Disclaimer: This material is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it. It is not intended to provide medical advice, diagnosis, or treatment, nor does it replace the advice or counsel of a doctor or health care professional. Reference to a specific commercial product, service, or external web site does not imply endorsement or recommendation of that product, service, or external web site content by CPCMG. We attempt to keep lists of resources and referrals as up to date as possible; however, this information is constantly changing. Please check with the service provider and your insurance company to verify coverage.
Preemie:
Was your baby born more than 3 weeks early? Read on for information from the American Academy of Pediatrics about developmental milestones for your premature/preterm baby (also known as a preemie).
Adjusted Age:
Keep in mind that babies develop at their own speed and in their own way. To understand how your baby is developing, it is important to ADJUST their age.
Here is what to do: subtract the number of weeks your baby was born early from your baby’s actual age in weeks (number of weeks since the date of birth). This is your baby’s adjusted or corrected age. (Your baby’s primary healthcare provider can help with this).
For this calculation, one month equals 4 weeks.
Examples of Adjusted Ages (below):
Actual Age | Weeks Born Early | Adjusted Age |
|---|---|---|
8 weeks (2 months) 4 weeks (1 month 24 weeks (6 months) | 4 weeks 3 weeks 5 weeks | 4 weeks (1 month) 1 week 19 weeks (4 months and 3 weeks) |
Calculate your baby’s adjusted age in weeks.
_________________ - | _____________________ = | ___________________ |
Actual age in weeks | Weeks born early | Adjusted age in weeks |
By 2 years of age, most children have caught up to the typical milestone range. If your child has not caught up, they may need extra support for a longer period.
Your child’s primary care provider can help with any concerns and support needed.
Your Child’s Progress:
You know your child better than anyone else. Even with an adjusted age, you will want to see your child move forward in their development.
For example, your child should go from pulling up, to standing, and then to walking. When you watch your child carefully, you will see ways they are growing well. You will also know whether they need more help.
Make sure to take your child to recommended well-child visits. At each visit, your child’s primary healthcare provider will check their progress and ask you about the ways you see your child growing.
Developmental Milestones:
Here is information about how babies and young children typically develop.
Examples of developmental milestones for ages 1 month to 6 years are listed below.
The developmental milestones are listed by month or year first because well-child visits are organized this way.
For a preterm baby, it is important to use the baby’s adjusted age when tracking development until 2 years of age.
What is your child’s adjusted age?
See milestone for the adjusted age in the next section.
NOTE: Ask your baby’s healthcare provider about Early Intervention (EI)—extra care some babies and children receive to help them develop.
At 1 Month (4 Weeks) Adjusted Age:
Social
Looks at parent; follows parent with their eyes.
Has self-comforting behaviors, such as bringing their hands to their mouth.
Starts to become fussy when bored; calms when picked up or is spoken to.
Looks briefly at objects.
Language
Makes brief, short vowel sounds (examples: e, a, o).
Alerts to unexpected sound; quiets or turns to parent’s voice.
Shows signs of sensitivity to the world around them such as crying, startling, or having tremors.
Motor
Moves both arms and both legs together.
Holds chin up when on tummy.
Opens fingers slightly when at rest.
At 2 Months (8 Weeks) Adjusted Age:
Social
Smiles when smiled at.
Makes sounds that show happiness or upset.
Language
Motor
Opens and shuts hands.
Lifts head and chest when lying on tummy.
Keeps head steady when held in a sitting position.
At 4 Months (16 Weeks) Adjusted Age:
Social
Laughs aloud.
Looks for parent or another caregiver when upset.
Language
Motor
Supports self on elbows and wrists when on tummy.
Rolls over from tummy to back.
Keeps hands open (not in a fist).
Plays with fingers near middle of body.
Grasps objects.
At 6 Months (24 Weeks) Adjusted Age:
Social
Pats or smiles at their own reflection.
Looks when name is called.
Language
Motor
Sits briefly without support.
Rolls over from back to tummy.
Passes a toy from one hand to another.
Rakes small objects with 4 fingers to pick them up
At 9 Months (36 Weeks) Adjusted Age:
Social
Uses basic gestures such as holding out arms to be picked up or waving bye-bye.
Looks for dropped objects.
Plays games such as peek-a-boo and pat-a-cake.
Turns consistently when their name is called.
Language
Says “Dada” or “Mama” nonspecifically.
Meaning they may say “Mama” to everyone or “Dada” to everyone.
Looks around when hearing things such as “Where’s your bottle?” or “Where’s your blanket?”
Copies sounds that parent or caregiver makes.
Motor
Sits well without support.
Pulls to a stand.
Moves easily between sitting and lying down.
Crawls on hands and knees.
Picks up food to eat.
Picks up small objects with 3 fingers and thumb.
Will let go of objects on purpose.
Bangs objects together.
At 12 Months (48 Weeks, or 1 Year) Adjusted Age:
Social
Looks for hidden objects.
Imitates new gestures.
Language
Uses “Dada” or “Mama” specifically.
Meaning will use “Mama” only for mom or the caretaker the infant identifies as mom and “Dada” for the dad or caretaker the infant identifies as dad.
Uses 1 word other than Mama, Dada, or a personal name.
Follows directions with gestures, such as motioning and saying, “Give me (object).”
Motor
Stands without support.
Drops an object into a cup.
Picks up small objects with 1 finger and thumb.
Picks up food to eat.
At 15 Months (60 Weeks, or 1 ¼ Years) Adjusted Age:
Social
Imitates scribbling.
Drinks from cup with little spilling.
Points to ask something or get help.
Looks around after hearing things such as “Where’s your ball?” or “Where’s your blanket?”
Language
Uses 3 words other than names.
Speaks in what sounds like an unknown language.
Follows directions even when a parent or caretaker is using words, not gestures.
Motor
Squats to pick up objects.
Crawls up a few steps.
Runs.
Makes marks with crayons.
Drops object into and takes it out of a cup.
At 18 Months (72 Weeks, or 1½ Years) Adjusted Age:
Social
Engages with others for play.
Helps dress and undress self.
Points to pictures in books or to objects of interest to draw parent’s or caregivers' attention to it.
Turns to look at adults if something new happens.
Begins to scoop with a spoon.
Uses words to ask for help.
Language
Identifies at least 2 body parts.
Names at least 5 familiar objects.
Motor
Walks up steps with 2 feet per step when hand is held.
Sits in a small chair.
Carries toy when walking.
Scribbles spontaneously.
Throws a small ball a few feet while standing.
At 24 Months (2 Years) Adjusted Age:
Social
Plays alongside other children.
Takes off some clothing.
Scoops well with a spoon.
Language
Uses at least 50 words.
Combines 2 words into short phrases or sentences.
Follows 2-part instructions.
Example: “Go get the ball and give it to me.”
Names at least 5 body parts.
Speaks in words that are about strangers can understand about 50% of the time.
Motor
Kicks a ball.
Jumps off the ground with 2 feet.
Runs with coordination.
Climbs up a ladder at a playground.
Stacks objects.
Turns book pages.
Uses hands to turn objects such as knobs, toys, or lids.
Draws lines.
At 2½ Years (30 months):
Social
Urinates in a potty or toilet.
Spears food with fork.
Washes and dries hands.
Increasingly engages in imaginary play.
Tries to get parents to watch by saying, “Look at me!”
Language
Uses pronouns correctly (examples: he, she, them).
Motor
Walks up steps, alternating feet.
Runs well without falling.
Copies a vertical line.
Grasps crayon with thumb and fingers instead of fist.
Catches large balls.
At 3 Years:
Social
Enters bathroom and pees in the potty on their own.
Puts on a coat, jacket, or shirt without help.
Eats without help.
Engages in imaginative play.
Plays well with others and shares.
Language
Uses 3-word sentences.
Speaks in words that strangers can understand about 75% of the time.
Tells you a story from a book or TV.
Compares things using words such as bigger or shorter.
Understands prepositions such as on or under.
Motor
Pedals a tricycle.
Climbs on and off couch or chair.
Jumps forward.
Draws a single circle.
Draws a person with a head and 1 other body part.
Cuts with child scissors.
At 4 Years:
Social
Enters bathroom and poops on the potty on their own.
Brushes their teeth.
Dresses and undresses without much help.
Engages in well-developed imaginative play.
Language
Answers questions such as “What do you do when you are cold?” or “What do you do when you are you sleepy?”
Uses 4-word sentences.
Strangers can understand them nearly 100% of the time.
Draws recognizable pictures.
Follows simple rules when playing a board or card game.
Tells parents or caregivers a story from a book.
Motor
Hops on one foot.
Climbs stairs while alternating feet without help.
Draws a person with at least 3 body parts.
Can draw a cross.
Unbuttons and buttons medium-sized buttons.
Grasps pencil with thumb and fingers instead of fist.
At 5 and 6 Years:
Social
Follows simple directions.
Dresses with little assistance.
Language
Has good language skills.
Can count to 10.
Names 4 or more colors.
Motor
Balances on one foot.
Hops and skips.
Able to tie a knot.
Draws a person with at least 6 body parts.
Can write some letters and some numbers.
Can copy a square and a triangle.
At School Age:
Ongoing Issues Your Child May Face
Once your child reaches school age, continue to monitor your child closely and check in with the teacher and school staff about any concerns they have.
The school staff can also help you find the right resources for help.
If the school does not have the resources your child needs, continue to ask for help and you can also ask your child’s primary care provider.
You are not alone! Your child’s teachers and health care team are dedicated to helping you meet all their health and educational needs.
Your Child’s Development:
All children will babble before they say real words.
All children will pull up to a stand before they walk.
We are sure that children will develop in these patterns.
Children can reach these stages in different ways and at different times.
This is especially true if they were born preterm. Take some time to think about your child’s development and answer the following questions. Contact your child’s primary healthcare provider if you have any questions about your child’s development.
How does my child like to communicate?
How do they let me know what they are thinking and feeling?
How does my child like to explore how to use their body?
Do they prefer using their fingers and hands (small muscles)?
Do they prefer using their arms and legs (large muscles)?
How does my child respond to new situations?
Do they jump right in?
Do they prefer to hang back and look around before feeling safe?
How does my child like to explore?
What kinds of objects and activities interest them?
What do those interests tell me about them?
What are my child’s strengths?
In what ways does my child need more support?
The information in this publication should not be used as a substitute for your child’s primary care provider’s medical care and advice. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Developmental milestones are adapted from Hagan JF Jr, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents [pocket guide]. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017.
© 2019 American Academy of Pediatrics. All rights reserved.
Reviewed by: MJ, M.D., IB M.D., TT D.O, AR D.O. | 07/2024