4-6 Month Milestones
GROSS MOTOR MILESTONES
Key Developmental Milestones
Further Diagnostic Testing / Referral
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General Movements: normal fidgety movements
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Prone: able to prop on hands | arms extended in front of body | raise head and chest off mat | maintain chin tuck | reach for nearby toys | kick lower limbs | pivot developing | may begin to make crawling movements
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Supine: able to maintain head in midline | play with hands, feet and toes in midline | reach and grasp dangling toys
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Transfers: initially able to roll from prone to supine (~5months) | able to roll from supine to prone (~6months)
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Sitting: able to sit with extended arm support | maintain head control | extension of cervical spine | begins to extend thoracic and lumbar spine | reach for objects outside base of support equally with both hands | anterior propping reactions emerge
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Standing: initially tends to withdraw legs during supported standing | begins to accept entire weight through legs during supported standing
Proceed to examine the ‘tone’ and ‘reflexes and reactions’ component of the Hammersmith Infant Neurological Examination (HINE) if the infant:
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Has poor head control or is unable to lift head in prone
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Has poor head control and a rounded back when sitting
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Has significant head lag, arches back and/or stiffens legs during pull to a sit
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Has not attempted to roll from prone to supine
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Holds arms back and has stiff legs in supported standing
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Note: For a 4-6-month-old infant the following is expected:
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Pull to Sit: anticipates movement by pulling with upper limbs to sitting | able to maintain head and trunk control | head and shoulders flexed | upper limbs flexed | flexion at the hips | control lowering of head and trunk upon return to supine
The following videos and links explain and demonstrate expected gross motor milestones of infants at 4-6 months.
Video 13. Pull to Sit
(Larsen & Stensaas, 2019b)
Video 14-15. Gross Motor Skills
(Larsen & Stensaas, 2019b)
FINE MOTOR MILESTONES
Key Developmental Milestones
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Reaches for and grasps objects using both hands equally
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Brings objects to midline (usually the mouth)
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Transfers toys from one hand to the other
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Grasps objects the size of a cube
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Uses palmar grasp motion to trap objects with fingers against the palm
The following video and links explain and demonstrate expected fine motor milestones of infants at 4-6 months.
Further Diagnostic Testing / Referral
Refer to a Paediatrician and Occupational Therapist if the infant:
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Does not reach for and grasp toys
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Frequently has clenched fists
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Does not transfer objects between hands
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Does not bring hands together at midline
Video 16. Fine Motor Skills
(Larsen & Stensaas, 2019b)
COGNITIVE MILESTONES
Key Developmental Milestones
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Eyes smoothly track and follow objects in unison through the horizontal and vertical plane
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Enjoys shaking and banging toys / objects
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Will search for partly hidden objects
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Explores toys with eyes, hands and mouth
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Repeats accidentally caused actions that are interesting
The following video and link explains and demonstrates expected cognitive milestones of infants at 4-6 months.
Further Diagnostic Testing / Referral
Refer to a Paediatrician if the infant:
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Does not visually track moving objects
Video 17. Cognitive Skills
(Larsen & Stensaas, 2019b)
COMMUNICATION MILESTONES
Key Developmental Milestones
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Uses consonant sounds when babbling (Eg. da, da, da)
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Uses babbling to get attention
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Reacts to sudden noises or sounds
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Turns head to sound of voices
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Listen and responds to own name
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Makes different types of sounds to express feelings
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Notices toys that make sounds
Further Diagnostic Testing / Referral
Refer to a Paediatrician and Speech Pathologist if the infant:
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Has not started to babble
Refer for a hearing test if the infant:
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Does not respond to sounds or voices
The following link explains and demonstrates expected communication milestones of infants at 4-6 months.
SOCIAL / EMOTIONAL MILESTONES
Key Developmental Milestones
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Smiles, laughs and babbles during social interactions
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Recognises familiar faces and stretches arms to be lifted
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Enjoys playful interactions with others (Eg. peek a boo)
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Smiles and shows excitement when sees preparations being made for meals or bath
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Begins to show wariness of strangers
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May fret when parent leaves the room
The following video and link explains and demonstrates expected social / emotional milestones of infants at 4-6 months.
Further Diagnostic Testing / Referral
Refer to a Paediatrician if the infant:
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Does not respond to familiar faces / carers
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Does not smile or squeal in response to people
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Avoids eye contact
Video 18. Social / Emotional Skills
(Larsen & Stensaas, 2019b)
REFLEXES
Key Developmental Milestones
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Primitive reflexes including the Moro Reflex and Asymmetric Tonic Neck Reflex should have abated by ~6months of age
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Plantar Grasp Reflex: when the ball of an infant’s foot is touched, the infant’s toes will flex and adduct
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Positive Support Reflex: when the infant is placed in vertical suspension with their feet touching the mat, the infant will extend their legs and attempt to support their weight
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Landau Reflex: when the infant is suspended in a prone position, the infants head and lower limbs will extend. When the infant’s head is gently pushed into flexion, the lower limbs drop into flexion
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Lateral Propping Reflex: when the infant is falling to one side or the other, the infant with extend their arm laterally to catch themselves
The following videos explain and demonstrate expected reflexes of infants at 4-6 months.
Video 19-23. Reflexes
(Larsen & Stensaas, 2019b)
The above information has been adapted from ACECQA (2015); Larsen & Stensaas (2019b); and Pathways (2019b).