Guided parental surveillance and intervention of infant development and referral to subspecialists as needed

Adapted from American Academy of Pediatrics. "Caring for Your Baby and Young Child: Birth to Age 5, Fourth Edition" (Bantam Books, 2005)

Developmental Milestones for Babies

During the first year of life, your baby will grow and develop at an amazing speed. Her weight will double by 5 to 6 months, and triple by her first birthday. And she is constantly learning. Major achievements—called developmental milestones—include rolling over, sitting up, standing and possibly walking. And your heart will likely melt at the sound of her first “mama” or “dada.”
No two babies are exactly alike. Your baby will develop at her own pace. Most babies reach certain milestones at similar ages. However, it's not unusual for a healthy, “normal” baby to fall behind in some areas or race ahead in others.

The following milestones are only guidelines.* Your baby's health care provider will evaluate your baby's development at each well-baby visit. Remember: Always talk to your child's health care professional if you think your baby is lagging behind.

If your baby was born prematurely (before 37 weeks of pregnancy), you need to look at the milestone guidelines a little differently. The age at which your baby is expected to reach various milestones is based on her due date, not her birthday. So if your baby was born two months early, she will most likely achieve milestones two months later than the guidelines below predict.


By the end of their first month, most babies:

Make jerky, quivering arm movements
Bring hands near face
Keep hands in tight fists
Move head from side to side while lying on stomach
Focus on objects 8 to 12 inches away
Prefer human faces over other shapes
Prefer black-and-white or high-contrast patterns
Hear very well
Recognize some sounds, including parents' voices


By the end of their third month, most babies:

Raise head and chest when lying on stomach
Support upper body with arms when lying on stomach
Stretch legs out and kick when lying on stomach or back
Push down on legs when feet are placed on a firm surface
Open and shut hands
Bring hands to mouth
Grab and shake hand toys
Follow moving object with eyes
Watch faces closely
Recognize familiar objects and people at a distance
Start using hands and eyes in coordination
Begin to babble and to imitate some sounds
Smile at the sound of parents' voices
Enjoy playing with other people
May cry when playing stops


By the end of their seventh month, most babies:

Roll over both ways (stomach to back and back to stomach)
Sit up
Reach for object with hand
Transfer objects from one hand to the other
Support whole weight on legs when held upright
Develop full-color vision and mature distance vision
Use voice to express joy and displeasure
Respond to own name
Babble chains of consonants (ba-ba-ba-ba)
Distinguish emotions by tone of voice
Explore objects with hands and mouth
Struggle to get objects that are out of reach
Enjoy playing peek-a-boo
Show an interest in mirror images


By their first birthday, most babies:

Sit without assistance
Get into hands-and-knees position
Crawl
Pull self up to stand
Walk holding onto furniture, and possibly a few steps without support
Use pincer grasp (thumb and forefinger)
Say “dada” and “mama”
Use exclamations, such as “oh-oh!”
Try to imitate words
Respond to “no” and simple verbal requests
Use simple gestures, such as shaking head “no” and waving bye-bye
Explore objects in many ways (shaking, banging, throwing, dropping)
Begin to use objects correctly (drinking from cup, brushing hair)
Find hidden objects easily
Look at correct picture when an image is named


By their second birthday, most children:

Walk alone
Pull toys behind them while walking
Carry large toy or several toys while walking
Begin to run
Kick a ball
Climb on and off furniture without help
Walk up and down stairs while holding on to support
Scribble with crayon
Build tower of four blocks or more
Recognize names of familiar people, objects and body parts
Say several single words (by 15 to 18 months)
Use simple phrases (by 18 to 24 months)
Use two- to four-word sentences (“want snack”)
Follow simple instructions
Begin to sort objects by shapes and colors
Begin to play make-believe
Imitate behavior of others
Show growing independence


Promoting infant development from birth to one year (from MayoClinic.com)

0-3 months

	Hold your baby. Gentle caresses and tender kisses can help your newborn feel safe, secure and loved. Hold and rock your baby. Allow him or her to study your face. Let your baby grasp your little finger and touch your face.
	Speak freely. Simple conversation lays the groundwork for language development, even before your baby can understand a word. Ask questions and respond to your baby's coos and gurgles. Describe what you see, hear and smell around the house, outdoors, and when you're out and about. Use simple words that apply to your baby's everyday life. Remember that your tone of voice communicates ideas and emotions as well.
	Change positions. Hold your baby facing outward. With close supervision, place your baby on his or her tummy to play. Hold a colorful toy or make an interesting noise to encourage your baby to pick up his or her head. Many newborns get fussy or frustrated on their tummies, so keep these sessions brief at first — just a few minutes at a time. If drowsiness sets in, place your baby on his or her back to sleep.
	Respond quickly to tears. In any given day, the average newborn cries for more than two hours. Whether your baby needs a diaper change, feeding session or simply warm contact, respond quickly. Your attention will help build a strong bond with your baby — and the confidence he or she will need to settle down without your help one day.

4-6 months

At this age, learning and play are inseparable. But it doesn't take expensive educational toys or intense effort to capture your baby's attention. Consider these simple ideas to promote infant development.

	Talk to your baby. Your baby may be too young to understand specific words, but easy conversation can lay the groundwork for language development. Your tone of voice can communicate ideas and emotions as well. Ask questions and respond to your baby's coos and gurgles. Describe what you see, hear and smell around the house, outdoors, and when you're out and about. Use simple words that apply to your baby's everyday life.
	Change positions. Lay your baby on his or her tummy for a few minutes, as long as an attentive adult supervises. Hold a colorful toy or make an interesting noise to encourage your baby to pick up his or her head or practice rolling over. Hold your baby's hands while he or she is lying down and say, "Are you ready to stand up? Here we go!" Count to three as you gently pull your baby to a standing position. When your baby's ready, try a sitting position. Hold your baby or use pillows for support.
	Offer simple toys. Babies this age often enjoy colorful toys, especially those that make sounds. Try a musical toy, a small rattle with a handle, a soft doll or a sturdy book. Household items such as plastic bowls and measuring cups may be a hit as well. Avoid toys with small detachable parts. To help your baby focus, put out only one or two toys at a time. Place one toy slightly out of reach to encourage your baby to stretch and creep. Shake a rattle behind your baby's head and let him or her turn and grab it.
	Read to your baby. Your baby won't grasp the plot, but that's OK. Reading helps babies develop speech and thought. Your baby will soak in your words and may even mimic the sounds you make. Start with books featuring large, brightly colored pictures. Describe what's happening on each page. Point to and name common objects.
	Play favorite games. Cover your face with your hands, then remove your hands and say, "Peekaboo, I see you!" Play patty-cake. Ask, "Where are your toes?" Then touch your child's toes and say, "Here are your toes!" Hide one of your baby's toys with the corner of a blanket and encourage him or her to find it.
	Head out. Simple activities such as a walk through the neighborhood or a trip to the supermarket can be great adventures for a baby. Even the most routine outings will expose your baby to new sights and sounds.
	Take time to cuddle. Balance stimulation with plenty of quiet time. Gentle caresses and tender kisses can help your baby feel safe, secure and loved. When you hold or rock your baby, talk quietly or sing lullabies or other soothing songs.
	Turn on the tunes. Music can help soothe, entertain and teach your baby. Try calming lullabies, upbeat children's songs, classical music or your own favorites.
	Let your baby set the pace. When your baby turns away, closes his or her eyes, or gets fussy, take a break. Even babies need their space. Responding to your baby's needs will help you continue to build your baby's trust in you.

7-9 months

For babies of any age, learning and play are inseparable. Here's what you can do at home to support your budding adventurer.

	Create an exploration-safe environment. Keep only safe objects within your baby's reach. Move anything that could be poisonous, pose a choking hazard or break into small pieces. Cover electrical outlets, use stairway gates, place cords from blinds or shades out of reach, and install child locks on doors and cabinets. If you have furniture with sharp edges, remove it from rooms where your baby plays. The same goes for lightweight objects your baby may use to pull himself or herself to a standing position, such as plant stands, decorative tables, potted trees and floor lamps.
	Keep chatting. Chances are, you've been talking to your baby all along. Keep it up! Narrate what you're doing, and give your baby time to respond. Say something to your baby and then wait for him or her to repeat the sounds. Ask your baby questions that involve more than a yes or no response. You may not be able to pick words from your baby's babble, but you can encourage a back-and-forth conversation.
	Teach cause and effect. Push the button on a musical toy and dance to the tune. Open the door on the toy barn and listen to the cow say "moo." Help your baby do the same. Self-confidence will grow as your baby realizes he or she can make things happen.
	Take time to play. By now, you and your baby may be old pros at classics such as peekaboo, patty-cake and itsy-bitsy spider. Get creative as you add to your repertoire. Crouch behind a chair or the dresser, leaving a hand or foot within your baby's view, and prompt your baby to look for you. Or make an obstacle course. Arrange cushions and pillows on a carpeted floor. Encourage your baby to creep or crawl over the mounds.
	Pull out the books. Set aside time for reading every day — even if it's only a few minutes. Reading aloud is one of the simplest ways to boost your baby's language development. Make it more interesting with facial expressions, sound effects and voices for various characters. Store books within easy reach so that your baby can explore them whenever the mood strikes.
	Turn on the tunes. Music can help soothe, entertain and teach your baby. Try calming lullabies, upbeat children's songs, classical music or your own favorites.
	Encourage experimentation. Toy box aside, help your baby's imagination and creativity take shape. If you're up for a mess, smear applesauce, pudding or another pureed food on the highchair tray and let your baby "paint" with the mixture. Give your baby measuring cups for stacking or clapping together. At bath time, provide small containers and plastic utensils for pouring and mixing.
	Offer a comfort object. Babies this age often form an attachment to a blanket, stuffed animal or other comfort object. Although holding, rocking and cuddling your baby remain as important as ever, a comfort object can help your baby feel secure when you're not in sight or your baby is tired, frightened or upset.

	Create an exploration-safe environment. Keep only safe objects within your baby's reach. Move anything that could be poisonous, pose a choking hazard or break into small pieces. Cover electrical outlets, use stairway gates, and install child locks on doors and cabinets. If you have furniture with sharp edges, remove it from rooms where your baby plays. The same goes for lightweight objects your baby may use to pull himself or herself to a standing position, such as plant stands, decorative tables, potted trees and floor lamps.
	ß Snuggle up and read. Set aside time for reading every day — even if it's only a few minutes. At this age, your baby may love books with flaps, textures or simple activities. Make your reading more interesting by adding facial expressions, sound effects and voices for various characters. Store books within easy reach so that your baby can explore them whenever the mood strikes.
	Keep conversations going. If your baby reaches for a book, ask, "Would you like to read a story?" If he or she points to the cow on the cover, say, "You found the cow! What does a cow say?" Wait for your baby's response and then offer the correct answer. As you're reading the book, get creative. Make up your own stories to fit the pictures. Ask your baby questions about the pictures. Don't limit yourself to "yes" or "no" questions.
	Encourage repetition. Doing things repeatedly can build self-confidence — and strengthen the connections in your baby's brain. Play patty-cake one more time. Build a new tower after the first one tumbles down. If your baby returns to a page you've just read, read it again with as much excitement as you did the first time.
	Turn on the tunes. Music can help soothe, entertain and teach your baby. Try calming lullabies, upbeat children's songs, classical music or your own favorites.
	Help your baby handle his or her feelings. Expect episodes of frustration as your baby struggles to make sense and take control of his or her environment. If your baby throws plastic rings out of frustration, calmly pick up the pieces and say, "I can see you're frustrated. Let's figure it out. The big ring goes here. Now you try." For some babies, learning a few simple words in sign language can be helpful as well. Help your baby make simple motions for common words, such as milk, snack and blanket.
	Set limits. Babies don't have a sense of right or wrong. Praise your baby for good choices while steering him or her away from hazardous situations. Use a firm "no" when your baby may be hurt or is hurting others. Explain calmly why the behavior is not OK, and then distract your baby with a favorite toy or other activity.