Birth weight

Doubles by 5 months

Triples by 1 year

Quadruples by 2 years

Normal HC at birth (Term) = 35cm

HC at 12 months, 35+12 = 47cm

GROSS MOTOR MILESTONES

(First Year of Life)

• 3 Months - Supports chest in prone on outstretched arms (Puppy prop)
• 6 Months - Sits with trunk support only (no hands)
• 9 Months - Creeping
• 12 Months - Walking

Gross Motor Milestones

1 Month

Gross Motor Milestones

2 Months

Gross Motor Milestones

3 Months

• "Puppy prop" Weight Supported on Forearms with Head Up, Chest Clears Mat

• Some Head Lag on Pull to Sit

Gross Motor Milestones

4 Months

• Chest Off the Mat with Weight Bearing on Extended Arms in Prone

• Rolls Front to Back

• Head Even on Pull to Sit

Gross Motor Milestones

5 Months

• Rolls Back to Front

• Leads with Head on Pull to Sit

Gross Motor Milestones

6 Months

Gross Motor Milestones

7 Months

• Sits Without Support

• Commando/Combat Crawl

Gross Motor Milestones

8 Months

• Assumes Sitting Position

• Can Reach From Quadruped (Hands and Knees)

Gross Motor Milestones

9 Months

• Pulls to Stand

• Creeps on Hands and Knees

Gross Motor Milestones

10 Months

Gross Motor Milestones

11 Months

Gross Motor Milestones

12 Months

Gross Motor Milestones

18 Months

• Runs
• Pushes Large Object
• Throws Ball From Standing
• Can Ascend and Descend Stairs With One Hand Held

Gross Motor Milestones

24 Months

• Runs Well
• Kicks Ball
• Jumps in Place
• Throws Ball Overhand
• Ascends/Descends Stairs by Placing BOTH Feet on Each Step

Gross Motor Milestones

36 Months

• Pedals a Tricycle (3 years/3 wheels)
• Ascends Stairs by ALTERNATING Feet
• Descends by placing BOTH Feet on Each Step

Gross Motor Milestones

4 Years

• Hops 5 Times
• Balances on One Foot for 5 Seconds
• Ascends/Descends Stairs by Alternating Feet

Gross Motor Milestones

5 Years

• Skips by Alternating Feet
• Hops in Place 10 Times
• Balances on One Foot for Over 10 Seconds

Gross Motor Milestones

6 Years

• Hops on One Foot for 15 Feet

• Running Broad Jump of 2-3 Feet

Gross Motor Milestones

7 Years

Stair-Climbing Abilities

• 18 months:
• Ascend/Descend with one hand held
• 2 years:
• Ascend/Descend by placing BOTH feet on each step
• 3 years:
• Ascend with ALTERNATING feet
• Descend by placing BOTH feet on each step
• 4 years:
• Ascend/Descend by Alternating feet

• Rolling before 3 months
• Poor head control at 5 months
• Not sitting by 9 months
• Persistence of Moro, ATNR or tonic labyrinthine reflex past 6 months
• Hand dominance before 18 months
• Not walking independently by 18 months

14 months -----> Tower of 2 cubes

16 months -----> Tower of 3 cubes

18 months -----> Tower of 4 cubes

22 months -----> Tower of 6 cubes

36 months -----> Tower of 9 cubes

Fine Motor Milestones

3 Months

Fine Motor Milestones

6 Months

Fine Motor Milestones

9 Months

Fine Motor Milestones

10 Months

Fine Motor Milestones

12 Months

Fine Motor Milestones

16 Months

Runs

Pushes Large Object

Throws Ball From Standing

Runs Well

Kicks Ball

Jumps in Place

Throws Ball Overhand

36 months

(3 years/3 wheels)

Hops 5 times

Balances on one foot for 5 seconds

Skips by alternating feet

Hops in place 10 times

Balances on one foot for over 10 seconds

Hops on one foot for 15 seconds

Running broad jump of 2-3 feet

1 year ---> 2 words

2 years ---> 2 word sentences

Receptive Language Milestones

(4, 6, 10, 12, 14, 15, 18 and 24 months)

• 4 months: Looks Toward Voice
• 6 months: Turns Toward Voice
• 10 months: Comprehends "No", Orients to Name
• 12 months: Follows Command With Gesture
• 14 months: Follows Command Without Gesture
• 15 months: Points to Body Part
• 18 months: Points to 3 Body  Parts and Self
• 24 months: 2-Step Commands, Understands me/you

ExpressiveLanguage Milestones

(2, 6, 9, 10, 11, 14, 18 and 24 months)

• 2 months: Social Smile, Cooing
• 6 months: Babbles
• 9 months: Waves Bye
• 10 months: Dada/Mama Appropriate
• 11 months: First Word
• 14 months: Names 1 Object, Meaningful "No", Protodeclarative Pointing
• 18 months: 10-25 Words
• 24 months: 50+ Words

• Vocabulary
• 1 year  ---> 2 Words
• 2 years ---> 2 Word Sentences

• "Understandability"
• 2 years ---> 2/4 (50%)
• 3 years ---> 3/4 (75%)
• 4 years ---> 4/4 (100%)

Social/Emotional Milestones

(15-18, 18-21, 21-24 months)

• 15-18 months: 
• Awareness of self with coyness
• Awareness of shame and Guilt
• 18-21 months: 
• Associates feelings with words (Happy/Sad)
• Initiates Interactions With Adults
• 21-24 months: 
• Imitates to Please Others
• Parallel Play
• Modulates Emotional Expression by Social/Cultural Influences

Fragile X (Most are fertile)

Down Syndrome

• Clinical History
• 3-Generation Family HIstory
• Dysmorphologic Examination
• Neurologic Examination (MRI if there is a DEFINITE neurologic abnormality)
• Targeted Studies for Metabolic Disorders

• Consider: EEG/Serum Lead

• Characteristic facial anomalies
• Short palpebral fissures
• Flat upper lip
• Midface hypoplasia (flattened philtrum and midface)
• Evidence of Growth Retardation
• Low Birth Weight
• Decelerating weight gain over time not related to nutrition
• Disproportionately low weight-to-height ratio
• CNS Neurodevelopmental Abnormalities
• Microcephaly
• Structural Brain Abnormalities
• Microcephaly
• Agenesis of Corpus Callosum
• Cerebellar Hypoplasia
• Hard or soft neurologic signs
• Hearing Loss
• Fine Motor Coordination
• Difficulty with tandem gait
• Poor hand-eye coordination

• Cardiac
• ASD/VSD/TOF
• Skeletal
• Clinodactyly, pectus, nail hypoplasia, scoliosis, radial-ulnar stenosis, flexion contractures
• Renal
• Dysplastic/hypoplastic/aplastic, Horseshoe, Hydronephrosis
• Ocular
• Strabismus, refractive problems
• Auditory
• Neurosensory or conductive loss

• Greater then 200 repeats of CGG in FMR1 gene
• Males more severely affected (IQ 50-70). Females may be borderline normal
• MOST COMMON HERITABLE CAUSE OF COGNITIVE IMPAIRMENT

• Large ears
• Connective tissue differences: soft skin, flat feet, pectus excavatum, high palate
• Low muscle tone
• Flexible joints
• Long face
• Large testicles (after puberty)
• Seizures (20%)

Speech/Language Delay

Delayed crawling, walking, toileting

Tactile defensiveness (Sensory integration)

Impulsivity

Autism Spectrum D/O's

Cognitive impairments (Borderline to Mild MR)

+FH of CI, LD or ASD's

+FH of Adult-onset ataxia/tremor

Down Syndrome (Dysmorphology)

[7 features]

Small Brachycephalic Head
Epicanthal folds
Upslanting palpebral fissures
Flat Nasal Bridge

Simian Crease
Wide space between first and second toes
Clinodactyly (5th finger does not pass DIP of 4th finger)

Down Syndrome (Medical Conditions)

[5 with >50% occurence]

• Variable CI
• Hearing Loss Risk (75%) [Screen q6 months]
• OSA (50-79%) [Sleep eval before age 4]
• Eye disease [cataract, refractive error] (60%)
• Congenital Heart Dz [AV Canal, VSD, TOF] (50%) [ECHO prior to leaving hospital]

 Atlantoaxial xrays no longer routinely recommended

• Females
• Normal HC at birth
• Normal development until 6 months
• Between 6m and 30m, head growth slows and loss of language and social skills
• Purposeful hand movements lost
• Stereotyped hand movements ("Wringing" or "Washing")