DEVELOPMENTAL MILESTONES
DEVELOPMENTAL MILESTONES
Development is a highly complex, dynamic process characterised by spurts and plateaus (Oberklaid & Drever, 2011). As development is not always predictable or linear, a sound understanding of typical developmental milestones enables physiotherapists to detect problems early (Australian Children’s Education and Care Quality Authority (ACECQA), 2015). Early detection of developmental delay provides an opportunity for early intervention to shift a child’s developmental trajectory and optimise their potential (Oberklaid & Drever, 2011).
When tracking an infant’s development who was born prematurely, it is important to adjust their age to accurately assess their developmental milestones. The Neonatal Research Network (2019) have produced a simple calculator to determine an infant’s adjusted age.
Figure 1. Gross Motor Development (Adolph & Franchak, 2017)
DEVELOPMENTAL SCREENING TOOLS
Developmental screening tools may be used to ascertain developmental risk and identify problems in infants considered to have difficulties (Oberklaid & Drever, 2011). The table below outlines several developmental screening tests that may be used in clinical practice.
Adapted from the Australian Government Department of Health (2013)
RED FLAG EARLY INTERVENTION REFERRAL GUIDE
Developmental red flags refer to functional indicators which are linked to the absence or delay of skills, that suggest the need for further evaluation from appropriate disciplines. Table 2 identifies red flags for each stage of infant development. The below guide should not be used as a ‘milsetones’ screener, as red flags are not indicative of typical developmental milestones (Central Queensland Hospital and Health Service (CQHHS), 2016).
A single red flag is not always an indication for concern or referral, however, the presence of multiple red flags across any of the developmental areas that impacts upon the infant’s everyday functioning and participation is a prompt for further diagnostic evaluation (CQHHS, 2016).
Infants with developmental concerns may benefit from input from a multidisciplinary team of health professionals. Therefore, referrals to Paediatricians, Speech Pathologists, Occupational Therapists, Social Workers etc. should be made where appropriate. For infants with developmental delay or disability that are likely to require ongoing multidisciplinary team input, referral to the Early Childhood Early Intervention (ECEI) branch of the National Disability Insurance Scheme (NDIS; 2019) may be necessary.
Developmental
Area
6 Months
9 Months
12 Months
Red Flags at any Stage
Gross Motor
-
Not holding head and shoulders up with good control when prone
-
Significant head lag during pull to sit
-
Not holding head with control in supported sitting
-
Not rolling
-
Not sitting independently / without support
-
Not moving (Eg. creeping or crawling)
-
Not taking weight on legs when held in standing
-
No form of independent mobility (Eg. crawling, commando crawling, bottom shuffling)
-
Not pulling to stand independently
-
Not standing holding onto furniture
Fine Motor, Cognition and Self-Care
-
Not reaching for and grasping toys
-
Hands frequently clenched
-
Does not explore objects with hands, eyes and mouth
-
Does not bring hands together at midline
-
Does not hold objects
-
Does not give objects on request
-
Cannot move toy from one hand to the other
-
Does not feed self, finger foods or hold own bottle / cup
-
Unable to pick up small items using index finger and thumb
Communication
-
Not starting to babble (Eg. aahh, oohh)
-
No gestures (Eg. pointing, showing, waving)
-
Not using two-part babble (Eg. dada, bubu)
-
No babbled phrases that sound like talking
-
No response to familiar words (Eg. bottle, daddy)
Social / Emotional
-
Does not smile or squeal in response to people
-
Not sharing enjoyment with others using eye contact or facial expression
-
Does not notice someone new
-
Does not play early turn taking games (Eg. peekaboo, rolling a ball)
-
Not achieving indicated developmental milestones
-
Strong parent concerns
-
Significant loss of skills
-
Marked low tone (floppy) or high tone (stiff and tense) and significantly impacting on development and functional motor skills
-
Lack of response to sound or visual stimuli
-
Poor interaction with adults or other children
-
Lack of, or limited eye contact
-
Difference between right and left sides of the body in terms of strength, movement or tone
Adapted from the CQHHS (2016) and
National Task Force for Early Identification of Childhood Neuromuscular Disorders (2019).