinic. It is a good starting point for learning about child development.  The second page of the chart includes descriptions of each developmental domain, red flags, and examples of specific developmental disorders to consider.

For a more detailed approach, please see our podcast on "Developmental Assessment," which reviews the content of the clerkship seminar on this subject.

Here are some tips for using this table:

  • The milestones in this chart were picked because they are either easy for parents to remember or easy for you to see.
  • Ask about age-appropriate milestones in each domain.  If a child has not reached that milestone yet, you can ask about other skills earlier in the sequence.  Conversely, you can ask about later skills to assess advanced development.
  • Ask about current milestones. It is easy to assess what a child is doing today, but can be difficult to remember what a child was doing 6 months ago.
  • Parents tend to remember major milestones like a child's first words or first steps.
  • If a child hasn’t reached a milestone in this table, this does not mean they have a developmental delay, but it does mean you will need to look more closely. You will need to specify if this is truly abnormal development, as half of normal children will be below the 50th percentile.  Work backwards and see if you can find what age level of items the child can do.
  • Remember that any developmental concerns you identify should be followed up by a standardised screener like the ASQ or the PEDS-DM which is much more accurate than history alone.
  • Do not try to memorize all of the milestones!  Start with a few memorable milestones in each sector, and then review milestones as you see children of different ages in clinic.  It’s easier to remember real children than lists.
  • Use your chart often.  The more you practice your developmental review on real children, the more milestones you will add to your knowledge base.
  • Always check the percentile at which milestones are reported whenever using a milestone chart!

Next steps:

Once you have mastered the 50th percentile for normal or “typical” development, you may want to learn more about the ages when most children have mastered the milestones (90-95th percentile), which is usually the focus of your learning during pediatric or family medicine residency training. 

For evidence-based red flags developmental milestones (90th-percentile where possible), you can read the following publication from Drs. Dosman, Andrews and Goulden: "Evidence-based milestone ages as a framework for developmental surveillance."

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