Developmental Milestones Rescue
You'll answer 90% of developmental milestones questions by memorizing these few lines:
- While prone, lifts head up 90° --> 1 mo
- Rolls front to back --> 4-5 mo
- Sits with no support --> 7 mo
- Voluntary grasp (no release) --> 5 mo
- Voluntary grasp with voluntary release --> 10 mo
- Plays pat-a-cake --> 9-10 mo
- Can build tower of 2 cubes --> 13-15 mo
- Can build tower of 6 cubes --> 2 yr
- Good use of cup and spoon --> 15-18 mo
- Understands 1-step commands (no gesture) --> 15 mo
- Separation anxiety --> 12-15 mo
- First words --> 9-12 mo
- Imitates others' sounds --> 9-12 mo
- Cooing --> 2-4 mo
- Ties shoelaces --> 5 yr
- Waves "bye-bye" --> 10 mo
- Social smile --> 1-2 mo
- Runs well --> 2 yr
- Walks without help --> 13 mo
- Pulls to stand --> 9 mo
- Stranger anxiety --> 6-9 mo
*Reduce the age of premature infants in the first 2 years for assessing development. For example, for children born after 6 months' gestation, subtract 3 months from their chronologic age. Therefore, they
should be expected to perform only at the 6-month-old level when they are 9 months old.
Q True or false: The overall pattern of development is more important than the age at which individual milestones are reached?
A True. The exact age is not as important as the overall pattern in looking for dysfunctional development. When in doubt, use a formal developmental test.
Q What screening and preventive care measures should be done at every pediatric visit?
A Height, weight, blood pressure, developmental behavioral assessment, and anticipatory guidance (counseling/discussion about age-appropriate concerns).
Q True or false: Screening and preventive care are important mainly during a well check-up.
A False. Screening and preventive care are an important part of every encounter with a patient (adult or child). Questions may try to fool you on this point. For example, a mother complains that her 4-year-old child sleeps 11 hours every night. This is normal behavior. The answer to the
question, "What should you do next?," may be to give an objective hearing exam, which is a routine screening procedure in a 4 year old.
Q What are the commonly performed screening tests for metabolic and congenital disorders?
A All states screen for hypothyroidism and phenylketonuria at birth; screens must be done within the first month of life. Most states screen for galactosemia and sickle cell disease.